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IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/S0740-5472(22)00124-6
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引用次数: 0
Client attitudes toward virtual treatment court 客户对虚拟治疗法庭的态度
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108833
Bradley Ray , Tara Kunkel , Kristina Bryant , Bethany Hedden , Barbara Andraka-Christou , Meghan O'Neil , Philip Huynh

Introduction

As a response to the COVID-19 pandemic, many treatment courts shifted to offering teleservices. We sought to examine the barriers that clients faced when transitioning to virtual court and treatment, and how this transition impacted their perceptions of the treatment court experience.

Methods

The National Center for State Courts administered an online survey between January 1, 2021, and July 31, 2021, deployed to state and local court administrators, which resulted in 1356 unique client responses from 121 courts. The survey measured attitudes about the treatment court process, including interactions with the judge, the behavioral health treatment staff, and treatment groups, as well as barriers to virtual and in-person court. We hypothesized that clients with fewer technological barriers to virtual service, who shifted to virtual court or treatment, would report more positive attitudes to this service delivery.

Results

Clients felt more comfortable participating in virtual court sessions than in-person sessions but were less likely to feel like the judge was familiar with their case during virtual court sessions. From the treatment perspective, clients felt more connected with other group members and reported greater benefit from treatment staff when treatment services were delivered in-person, but clients felt less anxious when treatment groups were virtual.

Conclusions

Even though virtual experiences were more comfortable than in-person experiences for clients, the results are nuanced and show preference for some in-person connections as they transitioned to virtual connections. Future research should examine how to improve client connections with staff/group members during virtual court or treatment sessions, particularly as courts and treatment providers are likely to continue some services virtually into the future.

为应对COVID-19大流行,许多治疗法院转向提供远程服务。我们试图研究客户在过渡到虚拟法庭和治疗时面临的障碍,以及这种过渡如何影响他们对治疗法庭经验的看法。方法国家州法院中心在2021年1月1日至2021年7月31日期间进行了一项在线调查,部署到州和地方法院管理人员中,从121家法院获得了1356份独特的客户回复。调查测量了人们对治疗法庭程序的态度,包括与法官、行为健康治疗人员和治疗小组的互动,以及虚拟和面对面法庭的障碍。我们假设,对虚拟服务的技术障碍较少的客户,转向虚拟法庭或虚拟治疗,会报告对这种服务提供的更积极的态度。结果客户在虚拟庭审中比面对面庭审时感觉更舒服,但在虚拟庭审中不太可能觉得法官熟悉他们的案件。从治疗的角度来看,当治疗人员亲自提供治疗服务时,客户感到与其他小组成员的联系更紧密,并报告从治疗人员那里获得了更大的好处,但当治疗小组是虚拟的时,客户感到的焦虑程度降低了。虽然虚拟体验对客户来说比面对面体验更舒适,但结果是微妙的,并且在他们过渡到虚拟连接时显示出对某些面对面连接的偏好。未来的研究应审查如何在虚拟法庭或治疗期间改善客户与工作人员/小组成员的联系,特别是因为法院和治疗提供者可能在未来继续提供虚拟服务。
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引用次数: 2
Treatment for hepatitis C virus with direct acting antiviral agents: Perspectives and treatment experiences of people who inject drugs 直接抗病毒药物治疗丙型肝炎病毒:注射吸毒者的观点和治疗经验
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108768
Alison Karasz , Reena Singh , M. Diane McKee , Krupa Merchant , Arthur Y. Kim , Kimberly Page , Irene Pericot-Valverde , Ellen S. Stein , Lynn E. Taylor , Katherine Wagner , Alain H. Litwin

Introduction

Increasingly, people who inject drugs (PWID) infected with hepatitis C virus (HCV) are gaining access to highly effective direct-acting antiviral agents (DAAs). Although past studies examined patient experiences with interferon-based treatments, few have explored patient experiences with these new generation therapeutics. Research and real world experience indicate that many PWID can be successfully treated with the new DAAs. Yet a substantial minority fail to complete treatment or achieve only suboptimal adherence. This qualitative study examines experiences with treatment among participants in Project HERO, a large multisite trial designed to compare treatment delivery methods for DAAs. We explored treatment experiences among HERO participants, with the goal of understanding potential barriers to treatment engagement and completion.

