Addiction Science & Clinical Practice最新文献

Background: There is increasing attention in clinician care to the importance of using person-first language. Clinicians' words can reinforce clinicians' pre-existing stigmas and biases. People who use drugs (PWUD) continue to face stigma from clinicians. Person-first language is a way to reduce stigma and perpetuation of bias.

Methods: Through specific structured in-person interviews, we examined the usage of stigmatizing language in the care of PWUD by surveying key clinicians- such as physicians, nurses, and social workers-and patients who self-identified as PWUD at Tufts Medical Center (Boston, MA) between July 2022-September 2022. Interview guides were created using the Consolidated Framework for Implementation Research (CFIR) 2.0 as a framework. We evaluated perceptions of person-first language and barriers to using person-first language amongst participants. Interviews were coded with Dedoose Software and inductive thematic analysis (ITA) methods were used until all themes were captured; CFIR 2.0 determinants used during interview guide creation were used as preliminary themes and modified as needed.

Results: We interviewed thirty-four people, including eleven PWUD at time of interview. Most clinicians agreed that language is important and matters when talking to patients and during documentation. Almost all patients agreed that language was important to them and impacted their relationship with their provider. However, there were responders that felt that person-first language was unnecessary, ineffective, and overly verbose in the medical setting. Major barriers to using person-first language were unawareness, lack of formal training, and perceived generational differences in appropriate language.

Conclusion: Addressing language usage is a critical opportunity to promote inclusion and reduce bias amongst PWUD. As medical charts become increasingly accessible by patients, the use of language by the clinician becomes increasingly important. To create and maintain equitable systems of care, it is important to meet clinicians where they are at and to work with them to address these issues. This can include targeted educational sessions and resources informing clinicians on preferred language use and curriculum for providers-in-training.

Background: Incorporating clinicians' perspectives is essential for the successful implementation of novel interventions in health care. This study aimed to explore clinicians' experiences of using smartphone-derived data in alcohol dependency treatment, and factors affecting implementation into routine care.

Methods: Two focus group discussions were conducted in April 2023, including 10 clinicians working at a specialist addiction clinic in Stockholm, Sweden. The clinicians had various levels of experience using smartphone-based data, which was available through two online portals, as part of a randomised controlled trial evaluating two smartphone-based interventions. Data were analysed using Thematic Framework Analysis, guided by Normalisation Process Theory.

Results: Two main themes were identified: The patient as the driving force and Cultivating commitment, competence and credibility. The first theme highlighted a person-centred approach that permeated the practice and how the patients' engagement with the app-based interventions guided the clinicians' own involvement. Benefits of the interventions for both patients (i.e., increased awareness and control) and clinicians (i.e. supportive during treatment sessions) were also acknowledged. Clinicians believed that the interventions offered an opportunity for patients to become more actively involved in treatment and noted that clinician access to the app-derived data was less important. The second theme covered clinician discussions on the need for support and guidance to make better use of the interventions, continuity in the work, and additional work time. Moreover, the use of external portals made the intervention less accessible. Potential risks and concerns with the interventions were raised, including technical instability and data security.

Discussion and conclusions: The results of this study indicate that a breathalyser-coupled and a drink-counting smartphone application have potential to be supportive complements to alcohol dependency treatment. According to the clinicians, the app-based interventions enhanced patient accountability in the change process and supported treatment delivery. To be effectively implemented into routine care, using a person-centred approach is key, as well as ensuring optimal conditions for clinicians to effectively use the systems. Technical issues constitute a barrier to acceptance, why technical robustness must be ensured.

Introduction: Increasingly, services for the management of substance use disorders have been developed or adapted for remote delivery. Limited research has investigated service user experience of these services. We undertook a qualitative sub-study, embedded within a pilot feasibility study of remote symptom-triggered alcohol withdrawal management, to better understand the experiences of participants. Our aim was to determine the acceptability of the intervention and refine intervention procedures.

Methods: Eligible participants were enrolled in the parent study and completed at least one day of telemedicine-delivered symptom-triggered alcohol withdrawal management. Individuals were adults with alcohol use disorder recruited using intensity sampling. Participants completed an audio-recorded, semi-structured interview. Thematic analysis was conducted using Braun and Clarke interpretive methodology.

Results: Fourteen individuals were enrolled in the study. Six themes were identified: benefits of being in the home environment, technological tensions, intervention-specific feedback, personal motivations for participation, post-program achievements and changes and navigating the 'system'. Participants identified numerous benefits of being in the home environment including: increased comfort, privacy and security, normalizing abstinence in the home, flexibility to engage in other tasks, and the convenience of not travelling. Intervention-specific feedback included positive aspects of the intervention (interactions with staff, accountability, counselling, use of medication), areas for improvement (preparation, scheduling, medication logistics, and aftercare), and the meaning and role of having a support person available during treatment.

