Prevalence of Substance Use Among Students in Health Colleges in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Substance misuse is a global and substantial health concern that includes the inappropriate use of illicit substances or prescription and over-the-counter medications, which subsequently leads to poor outcomes such as a mental health disorder, financial distress, work malfunction, and academic failure. AIM: This study aimed to assess the prevalence of substance use, identify associated risk factors, explore potential complications within this specific demographic, and investigate the relationship between sociodemographic/lifestyle variables such as age, gender, marital status, family income, smoking, physical activity, and academic variables including grade point averages (GPAs), study hours, and the parental educational level with substance use history among students in health colleges in Saudi Arabia. METHODS: This quantitative, descriptive cross-sectional study employed a questionnaire-based approach to collect data from students in health colleges across the regions of Saudi Arabia in the year 2022. RESULTS: The study found the prevalence of the use of various substances among students in health colleges to be 20.2%. Multiple factors were found to be associated with substance abuse. Smoking habits were the strongest predictor of substance misuse, with 49.1% of smokers reporting a history of substance use, compared to only 15.5% of non-smokers. This makes smoking the most impactful lifestyle factor related to substance use. Sleep patterns also played a significant role. A notable 43.6% of those who took up to two hours to fall asleep reported substance use, followed by 32.4% of those with sleep disorders and 25.5% with poor sleep quality. Unpredictable sleep patterns and a history of sleep disorders further strengthened the link between disrupted sleep and substance misuse. Academic performance, specifically GPA, showed that individuals with lower academic achievement were more likely to report substance use. Among those with a GPA below 3.0, 43.5% had a history of substance use, while only 16.7% of those with a GPA above 4.5 did so. CONCLUSIONS: The findings underscored the high prevalence of substance use, even among students in health colleges, and shed light on its connection to specific determinants. This poses a serious public health concern, as substance use is associated with poorer GPA, diminished knowledge acquisition, and overall academic performance. This, in turn, may negatively impact their future roles as healthcare providers, compromising both the quality of patient care and their personal well-being. These results emphasize the need for further investigations to unravel the underlying mechanisms of substance misuse and formulate innovative strategies to address this pressing issue effectively.

Expansion and evaluation of level II and III recovery residences for people taking medications for an opioid use disorder: project HOMES (Housing for MAR Expanded Services) study protocol.

INTRODUCTION: As the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced by people who live in recovery residences, little is known about the experience of people who live in these residences while taking medications for an opioid use disorder (MOUD) as part of their recovery. Thus, this study has three aims: (1) expand the availability of recovery residences that meet the National Alliance for Recovery Residences standards in Texas and serve individuals taking medications for an opioid use disorder as part of their recovery; (2) evaluate recovery residences for people taking MOUD as part of their recovery; and (3) compare the cost-effectiveness of recovery residences to treatment-as-usual. METHODS AND ANALYSIS: In collaboration with community partners, we opened 15 recovery residences in the State of Texas to house people taking MOUD as part of their recovery. We are collecting quantitative and qualitative data to evaluate outcomes at the intrapersonal, interpersonal, organisational and community levels. At the intrapersonal level, we are assessing changes in behavioural and psychosocial constructs using a longitudinal survey, objectively measuring current substance use with a point-of-interview breathalyser and urinalysis, and examining changes in healthcare utilisation using data obtained from a healthcare information exchange. We are collecting interpersonal data using in-depth individual interviews with residents and staff. We are collecting organisational data using field observation and a cost-effectiveness study, and we are collecting community data using neighbourhood mapping. ETHICS AND DISSEMINATION: The UTHealth institutional review board approved all protocols. We will disseminate study findings via conference presentations, peer-reviewed publications and brief community reports.

The Nexus of Aging and Substance Use: A Scoping Review of Therapeutic Modalities for Geriatric Substance Use Disorders.

