Journal of substance use and addiction treatment最新文献

Introduction: American Indian/Alaska Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) peoples experience disproportionate burdens of posttraumatic stress disorder (PTSD) and substance use disorder (SUD), which frequently co-occur (PTSD/SUD). Historical trauma, structural inequities, and discrimination may exacerbate the severity and chronicity of these disorders. This review aimed to assess the extent to which PTSD/SUD clinical research includes these Indigenous groups and whether interventions are designed or adapted to meet their specific experiences and risk factors.

Methods: We conducted a systematic review of PTSD/SUD studies in the United States. From 135 studies identified in prior systematic reviews and meta-analyses, 66 studies met inclusion criteria. We extracted participant demographic data to quantify Indigenous (AI/AN and NH/PI) representation, assessed whether interventions tested effectiveness across racial groups with attention to Indigenous participants, examined whether interventions were culturally adapted for Indigenous groups, and evaluated whether studies that included higher proportions of Indigenous participants employed distinct recruitment strategies or methodological approaches.

Results: Indigenous participants comprised only 2.2% of all participants. Over half of all studies failed to include Indigenous participants. Only one study tested a culturally adapted intervention. In contrast, over half of studies recruited women or veterans and studied their challenges. Only two studies evaluated outcomes by race, yet neither included Indigenous people. Studies that included higher numbers of Indigenous participants often recruited women exposed to violent trauma or veterans in regions with larger Indigenous populations; however, most studies recruited few or no Indigenous participants regardless of population or location.

Conclusions: We identified a pattern of Indigenous neglect marked by underinclusion, a lack of attention to Indigenous groups relative to other groups, and insufficient evaluation of treatment outcomes for these groups. These issues limit our understanding of what works for Indigenous groups with PTSD/SUD. We make recommendations for addressing these issues.

Background: Emerging research suggests that service providers experience dilemmas when implementing a harm reduction approach with pregnant or parenting people who use substances (PPPWUS). This study aims to (1) describe perinatal harm reduction practices (2) describe tensions that arise from applying a perinatal harm reduction framework and (3) examine how service providers negotiate these challenges.

Methods: This participatory qualitative study was co-developed with a perinatal substance use program in Montreal that operates from a harm reduction framework. We conducted 10 semi-structured interviews with interdisciplinary perinatal service providers and performed a reflexive thematic analysis informed by Dubet's sociology of experience framework.

Results: Providers experience tension due to divergent personal and professional values within themselves. Additionally, an important tension emerges between reporting to Child Protection Services and protecting the therapeutic alliance. These challenges are exacerbated by systemic injustices, social inequities, inefficiencies within health and social services, and collaborating with clinical partners who may have different commitments towards, or understandings of, harm reduction. Providers rely on team collaboration and re-ground themselves in the harm reduction ethic when confronted with opposing forces.

Conclusions: Results highlight a need to strengthen academic formation and ongoing interdisciplinary/interagency development for professionals who might interface with PPPWUS to gain a shared understanding of the harm reduction philosophy. Further, results support the importance for health and social services system to prioritize greater capacity, accessibility, and collaboration between services to support PPPWUS, mobilize their strengths, and reduce harms for families.

Introduction: Substance use disorders (SUDs) profoundly affect not only individuals but also their families. Affected family members (AFMs) frequently experience ambiguous loss (AL) - a form of loss marked by uncertainty and lack of closure - as their loved one is physically present but psychologically absent due to addiction. Despite its prevalence, limited quantitative research examines the role of psychological strengths such as hope and resilience in mitigating AL among AFMs. This study investigates the statistical associations of hope and resilience on AL, with demographic factors explored as potential moderators.

Methods: This cross-sectional, quantitative study recruited 708 AFMs (e.g., spouses, parents, siblings, close friends "like family") of individuals with SUDs through the use of Qualtrics as the main recruitment medium. Participants completed the Ambiguous Loss Inventory Plus (ALI+), Adult Hope Scale (AHS), and Brief Resilient Coping Scale (BRCS). Data were analyzed using multiple regression to examine statistical associations, and moderation analyses to assess the influence of age, gender, and relationship type.

