Invited Commentary: Unveiling the Grim Reality- Suicide Mortality Among Formerly Incarcerated Individuals in North Carolina.

In the article by Fitch et al. (Am J Epidemiol. 2024; 193(3):489-499) the authors highlight the concerning prevalence of suicide mortality among formerly incarcerated individuals in North Carolina. Their retrospective study reveals a doubled suicide risk post-release, with notable disparities among demographic groups. Urgent interventions are needed, including comprehensive re-entry programs and systemic reforms to address structural inequalities. I suggest tailored support services to mitigate suicide risks and promote successful community reintegration, advocating for equity, justice, and human dignity in post-release efforts.

Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019.

BACKGROUND: As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE: To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN: We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS: We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES: We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS: Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS: Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.

Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants.

BACKGROUND: As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS: A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS: There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION: Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.

Characteristics of Students Participating in Collegiate Recovery Programs and the Impact of COVID-19: An Updated National Longitudinal Study.

The goals of the present study were to describe the development of the first national longitudinal study of collegiate recovery programs (CRP) students; provide an updated characterization of CRP students' demographics, past problem severity, and current recovery-related functioning; and examine the perceived impact of COVID-19 on CRP students' recovery. Universities and community colleges with CRPs across the United States and Ontario, Canada, were invited to partner on this project. Launched in fall 2020, three cohorts of participants were recruited. All participants who completed the baseline survey (N = 334 from 43 CRPs) were invited to complete follow-up surveys. The sample was composed of mostly undergraduate, White, cisgender women averaging 29 years old at baseline. They reported challenging backgrounds, including high levels of polysubstance use, alcohol/substance problem severity, mental health challenges, and involvement with the criminal legal system. Despite such adversity, they evidenced high levels of recovery-related functioning. Recovery capital and quality of life were high. Students reported an average of nearly four years in recovery, with most having between two and four years of abstinence from their primary substance of choice. COVID-19 represented a substantial source of stress for many, impacting some students' abstinence and recovery-related functioning. Results generally parallel findings from the only other national study of CRP students conducted a decade ago, providing a much-needed update and novel insights into CRP students. Findings can inform our understanding of the CRP student population and can be used to tailor CRP design and service offerings to students' backgrounds and needs.

Trajectories of depression among patients in treatment for opioid use disorder: A growth mixture model secondary analysis of the XBOT trial.

BACKGROUND AND OBJECTIVES: To inform clinical practice, we identified subgroups of adults based on levels of depression symptomatology over time during opioid use disorder (OUD) treatment. METHODS: Participants were 474 adults in a 24-week treatment trial for OUD. Depression symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAM-D) at nine-time points. This was a secondary analysis of the Clinical Trials Network Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (XBOT) trial using a growth mixture model. RESULTS: Three distinct depression trajectories were identified: Class 1 High Recurring-10% with high HAM-D with initial partial reductions (of HAM-D across time), Class 2 Persistently High-5% with persistently high HAM-D, and Class 3 Low Declining-85% of the participants, with low HAM-D with early sustained reductions. The majority (low declining) had levels of depression that improved in the first 4 weeks and then stabilized across the treatment period. In contrast, 15% (high recurring and persistently high) had high initial levels that were more variable across time. The persistently high class had higher rates of opioid relapse. DISCUSSION AND CONCLUSIONS: In this OUD sample, most depressive symptomatology was mild and improved after medication treatment for opioid use disorder (MOUD). Smaller subgroups had higher depressive symptoms that persisted or recurred after the initiation of MOUD. Depressive symptoms should be followed in patients initiating treatment for OUD, and when persistent, should prompt further evaluation and consideration of antidepressant treatment. SCIENTIFIC SIGNIFICANCE: This study is the first to identify three distinct depression trajectories among a large clinical sample of individuals in MOUD treatment.

The Involvement in Alcoholics Anonymous Scale - Short Form: Factor Structure & Validation.

Background: The aim of this research was to examine the psychometrics of a short form version of the multidimensional Involvement in Alcoholics Anonymous scale (IAA-SF) by assessing the factor structure, internal consistency, and predictive validity. While there are several existing measures of involvement in Alcoholics Anonymous, many are either unidimensional or are limited in their ability to gather variation in the level of involvement in the different dimensions of 12-step programs. Objective: To achieve our aim, we used exploratory and principal axis factor analysis, correlation, and logistic regression with two unique and diverse samples. Longitudinal data were collected from a northern Illinois sample of 110 post-treatment adults, and cross-sectional data were from a random sample of 296 recovery home residents in the United States. Results: Results from the first sample suggested three exploratory factors (Principles Involvement, Social Involvement, and Spiritual Involvement) that were concordant with the proposed conceptualization and were then confirmed in the second sample. A 2nd order factor of global involvement was also found. All subscales demonstrated good to excellent internal consistency and were moderately associated with AA affiliation. Global and social involvement predicted greater odds of abstinence 2 years later, but principles and spiritual involvement did not. Conclusion: Overall results suggest the IAA- SF is a valid and reliable 12-item instrument for assessing involvement in the AA program, and the differential prediction suggests potential utility for a multidimensional approach to 12-step involvement.

A Socio-Ecological Model for Collegiate Recovery Programs.

Given the major public health issue of substance use in the college environment and among college students, we must improve our understanding of students attempting to resolve substance related issues. Though much of research and policy attention has focused on individual progress according to personal characteristics and experiences, a much broader, theoretically informed understanding based on interpersonal relationships and contextual conditions of the school and society is warranted. Collegiate recovery programs (CRPs) are a system-level intervention that acknowledges the individual in context and seeks to support them and capitalize on their own skills within a safe environment to practice recovery. To ground CRPs as an environmental support targeting emerging adults that can improve student health and well-being, we developed a social-ecological framework that conceptualizes the multifaceted factors that influence them. Specifically, we aimed to understand factors influencing individuals in CRPs through direct and indirect effects. This conceptualization will better inform the development, implementation, and evaluation of these programs. Our theory-driven framework elucidates the multi-level complexity of CRPs and the importance of individual interventions as well as intervention from multiple stakeholder groups.

Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System.

People in prison are particularly vulnerable to infectious disease due to close living conditions and the lack of protective equipment. As a result, public health professionals and prison administrators seek information to guide best practices and policy recommendations during the COVID-19 pandemic. Using latent profile analysis, we sought to characterize Texas prisons on levels of COVID-19 cases and deaths among incarcerated residents, and COVID-19 cases among prison staff. This observational study was a secondary data analysis of publicly available data from the Texas Department of Criminal Justice (TBDJ) collected from March 1, 2020, until July 24, 2020. This project was completed in collaboration with the COVID Prison Project. We identified relevant profiles from the data: a low-outbreak profile, a high-outbreak profile, and a high-death profile. Additionally, current prison population and level of employee staffing predicted membership in the high-outbreak and high-death profiles when compared with the low-outbreak profile. Housing persons at 85% of prison capacity was associated with lower risk of COVID-19 infection and death. Implementing this 85% standard as an absolute minimum should be prioritized at prisons across the USA.

Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with co-occurring Conditions: A Longitudinal Parallel Growth Mixture Model.

BACKGROUND: Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses. METHODS: Participants were adults with cooccurring disorders (n = 406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up. RESULTS: A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3 months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment. CONCLUSIONS: These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.