Journal of Addictions Nursing最新文献

Abstract: The purpose of this study was to examine the effectiveness of a therapeutic community program on resilience and positive change of lifestyle in people with alcohol use disorder. This study used a quasi-experimental study design. The Therapeutic Community Program was conducted daily for 12 weeks from June 2017 to May 2018. Subjects were selected from the Therapeutic Community and a hospital. Of the 38 subjects, 19 subjects belonged to the experimental group and 19 subjects belonged to the control group. Our findings were that the Therapeutic Community Program has improved resilience and promoted global lifestyle changes in the experimental group compared with the control group.

Objective: The purpose of this study was to provide an understanding of the health care provider's perceptions and experiences with technology adoption in alcohol use disorder and clinical Screening, Brief Intervention, and Referral to Treatment (SBIRT).

Method: The study used an exploratory, multimethod strategy to gain a comprehensive understanding of facilitators and barriers to technology adoption in alcohol SBIRT in a primary care setting. However, although providers state that they understand the importance of screening patients for alcohol use disorder, only 15.4% of providers consistently screen. This study's primary aim was to gain insights of the study participants and what events or experiences help them with SBIRT adoption.

Results: The findings show a gap in the understanding of how to integrate behavioral health screenings in the primary care workflow using the electronic health record system. Providers want to do SBIRT in clinical care, yet time-constrained visits remain an issue.

Conclusions: Taking the time to map the workflow in advance of a practice change is a critical first step toward implementing it in a primary care setting. Time-constrained patient visits remain an ongoing problem and require novel methods to address issues, particularly in early identification of alcohol use disorder.

Abstract: The United States and many other developed nations are in the midst of an opioid crisis, with consequent pressure on prescribers to limit opioid prescribing and reduce prescription opioid misuse. This review addresses prescription opioid misuse for older adult surgical populations. We outline the epidemiology and risk factors for persistent opioid use and misuse in older adults undergoing surgery. We also address screening tools and prescription opioid misuse prevention among vulnerable older adult surgical patients (e.g., older adults with a history of an opioid use disorder), followed by clinical management and patient education recommendations. A significant plurality of older adults engaged in prescription opioid misuse obtain opioid medication for misuse from health providers. Thus, nurses can play a critical role in identifying those older adults at a higher risk for misuse and deliver quality care while balancing the need for adequate pain management against the risk for prescription opioid misuse.

Abstract: In 2018, more than 67,000 people died because of drug overdoses, and of that number, approximately 69.5% involved an opioid, making it a leading cause of death in the United States. Additionally concerning is that 40 states have reported increased overdose deaths and opioid-related deaths since the start of the COVID-19 global pandemic. Presently, many insurance companies and healthcare providers require patients to receive counseling during medication treatment for opioid use disorder (OUD), despite the lack of evidence that it is necessary for all patients. To inform policy and improve quality of treatment, this nonexperimental, correlational study examined the relationship between individual counseling status and treatment outcomes in patients receiving medication treatment for OUD. Treatment outcome variables (treatment utilization, medication use, and opioid use) were extracted from the electronic health records of 669 adults who received treatment between January 2016 and January 2018. Study findings suggest women in our sample were more likely to test positive for benzodiazepines (t = -4.3, p < .001) and amphetamines (t = -4.4, p < .001), whereas men used alcohol at higher rates than women (t = 2.2, p = .026). In addition, women were more likely to report having experienced Post-Traumatic Stress Disorder/trauma (χ2 = 16.5, p < .001) and anxiety (χ2 = 9.4, p = .002). Regression analyses revealed concurrent counseling was unrelated to medication utilization and ongoing opioid use. Patients who had prior counseling utilized buprenorphine more frequently (β = 0.13, p < .001) and used opioids less often (β = -0.14, p < .001); however, both relationships were weak. These data do not provide evidence that counseling during OUD outpatient has a significant impact on treatment outcomes. These findings provide further evidence that barriers to medication treatment such as mandatory counseling can and should be removed.

Background: Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based set of skills and strategies used by health care providers. Data have suggested SBIRT should be used in detecting persons at risk for substance use and be included in every primary care encounter, as many needing substance abuse treatment do not receive it.

Methods: This descriptive study evaluated data for 361 undergraduate student nurses who participated in SBIRT training. Pretraining and 3-month posttraining surveys were used to evaluate changes in trainees' knowledge, attitudes, and skills toward people with substance use disorder. A satisfaction survey immediately after the training measured satisfaction with and usefulness of the training.

Results: Eighty-nine percent of students self-reported that the training increased their knowledge and skills related to screening and brief intervention. Ninety-three percent reported that they intended to use these skills in the future. Pre-post measures indicated statistically significant increases in knowledge, confidence, and perceived competence on all measures.