Methods

We conducted qualitative interviews with a sample of 21 participants, including 14 who completed HCV treatment and 7 participants who discontinued treatment before the end of the 12-week medication course. The first phase of the analysis was descriptive, examining participants' life experiences, histories of disease and treatment seeking, experiences with the program, and barriers to treatment completion. The second phase of the analysis examined differences between completers and noncompleters.

Results

Participants offered a variety of reasons for seeking treatment. Both groups of participants reported highly positive experiences of the HERO trial. Participants described research staff as caring, respectful, and nonjudgmental. Substance use was reported by both groups, yet completers described “manageable” substance use, while noncompleters described substance use that sapped their energy and motivation. Shame over drug use was a barrier to treatment completion. Homelessness and a reported lack of social support were much more common in the noncompleter group.

Conclusions

Reasons for noncompletion were not related to features of the clinical trial or treatment program. Our results indicate the importance of: 1) recognizing and addressing severe social and economic challenges such as homelessness; and 2) building a program culture of respect and compassion in treatment programs for PWID infected with HCV.

越来越多的丙型肝炎病毒(HCV)注射吸毒者(PWID)正在获得高效的直接作用抗病毒药物(DAAs)。尽管过去的研究考察了患者对干扰素治疗的体验,但很少有研究探索这些新一代疗法的患者体验。研究和现实世界的经验表明,许多PWID可以用新的daa成功治疗。然而,有相当数量的少数患者未能完成治疗或仅达到次优依从性。这项定性研究考察了HERO项目参与者的治疗经验,该项目是一项大型多地点试验,旨在比较DAAs的治疗方法。我们探讨HERO参与者的治疗经历,目的是了解治疗参与和完成的潜在障碍。方法我们对21名参与者进行了定性访谈,包括14名完成HCV治疗的参与者和7名在12周药物疗程结束前停止治疗的参与者。分析的第一阶段是描述性的,检查参与者的生活经历、疾病史和寻求治疗的经历、参与项目的经历以及完成治疗的障碍。分析的第二阶段检查了完井者和非完井者之间的差异。结果参与者提供了多种寻求治疗的原因。两组参与者都报告了HERO试验的高度积极体验。参与者描述研究人员关心他人、尊重他人、不偏不倚。两组都报告了物质使用,但完成者描述的物质使用是“可控的”,而非完成者描述的物质使用消耗了他们的精力和动力。对吸毒的羞耻感是完成治疗的障碍。无家可归和缺乏社会支持在未完成组中更为常见。结论未完成的原因与临床试验或治疗方案的特点无关。我们的研究结果表明:1)认识和解决严重的社会和经济挑战,如无家可归;2)在丙型肝炎病毒感染的PWID治疗方案中建立尊重和同情的项目文化。
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引用次数: 1
Utility of interactive voice response self-monitoring in stabilizing initial change during natural recovery attempts among persons with alcohol use disorder 交互式语音应答自我监测在酒精使用障碍患者自然恢复过程中稳定初始变化的效用
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108831
JeeWon Cheong, Jalie A. Tucker

Background

Providing extensive low threshold, low intensity interventions during self-initiated recovery attempts may help to stabilize initial change during early recovery when relapse risk is high. This study provided untreated persons with alcohol use disorder (AUD) daily access to an interactive voice response (IVR) self-monitoring system during the early months of a natural recovery attempt to report drinking-related variables. The study prospectively examined event-level associations among IVR call frequency, urges to drink, and drinking practices to evaluate whether more frequent IVR utilization helped participants to manage urges and attenuated the established relationship between urges and relapse.

Methods

Recently resolved untreated problem drinkers (N = 128) recruited from the community received daily IVR access via telephone for 4–5 months to report their urges to drink and drinking practices during the preceding 24 h. Among IVR callers, analyses using SAS Proc Glimmix evaluated associations among IVR utilization, urges to drink, and drinking practices.

