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C2: editorial board C2:编辑委员会
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/S2949-8759(24)00212-1
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引用次数: 0
TOC (update) 技术选择委员会(更新)
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/S2949-8759(24)00213-3
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引用次数: 0
Evaluating and identifying changes in the rate of unplanned discharge among Department of Veterans Affairs (VA) facilities providing substance use disorder residential care 评估并确定退伍军人事务部(VA)提供药物使用障碍住院治疗的机构中计划外出院率的变化情况
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/j.josat.2024.209514

Introduction

Quality improvement (QI) methods play a critical role in ensuring that patients receive high-quality and timely care. Healthcare systems should use valid and reliable measures to inform QI efforts. Mental health settings including substance use disorder (SUD) residential programs have been slow to develop and incorporate quality measurement into routine practice. Unplanned discharge is of particular concern because this event is associated with harm including suicide. Healthcare systems require criteria that they can use to operationalize unplanned discharge as a quality measure in SUD residential programs.

Methods

The study included all discharges from the Department of Veterans Affairs (VA) residential SUD programs between 2018 and 2022. The study calculated crude and adjusted rates of irregular discharge. The study used the first two years of observation (2018–2019) in a logistic regression model to determine the parameter estimates for three important covariates, age, risk for homelessness, and principal diagnosis. The study tested permutations of bin size (N) and days (D) per bin to identify a single set of parameters to enable small and large facilities to have sufficient power to detect out-of-control processes (i.e., significant worsening or improvement in rates). Aligned with standard nomenclature, the study calculated the control limits based on three standard deviations (SD). Values that fell above or below three SD were statistically significant.

Results

The cohort included 56 facilities (26,361 discharges). Irregular discharge was associated with younger age (18–40 years) and a principal diagnosis of a drug use disorder. Testing parameter values of 100 discharges (N) over 120 days (D) would yield enough power to detect modest relative changes to the irregular discharge rate for small and large facilities while testing frequently enough to make the evaluations temporally relevant. Because secular trends such as staff changes over time will impact results, the quality control method should allow for real-time feedback to those most proximal to the event.

Conclusions

The study created a set of parameters and a methodology that residential SUD programs can use to operationalize unplanned discharge locally. These data could assist programs in conducting QI work to address unplanned discharge and related harms.

导言质量改进(QI)方法在确保患者获得高质量和及时的护理方面发挥着至关重要的作用。医疗保健系统应使用有效、可靠的测量方法为 QI 工作提供依据。包括药物使用障碍(SUD)住院治疗项目在内的精神卫生机构在开发质量测量方法并将其纳入常规实践方面进展缓慢。计划外出院尤其值得关注,因为这一事件与包括自杀在内的伤害有关。医疗保健系统需要制定标准,以便将计划外出院作为 SUD 住院治疗项目的质量衡量标准。研究计算了非正常出院的粗略率和调整率。研究在逻辑回归模型中使用了前两年(2018-2019 年)的观察数据,以确定年龄、无家可归风险和主要诊断这三个重要协变量的参数估计。该研究测试了每个分区的分区大小(N)和天数(D)的排列组合,以确定一组参数,使小型和大型设施都有足够的能力检测失控过程(即比率的显著恶化或改善)。根据标准术语,该研究以三个标准差 (SD) 为基础计算控制限值。高于或低于三个标准差的数值具有统计学意义。非正常出院与年龄较小(18-40 岁)和主要诊断为吸毒障碍有关。在 120 天(D)内测试 100 次出院(N)的参数值,将产生足够的力量来检测小型和大型机构的非正常出院率的适度相对变化,同时测试频率也足以使评估具有时间相关性。由于随着时间的推移,人员变动等世俗趋势会对结果产生影响,因此质量控制方法应允许向最接近事件的人员提供实时反馈。这些数据可帮助项目开展质量改进工作,以解决计划外出院及相关危害问题。
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引用次数: 0
Barriers and facilitators to implementing treatment for opioid use disorder in community hospitals 社区医院实施阿片类药物使用障碍治疗的障碍和促进因素
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/j.josat.2024.209520

Introduction

Methadone and buprenorphine are effective treatment for opioid use disorder (OUD), yet they are vastly under-utilized across US hospitals. To inform a national trial assessing the effectiveness of implementation strategies to increase adoption of an inpatient hospital-based opioid treatment (HBOT) model (NCT04921787), we explored barriers and facilitators to expanding medication for opioid use disorder (MOUD) within community hospitals across the United States.

