Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse.

INTRODUCTION: The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. METHODS: Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. RESULTS: In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk. DISCUSSION AND CONCLUSIONS: Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.

Associations between smoking and pain in early recovery in residential substance use treatment-seekers.

INTRODUCTION: A growing literature indicates bidirectional associations between pain and tobacco use. Cigarette smokers are at increased risk for chronic pain, and observational and experimental studies indicate that pain increases motivation to smoke. Tobacco use disorder frequently co-occurs with other substance use disorders, which are also associated with chronic pain vulnerability. Despite evidence that pain significantly predicts smoking and relapse, associations between smoking history/trajectory and changes in pain over the course of treatment have not been characterized. The objective of the study was to determine the association between in-treatment smoking trajectory, pack-years (i.e., number of cigarette packs smoked per day multiplied by smoking duration), pain-related interference in daily activities, and pain intensity over the course of residential treatment. METHODS: In this study, 280 adult smokers in a residential SUD treatment center in North Central Florida completed questionnaires assessing cigarette use, pain intensity, and pain interference at treatment entry and discharge (Mean = 80.3 days, SD = 25.6). Most participants were diagnosed with alcohol use disorder (66.1 %). Opioid (27.9 %) and cannabis use disorders (29.6 %) were also common. Participants were grouped by whether their smoking increased (n = 36), decreased (n = 46), or stayed the same (n = 133) from entry to discharge. RESULTS: Analyses indicated a positive association between pack-years and pain intensity at both baseline (r = 0.185, p = 0.018) and discharge (r = 0.184, p = 0.019). Smoking trajectory was associated with pack-years, with those decreasing smoking having greater pack-years than those sustaining or increasing use [F(2,136) = 8.62, p < 0.01, η2p = 0.114]. Mixed general linear models indicated pain intensity [F(1,274) = 44.15, p < 0.0001, η2p = 0.138] and interference in day-to-day activities [F(1,276) = 31.79, p < 0.0001, η2p = 0.103] decreased significantly over time. However, there was no main effect of smoking trajectory on pain intensity [F(2,212) = 2.051, p = 0.131, η2p = 0.019] or of smoking trajectory by time interaction [F(2, 212) = 1.228, p = 0.295, η2p = 0.011]. CONCLUSIONS: Overall, findings provide evidence that smoking behavior influences pain within the context of residential substance use treatment. Given that pain is associated with urge to use substances and risk of return to use, more consistent and rigorous assessment of pain and proactive pain management is likely to enhance substance use treatment outcomes among people who smoke.

Psychometric Evaluation of an Adapted Short-Form Spirituality Scale in a Sample of Predominantly White Adults in an Inpatient Substance Use Disorder Treatment Program.

Spirituality is an important aspect of treatment and recovery for substance use disorders (SUDs), but ambiguities in measurement can make it difficult to incorporate as part of routine care. We evaluated the psychometric properties of an adapted short-form version of the Spirituality Scale (the Spirituality Scale-Short-Form; SS-SF) for use in SUD treatment settings. Participants were adult patients (N = 1,388; Mage = 41.23 years, SDage = 11.55; 68% male; 86% White) who entered a large, clinically mixed inpatient SUD treatment program. Factor analysis supported the two-dimensional structure, with factors representing Self-Discovery and Transcendent Connection. Tests of measurement invariance demonstrated that the scale was invariant across age and gender subgroups. The SS-SF exhibited convergent and concurrent validity via associations with participation in spiritual activities, hopefulness, life satisfaction, 12-step participation, and depressive symptoms. Finally, scores on the SS-SF were significantly higher at discharge compared to admission, demonstrating short-term sensitivity to change. These findings support use of the SS-SF as a concise, psychometrically sound measure of spirituality in the context of substance use treatment.

Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa.

