Pub Date : 2024-09-23DOI: 10.1177/29767342241271991
Francesca Melis, Thomas Clausen, Charlotte Castel, Omid Dadras, Silvana De Pirro, Lars Henrik Myklebust, Ann Oldervoll, Linda Elise Wüsthoff, Desiree Eide
Background: Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country's OUD treatment system. This study describes and compares patients' baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT.
Methods: This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (n = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using t-tests, Mann-Whitney U tests, Chi-square, and Fisher's exact test.
Results: The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, P < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment.
Conclusion: This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.
背景:海洛因辅助治疗(HAT)是治疗阿片类药物使用障碍(OUD)的一种循证治疗方案,仅在少数国家使用。挪威于2022年实施了一项为期5年的海洛因辅助治疗项目,旨在评估其有效性以及将其纳入该国阿片类药物使用障碍治疗系统的可能性。本研究描述并比较了奥斯陆和卑尔根 HAT 诊所的患者基线特征,全面介绍了 HAT 的独特人群和实际应用情况:这项横断面研究调查了开业两年内获得同意的 HAT 患者(n = 86)的基线特征。自我报告问卷收集了社会人口统计、以往的治疗经历、自我报告的犯罪情况和药物使用情况,以及治疗动机和期望。采用 t 检验、曼-惠特尼 U 检验、卡方检验和费雪精确检验对各诊所进行比较:大多数患者在奥斯陆诊所登记(76%),男性(80%)。入院时的平均年龄为 45.9 岁,卑尔根的患者明显更年轻(42.5 岁对 47.3 岁,P 结论:这项研究揭示了一个社会边缘群体:本研究揭示了这一群体的社会边缘化问题,包括住房不稳定、之前的 OUD 治疗效果不理想、高风险行为以及与犯罪活动的频繁互动(主要是作为受害者)。虽然奥斯陆和卑尔根诊所服务的患者情况相似,但在中断以往 OUD 治疗的原因和犯罪相关因素方面出现了显著差异。
{"title":"Patient Characteristics From Norway's First Heroin-Assisted Treatment Clinics.","authors":"Francesca Melis, Thomas Clausen, Charlotte Castel, Omid Dadras, Silvana De Pirro, Lars Henrik Myklebust, Ann Oldervoll, Linda Elise Wüsthoff, Desiree Eide","doi":"10.1177/29767342241271991","DOIUrl":"https://doi.org/10.1177/29767342241271991","url":null,"abstract":"<p><strong>Background: </strong>Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country's OUD treatment system. This study describes and compares patients' baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT.</p><p><strong>Methods: </strong>This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (<i>n</i> = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using <i>t</i>-tests, Mann-Whitney <i>U</i> tests, Chi-square, and Fisher's exact test.</p><p><strong>Results: </strong>The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, <i>P</i> < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment.</p><p><strong>Conclusion: </strong>This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1177/29767342241271404
Diane K King, Steven J Ondersma, Bonnie G McRee, Jacqueline S German, Amy M Loree, Amy Harlowe, Daniel P Alford, Robyn N M Sedotto, Mary Kate Weber
Background: The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies.
Methods: We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers.
Results: Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving.
Conclusions: Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.
{"title":"Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems.","authors":"Diane K King, Steven J Ondersma, Bonnie G McRee, Jacqueline S German, Amy M Loree, Amy Harlowe, Daniel P Alford, Robyn N M Sedotto, Mary Kate Weber","doi":"10.1177/29767342241271404","DOIUrl":"https://doi.org/10.1177/29767342241271404","url":null,"abstract":"<p><strong>Background: </strong>The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies.</p><p><strong>Methods: </strong>We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers.</p><p><strong>Results: </strong>Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving.</p><p><strong>Conclusions: </strong>Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1177/29767342241275738
Mishka Terplan, Kevin E O'Grady, Laura B Monico, Robert P Schwartz, Jan Gryczynski, Marc J Fishman, Shannon Gwin Mitchell
Background: We assess adverse events (AEs) following medication initiation for adolescents and young adults with opioid use disorder (OUD).