Methods

From November 2021 to March 2022, we used purposeful and snowball sampling to identify and interview participants involved in inpatient care of patients with OUD from twelve community hospitals. We conducted semi-structured interviews on providers' experiences and perspectives on current treatment approaches as well as potential influences on MOUD expansion in their hospitals. We used thematic analysis to identify key barriers and facilitators that could impact implementation of an HBOT model, and organized these findings based on the Consolidated Framework for Implementation Research (CFIR).

Results

From qualitative interviews with 57 participants (30 physicians, 7 pharmacists, 6 nurses, and 14 professionals involved in the care of patients with OUD), we identified key barriers and facilitators mapped to CFIR's internal and outer settings. The most salient inner setting domains included tension for change and relative priority, compatibility, available resources, organizational culture, access to knowledge and information, relational connections and communications, and information technology infrastructure. Outer setting domains included policies and laws, financing, and partnerships and connections.

Conclusions

Identifying potential barriers and facilitators can inform hospital-specific strategies to support implementation of HBOT. Implementation strategies that address barriers such as staff availability, knowledge, and attitudes may support increased HBOT adoption. On a broader scale, national policy changes such as increased financing and public reporting of quality metrics would address other barriers we identified and may also encourage hospitals to adopt HBOT models.

导言:美沙酮和丁丙诺啡是治疗阿片类药物使用障碍(OUD)的有效药物,但在美国医院中的使用率却非常低。为了为一项全国性试验提供信息,该试验评估了提高住院阿片类药物治疗(HBOT)模式采用率的实施策略的有效性(NCT04921787),我们探讨了在全美社区医院中扩大阿片类药物使用障碍(MOUD)药物治疗的障碍和促进因素。方法从 2021 年 11 月到 2022 年 3 月,我们采用有目的的滚雪球式抽样,确定并采访了 12 家社区医院中参与住院治疗 OUD 患者的参与者。我们进行了半结构化访谈,内容涉及医疗服务提供者的经验、对当前治疗方法的看法以及在其所在医院推广 MOUD 的潜在影响因素。结果通过对 57 名参与者(30 名医生、7 名药剂师、6 名护士和 14 名参与治疗 OUD 患者的专业人员)的定性访谈,我们确定了映射到 CFIR 内部和外部环境的关键障碍和促进因素。最突出的内部环境领域包括变革的压力和相对优先级、兼容性、可用资源、组织文化、知识和信息的获取、关系连接和沟通以及信息技术基础设施。外部环境领域包括政策和法律、融资以及合作伙伴关系和联系。针对员工可用性、知识和态度等障碍的实施策略可能有助于提高 HBOT 的采用率。在更广泛的范围内,国家政策的改变(如增加融资和公开报告质量指标)将解决我们发现的其他障碍,并可能鼓励医院采用 HBOT 模式。
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引用次数: 0
Levels and outcomes of 12-step participation among sexual and gender minority subgroups 性少数群体和性别少数群体参与 12 步计划的程度和结果。
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/j.josat.2024.209519

Introduction

Sexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes.

Methods

We used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately.

Results

Participants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model.

