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A qualitative inquiry into music consumption at drug treatment centers with and without music therapy sessions – challenges, dangers, and successes
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-19 DOI: 10.1016/j.josat.2025.209641
Jeffrey Lozon, Moshe Bensimon

Introduction

Music therapy supports individuals with substance use disorders (SUD) in their recovery. Although robust quantitative research exists on the topic, research on subjective experiences of people with SUD is scarce. This qualitative study offers a retrospective perspective on clients with SUD at treatment centers, exploring the impact of music consumption and music therapy on their recovery process, examining the varying experiences of participants from treatment centers providing music therapy and participants from treatment centers not providing music therapy.

Methods

This phenomenological study included semi-structured interviews with 23 clients with SUD from treatment centers in Israel. Six participants came from treatment centers providing music therapy. Participants from treatment centers without music therapy consisted of two groups: those from treatment centers with a policy prohibiting all music (n = 4), and those from treatment centers allowing all types of music (n = 13).

Results

Content analysis revealed that at treatment centers providing music therapy, participants completed a 4-stage process: 1) developing awareness of problematic music as a trigger to possible relapse; 2) avoiding problematic music; 3) finding alternative music genres to enjoy; 4) developing tolerance to problematic music. At treatment centers without music therapy and having a policy prohibiting all music, participants developed anxiety towards music, and consequently one person relapsed. At treatment centers not providing music therapy but allowing all types of music, some participants achieved stages 1 to 3, some did not, and two participants relapsed.

Conclusions

At treatment centers providing music therapy, participants completed a four-stage process in which they developed tolerance to problematic music. At treatment centers not providing music therapy, participants failed to develop tolerance and some relapsed. The ability to develop tolerance to musical triggers seems crucial for rehabilitation, as music is fundamental for human life and cannot be completely avoided outside treatment. The current study calls policy makers in the field of treating clients with SUD to incorporate music therapy in treatment programs.
{"title":"A qualitative inquiry into music consumption at drug treatment centers with and without music therapy sessions – challenges, dangers, and successes","authors":"Jeffrey Lozon,&nbsp;Moshe Bensimon","doi":"10.1016/j.josat.2025.209641","DOIUrl":"10.1016/j.josat.2025.209641","url":null,"abstract":"<div><h3>Introduction</h3><div>Music therapy supports individuals with substance use disorders (SUD) in their recovery. Although robust quantitative research exists on the topic, research on subjective experiences of people with SUD is scarce. This qualitative study offers a retrospective perspective on clients with SUD at treatment centers, exploring the impact of music consumption and music therapy on their recovery process, examining the varying experiences of participants from treatment centers providing music therapy and participants from treatment centers not providing music therapy.</div></div><div><h3>Methods</h3><div>This phenomenological study included semi-structured interviews with 23 clients with SUD from treatment centers in Israel. Six participants came from treatment centers providing music therapy. Participants from treatment centers without music therapy consisted of two groups: those from treatment centers with a policy prohibiting all music (<em>n</em> = 4), and those from treatment centers allowing all types of music (<em>n</em> = 13).</div></div><div><h3>Results</h3><div>Content analysis revealed that at treatment centers providing music therapy, participants completed a 4-stage process: 1) developing awareness of problematic music as a trigger to possible relapse; 2) avoiding problematic music; 3) finding alternative music genres to enjoy; 4) developing tolerance to problematic music. At treatment centers without music therapy and having a policy prohibiting all music, participants developed anxiety towards music, and consequently one person relapsed. At treatment centers not providing music therapy but allowing all types of music, some participants achieved stages 1 to 3, some did not, and two participants relapsed.</div></div><div><h3>Conclusions</h3><div>At treatment centers providing music therapy, participants completed a four-stage process in which they developed tolerance to problematic music. At treatment centers not providing music therapy, participants failed to develop tolerance and some relapsed. The ability to develop tolerance to musical triggers seems crucial for rehabilitation, as music is fundamental for human life and cannot be completely avoided outside treatment. The current study calls policy makers in the field of treating clients with SUD to incorporate music therapy in treatment programs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209641"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preparations for rave music parties and consequences for attendees who consume psychedelic drugs.
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-19 DOI: 10.1016/j.josat.2025.209637
Yula Milshteyn, Moshe Bensimon

Introduction: A few studies have shown that rave music parties (RMP) enabled long-term positive transformative experiences. However, phenomenological inquiry on the subjective meaning of RMP attendees' experience before and after such parties is scant. The present study explored the preparations for participation in RMP and the parties' consequences for attendees who consume psychedelic drugs.

