Showing papers in "Substance Abuse Treatment Prevention and Policy in 2019"
TL;DR: A scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders and revealed population and context-specific evidence regarding the defining characteristics of PCC-principles.
Abstract: Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. Following the iterative stages of the Arksey and O’Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.
105 citations
TL;DR: It is proposed that higher doses of naloxone are needed to combat the new era of overdoses due to the more potent synthetic opioids such as fentanyl.
Abstract: There has been a dramatic increase of deaths due to illicit fentanyl. We examined the pharmacology of fentanyl and reviewed data on the number of repeat doses of naloxone used to treat fentanyl overdoses. Multiple sequential doses of naloxone have been required in a certain percentage of opioid overdoses due to fentanyl. In addition, fentanyl appears to differ from other opioids as having a very rapid onset with high systemic levels found in overdose victims. A rapid competition is required by naloxone to out-compete large numbers of opioid receptors occupied by fentanyl in the CNS. Taken together, we propose that higher doses of naloxone are needed to combat the new era of overdoses due to the more potent synthetic opioids such as fentanyl.
84 citations
TL;DR: Screening and appropriate management of AUD among PLWHA are recommended and possible recommendations for future clinical practice and research are forward.
Abstract: Alcohol use disorder (AUD) is common among people living with HIV/AIDS (PLWHA) and associated with a greater risk of poor medication adherence, unsafe sexual behaviors as well as poor quality of life. To our knowledge, there is no previous systematic review and meta-analysis that reported the pooled prevalence estimate of AUD among PLWHA. Therefore, this review aimed to systematically review the available studies on the prevalence of AUD among PLWHA and forward possible recommendations for future clinical practice and research. PubMed, EMBASE, Psych INFO and SCOPUS databases were searched to identify the relevant studies. We have also scanned the reference lists of the eligible studies to supplement our electronic search. We used the Comprehensive Meta-Analysis software versions 3.0 to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran’s Q- and the I2- test were employed to see the heterogeneity. The presence of publication bias was explored by utilizing Egger’s test and visual inspection of the symmetry in funnel plots. A total of 25 studies with 25,154 participants across developed and developing countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence estimate of AUD among PLWHA was found to be 29.80% (95% CI; 24.10–35.76). The prevalence of AUD was higher in males (26.90%) than female (13.37%) HIV patients. In this study, the pooled prevalence of AUD was considerably higher (31.52%) when measured by Alcohol Use Disorders Identification Test (AUDIT) as compared to Composite International Diagnostic Interview (CIDI) (13.51%). In addition, the pooled prevalence of AUD was higher in the developed countries (42.09%) while lower for developing countries (24.52%). In the current study, the pooled prevalence estimates of AUD among PLWHA was considerably high (29.80%). Screening and appropriate management of AUD among PLWHA are recommended.
73 citations
TL;DR: Although alcohol use disorders are common problems in Ethiopian community, the unmet need for treatment is substantial and an integrated care approach has the potential to address this need, but stigma and low awareness may be major barriers to help-seeking.
Abstract: Although alcohol use disorders contribute a high proportion of population disease burden, the treatment gap is large, especially in low- and middle-income countries. To narrow this gap, contextually relevant evidence is needed to inform service development in low- and middle-income country settings. The aim of this study was to assess the magnitude of the treatment gap for alcohol use disorder, help-seeking behavior, stigma and barriers to care among people with alcohol use disorder in rural Ethiopia. A cross-sectional, house-to-house survey was conducted in Sodo district, south Ethiopia. A sample of 1500 adults was selected using simple random sampling from a census of households and screened for alcohol use disorder using the alcohol use disorders identification tool (AUDIT). Help-seeking, barriers to care and internalized stigma were investigated among people with moderately severe alcohol use disorder (AUDIT score ≥ 16). Poisson regression with robust variance was used to examine factors associated with alcohol use disorder. The prevalence of alcohol use disorder (AUDIT ≥8) in the past 12 months was 13.9% (25.8% in men and 2.4% in women, p-value < 0.001). People with alcohol use disorder had increased disability (adjusted prevalence ratio (aPR) 1.03, 95% confidence interval (CI) 1.01, 1.03) and higher depressive symptom scores (aPR 1.02, 95% CI 1.01, 1.04). The treatment gap was very wide, about 87.0% (only 13% sought help) of participants with an AUDIT score ≥ 16 had never sought help for their alcohol problems and 70.0% reported high internalized stigma. Major barriers to seeking help were wanted to handle the problem on their own, believing that it would get better by itself and being unsure about where to go. Although alcohol use disorders are common problems in Ethiopian community, the unmet need for treatment is substantial. An integrated care approach has the potential to address this need, but stigma and low awareness may be major barriers to help-seeking. Interventions to reduce stigma and enhance community awareness are recommended.
51 citations
TL;DR: It is suggested that MMT patients receiving treatment in public health facilities might have higher rate of psychological problems, including depression, anxiety, and stress than that of those in the private health facility.