Conclusions

This study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

导言:与异性恋和双性恋(即非变性者)相比,性少数群体(如双性恋、男同性恋、女同性恋、同性恋者)和性别少数群体(如变性者、非二元性别者、性别扩张者)的酗酒和其他药物使用障碍发生率更高。在美国,12 步疗法是目前治疗酒精和其他药物使用相关问题的最常见方法。人们对 SGMI 参与 12 步计划的比例和水平以及结果知之甚少。本研究以终生患有酒精或其他药物使用障碍的 SGMI 为对象,旨在1)描述 SGMI 总体终生参加 12 步计划团体的比率(参加过与未参加过)和参与水平(计划活动次数),并比较不同性少数群体和性别少数群体身份的参加比率和参与水平;2)确定终生参加 12 步计划的水平与过去一年酗酒和其他药物使用结果之间的关系。 方法我们使用了 PRIDE 研究收集的数据,该研究是一项针对成年 SGMI 的全国性、大规模、纵向健康研究,使用补充问题来评估酗酒和其他药物使用障碍以及 12 步计划参与情况。以性取向和性别认同作为终生参加 12 步疗法(是/否)和 12 步疗法参与程度的预测因素,运行零膨胀负二项模型(N = 1353),以确定 12 步疗法参与程度越高,上一年酒精和药物使用障碍(AUD & SUD)症状越低。研究分别对终生患有 AUD(n = 1074)和 SUD(n = 659)的受访者进行了建模。结果参与 12 步疗法程度较高的受访者过去一年的 AUD 和 SUD 症状程度较低。与其他参与者相比,患有 AUD 的男同性恋和同性恋受访者更有可能参加过 12 步疗法项目,而患有 SUD 的女同性恋受访者参加过 12 步疗法项目的可能性较小。当年龄被添加到模型中时,性/性别认同与 12-步骤参与之间的所有其他关联都消失了。结论:本研究提供了初步证据,表明参与 12-步骤可能是减少 SGMI 中 AUD 和 SUD 症状的有效资源。年龄较小的 SGMI 和持有除男同性恋和同性恋以外的性/性别身份的 SGMI 可能需要额外的支持才能开始参与 12 步疗法项目。
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引用次数: 0
Naloxone vending machines in county jail 县监狱内的纳洛酮自动售货机。
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/j.josat.2024.209521

Introduction

The overdose epidemic in the United States has intensified following the introduction of illicitly manufactured fentanyl to drug markets with recent estimates indicating 110,000 deaths in 2022 and longer-term trends adversely impacting national life expectancy. A period of incarceration has been identified as a critical touchpoint for overdose prevention given its strong association with risk of overdose. In this paper we describe efforts funded by the Centers for Disease Control and Prevention (CDC) Overdose Data to Action (OD2A) grant to design and implement naloxone vending machines that provide free naloxone within county jails to returning citizens and those visiting county jail facilities.

Methods

This study utilized three sources of data. First, we describe the results of a pre-implementation survey administered by technical assistance providers to 18 jails across the state of Michigan. Second, among the 6 jail facilities that accepted a naloxone vending machine we examine administrative data from Michigan Department of Health and Human Services on naloxone orders to look at changes 6-months before and after implementation. Third and lastly, we conducted semi-structured interviews (N = 6) with jail administrators (i.e., County Sheriffs) on the barriers and facilitators to implementing a naloxone vending machine.

Results

Six facilities indicated they would accept a vending machine to distribute free naloxone. Overall, the total number of naloxone box orders that were distributed across all jail sites increased by 63.5 % from 4104 boxes pre-naloxone vending machine to 6708 boxes post-naloxone vending machine implementation. Qualitative interviews revealed that prior naloxone distribution efforts and foundational knowledge about opioids, overdose, and naloxone emerged as facilitators for vending machine implementation.

Conclusion

This study illustrates the utility of policy-driven funding strategies aimed at mitigating accidental overdose deaths among a high-risk population while building community naloxone saturation efforts.