Methods: This is a secondary analysis of a clinical trial of long-acting injectable naltrexone (LAI-naltrexone) among youth with OUD aged 15 to 21 years. Participants were recruited from residential treatment and placed into 1 of 3 treatment groups based on medication receipt at time of discharge (no medication, sublingual buprenorphine-naloxone [buprenorphine], or LAI-naltrexone). Frequencies and percentages of AEs by body system were compared by medication group at the 1-month follow-up visit. Logistic regression was used to compare groups on their likelihood of reporting an AE, overall and excluding injection site reactions.
Results: Of 199 participants, 71 (36%) received no medication, 59 (30%) buprenorphine, and 69 (35%) LAI-naltrexone at discharge. Participants who received LAI-naltrexone experienced more AEs, primarily due to injection site reactions (62%, accounting for 43% of all AEs among participants who received LAI-naltrexone). There were 6 reports of nonlethal overdose, 5 in the no medication, 1 in the buprenorphine, and none in the LAI-naltrexone group. Participants receiving LAI-naltrexone were more likely to report an AE compared to the other groups (P = .04), but this difference was no longer significant when excluding injection site reactions (P = .82).
Conclusions: Excluding injection site reactions, there were no significant differences in the likelihood of reporting an AE 1 month after receiving LAI-NTX, buprenorphine, and no medications. LAI-naltrexone should be among the medications offered for the treatment of OUD in youth.
{"title":"Adverse Events at 1 Month Following Medication Initiation for Opioid Use Disorder Among Adolescents and Young Adults.","authors":"Mishka Terplan, Kevin E O'Grady, Laura B Monico, Robert P Schwartz, Jan Gryczynski, Marc J Fishman, Shannon Gwin Mitchell","doi":"10.1177/29767342241275738","DOIUrl":"https://doi.org/10.1177/29767342241275738","url":null,"abstract":"<p><strong>Background: </strong>We assess adverse events (AEs) following medication initiation for adolescents and young adults with opioid use disorder (OUD).</p><p><strong>Methods: </strong>This is a secondary analysis of a clinical trial of long-acting injectable naltrexone (LAI-naltrexone) among youth with OUD aged 15 to 21 years. Participants were recruited from residential treatment and placed into 1 of 3 treatment groups based on medication receipt at time of discharge (no medication, sublingual buprenorphine-naloxone [buprenorphine], or LAI-naltrexone). Frequencies and percentages of AEs by body system were compared by medication group at the 1-month follow-up visit. Logistic regression was used to compare groups on their likelihood of reporting an AE, overall and excluding injection site reactions.</p><p><strong>Results: </strong>Of 199 participants, 71 (36%) received no medication, 59 (30%) buprenorphine, and 69 (35%) LAI-naltrexone at discharge. Participants who received LAI-naltrexone experienced more AEs, primarily due to injection site reactions (62%, accounting for 43% of all AEs among participants who received LAI-naltrexone). There were 6 reports of nonlethal overdose, 5 in the no medication, 1 in the buprenorphine, and none in the LAI-naltrexone group. Participants receiving LAI-naltrexone were more likely to report an AE compared to the other groups (<i>P</i> = .04), but this difference was no longer significant when excluding injection site reactions (<i>P</i> = .82).</p><p><strong>Conclusions: </strong>Excluding injection site reactions, there were no significant differences in the likelihood of reporting an AE 1 month after receiving LAI-NTX, buprenorphine, and no medications. LAI-naltrexone should be among the medications offered for the treatment of OUD in youth.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1177/29767342241273423
Gabriela Garcia-Vassallo, Noel B Quinn, Brent A Moore, Sara Chaudhry, David T Moore, Sarah T Sorenson, Shawn Braddock, Ellen L Edens
Background: Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic.
Methods: A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings.
Results: Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination.
Conclusion: Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.