The insidious grip of substance use disorders (SUDs) manifests as a ubiquitous public health crisis, indiscriminately affecting individuals across the spectrum of age, gender, and socioeconomic status. While advancements in treatment offer a glimmer of hope, millions continue to grapple with the debilitating physical, psychological, and social consequences of addiction, particularly those involving alcohol and opioids. This crisis is further exacerbated by the alarming rise of SUDs among older adults. As the global population undergoes a process of demographic senescence, the escalating prevalence of SUDs in this demographic underscores the urgent need for nuanced interventions. This review explores the therapeutic landscape for managing SUDs in older adults, evaluating pharmacological and non-pharmacological treatment modalities. A detailed literature search was conducted using databases like PubMed, Google Scholar, and Scopus, and studies were selected based on their relevance to therapeutic interventions for older adults with SUDs, encompassing pharmacological and non-pharmacological modalities. The synthesized results provide an extensive overview of contemporary therapeutic approaches. The findings indicate that pharmacological interventions demonstrate varied effectiveness in managing opioid and alcohol use disorders, with each drug offering distinct benefits and limitations regarding safety, tolerability, and patient adherence. Non-pharmacological interventions provide critical psychological and social support, often requiring adaptations to meet elderly patients' needs effectively. Integrated care models, which combine pharmacological and non-pharmacological treatments, emerge as the most effective approach, addressing the comprehensive needs of elderly patients by leveraging multidisciplinary teams, centralized service access, and coordinated, patient-centered care. Implementing these models, however, requires overcoming significant resource and coordination challenges. Indeed, the confluence of a burgeoning geriatric population and escalating rates of SUDs necessitates the development and implementation of granular and integrated care protocols specifically designed for older adults. By employing such a targeted approach, optimism can be cultivated and the quality of life enhanced for this vulnerable and often overlooked segment of society. This ensures the fight against addiction extends its reach, leaving no one behind.

Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial.

BACKGROUND: Several adversity-focused treatment trials have reported improvements to adversity sequelae (e.g., PTSD symptoms) and decreases in psychotic symptoms among individuals with psychotic disorders. Yet, no trials have examined the impact of adversity-focused treatment on substance use or examined the outcomes among an early phase psychosis population. These gaps in both the research literature and clinical practice have resulted in less knowledge about the outcomes of adversity-focused treatment at this stage of illness, including the impact on substance use. METHODS: The outcomes of an adapted prolonged exposure protocol (PE+) among an early phase psychosis population were examined using a multiple-baseline design. Nineteen adults with a psychotic disorder, current substance misuse, and a history of adversity were recruited from an early psychosis program. Participants were randomized to treatment start time and participated in a 15-session course of PE + therapy. Ten assessments were completed focusing on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to establish whether there were clinically significant changes to primary or secondary outcomes. RESULTS: Half or more of treatment completers experienced clinically significant changes to most domains of adversity sequelae, no participants experienced improvements in negative psychotic symptoms, and substance misuse increased for several participants. In terms of secondary outcomes, functioning and experiential avoidance were improved for a number of participants, while hopelessness decreased for only one participant. Participants reported high satisfaction with the PE + treatment, and exposure and coping skills were rated as the most helpful elements of treatment. CONCLUSIONS: Reductions in adversity sequelae were observed following PE + treatment, suggesting that adversity-focused treatment may be beneficial for an early psychosis population. Yet, few positive changes to psychotic symptoms or substance use were observed. Further integrating treatment strategies for psychosis and substance use into PE + may be required to effectively treat the links between psychosis, adversity sequelae, and substance use. Future studies should make efforts to integrate substance use strategies into adversity treatment trials for people with psychotic disorders. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04546178; registration posted 11/09/2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1 .

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study.

OBJECTIVES: The objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to examine the relationship between substance use and suicide risk among this population. SETTING: MHA intake programme, a province-wide centralised intake process established in 2019 by the Department of Health and Wellness of Nova Scotia. PARTICIPANTS: We included 22 500 MHA intake clients aged 19-64 years old who contacted MHA intake from 2020 to 2021. PRIMARY OUTCOME MEASURES: During the intake assessment, clients were assessed for suicide risk (past suicide attempt, suicidal ideation during the interview or 2 weeks before the interview). RESULTS: The lifetime prevalence of suicide attempt was 25.25% in the MHA clients. The prevalence of mild and moderate/high suicide risk was 34.14% and 4.08%, respectively. Clients who used hallucinogens had the highest prevalence of mild and moderate/high suicide risk (61.3% and 12.9%, respectively), followed by amphetamine/methamphetamine (47.6% and 13.3%, respectively) and sedative/hypnotics (47.2% and 8.9%, respectively) users. Stimulant (aOR=1.84, 95% CI 1.23 to 2.75) and hallucinogen (aOR=3.54, 95% CI 1.96 to 6.43) use were associated with increased odds of moderate/high suicide risk compared with denying current use. Additionally, alcohol (aOR=1.17, 95% CI 1.06 to 1.30) and tobacco (aOR=1.20, 95% CI 1.10 to 1.30) use were associated with increased odds of mild suicide risk. CONCLUSION: Suicide behaviours were prevalent among clients seeking MHA services. Substance use is an important factor associated with suicide risk in this population. This result underscored the importance of considering substance use patterns when assessing suicide risk and highlighted the need for targeted interventions and preventive measures for individuals engaging in substance use. Future interventional studies are needed to identify and evaluate effective strategies for reducing substance use and suicide risk among clients of MHA central intake.

