Journal of substance use and addiction treatment最新文献_第4页

Timing and type of posttraumatic stress disorder treatment in patients with co-occurring substance use disorder and posttraumatic stress disorder – A randomized controlled trial 同时发生物质使用障碍和创伤后应激障碍患者的创伤后应激障碍治疗的时机和类型-一项随机对照试验。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2026-01-09 DOI: 10.1016/j.josat.2025.209878

Sera Lortye , Nathalie N.M. Faber , Joanne P. Will , Loes A. Marquenie , Nick M. Lommerse , Anna E. Goudriaan , Arnoud Arntz , Marleen M. de Waal

Introduction

Co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is common and difficult to treat. Understanding which timing and type of PTSD treatment is most effective for treating PTSD in patients with SUD and PTSD is important to improve treatment outcomes. This study compared effectiveness of simultaneous versus sequential SUD-PTSD-treatment and compared Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Imagery Rescripting (ImRs) head-to-head in patients with co-occurring SUD and PTSD.

Method

A single-blind 6-arm randomized controlled trial with 209 patients with co-occurring SUD and PTSD at two addiction treatment centers in the Netherlands, providing intra- and extramural care. Patients were allocated to simultaneous SUD + PE, SUD + EMDR or SUD + ImRs treatment or sequential SUD-PTSD-treatment (25% each). Next, sequential SUD + PTSD patients were randomly assigned to PE, EMDR, or ImRs (33% each). Data were collected at baseline, 3-month, 6-month, and 9-month follow-up. All analyses were intention-to-treat.

Participants were randomized to receive 12 PTSD treatment sessions of simultaneous SUD + PE (n = 53), simultaneous SUD + EMDR (n = 50), simultaneous SUD + ImRs (n = 55), sequential SUD + PE (n = 17), sequential SUD + EMDR (n = 17) or sequential SUD + ImRs (n = 17). Standard protocols were used.

Primary outcome was clinician-administered PTSD symptom severity. Secondary outcomes were treatment completion and SUD-severity. Additionally, loss of PTSD diagnosis and full remission of PTSD criteria were tested. Linear-Mixed-Models with a two-level structure (repeated measures, patients), were used to investigate treatment-effects.

Results

In the primary analyses including the 6-month and 9-month follow up, no significant differences in PTSD-severity were found between timing nor treatment-types. However, simultaneous treatment outperformed sequential treatment at 3-month follow-up and was preferred by most participants. ImRs was superior to PE and EMDR regarding PTSD-treatment completion. No between-group differences in SUD outcomes were found.

Conclusions

EMDR and ImRs are effective alternatives to the more established PE. These findings indicate that delaying PTSD treatment until after SUD treatment is not necessary.

简介：创伤后应激障碍（PTSD）和物质使用障碍（SUD）的共存是一种常见且难以治疗的疾病。了解创伤后应激障碍治疗的时间和类型对治疗SUD和PTSD患者的创伤后应激障碍是最有效的，这对改善治疗结果很重要。本研究比较了同时与顺序的SUD-PTSD治疗的效果，并比较了同时发生SUD和PTSD患者的长时间暴露（PE）、眼动脱敏和再处理（EMDR）和图像处方（ImRs）。方法：采用荷兰两家成瘾治疗中心209例合并SUD和PTSD的患者进行单盲6组随机对照试验，提供院内和院外治疗。患者被分配同时接受SUD + PE、SUD + EMDR或SUD + ImRs治疗或顺序的SUD- ptsd治疗（各25%）。接下来，顺序SUD + PTSD患者被随机分配到PE、EMDR或ImRs组（各33%）。在基线、3个月、6个月和9个月的随访中收集数据。所有分析均为意向治疗。参与者被随机分配接受12 PTSD治疗的同时SUD + PE (n = 53),同时SUD + EMDR (n = 50),同时SUD + imr (n = 55),顺序SUD + PE (n = 17),顺序SUD + EMDR (n = 17)或顺序SUD + imr (n = 17)。采用标准方案。主要结局是临床给药的PTSD症状严重程度。次要结局是治疗完成度和sud严重程度。此外，还测试了PTSD诊断的丧失和PTSD标准的完全缓解。采用双水平结构的线性混合模型（重复测量，患者）来调查治疗效果。结果：在包括6个月和9个月随访的初步分析中，创伤后应激障碍严重程度在治疗时间和治疗类型之间无显著差异。然而，在3个月的随访中，同时治疗优于序贯治疗，是大多数参与者的首选。在ptsd治疗完成度方面，ImRs优于PE和EMDR。未发现两组间SUD结果的差异。结论：EMDR和ImRs是更成熟的PE的有效替代方案。这些发现表明，将PTSD治疗推迟到SUD治疗之后是没有必要的。