背景:需要为医护人员提供可获得的、手册化的、以技能为基础的培训,以便广泛传播:为使医护人员做好准备,以满足受阿片类药物流行病影响的人群的需求,需要提供可获得的、手册化的、以技能为基础的培训,以便广泛传播:方法:一个跨专业的药物使用障碍(SUD)专科护理团队设计了一个为期 2 天的研讨会和模拟培训,并将其改编成虚拟平台、手册,提供给一个大型医疗保健系统的医护人员和受训人员。在 10 个月的时间里,该研讨会共举办了 6 次,共有来自美国各地的 177 名学员参加了培训。培训采用互动体验式学习策略,包括测试知识的游戏、小组案例讨论、技能视频演示、患者小组讨论,以及 3 次模拟慢性疼痛患者在长期阿片类药物治疗过程中出现阿片类药物使用障碍的情景,以努力培养在初级保健和普通心理健康环境中管理 SUDs 的技能和信心:结果: 在完成研修班后调查的学员中,大多数人认为研修班的内容和培训结构都很有用,尤其是与药物管理、污名化和合作护理相关的内容。此外,在评估、诊断和治疗 SUD 方面的总体信心分数也有所提高。技能培养练习,如跨专业团队模拟,被认为是最有益的。该研讨会受到了全国的关注,因此与医疗系统的模拟中心建立了合作关系,以便进行更广泛的推广:结论:要扩大 SUD 治疗的覆盖面,就必须对医护人员进行培训,以有效改变态度、增加知识并提高关键技能。为期两天的跨专业研讨会受到了参与者的欢迎,他们对研讨会的接受度和满意度都很高,并表现出对治疗药物依赖性失调症的信心有所增强。这种手册化、协作式、以技能为基础的学习体验可以促进医务人员做好准备,并愿意在不同的医疗环境中将药物依赖性精神障碍视为一种可接受治疗的慢性疾病。
{"title":"National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management.","authors":"Gabriela Garcia-Vassallo, Noel B Quinn, Brent A Moore, Sara Chaudhry, David T Moore, Sarah T Sorenson, Shawn Braddock, Ellen L Edens","doi":"10.1177/29767342241273423","DOIUrl":"https://doi.org/10.1177/29767342241273423","url":null,"abstract":"<p><strong>Background: </strong>Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic.</p><p><strong>Methods: </strong>A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings.</p><p><strong>Results: </strong>Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination.</p><p><strong>Conclusion: </strong>Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1177/29767342241273397
Faith Ozer Green, Amy K Harlowe, Alexandra Edwards, Daniel P Alford, Hetal Choxi, Jacqueline S German, Diana Ling, Iwona Pawlukiewicz, Reshana Peterson, Kirk von Sternberg, Mary M Velasquez
Background: Alcohol-exposed pregnancies, which can lead to fetal alcohol spectrum disorders (FASDs), is one of the most common preventable causes of lifelong intellectual and developmental disabilities in the U.S. Healthcare teams can play a critical role in preventing FASDs; however, they are currently unprepared to do so. Training can remediate this problem. This article explores the different approaches to the education and training of healthcare providers around FASD prevention used by six Centers for Disease Control (CDC)-funded programs, and how they have been adapted to (1) the specific needs of the healthcare professionals and/or the clinical setting and (2) the challenges posed by the COVID-19 pandemic.
Methods: This article offers an in-depth description and comparison of the models utilized by the programs described, detailing the challenges of each model as well as the adaptations made. Interdisciplinary collaboration and review highlights these models and offers a variety of solutions and lessons learned that can be implemented in similar practice settings and/or educational initiatives.
Results: Based on organizational structure (i.e., national organization, educational institution, and clinical settings) and program purpose, different methods were employed for FASD education. Some programs were focused on FASD prevention through staff training and alcohol screening and brief intervention/clinical intervention and others were focused on broadscale professional education and awareness. Improvements were made on an ongoing basis as challenges related to COVID-19, staff shortages, and patient and clinician discomfort were identified, resulting in modifications to content and delivery modality (e.g., online forums and use of social media).
Conclusion: FASD prevention education is wrought with a variety of challenges related to stigma, discomfort, and misinformation, which these programs encountered in a variety of ways.