Method: The study used interpretative phenomenological analysis to analyze transcriptions of semi-structured interviews with 27 Israeli rave party attendees.

Results: The study found five themes regarding attendees' preparations for RMP: physical preparations; anticipation and body sensations; cognitive preparations; social preparations; and logistic preparations. Four themes relate to the attendees' experienced consequences after RMP: physical consequences; emotional consequences; cognitive effects; and positive social consequences.

Conclusions: In light of liminality and rite of passage theories, the study highlights the importance of the pre-liminal rites of separation, including physical preparations, anticipation and body sensations, and cognitive, social and logistic preparations. The consequences after the party correspond to the post-liminal stage where the participants return to their normal life, yet with changes in physical, emotional, cognitive, and social aspects. Israeli policymakers should consider adopting European drug-checking policy as a harm reduction measure to minimize negative consequences of drug use in the pre-liminal and post-liminal stages of RMP.

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引用次数: 0
Medicaid expansion is not associated with prescription opioid and benzodiazepine misuse among people who inject drugs: A serial cross-sectional observational study using generalized difference-in-differences models
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-16 DOI: 10.1016/j.josat.2025.209639
Danielle F. Haley , Stephanie Beane , Courtney R. Yarbrough , Janet Cummings , Sabriya Linton , Umed Ibragimov , Regine Haardörfer , Catlainn Sionean , Rashunda Lewis , Hannah L.F. Cooper , For the NHBS Study Group

Background

While evidence suggests Medicaid expansion can reduce overdose, some expressed concern expansion fueled the US opioid overdose crisis by increasing access to low-cost prescription opioids diverted for non-prescribed use. Ecologic studies find a protective relationship or no relationship between expansion and area-level opioid prescribing. Little is known about the relationship between expansion and opioid use among people experiencing poverty who inject drugs (PWID), a population at heightened risk of overdose likely to benefit from Medicaid expansion. We examined whether expansion was associated with prescription opioid and benzodiazepine misuse among PWID experiencing poverty and whether associations varied by race/ethnicity and HIV status.

Methods

This serial cross-sectional observational study used generalized difference-in-differences models to analyze data (2012, 2015, 2018) from 19,728 PWID aged 18–64 with income ≤138 % of federal poverty line from 13 states in the CDC's National HIV Behavioral Surveillance. Outcomes included past 12-month non-injection and injection prescription opioid misuse and benzodiazepine misuse.

Results

The sample (N = 19,728) was 40 % non-Latinx Black persons and 22 % Latinx persons. Past 12-month non-injection prescription opioid misuse was 33 %, injection prescription opioid misuse was 16 %, and benzodiazepine use was 40 %. Across all models, there was no association between expansion and prescription opioid misuse (confidence intervals included 0) or prescription benzodiazepine misuse (confidence intervals included 0). Associations did not vary by race/ethnicity or HIV status.