Results

Consistent with previous research, greater urges were associated with a higher likelihood of heavy drinking. Moreover, heavier drinking was associated overall with higher IVR utilization, and the more frequently participants called the IVR system over time, the likelihood of heavy drinking episodes was less strongly related to urges.

Conclusions

Recently resolved persons with AUD who experienced higher urges to drink and were consuming alcohol above heavy drinking thresholds received some limited benefits in slowing their return to a heavy drinking pattern if they called the IVR system frequently, even though they were not successfully maintaining their initial abstinent or moderation drinking recoveries. These results, using a prospective design, indicated complex event-level associations among IVR calls, urges, and drinking during early natural recovery that merit further investigation.

背景:在自我启动的恢复过程中,提供广泛的低阈值、低强度的干预可能有助于稳定早期恢复过程中复发风险高的初始变化。本研究为未经治疗的酒精使用障碍(AUD)患者提供了在自然恢复的最初几个月每天访问交互式语音应答(IVR)自我监测系统的机会,以报告与饮酒相关的变量。该研究前瞻性地检查了IVR呼叫频率、饮酒冲动和饮酒习惯之间的事件级关联,以评估更频繁地使用IVR是否有助于参与者控制冲动和减弱冲动与复发之间的既定关系。方法从社区招募的最近解决的未经治疗的问题饮酒者(N = 128)通过电话每天接受4-5个月的IVR访问,报告他们在之前24小时内的饮酒冲动和饮酒习惯。在IVR呼叫者中,使用SAS Proc Glimmix分析评估了IVR利用、饮酒冲动和饮酒习惯之间的关系。结果与之前的研究一致,更大的冲动与更大的酗酒可能性有关。此外,重度饮酒总体上与更高的IVR利用率相关,随着时间的推移,参与者越频繁地调用IVR系统,重度饮酒发作的可能性与冲动的关系就越小。结论:近期解决的AUD患者经历了更高的饮酒冲动,并且饮酒超过重度饮酒阈值,如果他们经常调用IVR系统,即使他们没有成功地维持最初的戒酒或适度饮酒恢复,也可以在减缓他们回归重度饮酒模式方面获得一些有限的好处。使用前瞻性设计的这些结果表明,在早期自然恢复期间,IVR呼叫、冲动和饮酒之间存在复杂的事件级关联,值得进一步研究。
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引用次数: 2
Using structured implementation interventions to improve referral to substance use treatment among justice-involved youth: Findings from a multisite cluster randomized trial 使用结构化的实施干预措施,以改善司法参与青年的物质使用治疗转诊:来自多地点集群随机试验的结果
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108829
Steven Belenko , Richard Dembo , Danica K. Knight , Katherine S. Elkington , Gail A. Wasserman , Angela A. Robertson , Wayne N. Welsh , James Schmeidler , George W. Joe , Tisha Wiley

Introduction

Youth involved in the justice system have high rates of alcohol and other drug use, but limited treatment engagement. JJ-TRIALS tested implementation activities with community supervision (CS) and behavioral health (BH) agencies to improve screening, identification of substance use service need, referral, and treatment initiation and engagement, guided by the BH Services Cascade and EPIS frameworks. This paper summarizes intervention impacts on referrals to treatment among youth on CS.

Methods

This multisite cluster-randomized trial involved 18 matched pairs of sites in 36 counties in seven states randomly assigned to core or enhanced conditions after implementing the core intervention at all sites for six months. Enhanced sites received external facilitation for local change team activities to reduce unmet treatment needs; Core sites were encouraged to form interagency workgroups. The dependent variable was percentage referred to treatment among youth in need (N = 14,012). Two-level Bayesian regression assessed factors predicting referral across all sites and time periods. Generalized linear mixed models using logit transformation tested two hypotheses: (H1) referrals will increase from baseline to the experimental period, (H2) referral increases will be larger in enhanced sites than in core sites.