引言 在非法制造的芬太尼进入毒品市场后,美国用药过量流行病愈演愈烈,最近的估计表明 2022 年将有 110,000 人死亡,长期趋势将对国民预期寿命产生不利影响。鉴于监禁期与用药过量风险的密切联系,监禁期已被确定为预防用药过量的关键接触点。在本文中,我们介绍了由美国疾病控制和预防中心 (CDC) 药物过量数据转化为行动 (OD2A) 补助金资助的设计和实施纳洛酮自动售货机的工作,该自动售货机可在县监狱内为归国公民和访问县监狱设施的人提供免费纳洛酮。首先,我们介绍了技术援助提供方对密歇根州 18 所监狱进行的实施前调查结果。其次,在接受纳洛酮自动售货机的 6 所监狱中,我们检查了密歇根州卫生与公众服务部关于纳洛酮订单的管理数据,以了解实施前后 6 个月的变化情况。第三也是最后一点,我们就实施纳洛酮自动售货机的障碍和促进因素对监狱管理人员(即县警长)进行了半结构化访谈(N = 6)。总体而言,所有监狱场所分发的纳洛酮盒订单总数增加了 63.5%,从使用纳洛酮自动售货机前的 4104 盒增加到使用纳洛酮自动售货机后的 6708 盒。定性访谈显示,之前的纳洛酮分发工作以及有关阿片类药物、用药过量和纳洛酮的基础知识成为自动售货机实施的促进因素。
{"title":"Naloxone vending machines in county jail","authors":"","doi":"10.1016/j.josat.2024.209521","DOIUrl":"10.1016/j.josat.2024.209521","url":null,"abstract":"<div><h3>Introduction</h3><p>The overdose epidemic in the United States has intensified following the introduction of illicitly manufactured fentanyl to drug markets with recent estimates indicating 110,000 deaths in 2022 and longer-term trends adversely impacting national life expectancy. A period of incarceration has been identified as a critical touchpoint for overdose prevention given its strong association with risk of overdose. In this paper we describe efforts funded by the Centers for Disease Control and Prevention (CDC) Overdose Data to Action (OD2A) grant to design and implement naloxone vending machines that provide free naloxone within county jails to returning citizens and those visiting county jail facilities.</p></div><div><h3>Methods</h3><p>This study utilized three sources of data. First, we describe the results of a pre-implementation survey administered by technical assistance providers to 18 jails across the state of Michigan. Second, among the 6 jail facilities that accepted a naloxone vending machine we examine administrative data from Michigan Department of Health and Human Services on naloxone orders to look at changes 6-months before and after implementation. Third and lastly, we conducted semi-structured interviews (<em>N</em> = 6) with jail administrators (i.e., County Sheriffs) on the barriers and facilitators to implementing a naloxone vending machine.</p></div><div><h3>Results</h3><p>Six facilities indicated they would accept a vending machine to distribute free naloxone. Overall, the total number of naloxone box orders that were distributed across all jail sites increased by 63.5 % from 4104 boxes pre-naloxone vending machine to 6708 boxes post-naloxone vending machine implementation. Qualitative interviews revealed that prior naloxone distribution efforts and foundational knowledge about opioids, overdose, and naloxone emerged as facilitators for vending machine implementation.</p></div><div><h3>Conclusion</h3><p>This study illustrates the utility of policy-driven funding strategies aimed at mitigating accidental overdose deaths among a high-risk population while building community naloxone saturation efforts.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180733","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
“I need as much support as I can get”: A qualitative study of young adult perspectives on family involvement in treatment for opioid use disorder "我需要尽可能多的支持":关于年轻成人对家庭参与阿片类药物使用障碍治疗的看法的定性研究
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-10 DOI: 10.1016/j.josat.2024.209512

Background

Opioid use disorder (OUD) among young adults (YAs) continues to persist as a national health crisis. Best practice recommendations for YA OUD treatment highlight the importance of medication for OUD (MOUD) and family involvement across the treatment services continuum for better treatment retention and outcomes. Yet, concerned significant others (CSOs) such as family members, romantic partners, and family-of-choice members are not routinely involved in OUD and MOUD treatment for YAs.

Method

We used convenience sampling to recruit 25 YAs (ages 21 to 36) in treatment for OUD from two urban treatment centers. We discussed with YAs the identities of their CSOs and the dynamics of those relationships, their perspectives on CSO involvement in their OUD treatment, and the beliefs and attitudes they hold about family involvement in treatment and recovery. Thematic content analysis was deductive-dominant based on a semi-structured qualitative interview guide. Group consensus coding was followed by matrix analysis.

Results

We identified five main themes: (1) YA and CSO relationships were supportive, evolving, and complex. (2) CSO support motivated treatment engagement and participation. (3) Only a small proportion of CSOs participated in treatment activities despite actively supporting treatment in other ways. (4) YAs experienced their CSOs as supportive of their treatment and recovery goals, including MOUD. (5) YAs believed family involvement is essential to treatment and many were unsatisfied with current family involvement in their care.