Conclusions

We found no association between Medicaid expansion and opioid or benzodiazepine misuse overall, by race/ethnicity, or HIV status among a large, geographically diverse sample of PWID. These findings provide empirical evidence that expansion is not associated with prescription opioid or benzodiazepine misuse in a population likely to benefit from expansion.
{"title":"Medicaid expansion is not associated with prescription opioid and benzodiazepine misuse among people who inject drugs: A serial cross-sectional observational study using generalized difference-in-differences models","authors":"Danielle F. Haley ,&nbsp;Stephanie Beane ,&nbsp;Courtney R. Yarbrough ,&nbsp;Janet Cummings ,&nbsp;Sabriya Linton ,&nbsp;Umed Ibragimov ,&nbsp;Regine Haardörfer ,&nbsp;Catlainn Sionean ,&nbsp;Rashunda Lewis ,&nbsp;Hannah L.F. Cooper ,&nbsp;For the NHBS Study Group","doi":"10.1016/j.josat.2025.209639","DOIUrl":"10.1016/j.josat.2025.209639","url":null,"abstract":"<div><h3>Background</h3><div>While evidence suggests Medicaid expansion can reduce overdose, some expressed concern expansion fueled the US opioid overdose crisis by increasing access to low-cost prescription opioids diverted for non-prescribed use. Ecologic studies find a protective relationship or no relationship between expansion and area-level opioid prescribing. Little is known about the relationship between expansion and opioid use among people experiencing poverty who inject drugs (PWID), a population at heightened risk of overdose likely to benefit from Medicaid expansion. We examined whether expansion was associated with prescription opioid and benzodiazepine misuse among PWID experiencing poverty and whether associations varied by race/ethnicity and HIV status.</div></div><div><h3>Methods</h3><div>This serial cross-sectional observational study used generalized difference-in-differences models to analyze data (2012, 2015, 2018) from 19,728 PWID aged 18–64 with income ≤138 % of federal poverty line from 13 states in the CDC's National HIV Behavioral Surveillance. Outcomes included past 12-month non-injection and injection prescription opioid misuse and benzodiazepine misuse.</div></div><div><h3>Results</h3><div>The sample (<em>N</em> = 19,728) was 40 % non-Latinx Black persons and 22 % Latinx persons. Past 12-month non-injection prescription opioid misuse was 33 %, injection prescription opioid misuse was 16 %, and benzodiazepine use was 40 %. Across all models, there was no association between expansion and prescription opioid misuse (confidence intervals included 0) or prescription benzodiazepine misuse (confidence intervals included 0). Associations did not vary by race/ethnicity or HIV status.</div></div><div><h3>Conclusions</h3><div>We found no association between Medicaid expansion and opioid or benzodiazepine misuse overall, by race/ethnicity, or HIV status among a large, geographically diverse sample of PWID. These findings provide empirical evidence that expansion is not associated with prescription opioid or benzodiazepine misuse in a population likely to benefit from expansion.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209639"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and validation of the compulsive substance use questionnaire: Attending to substance use automaticity, craving, and continued use despite negative consequences
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-16 DOI: 10.1016/j.josat.2025.209638
Nadine R. Taghian, E. Marie Parsons, Michael W. Otto

Background

Compulsivity characterizes an important subtype of substance use disorders (SUDs), but there has been variability in how compulsive substance use is defined and measured. The current study was designed to (1) develop a new measure of substance use compulsivity, (2) validate this scale in a community sample of adults who drink alcohol, and (3) evaluate the association between this new measure of compulsivity and substance use severity. We hypothesize that compulsivity will be characterized by automaticity, craving and insensitivity to negative consequences, and greater substance use severity will be associated with higher levels of substance use compulsivity.

Methods

A preliminary set of items were generated for the novel Compulsive Substance Use Questionnaire (CSUQ) to reflect three conceptual aspects of substance use compulsivity: automaticity, craving, and disregarding negative consequences. The study recruited a total of 253 adults who drink alcohol, with a range of severity. Participants answered online surveys on compulsivity, frequency of alcohol use, craving, and negative consequences of alcohol use.

Results

We obtained a single-factor solution with 22 items that included 3 automaticity items, 10 craving items, and 9 disregarding negative consequences items. The resulting measure had excellent internal consistency (α = 0.96). The CSUQ was associated with substance use severity; specifically, greater compulsivity was associated with heavy alcohol use and higher frequency of negative consequences associated with alcohol use.

Conclusions

The current study supports the validity of a new measure of substance use compulsivity, composed of items that closely hew to the concept of substance use compulsivity. Future work investigating compulsivity in other substance use populations with varying levels of severity will further our understanding of compulsive substance use and SUD subtypes.
{"title":"Development and validation of the compulsive substance use questionnaire: Attending to substance use automaticity, craving, and continued use despite negative consequences","authors":"Nadine R. Taghian,&nbsp;E. Marie Parsons,&nbsp;Michael W. Otto","doi":"10.1016/j.josat.2025.209638","DOIUrl":"10.1016/j.josat.2025.209638","url":null,"abstract":"<div><h3>Background</h3><div>Compulsivity characterizes an important subtype of substance use disorders (SUDs), but there has been variability in how compulsive substance use is defined and measured. The current study was designed to (1) develop a new measure of substance use compulsivity, (2) validate this scale in a community sample of adults who drink alcohol, and (3) evaluate the association between this new measure of compulsivity and substance use severity. We hypothesize that compulsivity will be characterized by automaticity, craving and insensitivity to negative consequences, and greater substance use severity will be associated with higher levels of substance use compulsivity.</div></div><div><h3>Methods</h3><div>A preliminary set of items were generated for the novel Compulsive Substance Use Questionnaire (CSUQ) to reflect three conceptual aspects of substance use compulsivity: automaticity, craving, and disregarding negative consequences. The study recruited a total of 253 adults who drink alcohol, with a range of severity. Participants answered online surveys on compulsivity, frequency of alcohol use, craving, and negative consequences of alcohol use.</div></div><div><h3>Results</h3><div>We obtained a single-factor solution with 22 items that included 3 automaticity items, 10 craving items, and 9 disregarding negative consequences items. The resulting measure had excellent internal consistency (α = 0.96). The CSUQ was associated with substance use severity; specifically, greater compulsivity was associated with heavy alcohol use and higher frequency of negative consequences associated with alcohol use.</div></div><div><h3>Conclusions</h3><div>The current study supports the validity of a new measure of substance use compulsivity, composed of items that closely hew to the concept of substance use compulsivity. Future work investigating compulsivity in other substance use populations with varying levels of severity will further our understanding of compulsive substance use and SUD subtypes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209638"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The difference-making role of staff support in implementing nurse care management for opioid use disorder treatment: A configurational analysis.
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-15 DOI: 10.1016/j.josat.2025.209642
Theresa E Matson, Amy K Lee, Edward J Miech, Paige D Wartko, Rebecca C Phillps, Mary Shea, Andrea Altschuler, Aimee N C Campbell, Colleen T Labelle, Julia H Arnsten, Jordan M Braciszewski, Joseph E Glass, Viviana E Horigian, Mark T Murphy, Mohammad Zare-Mehrjerdi, Katharine A Bradley

