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1.
Proc Natl Acad Sci U S A ; 119(26): e2116703119, 2022 Jun 28.
Article in English | MEDLINE | ID: mdl-35727973

ABSTRACT

Diffusion tractography allows identification and measurement of structural tracts in the human brain previously associated with motivated behavior in animal models. Recent findings indicate that the structural properties of a tract connecting the midbrain to nucleus accumbens (NAcc) are associated with a diagnosis of stimulant use disorder (SUD), but not relapse. In this preregistered study, we used diffusion tractography in a sample of patients treated for SUD (n = 60) to determine whether qualities of tracts projecting from medial prefrontal, anterior insular, and amygdalar cortices to NAcc might instead foreshadow relapse. As predicted, reduced diffusion metrics of a tract projecting from the right anterior insula to the NAcc were associated with subsequent relapse to stimulant use, but not with previous diagnosis. These findings highlight a structural target for predicting relapse to stimulant use and further suggest that distinct connections to the NAcc may confer risk for relapse versus diagnosis.


Subject(s)
Central Nervous System Stimulants , Nucleus Accumbens , Prefrontal Cortex , Substance-Related Disorders , White Matter , Animals , Central Nervous System Stimulants/adverse effects , Humans , Nucleus Accumbens/diagnostic imaging , Prefrontal Cortex/diagnostic imaging , Recurrence , Substance-Related Disorders/diagnostic imaging , White Matter/diagnostic imaging
2.
Ned Tijdschr Geneeskd ; 1662022 06 16.
Article in Dutch | MEDLINE | ID: mdl-35736387

ABSTRACT

AIM: To demonstrate the results of routine screening and treatment for psychiatric problems, psychosocial problems and substance use (PPS) among pregnant women in the Netherlands. This approach is advocated by the national program 'The first 1000 days', which focuses on a healthy start for (unborn) children in vulnerable situations. DESIGN: Secondary data analysis of a routine care dataset obtained from midwifery practices and hospitals throughout the Netherlands. All practices and hospitals applied systematic screening with Mind2Care. METHOD: Each Mind2Care screening results in either a negative result (no risk), an alert and/or a treatment advice based on local care pathways. Anonymous data on detected risk factors and subsequent alerts/advices from 22.141 pregnant women were analyzed. RESULTS: Of all women, 24% had at least one PPS risk factor. Accumulation of risks was present in 10% of women. Thirty-one percent of all pregnant women received at least one specific advice (15% alerts, 24% treatment advices, including overlap). CONCLUSION: One in four pregnant women has psychiatric problems, psychosocial problems and/or substance use for which guideline care is available. Implementation of Mind2Care is demanding to the obstetrical system, and requires multidisciplinary care processes of medical and social caregivers. Despite the lack of a scientific evidence on the added value of systematic detection and treatment of PPS-risks in all pregnancies, this programmatic approach is increasingly acknowledged on the national attention level as the way forward to a healthy start for every child, even if born under vulnerable conditions.


Subject(s)
Midwifery , Pregnancy Complications , Substance-Related Disorders , Child , Female , Humans , Mass Screening/methods , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/prevention & control , Pregnant Women/psychology , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy
5.
Harm Reduct J ; 19(1): 66, 2022 Jun 25.
Article in English | MEDLINE | ID: mdl-35752850

ABSTRACT

BACKGROUND: The aim of this study was to critically analyse information concerning the relationship between alcohol and food consumption provided via alcohol industry (AI) funded and non-AI-funded health-oriented websites, to determine the role it plays within the alcohol information space, and how this serves the interests of the disseminating organisations. METHODS: Information on food as a harm reduction measure while drinking alcohol was extracted from 15 AI websites and websites of AI-funded corporate social responsibility (CSR) organisations. As a comparison group, non-AI-funded health websites were also searched (n = 16 websites with food and alcohol-related content). Information was included from webpage content and associated downloadable documents. Critical discourse analysis (CDA) was adopted to allow the texts analysed to be situated within the broader political and social context. Analysis was carried out iteratively, involving continuous comparison within and between websites. Discursive themes were identified by three researchers. Identified discursive elements were discussed to reach a consensus, and a final coding framework was then developed. "Tone" analysis was used to assess whether the overall tone within individual websites was considered to be pro-alcohol consumption, neutral or discouraging of alcohol consumption. RESULTS: There were some commonalities across AI and non-AI-funded websites, whereby both appeared to normalise alcohol consumption and to encourage use of food as a measure to enable sustained drinking, to avoid drinking in a way that results in short-term harms, and to prevent or "cure" a hangover. The fact that both AI-funded and non-AI-funded organisations shared many of these narratives is particularly concerning. However, a discourse of food and alcohol that served to promote "moderate" drinking as beneficial to health was used exclusively by AI-funded organisations, focusing on special occasions and individual-blaming. CONCLUSIONS: Alcohol consumption, including heavy and harmful consumption, is frequently normalised within the online information space. Emphasising food consumption with alcohol may have the effect of supporting consumers to drink for longer periods of time. Health professionals and independent health organisations should review the information they provide in light of our findings and challenge why AI-funded organisations, with a major conflict of interest, and a history of health misinformation, are often given the responsibility for disseminating health information to the public.


