Showing papers in "Substance Abuse and Rehabilitation in 2021"

Substance Use in Pregnancy: Identifying Stigma and Improving Care

Abstract: This review examines the impact of stigma on pregnant people who use substances. Stigma towards people who use drugs is pervasive and negatively impacts the care of substance-using people by characterizing addiction as a weakness and fostering beliefs that undermine the personal resources needed to access treatment and recover from addiction, including self-efficacy, help seeking and belief that they deserve care. Stigma acts on multiple levels by blaming people for having a problem and then making it difficult for them to get help, but in spite of this, most pregnant people who use substances reduce or stop using when they learn they are pregnant. Language, beliefs about gender roles, and attitudes regarding fitness for parenting are social factors that can express and perpetuate stigma while facilitating punitive rather than therapeutic approaches. Because of stigmatizing attitudes that a person who uses substances is unfit to parent, pregnant people who use substances are at heightened risk of being screened for substance use, referred to child welfare services, and having their parental rights taken away; these outcomes are even more likely for people of color. Various treatment options can successfully support recovery in substance-using pregnant populations, but treatment is underutilized in all populations including pregnant people, and more knowledge is needed on how to sustain engagement in treatment and recovery activities. To combat stigma when working with substance-using pregnant people throughout the peripartum period, caregivers should utilize a trauma-informed approach that incorporates harm reduction and motivational interviewing with a focus on building trust, enhancing self-efficacy, and strengthening the personal skills and resources needed to optimize health of the parent-baby dyad.

Prevalence of Khat (Catha edulis) Chewing and Its Determinants: A Respondent-Driven Survey from Hossana, Ethiopia.

Abstract: Background Ethiopia is a leading khat producer in East Africa, and almost all regions are involved in khat production. Hossana, a small town in Southern Ethiopia, is also actively involved in khat production and its use. However, very few studies have been conducted to investigate the habit of khat chewing in this area. This study was conducted to assess the prevalence and predictors of khat chewing among Hossana residents. Methods The study was conducted on 1700 individuals in Hossana town from March 2018 to June 2019. A structured pre-tested self-administered questionnaire was designed and used for data collection. Descriptive statistics and logistic regression were carried out to study the prevalence and predictors of khat chewing in the study area. Results The overall prevalence of khat chewing among the respondents was 58.0% (95% CI 53.4-63.3) of which 68.4% were daily khat users and 31.5% used it occasionally. About 24.7% of females and 75.2% of males had chewed khat. Muslim religion (AOR 2.37; 95% CI 1.58-4.32), male gender (AOR 3.48; 95% CI 2.16-5.61), Older age (AOR 1.36; 95% CI 0.84-2.21), participants having habitual khat chewing friends or a khat chewer family associate (OR 1.70; 95% CI 1.17-2.20) were found to be independent predictors of chewing. Conclusion Significant portion of the population in the study area chew khat. Khat use is significantly associated with the Muslim religion, gender, age, and habit of family and friends. Further studies with larger demographic area are warranted from the study area to reproduce these findings.

Why are Youth Engaged in Substance Use? A Qualitative Study Exploring Substance Use and Risk Factors Among the Youth of Jimma Town, Southwest Ethiopia.

Abstract: Introduction Substance use refers to the use of psychoactive substances such as khat, alcohol, cigarettes, and illicit drugs. Young people are more vulnerable to substance use than older people. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health concern among the youth of Ethiopia, mainly in Jimma town. Therefore, this study aimed to explore the substance use and risk factors among the youth of Jimma town in 2019. Methods The study was conducted in Jimma town among youth who were engaged in substance use, from March to April 2019. A descriptive qualitative study design was employed and the study participants were acquired using purposive/judgmental sampling techniques. In total, 20 interviews were conducted with young people using in-depth and key informant interview methods. The data were analyzed by using ATLAS.ti version 7. Thematic analyses were performed in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings. Results The findings of this study were discussed under six themes and 12 categories, which emerged from thematic analysis of the data: substance use setting, time and means of distribution, substance-related factors, social and economic factors, individual factors, psychological factors, and legal and policy factors. Conclusion The study indicated that khat, alcohol, cigarettes and shisha or water pipes were the most commonly used substances. Different factors that drive the youth to engage in substance use were identified; individual factors, social and economic factors, substance-related factors, and legal and policy factors were most common. Generally, to overcome this problem, the community, lawyers, and policemen should participate in the implementation and enforcement of rules and regulations on substance use. Family should monitor their children and need to act as good role models by avoiding substance use.

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures.

Abstract: Introduction The need for innovative approaches to address the opioid epidemic in the United States is widely recognized. Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments. Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice. To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes. This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies. Methods A key step in the development of AMNet was the selection of substance use-specific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association's mental health patient registry, PsychPRO. A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD). Results Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants. These tools were further categorized as core and optional. Conclusion By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD. Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.

Disability Status, Unemployment, and Alcohol-Related Liver Disease (ALD) Mortality: A Large Sample Individual Level Longitudinal Study.