Results: Hope (β = -0.28, p < .001) and resilience (β = -0.23, p < .001) were both significantly and negatively associated with ambiguous loss, collectively accounting for 13.6% of the variance. Hope demonstrated a slightly stronger association with ambiguous loss than resilience. A second regression model supported the robustness of these associations (R² = 0.042, p < .001). Moderation analyses indicated that age (β = -0.731, p < .001) and relationship type (β = 0.215, p = .014) were significantly associated with ambiguous loss, such that older age was linked to lower ambiguous loss and closer relationships were linked to higher ambiguous loss; however, no demographic variables significantly moderated the associations between hope, resilience, and ambiguous loss.

Conclusions: Findings highlight the universal protective role of hope and resilience in mitigating AL for AFMs, regardless of demographic differences. Addiction counselors should integrate evidence-based interventions such as solution-focused therapy, CBT, and positive psychology to cultivate hope and resilience in AFMs. Counselor supervisors and educators should ensure training emphasizes ambiguous loss and strength-based strategies to better support families impacted by SUDs.

Background: Methadone is a highly effective, strictly regulated medication to treat opioid use disorder. COVID-19 flexibilities allowed for up to 28 days of take-homes versus daily travel to clinics for observed dosing, but receiving take-homes differed widely across clinics and individuals. We examined the relationship between state take-home policies and social vulnerability on take-home methadone receipt and days' supply.

Methods: Data were from the VOICES study, a telephone survey conducted between 1/2023-8/2024 of people who use drugs from Wisconsin, Michigan, New Mexico, and New Jersey. We estimated average marginal effects of state methadone policy (flexibility-adoption vs non-adoption) on methadone take-home receipt and days' supply. Models were fully adjusted for individual sociodemographic characteristics.

Results: Most participants were recruited from flexibility-adoption states (n = 285/428, 67%). Over half received take-home methadone (65%; average 3.1 days' supply, SD 6.2); 19% of take-home recipients (n = 54) received ≥3 days' supply. Take-home receipt was higher for participants in flexibility-adoption states (AME 0.52, p < 0.0001). Receiving ≥3 days' supply was lower in people reporting unemployment (vs. employment, AME -0.23, p = 0.0032) and past 30-day drug use (vs. no drug use, AME -0.23, p = 0.0014).

Conclusions: State take-home policy was most strongly associated with take-home methadone receipt. Receiving longer days of take-home supplies remains rare. Take-home eligibility guidelines should be established and consider potential social vulnerability factors to daily on-site dosing.

Introduction: Despite the severe consequences of substance use disorder (SUD), most Americans with SUD do not seek treatment. Uptake of treatment is especially important for mothers involved in the child welfare system (CWS), where SUD is common and can result in child maltreatment and loss of child custody. This study examines how local treatment accessibility influences utilization among CWS-involved mothers.

Methods: Our sample includes 98,343 CWS referrals in Pennsylvania (2015-2019) in which the referred biological mother was receiving Medicaid. Using geocoded referral addresses and SUD treatment facilities statewide, we estimate how the drive time to and supply of SUD treatment is associated with maternal treatment uptake in the quarter following the referral. Given lack of consensus regarding the distance individuals will travel for SUD treatment (service areas), we consider multiple versions of our measures and allow operationalization of service areas to vary by county urbanicity and SUD treatment type. We use hierarchical logistic regression models with conditional autoregressive random effects to account for spatial autocorrelation to estimate treatment utilization.

Results: Drive time is associated with lower outpatient utilization, particularly in large metropolitan areas with broader service area definitions. Greater treatment supply is associated with increased outpatient and inpatient utilization, with the magnitudes being higher for inpatient care. For both measures, levels of significance depend on urbanicity.

Conclusions: The associations between the accessibility measures and treatment uptake are statistically significant but relatively small in magnitude. Greater attention to access barriers beyond drive time and supply of SUD treatment is needed to increase uptake among child welfare-involved mothers.