Conclusion: Participants found remote alcohol withdrawal management to be satisfactory and associated with several benefits including increased comfort, privacy, normalizing abstinence in the home, flexibility and convenience. They also provided important feedback for refinement of the intervention. Findings suggest that remote alcohol withdrawal management could play an important role in improving access to medical management of alcohol withdrawal, particularly in rural, remote or underserved areas.

Background: Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.

Methods: Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented "other stimulant abuse" or "other stimulant dependence" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.

Results: Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.

Conclusions: In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.

Background: Substance use often begins in adolescence, making early identification and prevention essential to avert downstream harms, including substance use disorders. This study evaluated the impact of a peer-led, school-based storytelling program on participating middle- and high school students.

Methods: A cross-sectional, anonymous, online survey was distributed from 2014 to 2020 to Midwestern middle and high-schoolers who had attended a school-based event, "Ignite & Engage," led by a recovery community organization (RCO). Descriptive statistics summarized quantitative and an inductive thematic analysis summarized qualitative survey results.

Results: Of 10,438 surveyed students, 2,853 (27.3%) reported ever using substances The majority (55.2%) reported initiating substance use between the ages of 14 and 16 years, and 29.2% initiated it at an earlier age. The program impact was rated by 996 respondents, with 71.3% of them viewing it favorably and 76.3% noting presenters' personal recovery stories as the most valuable elements, and 51.2% feeling less likely to use alcohol or drugs afterwards, an effect stronger in middle- than high school youth (60.3% vs. 49.5%, respectively, p < 0.001). Qualitative feedback (N = 2,884) echoed the quantitative findings, emphasizing students' greater intent to avoid substance use, seek help, support peers, and reflect on recovery.

Conclusion: This school-based storytelling program, delivered by presenters with lived experience of addiction recovery, represents a promising, novel approach to substance use prevention and harm reduction among middle- and high school students.

Background: Contingency management (CM) is an effective intervention that provides financial incentives as positive reinforcement for reducing opioid or stimulant use. However, it has not been tested in populations of women who inject drugs (WWID) engaging in polysubstance use.

Methods: We aimed to compare the feasibility of two CM protocols designed to encourage illicit stimulant and opioid abstinence among WWID participating in an ongoing HIV prevention trial. Participants completed a 3-month CM period during which they submitted thrice weekly urine toxicology screenings (UTOX). In the 'abstinence from stimulants and opioids' protocol, participants received a $5 USD incentive when metabolites of stimulants and opioids were not detected in urine. In the 'partial-abstinence protocol', they received a $5 USD incentive when metabolites of stimulants or opioids were not detected, thus doubling the potential incentive obtained each visit. Women also received scaling bonuses after three consecutive negative UTOX ($5-$15 USD). We used descriptive statistics to summarize the total number of (1) UTOXs completed and (2) bonuses distributed. Rates of engagement per person per month were calculated (i.e., total number of completed UTOX/3 months*24 participants). Rates of engagement were compared by CM protocol period.

Results: Participants were primarily White women (67%) with an average age of 47 years. Self-reported polysubstance use was common (96%) with women reporting injecting an average of 5 times daily (Interquartile Range: 2-7). Participants (N = 24) collectively submitted 177 UTOX during their 3-month CM periods. Rates of non-reactive UTOX results were slightly higher in the partial-abstinence protocol compared to the abstinence from stimulants and opioids protocol (2.9 per month versus 1.0 per month). More bonuses were earned in the partial-abstinence protocol (0.50 bonuses per participant per month) compared to the abstinence from stimulants and opioids protocol (none). There were no study related adverse events in either protocol group during the CM period.

Conclusions: Findings demonstrate the feasibility of a CM protocol that provided financial incentives for partial abstinence, periods with documented stimulant or opioid abstinence, as well as abstinence to both, without the occurrence of iatrogenic effects. Future research focusing on CM protocols with more flexible incentive structures remains critical.

Trial registration: NCT05192434.

Background: Virtual reality (VR) technology has been increasingly employed to develop innovative treatments for Alcohol use disorder (AUD) and overcome limitations of currents therapies. However, previous research in this field has yielded inconclusive results. To improve the quality and comparability of studies, a critical analysis of the research methodology employed in this field is necessary.

Objectives: This scoping review aims to provide an overview of existing studies with a focus on their objectives, methodology, treatment paradigms, and VR design characteristics.

