Substance Abuse and Rehabilitation最新文献

Background: Adolescents and young adults in sub-Saharan Africa face a growing burden of alcohol use and related disorders, driven by a convergence of biological vulnerability, socio-environmental pressures, and weak regulatory systems. Rising digital media exposure and socio-economic disparities further exacerbate risky drinking behaviors.

Objective: This review synthesizes current evidence on the prevalence, risk factors, health and social impacts, and intervention strategies related to alcohol use among adolescents and young people in sub-Saharan Africa.

Methods: A narrative review approach was employed, drawing on peer-reviewed articles and global reports published between 2000 and 2024. Studies were identified through searches in databases including PubMed, Scopus, Google Scholar, and Web of Science, using defined inclusion criteria focused on youth aged 10-24 years.

Findings: Alcohol use and alcohol use disorders (AUD) among youth are influenced by a complex interplay of genetic, psychological, familial, social, and digital factors. Consequences include increased risks of mental illness, HIV infection, gender-based violence, poor educational outcomes, and long-term health complications. Despite these harms, interventions remain fragmented and under-resourced across much of the region. Promising interventions include school-based programs, community engagement, digital media regulation, and integration of alcohol services into mental and sexual health platforms.

Conclusion: Tackling adolescent alcohol misuse in sub-Saharan Africa requires urgent, multisectoral action. Policies must be evidence-based, culturally responsive, and supported by robust surveillance, regulation, and youth-centered programming to prevent long-term public health and socio-economic consequences.

Purpose: This study investigates how weighted family history density (WFHD) influences the intergenerational transmission of substance use disorders (SUDs), focusing on onset, escalation, and duration of substance use. Substance preference concordance and sex-specific links between affected family members and participants were also assessed.

Methods: A cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III) included 36,309 adults. WFHD was defined as drug or alcohol problems among first- and second-degree relatives. Linear regression models assessed the relationships between WFHD, age at onset, and duration of substance use, adjusting for sociodemographic factors. The escalation period to peak alcohol use was plotted by WFHD level, and correlation analyses examined the role of affected family members in shaping participant substance preferences and sex-stratified SUD diagnoses.

Results: Each unit increase in WFHD was linked to a minimum 0.53-year earlier onset [β = -0.53, SE = 0.02] and 0.48-year longer duration (β = 0.48, SE = 0.03) of substance use. WFHD increased the adjusted odds of onset before age 18 by 27% and duration exceeding half of one's age by 19%. Adjusted odds for durations exceeding 5 and 10 years rose by 26% and 21%, respectively. Higher WFHD was linked to faster escalation to peak use. Substance preferences showed significant concordance within families. Males were most strongly associated with paternal use, while females were more closely linked to maternal use.

Conclusion: Higher WFHD is strongly associated with earlier initiation, faster escalation to peak use, prolonged duration of substance use, and patterns of substance preference concordance, highlighting the importance of including family history assessments in substance use prevention and intervention strategies. Future research should use longitudinal studies to establish causal relationships and explore interactions between WFHD and other risk factors, such as environmental stressors, epigenetic changes, or genetic markers.

Background: Substance use disorder (SUD) group therapy has traditionally been conducted in-person; however, there is growing interest in virtual formats. While virtual group therapy can address certain barriers for in-person attendance, it may compromise key elements like therapeutic alliance and group cohesiveness. A model that integrates both in-person and virtual participants may help balance the benefits of these two approaches.

Objective: To identify and define approaches to SUD group therapy that integrate in-person and virtual participants, summarize study outcomes associated with these models, propose standardized terminology, and provide preliminary recommendations for their application in SUD treatment.

Design: A comprehensive search was conducted on 11/13/2024 and updated on 12/16/2024 by a medical librarian. Included articles were published 2000 onwards and conducted with SUD group therapy where participants or group facilitators were both in-person and virtual. We extracted data from 4 articles that met the search criteria.

Results: A total of 1353 articles were screened, 20 were evaluated at the full-text level, and 4 met study inclusion criteria. Two "hybrid" model designs for SUD were identified. One model utilized a virtual group facilitator, while participants remained together in-person. The second model kept the facilitator in-person and allowed group participants to be present either virtually or in-person within the same group. Outcomes evaluated included treatment completion across groups and patient perceived changes in therapeutic alliance, group cohesion, and understanding of addiction.

Conclusion: We propose a consensus definition of hybrid virtual group models where at least one group member, either the facilitator or one of the participants, attends groups in-person while at least one member attends virtually. While research is limited, early findings suggest that hybrid SUD groups have similar outcomes to in-person groups and better outcomes than virtual-only groups. Unique considerations should be made to ensure that hybrid SUD models are implemented appropriately and effectively.

