Pub Date : 2026-02-01DOI: 10.1016/j.josat.2026.209907
Amanda I. Aguila Gonzalez , Elizabeth Ablah
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.
{"title":"Understanding health literacy and perceptions of substance use disorder among racial and ethnic minority communities: Insights from the health belief model","authors":"Amanda I. Aguila Gonzalez , Elizabeth Ablah","doi":"10.1016/j.josat.2026.209907","DOIUrl":"10.1016/j.josat.2026.209907","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>Semi-structured, one-hour qualitative interviews were conducted virtually or by phone with participants from each racial/ethnic community.</div></div><div><h3>Results</h3><div>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 “<em>dependence,</em>” a “<em>lack of control,</em>” 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.</div></div><div><h3>Conclusion</h3><div>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.</div><div>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.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209907"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115129","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}
Pub Date : 2026-01-31DOI: 10.1016/j.josat.2026.209910
Megan E Hamm, Ramona Emerson, Shari S Rogal, Hailey W Bulls, Shannon M Nugent, Alana Anderson, Samantha Nash, Melessa Salay, Erin L Winstanley, Flor de Abril Cameron, William DeMonte, Promiti Debi, Brian Chan, Eric Weintraub, Rachel L Bachrach, Dorothy van Oppen, Karlyn A Edwards, Jessica S Merlin
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.
{"title":"Tailoring of a chronic pain self-management intervention for individuals with opioid use disorder in office-based addiction treatment.","authors":"Megan E Hamm, Ramona Emerson, Shari S Rogal, Hailey W Bulls, Shannon M Nugent, Alana Anderson, Samantha Nash, Melessa Salay, Erin L Winstanley, Flor de Abril Cameron, William DeMonte, Promiti Debi, Brian Chan, Eric Weintraub, Rachel L Bachrach, Dorothy van Oppen, Karlyn A Edwards, Jessica S Merlin","doi":"10.1016/j.josat.2026.209910","DOIUrl":"https://doi.org/10.1016/j.josat.2026.209910","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209910"},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108984","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}
Pub Date : 2026-01-30DOI: 10.1016/j.josat.2026.209908
Anna A Ilyasova, Frederick L Altice, Dinara Madybaeva, Ainura Kurmanalieva, Natalya Shumskaya, Daniel J Bromberg, Jin Hee Kim, David Oliveros, Lynn M Madden
<p><strong>Background: </strong>Opioid agonist therapy, including methadone, is an evidence-based practice for treating opioid use disorder and preventing HIV. Yet in Kyrgyzstan, methadone coverage among people who inject drugs (PWID) remains suboptimal despite decades of availability. A human-centered design lens and implementation science frameworks guided exploration of multi-level barriers and potential strategies to increase opioid agonist therapy uptake.</p><p><strong>Methods: </strong>In June-July 2023, a pre-implementation study was conducted in three high-burden regions (Bishkek, Chuy, Osh), following the exploration phase of the Exploration-Preparation-Implementation-Sustain framework. We used nominal group technique to conduct six focus groups stratified by methadone use (clients vs. non-clients) with 52 PWID. Participants generated and rank-ordered barriers to methadone scale-up. Analyses applied the Socio-Ecological Model, and identified barriers were mapped to discrete and blended implementation strategies via the Expert Recommendations for Implementing Change framework.</p><p><strong>Results: </strong>Participants identified 25 distinct barriers across individual, interpersonal, clinic, community, and policy levels. The four highest-ranked barriers were: (1) fear of consequences from narcological registration (e.g., driver's license revocation, employment discrimination); (2) perceived poor quality or diluted methadone, especially among clients who associated symptoms of withdrawal with low-dose variability; (3) structural inconveniences in methadone programs, such as rigid dosing schedules and lack of geographic access; and (4) insufficient medical, psychosocial, and socioeconomic support services at clinics. Stigma permeated across socioecological model levels-participants described judgment from family, community members, peers, and healthcare providers. Participants not on methadone commonly endorsed misinformation about methadone's side effects (e.g., harmful consequences, dental decay). Region-specific variations were pronounced: for example, registration concerns predominated in Osh, while program inconvenience was more salient in Chuy. Participants proposed client-driven solutions, including eliminating narcology registration, expanding take-home dosing, enhancing transparency in dosing practices, offering additional support services, and promoting success stories from current clients. Proposed solutions aligned with Expert Recommendations for Implementing Change strategies, including altering incentive structures, conducting educational outreach, revising professional roles, and facilitating client-centered care redesign.