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引用次数: 0

An exploratory study of adaptive brief interventions for alcohol use among non-specialty treatment seeking volunteers: The moderating effect of age 在寻求非专业治疗的志愿者中对酒精使用进行适应性简短干预的探索性研究：年龄的调节作用

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2026-01-06 DOI: 10.1016/j.josat.2025.209880

Alexis Kuerbis , Silke Behrendt , Simone Schultz , Julie Glickman , Svetlana Levak , Nehal P. Vadhan , Jon Morgenstern

Introduction

Older adults drinking above low-risk guidelines, including those with AUD, are uniquely susceptible to alcohol-related harm yet largely perceive their drinking as non-problematic and avoid formal treatment. Adaptive brief interventions available in non-specialist settings, either in-person or via telehealth, could provide crucial alternatives, yet they remain untested across age and/or modality.

Methods

A secondary data analysis used data from a sequential multiple assignment randomization trial of adaptive brief interventions to test moderators, age and modality (video-conferencing vs. in-person), on drinking at 12 (treatment end) and 24 weeks. After receiving brief advice (BA) at week 1, 160 participants were reassessed at week 4. Those drinking at high-risk levels (non-responders) were randomized to 2 sessions of Motivational Interviewing (MI) or 20 min more of BA (BA Plus). At week 8, MI non-responders were randomized to either a third session of MI or 4 sessions of brief self-control therapy (BSCT); BA Plus non-responders were randomized to either 2 sessions of MI or 1 session MI and 4 BSCT. Generalized estimating equations tested main and moderating effects of age and modality on intervention effects on longitudinal drinking outcomes, average weekly sum of standard drinks (SSD) and average weekly number of heavy drinking days (HDD).

Results

A significant main effect of age demonstrated OAs (57+) had the smallest reduction in SSD and HDD compared to middle-aged (48–56) and younger (< 48) adults; with middle-aged adults reducing the most. Modalities were equivalent by week 24, yet in-person reduced more rapidly than telehealth. Significant interaction terms (age x condition; modality x condition) revealed that 3 sessions of MI performed poorest among OA and that 3 MI in-person sessions outperformed its telehealth counterpart and other conditions.

Conclusions

These findings suggest OA with AUD may need immediate, longer duration interventions compared to other age groups. Those ages 48–56 provide a unique window for substantial change in drinking among those with AUD. While in-person interventions yielded earlier changes than those implemented via telehealth, both modalities successfully reduced drinking, providing an important alternative way to access treatment. Future research on intervention components, such as dosage, timing and duration, across age groups and modality, would further inform their implementation across the life span.

饮酒高于低风险指南的老年人，包括AUD患者，是唯一容易受到酒精相关伤害的人，但大部分人认为他们的饮酒没有问题，并避免正式治疗。在非专业环境中可获得的适应性简短干预措施，无论是面对面还是通过远程保健，都可以提供重要的替代方案，但它们仍未经过年龄和/或方式的检验。方法辅助数据分析使用适应性简短干预的顺序多任务随机化试验数据，以测试在12周（治疗结束）和24周饮酒的调节因素、年龄和方式（视频会议与面对面）。在第1周接受简短建议（BA）后，160名参与者在第4周重新评估。高危饮酒者（无应答者）随机接受2次动机性访谈（MI）或20分钟以上的BA （BA Plus）。在第8周，MI无应答者被随机分配到第三次MI治疗或4次简短自我控制治疗（BSCT）；BA +无应答者被随机分为2期MI组或1期MI + 4期BSCT组。广义估计方程检验了年龄和方式对纵向饮酒结果、平均每周标准饮酒量（SSD）和平均每周重度饮酒天数（HDD）的干预效果的主要和调节作用。结果年龄的显著主效应表明，与中年（48 - 56岁）和年轻（48岁）成人相比，57岁以上老年人的SSD和HDD减少最小；中年人减少最多。到第24周时，方式是相同的，但面对面医疗比远程医疗减少得更快。重要的相互作用条件（年龄x条件；方式x条件）表明，在OA中，3次MI的表现最差，3次面对面MI的表现优于远程医疗和其他条件。这些发现表明，与其他年龄组相比，OA合并AUD可能需要立即进行更长时间的干预。48-56岁年龄段为AUD患者饮酒方面的实质性变化提供了一个独特的窗口期。虽然面对面的干预措施比通过远程保健实施的干预措施产生的变化更早，但这两种方式都成功地减少了饮酒，提供了获得治疗的重要替代途径。未来对干预成分的研究，如剂量、时间和持续时间，跨年龄组和方式，将进一步为其在整个生命周期内的实施提供信息。