Introduction: Understanding conditions in which interventions succeed or fail is critical. The PRimary care Opioid Use Disorders treatment (PROUD) trial, a cluster-randomized hybrid study, tested whether implementation of office-based addiction treatment supported by a nurse increased medication of OUD. Six health systems each provided two primary care (PC) clinics that were randomly assigned to implement the intervention or usual care. This secondary, exploratory study used an innovative mixed methods approach to understand contextual factors that consistently distinguished intervention clinics that increased OUD treatment from those that did not.

Methods: The study collected contextual information through field notes, health system debriefs, and nurse interviews. Rapid qualitative analysis using a template based on the Practical, Robust Implementation and Sustainability Model identified themes reflecting the external environment, recipients, and implementation infrastructure. The study used qualitative themes to create binary factors reflecting barriers and facilitators potentially critical to implementation success and assigned clinics a factor value of 1 if present and 0 if absent. Two clinic-level outcomes were defined: 1) significant increase in patient-years of OUD treatment from baseline to two-year follow-up; and 2) high rate of OUD treatment at two-year follow-up (≥20 per 10,000 patient-years). Coincidence analysis, a cross-case configurational method, identified difference-makers for both OUD outcomes across intervention clinics.

Results: Qualitative analysis yielded 11 themes which were dichotomized and consolidated into 9 factors. Two factor values perfectly distinguished between intervention clinics with and without increased OUD treatment (outcome #1): (a) presence of strong support from PC staff and providers and (b) lack of OUD treatment in the community. Intervention clinics increased OUD treatment when either factor value was present; when both were absent, clinics did not increase treatment. Strong support from PC staff and providers was independently sufficient to achieve high rates of OUD treatment (outcome #2) while the absence of support explained low rates of treatment. Importantly, strong support from leadership was not sufficient for either outcome.

Conclusion: Strong support from staff and providers consistently differentiated between clinics with increased OUD treatment across both outcomes in the PROUD trial from those without. OUD programs should consider increasing support across clinic roles.

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引用次数: 0
Introduction to the special issue on legislative-driven responses to the opioid crisis: Expanding research and implementation through federal and state funding
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-14 DOI: 10.1016/j.josat.2025.209636
Dennis P. Watson , Barbara Andraka-Christou
This special issue focuses on legislative-driven responses to the opioid crisis in the United States, emphasizing the expansion of research and implementation through federal and state funding. Since 2017, federal, state, and local initiatives have allocated billions of dollars to combat the opioid epidemic. This issue comprises 10 articles that collectively demonstrate the critical role of federal and state funding in enhancing opioid-related prevention, treatment, and recovery services. They also bring to light ongoing challenges such as funding sustainability and equitable service access that can guide future funding initiatives.
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引用次数: 0
Enhancing access to medication-assisted treatment in tribally-operated health and behavioral health systems: A qualitative study
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-03 DOI: 10.1016/j.josat.2025.209635
Sierra Quintana , Gregory Aarons , Ashleigh Coser , Terrence Kominsky , Laura Martin , Sasha Tsurnos , Douglas Novins

Background

American Indian and Alaska Native (AI/AN) communities' resiliency perseveres despite the disproportionate impact of the opioid crisis. Medication-assisted treatment (MAT) combines traditional psychosocial therapy with pharmacotherapies and has emerged as the standard of care for individuals with alcohol and opioid misuse. Combining traditional healing, evidence-based practices, and medications for the treatment of substance misuse to create a form of MAT that is culturally appropriate for AI/AN communities has proven challenging. This study explores how AI/AN culture and community perceptions impact the acceptability and feasibly of MAT and insights into what intervention components would support its provision.