A qualitative study of psychological stress and coping among persons using crack cocaine.

BACKGROUND: Research has identified a strong link between stress and drug use behaviours. Also, it has been established that the prolonged use of crack cocaine stimulates emotional, cognitive, neurological and social changes. This paper explores the psychological stressors that occur from crack cocaine use and the coping mechanisms used to mitigate them. This will provide an understanding of the intricate relationship between substance use and psychological well-being. METHODOLOGY: The study is qualitative and uses a descriptive phenomenological approach. The coping circumplex model is the theoretical model that underpins the study. Data was collected through 26 face-to-face in-depth semi-structured interviews with people who use crack cocaine. Data were analysed using thematic analysis. Participants consisted of 15 males and 11 females between the ages of 24-57 years, guaranteeing multiplicity within the study sample. RESULTS: Cravings, financial burdens, relationship breakdown and emotional /cognitive stimulation were revealed as psychological stressors. Maladaptive coping which includes self-harm, isolation, not speaking about/not dealing with emotions and using substances were adopted by study participants. Also, positive coping such as seeking help and keeping busy were adopted by study participants. Social and environmental factors such as stigma, easy accessibility of crack and flashbacks served as barriers to positive coping. Positive coping was linked to the availability and easy accessibility to social support and strong family bonds, underlining the importance of accessible support systems in managing the challenges linked with crack cocaine use. CONCLUSION: The challenges faced by study participants in coping with the psychological stressors linked to their crack cocaine use highlight the importance of adopting personalised and comprehensive strategies to tackle the intricate dynamics between psychological stress, coping and crack cocaine use.

Association between cannabis use and brain structure and function: an observational and Mendelian randomisation study.

BACKGROUND: Cannabis use during adolescence and young adulthood has been associated with brain harm, yet despite a rapid increase in cannabis use among older adults in the past decade, the impact on brain health in this population remains understudied. OBJECTIVE: To explore observational and genetic associations between cannabis use and brain structure and function. METHODS: We examined 3641 lifetime cannabis users (mean (SD) age 61.0 (7.1) years) and 12 255 controls (mean (SD) age 64.5 (7.5) years) from UK Biobank. Brain structure and functional connectivity were measured using multiple imaging-derived phenotypes. Associations with cannabis use were assessed using multiple linear regression controlling for potential confounds. Bidirectional two-sample Mendelian randomisation analyses were used to investigate potential causal relationships. FINDINGS: Cannabis use was associated with multiple measures of brain structure and function. Participants with a history of cannabis use had poorer white matter integrity, as assessed by lower fractional anisotropy and higher mean diffusivity in the genu of the corpus callosum, as well as weaker resting-state functional connectivity in brain regions underlying the default mode and central executive networks. Mendelian randomisation analyses found no support for causal relationships underlying associations between cannabis use and brain structure or function. CONCLUSIONS: Associations between lifetime cannabis use and brain structure and function in later life are probably not causal in nature and might represent residual confounding. CLINICAL IMPLICATIONS: Cannabis use is associated with differences in brain structure and function. Further research is needed to understand the mechanisms underlying these associations, which do not appear to be causal.

Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation.

BACKGROUND: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. OBJECTIVE: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. METHODS: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. RESULTS: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. CONCLUSIONS: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. TRIAL REGISTRATION: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523.

Resilience and relapse risk in Emirate adult patients with substance use disorder: a national cross-sectional study from the United Arab Emirates.