Results

Although the intervention significantly increased referral, condition did not significantly predict referral across all time periods. Youth who tested drug positive, had an alcohol/other drug–related or felony charge, were placed in secure detention or assigned more intensive supervision, or who were White were more likely to be referred. H1 (p < .05) and H2 (p < .0001) were both significant in the hypothesized direction. Interaction analyses comparing site pair differences showed that findings were not consistent across sites.

Conclusions

The percentage of youth referred to treatment increased compared with baseline overall, and enhanced sites showed larger increases in referrals over time. However, variations in effects suggest that site-level differences were important. Researchers should carry out mixed methods studies to further understand reasons for the inconsistent findings within randomized site pairs, and how to further improve treatment referrals across CS and BH systems. Findings also highlight that even when CS agencies work collaboratively with BH providers to improve referrals, most justice-involved youth who need SU services are not referred.

涉及司法系统的青少年酒精和其他药物使用率很高,但接受治疗的人数有限。JJ-TRIALS在社区监督(CS)和行为健康(BH)机构的指导下测试了执行活动,以改进筛查、确定物质使用服务需求、转诊以及治疗的启动和参与,这些活动是在社区监督服务级联和EPIS框架的指导下进行的。本文综述了干预措施对青少年CS转诊治疗的影响。方法本多站点集群随机试验涉及7个州36个县的18对匹配的站点,在所有站点实施核心干预6个月后随机分配到核心或增强条件。改善的地点接受外部协助,以促进本地变革小组的活动,以减少未获满足的治疗需要;鼓励核心站点组成机构间工作组。因变量是有需要的青少年中涉及治疗的百分比(N = 14,012)。双水平贝叶斯回归评估了在所有地点和时间段预测转诊的因素。使用logit变换的广义线性混合模型检验了两个假设:(H1)从基线到实验期间,转诊人数将增加;(H2)增强站点的转诊人数增加将大于核心站点。结果虽然干预显著增加了转诊,但在所有时间段,病情对转诊没有显著的预测作用。毒品检测呈阳性,有酒精/其他毒品相关或重罪指控的青少年,被安置在安全拘留或被分配更严格的监督,或者白人更有可能被转介。H1 (p <p <.0001)在假设的方向上都是显著的。相互作用分析比较了位点对的差异,结果表明不同位点的结果并不一致。与基线相比,青少年接受治疗的百分比增加了,并且随着时间的推移,增强的站点显示了更大的转诊增加。然而,影响的变化表明,地点水平的差异是重要的。研究人员应该开展混合方法研究,以进一步了解随机位点对中不一致发现的原因,以及如何进一步改善CS和BH系统之间的治疗转诊。调查结果还强调,即使社会服务机构与BH提供者合作改善转诊,大多数需要社会服务的涉及司法的青少年也没有被转诊。
{"title":"Using structured implementation interventions to improve referral to substance use treatment among justice-involved youth: Findings from a multisite cluster randomized trial","authors":"Steven Belenko ,&nbsp;Richard Dembo ,&nbsp;Danica K. Knight ,&nbsp;Katherine S. Elkington ,&nbsp;Gail A. Wasserman ,&nbsp;Angela A. Robertson ,&nbsp;Wayne N. Welsh ,&nbsp;James Schmeidler ,&nbsp;George W. Joe ,&nbsp;Tisha Wiley","doi":"10.1016/j.jsat.2022.108829","DOIUrl":"10.1016/j.jsat.2022.108829","url":null,"abstract":"<div><h3>Introduction</h3><p>Youth involved in the justice system have high rates of alcohol and other drug<span> use, but limited treatment engagement. JJ-TRIALS tested implementation activities with community supervision (CS) and behavioral health (BH) agencies to improve screening, identification of substance use service need, referral, and treatment initiation and engagement, guided by the BH Services Cascade and EPIS frameworks. This paper summarizes intervention impacts on referrals to treatment among youth on CS.</span></p></div><div><h3>Methods</h3><p><span>This multisite cluster-randomized trial involved 18 matched pairs of sites in 36 counties in seven states randomly assigned to core or enhanced conditions after implementing the core intervention at all sites for six months. Enhanced sites received external facilitation for local change team activities to reduce unmet treatment needs; Core sites were encouraged to form interagency workgroups. The dependent variable was percentage referred to treatment among youth in need (</span><em>N</em> = 14,012). Two-level Bayesian regression assessed factors predicting referral across all sites and time periods. Generalized linear mixed models using logit transformation tested two hypotheses: (H1) referrals will increase from baseline to the experimental period, (H2) referral increases will be larger in enhanced sites than in core sites.</p></div><div><h3>Results</h3><p>Although the intervention significantly increased referral, condition did not significantly predict referral across all time periods. Youth who tested drug positive, had an alcohol/other drug–related or felony charge, were placed in secure detention or assigned more intensive supervision, or who were White were more likely to be referred. H1 (<em>p</em> &lt; .05) and H2 (<em>p</em> &lt; .0001) were both significant in the hypothesized direction. Interaction analyses comparing site pair differences showed that findings were not consistent across sites.</p></div><div><h3>Conclusions</h3><p>The percentage of youth referred to treatment increased compared with baseline overall, and enhanced sites showed larger increases in referrals over time. However, variations in effects suggest that site-level differences were important. Researchers should carry out mixed methods studies to further understand reasons for the inconsistent findings within randomized site pairs, and how to further improve treatment referrals across CS and BH systems. Findings also highlight that even when CS agencies work collaboratively with BH providers to improve referrals, most justice-involved youth who need SU services are not referred.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108829"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10135244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Using machine learning to examine predictors of treatment goal change among individuals seeking treatment for alcohol use disorder 使用机器学习检查寻求酒精使用障碍治疗的个体治疗目标变化的预测因素
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108825
Frank J. Schwebel , Noah N. Emery , Rory A. Pfund , Matthew R. Pearson , Katie Witkiewitz

