Substance Abuse Treatment, Prevention, and Policy最新文献

Background: Stigma related to drug use is a well-documented barrier to engaging and remaining on medication for opioid use disorder (MOUD), yet little is known about how stigma operates across multiple social and institutional settings in low-resource contexts.

Methods: This qualitative study draws on 40 in-depth interviews with current and former MOUD clients and four focus groups with 35 current clients at an opioid treatment clinic in Dar es Salaam, Tanzania. Transcripts were thematically analyzed to explore how stigma influenced MOUD adherence and retention.

Results: Five themes emerged: stigma encountered while using public transportation; employment-related stigma; lack of family support due to misinformation; institutional stigma within the treatment setting; and stigma management strategies, including altering appearance and distancing from peers. Gendered expectations intensified stigma for women, while assumptions of untrustworthiness shaped client interactions across settings. These experiences posed significant barriers to consistent treatment engagement.

Conclusions: To support MOUD retention, programs should integrate stigma reduction through expanded family engagement, more flexible clinic policies, and client-informed approaches. Public education efforts are also critical to addressing widespread misconceptions about MOUD and people who use drugs.

Objectives: We aimed to identify factors correlated with completion, non-completion and cycling between completion and non-completion among clients admitted to Alberta Residential Withdrawal Management Services.

Methods: The study included data on clients from a provincial database (N = 20,020) admitted to residential withdrawal management units across Alberta between April 1, 2015, and March 31, 2022. We collapsed admission-level data into client-level data, where each individual's information is captured as a unique record. Multinomial logistic regression was performed to investigate correlates of completion, non-completion, and multiple cycles of completion and non-completion. Clients in these three categories were compared in their socio-demographics, primary substance of concern, and other program variables of admission count, length of stay, transition to treatment, facilities utilized, days of discharge, and years of admission.

Results: The study sample included 39,952 admissions, with an average of two per client. Overall, 55.8% (n = 11,170) of discharged clients completed the program, 25.5% (n = 5,106) were non-completed, and 18.7% (n = 3,744) cycled between completion and non-completion. Regression analysis indicated that clients who used a single substance, primarily alcohol, cocaine and marijuana, completed post-secondary education, were employed or had unstable employment, and were married had lower odds of non-completion. Other variables related to higher odds of completion were urban residence, multiple admissions to a facility, and longer lengths of stay. Conversely, clients who primarily used amphetamines, barbiturates, crystal meth, opiates, and tranquillizers had higher odds of non-completion. Female gender, being discharged on Saturday and Sunday, using detoxification as a standalone service without transitioning to residential treatment and admission to two or more facilities also correlated with higher odds of non-completion.

Conclusion: Results indicated that the type of substances, gender, education, marital status, employment, place of residence, and transition to residential services were associated with detoxication outcomes. These findings can inform the customization and allocation of services, targeted support, service intensity and areas requiring additional attention and investment to improve treatment outcomes.

Background: Lived experience recovery organisations (LEROs) are social support services facilitated by those who have shared lived experience. Typically, they aim to build shared identity and reducing stigma in this area, although there is limited knowledge on the experiences of those using LEROs, with research rarely permitted into these groups. The current study aims to provide insight into these groups, examining the experiences of service users in a UK-based LERO focussed on substance use disorder recovery.

Methods: Fifteen service users were interviewed about their experiences attending this LERO. Transcripts from these semi-structured interviews were thematically analysed by authors, with an inductive approach adopted.

Results: Eight themes and 10 sub-themes were identified. Themes were; Feeling supported in recovery, Experiencing life outside of substance use disorder, Fun, Skills acquisition, Preventing relapse by filling time, Gaining a sense of community, Psychological impact, and Changes in public perception. Participants reported having a positive experience within this LERO, particularly in comparison to traditional treatment pathways. Specifically, participants highlighted feelings of self-worth, belongingness, and enjoyment from this LERO - experiences they felt made this treatment pathway unique.

