Substance use : research and treatment最新文献

Background: Implementing buprenorphine medication treatment for opioid use disorder (B-MOUD) in office-based, non-addiction specialty care settings is challenging. Clinical pharmacist practitioners (CPPs) can facilitate this care. The Veterans Health Administration's (VHA) Stepped Care for Opioid Use Disorder Train the Trainer Initiative (SCOUTT) implemented B-MOUD in primary care, mental health, and pain clinics across 37 VHA facilities. B-MOUD activities provided by CPPs within SCOUTT are not well known.

Objectives: We sought to examine CPPs' roles, typical activities, and opportunities to provide B-MOUD.

Design: We performed a cross-sectional survey of CPPs within SCOUTT facilities.

Methods: In March 2023, known CPPs in SCOUTT clinics were invited via email to participate in an online survey. We also emailed local SCOUTT leaders to forward the invitation to CPPs not initially invited. The anonymous survey gathered information on clinic settings, CPP roles in 25 B-MOUD related tasks (eg, patient intake, risk assessment, initiation), state licensure, and whether they had or desired controlled substance prescriptive authority for B-MOUD.

Results: Twenty-two CPPs responded to the survey working in pain (40.9%), primary care (27.3%), mental health (22.7%), and primary care mental health integrated (22.7%) settings. Nearly all (95.5%) reported involvement in naloxone education and distribution and patient management after B-MOUD initiation. Additionally, 90.9% reviewed and interpreted urine drug test results, 90.9% conducted B-MOUD follow-up (assessing side effects or treatment outcomes) and 72.7% assisted in B-MOUD initiation. Most CPPs (95.5%) indicated they work in a team-based environment often acting as a medication expert, were prescribing B-MOUD (27.3%), or desired to do so (86.4%).

Conclusion: In the VHA's SCOUTT Initiative, CPPs play a significant role in leading and collaboratively facilitating B-MOUD. The VHA's SCOUTT approach to CPP management and B-MOUD prescribing efforts may be a model to emulate in other health systems to improve access to and management of B-MOUD care.

Background: Graduate-level licensed addiction counselors are a critical component of the substance use disorder workforce, yet their scope of practice, education and training requirements, and credentialing varies in the U.S.

Objectives: To better understand the roles and functions of the graduate-level addiction counselor workforce across the U.S., this state-by state analysis sought to identify the titles, minimum education and training requirements, scope of practice, and supervisory opportunities for graduate-level addiction counselors.

Design: This project conducted systematic abstraction and descriptive analysis of U.S. state Practice Acts, certification board rules, materials from behavioral health professional organizations, and state Medicaid plans, fee schedules, and provider manuals.

Methods: Descriptive summaries were produced to describe trends across states. Tables synthesized aggregated data across the workforce domains of education and training, regulation and credentialing, supervision, and payment for graduate-level addiction counselors only.

Results: Forty-one states offer a graduate-level addiction counselor credential, 18 of which offer multiple credentials for a total of 69 credentials. States varied in services permissible by scope of practice definition, including assessments (41 states), psychotherapy (28 states), telehealth (28 states), and diagnosis (16 states). Only 26 states allow for independent practice. States required an average of 2,887 practice hours and 143 post-graduate supervision hours. Sixteen states permitted all tiers of graduate-level addiction counselors to supervise others, and 10 states specifically offer a graduate-level supervisory credential.

Conclusion: State graduate-level addiction counselor credentials widely vary, suggesting that states utilize this workforce differently based on differing training criteria, required competencies, scope of practice, and supervision. Strategies to support growth of this workforce include alignment of training competencies, additional substance use disorder training in behavioral health graduate programs, and expansion of supervisory pathways and credentials.

Background and objectives: Early traumatic exposure to factors such as household substance use, violence, and familial death increase the likelihood of substance use across a person's lifespan. Our qualitative analysis sought to explore the social and relational drivers of substance use among people who inject drugs (PWID).

