Journal of Addictions Nursing最新文献

This article highlights the limitations of culturally relevant care for Indigenous people in the prevention, treatment, and recovery of substance use disorders. It provides recommendations for consideration that expand the capacity for cultural humility. The "one-size-fits-all" approach to providing services, employed by most health and human service providers who are non-Indigenous, has failed. These limitations are often because of a lack of understanding of the larger historical and cultural context of Indigenous people. The authors emphasize the importance of health and human service providers' acquisition of the requisite knowledge about the impact of colonization and trauma that guides a trauma-informed approach to treatment. Sixteen suggestions are provided to serve as a guide when serving Indigenous populations. They include expanding the body of literature on evidence-based practices to include the voice of Indigenous populations through the application of a Community-Based Participatory Action Research approach. Critical to achieving these outcomes is an expansion of the number of behavioral health providers who are Indigenous through the adoption of pedagogical practices that better serve the educational needs of this population. In addition, expanding the capacity of the preservice workforce to understand the impact of colonialization and cultural genocide is paramount. The goal is to prevent the perpetuation of negative attitudes and beliefs that result in addiction treatment providers becoming frustrated with the outcome and blaming the patient. These suggestions, based on the literature, will maximize positive outcomes and can be adapted by a broad spectrum of providers of substance use disorder services.

Abstract: This article provides an overview of the barriers to accessing intervention, treatment, and recovery supports for persons impacted by substances in rural communities. It defines "rural" and the complications of accessing intervention and treatment services in rural communities including the limitations of accessibility, availability, affordability, and acceptability of care. Ten suggestions, based on needs in rural communities and evidence-based practices, are outlined. They include suggestions for addressing the shortage of care providers in rural communities; educating and training professionals who are willing to adopt evidence-based practices; advancing a population health approach; addressing the limitation of substance use intervention and access to treatment because of stigma; adopting Screening, Brief Intervention, and Referral to Treatment and integrated care; ensuring support to address alcohol, stimulant, and opioid use disorder; offering culturally competent care; addressing the limitations of funding to access care in rural areas; and expanding the use of technology to deliver telehealth services. The recommendations are practical and support both the current and future health and behavioral health workforce serving people with substance use disorders in rural communities and health care administrators. If implemented, this will begin to address the disparities people residing in rural areas experience in securing treatment for substance use disorder and expand access to support for early intervention for people at risk through the adoption of evidence-based practices.

Abstract: In recent years there has been increased interest in the social determinants of health (SDoH) by nurses and other healthcare professionals. Numerous seminars and discussions among nurses and other health professionals have focused on addressing social, economic, and environmental factors that impact the health and wellbeing of individuals and communities. Although these conversations are important and represent a movement towards health and social justice, they may be insufficient to address health inequities. There is an urgent need to move beyond community surveillance to implementing health equity programs and policies, especially in marginalized communities. Such is the case in Baltimore City, Maryland, where a nurse-led, community-based network of stakeholders transformed a grassroots health equity model to a state-mandated SDoH Taskforce focusing on a local community. The purpose of this column is to present a short case study that helps nurses understand their potential role in advancing health equity through policy.

Abstract: Substance use disorders continue to trend as an increasingly pervasive public health problem in the United States. Substance use disorders are recognized as a global health problem by the World Health Organization. It is imperative to explore all opportunities to improve outcomes of substance use disorder treatment. Consideration of social determinant risks in assessment, treatment planning, and treatment implementation is one such opportunity. Social determinant conditions can be conceptualized along a continuum of primary categories. Developing methods to help clinicians understand and incorporate social determinants into assessment and treatment plan formulation processes may help improve outcomes for those who are experiencing one or more substance use disorders. This column includes a proposal for a framework of primary categories of social determinants and offers a definition for each. The categories are identified as basic needs insecurity, past trauma, historical oppression, current/ongoing severe distress and layered/compounded risks. These categories and definitions are developed in the context of practical application for clinical assessment and treatment plan formulation.