</p><p><strong>Conclusions: </strong>Applying human-centered design within implementation science frameworks identified context-specific barriers and actionable strategies. Addressing these client-prioritized challenges may be essential to improving methadone retention and could contribute to reducing HIV
{"title":"Exploring multi-level barriers and human-centered solutions to expand methadone for HIV prevention among people who inject drugs in Kyrgyzstan.","authors":"Anna A Ilyasova, Frederick L Altice, Dinara Madybaeva, Ainura Kurmanalieva, Natalya Shumskaya, Daniel J Bromberg, Jin Hee Kim, David Oliveros, Lynn M Madden","doi":"10.1016/j.josat.2026.209908","DOIUrl":"10.1016/j.josat.2026.209908","url":null,"abstract":"<p><strong>Background: </strong>Opioid agonist therapy, including methadone, is an evidence-based practice for treating opioid use disorder and preventing HIV. Yet in Kyrgyzstan, methadone coverage among people who inject drugs (PWID) remains suboptimal despite decades of availability. A human-centered design lens and implementation science frameworks guided exploration of multi-level barriers and potential strategies to increase opioid agonist therapy uptake.</p><p><strong>Methods: </strong>In June-July 2023, a pre-implementation study was conducted in three high-burden regions (Bishkek, Chuy, Osh), following the exploration phase of the Exploration-Preparation-Implementation-Sustain framework. We used nominal group technique to conduct six focus groups stratified by methadone use (clients vs. non-clients) with 52 PWID. Participants generated and rank-ordered barriers to methadone scale-up. Analyses applied the Socio-Ecological Model, and identified barriers were mapped to discrete and blended implementation strategies via the Expert Recommendations for Implementing Change framework.</p><p><strong>Results: </strong>Participants identified 25 distinct barriers across individual, interpersonal, clinic, community, and policy levels. The four highest-ranked barriers were: (1) fear of consequences from narcological registration (e.g., driver's license revocation, employment discrimination); (2) perceived poor quality or diluted methadone, especially among clients who associated symptoms of withdrawal with low-dose variability; (3) structural inconveniences in methadone programs, such as rigid dosing schedules and lack of geographic access; and (4) insufficient medical, psychosocial, and socioeconomic support services at clinics. Stigma permeated across socioecological model levels-participants described judgment from family, community members, peers, and healthcare providers. Participants not on methadone commonly endorsed misinformation about methadone's side effects (e.g., harmful consequences, dental decay). Region-specific variations were pronounced: for example, registration concerns predominated in Osh, while program inconvenience was more salient in Chuy. Participants proposed client-driven solutions, including eliminating narcology registration, expanding take-home dosing, enhancing transparency in dosing practices, offering additional support services, and promoting success stories from current clients. Proposed solutions aligned with Expert Recommendations for Implementing Change strategies, including altering incentive structures, conducting educational outreach, revising professional roles, and facilitating client-centered care redesign.</p><p><strong>Conclusions: </strong>Applying human-centered design within implementation science frameworks identified context-specific barriers and actionable strategies. Addressing these client-prioritized challenges may be essential to improving methadone retention and could contribute to reducing HIV ","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209908"},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100609","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}
Pub Date : 2026-01-27DOI: 10.1016/j.josat.2026.209893
Leslie W. Suen , Elyssa Samayoa , Matthew A. Spinelli , Maia Scarpetta , Kelly R. Knight , Julia Chael , Christine S. Soran , Michelle Geier , Hannah R. Snyder , Phillip O. Coffin
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.
