Focus (American Psychiatric Publishing)最新文献

The authors discuss the multidimensionality of risk factors for substance use and substance use disorder across the lifespan and the interplay between biological and environmental factors that may lead to substance use. When these underlying factors are not addressed, and usage continues, altered networks in the brain may lead to substance use disorders. Progress in prevention science, and in approaches to delay or prevent substance use initiation and progression to substance use disorder, is reviewed. Four barriers to delivering prevention approaches-unstable funding with a lack of coordination across systems, insufficient workforce capacity, states not knowing where to find evidence-based programs, and a lack of knowledge in how to adapt programs for specific settings-are identified, highlighting the need for a national prevention infrastructure. The authors conclude by providing examples and resources for mental health professionals in promoting prevention of substance use initiation and disorders.

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

Key messages: • A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.• The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.Appeared originally in Ann Med 2022; 54:2024-2038.

In the 50 years since its establishment, the National Institute on Drug Abuse has made significant investment and strides toward improving individual and public health. Epidemiology serves as the foundation for understanding the how many, why, how, where, and who of drug use and its consequences, and effective epidemiology research and training are geared toward actionable findings that can inform real-world responses. Epidemiologic findings enhance clinicians' ability to provide ongoing care by incorporating information about the patterns and outcomes of drug use that their patients may experience. The goal of this article is to provide a context for epidemiology of substance use as a foundation for prevention, with examples of how epidemiology can provide targets for prevention, and to set the stage for addressing the importance of prevention in clinical settings.

Disparities in health care access and quality of care like affordability and the lack of a properly trained workforce are associated with a greater risk for substance misuse. In pursuing health equity, the behavioral health workforce must ensure interventions are accessible and meaningful to all populations and allocate resources to those with the highest burden of substance use-related consequences. Behavioral health clinicians can support efforts to achieve equity by engaging with upstream, community-level prevention efforts aimed at providing culturally responsive prevention services. Coordination across the continuum of care that includes cultural humility, trauma-informed approaches, diverse perspectives, and community engagement can lead to more equitable and accessible care. This article describes health equity in the context of substance misuse prevention, considers health equity across the continuum of behavioral health services, and provides an overview of promising practices that align clinical care with prevention work to promote healthy, equitable community conditions.

Substance use and misuse remain formidable public health challenges and are intricately linked to social determinants of health (SDOH). Addressing SDOH requires structural interventions along with clinical support to change relevant policies. In this article, the authors review structural interventions known as prevention infrastructures and provide a framework for considering how different models of prevention infrastructures can be used to address SDOH that contribute to substance use. In particular, they introduce a typology of prevention infrastructures and explain how different infrastructure types can affect policy decision making across contexts and how these models can interact with each other. Furthermore, they consider the importance of cultural responsiveness in the creation of effective infrastructures to support communities and policy makers within organizations and government.

Increasing rates of overdose among U.S. adolescents and young adults, along with rising rates of emotional distress in these groups, are renewing the urgency for developmentally targeted and personalized substance use and other mental health prevention interventions. Most prevention programs recognize the unique vulnerability of childhood and adolescence and target parents and youths, addressing modifiable environmental risk and protective factors that affect behavior during periods when the brain is most susceptible to change. Until recently, a scarcity of comprehensive studies has limited a full understanding of the complexity of factors that may affect neurodevelopment, including substance exposure in pregnancy and/or subsequent substance use in adolescence, alongside their dynamic interactions with environmental factors and genetics. Two large longitudinal cohort studies funded by National Institutes of Health-the Adolescent Brain Cognitive Development (ABCD) Study and the HEALthy Brain and Child Development (HBCD) Study-are collecting data on neurodevelopment and a wide range of environmental and biological factors across the first two decades of life to build databases that will allow researchers to study how individual neurodevelopmental trajectories are influenced by drugs, adverse childhood experiences, and genetics, among other factors. These studies are already deepening the understanding of risk and resilience factors that prevention programs could target and will identify critical windows where interventions can have the most impact on an individual's neurodevelopmental trajectory. This article describes what is being learned from ABCD and expected from HBCD and how these studies might inform prevention as these children grow and more data are gathered.

Over the last few decades, psychologists and other health professionals have called attention to the importance of considering cultural and ethnic-minority aspects in any psychosocial interventions. Although, at present, there are published guidelines on the practice of culturally competent psychology, there is still a lack of practical information about how to carry out appropriate interventions with specific populations of different cultural and ethnic backgrounds. In this article, the authors review relevant literature concerning the consideration of cultural issues in psychosocial interventions. They present arguments in favor of culturally centering interventions. In addition, they discuss a culturally sensitive framework that has shown to be effective for working with Latinos and Latinas. This framework may also be applicable to other cultural and ethnic groups. Reprinted from J Community Psychol 2006; 34:121-132, with permission from Wiley Periodicals, Inc. Copyright © 2006.