Background: The Addiction Severity Index (ASI) is a globally recognized tool for assessing substance use disorder (SUD) severity. Despite its widespread use, no validated Arabic version exists. This study aimed to validate the Arabic ASI-5 in Egypt and Saudi Arabia and evaluate its psychometric properties.

Methods: : A cross-sectional study recruited 400 participants (200 per country) from inpatient/outpatient SUD treatment centers. The ASI-5 underwent forward-backward translation, pilot testing, and cultural adaptation. Internal consistency (Cronbach's α), test-retest reliability (Spearman's ρ), and inter-observer reliability were assessed. Convergent and discriminant validity were evaluated using adjusted Spearman's correlations.

Results: The Arabic ASI-5 demonstrated acceptable internal consistency (α = 0.61-0.82), with medical (α = 0.78) and psychiatric (α = 0.82) domains showing the highest reliability. Lower consistency in drug (α = 0.62) and legal (α = 0.61) domains reflected cultural and methodological factors. Test-retest (ρ = 0.55-0.98) and inter-observer reliability (ρ = 0.78-0.99) were strong. Convergent validity was robust for medical and psychiatric domains (r = 0.70-0.85).

Conclusion: The Arabic ASI-5 is a reliable tool for assessing SUD severity in Arabic-speaking populations. Further refinement of drug and legal domains is recommended to enhance cultural relevance.

Purpose: Rapid access addiction medicine (RAAM) walk-in clinics offer low-barrier, prompt treatment for substance use disorders (SUDs). These models differ from bridge clinics, which primarily address the barriers of transitioning between inpatient and outpatient SUD treatment settings. Previous RAAM models have been shown to be effective in urban areas. Through patient interviews, this qualitative study sought to describe the unique challenges and successes of a RAAM clinic that serves a primarily rural area.

Patients and methods: Adult patients with a SUD who utilized a medication for addiction treatment (MAT) walk-in clinic participated in semi-structured, recorded interviews. Participants were asked about facilitators and barriers to attaining treatment, as well as their perspectives/experiences and unmet wants/needs. Interviewee responses were transcribed, qualitatively coded, and analyzed for prominent trends.

Results: Twelve patients participated. Stigma, lack of rural treatment options, and accessibility concerns were identified as general barriers to receiving SUD care. MAT walk-in clinic specific barriers included distance to clinic, clinic hours, and transportation. Patients identified the clinic's walk-in structure as a primary facilitator of receiving quality SUD care and felt the clinic offered a non-judgmental and accessible environment, differing positively from past treatments. Unmet wants and needs that patients identified included more extensive social services and communication after leaving the clinic.

Conclusion: This MAT walk-in clinic is the only RAAM-style clinic offering same-day dual-diagnosis medication management in the state of Iowa. The walk-in structure was a key facilitator for patients accessing initial care. Expanding RAAM models in rural areas and incorporating telehealth may help address proximity barriers reported by patients.

Relapsing on opioids after residential treatment may involve fatal outcomes, considering the potential for reduced tolerance and the potency of fentanyl in the illicit opioid market. The present paper examines recent literature on the risk of relapse among adults with opioid use disorder after discharge from residential treatment. We searched for published studies from 2018 to 2022 through database searches, including CINAHL, PsychINFO, PubMed, and Scopus. Across the N=10 studies included in this review, returning to substance use after residential treatment was captured differently, including self-report, hair samples, and urine samples. Follow-up relapse data after discharging from treatment was also captured across different time periods of included studies ranging from one month to six months. Variability was also identified in the percentage of individuals who relapsed after treatment, ranging from 0% to 95%. Considering the potential for a fatal overdose in the current fentanyl era, it is imperative to provide resources during residential treatment that can reduce the risk of relapse after discharge.

Background: A war state followed the October 7th, 2003, Hamas vast attack on civilians and military in the southern part of Israel, requiring an immediate adaptation of the routine functioning of the methadone maintenance treatment (MMT) clinics - typically, through the expansion of the take-home dose (THD) policies.

Aim: To evaluate the level of anxiety and its relation to patients' satisfaction regarding THD expansion one month post-attack.

Methods: Of the 320 current patients in one MMT clinic, 297 (92.8%) were interviewed for anxiety (GAD-7) and rated whether the THD expansion benefited them (1 to 5). Substance in urine, sociodemographic, and addiction history details were taken.

Results: Of the participants, 35% were found to have no anxiety, 22.2% with mild, 21.9% with moderate, and 20.9% had severe anxiety. Logistic regression for anxiety found cocaine in urine and not opioids in urine (Odds Ratio (OR) = 3.6), history of having experienced physical violence (OR = 1.8), and not working (OR = 2.1) as risk factors. THD expansion benefited (scored ≥ 4) 82.2% of the responders, and in logistic regression for severe anxiety, not satisfied with THD expansion (OR = 2.9), being Israeli born (OR = 2.1), and not working (OR = 2.5) were included. Substance use did not change pre- and post-Hamas attack.