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引用次数: 0

Buprenorphine dosing patterns and treatment outcomes for patients with opioid use disorder insured by Medicaid in Philadelphia 由费城医疗补助计划保险的阿片类药物使用障碍患者的丁丙诺啡剂量模式和治疗结果。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2026-01-04 DOI: 10.1016/j.josat.2025.209879

Rachel French , Emily Lorenc , Oluwatoyin Fadeyibi , Jewell Johnson , Suet Lim , Charles Altman , Samuel Williams , Lisa Shen , Molly Candon

Introduction

Opioid use disorder (OUD) remains a significant public health challenge, exacerbated by the rise of potent, synthetic opioids like fentanyl in the illicit drug supply. Buprenorphine, a partial opioid agonist, is an evidence-based treatment for OUD. While evidence suggests that higher buprenorphine doses (>16 mg/day) improve treatment retention and reduce overdose, many providers hesitate to prescribe these doses.

Methods

This study analyzed buprenorphine dosing patterns and treatment outcomes among Medicaid-insured individuals with OUD in Philadelphia from 2017 to 2023. Data were obtained from Community Behavioral Health (CBH), Philadelphia's Medicaid behavioral health managed care organization. The study included individuals with OUD who received buprenorphine through a prescription filled by a pharmacy, and are grouped into 3 dosage groups: ≤8 mg, 9–16 mg, and 17–24 mg. We examined demographic characteristics, co-occurring conditions, and outcomes such as emergency department visits and detoxification and rehabilitation stays across these dosage groups.

Results

We identified 5760 individuals with OUD who were prescribed buprenorphine in 2023. The proportion of prescriptions for 17–24 mg doses increased from 12.05 % in 2017 to 40.51 % in 2023 (p < 0.0001). Higher doses were associated with improved treatment outcomes compared to those on lower doses: individuals on higher dosing levels were less likely to have detoxification and rehabilitation stays (39.16 % for 17-24 mg; 60.75 % for ≤8 mg and 49.93 % for 9–16 mg; (p < 0.0001) and were more likely to remain in care (90.2 vs. 205.3 days of buprenorphine supplied on <8 mg vs. >24 mg, respectively, (p < 0.0001). Black individuals were more likely to receive lower doses compared to white patients.

Conclusion

Higher buprenorphine doses are associated with better treatment outcomes, including reduced detoxification and rehabilitation stays. Racial disparities in dosing highlight the need for equitable access to evidence-based OUD treatment. Addressing provider hesitancy and systemic barriers to higher doses is crucial in improving outcomes, particularly in the context of fentanyl-contaminated drug supplies.

导言：阿片类药物使用障碍（OUD）仍然是一个重大的公共卫生挑战，因非法药物供应中芬太尼等强效合成阿片类药物的增加而加剧。丁丙诺啡是一种部分阿片类激动剂，是一种循证治疗OUD的方法。虽然有证据表明，较高的丁丙诺啡剂量（bbb16 毫克/天）可以改善治疗效果并减少用药过量，但许多提供者对开这种剂量的处方犹豫不决。方法：本研究分析了2017年至2023年费城医疗保险投保的OUD患者的丁丙诺啡剂量模式和治疗结果。数据来自社区行为健康（CBH），费城的医疗补助行为健康管理护理组织。该研究纳入了通过药房处方服用丁丙诺啡的OUD患者，并将其分为3个剂量组：≤8 mg， 9-16 mg和17-24 mg。我们检查了这些剂量组的人口统计学特征、共同发生的条件和结果，如急诊就诊、戒毒和康复停留时间。结果：我们确定了5760例OUD患者，他们在2023年开了丁丙诺啡。17-24 mg剂量的处方比例从2017年的12.05 %增加到2023年的40.51 % (p 24 mg) （p ）结论：丁丙诺啡剂量越高，治疗效果越好，包括戒毒和康复时间缩短。剂量上的种族差异突出了公平获得循证OUD治疗的必要性。解决提供者对更高剂量的犹豫和系统性障碍对于改善结果至关重要，特别是在芬太尼污染药物供应的情况下。