Abstract: Methadone, a long-acting opioid agonist maintenance treatment (MMT) is used to treat opioid addiction by preventing opioid withdrawal and reducing cravings. However, it is important to note that mental conditions may persist, or even remain undetected while methadone maintenance treatment is ongoing. This study aimed to examine the level of psychological problems among MMT patients at public and private health facilities and identify associated factors. From January to September 2018, a cross-sectional study was performed in Nam Dinh province, one of the largest epicenters providing HIV/AIDS surveillance and treatment services in the North of Vietnam. 395 male respondents currently receiving MMT agreed to participate in a face-to-face interview. Depression, Anxiety and Stress Scale-21 (DASS-21) were used to assess psychological problems among patients. The percentage of patients suffering from mild to extremely severe anxiety was the highest among psychological problems (18%). 2.8% of participants had mild depressive symptoms and the percentage of those having mild or moderate stress was approximately 4%. In addition, the longer treatment duration, the lower mental health scores regarding three types of psychological problems. Respondents who received MMT services in public health facilities were more likely to have a higher score of all psychological problems. Participants who lived with partners or spouse, having higher monthly family income had a lower likelihood of having severe depression and stress status. Freelancers or blue-collars/farmers had lower score of depression and anxiety compared to people being unemployed. This study suggests that among our sample, MMT patients receiving treatment in public health facilities might have higher rate of psychological problems, including depression, anxiety, and stress than that of those in the private health facility. These results highlight the necessity of taking psychological counseling adequately for MMT patients and psychological assessment should be prioritized in the early stage of treatment.
51 citations
TL;DR: Subscales of the Arabic version of the DASS-21 do not differentiate between depression and anxiety, and a modified 17-item version was suitable for measuring overall distress, and the results of convergent validation testing indicated that it was superior to the Dass-21.
Abstract: Emotional distress is common among illicit drug users, and it can negatively affect treatment outcomes and increase the risk of relapse. Nonetheless, instruments that properly measure emotional distress are lacking. Therefore, this study investigated the factor structure of the Arabic Depression Anxiety Stress Scale-21 (DASS-21) in that population. The DASS-21 and the Self-stigma of Alcohol Dependence Scale (SSAD) were completed by 149 inpatient Egyptian drug users. The DASS-21 was examined using exploratory factor analysis, partial confirmatory factor analysis, and parallel analysis. For validation testing, correlations between stigma scores and DASS scores were computed. A one-factor solution provided the best fit to the DASS-21 data. Four items with low loadings were removed. The resulting DASS-17 was also unidimensional, and its reliability was high (0.88). On the validation tests, the DASS scores correlated with the stigma scores as hypothesized. Subscales of the Arabic version of the DASS-21 do not differentiate between depression and anxiety. A modified 17-item version (the DASS-17) was suitable for measuring overall distress, and the results of convergent validation testing indicated that it was superior to the DASS-21.
46 citations
TL;DR: A comprehensive picture of the global trend of publications of substance use disorder is offered and findings suggest a need for research policy that supports the examination of interventions that culturally adhere to different local contexts to address substance use disorders in communities.
Abstract: Globally, substance use disorders are prevalent and remain an intractable public health problem for health care systems. This study aims to provide a global picture of substance use disorders research. The Web of Science platform was used to perform a cross-sectional analysis of scientific articles on substance use disorders and treatment. Characteristics of publication volume, impact, growth, authors, institutions, countries, and journals were examined using descriptive analysis and network visualization graphs. Thirteen thousand six hundred eighty-five papers related to illicit drugs (5403), tobacco (4469), and alcohol (2137) use disorders and treatment were published between 1971 and 2017. The number of publications on Mindfulness and Digital medicine topics had the highest increase with more than 300% since 2003–2007 despite later presence than other methods. The number of papers on other non-pharmaceutical therapies (behavioral therapy, cognitive behavioral therapy, skills training or motivational interviewing) grew gradually, however, the growth rate was lower every 5-year period. The United States is the substance use disorder research hub of the world with the highest volume of publications (8232 or 60.2%) and total citations (252,935 or 65.2%), number of prolific authors (25 of top 30 or 83%) and institutions (24 of top 26 or 92%), formed the most international research partnerships (with 96 distinct countries). The international collaboration followed a pattern based on geographic proximity and cultural similarity. This study offers a comprehensive picture of the global trend of publications of substance use disorder. Findings suggest a need for research policy that supports the examination of interventions that culturally adhere to different local contexts to address substance use disorder in communities.
35 citations
TL;DR: Health problems, motivations for AAS cessation, and treatment desires among AAS users are described and barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process.
Abstract: Anabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. In Norway, the substance use disorder treatment system provides health care to this patient group, but few AAS users have sought such treatment. Therefore, a service was created to inform AAS users and next of kin of potential negative consequences and their treatment options. This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users. Over four years, 232 AAS users and 60 next of kin contacted the information service and received an hour-long information session with healthcare personnel. Information about AAS use, physical and mental health problems, substance use, motivation for cessation, and whether the information seeker desired treatment were registered. Qualitative interviews were conducted among seven individuals and analyzed thematically to explore information service experiences. Of the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. Those who desired treatment were significantly older, had used AAS longer, reported more physical and mental health side effects, and a higher proportion reported having children than those who did not desire treatment. Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n = 108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). Findings from qualitative interviews suggest that barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process. Healthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects. The desire for health care reveals extensive health problems and the user group is so non-homogeneous that examination and treatment must be adapted individually with focus on physical, mental and social factors as well as possible dependence of AAS and/or psychoactive substances.
33 citations
TL;DR: It is indicated that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health status and Crocin can be recommended as an adjunct to methadone in opioid withdrawal protocols because of the ability to improve the quality of life and decrease opioids side effects in these patients.