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission data explores self-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol and other drug use. SACENDU data from 2012 to 2017 was analyzed using chi-square test of independence and logistic regression to examine associations between HTS, demographic characteristics and substances of use. Of 87,339 treatment admissions, 47.5% (n = 41,481) of patients had not accessed HTS in the prior 12 months. HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively). None of the substance use sub-groups reported a testing rate above 70%. Compared to specific reference groups, logistic regression showed those with lower odds of HTS were: 15-19 years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); and primarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reported HTS among sub-groups of patients in SSATCs, the integration of HIV services for PWUD should be a priority in South Africa and a focus of the national HIV strategy.

Evaluating substance use treatment efficacy for younger and older adults.

The purpose of this study was to examine the differential efficacy of aftercare substance use treatments for younger (below 40, n = 107) versus older (40+, n = 114) adults (N = 221), using data from a randomized controlled trial in a community-based substance abuse treatment center. The younger adult sample had a mean age of 28.9 while the older adult sample had a mean age of 48.1. Primary outcomes were rates of abstinence and percent use days at 1-year follow-up. Outcomes were compared between standard cognitive behavioral relapse prevention (RP), Mindfulness-Based Relapse Prevention (MBRP), and 12-step-based treatment as usual (TAU). Results showed significant differences by treatment in the older, but not in younger, subsample of participants. Specifically, the older participants in MBRP had significantly higher abstinence rates compared with those in TAU. Further, the older individuals in MBRP had a significantly lower percent of days on which they used compared with those in TAU and RP. Overall, findings suggest that age group may impact aftercare treatment substance use outcomes.

Psicodrama y psicoanálisis en un grupo "monosintomático": Un luagar para la diferencia / Psychodrama and psychoanalysis in a "monosymptomatic" group: a place for difference

El presente trabajo fue llevado a cabo durante el año 2018 en la provincia de Buenos Aires, Argentina, dentro una institución especializada en personas que padecen de consumo problemático de sustancias psicoactivas. En el mismo se presentará el resultado del análisis de un dispositivo grupal de orientación psicoanalítica con la utilización de técnicas psicodramáticas. Uno de los malestares que se manifestaba constantemente en los pacientes internados en la institución se relaciona al vínculo con su familia y/o grupo continente. Este vínculo se caracterizaba en la mayoría de los casos por ser escaso o prácticamente nulo. En relación a esto, los miembros del grupo consideraban que el "ser adicto" los alejó de sus afectos. Pensando sobre esta problemática se realizó el grupo terapéutico, con el objetivo de poder trabajar la dinámica intervincular de cada uno de los integrantes del grupo, así como también interrogar sobre la identificación al "ser adicto". Se realizó una lectura de lo sucedido en el grupo en dos tiempos, tomando como fundamento lo planteado por Massimo Recalcati. Partiendo desde un primer momento de identificación grupal "monosintomática", se promovieron las condiciones de posibilidad de trabajar sobre la singularidad del caso por caso

The present study is located in Buenos Aires Province, Argentina, in the year 2018, executed in an specialized institution of consumption of psychoactive substances pathologies. The aim of the following work is to present the result of a psychoanalytic group in relation with the use of "psychodramatic" techniques. Hospitalized patients constantly manifested discomforts related to the bond with their family and/or continent group. Said bond was characterized in most cases as being scarce or practically non-existent. And members of the group considered that "the addiction" distanced them from their affections. Regarding this problem, the therapeutic group was carried out, with the aim of being able to work on the inter-bond dynamics of each members of the group, as well as questioning about the identification of "being addicted". The final approach was made in two stages considering what happened in the group, taking Massimo Recalcati (2015) as a reference. Conditions of possibility were promoted to address the singularity of each case starting from the first moment of "monosymptomatic" group identification

Viral Hepatitis and Human Immunodeficiency Virus Testing and Linkage to Care for Individuals Enrolled in an Opioid Treatment Program.