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引用次数: 0

TOC (update) TOC(更新)

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2026-01-03 DOI: 10.1016/S2949-8759(25)00250-4

引用次数: 0

C2: editorial board C2：编辑部

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2026-01-03 DOI: 10.1016/S2949-8759(25)00249-8

引用次数: 0

Justice system experiences and health risks among Medicaid and uninsured populations receiving treatment for substance use disorder 司法系统经验和医疗补助和未投保人群接受药物使用障碍治疗的健康风险。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2025-12-26 DOI: 10.1016/j.josat.2025.209863

Meghan M. O'Neil , Jenna Pryor , Rebecca A. Johnson , MinAh Kim , Charlene Nguyen , Debra A. Pinals

Introduction

We explored the relationship between justice system experiences and health risks using a sample of Medicaid and uninsured patients in addiction treatment, focusing on four health behaviors correlated with premature mortality: (1) opioid misuse, (2) overdose, (3) multi-substance use, (4) recurrent treatment admissions.

Methods

From 2021 to 2023, electronic in-depth life-course history surveys were administered in-person with adult patients selected from a community-based public health case management system while undergoing addiction treatment in Michigan, USA. This study utilized a series of logistic regression models to examine the impact of civil and criminal justice predictors on risk for each of the four outcomes of interest.

Results

Participants were highly vulnerable: seventy percent of participants reported prior homelessness, modal income was $10,000 or less, and nine out of ten reported histories of having been arrested. Participants were more likely to identify as Black or American Indian Alaska Native relative to the broader community, in line with the disproportionate justice system involvement among these communities in Michigan, USA. In logistic regressions, participants with a history of homelessness were 2.16 times as likely to have misused opioids, 2.4 times as likely to have overdosed, and 2.41 times as likely to report multi-substance use relative to peers who had not experienced homelessness (p < 0.01); those with child support obligations were 1.78 times more likely to have misused opioids relative to their peers who did not have a child support obligation (p < 0.05); those who had experienced eviction were 1.8 times as likely to have overdosed and 2.09 times as likely to report multi-substance use compared to peers who did not report eviction history (p < 0.01); and those reporting legal financial obligations (LFOs) were 1.85 times as likely to report multi-substance use (p < 0.05) and 2.28 times as likely to report recurrent treatment admissions (p < 0.05) relative to peers who did not have LFOs.

Conclusions

Absent intervention, these systemic risk factors present barriers to successful recovery and reentry, with ramifications for public health and community-based crime prevention as well as potential to contribute to growing premature mortality among Black and American Indian Alaska Native persons and broader racial health disparities.

前言：我们以医疗补助和未参保的成瘾治疗患者为样本，探讨了系统体验与健康风险之间的关系，重点关注与过早死亡相关的四种健康行为：(1)阿片类药物滥用，(2)过量，(3)多种物质使用，(4)反复接受治疗。方法：从2021年至2023年，对美国密歇根州社区公共卫生病例管理系统中选择的正在接受成瘾治疗的成年患者进行深入的生活史调查。本研究利用一系列逻辑回归模型来检验民事和刑事司法预测因子对四种结果的风险影响。结果：参与者非常脆弱：70% %的参与者报告先前无家可归，模式收入为10,000美元或更少，十分之九的人报告被逮捕的历史。相对于更广泛的社区，参与者更有可能认为自己是黑人或美国印第安人阿拉斯加原住民，这与密歇根州这些社区中不成比例的司法系统参与一致。在logistic回归中，报告无家可归者中阿片类药物的使用增加了15 %，过量使用的可能性增加了19 %，多物质使用的可能性增加了13.5 % （p ）。如果不采取干预措施，这些风险因素对成功康复和重返社会构成障碍，对公共卫生和以社区为基础的预防犯罪产生影响，并有可能导致黑人和美洲印第安人阿拉斯加土著人的过早死亡率不断上升，并造成更大的种族健康差距。