Introduction: The United Arab Emirates is among the countries affected by substance use disorders (SUDs), which have economic and social impacts. Relapse after successful rehabilitation is a major issue in the treatment of SUD. Several factors increase the risk of relapse in patients with SUD, such as craving and negative social experiences. Resilience could empower patients struggling with SUD. This study aims to explore levels of resilience and relapse risk in adult Emirati patients diagnosed with SUD, and also the possible correlation between the two variables. Methods: Two hundred eighty-six Emirati adult patients with SUD completed a self-administered questionnaire for demographics, resilience (Connor and Davidson Resilience Scale), and relapse risk (Stimulant Relapse Risk Scale). Descriptive statistics (frequency, percentage, mean, SD, etc.) were used to describe study participants and variables. Inferential statistics were used to analyze the relationships, associations, and correlations between resilience and relapse risk, the main variables, and the participants demographics. Result: Participants' mean total score for resilience was 72.92 out of a maximum possible score of 100 (SD = 16.99), while their mean total score for relapse risk was 59.07 out of a maximum possible score of 105 (SD = 12.23). Furthermore, examining the correlation between the resilience subscales and the relapse risk subscales revealed similar significant, negative, low-to-moderate correlations between all the subscales (r = -0.486). Discussion: Protective and risk factors to enhance resilience and reduce relapse risk in patients with SUD were discussed.

Effect of pharmacological treatment of attention-deficit/hyperactivity disorder on later psychiatric comorbidity: a population-based prospective long-term study.

BACKGROUND: Psychiatric comorbidity is frequent among persons with attention-deficit/hyperactivity disorder (ADHD). Whether pharmacological treatment of ADHD influences the incidence of psychiatric comorbidity is uncertain. OBJECTIVE: To investigate associations and causal relations between pharmacological treatment of ADHD and incidence of subsequent comorbid psychiatric diagnoses. METHODS: We employed registry data covering all individuals aged 5-18 years in Norway who were diagnosed with ADHD during 2009-2011 (n=8051), followed until 2020. We used linear probability models (LPM) and instrumental variable (IV) analyses to examine associations and causal effects, respectively, between pharmacological treatment and subsequent comorbidity. FINDINGS: From time of ADHD diagnosis to 9 years of follow-up, 63% of patients were registered with comorbid psychiatric disorders. For males, LPM showed associations between ADHD medication and several incident comorbidities, but strength and direction of associations and consistency over time varied. For females, no associations were statistically significant. IV analyses for selected categories isolating effects among patients 'on the margin of treatment' showed a protective effect for a category of stress-related disorders in females and for tic disorders in males for the first 2 and 3 years of pharmacological treatment, respectively. CONCLUSIONS: Overall, LPM and IV analyses did not provide consistent or credible support for long-term effects of pharmacological treatment on later psychiatric comorbidity. However, IV results suggest that for patients on the margin of treatment, pharmacological treatment may initially reduce the incidence of certain categories of comorbid disorders. CLINICAL IMPLICATIONS: Clinicians working with persons with ADHD should monitor the effects of ADHD medication on later psychiatric comorbidity. TRIAL REGISTRATION NUMBER: ISRCTN11891971.

The role of substance misuse and sexual victimization history on sexual violence risk perception in men who have sex with men: A novel paradigm.

OBJECTIVE: Sexual victimization (SV) is common among men who have sex with men (MSM) as is dating and sexual networking (DSN) app use. We developed a novel laboratory paradigm ("G-Date") of sexual violence risk perception in DSN app environments and explored its validity and the role of substance misuse and SV history on sexual violence risk perception. METHOD: Using convenience sampling, we recruited 145 MSM to use G-Date to interact with two bogus speed dates whose responses were scripted to be risky or non-risky. Risky dates displayed several cues indicating risk for sexual violence perpetration. Dependent variables included pre/post changes in ratings of their dating partner's appeal; ratings of the presence of each of the embedded risk cues; and the duration of the speed dates. RESULTS: Compared to non-risky dates, participants terminated risky dates significantly sooner, rated them higher in each of the risk cues, and their pre- to post-date ratings of partner appeal declined significantly more. Participants' drug misuse was associated with reduced interest in the non-risky date, but not the risky date and predicted shorter speed date length and lower partner appeal ratings across date type. Substance-facilitated SV history interacted with alcohol misuse and date type to predict sexual violence risk perception. CONCLUSIONS: Results provide evidence for the paradigm's validity and suggest that drug misuse and substance-facilitated SV history shape MSM's risk perception in DSN apps. Efforts to prevent SV among MSM should consider individual characteristics, including substance misuse, in risk perception.