Introduction

The goals of individuals seeking treatment for alcohol use disorder (AUD) are typically quantified as abstinent or nonabstinent (e.g., moderate drinking) goals. However, treatment goals can vary over time and be influenced by life circumstances. This study aims to identify predictors of treatment goal change and direction of change from baseline to six-month follow-up among individuals seeking treatment for AUD.

Methods

This study is a secondary analysis of data from the Relapse Replication and Extension Project. The study included participants who completed assessments at baseline and six-month follow-up in the analysis (n = 441). We used decision trees to examine 111 potential predictors of treatment goal change. The study cross-validated results using random forests. The team examined changes in goal between baseline and follow-up (Decision Tree 1) and quantified them as being toward or away from a complete abstinence goal (Decision Tree 2).

Results

Nearly 50 % of the sample changed their treatment goal from baseline to 6 months, and 68.7 % changed from a nonabstinence goal toward a complete abstinence goal. The study identified seven unique predictors of goal change. The most common predictors of changing a treatment goal were number of recent treatment sessions prior to enrolling in the study, other substance use, negative affect, anxiety, social support, and baseline drinks per drinking day. Participants with a greater number of recent treatment sessions and who sought social support were most likely to change their goal. Additionally, individuals with more substance use tended to change away from complete abstinence goals. Cross-validation supported baseline drinks per drinking day, social support, baseline maximum blood alcohol concentration (BAC), lifetime tobacco use, baseline average BAC, lifetime cocaine use, Inventory of Drinking Situations total score, and Situational Confidence Questionnaire average score as important predictors.

Conclusions

This study identified seven unique predictors of treatment goal change while in AUD treatment. Prior treatment, drinking to cope, and social support were most associated with goal changes. This information can inform providers who seek to understand factors associated with treatment goal selection and changes in goals during treatment.