Design and methods: We conducted qualitative interviews with 30 PWID (n = 30) in Los Angeles, CA from July 2021 to April 2022. To be eligible for this study, participants had to report being 18 years of age or older and self-report any opioid and injection drug use within the past 30 days. We used constructivist grounded theory to analyze the contexts that contribute to lived experiences surrounding familial trauma, resource scarcity, and substance use as a coping mechanism.

Results: Participants in this study described drivers of current substance use patterns as related to childhood and familial trauma. These included: (1) early exposure to chaotic and/or disordered substance use by household members, (2) traumatic experiences, such as death of a family member, which they linked to substance use initiation, and (3) relying on substance use as a coping strategy which was modeled by family members.

Conclusions: Early traumatic experiences and exposure to disordered substance use (ie, household family members using substances to emotionally regulate) combined with experiencing resource deprivation (ie, lacking trauma-informed mental health support and financial and wraparound care) contributed to participants' experiences of substance use as a learned coping mechanism. Integrating social and structural support interventions, such as mental health service provision and financial stabilization services, into policy-making decisions may help to address the cyclical relationship between childhood exposure to trauma and adult substance use initiation.

Background: Problematic alcohol use is often driven by powerful cravings elicited when individuals encounter alcohol-related cues. This cue-reactivity is a major factor in relapse and in difficulty maintaining reduced drinking.

Aims: This study replicates and extends previous cue-reactivity research using a milk-based distraction task, by evaluating whether trait absorption can moderate the effect of distraction on alcohol craving. The paradigm involved exposing regular social drinkers to an alcohol-related stimulus and recording craving responses, while also assessing the influence of personality traits including absorption and mindfulness. Trait absorption and mindfulness were selected as absorption may amplify attentional focus on cues, and mindfulness supports non-reactive awareness-both factors that could moderate craving intensity and the effectiveness of distraction techniques.

Methods: Seventy-nine social drinkers were recruited through convenience sampling and randomly assigned to either a control group (standard cue-reactivity paradigm) or an experimental group (cue-reactivity with a milk-based distraction task). Participants self-reported their alcohol cravings using the Visual Analogue Scale. Additionally, personality traits including trait absorption and trait mindfulness were measured to determine their predictive power on craving levels. A 3 × 2 mixed design ANOVA was used to analyse differences between groups, while hierarchical regressions assessed the role of personality traits.

Results: A significant interaction between time and condition was found, indicating that participants in the distraction (experimental) group reported significantly lower alcohol cravings compared to the control group. However, the hierarchical regression analyses showed no significant effect of trait absorption or trait mindfulness in predicting changes in alcohol craving.

Conclusion: Cognitive distraction (milk) significantly reduced alcohol cravings in the experimental group compared to the control group, suggesting that distractions such as those involving milk might effectively manage alcohol cravings. While personality traits including absorption and mindfulness might be less impactful in alcohol craving responses.

In today's rapidly evolving substance use landscape, the traditional image of drug consumption is being replaced by a subtler, more socially accepted aesthetic. High Risk, Low Key: The New Face of Drug Use explores how modern intoxicants, from THC-infused beverages to microdosed psilocybin and nitrous oxide canisters, are increasingly marketed as wellness products rather than recreational drugs. This shift, driven by cultural, technological, and mental health trends, has led to the normalization and concealment of daily drug use, especially among youth. Cannabis, once emblematic of rebellion, is now branded as organic and therapeutic, despite rising potency and associated risks. Meanwhile, legal gray-area substances like kratom and nitrous oxide offer easily accessible highs with potentially serious health consequences. The rise of self-medication, fueled by online platforms and a mental health crisis, further blurs the line between therapy and abuse. Digital platforms now serve as decentralized drug markets, contributing to the fentanyl crisis through counterfeit pills. This article calls for a new framework to address these trends, one that includes updated education, regulation, and clinical tools responsive to a generation navigating a silent, rebranded drug crisis.