Abstract: Methadone maintenance treatment (MMT) might be associated with the symptoms of depression and anxiety, sleep disturbances and sexual dysfunctions. This study was designed to determine the effects of crocin on psychological parameters in patients under MMT. Patients under MMT were randomly allocated into two groups to receive either 30 mg/day crocin (2 plus crocin tablet, 15 mg BID) (n = 25) or placebo (2 tablets per day, 15 mg BID) (n = 25), one hour after taking food, for 8 weeks. Psychological parameters were evaluated at baseline and end of the trial to determine related associations between crocin and patients’ mental health status. After 8-week intervention, crocin significantly decreased Beck Depression Inventory (b − 6.66; 95% CI, − 9.88, − 3.45; P < 0.0001), Beck Anxiety Inventory (b − 4.35; 95% CI, − 5.94, − 2.75; P < 0.0001), general health questionnaire (b − 4.45; 95% CI, − 7.68, − 1.22; P = 0.008) and Pittsburgh Sleep Quality Index (b − 2.73; 95% CI, − 3.74, − 1.73; P < 0.0001) in patients under MMT, compared with the placebo. Crocin also significantly improved International Index of Erectile Functions (b 4.98; 95% CI, 2.08, 7.88; P = 0.001) rather than placebo. Our findings indicated that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health status. Crocin can be recommended as an adjunct to methadone in opioid withdrawal protocols because of the ability to improve the quality of life and decrease opioids side effects in these patients. This trial was registered in the Iranian website for clinical trials registry as http://www.irct.ir
: IRCT2017110537243N1. www.irct.ir: http://www.irct.ir: IRCT2017110537243N1
.
32 citations
TL;DR: The interventions reviewed demonstrate promising results for decreasing risky sexual practices for NIDUs and reducing high-risk drug practices for IDUs, thereby reducing HIV transmission risk.
Abstract: Behavioral Interventions are needed to prevent HIV in substance users, which is associated with higher risk for contracting HIV via unprotected sexual intercourse or syringe-based exposure. We reviewed universal HIV prevention interventions targeting intravenous drug users (IDUs) and non-IDUs (NIDUs) to identify which prevention interventions are the most effective at reducing HIV transmission risk among IDU’s and NIDU’s and identify gaps in the literature. A PubMed literature review (1998–2017), limiting studies to universal HIV prevention interventions targeting adult HIV-negative substance users. Interventions were compared across sample sizes, sociodemographic, intervention setting, study design, use of theoretical models, and intervention effects. Of 1455 studies identified, 19 targeted IDUs (n = 9) and NIDUs (n = 10). Both IDU and NIDU studies were conducted in substance use treatment centers and included both group (44% vs. 73%) and individual-based (56% vs. 27%) methods; only one NIDU study used a couple-based intervention. All IDU, and 89% of NIDU, studies used explanatory and behavior-change theoretical models to guide selection of intervention mechanisms. Reduction in frequency of risky sexual behaviors were observed in 33% IDU and 64% NIDU studies, where 56% of IDU studies effectively increased drug use-related hygiene and 67% decreased frequency of injections. Eight studies included start-of-study HIV testing and five examined HIV seroconversion. The interventions reviewed demonstrate promising results for decreasing risky sexual practices for NIDUs and reducing high-risk drug practices for IDUs, thereby reducing HIV transmission risk. Future studies should include HIV testing and measurement of HIV seroconversion to fully elucidate intervention effects.
31 citations
TL;DR: The current study revealed that the prevalence of alcohol consumption in Ethiopia is comparable with the global estimates ofcohol consumption from the World Health Organization (WHO) and male sex was found to be a significant predictor of alcohol Consumption.
Abstract: Globally, excessive alcohol consumption is a major public health problem and is associated with social, mental, physical and legal consequences. However, no systematic review and meta-analysis has been performed to report the consolidated magnitude of alcohol consumption in Ethiopia. PubMed, EMBASE, and SCOPUS were systematically searched to identify pertinent studies. Subgroup and sensitivity analysis was conducted and Cochran’s Q- and the I2 test were used to assess heterogeneity. Publication bias was evaluated by using Egger’s test and visual inspection of the symmetry in funnel plots. We included 26 articles with a total of 42,811 participants. The pooled current and lifetime prevalence of alcohol consumption was 23.86% (95%CI; 17.53–31.60) and 44.16% (95%CI; 34.20–54.62), respectively. The pooled prevalence of hazardous alcohol consumption was 8.94% (95%CI; 3.40–21.50). The prevalence of hazardous alcohol consumption was remarkably higher in men (11.58%) than in women (1.21%). The prevalence of current and lifetime alcohol consumptions among university students were 22.08% & 38.88% respectively. The pooled data revealed that male sex was found to be a significant predictor of hazardous alcohol consumption (OR 10.38; 95%CI 3.86 to 27.88) as well as current (OR 2.45; 95%CI 1.78 to 3.38) and lifetime (OR 2.14; 95%CI 1.39 to 3.29) consumption. The magnitude of alcohol consumption among university students was apparently lower than the magnitude in other population of the country. The current study suggested a remarkable recent increment in the magnitude of hazardous alcohol consumption in Ethiopia. The current study revealed that the prevalence of alcohol consumption in Ethiopia is comparable with the global estimates of alcohol consumption from the World Health Organization (WHO). The prevalence of hazardous alcohol consumption was remarkably higher in men (11.58%) than in women (1.21%). Male sex was found to be a significant predictor of alcohol consumption. The present study also suggested considerable recent increment in the magnitude of hazardous alcohol consumption in Ethiopia.
