Substance Abuse Treatment, Prevention, and Policy最新文献

Background: This qualitative study investigates how college students construct their alcohol-related content (ARC) identities on social media platforms. Through the lens of social norms theory, symbolic interactionism, and public commitment paradigms, we examined how students portray themselves through ARC posts.

Methods: In-depth semi-structured interviews were conducted with 20 college students (M_age= 21.2, SD = 1.67) who reported engaging in drinking and ARC posting to elucidate what types of ARC-related identities students employed on social media by going through participants' social media posts. Thematic analysis was used to categorize ARC identity themes and subthemes.

Results: Results revealed two central themes where alcohol was either featured as focal point or as an accessory within students' ARC identities. Under the central theme of alcohol as a focal point, subthemes of partier, humorist, and master drinker ARC identities were uncovered. Under the central theme of alcohol as an accessory, the subthemes of social/outgoing, sophisticated, and material status ARC identities were identified. Some students within the partier, humorist, social/outgoing, and sophisticated subthemes engaged in secrecy/implicit signaling to shield their drinking from others outside their in-groups.

Conclusions: Uncovering specific types of ARC identities could be helpful to identify harmful drinking patterns in college students. Future research could explore how the frequency in which students display their identities using alcohol as either a focal point or alcohol as an accessory might differentially predict varying levels of drinking and alcohol-related problems among college students. This type of research could help target which college students are more at-risk and inform intervention strategies for college students whose ARC identities are more intertwined with alcohol misuse and alcohol-related problems.

This study describes the delivery of opioid use disorder (OUD) services in a Pacific Northwest County jail focusing on screening, assessment, withdrawal management, and medications for opioid use disorder (MOUD). Guided by the 2023 Medicaid performance measures, self-assessment data were collected through stakeholder interviews, policy and electronic healthcare records (EHR) analyses, and a systematic survey focusing on conformity to practice, policy, and documentation. This jail provided OUD screening, assessment, withdrawal management, and MOUD supported by institutional policy and an EHR software system. Survey results confirmed strong conformity to the 2023 Medicaid performance measures, with 91.9% of required recommendations met for policy and practice domains and 87.9% for documentation. Optional (not required) recommendations achieved 80.0% conformity for policy, 93.3% for practice, and 60.0% for documentation. The findings from this self-assessment underscore the robust implementation of OUD services in one jail and can inform internal and external performance improvement goals and activities. (150 words).

People living in rural communities are more likely to receive opioid prescriptions, partly due to job-related injuries. State-level interventions have reduced opioid prescribing; however, rural/urban disparities persist due to differences in demographics and prescribing practices, particularly in states with large rural populations like Indiana. While spatiotemporal analyses have explored aspects of the opioid crisis, spatiotemporal patterns of opioid prescribing have not been sufficiently studied. This study utilizes a sample of Medicaid claims data from the Indiana Family and Social Services Administration from 2015 to 2019 to analyze spatiotemporal patterns of patients receiving at least one opioid prescription across Indiana. The goal was to analyze patient demographics and track prescription hotspot movement over time in rural and urban areas. We analyzed data for 107,574 Medicaid enrollees who received opioid prescriptions during the study period. We found that most patients in the cohort resided in urban areas, with the number of patients who were prescribed opioids and resided in rural areas decreasing at a faster rate. We conducted a negative binomial regression analysis to examine the relationship between various demographics (sex, age, race/ethnicity, and urban/rural classification) and the number of patients receiving at least one opioid prescription over time. Our findings indicate that older patients, patients identifying as females, patients who identify as White, and patients living in urban areas, are more likely to receive at least one opioid prescription. Additionally, the interaction effects revealed that patients from all demographic groups were more likely to receive at least one opioid prescription if they lived in urban areas, compared to those living in rural areas. Using Local Moran's I as a local spatial autocorrelation measure, we identified clusters highlighting transitions from rural to urban areas over time. In 2015-2016, three significant clusters emerged within rural-surrounded 3-digit ZIP codes (472, 474, 476), based on the Rural-Urban Commuting Area Codes. Over time, significant clusters shifted towards urban or mixed areas, possibly influenced by state guidelines and legislation. These findings enhance the understanding of opioid prescription dynamics and identify patterns in opioid prescribing rates in terms of the proportion of patients receiving opioid prescriptions among urban vs. rural communities in Indiana.

Background: To further develop effective smoking cessation interventions within mental healthcare for people with severe mental illness (SMI), it is essential to gain insights into patients' experiences with smoking (cessation), and professionals' experiences with guiding patients in overcoming tobacco addiction.

Methods: We conducted 26 semi-structured interviews with 16 patients and 10 mental healthcare professionals (MHPs), as part of a one-year smoking cessation intervention. A purposive sampling strategy was applied to select the interviewees. All interviews were transcribed verbatim and thematically analysed using MAXQDA software. This study was embedded in a randomised controlled trial conducted in ambulatory mental healthcare in the Netherlands.