寻求酒精使用障碍(AUD)治疗的个体目标通常被量化为戒酒或非戒酒(例如,适度饮酒)目标。然而,治疗目标可能随着时间的推移而变化,并受到生活环境的影响。本研究旨在确定从基线到六个月随访期间寻求AUD治疗的个体的治疗目标变化和方向变化的预测因素。方法本研究是对复发复制和推广项目数据的二次分析。该研究包括完成基线评估和六个月随访分析的参与者(n = 441)。我们使用决策树来检查111个治疗目标改变的潜在预测因子。该研究使用随机森林对结果进行了交叉验证。研究小组检查了基线和随访期间目标的变化(决策树1),并将其量化为接近或远离完全戒断目标(决策树2)。结果近50%的样本将他们的治疗目标从基线改为6个月,68.7%的样本从非戒断目标改为完全戒断目标。该研究确定了目标改变的七个独特预测因素。改变治疗目标最常见的预测因素是参加研究前最近的治疗次数、其他物质使用、负面影响、焦虑、社会支持和每天饮酒的基线饮酒量。最近接受治疗次数较多、寻求社会支持的参与者最有可能改变他们的目标。此外,使用更多药物的个体往往会偏离完全戒断的目标。交叉验证支持每日饮酒基线饮酒量、社会支持、基线最大血液酒精浓度(BAC)、终生烟草使用、基线平均BAC、终生可卡因使用、饮酒情况量表总分和情境信心问卷平均分作为重要预测因子。结论:本研究确定了AUD治疗中治疗目标改变的七个独特预测因素。治疗前,饮酒应对和社会支持与目标改变最相关。这些信息可以告知提供者,他们试图了解与治疗目标选择和治疗过程中目标变化相关的因素。
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引用次数: 0
Associations of tobacco cigarette use and dependence with substance use disorder treatment completion by sex/gender and race/ethnicity 按性别/性别和种族/民族划分的烟草使用和依赖与物质使用障碍治疗完成的关系
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108834
Jung-Yun Min , Jacob Levin , Andrea H. Weinberger

Introduction

Individuals with substance use disorders (SUD) are approximately five times more likely to smoke cigarettes than the general population. Individuals who smoke cigarettes have greater odds of SUD relapse compared to individuals who do not smoke cigarettes, but we know little about how cigarette use is related to SUD treatment completion overall by sex/gender or race/ethnicity.

Methods

This study examined 2855 adults (71.98 % male; >70 % racial/ethnic minority) in outpatient and residential SUD treatment at a New York–based treatment agency over a six-month period in 2018.

Results

Overall, approximately three-fourths of SUD treatment-seeking participants smoked cigarettes, with high rates across sex/gender and racial/ethnic groups. Nicotine dependence did not differ by sex/gender, and White Non-Hispanic adults had the highest levels of nicotine dependence across racial/ethnic groups. Those who smoked cigarettes were significantly less likely to complete treatment compared to those who did not smoke cigarettes (OR = 0.69; 95 % CI: 0.58, 0.82). The study found no overall differences in SUD treatment completion and length of stay by sex/gender or race/ethnicity.

Conclusions

Given the high prevalence of cigarette smoking and lower odds of completing SUD treatment, the current system of care for SUD treatment may be enhanced by addressing cigarette smoking from onset of treatment.

物质使用障碍(SUD)患者吸烟的可能性大约是一般人群的5倍。吸烟的人与不吸烟的人相比,SUD复发的几率更大,但我们对吸烟与SUD治疗完成之间的关系知之甚少,这与性别/性别或种族/民族有关。方法本研究对2855名成人进行了调查,其中71.98%为男性;(70%是种族/少数民族)在2018年纽约治疗机构的门诊和住院SUD治疗中进行了为期六个月的研究。结果总体而言,大约四分之三寻求SUD治疗的参与者吸烟,跨性别/性别和种族/民族群体的吸烟率很高。尼古丁依赖没有性别差异,非西班牙裔白人成年人在种族/民族群体中尼古丁依赖程度最高。吸烟的患者完成治疗的可能性明显低于不吸烟的患者(OR = 0.69;95% ci: 0.58, 0.82)。研究发现,性别/性别或种族/民族在SUD治疗完成度和住院时间方面没有总体差异。结论考虑到吸烟的高流行率和完成SUD治疗的低几率,可以通过从治疗开始就解决吸烟问题来加强目前SUD治疗的护理体系。
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引用次数: 2
A randomized clinical trial evaluating the impact of counselor training and patient feedback on substance use disorder patients' sexual risk behavior 一项评估辅导员培训和患者反馈对药物使用障碍患者性风险行为影响的随机临床试验
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108826
Mary A. Hatch , Elizabeth A. Wells , Tatiana Masters , Blair Beadnell , Robin Harwick , Lynette Wright , Michelle Peavy , Esther Ricardo-Bulis , Katerina Wiest , Carrie Shriver , John S. Baer