Illicit drug use in Limerick City: A stakeholder and policy analysis using multiple streams model.

BACKGROUND: The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development. METHODOLOGY: The study is qualitative and uses a hybrid technique that combines document, content, and stakeholder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematic search for grey literature were adopted as the search strategy. RESULTS: Problem Stream: Illicit drug use and its related problems have changed. The increasing availability of drugs, increasing usage and changes in the types of drugs being used have led to increased drug-related crimes, adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug-related problems in the region. Policy Stream: The current national drug strategy 2017-2025 which informs action plans in Limerick is the first to focus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction-related services, which have evolved rapidly since their first introduction. The Mid-West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands-on approach has been adopted in the creation of strategies to tackle the drug problem. CONCLUSION: The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long-lasting drug policies.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting.

INTRODUCTION: The Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide on-demand addiction care in Vancouver, British Columbia, for patients with substance use disorders. The new model also coordinates the region's existing clinical substance use services to support patients across a care continuum that includes traditional office-based addiction treatment and harm reduction services, early withdrawal management and more intensive abstinence-based treatment programming. To understand the impact of offering on-demand and coordinated substance use care, an observational cohort of individuals who access any R2R clinical service will be created to examine health and social outcomes over time. METHODS AND ANALYSIS: This prospective mixed-methods study will invite individuals from Vancouver, Canada, who access substance use treatment through the R2R model of care to (1) complete a baseline and 12-month follow-up quantitative questionnaire that solicits sociodemographic, substance use and previous addiction treatment data and (2) provide consent to the use of participants' personal identifiers to access health records for chart review and for annual linkage to select health and administrative databases to allow for ongoing (virtual) community follow-up over 5 years. Additionally, a purposive sample of cohort participants will be invited to participate in baseline and 12-month follow-up qualitative interviews to share their experiences accessing R2R and identify challenges and opportunities associated with the implementation of R2R. ETHICS AND DISSEMINATION: The study was approved by the University of British Columbia Providence Health Care Research Ethics Board in September 2023. Results from the proposed study will be published in peer-reviewed journals, presented at national and international scientific conferences and disseminated through regular meetings with policymakers, individuals with lived and living experience, and other high-level stakeholders, academic presentations and lay media.

The Impact of Social Support and Social Network Characteristics on Trauma Symptoms Among Violence-Exposed Women with Substance Use Disorders.

Background: Women with substance use disorder (SUD) experience higher rates of violence exposure, post-traumatic stress disorder (PTSD), and post-traumatic stress symptoms (PTSS) than their non-substance-using peers. Exposure to violence in women with SUD is associated with PTSS symptom severity and leads to lower rates of treatment adherence, poorer treatment outcomes, and a higher risk for relapse. Little is known about the buffers to PTSS among violence-exposed women with SUD. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Using ordinary least squares regression models, we sought to identify the direct effects of violence, general social support, recovery-specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support, recovery social support, and greater duration of network relationships were associated with lower trauma symptom scores. General social network composition variables were directly associated with lower trauma symptom severity. Recovery-specific social network variables moderated the association between violence exposure and PTSS for Black participants only. Conclusions: These data suggest that providers should target the quality of the client's interpersonal relationships to reduce PTSS among violence-exposed women with SUD. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence.

Substance misuse by birth parents: Outcomes for children and young people placed into out-of-home-care.

BACKGROUND: There is inconsistent evidence regarding the effect of birth parent substance use on developmental outcomes for children placed into out-of-home-care (OOHC). OBJECTIVE: This study aims to examine how parental substance use affects outcomes of Australian children in out-of-home care, adjusting for key demographic, social and system factors. PARTICIPANTS AND SETTING: Four waves of survey data were collected for children and young people who agreed to participate in the Pathways of Care Longitudinal Study (POCLS) between 2011 and 2018. The study sample included 1,506 children and young people (792 with a history of parental substance misuse) aged 9 months to 17 years who participated in at least one wave of the POCLS and had linked administrative data from the Department of Communities and Justice (DCJ), NSW, Australia. METHODS: Multilevel longitudinal models were used to analyse the relationship of child developmental outcomes (physical health, socio-emotional wellbeing, and verbal and non-verbal cognitive ability) with parental substance misuse in their child protection history. Each model included adjustments for child demographics, family socio-economic status, child protection system factors and the unbalanced panel. RESULTS: Children in OOHC with a history of parental substance misuse were more likely to be in the typical range for verbal cognitive development compared to those in OOHC without this history. In addition, younger (9 months to 5 years) children with a record of parental substance misuse exhibited significantly more typical fine and gross motor skill development than those without this history. CONCLUSIONS: Concerns that children in OOHC with a history of parental substance misuse may be more affected with regards to early-stage physical development, and later verbal cognitive development than those without this history in OOHC, may not be justified.

