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A Brief Intervention on Alcohol Use Disorder Is Associated With Treatment Access for Inpatients With Alcohol-Associated Liver Disease. 对酒精相关肝病住院患者进行酒精使用障碍简短干预与获得治疗有关。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-16 DOI: 10.1097/ADM.0000000000001371
Patrick A Twohig, Alena Balasanova, Lauren Cooper, Michelle Le, Nathalie Khoury, Wuittporn Manatsathit, Marco Olivera, Thoetchai Bee Peeraphatdit

Abstract:

Background: Alcohol-associated liver disease (ALD) is the most common indication for liver transplantation in the United States. Alcohol use disorder (AUD) treatment is recommended in all patients with ALD and AUD, but it remains underutilized.

Aims: To identify predictors of AUD treatment and to assess 30-day readmission, return to drinking, and 1-year transplant-free survival.

Methods: Retrospective single-center cohort study of consecutive patients hospitalized with ALD and AUD between 2018 and 2020. Patients who died or were lost to follow-up at 90 days after hospitalization were excluded. AUD treatment was defined as receiving medication or participating in residential, outpatient, or support groups within 90 days of discharge.

Results: One hundred nine patients were included. Mean age was 51.7 years, and 63% were male. Fifty-six (51%) patients received AUD treatment, and 23 (21%) patients received more than one treatment. Predictors of AUD treatment were younger age (OR, 1.07 [95% CI, 1.04-1.12]; P < 0.001), gastroenterology/hepatology consult (AOR, 8.54 [95% CI, 2.55-39.50]; P = 0.0002), addiction psychiatry consult (AOR, 2.77 [95% CI, 1.16-6.84]; P = 0.02), and a brief AUD intervention (AOR, 18.19 [95% CI, 3.36-339.07]; P = 0.0001). Cirrhosis decompensation, MELD-Na score, and insurance status were not associated with treatment. Thirty-one patients (28.4%) were readmitted, and 29 (26.6%) remained abstinent 30 days from discharge. Patients who received treatment had improved transplant-free survival (HR, 0.44, P = 0.04).

Conclusion: A brief intervention on AUD had the strongest association with receiving AUD treatment in our cohort. Further efforts to incorporate brief interventions when offering AUD treatment to patients with ALD may be beneficial.

摘要:背景:酒精相关性肝病(ALD)是美国最常见的肝移植适应症。目的:确定酒精相关性肝病(ALD)治疗的预测因素,评估30天再入院率、恢复饮酒率和1年无移植生存率:对2018年至2020年间因ALD和AUD住院的连续患者进行回顾性单中心队列研究。排除住院后90天死亡或失去随访的患者。AUD治疗定义为出院后90天内接受药物治疗或参加住院、门诊或支持小组:结果:共纳入 199 名患者。平均年龄为 51.7 岁,63% 为男性。56名(51%)患者接受了 AUD 治疗,23 名(21%)患者接受了一种以上的治疗。AUD 治疗的预测因素包括年龄较小(OR,1.07 [95% CI,1.04-1.12];P < 0.001)、胃肠病学/肝病学咨询(AOR,8.54 [95% CI,2.55-39.50];P = 0.0002)、成瘾精神病咨询(AOR,2.77 [95% CI,1.16-6.84];P = 0.02)和简短的 AUD 干预(AOR,18.19 [95% CI,3.36-339.07];P = 0.0001)。肝硬化失代偿、MELD-Na 评分和保险状况与治疗无关。31名患者(28.4%)再次入院,29名患者(26.6%)在出院后30天仍未复发。接受治疗的患者无移植生存率有所提高(HR,0.44,P = 0.04):结论:在我们的队列中,针对 AUD 的简短干预与接受 AUD 治疗的关系最为密切。在为 ALD 患者提供 AUD 治疗时,进一步努力纳入简短干预可能会有所裨益。
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引用次数: 0
Medications for Opioid Use Disorder after Entering Residential Treatment: Evidence from Louisiana Medicaid. 进入住院治疗后阿片类药物使用障碍的药物治疗:路易斯安那州医疗补助的证据。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-16 DOI: 10.1097/ADM.0000000000001373
Wenshu Li, Matthew Eisenberg, Minna Song, Alene Kennedy-Hendricks, Brendan Saloner

Objective: Policies have attempted to increase the use of medication for opioid use disorder (MOUD) during an admission to a residential treatment program, but little is known about the association of residential admission with subsequent MOUD use.

