Substance Abuse Treatment, Prevention, and Policy最新文献

Background: The Drug User Liberation Front led an evaluation of a non-medicalized model of safer supply known as a "Compassion Club." This club sourced, rigorously tested, packaged, and accurately labeled certain illicit substances and then provided them to club members at cost in order to investigate the effects and feasibility of a non-medical model of safer supply. Operating for 14 months, the club provided low-cost, quality-controlled illicit substances to individuals at risk of fatal overdose in Vancouver, Canada's Downtown Eastside neighbourhood. This study was undertaken to explore perceived impacts of the Compassion Club among its participants, as well as their perceptions regarding how the Club could be improved.

Methods: At the one-year time point of club operations 43 participants from the club's membership completed an interviewer-administered survey which is utilized in this cross sectional analysis. Descriptive statistics were employed to assess the perceived influence of club membership on various factors, including drug use patterns, harm reduction practices, financial outcomes, housing stability, and overall well-being.

Results: Applicable responses reported benefits from membership in the Compassion Club, including reduced drug use (64.3%), decreased reliance on illicit markets (86.7%), lowered risk of overdose (90.0%), and increased likelihood of using sterile equipment (84.6%). Mental health (74.2%), physical health (63.3%), and overall well-being (70.0%) were also noted improvements. Suggestions for club improvement included extended operating hours, broader substance selection, and improved accessibility.

Conclusion: The reported reductions in drug use and improved adherence to harm reduction practices described herein underscore the perceived benefits of this unique program. Compassion Clubs represent a distinct strategy to mitigate overdose risk and enhance the well-being of drug users. These insights advance ongoing dialogues on overdose prevention strategies, urging further research to refine non-medicalized approaches within the evolving landscape of interventions.

Background: Cognitive deficits are prevalent among substance use disorder (SUD) patients and affect treatment retention and outcome. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well-researched instrument in diverse patient groups and has the potential to serve as an effective and accurate method for identifying cognitive impairment in SUD patients. This systematic review examines the RBANS' ability to detect cognitive impairment in SUD patients. Limitations of knowledge and the need for further research are discussed.

Methods: We conducted a systematic search using PsycINFO, Medline, and Cochrane databases to identify relevant studies and articles on applying RBANS in SUD. No time limits were imposed on the search. Search words were RBANS, substance use disorder, drug use disorder, and alcohol use disorder, and the most common specific types of drugs (e.g., opiates, cannabis, and methamphetamine).

Results: A systematic search identified 232 articles, of which 17 were found eligible and included in the review. Most studies examined patient groups using either alcohol, methamphetamine, or opioids. The results are presented in the form of a narrative review. We identified some evidence that the RBANS can detect group differences between SUD patients and healthy controls, but the findings were somewhat inconsistent. The literature search revealed little information about cognitive profiles, reliability, factor structure, and construct and criterion validity.

Conclusions: The evidence concerning the validity and usefulness of the RBANS in SUD populations is scarce. Future research should investigate cognitive profiles, reliability, factor structure, and construct and criterion validity.

Background: Binge drinking constitutes a significant public health concern. Defined as the consumption of five or more alcoholic beverages on a single occasion, binge drinking leads to acute cognitive and motor impairments and is associated with a multitude of detrimental health consequences. Therefore, the aim of this study was to analyse globally published peer-reviewed literature on binge drinking.

Methods: A thorough search of the Scopus database was conducted to gather all the relevant research. Keywords related to binge drinking were used to locate a wide range of studies. Specific criteria were subsequently applied to narrow the results, ensuring the inclusion of only the most relevant articles. This process yielded a collection of 2,763 research papers. Finally, a software program called VOSviewer was utilized to analyse and visualize the connections between these studies.

Results: A bibliometric analysis was performed to investigate trends in binge drinking research literature published between 1980 and 2024. The findings revealed a significant increase in publications (R²=0.916; p < 0.001), with a peak in 2018 (191 articles). The majority (89.65%, n = 2,477) were research articles, followed by review articles (4.74%, n = 131). Authors from 139 countries contributed to binge-drinking research, with the USA (n = 1,550; 56.1%) and the UK (n = 216; 7.82%) leading in the volume of publications. The National Institute on Alcohol Abuse and Alcoholism (n = 65; 2.35%) and the University of North Carolina at Chapel Hill (n = 63; 2.28%) emerged as the main institutional contributors. The National Institute on Alcohol Abuse and Alcoholism in the United States was the main funding source, supporting 599 articles (21.68%), followed by the National Institutes of Health in the United States, with 544 articles (19.69%). In particular, the post-2016 period witnessed a shift in research themes toward mechanistic investigations alongside studies on societal interventions, reflecting a growing focus on mitigating the broader social impact of binge drinking.