{"title":"Justice system experiences and health risks among Medicaid and uninsured populations receiving treatment for substance use disorder","authors":"Meghan M. O'Neil , Jenna Pryor , Rebecca A. Johnson , MinAh Kim , Charlene Nguyen , Debra A. Pinals","doi":"10.1016/j.josat.2025.209863","DOIUrl":"10.1016/j.josat.2025.209863","url":null,"abstract":"<div><h3>Introduction</h3><div>We explored the relationship between justice system experiences and health risks using a sample of Medicaid and uninsured patients in addiction treatment, focusing on four health behaviors correlated with premature mortality: (1) opioid misuse, (2) overdose, (3) multi-substance use, (4) recurrent treatment admissions.</div></div><div><h3>Methods</h3><div>From 2021 to 2023, electronic in-depth life-course history surveys were administered in-person with adult patients selected from a community-based public health case management system while undergoing addiction treatment in Michigan, USA. This study utilized a series of logistic regression models to examine the impact of civil and criminal justice predictors on risk for each of the four outcomes of interest.</div></div><div><h3>Results</h3><div>Participants were highly vulnerable: seventy percent of participants reported prior homelessness, modal income was $10,000 or less, and nine out of ten reported histories of having been arrested. Participants were more likely to identify as Black or American Indian Alaska Native relative to the broader community, in line with the disproportionate justice system involvement among these communities in Michigan, USA. In logistic regressions, participants with a history of homelessness were 2.16 times as likely to have misused opioids, 2.4 times as likely to have overdosed, and 2.41 times as likely to report multi-substance use relative to peers who had not experienced homelessness (p < 0.01); those with child support obligations were 1.78 times more likely to have misused opioids relative to their peers who did not have a child support obligation (p < 0.05); those who had experienced eviction were 1.8 times as likely to have overdosed and 2.09 times as likely to report multi-substance use compared to peers who did not report eviction history (p < 0.01); and those reporting legal financial obligations (LFOs) were 1.85 times as likely to report multi-substance use (p < 0.05) and 2.28 times as likely to report recurrent treatment admissions (p < 0.05) relative to peers who did not have LFOs.</div></div><div><h3>Conclusions</h3><div>Absent intervention, these systemic risk factors present barriers to successful recovery and reentry, with ramifications for public health and community-based crime prevention as well as potential to contribute to growing premature mortality among Black and American Indian Alaska Native persons and broader racial health disparities.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209863"},"PeriodicalIF":1.9,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851335","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

Predicting and differentiating opioid and non-opioid drug poisonings using health records data 使用健康记录数据预测和区分阿片类药物和非阿片类药物中毒。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2025-12-22 DOI: 10.1016/j.josat.2025.209861

Gregory E. Simon , Robert Wellman , Susan M. Shortreed , Eric Johnson , Stacy A. Sterling , Karen J. Coleman , Brian K. Ahmedani , Zimri S. Yaseen , Andrew D. Mosholder

Introduction

To facilitate effective targeting of overdose prevention programs, this research developed and evaluated prediction models to identify people at highest risk of specific types of drug overdose or poisoning. Using samples of mental health specialty visits and general medical visits with mental health or substance use diagnoses, this research examined how well prediction models using health records data perform in predicting either any drug poisoning or opioid-involved poisoning and how the specific predictors of opioid-involved poisoning differ from general predictors of any drug poisoning.

Methods

Records data regarding mental health and general medical visits between 2015 and 2019 in four large health systems were used to develop two-step models predicting any poisoning or overdose and differentiating opioid-involved poisonings from other poisonings. Random forest models were developed in random samples of 70 % of visits and validated in held out 30 % samples.

Results

Among 19,130,028 visits, 114,911 were followed by a poisoning event and 12,758 by a poisoning involving opioids. A first-step model predicting any poisoning had moderate accuracy, with AUCs of 0.778 among mental health specialty visits and 0.767 among general medical visits. The two-step model to specifically predict opioid involved poisoning had superior performance (AUCs = 0.895 among mental health specialty visits and 0.915 among general medical visits). Predictors of any poisoning included prior self-harm, accidental poisoning, and mental health service use. Specific predictors of opioid-involved poisoning included prior substance use disorder diagnoses and opioid dispensings.

Limitations

Health records data would not identify overdoses or poisonings that do not present for health care and would not identify use of non-prescribed opioids. Finding may not generalize to settings with different patterns of diagnosis or service use.