Methods: In a cohort study of Louisiana Medicaid beneficiaries age 18-64 with diagnosed opioid use disorder (OUD), weekly MOUD use and overdose for 20 weeks before and after an admission to residential treatment was analyzed using comparative interrupted time series regression. Participants with residential treatment admission between January 1, 2018, and December 31, 2020 (N = 12,222) were compared against a demographically similar group of people with OUD without residential treatment during the study period.

Results: The samples with residential treatment were largely male (61.9%), White (47.2%), and aged 30 to 39 years (41.4%). At baseline, people admitted to residential treatment were much less likely to use MOUD than the comparison group (4.2% lower, CI: 3.8%, 4.5%, P < 0.01). After admission, use of any MOUD initially increased by 3.1% (P < 0.01) relative to the comparison group, which reverted to the counterfactual trend by 20 weeks. Post-admission MOUD use differed widely by medication. Overdose incidence was highest in the weeks right before admission, but otherwise, it did not change during the study period.

Conclusions: Admission to residential treatment for OUD was associated with a temporary increase in MOUD use. Policy initiatives should focus on both boosting use of MOUD during residential treatment and sustaining access to MOUD in outpatient care in the weeks following discharge.

目标:相关政策曾试图提高住院治疗项目中阿片类药物使用障碍(MOUD)药物的使用率,但人们对住院治疗项目与后续阿片类药物使用障碍之间的关系知之甚少:在一项针对路易斯安那州 18-64 岁确诊阿片类药物使用障碍(OUD)的医疗补助受益人的队列研究中,采用比较间断时间序列回归法分析了入院治疗前后 20 周内每周的 MOUD 使用情况和用药过量情况。将在 2018 年 1 月 1 日至 2020 年 12 月 31 日期间接受住院治疗的参与者(N = 12,222 人)与在研究期间未接受住院治疗的人口统计学相似的 OUD 患者群体进行了比较:接受住院治疗的样本大多为男性(61.9%)、白人(47.2%)、30 至 39 岁(41.4%)。在基线时,接受住院治疗的人使用 MOUD 的可能性远低于对比组(低 4.2%,CI:3.8%,4.5%,P <0.01)。入院后,与对比组相比,使用任何MOUD的人数最初增加了3.1%(P < 0.01),但到20周后又恢复到反事实趋势。入院后使用的 MOUD 因药物不同而有很大差异。入院前几周用药过量的发生率最高,但除此之外,研究期间用药过量的发生率没有变化:结论:接受住院治疗治疗 OUD 与 MOUD 使用的暂时增加有关。政策措施应侧重于在住院治疗期间促进 "MOUD "的使用,并在出院后的几周内在门诊治疗中维持 "MOUD "的使用。
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引用次数: 0
Association between Smoking Abstinence and Depression and Anxiety Symptoms After Hospital Discharge: The Helping HAND 4 Trial. 出院后戒烟与抑郁和焦虑症状之间的关系:Helping HAND 4 试验
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-08 DOI: 10.1097/ADM.0000000000001358
Catherine S Nagawa, Nancy A Rigotti, Yuchiao Chang, Douglas E Levy, Joanna M Streck, Thomas Ylioja, Scott S Lee, Hilary A Tindle

Objectives: Some people who stop smoking experience improved mood, but few studies have examined this relationship after hospitalization or accounted for concomitant substance use and psychological factors. We examined associations between smoking abstinence after a hospital discharge and change in depression and anxiety symptoms.