BACKGROUND: In the United States, many opioid treatment programs (OTPs) do not offer viral hepatitis (VH) or human immunodeficiency virus (HIV) testing despite high prevalence among OTP clients. We initiated an opt-out VH and HIV testing and linkage-to-care program within our OTP. METHODS: All OTP intakes are screened for VH and HIV and evaluated for rescreening annually. A patient navigator reviews laboratory results and provides counseling in the OTP clinic. The medical record is queried to identify individuals with previously diagnosed, untreated VH or HIV. Navigation support is provided for linkage or relinkage to VH or HIV care. RESULTS: Between March 2018 and Februrary 2019, 532 individuals were screened for hepatitis C virus (HCV), 180 tested HCV antibody positive (34%), and 108 were HCV-ribonucleic acid (RNA) positive (20%). Sixty individuals were identified with previously diagnosed, untreated HCV. Of all HCV RNA+, 49% reported current injection drug use (82 of 168). Ninety-five individuals were seen by an HCV specialist (57% of HCV RNA+), 72 started treatment (43%), and 69 (41%) completed treatment. Individuals with primary care providers were most likely to start treatment. Four individuals were diagnosed with hepatitis B; 0 were diagnosed with HIV. CONCLUSIONS: The implementation of an OTP-based screening and navigation protocol has enabled significant gains in the identification and treatment of VH in this high prevalence setting.

Substance use service availability in HIV treatment programs: Data from the global IeDEA consortium, 2014-2015 and 2017.

BACKGROUND: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS: In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION: Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.

Indigenous Ecohumanist Architecture for Health in Canada's Far North.

BACKGROUND: Circumpolar nations are experiencing unprecedented environmental and public health policy challenges due to global climate change, exploitation of nonrenewable natural resources, the endangerment of myriad wildlife species, and growing sovereignty disputes. In a call to action, the Arctic states' health ministers recently signed a declaration identifying shared priorities for mutual international cooperation. Among agreed-upon collaborations, an enhancement of intercultural understanding and promotion of culturally appropriate healthcare delivery systems is to be of high priority going forward. PURPOSE AND AIM: In far north Canada, health policies perpetuated for generations upon indigenous communities have, traditionally, often had adverse consequences for the medically underserved inhabitants of these communities. This discussion addresses the cultural disconnect between the colonial era and current indigenous, decolonialist health and healing design strategies. METHOD AND RESULT: In response, two architectural design case studies are presented that synthesize ecological site planning precepts with salutogenic architectural design attributes-a behavioral health and substance abuse residential treatment center and three elderhousing prototypes for construction in Canada's Northwest Territories. CONCLUSION: This conceptual synthesis is practicable, transferable, and adaptable to varied, extreme climatic conditions, as reflective of best practices in the delivery of healthcare facilities that express a synthesis of ecohumanist and salutogenic values and methodologies. The discussion concludes with a call for empathic, evidence-based collaboration and research that further examines the blending together of prefabricated off-site construction with on-site construction approaches.

Mexican Traditional Medicine: Application of a Traditional and Complementary Medicine System to Improve Opioid Use Treatment in Latinos.

Background: Initially considered a primarily rural, White issue, opioid use and overdose rates have risen faster for Latinos (52.5%) than for White, non-Hispanics (45.8%) from 2014 to 2016. With an estimated 45% to 65% of Latino immigrant families using Mexican traditional medicine (MTM) practices before seeking Western medical services, these practices could be used as a method to increase access to care and improve outcomes. Practice Model: Although not well known, MTM is founded on a defined set of theoretical tenets that comprise a whole medical system as defined by the National Center for Complementary and Integrative Health. Whole medical systems are characterized as complete systems of theory and practice that develop independently and parallel allopathic medicine. Classifying MTM as a whole medical system to encourage further research and utilization of traditional and complementary medicine (T&CM) practices could help improve health outcomes for Latino patients. Specific T&CM practices that could be used in opioid treatment integration to decrease stigma and increase treatment utilization are then discussed. Conclusion: Incorporating T&CM practices will allow more effective, culturally competent and culturally sensitive health care provision for Latino immigrants in the United States to decrease stigma, improve health care outcomes, and address disparities in opioid use treatment.

Spiritual care performed in a drug user clinic.