Conclusion: This paper highlighted the importance of peer support in substance use disorder recovery. Embedding those with lived experience into services was highly valued by participants and generated a unique culture of comfort, hope and opportunity. Although the scope of this study was limited to participants only currently attending this organisation, those interviewed significantly valued this LERO, highlighting their future potential to alleviate the lack of satisfaction reported by some around traditional treatment methods.

The Tobacco Endgame is a global initiative that seeks to implement tobacco prevention policies to collectively end the commercial tobacco epidemic and eliminate tobacco-related health disparities around the world. California seeks to be among the first regions to effectively implement such an initiative, with a statewide Tobacco Endgame goal of 2035. Given the tobacco industry's manipulation marketing tactics that perpetuated tobacco-related disparities among select communities, California's Tobacco Endgame prioritizes these communities (i.e., African American, Hispanic, Asian American/Pacific Islander, and LGBTQ+). To effectively support underserved communities as they prepare for Tobacco Endgame-related policies, research is needed to understand their perspectives and priorities. Through a qualitative approach, this study explored the present awareness and perspectives of California's priority communities regarding the Tobacco Endgame. Following virtual focus groups (n = 19), analyses revealed four shared themes that appeared in all four community groups (i.e., health implications, addiction, post-implementation challenges, children and youth) as well as at least two unique themes that emerged within each of the four priority communities. Findings highlight community-specific concerns, including the prioritization of flavored products, an emphasis on the environmental impact, and the need to protect communities from black market sales, that can inform targeted communication and education outreach. In addition, shared concerns for health, enforcement challenges, and children can inform communication and outreach approaches for a statewide awareness campaign that could resonate broadly.

Background: Opioid use disorder (OUD) during pregnancy has increased dramatically, paralleling epidemic trends in the general population. Pregnant women with OUD face considerable risks of adverse outcomes. While medications for opioid use disorder (MOUD) is the mainstay of treatment, substantial barriers limit its implementation. Despite the critical need for effective interventions, a comprehensive synthesis of the challenges to MOUD during pregnancy remains lacking. This review examines these barriers to improve treatment access and outcomes for this vulnerable population.

Methods: This review was conducted in accordance with the PRISMA 2020 guidelines and was registered in PROSPERO (registration number: CRD420251047657). We searched for peer-reviewed articles in PubMed, Scopus, and ScienceDirect published between 2015 and 2025, using a combination of keywords and MeSH terms. Two independent reviewers screened studies, extracted data, and assessed quality using the Joanna Briggs Institute (JBI) critical appraisal tools. Discrepancies were resolved through consensus with a third author. Data were synthesized narratively to identify key challenges in the treatment of OUD during pregnancy.

Results: Of the 9,288 articles identified from databases and websites, 23 met the eligibility criteria, including 14 qualitative studies, 5 cross-sectional studies, and 4 review articles. Patient-related barriers to accessing MOUD for pregnant women with OUD included fear of stigma and child custody loss, concerns about fetal risks, childcare and legal issues, coping with abuse, guilt, social pressure, and financial constraints. Meanwhile, provider-related barriers involved knowledge gaps, inadequate training, bias, stigma, time constraints, and the perceived complexity of treating OUD during pregnancy. Moreover, system-level barriers such as fragmented care models, geographic disparities, gaps in insurance coverage, and punitive policies further limited access to treatment.

Conclusion: Pregnant women with OUD face barriers including stigma, childcare demands, provider bias, training gaps, fragmented care, financial and insurance issues, and punitive policies. Implementing patient-centered care, provider education, policy reforms, and practical supports may help promote compassionate, equitable treatment for this vulnerable population.

Background: Military populations are known to have higher prevalence and heavier alcohol use compared to the general population globally. This has serious negative implications to the military. The objective of this study was to describe the prevalence, patterns and associated factors of binge drinking among male military personnel in the Sri Lanka Army.