Methods: We conducted a secondary analysis of data from the Helping HAND 4 smoking cessation trial, which enrolled people who used tobacco when admitted to three academic medical center general hospitals. Participants (n = 986) were categorized as continuously abstinent (CA) or not. We used linear and logistic regression to model continuous and binary measures of depression (Patient Health Questionnaire [PHQ-8] ≥/<10), and anxiety (Generalized Anxiety Disorder Assessment [GAD-7], ≥/<8) over 6 months, adjusting for baseline mood, psychological factors, and substance use. Binary outcomes were defined using established clinical thresholds to aid in the clinical interpretation of the results.

Results: Mean age was 52.3 years, 56.5% were female, and the baseline mean cigarettes/day was 16.2 (SD: 3.2). In the adjusted analyses, depression and anxiety scores improved more in CA than non-CA participants over 6 months (difference-in-improvement, 2.43 [95% CI: 1.50-3.36] for PHQ-8; 3.04 [95% CI: 2.16-3.93] for GAD-7). At 6 months, CA participants were more likely to have a PHQ-8 score <10 (aOR = 2.07 [95% CI: 1.36-3.16]) and a GAD-7 score <8 (aOR = 2.90 [95% CI: 1.91-4.39]).

Conclusions: Individuals who were CA, compared to those who were not, had fewer depression and anxiety symptoms at 6 months, and were twice as likely to score below the population screening thresholds for major depression and anxiety disorders. Clinicians should emphasize the association between continuous abstinence and improved mood symptoms after hospital discharge.

研究目的:一些戒烟者的情绪会得到改善,但很少有研究对住院后的这种关系进行研究,也很少有研究考虑到同时使用药物和心理因素。我们研究了出院后戒烟与抑郁和焦虑症状变化之间的关系:我们对 Helping HAND 4 戒烟试验的数据进行了二次分析。参与者(n = 986)被分为连续戒烟(CA)或未连续戒烟。我们使用线性回归和逻辑回归对抑郁的连续和二元测量指标(患者健康问卷 [PHQ-8] ≥/结果)进行建模:平均年龄为 52.3 岁,56.5% 为女性,基线平均吸烟量为 16.2 支/天(标清:3.2 支)。在调整分析中,6 个月内,CA 参与者的抑郁和焦虑评分改善程度高于非 CA 参与者(PHQ-8 的改善差异为 2.43 [95% CI:1.50-3.36];GAD-7 的改善差异为 3.04 [95% CI:2.16-3.93])。在 6 个月时,CA 参与者更有可能得出 PHQ-8 评分结论:与非 CA 患者相比,CA 患者在 6 个月时的抑郁和焦虑症状较少,其得分低于重度抑郁和焦虑症人群筛查阈值的可能性是非 CA 患者的两倍。临床医生应强调持续戒酒与出院后情绪症状改善之间的关联。
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引用次数: 0
Trauma Prevalence and Its Association With Health-Related Quality of Life in Pregnant Persons with Opioid Use Disorder. 阿片类药物使用失调症孕妇的创伤发生率及其与健康相关的生活质量的关系。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-06 DOI: 10.1097/ADM.0000000000001366
T John Winhusen, Frankie Kropp, Shelly F Greenfield, Elizabeth E Krans, Daniel Lewis, Peter R Martin, Adam J Gordon, Todd H Davies, Elisha M Wachman, Antoine Douaihy, Kea Parker, Xie Xin, Ali Jalali, Michelle R Lofwall

Objectives: Trauma screening is recommended for pregnant persons with opioid use disorder (OUD), but there is limited literature on screening results from buprenorphine treatment. This study's objectives were to 1) describe the types, and severity, of traumatic events reported and 2) evaluate the associations between trauma and health-related quality of life (HRQoL).

Methods: Baseline data from an ongoing trial were analyzed. Participants were 155 pregnant persons with OUD receiving, or enrolling in, buprenorphine treatment at one of 13 sites. The experience, and relative severity, of 14 high magnitude stressors were assessed with the trauma history screen. The Patient-Reported Outcomes Measurement Information System-29+2 was used to assess 8 HRQoL domains.