Abstract: Purpose Unlike previous research, we evaluate disability within expanded employment status factors and stratify gender, race and ethnicity in alcohol-related liver disease (ALD) mortality in a large sample individual level longitudinal study. Materials and Methods The National Longitudinal Mortality Study (NLMS) was used covering the period 1990-2011. Statistical analysis involved the use of proportional hazards regression on a sample of almost 1.4 million people aged 18 and older, of whom 2638 died of ALD by the end of the follow-up period. Results With expanded employment status factors, disability (HR=3.76 [95%] CI 3.22, 4.39), unemployment (HR=1.90, CI 1.56, 2.31), and those not otherwise in the labor force (HR=2.31, CI 2.08, 2.56) were strongly related to ALD mortality compared to the employed. When stratified, gender, race, and ethnicity were not important modifiers in the relationships between disability, unemployment, those not in the labor force and subsequent ALD mortality. Consistent with other studies, males, minority status, living in a highly urban area, renting as opposed to owning a home, lower educational attainment, marital statuses other than marriage, low income, and age were related to ALD mortality. Conclusion In addition to unemployment which has been previously studied in a large longitudinal sample, disabled people who were unable to work and those not looking for work had a higher risk of ALD mortality. Alcohol consumption, abuse and morbidity in these populations are of considerable clinical concern.

Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out.

Abstract: Background Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients. Methods In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out. Results Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels. Conclusion AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations.

Prevalence of Cigarette Smoking and Associated Factors Among Adolescents in Eastern Ethiopia, 2020.

Abstract: Background Cigarette smoking is one of the leading causes of preventable morbidity and mortality globally, and it is accountable for many causes of premature deaths. Despite the negative consequences of cigarette smoking, studies to identify factors associated with cigarette smoking are scanty and little is known about this practice in the Somali region so far, so this study aimed to assess the prevalence of cigarette smoking and associated factors among adolescents in the Gode, eastern Ethiopia 2020. Methods A community-based cross-sectional study design was employed among 341 adolescents in the Godey administration of the Somali Region, Eastern Ethiopia from July to August 2020. A systematic sampling technique was used to select study participants. Data were collected using a pretested interviewer administered questionnaire. The collected data were entered with Epi-Data version 3.1 and exported to SPSS version 22 software for statistical analysis. Multivariable logistic regression analyses were done to identify the true effect of predictor variables on the outcome variable after controlling for possible confounders. Statistical significance was declared at a p-value < 0.05. Results Over all, the prevalence of current cigarette smoking among adolescents was found to be 21.1% (95% CI: (16.7-25.5). Having smoker parents [AOR = 2.57, 95% CI: (1.32-5.02)], whose friends smoke cigarette [AOR = 4.78, 95% CI: (2.12-10.76)], and currently chewing khat [AOR = 6.01, 95% CI: (2.96-12.23)] were significantly associated predictors of current cigarette smoking in the final model of multivariable analysis. Conclusion The prevalence of cigarette smoking was relatively high in this study area. This study reported having smokers' parents, having smokers' friends and chewing khat were found to be independent predictors for cigarette smoking. Therefore, effective smoking prevention and intervention programs are required in this area.

Self-Reported Sedative Drug Use Among Students Attending at University of Gondar, Gondar, Northwest, Ethiopia: A Cross-Sectional Study.

Abstract: Background Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Ethiopia. This study aimed to assess the prevalence and associated factors of self-reported sedative drug use among medical students attending the College of Medicine and Health Science (CMHS) students at the University of Gondar (UoG). Material and Methods A prospective cross-sectional study was conducted from May to July 2018 in CMHS at UoG. Data were collected using a pre-tested self-administered standard questionnaire. Data were collected, entered into a computer using Epi Info 7 software, and analyzed using SPSS version 20. Frequency, mean, and standard deviation were used to describe descriptive statistics, and binary and multiple logistic regression analyses were used to assess the association between different variables and sedative drug use; P <0.05 was used to declare association. Results Of the 422 students who returned questionnaires, 26 (6.2%) participants were reported sedative drug use at some time since enrollment. Of these, 61.54% participants used antihistamine drugs. Smoking status (AOR (95% CI), 0.046 (0.009-0.241) P = 0.0001), stimulant use (AOR (95% CI), 0.220 (0.062-0.780) P = 0.019), sleeping hour (AOR (95% CI), 9.931 (4.155-14.785) P = 0.001) and sleep disorder (AOR (95% CI), 0.149 (0.033-0.680) P = 0.014) were significantly associated with sedative drug use. Conclusion Self-reported sedative drug use among medical students at the University of Gondar is relatively low, and antihistamines are the most commonly used drugs. Smoking, stimulant use, sleeping hour, and the presence of sleep disorders were associated with sedative drug use.

Problems in Social Medicine Related to Alcohol and Deaths: Autopsy Cases in the Southern Part of Osaka City.

Abstract: Purpose The purpose of this study was to examine the social and medical background of alcohol dependence and to prevent the abuse of alcohol. Methods Alcohol and deaths were retrospectively investigated based on the forensic postmortem data of 1694 decedents ≥20 years of age in 2008-2017. Of these, the 999 cases that could be tested for alcohol within 48 h of death were examined. Results The alcohol-positive and alcohol-negative groups included 179 (17.9%) and 820 (82.1%) cases, respectively. In terms of medical issues, compared with the alcohol-negative group, men in the positive group were mostly in their 40s to 60s, whereas women's age peaked in the 70s. The causes of death included many blunt injuries in men, though there was no difference in women. Underlying diseases were more frequent in men than women, with many of them having heart or liver disease, and the percentage of cases with mental disorders was 16.8% in the alcohol-positive group. In 15 cases of the alcohol-positive group, phenothiazine and barbituric acids were detected in 53.3% and 46.7% of cases, respectively. The incidence of traffic accidents and homicides was higher in the alcohol-positive group than in the alcohol-negative group. Conclusion Measures to address social issues based on risk factors for alcohol and deaths are required.