{"title":"“It's like scratching at the door”: Experiences of outpatient buprenorphine low dose initiation among people using fentanyl","authors":"Leslie W. Suen , Elyssa Samayoa , Matthew A. Spinelli , Maia Scarpetta , Kelly R. Knight , Julia Chael , Christine S. Soran , Michelle Geier , Hannah R. Snyder , Phillip O. Coffin","doi":"10.1016/j.josat.2026.209893","DOIUrl":"10.1016/j.josat.2026.209893","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>To identify barriers and facilitators to successful LDI completion and inform strategies to improve outpatient buprenorphine treatment.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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 (<em>e.g.</em>, gift cards for completing LDI), environmental restructuring (<em>e.g.</em>, temporary housing or comfort spaces for LDI), behavior modeling (<em>e.g.</em>, peer coaches), and enablement (<em>e.g.</em>, 24/7 phone lines for patients to call) most directly addressing this barrier category.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209893"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088085","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}
Pub Date : 2026-01-27DOI: 10.1016/j.josat.2026.209899
Davida M Schiff, Alexindra Wheeler, Daniel Lewis, Mishka Terplan, Shelly F Greenfield, Jessica R Gray, Elizabeth E Krans, Marcela C Smid, Frankie Kropp, John T Winhusen
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.
{"title":"Association between pregnancy intention and postpartum contraceptive interest among pregnant people with opioid use disorder.","authors":"Davida M Schiff, Alexindra Wheeler, Daniel Lewis, Mishka Terplan, Shelly F Greenfield, Jessica R Gray, Elizabeth E Krans, Marcela C Smid, Frankie Kropp, John T Winhusen","doi":"10.1016/j.josat.2026.209899","DOIUrl":"https://doi.org/10.1016/j.josat.2026.209899","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209899"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088183","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}
Pub Date : 2026-01-23DOI: 10.1016/j.josat.2026.209891
Nathan W. Koranda , Jeremiah Fairbanks , Sheila Specker , Julie M. Krupa , Jaymie Mark , Christine Klein , Breanna Barrett , Esther (Seol Ju) Moon , Brandon A. Knettel
Introduction
The Minnesota Addiction Recovery Initiative (MARI) Safe Station program, launched in April 2023, provides a self-referral pathway for individuals with substance use disorders, including opioid use disorder. Operating through a coalition of government and community organizations, MARI Safe Station uses fire stations as access points for immediate support provided by certified peer recovery specialists (CPRSs). The program also emphasizes community outreach and harm-reduction efforts such as distributing naloxone and other supplies and delivering training to reduce provider stigma. In this study, we report early data on program engagement and perspectives of personnel involved in implementation.
Methods
Program participants could enter a fire station, where a CPRS performed comprehensive substance use assessment and made referrals for treatment needs. We obtained descriptive data from Safe Station participants at intake, including demographics and recovery needs. We collected additional mixed-methods data from program personnel, including qualitative interviews (n = 28) and one group interview (n = 3) to understand perspectives on the program, and a brief evaluation of attitudes toward opioid use disorder before and after an educational session.
Results
During the 18-month data collection period, 174 individuals completed the MARI Safe Station intake and screening process. Clients were demographically diverse and presented with housing instability, barriers to recovery, and substance use. Program personnel expressed programmatic strengths such as accessibility and scalability, while noting challenges including staff turnover, communication gaps, and concerns for long-term sustainability. The educational session led to a modest reduction in provider stigma, which should be interpreted with caution given the small and unpaired samples.
Conclusions
Preliminary findings highlight MARI Safe Station's ability to provide accessible, equitable addiction recovery services and reduce stigma, while identifying areas for continued improvement as the program evolves.