{"title":"Multi-Level Approaches to Fetal Alcohol Spectrum Disorders Prevention Education and Training for Health Professionals.","authors":"Faith Ozer Green, Amy K Harlowe, Alexandra Edwards, Daniel P Alford, Hetal Choxi, Jacqueline S German, Diana Ling, Iwona Pawlukiewicz, Reshana Peterson, Kirk von Sternberg, Mary M Velasquez","doi":"10.1177/29767342241273397","DOIUrl":"https://doi.org/10.1177/29767342241273397","url":null,"abstract":"<p><strong>Background: </strong>Alcohol-exposed pregnancies, which can lead to fetal alcohol spectrum disorders (FASDs), is one of the most common preventable causes of lifelong intellectual and developmental disabilities in the U.S. Healthcare teams can play a critical role in preventing FASDs; however, they are currently unprepared to do so. Training can remediate this problem. This article explores the different approaches to the education and training of healthcare providers around FASD prevention used by six Centers for Disease Control (CDC)-funded programs, and how they have been adapted to (1) the specific needs of the healthcare professionals and/or the clinical setting and (2) the challenges posed by the COVID-19 pandemic.</p><p><strong>Methods: </strong>This article offers an in-depth description and comparison of the models utilized by the programs described, detailing the challenges of each model as well as the adaptations made. Interdisciplinary collaboration and review highlights these models and offers a variety of solutions and lessons learned that can be implemented in similar practice settings and/or educational initiatives.</p><p><strong>Results: </strong>Based on organizational structure (i.e., national organization, educational institution, and clinical settings) and program purpose, different methods were employed for FASD education. Some programs were focused on FASD prevention through staff training and alcohol screening and brief intervention/clinical intervention and others were focused on broadscale professional education and awareness. Improvements were made on an ongoing basis as challenges related to COVID-19, staff shortages, and patient and clinician discomfort were identified, resulting in modifications to content and delivery modality (e.g., online forums and use of social media).</p><p><strong>Conclusion: </strong>FASD prevention education is wrought with a variety of challenges related to stigma, discomfort, and misinformation, which these programs encountered in a variety of ways.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1177/29767342241273419
Raymond L Moody, Sarah Gutkind, Priscila D Gonçalves, Morgan Philbin, Dustin T Duncan, Silvia S Martins
Background: Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents.
Methods: Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender.
Results: With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men.
Conclusions: Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.
{"title":"Driving Under the Influence of Alcohol and Cannabis by Sexual Identity, Race, Ethnicity, and Gender: A Nationwide Analysis Using the 2016 to 2019 National Survey on Drug Use and Health.","authors":"Raymond L Moody, Sarah Gutkind, Priscila D Gonçalves, Morgan Philbin, Dustin T Duncan, Silvia S Martins","doi":"10.1177/29767342241273419","DOIUrl":"https://doi.org/10.1177/29767342241273419","url":null,"abstract":"<p><strong>Background: </strong>Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents.</p><p><strong>Methods: </strong>Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender.</p><p><strong>Results: </strong>With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men.</p><p><strong>Conclusions: </strong>Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1177/29767342241274077
Maria Christina Herrera, Anjali Mahajan, Stephen Bonett, Shoshana Aronowitz, Jose Bauermeister, Daniel Teixeira da Silva
Background: People with substance use disorder (SUD) are at increased risk of HIV infection. HIV testing and pre-exposure prophylaxis (PrEP) are evidence-based practices to prevent HIV infection, yet these approaches are not regularly provided in SUD treatment programs. To address this evidence-to-practice gap, this study aimed to identify facilitators and barriers to implementing PrEP services in SUD treatment programs from the perspective of non-medical staff and administrators.
Methods: Semi-structured interviews were conducted from February to June 2022 with non-medical staff (N = 10) and administrators (N = 11) from 3 academic and 8 community-based SUD treatment programs in Philadelphia. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Qualitative descriptive techniques were used to examine interview data and identify key facilitators and barriers, which were grouped within CFIR domains and constructs.
Results: Of the 11 SUD treatment programs, 5 provided PrEP services. Most interviewees at programs without PrEP services reported high levels of receptivity to implementing PrEP and identified leadership engagement as a key determinant, but several lacked comfort with PrEP counseling. Inner setting facilitators included compatibility with workflows (eg, intake assessments), alignment with cultures of holistic care, and programs' longstanding community trust. Inner setting barriers included limited time to discuss PrEP, insufficient resources and staff (eg, phlebotomy), perception of clients' HIV risk, and lower prioritization of HIV prevention versus other services. Intervention facilitators included robust evidence and addressing costs through grants and drug pricing programs, and barriers included the time needed to initiate PrEP, loss to follow-up, and HIV stigma.