Conclusions: This study is the first comprehensive analysis of trends in binge drinking research. Over the past decade, binge drinking has increased dramatically, led by the United States, the UK, and Spain. Initially, focused on social and cultural factors, research shifted after 2016 to mechanistic and animal models, shaping future research directions and strategies.

Background: Heavy consumption of alcohol increases the risk of developing active tuberculosis (TB), contributes to delayed diagnosis and affects adherence to treatment. Within a large urban case-finding project, we aimed to determine the prevalence of and factors associated with alcohol use disorder (AUD) and to understand the challenges that people with AUD face while seeking for TB services and adhering to TB treatment.

Methods: We carried out an explanatory sequential study in two large urban districts in Uganda. We collected quantitative data on the prevalence of alcohol use disorder using the Cut, Annoyed, Guilty, Eye opener (CAGE) tool. We used a Poisson regression model with robust variance to examine factors associated with AUD. Both the crude and adjusted prevalence risk ratios with 95% confidence intervals were presented. We then conducted two focus group discussions with persons diagnosed with both TB and AUD. Focus group discussions (FGDs) were transcribed, data were analysed inductively and coded into themes using NVIVO version 12 software.

Results: Out of 325 people with TB people interviewed, 62 (18.7% 95% confidence interval [CI] 18-31%) screened positive for AUD. Majority 82.3% (51/62) were male. Being male aPR 2.32 (95% CI 1.19, 4.49) and living in an urban area aOR 1.79 (95% CI: 1.10, 2.92) were significantly associated with a positive screen. Among people who screened positive for AUD, there was a tendency towards suboptimal TB treatment outcomes, although this did not reach significance aPR 1.65 (95% CI: 0.95, 2.85). Fourteen people (eight male and six female) who screened positive for AUD attended two FGDs. These respondents often did not disclose alcohol use during TB treatment and missed clinic refill appointments due to lack of transport fares to the clinic.

Conclusion: A significant proportion of people with TB screened positive for AUD but did not disclose alcohol use to their healthcare workers. These patients experienced several challenges while on TB treatment. Therefore, TB care programs need to design interventions that actively assess for AUD and in order to address related challenges.

Objectives: Canada continues to experience an epidemic of toxic drug-related overdose deaths. Public health messaging emphasizes the dangers of using drugs alone as it restricts timely overdose response or renders it impossible, yet this practice remains prevalent among people who use drugs. While drug use practices and associated harms are known to be highly gendered, little is known about how factors shaping solitary drug use may differ across genders (including cisgender men, cisgender women, transgender women, Two-Spirit people and gender diverse people). Thus, we sought to explore solitary drug use practices according to gender in Vancouver, Canada.

Methods: Data were collected through Vancouver Injection Drug Users Study, a prospective cohort study between June 2019 and May 2023. We used gender-stratified multivariable generalized estimating equation models to identify factors associated with using drugs alone.

Results: Among the 697 participants, 297 (42.6%) reported using drugs alone in the previous 6 months at baseline. In multivariable analyses, we found that being in a relationship was negatively associated with using alone for both cisgender men and cisgender women (adjusted odds ratio [AOR] = 0.25 and 0.34, respectively), while homelessness was negatively associated for cisgender men only (AOR = 0.45). Factors positively associated for cisgender men included daily illicit stimulant use (AOR = 1.90), and binge drug use (AOR = 2.18). For cisgender women, only depression was positively associated with using drugs alone (AOR = 2.16). All p-values < 0.05. While unable to conduct a multivariable analysis on transgender, Two-Spirit and gender diverse people due to small sample sizes, bivariate analyses showed larger impact of depression on using alone for Two-Spirit (OR = 8.00) and gender diverse people (OR = 5.05) compared to others, and only gender diverse people's risk was impacted by experiences of violence (OR = 9.63). All p-values < 0.05.

Conclusion: The findings of this study suggest significant heterogeneity in gender-specific factors associated with using drugs alone. Factors exclusively impacting cisgender men's risk included homelessness and daily stimulant use, and depression having a significant impact on cisgender women's, but not cisgender men's, risk. Ultimately, gender-specific factors must be recognized in public health messaging, and in developing policies and harm reduction measures to address the risks associated with using alone.

Background: The opioid epidemic contributes to increasing morbidity and mortality due to drug overdoses in the US, but barriers to traditional opioid use disorder (OUD) treatment prevent a vast majority of patients from accessing quality care and medications for opioid use disorder (MOUDs). Public Health Emergency (PHE) provisions during the COVID-19 pandemic relaxed in-person evaluation requirements for buprenorphine inductions, allowing for the expansion of telehealth care to OUD populations. This qualitative study explores patients' experiences with a novel digital therapeutic telehealth program with buprenorphine for OUD.