Background: Alcohol and cannabis use disorders are among the most prevalent substance use disorders in the United States. Both conditions are associated with mental health disorders. Most individuals with co-occurring mental health and substance use disorders who receive treatment encounter mental health treatment services.

Objectives: This study examined national mental health treatment facility data over 10 years to describe persons with an alcohol or cannabis use disorder.

Design: Annual cross-sectional data were used. Using a descriptive epidemiological approach, this study captured the "who," "when," and "where" regarding individuals with alcohol or cannabis use disorders receiving mental health treatment.

Methods: Ten years of annual de-identified publicly available administrative data from the Mental Health Client-Level Data, a nationwide dataset based in the United States, were merged from 2013 to 2022. Sample selection criteria included having either an alcohol or cannabis use disorder diagnosis. These 2 samples were examined separately. Examined variables include year, region, treatment setting, age, sex, race and ethnicity, and co-occurring mental health disorder diagnoses.

Results: The analytic sample was N = 3 947 802 cases, approximately 6.4% of the merged dataset before sample selection. This includes n = 2 315 686 cases with an alcohol use disorder and n = 1 632 116 cases with a cannabis use disorder. Both samples were majority male at 60%. Numerically, the year with the most alcohol use disorder cases in the dataset was 2020 (n = 278 550), and the year 2018 had the most cannabis use disorder cases in the dataset (n = 199 744). Depressive disorders were the most common co-occurring mental health disorder among the alcohol use disorder sample (n = 821 659; 35.5%) and the cannabis use disorder sample (n = 494 113; 30.3%).

Conclusion: This descriptive study highlights the characteristics of individuals with alcohol and cannabis use disorders who received services from mental health treatment facilities during a 10-year period. Findings from this study provide a greater understanding of this population.

Background: The quality of methadone treatment for opioid use disorder varies across the U.S., affecting patient retention and overdose. Staff stress, trauma exposure, vicarious trauma (VT), burnout, and empowerment are important yet understudied factors that influence workforce well-being and performance.

Objectives: This study aimed to characterize trauma-related well-being among staff in a national sample of opioid treatment programs (OTPs) and to explore potential correlates of resilience.

Design: A cross-sectional survey was conducted from June to August 2024 with OTP staff from clinics participating in a parent national study.

Methods: The survey combined validated instruments and tailored questions to assess work experience, lifetime trauma exposure, trauma and stress-related symptoms, VT, burnout, and multiple dimensions of empowerment. Exploratory factor analysis was used to identify domains of staff well-being.

Results: The sample (N = 86) included medical staff, counselors, and non-medical/counseling staff from OTPs across 16 states. Thirteen percent of staff met preliminary criteria for posttraumatic stress disorder, 89.2% reported VT exposure at work, and 63.8% reported moderate to severe VT symptoms. Medical staff reported the highest VT and stress scores. Overall, 19.8% of staff met criteria for burnout, with counselors reporting the highest rates (30%). VT symptoms were positively correlated with burnout among counselors, medical, and other staff (r = 0.413-0.650, P < .05). Empowerment subscales were strongly correlated. Two distinct, uncorrelated domains of staff well-being emerged: VT resilience (low VT symptoms and burnout) and empowerment (high perceived control and influence), reflecting distinct aspects of trauma-related functioning. Despite high exposure to lifetime trauma and VT, staff demonstrated moderate resilience and moderate-to-high levels of empowerment.

Conclusion: Staff of OTPs experience high levels of trauma exposure and symptomatology, VT, and burnout, with notable differences by clinic role. Resilience and empowerment domains suggest opportunities to improve staff wellness.

Background: Despite the continuing opioid overdose crisis, the majority of those diagnosed with opioid use disorder (OUD) are not engaged in treatment due to various barriers. Low-threshold buprenorphine programs are designed to reduce treatment barriers. Key tenets of these programs are a harm reduction approach, same-day entry, flexibility, and accessibility. The development of novel programs has expanded low-threshold treatment into mobile units, syringe service programs, and community centers.