OBJECTIVE: To know the spiritual care practices of health workers in the context of an inpatient unit for the treatment of addictive disorders, aiming to incorporate an expanded care practice. METHOD: Qualitative study considering the Convergent Care Research theoretical framework. The data collection occurred using semi-structured interviews, with three rounds of conversations and informal chats with 14 health professionals, from July to November 2017. The analysis followed the steps of apprehension, synthesis, theorization and transference. RESULTS: Four categories emerged: respect for user ethical values; addressing the beliefs and values of professionals; the health professional-user relationship; and collective spiritual care. The main actions highlighted were individual (relaxation and prayer) and collective (meditation, spirituality and the 12 steps). CONCLUSION: The rounds of conversations carried out in this research allowed workers to talk about spiritual care in addiction, to better understand its relevance to meet the needs of the patient.

COPD Positive Screening with Spirometry Increases Motivation to Quit Tobacco Smoking in an Addiction Treatment Center.

Providing an on-site immediate diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and lung age in tobacco smokers could be a motivational tool for smoking cessation. Our aim was to investigate the effects of an abnormal spirometry results on motivational change and subsequent smoking cessation. We conducted a retrospective analysis of smoking status after 3 months of tobacco counseling. Patients were recruited in an addiction outpatient center. Spirometry results were obtained with a portable device during the first visit. The sample was thus divided in 3 groups: COPD, subthreshold-group (no COPD but abnormal lung age) and normal spirometry. Among the three groups, we compared the immediate motivation change, difference in Q-MAT motivation scale score after minus before spirometry (Kruskal-Wallis test) and the smoking status after 3 months (Fisher test). We included 48 patients (37 males, median age 44 years, median cigarette-per-day 20). Spirometry results divided the sample in COPD (N = 13), subthreshold (N = 11) and normal group (N = 24). Mean Q-MAT score change after spirometry was different between groups (p = 0.019), greater in COPD (4.62 ± 3.38) than normal group (1.46 ± 3.11), and lower in patient with a co-occuring hazardous alcohol use (p = 7.6 × 10-3). Three-months smoking status was different between spirometry results groups (p = 0.0021). COPD (5/13, 38.5%) and subthreshold patients (6/10, 60.0%) had stopped more frequently than patients from the normal-group (2/22, 9.1%). The effect of immediate spirometry results on motivation to quit varies according to the screened pulmonary damages and hazardous alcohol use. It could be a useful tool in addiction treatment centers.

Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder.

Importance: Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking. Objective: To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence. Design, Setting, and Participants: This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019. Exposures: One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health. Main Outcomes and Measures: Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment. Results: A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up. Conclusions and Relevance: Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa.

BACKGROUND: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS: We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS: The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS: Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India.

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18-60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.

Addiction-Focused Eye Movement Desensitization and Reprocessing Therapy as an Adjunct to Regular Outpatient Treatment for Alcohol Use Disorder: Results From a Randomized Clinical Trial.

BACKGROUND: This study examined the feasibility, safety, and efficacy of addiction-focused eye movement desensitization and reprocessing (AF-EMDR) treatment, as an add-on intervention to treatment as usual (TAU). METHODS: Adult outpatients with alcohol use disorder (AUD) (N = 109) who already received or had just started with TAU (Community Reinforcement Approach) were recruited at 6 outpatient addiction care facilities. They were randomly assigned to either TAU + 7 weekly 90-minute sessions of AF-EMDR (N = 55) or TAU-only (N = 54). Assessments were made at baseline, after AF-EMDR therapy (+ 8 weeks in the TAU-only group), and at 1- and 6-month follow-up. The primary outcomes were changes in drinking behavior as reported by the participant and biomarker indices. RESULTS: Data were analyzed as intent-to-treat with linear mixed models. Additionally, sensitivity analyses were performed. No group or interaction effects were found for any of the outcome variables. Only limited change over time was seen with regard to indices of personal and societal recovery and in some secondary indices of clinical recovery (craving, desire thinking, and rumination). Reliable Change Index calculations showed that more TAU-only participants showed clinical improvement with regard to alcohol consumption while a somewhat higher proportion of participants in the TAU + AF-EMDR group experienced less craving. The acceptability, safety, and feasibility of the treatments received in both groups were comparable. CONCLUSIONS: There was no add-on effect of AF-EMDR on TAU with regard to drinking behavior in outpatients with an AUD. Possible explanations are discussed. Future studies should first establish proof of principle regarding the potential of AF-EMDR therapy to disrupt operant learning and habits relevant in addiction.