Results: Patients reported to smoke to cope with psychological distress and psychiatric symptoms, and to alleviate potential side effects of antipsychotic medication. For some patients low self-esteem and a lack of confidence in one's own capacity to quit smoking were obstacles to a quit attempt. Therefore, for those patients these were crucial aspects to address. Patients and MHPs valued the exercises based on cognitive behavioural therapy (CBT). During group sessions, establishing personalised relapse prevention strategies was regarded as effective preparation for a quit attempt. The group setting was welcomed, however, adjustments to individual needs and preferences are required to personalise the intervention.

Conclusions: Findings highlight the need for personalised care in treating tobacco addiction among people with severe mental illness. The KISMET intervention may serve as a useful framework for tailored cessation support, informed by the diverse experiences presented in this study.

Background: Randomized controlled trials (RCTs) are a critical component of the development of pharmacological treatment options for substance use disorders. Pragmatic trials, in particular, aim to enhance generalizability by testing interventions in real-world settings. However, structural barriers, including socioeconomic marginalization and criminalization, continue to limit research participation among people who use drugs (PWUD). While prior research has explored perspectives of PWUD in research, less is known about how RCT staff navigate obstacles to engaging PWUD who experience structural disadvantage.

Methods: We conducted semi-structured interviews with 36 U.S. research staff (i.e., research coordinators; research assistants) working on pragmatic RCTs testing the effectiveness of medications for substance use disorders.

Results: Staff described challenges that complicated study enrollment and retention, including mistrust, negative perceptions of study components, restrictive eligibility criteria, and logistical challenges related to transportation, housing, and communication. Despite the more flexible design of pragmatic RCTs, staff still encountered constraints that conflicted with participant needs and necessitated going beyond their role to facilitate inclusion and retention. Research staff also identified important facilitators of recruitment and retention, including relationship building, leveraging referral systems, and adopting flexible, participant-centered approaches, where possible.

Conclusion: Even in pragmatic trials designed for real-world conditions, social and structural disadvantages and rigid research structures can limit study participation among PWUD. Our findings suggest that with support, research staff play a central role in navigating these challenges and devising potential strategies for engaging marginalized populations in research.

Substance use disorder remains a United States public health concern, particularly for minoritized populations. This systematic review explores the relationship between workforce diversity, cultural competency, and the quality of substance use disorder treatment for minoritized populations. Studies published between 2003 and 2023 were analyzed and nine studies met inclusion criteria. Findings reveal conflicting evidence about the impact of workforce diversity and cultural competency on quality outcomes. While some studies suggest positive associations, others report no relationship or adverse effects. Moreover, inconsistencies in research methodology limited comparative analyses. The literature predominantly focuses on Hispanic/Latinx populations, leaving gaps in understanding other minoritized populations' experiences. Despite national initiatives promoting health equity and diversity, federal research funding regarding substance use disorder treatment for minoritized populations remains limited. This review calls for further research to inform policy and practice, emphasizing multi-agency collaboration, standardized measures of cultural competency, and targeted funding to address disparities in treatment quality outcomes for minoritized populations.

Background: Dog ownership has been reported to positively influence the lives of individuals with substance use disorder (SUD) fostering social connection, a sense of belonging, and greater daily structure. However, the specific ways in which dog ownership impacts substance use and mental health remain underexplored. This study aimed to explore how people with SUD perceived that dog ownership affected their use of substances and mental health characteristics.

Method: Qualitative, semi-structured, in-depth interviews were conducted with eight individuals with experience of dog ownership and SUD. Data were gathered and analysed using a 4-step qualitative content analysis.

Results: Three key categories emerged from the analysis. The unique relationship with their dog encouraged the development of a new sense of self for participants that had not been previously possible. Participants reported an increased awareness and regulation of substance use, and they became more mindful of their use, often reducing or managing it to align with caring for their dog. The bond with their dog contributed to improved mental health, emotional stability and appeared to play a role in reducing suicidal ideation.

Discussion: Dog ownership provided participants with a positive sense of self and reinforced feelings of self-worth. This helped them move away from impulsive or habitual substance use patterns and adopt a more intentional, less harmful approach. The relationship with the dog also appeared to stabilise participants' mental health, enabling them to navigate depressive episodes more effectively and recover from negative moods more easily.

Background: Cigarette smoking is a major contributor to the global burden of bladder cancer. Its carcinogenic effects result from the harmful substances in tobacco smoke, which induce genetic mutations and disrupt cellular processes. Understanding how smoking contributes to bladder cancer is essential for developing effective prevention and treatment strategies.