Results: Traumatic stressors were reported by 91% of the sample (n = 155), with 54.8% reporting a lifetime persisting posttraumatic distress (PPD) event and 29.7% reporting a childhood PPD event. The most prevalent lifetime PPD event was sudden death of a close family/friend (25.8%); physical abuse was the most prevalent childhood PPD event (10.3%). Participants with lifetime PPD, relative to no PPD, reported significantly greater pain interference (P = 0.02). Participants with childhood PPD, relative to no PPD, had significantly worse HRQoL overall (P = 0.01), and worse pain intensity (P = 0.002), anxiety (P = 0.003), depression (P = 0.007), fatigue (P = 0.002), and pain interference (P < 0.001).

Conclusions: A majority of pregnant persons enrolled/enrolling in buprenorphine treatment reported persisting posttraumatic distress with sudden death of close family/friend being the most prevalent originating event; clinicians should consider the impact that the opioid-overdose epidemic may be having in increasing trauma exposure in patients with OUD.

目的:建议对患有阿片类药物使用障碍(OUD)的孕妇进行创伤筛查,但有关丁丙诺啡治疗筛查结果的文献有限。本研究的目标是:1)描述所报告的创伤事件的类型和严重程度;2)评估创伤与健康相关生活质量(HRQoL)之间的关联:方法: 对一项正在进行的试验的基线数据进行分析。参加者是在 13 个地点之一接受或加入丁丙诺啡治疗的 155 名患有 OUD 的孕妇。通过创伤史筛查评估了 14 个高强度压力源的经历和相对严重程度。患者报告结果测量信息系统-29+2 用于评估 8 个 HRQoL 领域:91%的样本(n = 155)报告了创伤应激源,54.8%的样本报告了终生持续性创伤后痛苦(PPD)事件,29.7%的样本报告了童年时期的PPD事件。一生中最常见的 PPD 事件是近亲/朋友突然死亡(25.8%);身体虐待是童年时期最常见的 PPD 事件(10.3%)。与未患过 PPD 的参与者相比,终生患过 PPD 的参与者报告的疼痛干扰明显更大(P = 0.02)。与未患过 PPD 的人相比,患过童年 PPD 的人的总体 HRQoL 明显较差(P = 0.01),疼痛强度(P = 0.002)、焦虑(P = 0.003)、抑郁(P = 0.007)、疲劳(P = 0.002)和疼痛干扰(P < 0.001)均较差:大多数接受丁丙诺啡治疗的孕妇都报告了持续的创伤后痛苦,而近亲/朋友猝死是最常见的起因事件;临床医生应考虑阿片类药物过量流行可能会增加 OUD 患者的创伤暴露。
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引用次数: 0
Off-Label Use of Lamotrigine and Naltrexone in the Treatment of Ketamine Use Disorder: A Case Report. 标签外使用拉莫三嗪和纳曲酮治疗氯胺酮使用障碍:病例报告。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-05 DOI: 10.1097/ADM.0000000000001359
Tucker Avra, Felipe Vasudevan, Rohit Mukherjee, Isabella Morton, Elizabeth A Samuels

Background: Ketamine is a dissociative anesthetic increasingly utilized in United States medical settings for the treatment of mental health conditions. Additionally, it is increasingly used in nonmedical settings for its dissociative properties. While nonmedical ketamine use and ketamine use disorder (KUD) have been observed internationally, KUD, and approaches to its treatment, have not been previously described in the US.

Case presentation: We present the case of a 32-year-old man with KUD who experienced severe cravings despite receipt of residential and intensive outpatient substance use disorder treatment. He resumed use after an initial period of abstinence and was subsequently started on lamotrigine and naltrexone for treatment of depressive symptoms and cravings. This combination altered his experience while on ketamine, resulting in nausea and decreased hallucinogenic effects. In addition, it substantially decreased his cravings, aiding him in achieving longer-term abstinence in combination with receipt of dialectical behavioral therapy, familial support, and involvement in 12-step programming.