Methods: A systematic literature research was conducted in the electronic databases MEDLINE (PubMed), APA PsychInfo, APA PsychArticles, PSYINDEX (EBSCOhost), Scopus, Web of Science and by search in the reference list of included publication to identify relevant publications. Clinical studies and study protocols using VR for the assessment or treatment of patients with AUD were included.

Results: The literature search yielded 1.197 studies, of which 22 met the inclusion criteria. Completed trials (n = 16) and study protocols (n = 6) were included. The majority of the studies (n = 19) used a VR cue exposure paradigm to induce craving. The studies can be classified either as assessment (n = 9) or treatment studies (n = 13). The duration (7-60 min) and number of applied sessions (1-13) varied significantly depending on the type of study. Craving outcomes were based on subjective and physiological measurements. All studies used alcoholic beverages and VR scenarios such as bars, pubs, parties and restaurants, with additional scenarios varying, except for one study using a hospital and subway scenario as aversive scenarios. Moreover, synchronized olfactory stimuli were frequently used.

Conclusions: Despite the heterogeneity of VR software features and VR interventions, it was possible to identify a similarity within the main VR scenarios employed, as well as consistent positive results concerning the induction of subjective craving by alcohol-associated VR cues. While VR interventions for AUD show methodological progress, future research should adopt standardized protocols, include objective psychophysiological outcomes, and evaluate long-term efficacy and feasibility in clinical settings. Integration of emerging VR paradigms and technologies may further enhance the therapeutic potential.

Background: Cigarette smoking remains the leading preventable cause of death, posing heightened risks for vulnerable populations. World Trade Center (WTC) disaster responders face an elevated burden of respiratory diseases, and despite access to an evidence-based tobacco cessation program, a subset continues to smoke cigarettes. Treatment engagement remains a critical barrier, as many people who smoke fail to enroll in or adhere to programs, particularly when participation requires decisions to actively opt-in to treatment. This randomized controlled trial integrates tobacco treatment into an existing low-dose computed tomography (LDCT) lung cancer screening program and compares the effectiveness of an Enhanced Care intervention with opt-out enrollment and biofeedback to Standard Care with opt-in enrollment and standard treatment.

Methods: The trial includes retired Fire Department of the City of New York (FDNY) responders aged 50 years or older who have a smoking history that satisfies either the National Comprehensive Cancer Network criteria of at least 20 pack-years or a simplified criterion of at least 20 years of smoking. Participants are randomized to either Enhanced Care, featuring opt-out enrollment in tobacco treatment with tailored counseling using biofeedback from chest LDCT and spirometry results, or Standard Care, requiring opt-in enrollment and standard tobacco treatment without biofeedback. Both arms receive a varenicline regimen with 4 weeks of pre-loading. Primary outcomes are treatment enrollment and biochemically verified 7-day abstinence. Factors associated with enrollment and abstinence, including retention, adherence, and quit motivation, will be evaluated.

Discussion: This trial addresses a key gap in tobacco cessation research by testing an innovative intervention for a high-risk occupational cohort participating in LDCT screening. The Enhanced Care model integrates opt-out enrollment, personalized biofeedback, and varenicline preloading to reduce smoking rates and health burdens in FDNY responders. Findings aim to inform scalable cessation strategies for both occupational and general populations, highlighting the need for novel approaches for hard-to-treat individuals who smoke.

Trial registration: This trial was registered at ClinicalTrials.gov under the identifier NCT05997225.

Background: Individuals with opioid use disorder (OUD) are frequently hospitalized for injection-related medical complications, yet they often receive inadequate treatment for the OUD itself. We previously conducted a qualitative study to adapt an existing remotely delivered intensive outpatient program (IOP) specifically for hospitalized patients with OUD. We then conducted a pilot feasibility and acceptability study to assess the program.

Methods: The 4-week IOP consisted of asynchronous video content and in-person peer support. The primary outcomes were the feasibility of recruitment, acceptability of the treatment as assessed by the completion of videos, and engagement with the peer recovery coach. Secondary outcomes included OUD treatment retention.

Results: Of the 12 participants, the mean age was 40.9 years, 58.3% were female, and 58.3% had an injection-related serious infection. Results demonstrated potentially acceptable recruitment feasibility (70.6%, 95% CI [48.9-92.3]), but the median percentage of video completion was only 2% (range: 0-16%) and the median percentage of engagement with recovery coach was 31.8% (range: 16.7-66.7%). All participants received medications for OUD (MOUD) during the hospital stay (methadone 83%, buprenorphine 17%), and 33.3% remained retained in MOUD treatment at 28 days.

Conclusions: Hospitalized patients with OUD desired additional support through an IOP along with MOUD. While recruitment feasibility was acceptable, the overall program was not. Future research should explore IOP content that is more personalized and engaging while also including peer support.