Introduction

High risk sex—such as sex with multiple partners, condomless sex, or transactional or commercial sex—is a risk factor in individuals with substance use disorders (SUDs). SUD treatment can reduce sexual risk behavior, but interventions to reduce such behavior in this context have not been consistently effective. This study sought to determine if the impact of treatment on sexual risk behavior can be increased.

Methods

In a nested 2 × 2 factorial repeated measures design, we examined outcomes of two interventions: training for counselors in talking to patients about sexual risk; and availability to both counselors and patients of a personalized feedback report based on patient self-report of sexual behavior. Counselors received either a brief, information-based, Basic Training, or a multi-session, skills-based Enhanced Training. Their patients completed an audio-assisted computerized assessment of sexual behavior and received either No Feedback or a Personalized Feedback Report (PFR). Four hundred seventy six patients participated. Patient follow-up occurred 3- and 6-months postbaseline. Primary patient outcome measures were Number of Unsafe Sex Occasions (USO) and whether patients reported talking about sex in counseling sessions (Discussed Sex), both in the past 90 days. Secondary outcomes included Number of Sexual Partners, Sex Under the Influence of Substances, and Perceived Condom Barriers.

Results

Patients of Enhanced-condition counselors compared to those of Basic-condition counselors were more likely to report talking about sex with their counselor at 6-month follow-up. Personalized feedback also increased the likelihood of reporting counselor discussions at 6-month follow-up. Neither the training nor the feedback condition affected USO, Number of Partners, or Sex Under the Influence.

Discussion

We discuss why these two interventions apparently altered counselor-patient communication about sexual risk behavior without affecting the behavior itself.

高危性行为,如与多个性伴侣发生性行为、无安全套性行为、交易性行为或商业性行为,是物质使用障碍(SUDs)患者的危险因素。SUD治疗可以减少性危险行为,但在这种情况下减少此类行为的干预措施并不总是有效的。这项研究试图确定治疗对性危险行为的影响是否可以增加。方法采用嵌套的2 × 2因子重复测量设计,研究了两种干预措施的结果:培训咨询师与患者谈论性风险;咨询师和患者都可以根据患者的性行为自我报告获得个性化反馈报告。辅导员要么接受简短的、基于信息的基本培训,要么接受多阶段的、基于技能的强化培训。他们的患者完成了一项音频辅助的计算机性行为评估,并收到无反馈或个性化反馈报告(PFR)。476名患者参与了研究。患者随访发生在基线后3个月和6个月。患者的主要结局指标是过去90天内不安全性行为发生次数(USO)和患者是否报告在咨询会议中谈论性(讨论性)。次要结局包括性伴侣数量、药物影响下的性行为和感知到的安全套障碍。结果在6个月的随访中,与基础状态咨询师相比,强化状态咨询师的患者更有可能报告与咨询师谈论性。在6个月的随访中,个性化反馈也增加了报告咨询师讨论的可能性。培训和反馈条件对USO、伴侣数量或受影响的性别都没有影响。我们讨论为什么这两种干预明显地改变了咨询师与患者关于性危险行为的沟通,而不影响行为本身。
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引用次数: 0
“If I had them, I would use them every time”: Perspectives on fentanyl test strip use from people who use drugs “如果我有,我每次都会用”:吸毒者对芬太尼试纸条使用的看法。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108790
Megan K. Reed , Venise J. Salcedo , Amanda Guth , Kristin L. Rising

Introduction

Fentanyl contamination in the illicit drug supply has contributed to a significant increase in overdose deaths in the United States. Fentanyl test strips (FTS), which can detect the presence of fentanyl in drugs, are increasingly given to people who use drugs (PWUD) as an overdose prevention intervention. No studies to date have described PWUD's perspectives from a real-world setting about ideal FTS program characteristics. These perspectives, specifically any identified facilitators, barriers, and suggestions for use, are crucial to informing scalability and implementation of FTS.