TL;DR: Responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS are examined.
Abstract: Canada is facing an urgent challenge to reduce the harms associated with opioids: from January 2016 to December of 2018, more than 11,500 individuals lost their lives due to opioid related harms. This review examines responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS. A search of peer-reviewed literature was conducted in PubMed and PsycNet, and grey literature was retrieved from reputable substance use and health organizations to determine responses to the opioid crisis and related outcomes between 2013 and 2019. Findings related to actions, outcomes and unintended consequences across the categories of prevention, treatment, harm reduction, enforcement and the evidence base were included and synthesized into a narrative review on lessons learned. The opioid crisis is a result of multiple, complex interrelated factors. Many physicians may not feel competent to appropriately treat pain and/or addiction. Pushes for opioid deprescribing have resulted in some individuals using illicit opioids as treatment. A range of effective and accessible pharmacological and psychological treatments are still required. When regulations are barriers, unsanctioned actions, such as overdose prevention sites, may be enacted by individuals to respond to urgent public health needs. A nimble response with evolving enforcement perspectives can aid individuals experiencing harms from opioid use. There is no one size fits all response to this crisis, and consideration should be given to the unique needs of different communities and populations, as well as the broader impact of harms on families, communities, and society. A situation so multifaceted requires both immediate and long-term strategies implemented concurrently in order to address the differing and on-going needs of Canadians experiencing opioid harms. The expertise of individuals and families affected by the opioid crisis must be included in consultations and decisions related to different strategies, to ensure responses are not stigmatizing, that they will be effective and acceptable and that unintended consequences are quickly recognized and mitigated.
TL;DR: Compared to the general population, the authors found substantially lower HRQOL in OST patients, especially in their mentalHRQOL, and OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients’ needs.
Abstract: Knowledge of health-related quality of life (HRQOL) of patients receiving opioid substitution treatment (OST) is limited and fragmented. The present study examines the HRQOL of a large national sample of OST patients in Germany and sociodemographic and clinical correlates. Cross-sectional data on the HRQOL of 2176 OST patients was compared with German general population norms. Patients were recruited from 63 OST practices across Germany. To identify correlates of HRQOL, as measured with the SF-12, we performed bi- and multivariate analyses with sociodemographic and clinical variables, including patient- and clinician-reported outcomes on physical and mental health. Patients’ HRQOL was significantly poorer than in the general population, especially their mental HRQOL. Factors associated with lower physical HRQOL were older age, longer duration of opioid dependence, hepatitis C virus infection, and HIV infection. Benzodiazepine use was associated with lower mental HRQOL, and amphetamine use with higher physical HRQOL, compared to non-use of these substances. For both mental and physical HRQOL, the factor with the strongest positive association was employment and the factors with the strongest negative associations were physical and mental health symptom severity, psychiatric diagnosis, and psychopharmacological medication. Compared to the general population, we found substantially lower HRQOL in OST patients, especially in their mental HRQOL. OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients’ needs. Clinicians may consider the use of patient-reported outcome measures to identify patients’ subjective physical and psychological needs. Further research is needed to determine if employment is a cause or consequence of improved HRQOL. ClinicalTrials.gov: NCT02395198
, retrospectively registered 16/03/2015
TL;DR: To reduce the initiation of alcohol use among Akha and Lahu youths, public health intervention programs should focus on males who are not attending school and should be implemented for both their family members and peers.
Abstract: Alcohol use impacts several dimensions, including physical health, mental health, families, and social interactions. This study aimed to estimate the prevalence and to determine the factors associated with alcohol use among Akha and Lahu hill tribe youths in Chiang Rai, Thailand. An analytic cross-sectional design was applied to obtain key data on these associations. The study sample was Akha and Lahu hill tribe youths aged 15-24 years who lived in 30 selected hill tribe villages. A questionnaire was developed from an in-depth interview and group discussion and tested for validation and reliability before use. Descriptive statistics were used to demonstrate the general characteristics, and Chi-square test and logistic regression were used to detect associations between variables at α=0.05. A total of 737 subjects were recruited into the study, of whom 50.0% were Lahu. The average age was 17.9 years, 80.7% were single, 71.1% were Christian, 65.9% graduated secondary school, and 65.7% had their major source of income from their parents. Overall, 17.3% smoked and 45.0% drank alcohol. Among the drinkers, 79.8% drank beer, 61.5% started drinking at an age of 15-19 years, 86.8% had drank for < 5 years, 42.5% were persuaded to drink by their peers, 20.2% suffered an accident after alcohol use, and 17.2% had experienced unsafe sex after drinking alcohol. In the multiple logistic regression, six variables were associated with alcohol use among the Akha and Lahu youths. Males had greater odds of alcohol use than females (ORadj = 3.50, 95% CI = 2.24-5.47). Buddhists had greater odds of alcohol use than Christians (ORadj = 1.88, 95% CI = 1.17-3.04). Participants who were unemployed, employed, and in other categories of occupation had greater odds of alcohol use than those who were students (ORadj = 2.20, 95% CI = 1.23-3.92; ORadj = 6.89, 95% CI = 3.38-13.89; and ORadj = 2.96, 95% CI = 1.01-8.59, respectively). Participants whose fathers were daily wage workers had greater odds of alcohol use (ORadj = 2.89; 95% CI = 1.23-6.79) than those whose parents worked in agriculture, and those whose fathers used alcohol had greater odds of alcohol use than those whose fathers did not use alcohol (ORadj = 2.17, 95% CI = 1.40-3.35). Finally, those who had 6-10 and ≥ 11 close friends living in the same village who used alcohol had greater odds of alcohol use (ORadj = 8.51, 95% CI = 3.10-23.3; and ORadj = 3.84, 95% CI = 1.15-12.77, respectively). To reduce the initiation of alcohol use among Akha and Lahu youths, public health intervention programs should focus on males who are not attending school and should be implemented for both their family members and peers.