Methods

Two health and human service care systems serving primarily AI/AN populations participated in the study. An Advisory Board consisting of clinical providers, program administrators, evaluation specialists, tribal members, and researchers led this project following community-based participatory research principles. Qualitative data was obtained over two waves of data collection, the first wave focusing on describing the cultural, community, systems, and clinical contexts for MAT implementation. The second wave gathered feedback on the feasibility and acceptability of intervention components developed from findings from the first wave. Participants in focus groups and key informant interviews (N = 41 with 29 participating in both waves of data collection) were at least 18 years of age and involved in substance misuse treatment services. Analysis involved extracting themes following principles of grounded theory to identify perspectives within and across each participating community.

Results

In the first wave of data collection, major themes included regulatory issues, procedural issues, clinical issues and the availability of consultation to therapists and counselors regarding MAT. In the second wave of data collection, participants reported that tribal, state, and federal resources for prescribing providers in response to the opioid crisis were robust and the gap was in supporting patients, their families, and therapists.

Conclusions

These results supported the Advisory Board in identifying the following intervention components to improve access to MAT: 1) the provision of patient and family educational materials and 2) education and clinical consultation opportunities for therapists and counselors to support them in discussing MAT as a treatment option for their patients.
{"title":"Enhancing access to medication-assisted treatment in tribally-operated health and behavioral health systems: A qualitative study","authors":"Sierra Quintana ,&nbsp;Gregory Aarons ,&nbsp;Ashleigh Coser ,&nbsp;Terrence Kominsky ,&nbsp;Laura Martin ,&nbsp;Sasha Tsurnos ,&nbsp;Douglas Novins","doi":"10.1016/j.josat.2025.209635","DOIUrl":"10.1016/j.josat.2025.209635","url":null,"abstract":"<div><h3>Background</h3><div>American Indian and Alaska Native (AI/AN) communities' resiliency perseveres despite the disproportionate impact of the opioid crisis. Medication-assisted treatment (MAT) combines traditional psychosocial therapy with pharmacotherapies and has emerged as the standard of care for individuals with alcohol and opioid misuse. Combining traditional healing, evidence-based practices, and medications for the treatment of substance misuse to create a form of MAT that is culturally appropriate for AI/AN communities has proven challenging. This study explores how AI/AN culture and community perceptions impact the acceptability and feasibly of MAT and insights into what intervention components would support its provision.</div></div><div><h3>Methods</h3><div>Two health and human service care systems serving primarily AI/AN populations participated in the study. An Advisory Board consisting of clinical providers, program administrators, evaluation specialists, tribal members, and researchers led this project following community-based participatory research principles. Qualitative data was obtained over two waves of data collection, the first wave focusing on describing the cultural, community, systems, and clinical contexts for MAT implementation. The second wave gathered feedback on the feasibility and acceptability of intervention components developed from findings from the first wave. Participants in focus groups and key informant interviews (<em>N</em> = 41 with 29 participating in both waves of data collection) were at least 18 years of age and involved in substance misuse treatment services. Analysis involved extracting themes following principles of grounded theory to identify perspectives within and across each participating community.</div></div><div><h3>Results</h3><div>In the first wave of data collection, major themes included regulatory issues, procedural issues, clinical issues and the availability of consultation to therapists and counselors regarding MAT. In the second wave of data collection, participants reported that tribal, state, and federal resources for prescribing providers in response to the opioid crisis were robust and the gap was in supporting patients, their families, and therapists.</div></div><div><h3>Conclusions</h3><div>These results supported the Advisory Board in identifying the following intervention components to improve access to MAT: 1) the provision of patient and family educational materials and 2) education and clinical consultation opportunities for therapists and counselors to support them in discussing MAT as a treatment option for their patients.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209635"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment completion among Australians attending publicly-funded specialist alcohol and other drug treatment services 参加公共资助的专业酒精和其他药物治疗服务的澳大利亚人的治疗完成情况。
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-01 DOI: 10.1016/j.josat.2024.209588
Amanda Roxburgh , Joseph Van Buskirk , Darren M. Roberts , Mark Stoove , Jacques Raubenheimer , Paul Dietze , Sharon Reid , Paul S. Haber , Carolyn A. Day

Introduction

Completion of alcohol and other drug (AOD) treatment is associated with improved health and social outcomes. Previous research has largely focused on individual (e.g. demographic) or service-level (e.g. treatment modality/setting) factors related to treatment completion in isolation. This study investigates the relationship between treatment completion and service-level and substance related factors, after controlling for demographics.