Method: Semi-structured qualitative interviews were conducted with a sub-sample (n = 15) of participants from a larger feasibility and acceptability pilot. Interviews explored participants' opioid use, OUD treatment history, previous MOUD experience, barriers to previous treatment attempts, medication adherence, counseling experience, treatment satisfaction, and comparisons between current and previous treatments.

Results: Barriers to care in previous OUD treatment episodes included logistical and program related inconveniences (program attendance requirements, commute distances, transportation, appointment wait times, and clinic patient volumes), financial strain, unreliable access to prescribers, residential program experiences, and the availability of detox-only based treatments. Participants with previous treatment experiences contrasted these barriers with the virtual delivery study setting and reported that the characteristics of telehealth OUD care facilitated improved engagement and retention by overcoming many of these barriers through: no transportation requirements, open and flexible appointment scheduling, appointment times confined to care team meetings only, absence of provider availability concerns, and the ability to receive buprenorphine maintenance care from home. The primary barrier noted for virtual care delivery was the fulfillment of buprenorphine prescriptions from local pharmacies.

Conclusion: A novel digital therapeutic telehealth program was reported to overcome almost all of the barriers encountered by participants during previous traditional OUD treatment episodes, contributing to a growing body of evidence supporting the permanency of current PHE expansions for OUD telehealth care. Findings also emphasize the importance of coming to workable policy solutions for buprenorphine supply threshold constraints on local pharmacies that unintentionally constrict access for telehealth and other OUD patients.

Background: Early identification of potential alcohol-problems is central for timely intervention and treatment referral. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) serve as globally recognized and validated screening tools for this purpose. We aimed to evaluate the diagnostic validity of internationally recommended AUDIT cut-off scores ≥ 8, ≥16, ≥ 20, and AUDIT-C cut-off scores ≥ 4, ≥5 using the Danish language versions of questionnaires in a hospital setting.

Methods: Questionnaire data were collected from 2/15/2023, to 4/27/2023 at the Department of Gastroenterology and Hepatology, Odense University Hospital, Denmark. We tested the World Health Organization's recommended AUDIT cut-offs: ≥8 for hazardous use, ≥ 16 suggestive of dependence, ≥ 20 high likelihood of dependence, along with AUDIT-C ≥ 4 and ≥ 5 using the following reference standard: Danish low-risk drinking guidelines (≤ 10 standard drinks/week) for hazardous use and self-reported ICD-10 alcohol dependence criteria for alcohol dependence. Analyses included ROC curves, AUC, sensitivity, specificity, predictive values, and agreement.

Results: Three hundred patients participated, mean age 52 years (SD 17.4, median 54) and 51.3% males. Mean AUDIT score was 4.5 (SD 5.8, median 3) with fourteen (4.7%) meeting at least three self-reported ICD-10 criteria for alcohol dependence. The prevalence of hazardous use was 10.7%. AUDIT ≥ 8 exhibited a sensitivity of 56% (95% CI 40.6-73.6) and specificity 91% (95% CI 87.8-94.5) for detecting hazardous use. Against at least three self-reported ICD-10 criteria for alcohol dependence, AUDIT cut-off ≥ 16 showed a sensitivity of 85% (95% CI 66.1-98.2) with 97% specificity (95% CI 96.0-99.2), while cut-off ≥ 20 had a sensitivity of 71% (95% CI 49.2-91.6) with 99% specificity (95% CI 98.1-99.9). The AUDIT-C cut-offs ≥ 4 and ≥ 5 exhibited low positive predictive values in detecting hazardous use (30.8% for ≥ 4 and 36.8% for ≥ 5) and dependence (13.5% for ≥ 4 and 18.4% for ≥ 5) and demonstrated a specificity ranging from 68.5 to 82.1% with negative predictive values from 98.2 to 100%.

Conclusion: In Danish gastroenterology and hepatology departments, the AUDIT and AUDIT-C may be used to identify patients who are unlikely to have an alcohol problem, while positive screen results should be carefully considered and followed by more exhaustive assessment.

Background: Substance use disorders are prevalent among youth in sub-Saharan Africa (SSA), yet treatment resources are scarce. Peer provider delivered brief interventions (BIs) represent an affordable and potentially scalable strategy for addressing youth substance use disorders. The goal of this study is to assess the acceptability of a peer provider delivered substance use BI from the perspective of youth in Kenya.