Introduction: In 2022, approximately 23.1% of U.S. adults had a substance use disorder (SUD). In the same year, approximately 17.7% of Kansas adults had a SUD. Racial and ethnic minority communities often experience disproportionate impacts of SUD, including greater prevalence and mortality. Limited research exists on how individuals in these communities conceptualize SUD. The current study sought to: 1) assess SUD health literacy among individuals from racial/ethnic minority communities, 2) describe how members of four racial/ethnic communities (specifically American Indian/Alaska Native, Asian/Asian American, Black/African American, and Hispano/Latino) define SUD, and 3) characterize perceptions of SUD through the lens of the Health Belief Model.

Methods: Semi-structured, one-hour qualitative interviews were conducted virtually or by phone with participants from each racial/ethnic community.

Results: Eighty-one interviews were completed with adults residing in Wichita, Kansas, who identified within one of the groups. Across all groups, participants defined SUD as "dependence," a "lack of control," and a means of coping with daily stressors. Perceptions of SUD prevalence, overall and within one's own racial/ethnic community, were greater among American Indian/Alaska Native, Black/African American, and Hispanic/Latino participants than among Asian/Asian American participants. All groups identified historical trauma, grief, discrimination, and mental health challenges as contributing factors to SUD. Depression was emphasized by Black and Hispanic/Latino participants. Across all four racial/ethnic groups, it was most reported that they would consider seeking treatment if SUD began to significantly interfere with daily life or if encouraged by loved ones.

Conclusion: Participants' definitions of SUD were shaped more by cultural background, education, and personal or familial exposure, rather than clinical definitions. Definitions emphasized the impact of SUD on the family rather than on mental and physical health implications. Perceptions of SUD revealed both shared and distinct views across communities. All groups identified perceived benefits of abstaining from substance use (e.g. improved health, longevity, functional ability), which may inform culturally sensitive prevention and outreach efforts. This study underscores the importance of tailoring interventions to reflect the cultural values and lived experiences of racial/ethnic communities. Understanding how these communities conceptualize and perceive SUD is critical to designing culturally responsive health literacy materials.

Introduction: Office-based opioid treatment with buprenorphine for opioid use disorder (OBOT-BUP) is most effective when patients are retained in treatment long-term, but average treatment duration is less than 6 months. Up to two thirds of individuals with opioid use disorder (OUD) have chronic pain. Treatment of chronic pain in OBOT-BUP settings could improve retention in OBOT-BUP programs. Therefore, this study qualitatively assessed how to tailor pain self-management (PSM) to people with co-occurring chronic pain and OUD in OBOT-BUP settings.

Methods: This study takes a Qualitative Description approach to data collection and interpretation. We conducted semi-structured qualitative interviews with 61 participants (23 clinicians/clinic staff and 38 patients) at OBOT-BUP clinics regarding experiences with chronic pain and its treatment, experiences with opioid use disorder and its treatment, and their thoughts the desirability, feasibility, and modification of a previously developed PSM program for patients with comorbid chronic pain and opioid use disorder. Interviews were coded using a primarily inductively developed codebook, and coding was used to conduct a thematic analysis of interview transcripts.

Results: Participants generally reacted positively to the PSM program as presented. We identified 4 themes in the data that could affect implementation of PSM, and/or that suggested modifications that should be made to the program. (1) Patients reported relying on a wide array of treatment modalities, bolstering the case for use of PSM, but also sometimes expressing resistance to the idea if past attempts at PSM components had been unsuccessful. (2) Patients' prior experiences of stigma related to OUD negatively impacted willingness to participate in a PSM intervention. (3) Effective pain management using buprenorphine was regarded as a vital companion to PSM in patients with chronic pain and OUD. (4) Participants identified several aspects of PSM implementation that would be important, including individual sessions, peer-led group sessions, and remote visits.