TL;DR: Young adults (ages 18–29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT, which is not consistent with treatment guidelines.
Abstract: Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18–29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30–39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56–1.68), 40–49 year olds (AOR = 1.90, 95% CI = 1.82–1.99), 50–59 year olds (AOR = 2.65, 95% CI = 2.52–2.78), and 60–64 year olds (AOR = 5.03, 95% CI = 4.62–5.48) were more likely to receive MAT. These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.
TL;DR: In this article, the authors devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand, where a randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units.
Abstract: Smoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand. This randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of:
The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up. The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117. The median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61. In relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries. Current controlled trials ISRCTN89315117
. WHO international clinical trial identifier number: U1111–1145-6916; 3/2013.
TL;DR: It seems that significant QTc prolongation is not uncommon among patients with opium overdose, and this is one of the adverse effects of methadone or opium overdose.
Abstract: Iran is a country with the highest rate of opioid addiction in the world. The most commonly used opioid in Iran is opium, and methadone is in second place. The trend of drug use has changed from opium to methadone from 2006 to 2011. Presence of a large number of addicted people and methadone maintenance therapy clinics make methadone readily available in Iran. Therefore, evaluation of the epidemiological characteristic of methadone toxicity and its effects on the heart is essential. In This cross-sectional, retrospective, descriptive, analytical study all patients with methadone or opium toxicity who had been admitted to Vasei hospital, Sabzevar, Iran, during the years 2015 and 2016 were included, and their records were evaluated. Demographic data, addiction history, underlying diseases, and the outcome of admission were recorded. Then, corrected QT interval (QTc) of the first ECG of the patients after admission was evaluated. The Majority of toxicities occurred in those above 30 years of age (71.4%), who lived in cities (62.8%), and were married (69.2%). A positive history of addiction was considerably higher in the opium group (72.3% versus 43.3%). There was no significant difference regarding QTc prolongation between patients with methadone and opium toxicity (p = 0.3). QTc prolongation is one of the adverse effects of methadone or opium overdose. It seems that significant QTc prolongation is not uncommon among patients with opium overdose.
TL;DR: The majority of involuntarily admitted patients scored high on motivation to seek help and were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization, suggestingTherapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity.
Abstract: Health care workers in the addiction field have long emphasised the importance of a patient’s motivation on the outcome of treatments for substance use disorders (SUDs). Many patients entering treatment are not yet ready to make the changes required for recovery and are often unprepared or sometimes unwilling to modify their behaviour. The present study compared stages of readiness to change and readiness to seek help among patients with SUDs involuntarily and voluntarily admitted to treatment to investigate whether changes in the stages of readiness at admission predict drug control outcomes at follow-up. This prospective study included 65 involuntarily and 137 voluntarily admitted patients treated in three addiction centres in Southern Norway. Patients were evaluated using the Europ-ASI, Readiness to Change Questionnaire (RTCQ), and Treatment Readiness Tool (TReaT). The involuntarily admitted patients had significantly lower levels of motivation to change than the voluntarily admitted patients at the time of admission (39% vs. 59%). The majority of both involuntarily and voluntarily admitted patients were in the highest stage (preparation) for readiness to seek help at admission and continued to be in this stage at discharge. The stage of readiness to change at admission did not predict abstinence at follow-up. The only significant predictor of ongoing drug use at 6 months was SUD severity at baseline. The majority of involuntarily admitted patients scored high on motivation to seek help. Their motivation was stable at a fairly high level during their stay, and even improved in some patients. Thus, they were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization. Therapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity. ClinicalTrials.gov, NCT00970372. Registered 1 September 2008, https://clinicaltrials.gov/ct2/show/NCT00970372. The trial was registered before the first participant was enrolled. The fist participant was enrolled September 02, 2009.
TL;DR: Multiple drivers that range from individual to structural levels are involved in university student’s use of psychoactive substances, with socialization process at the center of the factors, which appeals for a range of multifaceted interventions directed to the individual, interpersonal and organizational level factors.