Methods

The study team conducted qualitative interviews between January and May 2021 with PWUD in Philadelphia, PA, who had used FTS on a variety of substances. The study recruited participants outside of a harm reduction agency and provided informed consent. The team conducted interviews utilizing a semi-structured interview guide, and audio-recorded and transcribed them. The research team analyzed interviews with a conventional content analysis approach.

Results

A total of 29 PWUD participated in an interview. Participants were predominantly cisgender male (n = 21, 72.4%) and White (n = 18, 62.1%). Participants reported previously using FTS on heroin (65.5%), crack cocaine (55.2%), powder cocaine (48.3%), synthetic cannabinoids (31.0%), and benzodiazepines (24.1%). Eighty-six percent of participants learned about FTS through harm reduction or other social service organizations. Most participants incorporated FTS into their daily lives and found them easy to use. Participants identified key barriers, including lack of necessary supplies needed to test, not having an ideal testing location, and confusion reading test results. Suggestions included adding supplies needed for using FTS to distribution packets, ensuring that each PWUD receives enough FTS per distribution, and expanding the types of programs distributing FTS.

Conclusions

While most participants reported FTS as practical and easy to use, participants identified a few key barriers to use that should be addressed to optimize FTS use across a broader population. These barriers include expanding training materials and distributing additional testing materials (e.g., water, cookers) with FTS. Findings can inform sustainable and effective FTS distribution practices, such as distributing FTS in packs of 20 and distributing at other locations that regularly interact with PWUD (e.g., emergency departments, housing shelters, and food banks).

非法药物供应中的芬太尼污染导致美国过量死亡人数显著增加。芬太尼试纸(FTS)可以检测药物中芬太尼的存在,作为过量预防干预措施,越来越多地给吸毒者(PWUD)使用。迄今为止,还没有研究从现实世界中描述了PWUD关于理想FTS项目特征的观点。这些透视图,特别是任何确定的促进因素、障碍和使用建议,对于通知FTS的可伸缩性和实现至关重要。研究小组在2021年1月至5月期间对宾夕法尼亚州费城的PWUD进行了定性访谈,该患者对各种物质使用了FTS。该研究在减少伤害机构之外招募了参与者,并提供了知情同意。该团队利用半结构化采访指南进行采访,并对其进行录音和转录。研究小组使用传统的内容分析方法分析访谈。结果共有29名PWUD参与了访谈。参与者主要是顺性别男性(n = 21, 72.4%)和白人(n = 18, 62.1%)。参与者报告先前使用FTS吸食海洛因(65.5%)、快克可卡因(55.2%)、粉末可卡因(48.3%)、合成大麻素(31.0%)和苯二氮卓类药物(24.1%)。86%的参与者通过减少伤害或其他社会服务组织了解了FTS。大多数参与者将FTS融入到他们的日常生活中,并发现它们很容易使用。参与者确定了主要障碍,包括缺乏必要的测试用品,没有理想的测试地点,以及阅读测试结果的混乱。建议包括增加使用FTS分发包所需的供应,确保每个puwud每次分发都收到足够的FTS,并扩展分发FTS的程序类型。虽然大多数参与者报告FTS实用且易于使用,但参与者确定了几个关键的使用障碍,应该解决这些障碍,以优化FTS在更广泛人群中的使用。这些障碍包括使用FTS扩展培训材料和分发额外的测试材料(例如水、炊具)。调查结果可以为可持续和有效的家庭用品分发做法提供信息,例如以20包为单位分发家庭用品,并在与puwud定期互动的其他地点分发家庭用品(例如,急诊部门、住房庇护所和食品银行)。
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引用次数: 7
Poking the bear: The inapplicability of the RNR principles for justice-involved women 戳熊:RNR原则对涉及正义的妇女的不适用性。
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2022-09-01 DOI: 10.1016/j.jsat.2022.108798
Nena P. Messina , Patricia Esparza
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引用次数: 6
期刊
Journal of Substance Abuse Treatment
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