Spiritual care performed in a drug user clinic / El cuidado espiritual realizado en una unidad de internación en adición / O cuidado espiritual realizado em uma unidade de internação em adição

ABSTRACT Objective: To know the spiritual care practices of health workers in the context of an inpatient unit for the treatment of addictive disorders, aiming to incorporate an expanded care practice. Method: Qualitative study considering the Convergent Care Research theoretical framework. The data collection occurred using semi-structured interviews, with three rounds of conversations and informal chats with 14 health professionals, from July to November 2017. The analysis followed the steps of apprehension, synthesis, theorization and transference. Results: Four categories emerged: respect for user ethical values; addressing the beliefs and values of professionals; the health professional-user relationship; and collective spiritual care. The main actions highlighted were individual (relaxation and prayer) and collective (meditation, spirituality and the 12 steps). Conclusion: The rounds of conversations carried out in this research allowed workers to talk about spiritual care in addiction, to better understand its relevance to meet the needs of the patient.

RESUMEN Objetivo: Conocer las prácticas de cuidado espiritual de los trabajadores de la salud en el contexto de una unidad de hospitalización para el tratamiento de trastornos adictivos, con el objetivo de incorporar una práctica de atención ampliada. Método: Estudio cualitativo con referencial metodológico de la Investigación Convergente Asistencial. Se realizaron entrevistas semiestructuradas, tres rondas de conversaciones y conversaciones informales con 14 trabajadores de salud en una internación por adición de julio a noviembre de 2017. El análisis de las informaciones siguió las etapas de aprehensión, síntesis, teorización y transferencia. Resultados: Surgieron cuatro categorías: respeto de los valores éticos de los usuarios; creencias y valores de la persona; relaciones profesional de salud-usuario; y cuidado espiritual en grupo. Las principales acciones destacadas fueron individuales (relajación y oración) y colectivas (meditación, espiritualidad y 12 pasos). Conclusión: Las rondas de conversaciones, realizadas en esta investigación, permitieron a los trabajadores conversar sobre el cuidado espiritual en la adición, comprendiendo mejor su relevancia asistencial para atender las necesidades del paciente.

RESUMO Objetivo: Conhecer as práticas de cuidado espiritual de trabalhadores de saúde no contexto de uma unidade de internação para o tratamento de transtornos aditivos, visando incorporar uma prática assistencial ampliada. Método: Estudo qualitativo com referencial metodológico da Pesquisa Convergente Assistencial. Foram realizadas entrevistas semiestruturadas, três rodadas de conversas e conversas informais com 14 trabalhadores de saúde em uma unidade de internação em adição de julho a novembro de 2017. A análise das informações seguiu as etapas apreensão, síntese, teorização e transferência. Resultados: Emergiram quatro categorias: evocação dos valores éticos dos trabalhadores; respeito às crenças e valores do usuário; encontro trabalhador de saúde-usuário e cuidado espiritual em grupo. As principais ações destacadas foram individuais (relaxamento e oração) e coletivas (meditação, espiritualidade e 12 passos). Conclusão: As rodadas de conversas, realizadas nesta pesquisa, permitiram aos trabalhadores conversarem sobre o cuidado espiritual na adição, compreendendo melhor a sua relevância assistencial para atender às necessidades do paciente.

Peer involvement and cross-sector efforts in establishing integrated treatment of hepatitis C virus infection for people with substance use disorders: experiences from Norway.