Discussion: KUD is a poorly described condition that may become more prevalent as US ketamine use increases. Combining treatment of depressive symptoms and cravings, in this case with lamotrigine and naltrexone, may be a promising pharmacotherapeutic strategy. Lamotrigine, an antiepileptic with glutamate modulating effects, has been utilized to decrease cravings in a variety of substance use disorders. Naltrexone is an opioid antagonist approved for alcohol use disorder and opioid use disorder and is used off-label for stimulant use disorder. This combination offers a possible pharmacotherapeutic option for KUD with more research needed to further evaluate.

背景:氯胺酮是一种解离性麻醉剂,越来越多地被美国医疗机构用于治疗精神疾病。此外,氯胺酮的解离特性也越来越多地用于非医疗环境。虽然国际上已经出现了非医疗使用氯胺酮和氯胺酮使用障碍(KUD)的情况,但在美国,此前还没有关于氯胺酮使用障碍及其治疗方法的描述:我们介绍的病例是一名 32 岁的 KUD 患者,尽管他接受了住院和强化门诊药物使用障碍治疗,但仍有严重的渴求感。他在最初的戒断期后重新开始吸毒,随后开始服用拉莫三嗪和纳曲酮治疗抑郁症状和渴求感。这种组合改变了他吸食氯胺酮时的体验,导致恶心和致幻效果减弱。此外,这还大大降低了他的渴求感,帮助他在接受辩证行为疗法、家庭支持和参与12步计划的同时实现了较长期的戒断:KUD是一种描述不清的病症,随着美国氯胺酮使用量的增加,这种病症可能会变得更加普遍。在这种情况下,结合拉莫三嗪和纳曲酮治疗抑郁症状和渴求感可能是一种很有前景的药物治疗策略。拉莫三嗪是一种具有谷氨酸调节作用的抗癫痫药,已被用于减少各种药物使用障碍的渴求。纳曲酮是一种阿片类药物拮抗剂,获准用于治疗酒精使用障碍和阿片类药物使用障碍,并在标签外用于治疗兴奋剂使用障碍。这种组合为 KUD 提供了一种可能的药物治疗选择,但还需要更多的研究来进一步评估。
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引用次数: 0
The Impact of COVID-19 on Substance Use and Related Consequences among Patients in Office-Based Opioid Use Disorder Treatment. COVID-19 对接受办公室阿片类药物使用障碍治疗患者的药物使用及相关后果的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-08-05 DOI: 10.1097/ADM.0000000000001367
Zoe M Weinstein, Kara M Magane, Sara Lodi, Alicia S Ventura, Angela R Bazzi, Juliana Blodgett, Sarah Fielman, Melissa Davoust, Margaret G Shea, Clara A Chen, Anna Cheng, Jacqueline Theisen, Samantha Blakemore, Richard Saitz

Objectives: The COVID-19 pandemic led to increased substance-related morbidity and mortality and transformed care for opioid use disorder (OUD). We assessed the perceived impacts of the pandemic on substance use and related consequences among patients in office-based addiction treatment (OBAT).

Methods: We recruited patients with OUD on buprenorphine from July 2021 to July 2022, with data collection at baseline and 6 months. Exposures of interest were the following 6 domains potentially impacted by COVID-19: personal or family infection, difficulty accessing healthcare/medication, economic stressors, worsening physical or mental health, social isolation, and conflicts/disruptions in the home. Outcomes were past 30-day alcohol and other substance use, increased use, and substance-related consequences at baseline and 6 months. Generalized estimating equations Poisson regression models quantified associations between increasing impact domain scores and relative risks of each outcome.