Abstract: Psychoactive substance (PS) use is a public health concern among University students. Understanding the factors underlay the use helps to underpin effective preventive interventions. However, there is dearth of exploratory studies on the drivers of psychoactive substance use in Ethiopian universities. Here, we aimed to explore the drivers for psychoactive substance use among Mekelle University undergraduate students. Exploratory qualitative study was conducted from April 1 to May 30, 2017. We conducted five focus group discussions (FGDs) and eleven in-depth interviews (IDIs) with students, proctors and bar owners. We also conducted three round interviews within two weeks interval with each of four key-informant researchers (KIR). Participants were selected purposively and the investigators conducted the discussions and the interviews using semi-structured guides. Data were audio-recorded, transcribed verbatim and imported into qualitative data analysis software for coding and analysis. An inductive approach was applied to crystalize non-repetitive emerging themes overarching the drivers for psychoactive substance use among university students. The following themes emerged as drivers for psychoactive substance use among University students; (1)feeling helpless following detachment from family, (2) prior experience with substances, (3) socialization reasons, (4) low academic performance, (5) physical environment (explained by easy access to substance and limited recreational alternatives), and (6) sub-optimal organizational support. Multiple drivers that range from individual to structural levels are involved in university student’s use of psychoactive substances, with socialization process at the center of the factors. Thus, the study appeals for a range of multifaceted interventions directed to the individual, interpersonal and organizational level factors.
TL;DR: The ICS is a brief and pragmatic tool for researchers to better understand a critical antecedent for implementation effectiveness in SUD treatment and for organizational leaders in Sud treatment organizations to evaluate the extent to which providers perceive that their organization supports EBP implementation.
Abstract: One critical factor in the implementation of evidence-based practice (EBP) in substance use disorder treatment organizations is an inner organizational context that clearly supports implementation efforts. The Implementation Climate Scale (ICS) has been developed to allow researchers and organizations to assess climate for EBP implementation in health and allied health service organizations. The ICS consists of 18 items and measures six dimensions of implementation climate: focus on EBP, educational support for EBP, recognition for EBP, rewards for EBP, selection for EBP, and selection for openness. The ICS was initially developed in a mental health context; thus, the goal of this study was to provide initial validation of the ICS in substance use disorder (SUD) treatment settings. Confirmatory factor analysis (CFA) was used to assess the psychometric functioning of the ICS using survey data from 326 providers in 65 teams in SUD treatment programs. Cronbach’s alpha was examined to assess internal consistency of the ICS, and individual and team level construct-based validity was examined by comparing its correlations with service climate, molar climate, and organizational change. We found evidence for the reliability, factor structure, and validity of the ICS in SUD services. The psychometric functioning of the ICS in SUD treatment settings was comparable to that found in mental health contexts. The ICS is a brief and pragmatic tool for researchers to better understand a critical antecedent for implementation effectiveness in SUD treatment and for organizational leaders in SUD treatment organizations to evaluate the extent to which providers perceive that their organization supports EBP implementation.
TL;DR: Smoking, number of sisters, education and way of Spending leisure time with family and having sister were the most powerful preventive factors for substance use disorder in Iran.
Abstract: The problem of substance use disorder in Iran is of great national concern. The aim of this study was to measure the association between substance use disorder and demographic, social and behavioral factors in Yasuj city, located at southwest of Iran. As the second phase of a previously published study, this case-control study was conducted in 2015–2016 on 362 addicted participants and 207 controls (with no history of substance use disorder). The control group was selected from male hospital visitors in Yasuj city during the same period of selection of the case group. The required information was collected via a self-administered questionnaire. Based on the results of multivariate analysis, significant associations were found between the number of sisters (OR = 0.82, 95%CI = 0.68 to 0.99, P = 0.04), history of smoking (ORyes/no = 19.89, 95%CI = 10.02 to 39.49, P < 0.001), leisure time activity (ORwith friends/home = 8.98, 95%CI = 3.99 to 20.19, P < 0.001) and substance use disorder. This study introduced smoking, number of sisters, education and way of spending leisure time as predictors of substance use disorder. Among these factors, smoking was the most powerful risk factor and spending leisure time with family and having sister were the most powerful preventive factors for substance use disorder.
TL;DR: The perception of the recently implemented alcohol policies by patients diagnosed with alcohol dependence in two Russian cities in the years 2013–2014 are explored and light is shed on possible entry-points to prevention and reduction of availability of unrecorded alcohol in the form of cheap surrogates is urgently needed.
Abstract: Over the last decade Russia has introduced various policy measures to reduce alcohol consumption and alcohol-related harm at the population level. Several of these policies, such as higher pricing and taxation or restrictions of availability, may not work in the case of unrecorded alcohol consumption; they may encourage consumers to switch to unrecorded alcohol and even increase consumption. In the present qualitative interview study we explore the perception of the recently implemented alcohol policies by patients diagnosed with alcohol dependence in two Russian cities in the years 2013–2014 and shed light on possible entry-points to prevention. Semi-structured in-depth expert interviews were conducted with 25 patients of state-run drug and alcohol treatment centers in two Russian cities in 2013 and 2014. The interviews were analyzed using thematic content analysis. All of the interviewed participants have consumed unrecorded at some point with the majority being regular consumers, mostly switching between recorded and unrecorded alcohol depending on the situation, as predominantly defined by available money and available sources of alcohol. Low price and high availability were reported as the main reasons for unrecorded consumption. Participants voiced a general mistrust of the recently implemented alcohol regulations and viewed them largely as ineffective. They expressed particular concerns over price increases and restriction of night sales of alcoholic beverages. Substantial shifts within the unrecorded alcohol market were reported, with a decreasing availability of home-made beverages in favor of alcohol surrogates in the form of non-beverage alcohol, medicinal and cosmetic compounds. At the same time consumption of home-made alcoholic beverages was seen as a strategy to avoid counterfeit alcohol, which was frequently reported for retail sale. Despite the alcohol policy changes in the last years in Russia, consumption of unrecorded alcohol remained common for people with alcohol dependence. Reduction of availability of unrecorded alcohol, first and foremost in the form of cheap surrogates, is urgently needed to reduce alcohol-related harm. Implementation of screening and brief interventions for excessive alcohol consumption in various contexts such as primary healthcare settings, trauma treatment services or the workplace could be another important measure targeting consumers of unrecorded alcohol.