Conclusions: Successful implementation of HIV testing and PrEP in SUD treatment programs requires addressing multi-level barriers. Including perspectives of non-medical staff and administrators is important for implementation. Potential strategies include supporting organizational networks, leveraging peer specialists' expertise, and packaging PrEP to better meet client priorities and needs.
背景:药物使用障碍(SUD)患者感染 HIV 的风险增加。艾滋病毒检测和接触前预防(PrEP)是预防艾滋病毒感染的循证实践,但这些方法并未在药物滥用障碍治疗项目中定期提供。为了弥补这一从证据到实践的差距,本研究旨在从非医务人员和管理人员的角度出发,确定在药物滥用治疗项目中实施 PrEP 服务的促进因素和障碍:2022 年 2 月至 6 月,我们对费城 3 个学术性 SUD 治疗项目和 8 个社区性 SUD 治疗项目的非医务人员(10 人)和管理人员(11 人)进行了半结构化访谈。访谈指南采用实施研究综合框架(CFIR)制定。采用定性描述技术检查访谈数据,确定关键的促进因素和障碍,并将其归入 CFIR 领域和结构:结果:在 11 个 SUD 治疗项目中,有 5 个提供 PrEP 服务。在没有提供 PrEP 服务的项目中,大多数受访者表示对实施 PrEP 的接受程度很高,并认为领导层的参与是一个关键的决定因素,但也有几位受访者对 PrEP 咨询不甚满意。内部环境的促进因素包括与工作流程(如入院评估)的兼容性、与整体护理文化的一致性以及项目长期以来获得的社区信任。内部环境的障碍包括讨论 PrEP 的时间有限、资源和人员不足(如抽血)、对客户艾滋病风险的看法,以及艾滋病预防相对于其他服务的优先级较低。干预的促进因素包括有力的证据以及通过拨款和药品定价计划解决成本问题,而障碍则包括启动 PrEP 所需的时间、随访损失以及对 HIV 的污名化:在吸毒成瘾治疗项目中成功实施 HIV 检测和 PrEP 需要解决多层次的障碍。纳入非医务人员和管理人员的观点对于实施工作非常重要。潜在的策略包括支持组织网络、利用同伴专家的专业知识以及包装 PrEP 以更好地满足客户的优先事项和需求。
{"title":"Facilitators and Barriers to Implementing HIV Testing and Pre-Exposure Prophylaxis in Substance Use Treatment Programs: Perspectives of Non-medical Staff.","authors":"Maria Christina Herrera, Anjali Mahajan, Stephen Bonett, Shoshana Aronowitz, Jose Bauermeister, Daniel Teixeira da Silva","doi":"10.1177/29767342241274077","DOIUrl":"https://doi.org/10.1177/29767342241274077","url":null,"abstract":"<p><strong>Background: </strong>People with substance use disorder (SUD) are at increased risk of HIV infection. HIV testing and pre-exposure prophylaxis (PrEP) are evidence-based practices to prevent HIV infection, yet these approaches are not regularly provided in SUD treatment programs. To address this evidence-to-practice gap, this study aimed to identify facilitators and barriers to implementing PrEP services in SUD treatment programs from the perspective of non-medical staff and administrators.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted from February to June 2022 with non-medical staff (N = 10) and administrators (N = 11) from 3 academic and 8 community-based SUD treatment programs in Philadelphia. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Qualitative descriptive techniques were used to examine interview data and identify key facilitators and barriers, which were grouped within CFIR domains and constructs.</p><p><strong>Results: </strong>Of the 11 SUD treatment programs, 5 provided PrEP services. Most interviewees at programs without PrEP services reported high levels of receptivity to implementing PrEP and identified leadership engagement as a key determinant, but several lacked comfort with PrEP counseling. Inner setting facilitators included compatibility with workflows (eg, intake assessments), alignment with cultures of holistic care, and programs' longstanding community trust. Inner setting barriers included limited time to discuss PrEP, insufficient resources and staff (eg, phlebotomy), perception of clients' HIV risk, and lower prioritization of HIV prevention versus other services. Intervention facilitators included robust evidence and addressing costs through grants and drug pricing programs, and barriers included the time needed to initiate PrEP, loss to follow-up, and HIV stigma.</p><p><strong>Conclusions: </strong>Successful implementation of HIV testing and PrEP in SUD treatment programs requires addressing multi-level barriers. Including perspectives of non-medical staff and administrators is important for implementation. Potential strategies include supporting organizational networks, leveraging peer specialists' expertise, and packaging PrEP to better meet client priorities and needs.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1177/29767342241273417
Justin Berk, Jessica Brar, Ariel Hoadley, Rosemarie Martin
Background: The opioid overdose crisis significantly affects marginalized communities, with people of color experiencing higher rates of overdose and barriers to treatment. The syndemic of opioid use disorder and mass incarceration exacerbates racial health disparities. Some carceral facilities offer medication for addiction treatment, though no significant research explores differences in type of treatment uptake by race in these settings. This study focuses on the racial differences in medications for opioid use disorder (MOUD) preferences among incarcerated individuals.
