Journal of substance use and addiction treatment最新文献

Background: Alcohol-associated hepatitis (AH) carries high short-term mortality and long-term morbidity. Current guidelines recommend that patients hospitalized with AH receive treatment for alcohol use disorder (AUD), including behavioral counseling and pharmacotherapy. However, integration of addiction treatment into routine inpatient care remains low. We evaluated whether inpatient hepatology consultation is associated with increased provision of AUD counseling and pharmacotherapy.

Methods: We conducted a retrospective cohort study of adults hospitalized with AH between January 2020 and July 2024 at a single academic center. AH was defined by ICD-10 code and NIAAA criteria. The primary exposure was liver service consultation. Primary outcomes were AUD counseling (dichotomized as referral provided vs. not) and pharmacotherapy (prescription vs. none). Multivariable logistic and mixed effects regression modeling was used to assess associations.

Results: There were 134 unique patients with 213 hospitalizations for AH. Median age was 47 years, 67% were male, and 73% were English-speaking. While nearly all patients (96%) received some form of counseling, only 17% were referred to structured rehabilitation programs and 30% received pharmacotherapy such as naltrexone, acamprosate, gabapentin and baclofen. In adjusted analyses, hepatology consultation (with or without GI involvement) was independently associated with higher odds of both referral to AUD treatment services (aOR 3.99, 95% CI 1.23-13.73 in a per-patient analysis and aOR 3.10, 95% CI 1.21-7.93 in a per-hospitalization analysis) and prescription of AUD pharmacotherapy (aOR 2.44, 95% CI 0.59-10.4 per-patient and aOR 3.74, 95% CI 1.16-12.06 per hospitalization).

Conclusions: Despite hospitalization being a critical opportunity to initiate evidence-based AUD care, most patients with AH did not receive guideline-concordant treatment. Liver consultation services were associated with improved pharmacotherapy delivery and AUD referrals. Embedding addiction treatment protocols within hepatology pathways may improve delivery of AUD care and reduce disparities in this high-risk population.

Introduction: People experiencing homelessness face high rates of opioid use disorder (OUD) with substantial barriers to treatment. Peer recovery support-delivered by individuals with lived experience of substance use and recovery-has emerged as a promising strategy for improving OUD care. However, little is known about peer recovery support within Health Care for the Homeless (HCH) programs.

Methods: We conducted semi-structured qualitative interviews with 18 key informants from six stand-alone HCH programs across the United States, including program leaders (n = 6), OUD clinicians (n = 6), and peer recovery support specialists (PRSSs; n = 6). Interviews explored perspectives on peer support roles, perceived impacts, implementation, and sustainability. We used an inductive approach for codebook development, and themes were developed iteratively, examining patterns within and across key informant groups.

Results: Participants agreed that peer recovery support is highly valued and uniquely well-suited to the HCH context. PRSSs were viewed as critical to engaging individuals experiencing homelessness by building trust, addressing social needs, navigating fragmented systems, and providing harm-reduction-oriented, flexible support. Key implementation challenges included role ambiguity, training and supervision, workforce sustainability (risk of relapse and emotional burn out), structural constraints, and financing instability. Lack of sustainable funding was identified as a major threat to long-term program viability.

Conclusions: Key informants perceived that peer recovery support enhances OUD care in the HCH setting through rapport building and practical supports tailored to the needs of people experiencing homelessness. Strengthening workforce infrastructure, clarifying role expectations, and developing sustainable financing mechanisms are critical to realizing the full potential of peer support within HCH programs.

Background: Smartphone-delivered interventions have shown promise for behavior change in substance use contexts, yet their application to opioid use disorder (OUD) remains limited, particularly among rural and underserved populations. Geospatial ecological momentary assessment (GEMA)-which integrates real-time location monitoring with momentary self-report-has not yet been applied to OUD treatment but offers an approach to detecting and responding to environmental relapse risk. OptiMAT (Optimizing Medication-Assisted Treatment) is a smartphone application developed as an adjunctive therapy for individuals receiving medication for opioid use disorder (MOUD). This paper describes an exploratory aim embedded within a larger randomized controlled trial (RCT) of OptiMAT that evaluates the feasibility and acceptability of integrating GEMA and just-in-time adaptive intervention (JITAI) strategies to reduce relapse risk.

Methods: This is a two-arm, single-blind randomized controlled trial comparing outpatient MOUD with adjunctive OptiMAT versus MOUD alone among newly enrolled adults in the greater Little Rock, Arkansas area. Eligible participants are adults aged 18 years or older initiating or currently receiving outpatient MOUD who own a GPS-enabled smartphone. Participants randomized to the OptiMAT arm engage in a theory-informed GEMA protocol that monitors proximity to self-identified high-risk environments. Upon entry into predefined geofenced zones with sustained presence of at least 5 min, the application delivers tiered behavioral prompts, including motivational messages, craving check-ins, and optional escalation to social support. Primary outcomes for this exploratory aim include feasibility and acceptability, operationalized as app engagement metrics, responsiveness to GEMA-triggered alerts, and study retention. Recruitment began in May 2023, with follow-up assessments anticipated through September 2027.