Conclusions

In this qualitative study of OUD treatment experiences among YAs, we learned that many YAs have CSOs who are invested in their treatment and recovery and yet are not routinely involved in treatment. Moreover, YAs often expressed family involvement is essential to OUD treatment, and many expressed a desire for greater family involvement in their own treatment. Clinical recommendations for relationship-oriented treatment are presented.

背景青壮年阿片类药物使用障碍(OUD)仍然是一个全国性的健康危机。针对青少年类阿片使用障碍治疗的最佳实践建议强调了药物治疗类阿片使用障碍(MOUD)和家庭参与整个治疗服务连续性的重要性,以获得更好的治疗效果。然而,相关的重要他人(CSOs),如家庭成员、恋爱伴侣和选择家庭的成员,并没有经常参与到对青少年的 OUD 和 MOUD 治疗中。方法我们采用便利抽样法,从两个城市的治疗中心招募了 25 名接受 OUD 治疗的青少年(21 至 36 岁)。我们与亚裔青少年讨论了他们的民间组织的身份和这些关系的动态,他们对民间组织参与其 OUD 治疗的看法,以及他们对家庭参与治疗和康复所持的信念和态度。在半结构化定性访谈指南的基础上,进行了以演绎为主的主题内容分析。结果我们确定了五大主题:(1)YA 和 CSO 的关系是支持性的、不断发展的和复杂的。(2) 民间组织的支持推动了治疗的介入和参与。(3) 尽管民间组织以其他方式积极支持治疗,但只有一小部分民间组织参与了治疗活动。(4)亚裔青少年认为他们的社区服务组织支持他们的治疗和康复目标,包括 MOUD。 (5)亚裔青少年认为家庭参与对治疗至关重要,许多亚裔青少年对目前家庭参与他们的治疗并不满意。结论 在这项关于亚裔青少年 OUD 治疗经历的定性研究中,我们了解到许多亚裔青少年的社区服务组织对他们的治疗和康复很投入,但并不经常参与治疗。此外,青年艾滋病患者经常表示,家庭参与对他们的治疗至关重要,许多人表示希望家庭能更多地参与他们的治疗。本文提出了以关系为导向的临床治疗建议。
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引用次数: 0
Racial and ethnic composition of peer recovery community members and barriers to acquiring funding for organizations in the ecosystem of recovery 同伴康复社区成员的种族和民族构成,以及康复生态系统中的组织在获取资金方面的障碍。
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-07 DOI: 10.1016/j.josat.2024.209516

Introduction

Organizations in the “ecosystem of recovery”—most often non-profits led and staffed by individuals with lived substance use disorder (SUD) experience—offer peer services, group counseling, and a wide variety of programs to help those struggling with SUD. The efforts of such organizations are effective in transitioning those suffering from SUD into long-term recovery. Despite well-established evidence depicting inequitable access to SUD treatment between BIPOC and non-Hispanic White Americans, there has been no empirical undertaking of whether organizations in the ecosystem of recovery face barriers to fund their operations based on the racial and ethnic composition of their community members.

Methods

In this 2022 needs assessment, “Optimizing Recovery Funding,” we combined the results of quantitative and qualitative data for a mixed methods analytic approach. The study employs bivariate descriptive statistics and inferences along with thematic analyses. From an initial list of 537 organizations across U.S. states and territories, 145 leaders of these organizations comprise our survey analytic sample. A total of 85 leaders participated in one of 16 focus groups, with 10 based on geography and 6 based on population identity. This needs assessment produced comprehensive data on the operations of organizations in the ecosystem of recovery.

Results

A lack of training and existing organizational funding, as well as non-inclusive language in funding requests for proposals contributed to some organizations' decisions not to pursue certain grants and funding mechanisms. There were no statistical differences in applying for, nor success in receiving, federal and state funding between organizations serving predominantly BIPOC community members and those serving mostly non-Hispanic White community members. However, there were key instances of—at times inexplicable—inequity in funding outcomes.