Methods: A cross sectional study was conducted among 1337 male Army personnel in active service using multistage sampling. A self-administered questionnaire and the interviewer-administered Alcohol Use Disorders Identification Test which is a 10-item screening tool were used. Prevalence of binge drinking was summarised as a proportion with 95% Confidence Intervals (CI). Age specific prevalence rates and the age standardized prevalence rate of binge drinking were calculated. The standard measure of one unit of alcohol being equivalent to 10 g of pure alcohol was used as a reference to calculate the units of alcohol consumption. Binary logistic regression analysis was used to determine the factors associated with binge drinking.

Results: The overall prevalence of binge drinking was 51.2% (95% CI 48.5%-54.0%). The age standardized prevalence of binge drinking was 28.3%. The majority binge drank once a month (50.4%). Those engaged in binge drinking used 5.6 median units of alcohol on a typical day, 84% consumed arrack, 69.3% have ever thought or attempted to quit and median age of first alcohol consumption was 18 years. When controlled for confounding, those who had mental distress (AOR 2.46, 95% CI = 1.72-3.53), had sex with a commercial sex worker (AOR 1.92, 95% CI = 1.21-3.06), ever smoking (AOR 1.69, 95% CI = 1.27-2.25), had serious consequences (AOR 1.58, 95% CI = 1.13-2.20), currently used cannabis (AOR 1.39, 95% CI = 1.02-1.89) and had combat exposure (AOR 1.37, 95% CI 1.00-1.87) had a higher likelihood of binge drinking.

Conclusions: The high prevalence of binge drinking warrants immediate advocacy to the highest level of command of the Sri Lanka Army for support to implement sustainable evidence-based alcohol prevention programmes.

Introduction: Substance use disorders (SUDs) are a prevalent issue in the United States (U.S.) and there is a need for innovative treatments to address this public health issue. As of March 2025, there are seven states either approved or in the process of applying for Sect. 1115 Demonstration Waivers to implement pilot contingency management (CM) programs for SUD treatment. This manuscript qualitatively summarizes these Sect. 1115 Demonstration Waivers and the different aspects of each U.S. state's program.

Methods: Data are from states Sect. 1115 Demonstration Waivers, collected through September 2024 and updated in March 2025. When possible the information has been verified with pilot program managers from each state, and pilot program managers have provided information when possible.

Results: Eight states have applied for Sect. 1115 Demonstration Waivers to implement pilot CM programs. Five states have been approved (California, Washington, Montana, Hawaii, and Delaware), two are pending approval (Michigan, and Rhode Island) and one state's CM application was denied (West Virginia). California is the only state to have confirmed implementing the Sect. 1115 Demonstration Waiver funding and has started to review evaluation data. The CM programs covered under Sect. 1115 Demonstration Waivers vary in substance targeted (e.g., stimulants, opioids), length of program (12-64 weeks), amount of incentives ($596-1092), and other characteristics (e.g. incentive delivery type, schedule of reinforcement).

Conclusions: Section 1115 Demonstration Waivers addressing SUDs with CM are still new but with the increase in waivers approved, states who wish to apply and receive funding can learn from the approved waivers.

Background: Alcohol use disorder (AUD) is conceptualized as a dimensional phenomenon in the DSM-5, but electronic health records (EHRs) rely on binary AUD definitions according to the ICD-10. The present study classifies AUD severity levels using EHR data and tests whether increasing AUD severity levels are linked with increased comorbidity.

Methods: Billing data from two German statutory health insurance companies in Hamburg included n = 21,954 adults diagnosed with alcohol-specific conditions between 2017 and 2021. Based on ICD-10 alcohol-specific diagnoses, patients were classified into five AUD severity levels: 1 (F10.0, T51.0 or T51.9); 2 (F10.1); 3 (F10.2); 4 (F10.3/4); 5 (K70 + or one of the following diagnoses: K70.0-4, K70.9, K85.2, K85.20, K86.0, 10.5-9, E24.4, G31.2, G62.1, G72.1, I42.6, K29.2). Generalized estimating equation regression models for count data (Poisson distribution) were used to assess associations with the Elixhauser Comorbidity Score (ECS).