Conclusions: Participants reported interest in PSM, but also reluctance based in concerns about efficacy and/or fear of stigma. We identified several strategies to respond to these concerns, including positioning PSM as an evidence-based strategy that works adjunctive to buprenorphine, and directly addressing pain/OUD stigma.

Background: The fentanyl-driven overdose crisis has heightened challenges in buprenorphine initiation, as traditional methods risk precipitated withdrawal due to fentanyl's prolonged presence in the body. Buprenorphine low-dose initiation (LDI) offers a gradual approach to starting buprenorphine but requires continued full-agonist opioid use in outpatient settings, where success rates remain low and patient experiences have not been evaluated.

Objectives: To identify barriers and facilitators to successful LDI completion and inform strategies to improve outpatient buprenorphine treatment.

Methods: We conducted 19 semi-structured interviews with people with opioid use disorder using fentanyl who had attempted LDI in the past three months. Using the COM-B framework, we applied thematic analysis to identify barriers and facilitators to LDI completion from interviews until reaching thematic saturation.

Results: We found that barriers and facilitators to LDI completion were linked to five COM-B model components: physical capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. Despite high desirability and acceptability among participants towards starting LDI, several main barriers to LDI completion emerged, including difficulty tolerating "waves" of discomfort throughout LDI, anticipatory anxiety of precipitated withdrawal with each buprenorphine dose, lack of symptomatic response from small buprenorphine doses, loss of "high" from fentanyl, readily available fentanyl access leading to temptations to use, unstable or triggering housing environments, and being around others using fentanyl. Facilitators for completing LDI included increased optimism for success, the appeal of gradual recovery, bubble-packing medications, use of prescribed and non-prescribed drugs, supportive personal relationships, and non-stigmatizing clinic and pharmacy environments.

Conclusions: Our study applied a novel behavior-change framework to understanding barriers and facilitators to LDI completion. Barriers aligned closely with the COM-B model, providing a foundation for developing future interventions to enhance buprenorphine uptake and acceptability among people with OUD using fentanyl. Addressing barriers to automatic motivation is likely to have the largest benefit, with interventions such as incentivization (e.g., gift cards for completing LDI), environmental restructuring (e.g., temporary housing or comfort spaces for LDI), behavior modeling (e.g., peer coaches), and enablement (e.g., 24/7 phone lines for patients to call) most directly addressing this barrier category.

Objective: Identify sociodemographic and substance use characteristics associated with pregnancy intention and explore the relationship between pregnancy intent and postpartum contraception interest among pregnant individuals with opioid use disorder (OUD).

Methods: Secondary analysis of baseline data collected in the Medication Treatment for OUD in Expectant Mothers trial, which evaluated injectable versus sublingual buprenorphine. Current pregnancy intention was classified as "intended," "mistimed," "unwanted," or "ambivalent." Postpartum contraceptive interest was categorized into highly effective, effective, less effective, or none. Participant characteristics and contraceptive interest was compared across intention categories using Fisher's Exact and Kruskal-Wallis tests.

Results: Of 155 participants who completed baseline screening, 137 (88%) did not report any contraceptive use prior to their current pregnancy. Twenty-eight percent reported intended pregnancies, 27% mistimed, 15% never wanted, and 30% were ambivalent towards their current pregnancy. Individuals reporting intended pregnancies disclosed less substance use in the past ninety days and twelve months compared to other categories. Forty-seven percent of participants desired highly effective contraception after delivery, 28% desired effective contraception, 4% desired less effective contraception, and 21% did not desire any contraception. Participants reporting an unwanted pregnancy were significantly more interested in sterilization, while participants reporting a mistimed pregnancy were significantly more interested in a postpartum long-acting reversible contraception.

Conclusion: Our findings that individuals with intended pregnancies report less recent substance use suggests that reproductive health decision-making may be difficult to prioritize during periods of active addiction. In addition, the lack of association between pregnancy intention and postpartum contraceptive interest underscores a need for novel ways to support perinatal individuals with OUD in family planning conversations that honor their reproductive autonomy, values, and desires.