Study design

Retrospective cohort of 53,430 people engaging in government funded specialist AOD treatment across New South Wales, Australia, between 1 January 2015–31 December 2018.

Methods

Generalised linear mixed models were used to analyse factors associated with treatment completion, accounting for repeated measures across treatment episodes.

Results

Approximately two-thirds (69.8 %, n = 37,330) of the cohort completed treatment at least once during the study period, 42.3 % (22,605) on a single, and 27.5 % (14,725) on multiple occasions. After controlling for demographics, treatment episodes for amphetamines were least likely to be recorded as complete (52.5 %), while those for MDMA were 1.9 (95 % CI: 1.49, 2.45) times more likely (67 %) than amphetamine episodes to be completed. Treatment episodes mandated through criminal justice/child protection agencies were 1.25 (95 % CI: 1.20, 1.30) times more likely to be completed compared to those originating from self-referral. There were no differences in treatment completion between self or health professional referrals (aOR: 0.98, 95 % CI: 0.95, 1.02). Episodes involving involuntary AOD treatment modalities and residential withdrawal were 6.67 times (95% CI: 4.53, 9.81) and 5.02 times (95 % CI: 4.46, 5.64) more likely respectively to be completed compared to those for community rehabilitation. Case management episodes were also more likely (aOR: 2.43, 95 % CI: 2.16, 2.73) to be completed. Episodes of longer treatment duration (≥90 days) were 1.89 times (95 % CI: 1.82, 1.97) more likely to be completed compared to shorter (≤30 days) treatment episodes.

Conclusions

Treatment completion was moderated by a range of factors including drug type, treatment modality and duration, and referral source. Low rates of amphetamine treatment completion across treatment modalities confirms the urgent need for further research investigating more effective treatment options for amphetamine use disorders.
前言:酒精和其他药物(AOD)治疗的完成与改善健康和社会结果相关。以前的研究主要集中在与孤立治疗完成相关的个人(如人口统计学)或服务水平(如治疗方式/环境)因素上。本研究在控制人口统计因素后,探讨治疗完成程度与服务水平及物质相关因素的关系。研究设计:2015年1月1日至2018年12月31日期间,在澳大利亚新南威尔士州接受政府资助的专业AOD治疗的53,430人的回顾性队列。方法:采用广义线性混合模型分析与治疗完成相关的因素,并考虑治疗期间的重复测量。结果:大约三分之二(69.8 %,n = 37,330)的队列患者在研究期间至少完成了一次治疗,其中42.3 %(22,605)为单次治疗,27.5% %(14,725)为多次治疗。在控制了人口统计学因素后,安非他命的治疗期完成记录的可能性最小(52.5 %),而MDMA的治疗期完成记录的可能性是安非他命的1.9倍(95 % CI: 1.49, 2.45)(67 %)。通过刑事司法/儿童保护机构强制执行的治疗事件完成的可能性是自我转诊的1.25倍(95 % CI: 1.20, 1.30)。自我或健康专业人员转诊在治疗完成度上没有差异(aOR: 0.98, 95 % CI: 0.95, 1.02)。与社区康复相比,非自愿AOD治疗方式和住院戒断的发生率分别为6.67倍(95% CI: 4.53, 9.81)和5.02倍(95 % CI: 4.46, 5.64)。病例管理事件也更有可能完成(aOR: 2.43, 95 % CI: 2.16, 2.73)。较长的治疗时间(≥90 天)比较短的治疗时间(≤30 天)完成的可能性高1.89倍(95 % CI: 1.82, 1.97)。结论:治疗完成度受药物类型、治疗方式、持续时间和转诊来源等一系列因素的影响。各种治疗方式的低安非他明治疗完成率证实迫切需要进一步研究安非他明使用障碍的更有效治疗方案。
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引用次数: 0
“There was no services that I could access so I just stayed on the street…using until I went into labour.”: A qualitative study of accessibility and cultural safety of services for perinatal substance use in British Columbia, Canada “我无法获得任何服务,所以我只能呆在街上……直到分娩。”:对加拿大不列颠哥伦比亚省围产期药物使用服务的可及性和文化安全进行定性研究。
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-01 DOI: 10.1016/j.josat.2024.209604
S. Joyce , M. Piske , C. Norris (Eagle Spirit Woman) , B. Barker , R. David , U. Malhotra , B. Nosyk