Conclusions: This protocol describes one of the first applications of GPS-based GEMA and JITAI logic within a digital intervention for OUD. This work will inform the design of replicable, location-aware digital tools to support relapse prevention in MOUD care, with implications for extending these approaches to rural and underserved populations.

Trial registration: NCT05336188.

The use of public health vending machines (PHVMs) is an emerging strategy implemented to mitigate drug-related harms via the dispensation of supplies like naloxone and sterile syringes from vending machines that have been documented to reduce transmission of blood borne viruses, support hygiene and basic personal health needs, and prevent overdose. To inform future applications of this technology and performed initially as part of a technical assistance request, we sought to examine PHVM adoption and implementation by conducting semi-structured interviews with 26 individuals from diverse roles and organizations/agencies across the United States in March 2023 about their experiences launching and optimizing PHVMs. We engaged in a secondary thematic analysis of the interview data using both deduction and induction. Using the interview guide as the frame, we broadly organized our findings into themes that are pertinent to consider prior to PHVM implementation ("Pre-implementation") and those that are relevant during implementation ("Implementation and maintenance"). Pre-implementation themes included (1) Motivating factors influencing implementation, (2) Intended PHVM uptake population, (3) Partnership cultivation, (4) Responsiveness to community needs and concerns, and (5) Factors influencing placement of PHVMs. Implementation and maintenance themes included: (1) Operational components of implementation and (2) Tracking consumer use of machines and supply flow. We found that PHVMs have emerged as versatile and central tools to expand and extend critical, life-saving supplies and services to PWUD and other groups within communities throughout the United States, especially to underserved and high-risk populations, such as people of color, young people, rural residents, individuals leaving incarceration, and veterans. We also found that the planning phases of implementation were shaped by local needs, funding opportunities, collaboration, and community engagement, with PHVM placement most often determined by feasibility and willingness of host sites, as well as the perceptions and needs of the community. Operational challenges included unanticipated costs related to maintenance and supply stocking of the PHVMs. Our findings elucidate the local, ground-up, and bold approaches and innovations undertaken by many organizations, agencies, and programs throughout the country in PHVM implementation. Policymakers and government officials should consider passing local ordinances or granting permissions in support of placing PHVMs and securing access to life saving materials.

Introduction: Adolescence is a critical period during which teens initiate and escalate substance use, as well as begin learning to drive. Limited research has evaluated programs to prevent impaired driving behaviors in this age group. We tested effects of adding a single-session web intervention to existing driver education curriculum.

Methods: Driving school staff recruited participants aged 15.5 to 17 from 12 driver education programs. Participants were randomized to driver education only (usual care, 30 h) or driver education plus a single-session web intervention (webCHAT, ∼30 min). Participants completed surveys at baseline and six months.

Results: The sample (N = 198) was 60% female, 80% White, and averaged 15.7 (SD = 0.8) years old. At baseline, 25% and 8% reported past three-month alcohol and cannabis use, respectively, and 19% and 10% reported ever riding with someone under the influence of alcohol or cannabis, respectively. At follow-up, webCHAT participants reported significantly lower perceived peer alcohol (-1.14, 95% CI: -1.915, -0.372, p = 0.004) and cannabis (-1.09, 95% CI: -1.866, -0.306, p = 0.007) use norms compared to usual care participants. Both webCHAT and usual care participants significantly reduced past month alcohol and cannabis use and viewed impaired driving as riskier and less acceptable at follow-up.

Conclusion: Driver education programs offer a unique opportunity to prevent substance use and impaired driving when adolescents are motivated to participate to secure their driver's license. These programs should continue updating curricula to reflect the state of science for alcohol and drug prevention.

Clinical trial registration: NCT04959461.

Background: Harm reduction can decrease negative consequences of substance use, but the extent to which harm reduction practices are implemented in emergency shelter settings is unknown.

Methods: We conducted 55 semi-structured interviews at four shelters across Massachusetts to understand guest (40) and staff (15) experiences with harm reduction practices. We conducted thematic analysis rooted in the Social Ecological Model (SEM).

Results: Well-established harm reduction practices include naloxone distribution, bathroom checks, and safe-sex supplies. Less established practices include wound care supplies, bad-date lists for people engaging in survival sex work, "no questions asked" lockers, amnesty beds, and abolishing curfews. Recommended future practices include safer consumption spaces, drug checking, and a full suite of harm reduction supplies. Key findings at each SEM level were: At the individual level: guest and staff attitudes toward harm reduction were mixed and influenced by personal experience, or gender identity. At the interpersonal level: tensions between people who use drugs (PWUD) and others who are abstinent; stigma prevents guests from being candid with staff about substance use, and fuels tension between staff and guests. At the community level: Guests and staff have access to naloxone at shelters, carry it, and use it regularly; communication around the presence and availability of naloxone is essential; women innovate distinct interventions for themselves. Last, at the societal level: prohibitory policies do not stop people from using drugs but make people less safe; shelters can collaborate with community organizations to provide necessary harm reduction services.

Conclusions: Shelters are implementing increasingly creative programs of harm reduction practices.