Results: All participants (N = 150) reported at least one domain negatively impacted by COVID-19 at both time points. Higher "worsening physical or mental health" domain scores were associated with increased relative risk of recent alcohol or drug use (adjusted risk ratio [aRR] 1.04, 95% confidence interval [CI]: 1.01-1.07). Relative risks of experiencing substance-related consequences increased with higher scores in the domains of economic stressors (aRR 1.07, 95% CI: 1.02-1.13), difficulty accessing healthcare/medication (aRR 1.11, 95% CI: 1.04-1.19), and worsening physical or mental health (aRR 1.08, 95% CI: 1.04-1.12).

Conclusions: Among patients with OUD, stressors from COVID-19 were common. Three life domains impacted by COVID-19 appeared to be associated with consequential substance use, highlighting opportunities to address barriers to healthcare access and economic stressors.

目标:COVID-19 大流行导致与药物相关的发病率和死亡率上升,并改变了对阿片类药物使用障碍 (OUD) 的治疗。我们评估了这一流行病对接受诊室戒毒治疗(OBAT)患者的药物使用和相关后果的影响:我们在 2021 年 7 月至 2022 年 7 月期间招募了使用丁丙诺啡的 OUD 患者,并收集了基线和 6 个月的数据。我们关注的暴露是可能受 COVID-19 影响的以下 6 个领域:个人或家庭感染、难以获得医疗保健/药物、经济压力、身体或精神健康恶化、社会隔离以及家庭冲突/干扰。结果为过去 30 天内酒精和其他物质的使用情况、增加使用情况以及基线和 6 个月内与物质相关的后果。广义估计方程泊松回归模型量化了影响领域得分增加与各结果相对风险之间的关系:所有参与者(N = 150)在两个时间点均报告至少有一个领域受到 COVID-19 的负面影响。身体或心理健康恶化 "领域得分越高,近期酗酒或吸毒的相对风险越高(调整风险比 [aRR] 1.04,95% 置信区间 [CI]:1.01-1.07)。经济压力因素(aRR 1.07,95% CI:1.02-1.13)、获得医疗保健/药物治疗的困难(aRR 1.11,95% CI:1.04-1.19)以及身体或精神健康状况恶化(aRR 1.08,95% CI:1.04-1.12)领域的得分越高,出现药物相关后果的相对风险就越高:结论:在 OUD 患者中,来自 COVID-19 的压力因素很常见。受 COVID-19 影响的三个生活领域似乎与随后的药物使用有关,这凸显了解决医疗服务获取障碍和经济压力因素的机会。
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引用次数: 0
Hospitalists' Attitudes and Experiences With Posthospitalization Care Transitions for Patients With Substance Use Disorders: A Cross-sectional Analysis. 住院医生对药物使用障碍患者住院后护理过渡的态度和经验:横断面分析。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-15 DOI: 10.1097/ADM.0000000000001305
Michael A Incze, Sophia Huebler, David Chen, Andrea Stofko, Chaorong Wu, Jacob D Baylis, Chesley Wells, Danielle Babbel

Background: Medical hospitalizations are relatively common among individuals who have substance use disorders (SUDs) and represent opportunities for patient engagement and treatment. Posthospitalization transitions of care are an important element of providing full-spectrum inpatient SUD care; however, little is known about clinicians' experiences with postdischarge care transitions.

Methods: We conducted a cross-sectional study surveying hospital-based medical clinicians (ie, "hospitalists") across 2 large health systems in the state of Utah to assess current practices, barriers, facilitators, and perceptions toward posthospitalization care transitions for patients with SUDs. We used Wilcoxon signed-rank tests to identify the most impactful barriers and facilitators among all respondents. We used logistic regression models to explore the influence of hospitalists' attitudes toward providing SUD care on perceived barriers and facilitators.