Background

Perinatal substance use is a critical public health challenge, impacting both mother and fetus. Its prevalence has increased in British Columbia, Canada, disproportionately impacting First Nations people. For specialized perinatal substance use services to be effective, they must be accessible and safe. This study aimed to explore the accessibility and cultural safety of health services for perinatal substance use from the perspective of service users.

Methods

We conducted a qualitative study from six focus group discussions, consisting of five in-person sharing circles for people with lived/living experience of pregnancy and substance use and one virtual focus group with inreach workers, for a total of 55 participants including 48 people with lived experience and seven inreach workers across the five health delivery regions in British Columbia. We interpreted results using thematic analysis and narrative inquiry to explore inductively and deductively derived themes.

Results

Participants identified a lack of perinatal substance use specific services, particularly supportive housing facilities and wrap-around community centres in the province but highlighted that community-based services they were able to access made participants feel safe and respected. Thematic analysis identified six themes related to accessibility and cultural safety: geographic disparities in access to care, importance of Indigenous culture for Indigenous client's healing, transitions as critical moments in service accessibility, safe services protect the mother-infant dyad, inconsistent access to opioid agonist treatment, and relationality as a crucial element of safe service delivery.

Conclusion

This study suggests that services that preserve the mother-infant dyad, incorporate wholistic care including Indigenous culture, and are relationship-based are experienced as accessible and safe, and those that do not are often mistrusted and avoided. This study highlights needed improvements, particularly of acute care services, through supporting instead of reporting birthing parents with substance use, ensuring continuous access to opioid agonist treatment for pregnant people with opioid use disorder, and suffusing the client-provider relationship with empathy, respect, and connection.
背景:围产期药物使用是一项重大的公共卫生挑战,对母亲和胎儿都有影响。它在加拿大不列颠哥伦比亚省的患病率有所上升,对原住民的影响尤为严重。为了使专门的围产期药物使用服务有效,它们必须是可获得的和安全的。本研究旨在从服务使用者的角度探讨围产期物质使用卫生服务的可及性和文化安全性。方法:我们从六个焦点小组讨论中进行了定性研究,包括五个面对面的怀孕和物质使用的人分享圈和一个虚拟的接触工作者焦点小组,共有55名参与者,其中包括48名有生活经验的人和7名接触工作者,他们来自不列颠哥伦比亚省的五个卫生服务区域。我们使用主题分析和叙事探究来解释结果,以探索归纳和演绎衍生的主题。结果:参与者确定缺乏围产期药物使用特定服务,特别是该省的支持性住房设施和环绕式社区中心,但强调他们能够获得的社区服务使参与者感到安全和受到尊重。专题分析确定了与可及性和文化安全相关的六个主题:获得护理方面的地理差异、土著文化对土著客户康复的重要性、作为服务可及性关键时刻的过渡、安全服务保护母婴二人组、获得阿片类激动剂治疗的不一致以及关系作为安全服务提供的关键要素。结论:本研究表明,保护母婴二联体、纳入包括土著文化在内的整体护理以及以关系为基础的服务是可获得的和安全的,而那些不这样做的服务往往是不信任和避免的。本研究强调了需要改进的地方,特别是急性护理服务,通过支持而不是报告使用药物的分娩父母,确保阿片类药物使用障碍孕妇持续获得阿片类药物激动剂治疗,并使客户-提供者关系充满同情、尊重和联系。
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引用次数: 0
Barriers and facilitators to the implementation of screening and intervention for co-use of opioid medications and alcohol among community pharmacy patients 在社区药房患者中实施阿片类药物和酒精共同使用筛查和干预的障碍和促进因素。
0 PSYCHOLOGY, CLINICAL Pub Date : 2025-02-01 DOI: 10.1016/j.josat.2024.209606
Grace Broussard , Kenneth C. Hohmeier , Craig Field , Adam J. Gordon , Kristi Carlston , Alina Cernasev , Melissa Tyszko , Ashley M. Snyder , Gerald Cochran