Conclusion: Most patients were satisfied with the THD expansion. However, severe anxiety levels characterized those who were not, emphasizing the need for anxiety monitoring to determine those patients. Additional intervention and augmenting these patients' frequency of visits to the clinic (instead of THD expansion) is recommended so they have further meetings with their therapist and reduce their anxiety.

Purpose: To examine patient satisfaction with long-acting injectable buprenorphine (LAIB) as opioid agonist therapy (OAT) during custody, the effect on prisoner behavior and illicit drug use in custody, and the impact on healthcare utilization within OAT programs in Scottish prisons.

Patients and methods: This observational, service evaluation included 134 adult patients (≥18 years) with opioid dependence. Clinically appropriate patients were stabilized on monthly LAIB. The following outcomes were evaluated at 12, 24, and 52 weeks: patient satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM), patient-reported craving using a 100 mm visual analog scale (VAS), and opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS). Patient-reported illicit drug use and disciplinary actions were recorded.

Results: Retention on LAIB for 12 months or until release/transfer was 93.8%. Patient satisfaction with LAIB was high, with median global TSQM scores >80 at all timepoints in the whole population and in those transferred after reduction from high-dose methadone (>30 mg/day). Compared with the first 4 weeks, craving significantly decreased at Weeks 12 and 24; the decrease at Week 52 was not statistically significant. COWS scores were also significantly lower at all timepoints. Levels of illicit drug use and disciplinary actions were low throughout. Healthcare worker contact time saved with LAIB versus methadone was estimated at ~100 minutes per patient monthly. As of June 30, 2024, ~228 hours in total are estimated to have been saved per month across the Forth Valley prison estate.

Conclusion: This service evaluation demonstrates high levels of patient satisfaction with LAIB in the prison setting, with minimal disruption to patient comfort or behavior even during treatment transition. Provision of LAIB has reduced healthcare hours required to deliver OAT medication in the Forth Valley prison estate, allowing the reprioritization of some healthcare resources toward other health-promoting goals.

Individuals with Opioid Use Disorder (OUD) who use fentanyl are at high risk of mortality due to opioid-related overdose. While buprenorphine extended-release (BUP-XR) may reduce this risk, there is a need to optimize clinical practice with BUP-XR to overcome barriers to treatment initiation and retention in patients who use fentanyl. Through a narrative review of evidence from peer-reviewed publications and conference abstracts, this article provides an overview of current novel initiation and dosing strategies for BUP-XR in patient populations with confirmed or presumed use of fentanyl. Evidence in this area is rapidly emerging with multiple studies describing BUP-XR initiation prior to 7-day stabilization on transmucosal buprenorphine (TM-BUP). Results from a randomized controlled study indicate that initiating BUP-XR following a single TM-BUP dose is noninferior to standard initiation in terms of treatment retention at injection 2, with similar rates of precipitated withdrawal and adverse events, and this protocol is now included in the approved prescribing information in the USA. While additional "macro/high-dose" or "micro/low-dose" and "direct dose" induction approaches have also been reported, evidence for these is limited to small uncontrolled studies or case reports. Consistent with evidence from studies of TM-BUP, which suggests individuals who use fentanyl may require higher maintenance doses in order to be retained in treatment, administrative and observational data suggests that use of the 300-mg maintenance dose, shortened intervals between doses, and supplemental TM-BUP may be feasible approaches to increase buprenorphine exposure in patients with ongoing symptoms and improve retention. Evidence in this area is rapidly evolving, and many of these strategies are increasingly being adopted clinically and incorporated into clinical guidelines. Further research should incorporate increased sample sizes, broader and more consistent outcome measurement, and increased duration of follow-up to facilitate more robust evaluation of efficacy and safety as well as increase comparability between studies.

This study aimed to evaluate the use of prehospital medication-assisted treatment (MAT) administration by Emergency Medical Services for opioid use disorder (OUD) through a review of literature published between 2014-2024. A search of the NCBI repository using selected keywords returned N=28 results; articles meeting the inclusion criteria (n=13) were reviewed and analyzed. Heterogeneity among studies was assessed using the Chi-squared test and I² statistic. Studies were categorized into two primary domains: implementation and protocols or patient outcomes. Findings suggest that while MAT administration extends on-scene time, it significantly improves patient retention in OUD treatment. However, operational challenges, including geographical disparities in access and racial inequities in retention, limit widespread implementation. This review underscores the consistent safety of prehospital MAT administration, specifically by EMS personnel outside of an emergency department, yet highlights the need for addressing these barriers to optimize its effectiveness as a critical intervention in managing OUD in the prehospital setting.