{"title":"Program personnel perspectives and outcomes of the Minnesota Addiction Recovery Initiative (MARI) Safe Station program: A fire station-based substance use deflection program","authors":"Nathan W. Koranda , Jeremiah Fairbanks , Sheila Specker , Julie M. Krupa , Jaymie Mark , Christine Klein , Breanna Barrett , Esther (Seol Ju) Moon , Brandon A. Knettel","doi":"10.1016/j.josat.2026.209891","DOIUrl":"10.1016/j.josat.2026.209891","url":null,"abstract":"<div><h3>Introduction</h3><div>The Minnesota Addiction Recovery Initiative (MARI) Safe Station program, launched in April 2023, provides a self-referral pathway for individuals with substance use disorders, including opioid use disorder. Operating through a coalition of government and community organizations, MARI Safe Station uses fire stations as access points for immediate support provided by certified peer recovery specialists (CPRSs). The program also emphasizes community outreach and harm-reduction efforts such as distributing naloxone and other supplies and delivering training to reduce provider stigma. In this study, we report early data on program engagement and perspectives of personnel involved in implementation.</div></div><div><h3>Methods</h3><div>Program participants could enter a fire station, where a CPRS performed comprehensive substance use assessment and made referrals for treatment needs. We obtained descriptive data from Safe Station participants at intake, including demographics and recovery needs. We collected additional mixed-methods data from program personnel, including qualitative interviews (<em>n</em> = 28) and one group interview (<em>n</em> = 3) to understand perspectives on the program, and a brief evaluation of attitudes toward opioid use disorder before and after an educational session.</div></div><div><h3>Results</h3><div>During the 18-month data collection period, 174 individuals completed the MARI Safe Station intake and screening process. Clients were demographically diverse and presented with housing instability, barriers to recovery, and substance use. Program personnel expressed programmatic strengths such as accessibility and scalability, while noting challenges including staff turnover, communication gaps, and concerns for long-term sustainability. The educational session led to a modest reduction in provider stigma, which should be interpreted with caution given the <strong>s</strong>mall and unpaired samples.</div></div><div><h3>Conclusions</h3><div>Preliminary findings highlight MARI Safe Station's ability to provide accessible, equitable addiction recovery services and reduce stigma, while identifying areas for continued improvement as the program evolves.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209891"},"PeriodicalIF":1.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047522","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}
Pub Date : 2026-01-22DOI: 10.1016/j.josat.2026.209900
Kanya K. Shah , Sarah Messmer , Abigail Elmes-Patel , Daniel R. Touchette
Background
The University of Illinois Chicago (UIC) Community Outreach Intervention Project (COIP) established a low-threshold mobile medical unit that is among the first to carry and dispense buprenorphine on-site at point of care in Chicago neighborhoods with high opioid overdose rates. A deeper understanding of the mobile medical unit implementation and operation costs is needed to inform sustainability and financial planning for healthcare systems across the country. This study measured the implementation, operation, and indirect patient costs of the UIC COIP mobile medical unit.
Methods
We conducted three analyses to determine start-up, direct fixed operating, direct variable operating, and indirect costs of the UIC COIP mobile medical unit. (1) Micro-costing of administrative purchasing records and on-site time-motion studies determined operation costs. (2) Interviews with staff and providers identified resources and time invested in implementation, and supplemented time-motion observations. (3) Interviews with patients collected indirect costs (i.e. transportation time/cost, missed commitments, perceived alternatives). Additionally, we conducted sensitivity analyses to assess uncertainty in resources used, costs, and mobile medical unit operation assumptions.
Results
The startup costs for a mobile medical unit with buprenorphine dispensing capabilities were $148,690, including buildout, supplies, and labor. Annual fixed operating costs were $131,040, encompassing vehicle operations (i.e. fuel, maintenance) and resources for medical operations (i.e. cellular network, urine testing). Variable operating costs included patient care cost of $85.24 per patient, and aggregate salaries for staff on the mobile medical unit, which were $1082 per day. Indirect patient costs were assessed in 30 individuals; the average transportation time to the care site was 35 min, most individuals did not miss other obligations to present for care, and 40% of individuals would not seek care elsewhere if the mobile unit was not available.
Conclusion
We report start-up and operation costs of a mobile medical unit that provides care and on-site buprenorphine dispensing in Chicago neighborhoods with high need. Understanding the implementation and operation costs of a low-threshold mobile medical unit is imperative to justify the continuation and expansion, as well as inform future research assessing the value and cost-effectiveness of such an intervention for the health system and community.