Conclusions

Models to predict any overdose or poisoning from health records data in four large health systems had only moderate accuracy. Patients at highest risk for opioid poisoning can be more accurately identified by prediction models specifically focused on opioid poisoning, most strongly influenced by indicators of substance use disorder.

导论：为了促进药物过量预防计划的有效目标，本研究开发并评估了预测模型，以确定特定类型药物过量或中毒的最高风险人群。本研究利用精神健康专科就诊和精神健康或物质使用诊断的普通医疗就诊样本，检查了使用健康记录数据的预测模型在预测任何药物中毒或阿片类药物中毒方面的表现，以及阿片类药物中毒的具体预测因素与任何药物中毒的一般预测因素有何不同。方法：利用2015年至2019年四个大型卫生系统的心理健康和一般医疗就诊记录数据，建立两步模型，预测任何中毒或过量，并将阿片类药物中毒与其他中毒区分开来。随机森林模型在70% %的随机样本中建立，并在30% %的样本中得到验证。结果：在19130,028例就诊中，114,911例发生了阿片类药物中毒事件，12,758例发生了阿片类药物中毒。预测任何中毒的第一步模型具有中等准确性，心理健康专科就诊的auc为0.778，普通医疗就诊的auc为0.767。专门预测阿片类药物中毒的两步模型表现更优（心理健康专科就诊的auc = 0.895，普通医疗就诊的auc为0.915）。任何中毒的预测因素包括先前的自残、意外中毒和使用心理健康服务。阿片类药物中毒的具体预测因素包括先前的物质使用障碍诊断和阿片类药物分配。局限性：健康记录数据不能确定非保健用药过量或中毒，也不能确定非处方类阿片的使用情况。发现可能不能推广到具有不同诊断模式或服务使用的设置。结论：从四个大型卫生系统的健康记录数据中预测任何过量或中毒的模型只有中等准确性。阿片类药物中毒风险最高的患者可以通过专门关注阿片类药物中毒的预测模型更准确地识别出来，这些模型受物质使用障碍指标的影响最大。

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引用次数: 0

Online community reinforcement and family training (CRAFT) for rural concerned significant others: A randomized controlled trial 网络社区强化与家庭训练（CRAFT）：一项随机对照试验。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2025-12-22 DOI: 10.1016/j.josat.2025.209867

Heidi Gray , Nicola Ivory , Nicole Snowdon , Kedir Ahmed , Matt Thomas , Julaine Allan

Introduction

Despite Community Reinforcement and Family Training (CRAFT) being used throughout the United States of America and some parts of Europe, CRAFT has not been explored in rural Australia. This study aimed to evaluate the effectiveness on psychological scales of an online, practitioner-led delivery of Community Reinforcement and Family Training (CRAFT) in a rural Australian context.

Methods

A randomized controlled trial (RCT) using a parallel-group, two-arm, superiority design, with a baseline assessment, and two follow-up assessments. Adult concerned significant others were recruited from rural areas across Australia, via Facebook and Instagram. Participants were randomized (1:1) into the CRAFT or Waitlist groups. The CRAFT intervention consisted of 6 sessions of 60 min each, conducted over 6 weeks. Participants randomized to the waitlist received reading resources from the Center for Motivation and Change (2022). The primary outcome was the psychological well-being of the participant. Psychological well-being scales included the DASS-21, SWLS, FS, and Brief-COPE.

Results

126 participants were enrolled and randomly assigned to either the CRAFT intervention (n = 64) or Waitlist (n = 62). At baseline, the mean age of participants was 51.08 years (SD = 10.88). Females comprised of 92.06 % of the sample. Most participants (86.4 %) were born in Australia and 87.9 % identified as White/Caucasian. Post-intervention scores found a statistically significant difference between the intervention and waitlist groups. This included in the intervention group, a decrease in depression scores (DASS-21), with an adjusted mean difference of −2.71 (95 % CI: −5.36 to −0.06) between interventions and waitlist group, a significant increase in Satisfaction with Life scores (SWLS), with an adjusted mean difference of 1.98 (95 % CI: 0.45 to 3.50) and a significant increase in the use of problem-focused coping with an adjusted mean difference of 2.92 (95 % CI: 1.33 to 4.51).

Conclusion

Online CRAFT for rural Australians decreased depression, increased life satisfaction and increased problem-focused coping.