Methods: We conducted qualitative semi-structured interviews with youth participants (n = 25) to explore acceptability of a substance use BI. Youth were participants in a two-arm mixed-methods pilot randomized controlled trial (RCT) investigating the feasibility of a peer provider delivered single-session substance use BI for youth aged 15-24 years with moderate-risk substance use. The semi-structured interviews were conducted three months after the BI was delivered and were guided by the Theoretical Framework of Acceptability (TFA). Qualitative data were analyzed through thematic analysis.

Results: We interviewed 25 of 38 participants in the BI arm, 18 males and 7 females; 15 were ages 18-24 years, and 10 ages 15-17 years. Affective attitude: Most youth reported that they enjoyed the session content and enjoyed interacting with the peer provider. Burden: Most youth felt that it was easy to understand the session and participate in it. Perceived effectiveness: Most of the youth perceived the intervention to be effective in helping them reduce substance use and improve their well-being. Ethicality: All youth perceived that the counselling session fit in with their goals and values. Intervention coherence: Most youth understood the overall goal of the intervention. They reported that the goal of the intervention was to help youth stop substance use, and to bring about behavior change. Opportunity costs: Some youth reported that they had to forgo other activities to attend the session, such as work, school, sports, gaming, visiting family, or house chores. Self-efficacy: Most youth felt confident about being able to cut down or stop using substances following the intervention.

Conclusion and recommendations: Our findings indicate that the peer provider delivered single-session substance use BI was acceptable to youth. The youth recommended that follow-up sessions be provided to ensure sustained behavior change. This study supports the utility of the TFA in exploring acceptability of a substance use intervention from the perspective of young people.

Trial registration: NCT05545904 Registration date 16/09/2022 Registry ClinicalTrials.gov https//clinicaltrials.gov/study/NCT05545904.

Background: Little is known about mortality from four disorder combinations: fully attributable to alcohol or tobacco, partly attributable to both alcohol and tobacco, to tobacco only, to alcohol only.

Aim: To analyze whether residents who had disclosed risky alcohol drinking or daily tobacco smoking had a shorter time to death than non-risky drinkers and never daily smokers twenty years later according to the disorder combinations.

Methods: A random adult general population sample (4,075 study participants) of a northern German area had been interviewed in the years 1996-1997. Vital status and death certificate data were gathered 2017-2018. The data analysis included estimates of alcohol- or tobacco-attributable mortality using all conditions given in the death certificate and alternatively the underlying cause of death only.

Results: Among 573 deaths, 71.9-94.1% had any alcohol- or tobacco-attributable disorder depending on the estimate. Risky alcohol consumption and daily tobacco smoking at baseline were related to disorders in the death certificate according to the combinations. Deaths with an alcohol- and tobacco-attributable disorder were related to risky alcohol consumption (subhazard ratio 1.57; 95% confidence interval 1.25-1.98) and to daily tobacco smoking at baseline (subhazard ratio 1.85; 95% confidence interval 1.42-2.41).

Conclusion: First, more than 70% of the deceased persons had one or more alcohol- or tobacco-attributable disorders. This finding suggests that total mortality seems to be the suitable outcome if potential effects of alcohol or tobacco consumption in a general population are to be estimated. Second, the relations of risky alcohol consumption and tobacco smoking with time to death speak in favor of the validity of alcohol- and of tobacco-attributable disorders in death certificates and of considering both alcohol consumption and tobacco smoking if attributable deaths are to be estimated.

Background: Alternative payment models (APMs) are methods through which insurers reimburse health care providers and are widely used to improve the quality and value of health care. While there is a growing movement to utilize APMs for substance use disorder (SUD) treatment services, they have rarely included SUD prevention strategies. Challenges to using APMs for SUD prevention include underdeveloped program outcome measures, inadequate SUD prevention funding, and lack of clarity regarding what prevention strategies might fit within the scope of APMs.

Methods: In November 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), through a contract with Westat, convened an expert panel to refine a preliminary conceptual framework developed for utilizing APMs for SUD prevention and to identify strategies to encourage their adoption.

Results: The conceptual framework agreed upon by the panel provides expert consensus on how APMs could finance a variety of prevention programs across diverse populations and settings. Additional efforts are needed to accelerate the support for and adoption of APMs for SUD prevention, and the principles of health equity and community engagement should underpin these efforts. Opportunities to increase the use of APMs for SUD prevention include educating key groups, expanding and promoting the SUD prevention workforce, establishing funding for pilot studies, identifying evidence-based core components of SUD prevention, analyzing the cost effectiveness of APMs for SUD prevention, and aligning funding across federal agencies.

Conclusion: Given that the use of APMs for SUD prevention is a new practice, additional research, education, and resources are needed. The conceptual framework and strategies generated by the expert panel offer a path for future research. SUD health care stakeholders should consider ways that SUD prevention can be effectively and equitably implemented within APMs.