{"title":"Economic analysis of a low-threshold mobile medical unit dispensing buprenorphine for opioid use disorder","authors":"Kanya K. Shah , Sarah Messmer , Abigail Elmes-Patel , Daniel R. Touchette","doi":"10.1016/j.josat.2026.209900","DOIUrl":"10.1016/j.josat.2026.209900","url":null,"abstract":"<div><h3>Background</h3><div>The University of Illinois Chicago (UIC) Community Outreach Intervention Project (COIP) established a low-threshold mobile medical unit that is among the first to carry and dispense buprenorphine on-site at point of care in Chicago neighborhoods with high opioid overdose rates. A deeper understanding of the mobile medical unit implementation and operation costs is needed to inform sustainability and financial planning for healthcare systems across the country. This study measured the implementation, operation, and indirect patient costs of the UIC COIP mobile medical unit.</div></div><div><h3>Methods</h3><div>We conducted three analyses to determine start-up, direct fixed operating, direct variable operating, and indirect costs of the UIC COIP mobile medical unit. (1) Micro-costing of administrative purchasing records and on-site time-motion studies determined operation costs. (2) Interviews with staff and providers identified resources and time invested in implementation, and supplemented time-motion observations. (3) Interviews with patients collected indirect costs (i.e. transportation time/cost, missed commitments, perceived alternatives). Additionally, we conducted sensitivity analyses to assess uncertainty in resources used, costs, and mobile medical unit operation assumptions.</div></div><div><h3>Results</h3><div>The startup costs for a mobile medical unit with buprenorphine dispensing capabilities were $148,690, including buildout, supplies, and labor. Annual fixed operating costs were $131,040, encompassing vehicle operations (i.e. fuel, maintenance) and resources for medical operations (i.e. cellular network, urine testing). Variable operating costs included patient care cost of $85.24 per patient, and aggregate salaries for staff on the mobile medical unit, which were $1082 per day. Indirect patient costs were assessed in 30 individuals; the average transportation time to the care site was 35 min, most individuals did not miss other obligations to present for care, and 40% of individuals would not seek care elsewhere if the mobile unit was not available.</div></div><div><h3>Conclusion</h3><div>We report start-up and operation costs of a mobile medical unit that provides care and on-site buprenorphine dispensing in Chicago neighborhoods with high need. Understanding the implementation and operation costs of a low-threshold mobile medical unit is imperative to justify the continuation and expansion, as well as inform future research assessing the value and cost-effectiveness of such an intervention for the health system and community.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209900"},"PeriodicalIF":1.9,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042229","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}
Pub Date : 2026-01-21DOI: 10.1016/j.josat.2026.209888
John Moore , Tanya Renn , Christopher Veeh , Sara Beeler
Introduction
Opioid use and opioid use disorder (OUD) are prevalent among persons with legal system involvement. Medications for opioid use disorder (MOUD) are recommended for treatment, yet access is limited for legal-involved populations. In outpatient treatment settings, persons with legal-system involvement are less likely to receive MOUD. However, the influence of the type of legal system involvement on MOUD access is understudied. The purpose of this study was to examine if MOUD receipt differs by the type of legal system referral among adults referred to outpatient treatment by the legal system.
Methods
Data came from the 2021–2022 Treatment Episode Dataset-Admissions (TEDS-A). The sample included 32,213 legal-involved adult admissions to outpatient treatment for primary opioid use. The independent variable was the type of legal system referral; court/diversionary program, probation or parole, prison, or other. The outcome was whether MOUD was included in the treatment plan. Covariates included the following sociodemographic, substance use, and treatment-related variables: sex, age, race/ethnicity, education, employment, living arrangement, prior substance use treatment, co-occurring mental disorder, type of opioid use, attendance of a substance use self-help group, outpatient treatment type, injection drug use, past-month arrest, and past-month opioid use frequency. Multivariable logistic regression was used to examine associations of referral type with MOUD, adjusting for sociodemographic, substance use, and treatment-related covariates.
Results
Compared to court/diversionary referral, probation or parole referral (AOR = 0.80, 95% CI = 0.76–0.85), prison referral (AOR = 0.85, 95% CI = 0.76–0.94) and other referral (AOR = 0.42, 95% CI = 0.39–0.46) were each associated with lower odds of MOUD when adjusting for covariates. Use of other opioid analgesics and synthetic opioids was associated with lower odds of MOUD than heroin use (AOR = 0.48, 95% CI = 0.46–0.51).
Conclusions
MOUD access in the community varies by the type of legal system referral. To inform MOUD community linkage policies and practices, research is needed to identify gaps in referral processes for specific legal system institutions. Examining how opioid use behavior characteristics impact MOUD community linkage is an appropriate next step for future research.