简介：尽管社区强化和家庭培训（CRAFT）在美国和欧洲部分地区被广泛使用，但CRAFT尚未在澳大利亚农村进行探索。本研究旨在评估在澳大利亚农村地区由医生主导的在线社区强化和家庭培训（CRAFT）在心理量表上的有效性。方法：随机对照试验（RCT），采用平行组、双臂、优势设计，基线评估和两次随访评估。他们通过Facebook和Instagram从澳大利亚农村地区招募了关心重要他人的成年人。参与者被随机（1:1）分为CRAFT组或Waitlist组。CRAFT干预包括6个疗程，每次60 分钟，持续6 周。随机分配到候补名单的参与者从动机与改变中心获得了阅读资源。主要结果是参与者的心理健康状况。心理健康量表包括DASS-21、SWLS、FS和Brief-COPE。结果：126名参与者被纳入并随机分配到CRAFT干预组（n = 64）或Waitlist组（n = 62）。基线时，参与者的平均年龄为51.08 岁（SD = 10.88）。女性占样本的92.06 %。大多数参与者（86.4 %）出生在澳大利亚，87.9% %被确定为白人/高加索人。干预后得分发现，干预组和候补组之间存在统计学上的显著差异。这包括在干预组中，抑郁评分（DASS-21）下降，干预组和候补组之间的调整平均差异为-2.71(95 % CI: -5.36至-0.06)，生活满意度评分（SWLS）显著增加，调整平均差异为1.98(95 % CI: 0.45至3.50)，使用问题为中心的应对显著增加，调整平均差异为2.92（95 % CI: 1.33至4.51）。结论：澳大利亚农村地区的在线手工艺减少了抑郁症，提高了生活满意度，提高了以问题为中心的应对能力。

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引用次数: 0

Initiation and retention of opioid use disorder treatment medication after emergency department discharge among South Carolina Medicaid enrollees 南卡罗来纳医疗补助入选者在急诊科出院后开始和保留阿片类药物使用障碍治疗药物。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2025-12-22 DOI: 10.1016/j.josat.2025.209868

Skylar Gross , Chen Zhang , Angela Rogers , Yichen Li , Shujie Chen , Jiajia Zhang , Bankole Olatosi , Christina M. Andrews

Introduction

Opioid use disorder (OUD) remains a critical public health crisis in the U.S., affecting over six million people and contributing to more than 50,000 deaths annually. Medicaid enrollees are disproportionately impacted, comprising about 40 % of those with OUD. Despite the proven effectiveness of medications for opioid use disorder (MOUD), only 25 % receive them. The emergency department (ED) is a key touchpoint for initiating MOUD, especially in South Carolina (SC), where fentanyl-related overdoses have surged. However, little is known about MOUD initiation and retention following ED visits among SC Medicaid enrollees. This study addresses that gap by examining initiation within 30 days and retention at 90 days.

Methods

This study examined MOUD initiation and retention for Medicaid enrollees in South Carolina post-OUD related ED discharge utilizing claims data from January 1, 2020, through June 30, 2024. Estimates for MOUD initiation within 30 days of ED discharge and MOUD retention for 90 days post-initiation were calculated using logistic regression.

Results

There was a total sample size of 2605 Medicaid enrollees with an opioid-related ED visit. Of the total 2603 that had a follow-up period of at least 30 days, 7.6 % initiated any MOUD post-discharge. Furthermore, among the 183 enrollees who initiated MOUD and had at least 90-days of continuous-enrollment post-initiation, only 32.2 % retained MOUD for 90 days. Black enrollees had significantly lower odds of initiating MOUD compared to White enrollees (AOR: 0.29, CI = 0.17–0.50), while enrollees aged 45–54 had higher odds of initiating MOUD compared to enrollees aged 18–24 (AOR: 1.75, CI = 1.11–2.75). Similarly, enrollees aged 35–44 higher odds of retaining MOUD compared to enrollees aged 18–24 (AOR: 5.57, CI = 1.53–20.27).

Conclusions

Despite the ED being a key touchpoint for MOUD, initiation and retention rates among South Carolina Medicaid enrollees remain low, especially among Black enrollees and younger adults. These disparities highlight urgent needs for targeted, equitable strategies to improve MOUD access and engagement amid rising fentanyl-related overdose deaths.