BACKGROUND: For people with opioid dependence in Norway, chronic hepatitis C virus (HCV) infections contribute to high mortality and high morbidity. Around 50% of patients in medically assisted rehabilitation (MAR) have been shown to have HCV, and the current prevention and control efforts have been mostly unsuccessful. Thus, there is a need for new strategies for people-centred service delivery and innovative methods to improve health outcomes. METHODS: Over the last few years, the city of Bergen, Norway, has developed a cross-sector collaboration with substantial peer involvement in research and health provision related to substance use. User group representatives for people receiving MAR, addiction medicine health personnel, infectious disease specialists, policy makers in the municipality, low-threshold health care centres for people with substance use disorders in Bergen Municipality and researchers in the INTRO-HCV project have made concerted efforts in this regard. We will present here some of the strategies and steps we have taken. RESULTS: We have established an integrated HCV treatment scheme for people who inject drugs or who have opioid dependence. More than 800 persons have been tested for HCV within these frames, and more than 250 persons have been given treatment for HCV within the project. The integrated treatment of HCV is offered both in MAR outpatient clinics, municipal low-threshold healthcare centres, and local and regional prisons. The preliminary results indicate an increase in HCV treatment uptake among those receiving integrated treatment (96% initiating treatment compared to 75%). The user group organisation ProLAR Nett has established an outreach service to screen for HCV, increase awareness and reduce the proportion of people unknowingly living with HCV while informing and motivating people to receive treatment. Together with the other stake holders, peer user group, health care, research planning, concert events, and policy panels have been held. CONCLUSIONS: Peer involvement seems to have increased testing rates for HCV and acknowledgment of its importance. This seems to have improved health care for people with opioid dependence in Bergen over the last few years, particularly relating to the treatment of HCV. These experiences might be helpful in the planning of integrated policies in other settings that seek to eliminate the HCV endemic.

Integrating Reproductive Health Services Into Opioid Treatment Facilities: A Missed Opportunity to Prevent Opioid-exposed Pregnancies and Improve the Health of Women Who Use Drugs.

: Opioid treatment programs (OTPs) are federally mandated to provide certain medical services to patients, and are often the only place where people with substance use disorders (SUD) obtain medical care. Just as medication for addiction treatment (MAT) should be part of comprehensive addiction care, so should reproductive health care be a part of comprehensive medical care. The most significant barrier that must be overcome is that the majority of OTPs believe that it is outside their scope of service to provide reproductive health services. Reproductive health care is basic medical care. It is imperative for the long-term health of women with SUD, their children and the community that they receive this care. OTPs can and should do better for their female clients.

Provision of and Barriers to Integrating Reproductive and Sexual Health Services for Reproductive-age Women in Opioid Treatment Programs.

OBJECTIVES: To identify the level of provision of reproductive and sexual health (RSH) services to reproductive-age women enrolled in opioid treatment programs (OTPs) in 2017, and to understand provider-perceived barriers to integration of services. METHODS: A web-based survey was sent to medical or program directors at all OTPs (n = 48) in North Carolina (NC). Data were collected regarding program characteristics, demographic information about female patient populations, provision of RSH services, and provider-perceived barriers to service integration into OTPs. Survey results were aggregated for descriptive analysis. RESULTS: The survey response rate was 79%, representing 38 out of the 48 OTPs. Among OTPs, 95% serve pregnant and parenting women, 21% have female-specific programs, and together they serve a total of about 5000 women annually. Medical and program directors reported that approximately 53% of women have 1 or more children, and 6.5% are, at present, pregnant. Nearly 90% of programs provide pregnancy testing, but only about 50% provide contraception. Although more than half offer hepatitis C virus (HCV) testing, less than half offer human immunodeficiency virus (HIV) testing and sexually transmitted infection (STI) testing. Half of the programs provide education about STI prevention and safer sex practices. Most medical and program directors (84%) perceive female patients could benefit from RSH education and more than two-thirds (68%) perceive female patients need increased access to RSH services. Provider-perceived barriers to service integration include lack of facility equipment and supplies, trained staff, and childcare. CONCLUSIONS: NC OTPs are a logical setting for integrating RSH services to meet the needs of reproductive-age women in treatment for OUD.