Methods: A retrospective cohort study was conducted at the Rhode Island Department of Corrections (RIDOC), examining MOUD-type preferences (buprenorphine or methadone) among incarcerated individuals. The study utilized RIDOC electronic medical records from January 1, 2017 to December 31, 2022, involving 3533 unique incarceration events. Participants were categorized by race (White vs non-White) and MOUD status (new initiation vs community continuation), with logistic regression models.
Results: The study found no direct racial disparity in preferences for MOUD type. However, an interaction between race and MOUD initiation status significantly influenced MOUD-type preference. Among those initiating MOUD during incarceration, non-White individuals were more likely to choose buprenorphine compared to their White counterparts.
Conclusions: This research provides new insights into the intersection of race, incarceration, and MOUD preferences. While direct racial disparities in MOUD type were not observed, the analysis uncovered a notable interaction effect: race influences the relationship between MOUD initiation status and the selected MOUD treatment during incarceration. Specifically, data demonstrate that the likelihood of choosing buprenorphine varies significantly based on both racial background and whether the treatment was initiated during incarceration or in the community. Further research is needed in different geographic settings to understand the broader implications to help guide equitable healthcare delivery in jails and prisons.
{"title":"Racial Differences in Medications for Opioid Use Disorder Initiation in a Carceral Setting.","authors":"Justin Berk, Jessica Brar, Ariel Hoadley, Rosemarie Martin","doi":"10.1177/29767342241273417","DOIUrl":"https://doi.org/10.1177/29767342241273417","url":null,"abstract":"<p><strong>Background: </strong>The opioid overdose crisis significantly affects marginalized communities, with people of color experiencing higher rates of overdose and barriers to treatment. The syndemic of opioid use disorder and mass incarceration exacerbates racial health disparities. Some carceral facilities offer medication for addiction treatment, though no significant research explores differences in type of treatment uptake by race in these settings. This study focuses on the racial differences in medications for opioid use disorder (MOUD) preferences among incarcerated individuals.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at the Rhode Island Department of Corrections (RIDOC), examining MOUD-type preferences (buprenorphine or methadone) among incarcerated individuals. The study utilized RIDOC electronic medical records from January 1, 2017 to December 31, 2022, involving 3533 unique incarceration events. Participants were categorized by race (White vs non-White) and MOUD status (new initiation vs community continuation), with logistic regression models.</p><p><strong>Results: </strong>The study found no direct racial disparity in preferences for MOUD type. However, an interaction between race and MOUD initiation status significantly influenced MOUD-type preference. Among those initiating MOUD during incarceration, non-White individuals were more likely to choose buprenorphine compared to their White counterparts.</p><p><strong>Conclusions: </strong>This research provides new insights into the intersection of race, incarceration, and MOUD preferences. While direct racial disparities in MOUD type were not observed, the analysis uncovered a notable interaction effect: race influences the relationship between MOUD initiation status and the selected MOUD treatment during incarceration. Specifically, data demonstrate that the likelihood of choosing buprenorphine varies significantly based on both racial background and whether the treatment was initiated during incarceration or in the community. Further research is needed in different geographic settings to understand the broader implications to help guide equitable healthcare delivery in jails and prisons.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31DOI: 10.1177/29767342241277619
Katherine Hill, Katherine Dunham, Kristin Doneski, Kimberly L Sue, Kinna Thakarar, Jenna Butner