Results: The survey was distributed to 429 individuals across 15 hospitals. Eighty-two hospitalists responded to the survey (response rate, 21.4%). Most respondents frequently cared for hospitalized patients with SUDs (n = 63, 77%) and prescribed medications for SUDs (n = 44, 56%). Four respondents (5%) felt that patients received adequate support during care transitions. Lack of social support ( P < 0.001) and social factors such as lack of transportation ( P < 0.001) were perceived as the largest barriers to successful care transitions. Conversely, a partnering outpatient clinic/clinician ( P < 0.001) and outpatient-based care coordination ( P < 0.001) were perceived as the strongest facilitators. Respondents' attitudes toward people with SUDs had a modest effect on perceived barriers and facilitators.

Conclusions: Hospitalists perceived increased outpatient SUD treatment infrastructure and transitional care supports as most important in facilitating posthospitalization care transitions for patients with SUDs.

背景:住院治疗在药物使用障碍(SUD)患者中较为常见,是患者参与和治疗的机会。住院后的护理过渡是提供全方位住院 SUD 护理的一个重要因素;然而,人们对临床医生在出院后护理过渡方面的经验知之甚少:我们对犹他州两家大型医疗系统的医院临床医生(即 "住院医生")进行了一项横断面研究调查,以评估针对 SUD 患者的出院后护理过渡的当前实践、障碍、促进因素和看法。我们使用 Wilcoxon 符号秩检验在所有受访者中找出影响最大的障碍和促进因素。我们使用逻辑回归模型探讨了住院医生提供 SUD 护理的态度对感知到的障碍和促进因素的影响:我们向 15 家医院的 429 人发放了调查问卷。82名医院医生对调查做出了回复(回复率为21.4%)。大多数受访者经常护理患有药物依赖性精神障碍的住院病人(63 人,77%),并开具治疗药物依赖性精神障碍的处方(44 人,56%)。四名受访者(5%)认为患者在护理过渡期间得到了足够的支持。缺乏社会支持(P < 0.001)和交通不便等社会因素(P < 0.001)被认为是成功完成护理过渡的最大障碍。相反,合作门诊/临床医生(P < 0.001)和门诊护理协调(P < 0.001)被认为是最大的促进因素。受访者对 SUD 患者的态度对所感知的障碍和促进因素影响不大:住院医生认为,增加门诊 SUD 治疗基础设施和过渡性护理支持对促进 SUD 患者住院后的护理过渡最为重要。
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引用次数: 0
The American Society of Addiction Medicine Clinical Practice Guideline Development Methodology. 美国成瘾医学会临床实践指南制定方法。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1097/ADM.0000000000001312
Melissa B Weimer, Amanda Devoto, Devan Kansagara, Taleen Safarian, Emily Brunner, Audra Stock, Darius A Rastegar, Lewis S Nelson, Carlos F Tirado, P Todd Korthuis, Maureen P Boyle

Abstract: The American Society of Addiction Medicine (ASAM) has published clinical practice guidelines (CPGs) since 2015. As ASAM's CPG work continues to develop, it maintains an organizational priority to establish rigorous standards for the trustworthy production of these important documents. In keeping with ASAM's mission to define and promote evidence-based best practices in addiction prevention, treatment, and recovery, ASAM has rigorously updated its CPG methodology to be in line with evolving international standards. The CPG Methodology and Oversight Subcommittee was formed to establish and publish a methodology for the development of ASAM CPGs and to develop an ASAM CPG strategic plan. This article provides a focused overview of the ASAM CPG methodology.

摘要:美国成瘾医学会(ASAM)自 2015 年起开始发布临床实践指南(CPG)。随着美国成瘾医学会 CPG 工作的不断发展,该学会始终将建立严格的标准作为组织优先事项,以确保这些重要文件的制作值得信赖。ASAM 的使命是定义和推广以证据为基础的成瘾预防、治疗和康复最佳实践,为了与不断发展的国际标准保持一致,ASAM 严格更新了 CPG 方法。成立了 CPG 方法和监督小组委员会,以建立和发布 ASAM CPG 的开发方法,并制定 ASAM CPG 战略计划。本文重点概述了 ASAM CPG 方法。
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引用次数: 0
E-cigarettes and Youth: The Known, the Unknown, and Implications for Stakeholders. 电子烟与青少年:已知、未知以及对利益相关者的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-15 DOI: 10.1097/ADM.0000000000001304
Luba Yammine, Maria Tovar, Nastassia Anna Yammine, Cabrina Becker, Michael F Weaver