TL;DR: Transdermal fentanyl, specifically, which provides long acting and stable drug levels post-titration over several days, should be explored as an opioid agonist treatment option and is currently being piloted in Vancouver, Canada.
Abstract: The current opioid overdose epidemic affecting communities across North America is increasingly driven by illicitly manufactured fentanyl and its related analogues. A variety of public health interventions have been implemented and scaled up, including opioid agonist treatments (OAT). While these treatments are successful for many individuals, they have a variety of limitations. It is critical to trial alternative treatments if conventional opioid agonist treatment options are not successful for a proportion of patients who use illicit fentanyl. Prescription fentanyl has been widely used for pain management. The use of transdermal fentanyl, specifically, which provides long acting and stable drug levels post-titration over several days, should be explored as an opioid agonist treatment option. The use of transdermal fentanyl for patients who use illicit fentanyl is currently being piloted in Vancouver, Canada. To address potential diversion, the patch is signed, dated, and a film dressing is applied to mitigate tampering. Evaluation outcomes are still pending, but there have been no adverse outcomes thus far and clinical improvements have been noted for many patients. This exploratory therapeutic approach should be considered across multiple settings and rigorously evaluated. There are known limitations to existing OAT options and there is a need to urgently evaluate alternative strategies for patients who are using illicit fentanyl not successfully treated with conventional OAT. Many patients may be attracted to, and retained in, fentanyl assisted treatment. This may be another strategy for certain patients to prevent harms caused by illicit fentanyl use, including overdose and death.
TL;DR: An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes.
Abstract: Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities. In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses. Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS’ organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS’ organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees’ alcohol consumption constitute a public health challenge, and that OHS’ should focus more on alcohol prevention targeting employees. Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.
TL;DR: Recommendations for investigators are to partner with policy makers early in the research process, formulate and use research designs to meet the strategic goals of end-users, and systematically test alternative phrasing of scientific terminology that allow end users to better understand and repurpose the data.
Abstract: The National Institute on Drug Abuse has identified a persistent research-to-practice gap in the implementation of evidence-based prevention and treatment programs for substance use disorder. To identify mechanisms to close this gap, we sought to obtain and characterize the range of policy makers’ perspectives on the use of research in substance use disorder treatment and coverage decisions. We conducted open-ended, semi-structured interviews with a purposive sample of eighteen policy makers involved in the delivery of health services. The aim was to identify barriers and facilitators, attitudes, beliefs, and experiences surrounding the use of research related to the treatment and economics of substance use disorder. The analysis generated four themes: 1) policy maker engagement with evidence and researchers; 2) strategic use and usefulness of research; 3) scientific rigor versus relevance; and 4) communication of evidence. Within each theme, the participants identified barriers, facilitators, current practice, and gave their perspectives on “ideal conditions” for research design, conduct and communication. Recommendations for investigators are the following actionable steps: 1) partner with policy makers early in the research process, 2) formulate and use research designs to meet the strategic goals of end-users; 3) systematically test alternative phrasing of scientific terminology – particularly in the realm of cost effectiveness research – that allow end users to better understand and repurpose the data; 4) incorporate qualitative research methods to uncover the narratives that explain the context and relevance of evidence; 5) incorporate study designs that prioritize timeliness of results; and 6) promote and reward researcher involvement in policy discussions.
TL;DR: The results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies, and there is both a need and support for the implementation of alcohol prevention strategies at festivals.
Abstract: Alcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017. A cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson’s Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression. A total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16–64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women. The results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.
TL;DR: First evidence is provided that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may in turn improve detection of traumatic events.
Abstract: Despite the high rate of traumatic events in clients with substance use disorders, trauma exposure often remains undetected in a majority of treatment-seeking clients. Improving health professionals’ knowledge and skills in the inquiry of traumatic events is therefore of utmost importance for appropriately addressing trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to the inquiry about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings that aim to improve the systematic inquiry of traumatic events. Using a cluster-randomized trial, we examined whether a one-day training in trauma inquiry (‘Learning How to Ask’) would reduce professionals’ perceived barriers to trauma inquiry. One hundred forty-eight professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals in the intervention group received a one-day training plus a refresher session 3 months later, the professionals in the control group received no training. At baseline, and at 3-month and 6-month follow-up, professionals rated on a four-point Likert scale regarding how strongly they agreed with statements about six common barriers to trauma inquiry, namely ‘Feeling uncomfortable when asking about traumatic events’, ‘Fear of offending the client’, ‘Fear of retraumatizing the client’, ‘Fear that client may terminate treatment’, ‘Unsure whether authorities have to be informed when perpetrator is known’, and ‘No trauma-specific treatment available in my local area’. The trained group experienced significant greater decreases in five of the six perceived barriers to the inquiry of traumatic events from baseline to 6-month follow-up than the control group (‘Feeling uncomfortable when asking about traumatic events’: b = − 0.32, 95% CI [− 0.52, − 0.12]; ‘Fear of offending the client’: b = − 0.33, 95% CI [− 0.56, − 0.09]); ‘Fear of retraumatizing the client’: b = − 0.45, 95% CI [− 0.69, − 0.22]; ‘Fear that client may terminate treatment’: b = − 0.28, 95% CI [− 0.49, 0.07]; ‘No trauma-specific treatment available in my local area’: b = − 0.25, 95% CI [− 0.51, − 0.01]). Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may in turn improve detection of traumatic events.