Conclusions

All leaders of organizations in the ecosystem of recovery who participated in the needs assessment made it clear that there are fundamental issues to accessing peer recovery operational and programmatic funding. Innovative strategies for developing inclusive and culturally responsive funding approaches that prioritize organizations predominantly serving historically marginalized communities are needed.

导言:处于 "康复生态系统 "中的组织--通常是由具有药物滥用障碍(SUD)生活经验的个人领导并配备工作人员的非营利性组织--提供同伴服务、团体咨询和各种各样的计划,以帮助那些与药物滥用障碍作斗争的人。这些组织的努力能够有效地帮助那些患有药物滥用症的人进入长期康复阶段。尽管有确凿证据表明,黑人、印地安人和阿拉斯加原住民以及非西班牙裔美国白人在获得 SUD 治疗方面存在不平等,但对于康复生态系统中的组织是否会因社区成员的种族和民族构成而在运营资金方面面临障碍,还没有任何实证研究:在这项名为 "优化恢复资金 "的 2022 年需求评估中,我们将定量和定性数据的结果结合起来,采用混合方法进行分析。研究采用了双变量描述性统计和推论以及主题分析。在美国各州和地区的 537 个组织的初始名单中,这些组织的 145 名领导人构成了我们的调查分析样本。共有 85 名领导人参加了 16 个焦点小组中的一个,其中 10 个是基于地理位置的,6 个是基于人口身份的。此次需求评估提供了有关恢复生态系统中各组织运作情况的全面数据:缺乏培训和现有的组织资金,以及资金申请提案中的非包容性语言,导致一些组织决定不寻求某些赠款和资金机制。在申请或成功获得联邦和州资助方面,主要服务于黑人社区成员的组织与主要服务于非西班牙裔白人社区成员的组织之间没有统计差异。然而,在资助结果方面存在着关键的不公平现象,有时甚至是无法解释的不公平现象:所有参与需求评估的康复生态系统中的组织领导者都明确表示,在获取同伴康复业务和计划资金方面存在根本性问题。需要制定创新战略,以制定具有包容性和文化响应性的资助方法,优先考虑主要服务于历史上被边缘化社区的组织。
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引用次数: 0
Patient and navigator experiences with the opioid use disorder treatment system in Philadelphia, PA 宾夕法尼亚州费城阿片类药物使用障碍治疗系统的患者和导航员体验。
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-06 DOI: 10.1016/j.josat.2024.209509

Background

In 2022, 1413 people in Philadelphia died of an unintentional drug overdose. Addressing the complex challenges within the opioid use disorder (OUD) treatment system requires a comprehensive grasp of multiple system-level siloes from the perspective of patients who are accessing services and certified recovery specialists. Identifying facilitators and barriers to treatment entry and retention are critical.

Methods

We conducted 13 focus groups with 70 people with a history of opioid use in Philadelphia, Pennsylvania. The study recruited participants from non-profit organizations, OUD treatment programs, and street intercept. Certified Recovery Specialists (CRS), people with experience in residential, outpatient, methadone, and buprenorphine programs in Philadelphia, identity-specific groups with Black women, Black men, and Latino men, pregnant and parenting people, and people accessing harm reduction services participated in focus groups. Focus group guides varied by group, but the overarching focus remained on understanding participants' experiences in navigating the OUD treatment system. The research team summarized and edited CRS focus groups and coded all other focus groups for thematic analysis.

Results

Most focus group participants (mean age = 45.1 years; 52.9 % men, 40 % Black) had a history with multiple treatment types and reported experiences with different modalities. Salient themes that emerged from analysis included frustrations with the assessment process; reflections on facilitators and barriers by treatment type (residential, methadone, and buprenorphine); and recommendations across treatment modalities. Assessment centers, rather than being easy points of treatment entry, were identified as a major barrier to OUD treatment initiation; issues discussed included length of assessment, limited operating hours, and inadequate withdrawal management.

Discussion

The data from the present study were used to develop recommendations for policymakers and other stakeholders of OUD treatment programs to improve care across the spectrum of services. Expansion of residential programs that can support patients with complex comorbid conditions and wounds is needed to prevent delays for patients deemed ineligible for lower levels of care. Housing and income were identified as significant deterrents to initiating drug treatment and greater resources are needed. Greater investment in the OUD workforce is needed, especially expanding staff with lived experience. Findings can enhance OUD treatment programs elsewhere.