Parental domestic violence and abuse, mental ill-health, and substance misuse and the impact on child mental health: a secondary data analysis using the UK Millennium Cohort Study.

BACKGROUND: Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) can have a negative impact on both parents and children. However, it remains unclear if and how parental DVA, MH, and SU cluster and the impacts this clustering might have. We examined how parental DVA, MH, and SU cluster during early childhood, the demographic/contextual profiles of these clusters, and how these clusters relate to child MH trajectories. METHODS: We examined data from 15,377 families in the UK Millennium Cohort Study. We used: (1) latent class analysis to create groups differentially exposed to parental DVA, MH, and SU at age three; (2) latent growth curve modelling to create latent trajectories of child MH from ages 3-17; and (3) a case-weight approach to relate latent classes to child MH trajectories. RESULTS: We identified three latent classes: high-frequency alcohol use (11.9%), elevated adversity (3.5%), and low-level adversity (84.6%). Children in the elevated adversity class had higher probabilities of being from low-socioeconomic backgrounds and having White, younger parents. Children exposed to elevated adversity displayed worse MH at age three (intercept = 2.274; p < 0.001) compared the low-level adversity (intercept = 2.228; p < 0.001) and high-frequency alcohol use class (intercept = 2.068; p < 0.001). However, latent growth factors (linear and quadratic terms) of child MH did not differ by latent class. CONCLUSIONS: Parental DVA, MH, and SU cluster during early childhood and this has a negative impact on children's MH at age three, leading to similar levels of poor MH across time. Intervening early to prevent the initial deterioration, using a syndemic-approach is essential.

Implementation of time-limited parenteral hydromorphone in people with treatment-resistant injecting opioid use disorder: a protocol for a single-site, uncontrolled, open-label study to assess feasibility, safety and cost.

INTRODUCTION: Supervised injectable opioid treatment (SIOT) is an evidence-based intervention targeting opioid-dependent people for whom existing treatments have been ineffective. This project will primarily assess the feasibility and the acceptability of time-limited SIOT using injectable hydromorphone delivered in an existing Australian public opioid treatment programme, with secondary outcomes of safety, cost, changes in drug use and other health outcomes. If feasible, the goal is to scale up the intervention to be more widely available in Australia. METHODS AND ANALYSIS: Between 20 and 30 participants will be offered two times per day hydromorphone to inject under direct observation, in addition to their current opioid agonist treatment (OAT), for up to 2 years. At the end of 2 years of supervised hydromorphone treatment, participants will be continued on standard OAT only. Informed consent will be obtained from all participants included in the study. This is a single-site, uncontrolled, open-label study where quantitative and qualitative interview data will be collected at baseline, 12 months and lastly at 3 months following their final hydromorphone dose. The main outcome measures are feasibility, as assessed by recruitment, retention and participation in treatment, and acceptability to participants, clinic staff and other stakeholders assessed by qualitative interviews. Secondary outcome measures of safety, as assessed by adverse events, and cost will also be assessed, as well as a range of other drug and health outcomes. ETHICS AND DISSEMINATION: This study received ethical approval from the St Vincent's Hospital Human Research Ethics Committee (2019/ETH00418). This will be the first study of time-limited SIOT in the Australian setting. All results will be submitted to peer-reviewed journals, scientific conferences and local practice meetings. A preliminary report on outcomes will also be presented to local health policy makers. A consumer and community forum will also be held to feedback results to a broader audience. TRIAL REGISTRATION NUMBER: ACTRN12621001729819.

Protocol for a randomised trial of a self-directed digital pain management intervention (Empowered Relief) tailored to adults with chronic pain and prescription opioid misuse/disorder: the MOBILE Relief study.