Conclusions: Both formative and summative evaluation assisted in improving trainings each semester. These data confirm the need to integrate SBIRT content across the undergraduate nursing curriculum and include faculty and preceptors to improve rates of screening in clinical practice.

Objective: The aim of this healthcare improvement project was to evaluate healthcare provider use of screening and brief interventions (SBIs) for patients screening positive for alcohol at an upper Midwestern adult trauma center transitioning from Level II to Level I.

Method: Trauma registry data for 2,112 adult patients with trauma who screened positive for alcohol were compared between three periods: pre-formal-SBI protocol (January 1, 2010, to November 29, 2011); first post-SBI protocol (February 6, 2012, to April 17, 2016) after protocol implementation, healthcare provider training, and documentation changes; and second post-SBI protocol (June 1, 2016, to June, 30, 2019) after additional training and process improvements. Data analysis included descriptive statistics and logistic regression for comparisons over time and between admitting services.

Results: For the trauma admitting service, SBI rates increased from 32% to 90% over time, compared with 18%-51% for other admitting services combined. Trauma-service-admitted patients screening positive for alcohol had higher odds of receiving a brief intervention than other admitting services in each period in adjusted models: pre-SBI (OR = 1.99, 95% CI [1.15, 3.43], p = .014), first post-SBI (OR = 2.89, 95% CI [2.04, 4.11], p < .001), and second post-SBI (OR = 11.40, 95% CI [6.27, 20.75], p < .001) protocol periods. Within trauma service admissions, first post-SBI protocol (OR = 2.15, 95% CI [1.64, 2.82], p < .001) and second post-SBI protocol (OR = 21.56, 95% CI [14.61, 31.81], p < .001) periods had higher rates and odds of receiving an SBI than the pre-SBI protocol period.

Conclusion: The number of SBIs completed with alcohol-positive adult patients with trauma significantly increased over time through SBI protocol implementation, healthcare provider training, and process improvements, suggesting other admitting services with lower SBI rates could adopt similar approaches.

Background: Substance use disorders are a leading cause of morbidity and mortality in the United States, with opioid use disorder representing a growing public health concern and economic burden. Veterans within the Veterans Health Administration are impacted by opioid use disorder.

Significance: A common medication-assisted treatment is sublingual Suboxone (buprenorphine/naloxone) used in combination with behavior modification therapy. Missed Suboxone doses may lead to withdrawal and potential drug diversion. Sublocade (buprenorphine extended-release) is an alternative once-monthly subcutaneous injection administered by a healthcare provider. The purpose of this quality improvement project was to examine the effects of Sublocade on cravings in veterans with opioid use disorder.

Methods: Veterans were considered for Sublocade monthly injections if they were enrolled in the Suboxone program, not taking Suboxone as prescribed, and disenrolled from the Suboxone program more than 2 times. Cravings were measured before and after Sublocade program enrollment.

Results: Fifteen veterans were enrolled in the Sublocade program over a 12-month timeframe. Most were male (93%) with a median (range) age of 42 (33-62) years. The following were the primary opioids used before enrollment in the substance use disorder program: hydrocodone (47%), oxycodone (20%), and heroin (20%). Sublocade significantly reduced cravings (p = .001). In this small group, cravings were fully eliminated.

Discussion: Recent studies have shown Sublocade effectively blocks the effects of other opioids and minimizes the risk of medication diversion that occurs with Suboxone. For these reasons, Sublocade is an alternative medication-assisted treatment for veterans with opioid use disorder.

Abstract: Nurses support the recovery of individuals with substance use disorder. How they support individuals, however, may impact the effectiveness of their work. For example, there are various paradigms of recovery that alter interventions. In addition, negative attitudes adopted by clinicians discourage individuals who use substances from accessing healthcare services, experiencing further health deterioration. Alternatively, nurses can enact interventions that promote positive experiences, further supporting the recovery of individuals. Hence, it is beneficial to increase nurses' awareness of effective interventions that promote recovery. The purpose of this literature review is to examine effective nursing interventions that promoted recovery of those with substance use disorders from the perspective of nurses and individuals who received nursing care. The review identified that effective interventions were based on three major themes: person-centered care, empowerment, and maintaining supports and capability enhancement. In addition, literature revealed that some interventions were perceived to be more effective; this depended on whose viewpoint was examined-nurses or individuals with substance use disorders. Finally, there are interventions based on spirituality, culture, advocacy, and self-disclosure that are often disregarded but may be effective. Nurses should utilize the more prominent interventions as they offer the most benefit and integrate interventions that are often overlooked.