阿片类药物使用和阿片类药物使用障碍（OUD）在涉及法律系统的人群中普遍存在。阿片类药物使用障碍（mod）的药物被推荐用于治疗，但法律相关人群获得药物的机会有限。在门诊治疗设置中，有法律系统参与的人不太可能接受mod。然而，法律制度参与类型对mod获取的影响尚未得到充分研究。本研究的目的是检查是否mod收据不同类型的法律系统转诊的成年人转诊到门诊治疗的法律系统。方法：数据来自2021-2022年治疗期数据集-入院（TEDS-A）。样本包括32213名因主要使用阿片类药物而接受门诊治疗的合法成年人。自变量是法律系统转诊的类型；法庭/转移，缓刑或假释，监狱，或其他。结果是mod是否被纳入治疗计划。协变量包括以下社会人口学、物质使用和治疗相关变量：性别、年龄、种族/民族、教育、就业、生活安排、先前的物质使用治疗、共同发生的精神障碍、阿片类药物使用类型、参加物质使用自助小组、门诊治疗类型、注射药物使用、过去一个月的逮捕和过去一个月的阿片类药物使用频率。采用多变量logistic回归检验转诊类型与mod的关联，调整社会人口统计学和治疗相关协变量。结果:法院/转移注意力的转诊相比,缓刑或假释转诊(AOR = 0.80,95% CI = 0.76 - -0.85),监狱转诊(AOR = 0.85,95% CI = 0.76 - -0.94)和其他推荐(AOR = 0.42,95% CI = 0.39 - -0.46)均降低MOUD当协变量调整的几率。使用其他阿片类镇痛药和合成阿片类药物与使用海洛因相比，发生mod的几率更低（AOR = 0.48,95% CI = 0.46-0.51）。结论：社区的mod访问因法律系统转诊类型而异。为了为mod社区联系政策和实践提供信息，需要进行研究，以确定特定法律制度机构转诊过程中的差距。研究阿片类药物使用行为特征如何影响mod社区联系是未来研究的下一步。
{"title":"Differences in MOUD receipt by legal referral type in outpatient treatment","authors":"John Moore , Tanya Renn , Christopher Veeh , Sara Beeler","doi":"10.1016/j.josat.2026.209888","DOIUrl":"10.1016/j.josat.2026.209888","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid use and opioid use disorder (OUD) are prevalent among persons with legal system involvement. Medications for opioid use disorder (MOUD) are recommended for treatment, yet access is limited for legal-involved populations. In outpatient treatment settings, persons with legal-system involvement are less likely to receive MOUD. However, the influence of the type of legal system involvement on MOUD access is understudied. The purpose of this study was to examine if MOUD receipt differs by the type of legal system referral among adults referred to outpatient treatment by the legal system.</div></div><div><h3>Methods</h3><div>Data came from the 2021–2022 Treatment Episode Dataset-Admissions (TEDS-A). The sample included 32,213 legal-involved adult admissions to outpatient treatment for primary opioid use. The independent variable was the type of legal system referral; court/diversionary program, probation or parole, prison, or other. The outcome was whether MOUD was included in the treatment plan. Covariates included the following sociodemographic, substance use, and treatment-related variables: sex, age, race/ethnicity, education, employment, living arrangement, prior substance use treatment, co-occurring mental disorder, type of opioid use, attendance of a substance use self-help group, outpatient treatment type, injection drug use, past-month arrest, and past-month opioid use frequency. Multivariable logistic regression was used to examine associations of referral type with MOUD, adjusting for sociodemographic, substance use, and treatment-related covariates.</div></div><div><h3>Results</h3><div>Compared to court/diversionary referral, probation or parole referral (AOR = 0.80, 95% CI = 0.76–0.85), prison referral (AOR = 0.85, 95% CI = 0.76–0.94) and other referral (AOR = 0.42, 95% CI = 0.39–0.46) were each associated with lower odds of MOUD when adjusting for covariates. Use of other opioid analgesics and synthetic opioids was associated with lower odds of MOUD than heroin use (AOR = 0.48, 95% CI = 0.46–0.51).</div></div><div><h3>Conclusions</h3><div>MOUD access in the community varies by the type of legal system referral. To inform MOUD community linkage policies and practices, research is needed to identify gaps in referral processes for specific legal system institutions. Examining how opioid use behavior characteristics impact MOUD community linkage is an appropriate next step for future research.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209888"},"PeriodicalIF":1.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042216","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}
Pub Date : 2026-01-21DOI: 10.1016/j.josat.2026.209902
Elizabeth Charron , Amanda A. Allshouse , Casey Tak , Kristine A. Campbell , Adam J. Gordon , Gerald Cochran , Marcela C. Smid
Introduction
Opioid use disorder (OUD) exists in approximately 1% of US pregnancies and is associated with increased risk of severe maternal morbidity and mortality. Many pregnant individuals with OUD also have a stimulant use disorder (StUD), but it is unclear whether this co-occurring condition changes the types of treatment services they receive. We compared treatment services received during pregnancy between individuals with both OUD and StUD and those only with OUD.