More than 25% of all arrests made nationwide are related to drug offenses, affecting almost 1.2 million people and their social networks. Furthermore, roughly 20% of people in jails and prisons across the United States are incarcerated for a drug offense and millions more are under community supervision for these charges. This criminalization of drug use has negatively affected the health and well-being of people who use drugs (PWUD) and their communities. Decriminalization-a process of removing criminal sanctions for a previously criminalized behavior-of drug use is central to harm reduction as it mitigates these negative consequences of drug use and supports the health of PWUD. As such, AMERSA supports the decriminalization of drug and paraphernalia possession for personal use for all currently illicit drugs and all associated equipment. AMERSA continues to strongly advocate for the funding of harm reduction strategies and addiction services to improve the health and well-being of PWUD since decriminalization without complementary funding for harm reduction services, addiction treatment services, and social safety nets will be incomplete.
{"title":"In Support of the Decriminalization of Personal Drug and Paraphernalia Use and Possession: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use and Addiction).","authors":"Katherine Hill, Katherine Dunham, Kristin Doneski, Kimberly L Sue, Kinna Thakarar, Jenna Butner","doi":"10.1177/29767342241277619","DOIUrl":"https://doi.org/10.1177/29767342241277619","url":null,"abstract":"<p><p>More than 25% of all arrests made nationwide are related to drug offenses, affecting almost 1.2 million people and their social networks. Furthermore, roughly 20% of people in jails and prisons across the United States are incarcerated for a drug offense and millions more are under community supervision for these charges. This criminalization of drug use has negatively affected the health and well-being of people who use drugs (PWUD) and their communities. Decriminalization-a process of removing criminal sanctions for a previously criminalized behavior-of drug use is central to harm reduction as it mitigates these negative consequences of drug use and supports the health of PWUD. As such, AMERSA supports the decriminalization of drug and paraphernalia possession for personal use for all currently illicit drugs and all associated equipment. AMERSA continues to strongly advocate for the funding of harm reduction strategies and addiction services to improve the health and well-being of PWUD since decriminalization without complementary funding for harm reduction services, addiction treatment services, and social safety nets will be incomplete.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1177/29767342241271361
Courtney Townsel, Vincent C Smith, Hemalatha Senthilkumar, Lily R Bastian, Miranks Sanks, Diana Ling, Joshua Benke, Alexandra Edwards, Nancy Roget, Kimberly Prokosch, Mary M Velasquez, Kimi Yonamine, Kirk von Sternberg, Tonya McFadden, Antoinette Abou Haidar, Karen E Harris
Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use. However, this clinical preventive service remains critically underutilized in primary care. In 2014, the Centers for Disease Control and Prevention called for the creation of FASD Champion programs to promote clinician education about FASDs. Six professional health organizations and groups providing reproductive and child health services set out to create FASD Champion programs. The American College of Obstetricians and Gynecologists FASDs Prevention Program was created to focus on reducing alcohol-exposed pregnancies. The American Academy of Pediatrics' Champion program maintains the goal of improving health outcomes for children with FASDs by improving pediatricians' diagnostic capacity. The American Academy of Family Physicians has prioritized training family physician champions to improve the delivery of alcohol SBI among adult patients. The University of Alaska Anchorage has partnered with the National Association of Nurse Practitioners in Women's Health, the American College of Nurse-Midwives, and the Association of Women's Health, Obstetric, and Neonatal Nurses to assure advanced practice registered nurses and midwives have the knowledge and skills to prevent alcohol-exposed pregnancies and FASDs. The American Association of Medical Assistants has prioritized expanding the knowledge and skills of medical assistants related to promoting alcohol-free pregnancies. Finally, the Champions program at the University of Texas at Austin was established to train health social workers in alcohol SBI. Through the advocacy, education, and mission of these 6 health sectors in collaboration with national organizations and educational institutions, the evidence-based approach of alcohol SBI is being disseminated throughout the United States to reduce the harmful effects of prenatal alcohol exposure.