Objective: This scoping review aims to describe approaches taken by programs in non-clinical settings by identifying key components of delivery models, implementation barriers and facilitators, and outcomes. Given the diverse nature of the literature on these programs, a scoping review was selected to review outcomes and to identify gaps.

Methods: A protocol following the PRISMA-ScR guidelines was developed to systematically search 5 databases: Medline, Embase, CINAHL, PsycInfo, and Web of Science. Articles published prior to January 31, 2024 that described buprenorphine programs operating outside traditional healthcare settings were included.

Results: The search identified 18 784 articles, including 147 in full-text review, with 41 meeting eligibility criteria. Common program types encompassed syringe service, mobile, community center, and street medicine. All programs emphasized community partnerships as key implementation facilitators and noted funding is urgently needed.

Conclusion: Low-threshold buprenorphine programs are an innovative way to deliver OUD treatment to people who otherwise may not have access to and/or engage in treatment. Future efforts should determine which outcomes are most important to people who use drugs, standardize outcome measurements, and implement programs tailored to help communities meet those outcomes.

Background: The prevalence of substance use disorders (SUDs) is rising globally, significantly affecting public health. These disorders are associated with reduced quality of life, comorbid mental health conditions, and increased risk of infectious diseases such as HIV. This paper describes the development and implementation of group therapy as an intervention for SUDs in a resource-constrained setting.

Program description: An 8-week inpatient group therapy program was established at Sbrana Psychiatric Hospital in Botswana. The interdisciplinary team includes a social worker, psychologist, occupational therapist, psychiatric residents, and a psychiatrist. To date, 9 cohorts comprising 55 patients have fully participated. The average age was 35 years; most were males (61%), with alcohol being the most used substance, followed by crack cocaine. Of these, 21 have remained abstinent for at least 3 months and reintegrated into society, 11 have relapsed, and 23 are lost to follow-up.

Program insights: Challenges encountered include client dropouts, poor reintegration into the community, limited follow-up systems, and financial constraints. Key components contributing to the program's impact include peer support, relapse prevention, coping strategies, psychoeducation on triggers, and elements of the 12-step recovery model.

Conclusion: Program improvement areas include strengthening follow-up through objective measures, such as urine drug testing, and incorporating structured wellness and recreational activities to support recovery.

Background: Electronic cigarettes (EC) may serve as a potential smoking harm reduction tool by addressing both nicotine and behavioral dependence. This qualitative study reports the feasibility and acceptability of using EC and telehealth counseling among individuals in treatment programs for opioid use disorders (OUD) who smoke combustible cigarette, and was conducted as part of a randomized controlled trial. We report findings among participants in the EC arm.

Methods: Qualitative interviews were conducted from March to May 2021. The interviews were audio recorded, transcribed, and de-identified. An inductive approach guided by the Theoretical Framework of Acceptability was used. We developed and refined a codebook through a collaborative iterative process and team discussions. Five analysts coded the transcripts using Quirkos, with independent double coding for each transcript to achieve consensus and ensure inter-coder reliability. In-depth thematic analysis was conducted via synthesizing relevant codes that were described and exemplified using representative quotes. Saturation was achieved when no additional codes emerged.

Results: Eleven participants randomized to EC were interviewed: average age = 55 years (range = 39-69), 88% were male, 41% non-Hispanic black, and 35% non-Hispanic white. Four main themes identified included inciting sense of accountability toward cigarette smoking reduction; acknowledging the value of telehealth counseling; noting positive attributes such as addressing craving, as well as challenges in utilizing EC such as the need to remember charging the EC; and finally, participants' expression of the satisfaction with their perceived improvements in their health and other behavioral aspects.

Conclusion: The intervention combining telehealth counseling with EC was perceived as acceptable and helpful for reducing cigarette smoking, as well as resulting in other positive health benefits. ECs were easy to use and seemed to address craving; albeit with some challenges that can be addressed in future trials. EC combined with telehealth counseling carries great promise in smoking reduction among individuals with OUD.