Results: Across the study period, the annual prevalence of any AUD diagnosis varied between 2.7% and 2.9%. A dose-response relationship was observed between AUD severity and ECS, indicating that individuals with higher AUD severity experience more comorbid conditions, particularly cardiovascular and liver diseases.

Conclusions: The proposal to define AUD severity levels based on ICD-10 diagnoses allows for a more nuanced analysis of AUD in EHR data.

Background: Alcohol is a psychoactive substance that can lead to alcohol use disorders (AUDs), which encompass a spectrum of conditions including alcohol dependence and abuse, causing significant mental and physical health issues. Excessive drinking is linked to various diseases, such as liver damage, metabolic disorders, and mental health conditions, with notable gender differences in drinking patterns, particularly among workers. This study investigates the prevalence, risk factors, and metabolic implications associated with AUDs among male workers in China.

Method: Utilizing the Structured Clinical Interview for DSM-IV-TR Disorders (SCID), we diagnosed alcohol dependence and abuse in a sample of 665 male workers, categorizing them into a non-problem drinking group (n = 339) and a problem drinking group (n = 326). We compared depressive and anxiety symptoms, as well as sleep quality between the two groups. Additionally, we assessed metabolic parameters including liver and kidney function, blood lipid profiles, blood pressure, and heart rate.

Result: Our findings indicate that the problem drinking group exhibited significantly higher rates of alcohol consumption, including years of drinking, frequency, and quantity of alcohol intake, as well as a higher smoking prevalence (P < 0.05). Notably, sleep disturbances were more prevalent in the problem drinking group compared to the non-problem drinking group (P < 0.05). Metabolic assessments revealed that levels of alanine aminotransferase (ALT), glutamyl transpeptidase (GGT), uric acid, total cholesterol, triglycerides, low-density lipoprotein, fasting blood glucose, diastolic blood pressure, heart rate, and body mass index (BMI) were significantly elevated in the problem drinking group (P < 0.05).

Conclusion: Male workers with alcohol use disorders exhibit a significantly worse metabolic profile, placing them at increased risk for alcohol-related liver disease, cardiovascular events like hypertension and arrhythmias, and metabolic syndrome. Our findings also suggest that smoking history is a critical correlate of problem drinking. These results underscore the need for targeted screening and intervention programs in occupational settings.

The WHO recently published a Tobacco Knowledge Summary (TKS) which is prepared with the objective to summarize the current evidence on the association between tobacco use and asthma. This is also intended as an advocacy tool to widely include health care professionals in the fight for tobacco control and prevention of tobacco related adverse health effects. This article expands on the evidence outlined in the TKS, providing a more comprehensive and clinically focused analysis, aimed at lung-specialist audience. It emphasizes six key messages aimed at guiding healthcare providers and governments in advocating for the health of people living with asthma and the broader population: (1) Babies born to mothers who smoke have smaller lungs and an increased risk of developing asthma during childhood. Pregnant women should receive targeted support to quit tobacco use. (2) Children exposed to second-hand tobacco smoke have an increased risk of developing asthma. (3) Smoking during adolescence and adulthood increases the risk of developing asthma and exacerbates the condition, as well as causing other lung diseases such as chronic obstructive pulmonary disease (COPD) and lung cancer. (4) For people living with asthma, smoking worsens symptoms and can make treatment with medications less effective. All smokers with asthma should be supported to quit smoking. (5) E-cigarettes, heated tobacco products and other nicotine-delivery devices likely also carry risks. Governments should implement effective tobacco control measures to protect all individuals, including those who are vulnerable. (6) The tobacco and nicotine industries' aggressive tactics in the marketing of their products specifically target children, adolescents and young adults. Protecting youth from these harmful tactics is a top priority.