产前酒精暴露和胎儿酒精谱系障碍(FASD)仍然是严重的公共卫生问题。孕期饮酒是导致出生缺陷、发育障碍和学习障碍的主要可预防原因。酒精筛查和简单干预(SBI)可有效减少过度饮酒。然而,这项临床预防服务在初级保健中的利用率仍然严重不足。2014 年,美国疾病控制与预防中心呼吁设立 FASD 冠军计划,以促进临床医生对 FASD 的教育。六家提供生殖和儿童健康服务的专业健康组织和团体着手创建 FASD 冠军计划。美国妇产科医师学会 FASD 预防计划旨在减少酒精暴露怀孕。美国儿科学会的冠军计划坚持通过提高儿科医生的诊断能力来改善 FASD 儿童的健康状况。美国家庭医生学会已将培训家庭医生冠军作为优先事项,以改善成人患者的酒精 SBI 治疗。阿拉斯加大学安克雷奇分校与全国妇女健康执业护士协会、美国助产士学院以及妇女健康、产科和新生儿护士协会合作,确保高级执业注册护士和助产士掌握预防酒精暴露怀孕和 FASD 的知识和技能。美国医疗助理协会(American Association of Medical Assistants)已将扩展医疗助理与促进无酒精妊娠相关的知识和技能列为优先事项。最后,德克萨斯大学奥斯汀分校设立了 "冠军"(Champions)计划,对卫生社会工作者进行酒精SBI方面的培训。通过这 6 个卫生部门与全国性组织和教育机构合作开展的宣传、教育和任务,酒精 SBI 循证方法正在全美推广,以减少产前酒精暴露的有害影响。
{"title":"Answering a Call to Action: Reducing Fetal Alcohol Spectrum Disorders Using a Healthcare Champion Model.","authors":"Courtney Townsel, Vincent C Smith, Hemalatha Senthilkumar, Lily R Bastian, Miranks Sanks, Diana Ling, Joshua Benke, Alexandra Edwards, Nancy Roget, Kimberly Prokosch, Mary M Velasquez, Kimi Yonamine, Kirk von Sternberg, Tonya McFadden, Antoinette Abou Haidar, Karen E Harris","doi":"10.1177/29767342241271361","DOIUrl":"https://doi.org/10.1177/29767342241271361","url":null,"abstract":"<p><p>Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use. However, this clinical preventive service remains critically underutilized in primary care. In 2014, the Centers for Disease Control and Prevention called for the creation of FASD Champion programs to promote clinician education about FASDs. Six professional health organizations and groups providing reproductive and child health services set out to create FASD Champion programs. The American College of Obstetricians and Gynecologists FASDs Prevention Program was created to focus on reducing alcohol-exposed pregnancies. The American Academy of Pediatrics' Champion program maintains the goal of improving health outcomes for children with FASDs by improving pediatricians' diagnostic capacity. The American Academy of Family Physicians has prioritized training family physician champions to improve the delivery of alcohol SBI among adult patients. The University of Alaska Anchorage has partnered with the National Association of Nurse Practitioners in Women's Health, the American College of Nurse-Midwives, and the Association of Women's Health, Obstetric, and Neonatal Nurses to assure advanced practice registered nurses and midwives have the knowledge and skills to prevent alcohol-exposed pregnancies and FASDs. The American Association of Medical Assistants has prioritized expanding the knowledge and skills of medical assistants related to promoting alcohol-free pregnancies. Finally, the Champions program at the University of Texas at Austin was established to train health social workers in alcohol SBI. Through the advocacy, education, and mission of these 6 health sectors in collaboration with national organizations and educational institutions, the evidence-based approach of alcohol SBI is being disseminated throughout the United States to reduce the harmful effects of prenatal alcohol exposure.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}