Methods
A retrospective cohort study used 2014–2017 data from the Utah All-Payer Claims Database. The sample included pregnancies ≥20 weeks' gestation among individuals aged 15–49 years with ≥4 weeks of insurance enrollment and excluded pregnancies with outcome events occurring <28 weeks after the estimated conception date. Identification of OUD and StUD relied on ICD-9/10 diagnosis codes. Outcomes were receipt of (1) medication for OUD (MOUD; formulations of buprenorphine or methadone administration), (2) outpatient psychosocial services (evaluation and management/assessment services and psychotherapy/counseling or other psychosocial visits), and (3) higher-intensity treatment (intensive outpatient, partial hospitalization, or residential treatment). Logistic generalized estimating equation models, adjusted for demographic and clinical covariates, estimated odds of receiving each service and any service overall.
Results
Among 146,239 insurance beneficiaries, we identified 1206 pregnancies with OUD, including 305 (25.3%) with co-occurring StUD and 901 (74.7%) only with OUD. Pregnant individuals with StUD and OUD compared to those only with OUD had lower odds of receiving MOUD (adjusted odds ratio [aOR], 0.68; 95% CI, 0.48–0.96) and higher odds of receiving psychotherapy/counseling or other psychosocial visits (aOR, 2.73; 95% CI, 2.01–3.71) and higher-intensity treatment (aOR, 3.47; 95% CI, 1.58–7.59). There were no differences between groups in receipt of evaluation and management/assessment services (aOR, 0.97; 95% CI, 0.83–1.14) or of any treatment service overall (aOR, 1.07; 95% CI, 0.94–1.21).
Conclusions
In this sample of Utah insurance beneficiaries, pregnant individuals with co-occurring StUD and OUD were less likely to receive MOUD and more likely to receive psychosocial and higher-intensity services than those only with OUD.
{"title":"Treatment of opioid use disorder in pregnancy among individuals with and without co-occurring stimulant use disorder: A retrospective cohort study","authors":"Elizabeth Charron , Amanda A. Allshouse , Casey Tak , Kristine A. Campbell , Adam J. Gordon , Gerald Cochran , Marcela C. Smid","doi":"10.1016/j.josat.2026.209902","DOIUrl":"10.1016/j.josat.2026.209902","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid use disorder (OUD) exists in approximately 1% of US pregnancies and is associated with increased risk of severe maternal morbidity and mortality. Many pregnant individuals with OUD also have a stimulant use disorder (StUD), but it is unclear whether this co-occurring condition changes the types of treatment services they receive. We compared treatment services received during pregnancy between individuals with both OUD and StUD and those only with OUD.</div></div><div><h3>Methods</h3><div>A retrospective cohort study used 2014–2017 data from the Utah All-Payer Claims Database. The sample included pregnancies ≥20 weeks' gestation among individuals aged 15–49 years with ≥4 weeks of insurance enrollment and excluded pregnancies with outcome events occurring <28 weeks after the estimated conception date. Identification of OUD and StUD relied on ICD-9/10 diagnosis codes. Outcomes were receipt of (1) medication for OUD (MOUD; formulations of buprenorphine or methadone administration), (2) outpatient psychosocial services (evaluation and management/assessment services and psychotherapy/counseling or other psychosocial visits), and (3) higher-intensity treatment (intensive outpatient, partial hospitalization, or residential treatment). Logistic generalized estimating equation models, adjusted for demographic and clinical covariates, estimated odds of receiving each service and any service overall.</div></div><div><h3>Results</h3><div>Among 146,239 insurance beneficiaries, we identified 1206 pregnancies with OUD, including 305 (25.3%) with co-occurring StUD and 901 (74.7%) only with OUD. Pregnant individuals with StUD and OUD compared to those only with OUD had lower odds of receiving MOUD (adjusted odds ratio [aOR], 0.68; 95% CI, 0.48–0.96) and higher odds of receiving psychotherapy/counseling or other psychosocial visits (aOR, 2.73; 95% CI, 2.01–3.71) and higher-intensity treatment (aOR, 3.47; 95% CI, 1.58–7.59). There were no differences between groups in receipt of evaluation and management/assessment services (aOR, 0.97; 95% CI, 0.83–1.14) or of any treatment service overall (aOR, 1.07; 95% CI, 0.94–1.21).</div></div><div><h3>Conclusions</h3><div>In this sample of Utah insurance beneficiaries, pregnant individuals with co-occurring StUD and OUD were less likely to receive MOUD and more likely to receive psychosocial and higher-intensity services than those only with OUD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209902"},"PeriodicalIF":1.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015552","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}