TL;DR: The prevalence of HIV among PWID in Cambodia remains high, but is reducing compared with the 24.8% reported in the 2012 national survey, which underline the importance of socio-structural factors in HIV epidemiology among PWIDs, which require mitigation.
Abstract: Globally, people who inject drugs (PWID) continue to be among the most vulnerable populations to acquire infection of human immunodeficiency virus (HIV). The most recent national survey found that nearly a quarter of PWID in Cambodia were infected with HIV in 2012. The aim of this study is to estimate the current prevalence of and factors associated with HIV infection among PWID in Cambodia. This national integrated biological and behavioral survey was conducted from June to December 2017. Participants were recruited from the capital city and 11 major provinces using the respondent driven sampling method. Face-to-face interviews were conducted using a structured questionnaire, and blood samples were collected for HIV, syphilis, and hepatitis C virus (HCV) testing. Multiple logistic regression analysis was conducted to identify risk factors for HIV infection. All analyses were estimated with sampling weights that corrected for non-response and sample design. A total of 310 PWID participated in the study, and the mean age was 31.8 years (SD = 7.8). The prevalence of HIV was 15.2%. More than half (57.4%) of the HIV-positive participants were co-infected with HCV, and 44.7% were not aware of their HIV status prior to this study. After adjustment for other covariates, HIV infection remained positively associated with being female (AOR = 1.88, 95% CI = 1.03–4.04), being in the older age group of ≥35 (AOR = 2.99, 95% CI 1.33–9.22), being widowed, divorced or separated (AOR = 2.57, 95% CI = 1.04–6.67), living on the streets (AOR = 2.86, 95% CI 1.24–4.37), and HCV infection (AOR = 3.89, 95% CI 1.86–1.15). The HIV infection remained negatively associated with having higher level of formal education of ≥10 years (AOR = 0.44, 95% CI 0.13–0.83) and higher average income of ≥US$200 per month (AOR = 0.20, 95% CI = 0.05–0.74). The prevalence of HIV among PWID in Cambodia remains high, but is reducing compared with the 24.8% reported in the 2012 national survey. Findings from this study provide critical information for tailoring interventions based on identified vulnerabilities and risk factors for HIV. Our findings underline the importance of socio-structural factors in HIV epidemiology among PWID in Cambodia, which require mitigation.
TL;DR: It seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support in women with a substance use disorder.
Abstract: Relapse is one of the main challenges that must be tackled in the drug addiction treatment. Different factors contribute to the relapse process but it remains unclear how relapse occursin women. Describing the relapse phenomenon in women might be of interest to practitioners and academics. The aim of this study was to explore the relapse experiences of Iranian women with a substance use disorder. Qualitative in-depth interviews were conducted with women with a substance use disorder. The interviews contained open-ended questions regarding relapse experiences during previous treatment. Interviews were digitally recorded. Data were analyzed using the content analysis method. In total, 20 women who use drugs took part in the study. The mean age of the women was 34.57 (age range = 9.6 years), and the minimum age of participants was 23 years. The following five main themes were explored: socioeconomic backgrounds, physical complications of drug withdrawal, psychological burden of drug withdrawal, family atmosphere, and cultural factors. The findings highlighted the different treatment needs in women with a substance use disorder. Based on the interviews, it seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support. Furthermore, policymakers should be committed to providing a nonjudgmental social environment to remove or reduce stigma of women with drug use problems.
TL;DR: Despite substantial changes in alcohol control policies, the legalization of cannabis, and the increased availability of options for gambling, there appears to be very little associated change in societal perceptions regarding these addictive behaviours.
Abstract: Over the last decade, there have been a number of changes in the Canadian landscape - the deconstruction of alcohol policy in some provinces, the legalization of cannabis, increased availability of gambling options, and the increase in opioid use and its associated problems. Have there been concomitant changes in societal images of addictions? A general population survey on societal images of addictions was conducted in multiple countries in 2008 - Finland, Sweden, Canada (Canadian sample size: N = 864; 40% response rate), and part of Russia (St Petersburg). We repeated the same survey in 2018 in Canada (N = 813; response rate = 23%). The survey assessed perceptions of the seriousness of different issues to society - including items about alcohol, tobacco, marijuana, gambling, misuse of medical drugs, and drugs like amphetamine, cocaine, or heroin - among other items (e.g., pollution, violent crime, prostitution). There were increases in perceptions of the seriousness of misuse of medical drugs (p = .001), of illicit drugs (p = .005), ratings of the seriousness of cannabis use (p = .02), and a decrease in ratings of gambling as a social problem (p = .04). Ratings of the seriousness of alcohol and tobacco as social problems did not display significant changes over time (p > .05). There has been some variation in societal perceptions of the seriousness of different addictions. Increases in perceptions of the seriousness of misusing medical drugs and the use of illicit drugs may reflect increases in societal concerns about opioid use and its associated problems. Despite substantial changes in alcohol control policies, the legalization of cannabis, and the increased availability of options for gambling, there appears to be very little associated change in societal perceptions regarding these addictive behaviours.