INTRODUCTION: Chronic pain increases the risk of prescription opioid misuse or opioid use disorder (OUD). Non-pharmacological treatments are needed to dually address pain and opioid risks. The purpose of the Mobile and Online-Based Interventions to Lessen Pain (MOBILE Relief) study is to compare a one-session, video-based, on-demand digital pain relief skills intervention for chronic pain ('Empowered Relief' (ER); tailored to people at risk for opioid misuse or with opioid misuse/OUD) to a one-session digital health education intervention ('Living Better'; no pain management skills). METHODS AND ANALYSIS: MOBILE Relief is an international online randomised controlled clinical trial. Study participants are adults with chronic, non-cancer pain (≥6 months) with daily pain intensity ≥3/10, taking ≥10 morphine equivalent daily dose and score ≥6 on the Current Opioid Misuse Measure. Participants are recruited through clinician referrals and clinic advertisements. Study procedures include electronic eligibility screening, informed consent, automated 1:1 randomisation to the treatment group, baseline measures, receipt of assigned digital treatment and six post-treatment surveys spanning 3 months. Study staff will call participants at baseline and 1-month and 3 months post-treatment to verify the opioid prescription. The main statistical analyses will include analysis of covariance and mixed effects model for repeated measurements regression. MAIN OUTCOMES: Primary outcomes are self-reported pain catastrophising, pain intensity, pain interference, opioid craving and opioid misuse at 1-month and 3 months post-treatment. We will determine the feasibility of ER (≥50% participant engagement, ≥70% treatment appraisal ratings). We hypothesise the ER group will be superior to the Living Better group in the reduction of multiprimary pain outcomes at 1-month post-treatment and opioid outcomes at 1-month and 3 months post-treatment. ETHICS AND DISSEMINATION: The study protocol was approved by the Stanford University School of Medicine Institutional Review Board (IRB 61643). We will publish results in peer-reviewed journals; National Institute of Drug Abuse (funder) and MOBILE Relief participants will receive result summaries. TRIAL REGISTRATION NUMBER: NCT05152134.

Assessing experts' perspectives on challenges in substance misuse prevention, harm reduction, and treatment to shape funding priorities in New York State.

BACKGROUND: Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities. METHOD: Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback. RESULTS: The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes. CONCLUSIONS: Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.

Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe.

OBJECTIVES: Hazardous drinking (HD) and substance use (SU) can lead to disinhibited behaviour and are both growing public health problems among Southern African youths. We investigated the prevalence of SU and HD and their association with risky sexual behaviour among youth in Zimbabwe. DESIGN: Data analysis from a population-based survey conducted between October 2021 and June 2022 to ascertain the outcomes of a cluster randomised trial (CHIEDZA: Trial registration number:NCT03719521). Trial Stage: Post-results. SETTING: 24 communities in three provinces in Zimbabwe. PARTICIPANTS: Youth aged 18-24 years living in randomly selected households. OUTCOME MEASURES: HD was defined as an Alcohol Use Disorders Identification Test score ≥8, SU was defined as ever use of ≥1 commonly used substances in the local setting. RESULTS: Of 17 585 participants eligible for this analysis, 61% were women and the median age was 20 (IQR: 19-22) years. Overall, 4.5% and 7.0% of participants reported HD and SU, respectively. Men had a substantially higher prevalence than women of HD (8.2% vs 1.9%) and SU (15.1% vs 1.5%). Among men, after adjusting for socio-demographic factors, we found increased odds of having >1 sexual partner in those who engaged in SU (adjusted OR (aOR)=2.67, 95% CI: 2.21 to 3.22), HD (aOR=3.40, 95% CI: 2.71 to 4.26) and concurrent HD and SU (aOR=4.57,95% CI: 3.59 to 5.81) compared with those who did not engage in HD or SU. Similarly, there were increased odds of receiving/providing transactional sex among men who engaged in SU (aOR=2.51, 95% CI: 1.68 to 3.74), HD (aOR=3.60, 95% CI: 2.24 to 5.79), and concurrent HD and SU (aOR=7.74, 95% CI: 5.44 to 11.0). SU was associated with 22% increased odds of inconsistent condom use in men (aOR=1.22, 95% CI: 1.03 to 1.47). In women, the odds of having >1 sexual partner and having transactional sex were also increased among those who engaged in SU and HD. CONCLUSION: SU and HD are associated with sexual behaviours that increase the risk of HIV acquisition in youth. Sexual and reproductive health interventions must consider HD and SU as potential drivers of risky sexual behaviour in youths.