Pub Date : 2026-01-20DOI: 10.1016/j.josat.2026.209889
Katharine L. Thomas , Anka A. Vujanovic , Michael J. Zvolensky , Tanya Smit , Julia D. Buckner
Background and objectives
Posttraumatic stress symptoms are related to higher rates of heavy episodic drinking (HED). Given that women are at higher risk for posttraumatic stress symptoms and long-term health effects from HED, identification of factors related to HED among women with posttraumatic stress symptoms could have important implications for prevention and treatment. One such factor is romantic relationship impairment given the association between posttraumatic stress and greater relationship conflict. Further, women, but not men, are more likely to drink in heavy quantities when experiencing relationship difficulties. Thus, it may be that for women, but not men, PTSD is related to heavier drinking via relationship impairment.
Method
This study tested whether sex moderated the indirect effect of posttraumatic stress symptoms on HED through relationship impairment among 319 community-recruited adults with probable PTSD who endorsed current hazardous alcohol use and were living with a romantic partner and/or married.
Results
Posttraumatic stress symptoms were positively correlated with HED and relationship impairment. The indirect effect of posttraumatic stress symptoms on HED through relationship impairment was moderated by sex, such that posttraumatic stress symptoms were related to HED indirectly via relationship impairment for women, but not men.
Discussion and conclusions
Results highlight the importance of considering sex to better understand the role of posttraumatic stress symptoms on HED. Failure to consider sex could obfuscate the impact of factors relevant to women.
Scientific significance
This is the first known study to examine the differential relations between posttraumatic stress, romantic relationship impairment, and HED by sex.
{"title":"The role of relationship impairment on the link between posttraumatic stress severity and heavy episodic drinking varies by sex","authors":"Katharine L. Thomas , Anka A. Vujanovic , Michael J. Zvolensky , Tanya Smit , Julia D. Buckner","doi":"10.1016/j.josat.2026.209889","DOIUrl":"10.1016/j.josat.2026.209889","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Posttraumatic stress symptoms are related to higher rates of heavy episodic drinking (HED). Given that women are at higher risk for posttraumatic stress symptoms and long-term health effects from HED, identification of factors related to HED among women with posttraumatic stress symptoms could have important implications for prevention and treatment. One such factor is romantic relationship impairment given the association between posttraumatic stress and greater relationship conflict. Further, women, but not men, are more likely to drink in heavy quantities when experiencing relationship difficulties. Thus, it may be that for women, but not men, PTSD is related to heavier drinking via relationship impairment.</div></div><div><h3>Method</h3><div>This study tested whether sex moderated the indirect effect of posttraumatic stress symptoms on HED through relationship impairment among 319 community-recruited adults with probable PTSD who endorsed current hazardous alcohol use and were living with a romantic partner and/or married.</div></div><div><h3>Results</h3><div>Posttraumatic stress symptoms were positively correlated with HED and relationship impairment. The indirect effect of posttraumatic stress symptoms on HED through relationship impairment was moderated by sex, such that posttraumatic stress symptoms were related to HED indirectly via relationship impairment for women, but not men.</div></div><div><h3>Discussion and conclusions</h3><div>Results highlight the importance of considering sex to better understand the role of posttraumatic stress symptoms on HED. Failure to consider sex could obfuscate the impact of factors relevant to women.</div></div><div><h3>Scientific significance</h3><div>This is the first known study to examine the differential relations between posttraumatic stress, romantic relationship impairment, and HED by sex.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209889"},"PeriodicalIF":1.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031918","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}
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