Abstract: Despite the decline in the prevalence of e-cigarette use among youth during the coronavirus disease 2019 pandemic, more than 2.5 million of US high and middle schoolers are still using e-cigarettes. Furthermore, those who use e-cigarettes are starting at a younger age and are using them more intensely, reflecting, at least in part, a high addiction liability of modern e-cigarettes. Beyond addiction, accumulating evidence suggests that, in the short-term, e-cigarettes are associated with cardiovascular and pulmonary effects, whereas the long-term effects of e-cigarette use are yet to be established. The aim of this review is to synthesize current knowledge on e-cigarette use among youth, including established and potential risks and efforts to date to curb youth exposure to e-cigarettes. In addition, we provide recommendations for health care providers, researchers, and other stakeholders to address this significant public health issue.

摘要:尽管在2019年冠状病毒疾病大流行期间,青少年使用电子烟的流行率有所下降,但仍有250多万美国高中生和初中生在使用电子烟。此外,使用电子烟的青少年开始使用电子烟的年龄越来越小,使用强度也越来越大,这至少在一定程度上反映了现代电子烟的高成瘾性。除了上瘾之外,越来越多的证据表明,电子烟在短期内与心血管和肺部的影响有关,而使用电子烟的长期影响尚未确定。本综述旨在综合当前有关青少年使用电子烟的知识,包括已确定的和潜在的风险,以及迄今为止为遏制青少年接触电子烟所做的努力。此外,我们还为医疗服务提供者、研究人员和其他利益相关者提供了解决这一重大公共卫生问题的建议。
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引用次数: 0
Impact of Nicotine Replacement Therapy Sampling on Cessation-Related Processes. 尼古丁替代疗法取样对戒烟相关过程的影响。
IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI: 10.1097/ADM.0000000000001298
Michelle L Sisson, Jamie M Gajos, Caitlin Wolford-Clevenger, Keith R Chichester, Elizabeth S Hawes, Samantha V Hill, Richard C Shelton, Peter S Hendricks, Michael S Businelle, Matthew J Carpenter, Karen L Cropsey

Objectives: Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population.

Methods: This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries.

Results: The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use.

Conclusions: There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.

目标:低收入吸烟者的吸烟率仍然很高。了解早期戒烟的过程(如戒断、渴求、动机)对于为这一人群设计有效的干预措施至关重要:这是一项针对社区低收入吸烟者(n = 83)的二次分析,比较了一种新颖的会期抽样干预(即 In Vivo)与标准护理行为戒烟咨询(SC)。这项分析采用每日日记的方式,考察了5种会话采样干预对戒烟相关过程的影响,以及随着时间的推移,对尼古丁替代疗法(NRT)产品的优缺点的感知:In Vivo疗法在减少戒断症状和渴求感以及增加对尼古丁替代疗法优势的感知方面产生了早期积极影响,效果大小为中等至较大。结果还显示,该疗法在治疗过程中有效减少了戒断症状和渴求感,效果大小分别为中-小和中-大。除第 4 周戒断症状减轻外,SC 组的戒断症状和渴求在治疗过程中均未减轻。In Vivo 治疗对戒烟目标、戒烟愿望、戒烟自我效能、戒烟难度感知、戒烟动机参与度或对 NRT 的不利感知均无影响。In Vivo治疗组报告的每日吸烟量少于SC治疗组,此外,In Vivo治疗组还报告,在他们报告更多地联合使用NRT的日子里,吸烟量减少了:在减少戒断、渴求和每天吸烟数量方面,In Vivo疗法优于SC疗法,以及在提高低收入吸烟者对NRT的认知优势方面,In Vivo疗法得到了初步支持。
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引用次数: 0
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Journal of Addiction Medicine
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