Objective: This study systematically reviews global research on the relationship between smoking and bladder cancer through bibliometric analysis, identifying research hotspots, trends and future directions.

Methods: Relevant literature on the relationship between cigarette smoking and bladder cancer published between 1999 and 2023 was retrieved from the Web of Science database. Visual analyses were conducted using VOSviewer and CiteSpace software, focusing on contributions from countries, institutions, journals, authors and keywords.

Results: Our analysis of 2,802 publications revealed an upward trend in annual output on the relationship between smoking and bladder cancer, with the United States and China as leading contributors. Notable institutions included the NIH, National Cancer Institute, University of Texas System and the International Agency for Research on Cancer. Key journals were Cancer Epidemiology, Biomarkers & Prevention and International Journal of Cancer. Rothman, Nathaniel and Zeegers, M.P.A. were the most productive and co-cited authors. Keyword analysis highlighted DNA repair, genome-wide association studies, and smoking cessation.

Conclusion: This bibliometric analysis has significantly advanced the field by highlighting current research directions and the application of specific mechanisms. These findings also have implications for clinical practice and public health policy, potentially improving patient outcomes through a comprehensive understanding of disease pathogenesis.

Background: Tobacco use, particularly smoking, remains the leading cause of preventable death in the United States. While Medicaid in all states provides some coverage of tobacco cessation treatments, rates of tobacco use remain much higher among Medicaid beneficiaries (30.0%) compared to those with private insurance (18.0%). The extent to which Medicaid beneficiaries receive cessation counseling services remains unclear. The current study assessed tobacco counseling occurrence among individuals who use tobacco among South Carolina Medicaid fee-for-service beneficiaries from 2019 to 2022.

Methods: Individuals with a tobacco use disorder diagnosis were identified (N = 49,401) and the differences in the number of patients counseled between demographic groups and the types of providers delivering counseling were assessed. Between-group differences in receiving counseling were assessed using Chi-squared tests.

Results: Fewer Black (χ2 = 34.54, 23.51, 8.54, 12.02, p < 0.5) and younger (χ2 = 81.43, 117.45, 83.25, 78.98, p < 0.0001) beneficiaries received counseling across all four years compared to their White and older counterparts, respectively. Additionally, fewer individuals in rural areas (χ2 = 12.44, 4.05, 5.07, p < 0.05) received counseling compared to those in urban areas in years 2019-2021. There were additional sex and regional differences in some years.

Conclusions: To improve cessation rates, focusing on increasing availability of cessation counseling services to Medicaid beneficiaries is critical.

Introduction: Smoking cessation interventions tend to be less effective for people of lower socioeconomic position (SEP) compared to those of higher SEP. Mobile phone-based interventions have been shown to increase abstinence from smoking. Stopcoach is an mHealth smoking cessation intervention that specifically targets people with a lower SEP. A pilot study showed the potential and feasibility of Stopcoach but as yet no research exists that assesses the effectiveness of Stopcoach.

Objective: This study aims to evaluate whether using Stopcoach in combination with group-based smoking cessation counselling (SCC; intervention group) increases short- and long-term abstinence compared to SCC alone (control groups). Secondarily, this study aims to assess acceptability of Stopcoach as perceived by people who smoke and SCC group coaches.

Methods: This multi-methods study was originally designed comparing an intervention group (n = 242; 2020-2022) to a historical control group (n = 3362; 2018-2020) that did not use Stopcoach. However, the COVID-19 pandemic hampered realistic comparison due to declining abstinence rates. Therefore, a COVID-era control group was added (n = 312; 2020-2021). All participants enrolled in professionally led SCC groups. The primary outcome was abstinence at four weeks and one year after quit date. In the intervention group, usability, acceptability and usefulness were also measured. In a qualitative assessment, eight SCC trainers were interviewed to explore acceptance by trainers and integration of Stopcoach into SCC.

Results: Due to the COVID-19 related overall decline in abstinence rates, the intervention group had lower abstinence rates compared to the pre-COVID control group (73.6% vs. 78.2% p < 0.001). However, the COVID-era control group revealed that Stopcoach, as addition to accredited SCC, was associated with higher abstinence rates after four weeks than SCC alone (73.6% vs. 57.1%, p < 0.001). This difference was sustained in the lower SEP subgroup (65.6% vs. 49.6%, p = 0.043). No overall significant differences in 1-year abstinence rates were found between the intervention group and both control groups. Participants rated usability, acceptability and usefulness highly positive, irrespective of SEP. Qualitative measures showed most trainers welcomed adding Stopcoach to their SCC.

Conclusion: Addition of the Stopcoach app to SCC appears effective and feasible. Importantly, this also holds for the lower SEP subgroup. This makes Stopcoach one of the few smoking cessation mHealth interventions that also meets the needs of people with lower SEP who smoke.