阿片类药物使用障碍（OUD）在美国仍然是一个严重的公共卫生危机，每年影响600多万人，造成5万多人死亡。医疗补助计划的参保者受到了不成比例的影响，约占OUD患者的40% %。尽管阿片类药物使用障碍（mod）的药物已被证明有效，但只有25% %的人接受药物治疗。急诊部门（ED）是启动mod的关键接触点，特别是在南卡罗来纳州（SC），芬太尼相关的过量用药激增。然而，在SC医疗补助计划的参选者中，关于ED访问后mod的启动和保留知之甚少。本研究通过检查30 天内的启动和90 天内的保留来解决这一差距。方法：本研究利用2020年1月1日至2024年6月30日的索赔数据，调查了南卡罗来纳州医疗补助计划参保者在oud相关ED出院后的mod启动和保留情况。使用逻辑回归计算ED出院后30 天内的mod发作和发病后90 天的mod保留的估计值。结果：2605名与阿片类药物相关的急诊科就诊的医疗补助入选者的总样本量。在2603名随访期至少为30 天的患者中，7.6% %的患者在出院后开始了mod治疗。此外，在183名开始使用mod且在开始后至少连续使用90天的入组者中，只有32.2% %的人保留了90 天的mod。与白人受试者相比，黑人受试者发生mod的几率明显较低（AOR: 0.29, CI = 0.17-0.50），而45-54岁受试者发生mod的几率高于18-24岁受试者（AOR: 1.75, CI = 1.11-2.75）。同样，35-44岁的入组者与18-24岁的入组者相比，保留mod的几率更高（AOR: 5.57, CI = 1.53-20.27）。结论：尽管ED是mod的关键接触点，但南卡罗来纳州医疗补助计划参保者的开始和保留率仍然很低，尤其是黑人参保者和年轻人。这些差异突出表明，在芬太尼相关过量死亡人数不断上升的情况下，迫切需要制定有针对性、公平的战略，以改善mod的获取和参与。

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引用次数: 0

Examination of the DSM-5 level 2 substance use measure using Rasch modeling with United States parents 使用Rasch模型对美国父母进行DSM-5第2级物质使用测量的检查。

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2025-12-22 DOI: 10.1016/j.josat.2025.209864

Courtney Donovan , Noor Alibrahim , Margaret Lamar , Lisa Forbes , Megan Speciale

Background

The DSM-5 Substance Use Disorder (SUD) Adult Level 2 measure is one of the new Cross Cutting (CC) measures recommended by the American Psychiatric Association to evaluate symptoms across multiple disorders with two levels. While widely used, very little is published on the validity and reliability of the CC measures and none to date on the SUD level 2 measure, which examines the use of substances in the last 7 days.

Methods

Employing a scale development and validation framework, this study examined reliability and validity evidence for the SUD level 2 CC measure with a sample of 1049 U.S.-based parents. Factor structure, reliability, response scale, and targeting were examined via three Rasch models.

Results

This study found that this measure can be considered a unidimensional construct of substance use. While the item on marijuana use can be used within this construct, it does stand out with much more frequent use. Dimensionality and scale use patterns were the same when comparing a sample of parents in the United States that included those who use substances and those who do not to a sample of just those who used substances.

Conclusions

The 5-point scale indicating frequency of use was problematic and we recommend consideration of a 3-point scale instead, where 0 = never, 1 = sometimes, and 2 = frequently. Evidence of construct validity and reliability supports the use of this scale with adults in the United States.

背景：DSM-5物质使用障碍（SUD）成人2级测量是美国精神病学协会推荐的新的跨领域（CC）测量之一，用于评估两级多重障碍的症状。虽然广泛使用，但关于CC措施的有效性和可靠性的报道很少，迄今为止没有关于SUD 2级措施的报道，该措施检查了过去7 天内物质的使用情况。方法：采用量表开发和验证框架，本研究以1049名美国父母为样本，检验了SUD 2级CC测量的信度和效度证据。通过三个Rasch模型对因子结构、信度、反应量表和靶向性进行检验。结果：本研究发现，该测量可以被认为是物质使用的一维结构。虽然关于大麻使用的条目可以在这个结构中使用，但它的使用频率要高得多。当比较美国父母样本（包括使用药物和不使用药物的父母样本）和使用药物的父母样本时，使用模式的维度和规模是相同的。结论：表明使用频率的5分制量表存在问题，我们建议考虑使用3分制量表，其中0 = 从不，1 = 有时，2 = 频繁。结构效度和信度的证据支持在美国成年人中使用该量表。

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引用次数: 0