<div><h3>Introduction</h3><div>A significant risk for overdose among patients prescribed opioid medications is co-use of alcohol. Community pharmacies are underutilized as a resource to prevent and address co-use. The barriers and facilitators that promote or impede the adoption of universal alcohol screening and intervention at point of opioid medication dispensing are unknown. We assessed community pharmacy leaders, pharmacists, and technician's perceptions towards the implementation of a pharmacy-based screening/intervention for the co-use of opioids and alcohol among patients.</div></div><div><h3>Methods</h3><div>We conducted a multi-method study that included one-time key informant interviews combined with a close-ended survey to inform our understanding of pharmacy system/practice-level barriers and facilitators for universal screening and intervention. Participants were recruited from Utah and Tennessee and were required to have active employment as pharmacy leaders, pharmacists, or technicians, be English-speaking, and believe they could provide feedback regarding co-use screening and intervention within community pharmacies. Interviews used the Consolidated Framework for Implementation Research and the Organizational Readiness for Implementing Change assessment. Qualitative analysis included both inductive and deductive coding. Themes followed a cycle of open, initial coding whereby codes were derived inductively from the data.</div></div><div><h3>Results</h3><div>Themes from interviews (<em>N</em> = 68) included a) emphasizing a need to overcome the stigma associated with patients who engage in co-use and a mindset shift to treat the challenges and risks associated, b) need for corporate-level support, management buy-in, and c) appropriate technology to support the workflow including system-wide changes to support the integration of medication therapy management services within community pharmacies. However, barriers were offset by pharmacists eager to understand their role in screening patients and reiterated a focus on patient-centered care to achieve this goal.</div><div>From the ORIC assessment, 75 % (<em>n</em> = 51) of respondents reported that community pharmacy staff wanted to implement the screening and intervention, and 69.1 % (<em>n</em> = 47) reported motivation to implement the screening and intervention. Finally, 67.6 % (<em>n</em> = 46) felt that community pharmacies are committed to implementing the screening and intervention, but only 10.3 % (<em>n</em> = 7) expressed strong support to do “whatever it takes” to implement the screening and intervention.</div></div><div><h3>Conclusion</h3><div>These results provide critical insights into implementation strategies for the adoption of brief intervention by community pharmacists. These data are foundational to developing strategies for a powered trial and possible future system/practice-level implementation of universal alcohol screening and intervention for co-use.</div></d
在处方阿片类药物的患者中,过量使用酒精是一个重要的风险。社区药房作为一种预防和解决共同使用的资源未得到充分利用。促进或阻碍在阿片类药物配药时采用普遍酒精筛查和干预措施的障碍和促进因素尚不清楚。我们评估了社区药房领导、药剂师和技术人员对阿片类药物和酒精在患者中共同使用的基于药物的筛查/干预实施的看法。方法:我们进行了一项多方法研究,包括一次性关键信息提供者访谈和封闭式调查,以了解我们对药房系统/实践层面的障碍和促进普遍筛查和干预的因素的理解。参与者从犹他州和田纳西州招募,要求他们积极就业,担任药房领导,药剂师或技术人员,会说英语,并相信他们可以就社区药房的共同使用筛选和干预提供反馈。访谈使用了实施研究的统一框架和实施变更评估的组织准备情况。定性分析包括归纳编码和演绎编码。主题遵循一个开放的初始编码循环,代码从数据中归纳出来。结果:访谈的主题(N = 68)包括:a)强调需要克服与参与共同用药的患者相关的污名,以及心态转变,以应对相关的挑战和风险;b)需要企业层面的支持,管理层的支持;c)适当的技术来支持工作流程,包括系统范围的改变,以支持社区药房内药物治疗管理服务的整合。然而,药剂师渴望了解他们在筛查患者中的作用,并重申了以患者为中心的护理重点,以实现这一目标,从而抵消了障碍。ORIC评估显示,75% % (n = 51)的受访者表示社区药房工作人员希望实施筛查和干预,69.1 % (n = 47)的受访者表示有实施筛查和干预的动机。最后,67.6% % (n = 46)认为社区药房致力于实施筛查和干预,但只有10.3 % (n = 7)表示强烈支持“不惜一切代价”实施筛查和干预。结论:这些结果为社区药师采用简短干预的实施策略提供了重要的见解。这些数据是制定战略的基础,以进行有力的试验,并可能在未来的系统/实践层面实施普遍酒精筛查和干预以供共同使用。
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Journal of substance use and addiction treatment
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