背景:2022 年,费城有 1413 人死于意外吸毒过量。要应对阿片类药物使用障碍(OUD)治疗系统内的复杂挑战,就必须从获得服务的患者和经认证的康复专家的角度出发,全面把握多个系统层面的孤岛。确定进入治疗和保留治疗的促进因素和障碍至关重要:我们在宾夕法尼亚州费城与 70 名有阿片类药物使用史的人进行了 13 次焦点小组讨论。这项研究从非营利组织、OUD 治疗项目和街头拦截中招募参与者。认证康复专家 (CRS)、在费城住院、门诊、美沙酮和丁丙诺啡项目中有经验的人、黑人女性、黑人男性和拉丁裔男性的特定身份群体、怀孕和养育子女的人以及获得减低伤害服务的人参加了焦点小组。各小组的焦点小组指南各不相同,但总体重点仍然是了解参与者在驾驭 OUD 治疗系统方面的经验。研究小组对 CRS 焦点小组进行了总结和编辑,并对所有其他焦点小组进行了编码,以便进行主题分析:大多数焦点小组参与者(平均年龄 = 45.1 岁;52.9% 为男性,40% 为黑人)都曾接受过多种治疗,并报告了不同治疗方式的经验。分析中出现的突出主题包括:评估过程中的挫折;按治疗类型(住院、美沙酮和丁丙诺啡)对促进因素和障碍的反思;以及对不同治疗模式的建议。评估中心并不是一个容易进入的治疗点,而是被认为是开始 OUD 治疗的一个主要障碍;讨论的问题包括评估时间长、工作时间有限以及戒断管理不足:讨论:本研究的数据用于为政策制定者和其他 OUD 治疗项目的利益相关者提出建议,以改善整个服务范围内的护理。有必要扩大住院治疗项目,为合并有复杂病症和伤口的患者提供支持,以防止被认为不符合接受较低水平治疗条件的患者被延误治疗。住房和收入被认为是阻碍开始戒毒治疗的重要因素,因此需要更多的资源。需要加大对 OUD 工作人员队伍的投资,特别是增加有生活经验的工作人员。研究结果可以加强其他地方的 OUD 治疗计划。
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引用次数: 0
California's Recovery Incentives Program: Implementation strategies 加利福尼亚州的回收奖励计划:实施战略。
N/A PSYCHOLOGY, CLINICAL Pub Date : 2024-09-06 DOI: 10.1016/j.josat.2024.209513

Introduction

Due to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit.

Methods

The Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch.

Results

The present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program.

Conclusion

The California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

导言:由于精神兴奋剂在美国药物中毒危机中的作用越来越大,因此越来越需要对兴奋剂使用障碍(StimUD)患者有效实施循证治疗。应急管理是一种行为策略,在治疗 StimUD 方面拥有有力的证据支持。2023 年,加利福尼亚州启动了一项名为 "康复激励计划"(Recovery Incentives Program)的大规模工作,将应急管理作为一种针对兴奋剂使用障碍(可卡因、甲基苯丙胺、苯丙胺)患者的治疗方法:方法:恢复激励计划采用贝克等人的 "科学服务实验室(SSL)"实施方法进行系统实施,并在此项目中进行了若干扩充。科学服务实验室有三个核心组成部分:说教式培训、绩效反馈和外部促进。我们对这一方法进行了扩充,在中医学服务启动前对站点进行了准备情况评估,并在启动后进行了持续的保真度监控和反馈:本文是一份初步报告,介绍了在大规模实施工作中使用这种增强型 SSL 战略实施社区医疗服务的情况。本文提供的数据描述了恢复激励计划前十个月的实施活动:加利福尼亚康复激励计划已得到系统实施,并似乎得到了治疗计划工作人员和注册成员的积极响应。今后的文件和评估报告将继续记录会员对该计划的反应,并报告正在进行的培训和实施过程。
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Journal of substance use and addiction treatment
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