Subject(s)
Harm Reduction , Substance-Related Disorders , Alcohol Drinking/prevention & control , Humans , Social Responsibility
6.
Addict Biol ; 27(4): e13200, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35754101

ABSTRACT

An increasing number of neuroimaging studies indicate functional alterations in cortico-striatal loops in individuals with substance use disorders (SUD). Dysregulations in these circuits may contribute to drug-seeking and drug-consuming behaviour by impeding inhibitory control, habit formation, and reward processing. Despite evidence of network-level changes in SUD, a shared pattern of functional alterations within and between spatially distributed brain networks has not been systematically investigated. The present meta-analytic investigation aims at identifying common alterations in resting-state functional connectivity patterns across different SUD, including stimulant, heroin, alcohol, cannabis, and nicotine use. To this aim, seed-based whole-brain connectivity maps for different functional networks were extracted and subjected to multi-level kernel density analysis to identify dysfunctional networks in individuals with SUD compared with healthy controls. In addition, an exploratory analysis examined substance-specific effects as well as the influence of drug use status on the main findings. Our findings indicate a hypoconnectivity pattern for the limbic, salience, and frontoparietal networks in individuals with SUD as compared with healthy controls. The default mode network additionally exhibited a complex pattern of hypo- and hyperconnectivity across the studies. The observed disrupted connectivity between networks in SUD may associate with deficient inhibitory control mechanisms that are thought to contribute to excessive craving and automatic drug-related behaviour as well as failure in substance use cessation. The identified network-based alterations in SUD represent potential treatment targets for neuromodulation, for example, network-based real-time functional magnetic resonance imaging (fMRI) neurofeedback. Such interventions can evaluate the behavioural relevance of the identified neural circuits.


Subject(s)
Magnetic Resonance Imaging , Substance-Related Disorders , Brain/diagnostic imaging , Brain Mapping/methods , Humans , Neural Pathways/diagnostic imaging
7.
Article in English | MEDLINE | ID: mdl-35682446

ABSTRACT

Background: The aim of this study was to evaluate the trends of prevalence of health risk behaviors (HRBs) and health conditions over a 10 year period (2008-2018) in a representative sample of adolescents of Tuscany Region, Italy. Methods: This was a repeated cross-sectional (four survey waves) study. The prevalence of 17 HRBs and health conditions were analyzed by age, sex, and socioeconomic status (SES). Results: A total of 21,943 students were surveyed. During the study period, decreases in smoking participation, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased. Males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking, and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetable consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low-SES students than in high-SES students. Conclusions: The findings showed different tendencies in adolescent participation in HRBs over the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females' risk-taking behavior on the rise require careful monitoring.


Subject(s)
Adolescent Behavior , Alcoholism , Substance-Related Disorders , Adolescent , Cross-Sectional Studies , Female , Health Risk Behaviors , Humans , Male , Risk-Taking , Sexual Behavior , Smoking/epidemiology , Substance-Related Disorders/epidemiology
8.
PLoS One ; 17(6): e0269236, 2022.
Article in English | MEDLINE | ID: mdl-35731720

ABSTRACT

Adolescence is a complicated, full of challenges and explorations period in life on the way to adulthood. The behaviour of adolescents is considerably re-configuring under the pressure of biological, psychological, and social transformations, and the internalization of community rules and values, as well as the adoption of desirable behaviours, is not always easy or successful. During adolescence, anomie can easily become an attractive status quo, but it can also evolve, however, relatively easy, to delinquency. This exploratory study, part of the Planet Youth project, is based on an analysis of 17 items from a questionnaire applied to a sample of 2,694 young people in Bucharest, Romania, in 2018, high schoolers in grades 9-11. The main objective of this approach was to assess the impact of some socio-cultural factors regarding school, family, peer group, and neighbourhood on the adoption of deviant and delinquent behaviours among Bucharest teenagers. For data analysis, two dependent variables were built by aggregating items in the questionnaire: the level of anomie (composed of 8 items) and deviant behaviour (composed of 17 items). As independent variables, 17 predictors composed from 67 questions from the questionnaire were used. The main results reflect a high level of anomie among the adolescents of Bucharest and a low level of deviance, and a weak link between these two variables. On the other hand, adolescent anomie and deviance are favoured by anger management, perceived peer attitudes to substance use and digital leisure, together with low parental surveillance.


Subject(s)
Juvenile Delinquency , Substance-Related Disorders , Adolescent , Adult , Anomie , Attitude , Humans , Juvenile Delinquency/psychology , Peer Group , Substance-Related Disorders/psychology , Surveys and Questionnaires
9.
PLoS One ; 17(6): e0270045, 2022.
Article in English | MEDLINE | ID: mdl-35731791

ABSTRACT

INTRODUCTION: Prevalence of tobacco smoking among adults in substance misuse treatment is much higher than the wider population, yet limited research is available, and residential treatment services have been overlooked as a potential setting for cessation interventions. Exploring the perceptions of service users about smoking cessation in residential rehabilitation is important to gain better understanding of this issue and identify ways to inform future intervention development. METHODS: Ten semi-structured interviews were conducted in the Northwest of England in 2017 with adults (7 male, 3 female) who were currently or had previously been in residential treatment for substance misuse. Five participants were current smokers, three had never smoked, and two were former smokers. Participants were asked about their smoking behaviours, factors relating to smoking and smoking cessation and the relationship between smoking and substance use. All interviews were transcribed and data was analysed thematically. RESULTS: Study findings highlighted a general consensus amongst participants that residential treatment services offered an ideal opportunity for cessation but there were concerns that doing so might jeopardise recovery. Smoking in substance use treatment services is still the norm and factors such as perceived social and psychological benefits, normative behaviours and lack of perceived risk or prioritisation pose challenges for implementing smoking cessation within this setting, although facilitators such as motivation to change and appropriateness of the setting were also identified. CONCLUSIONS: This study suggests that service users perceive residential treatment services as suitable environments to introduce smoking cessation. To address the needs of adults who smoke and are in recovery from substance use, further research and cooperation from treatment organisations is needed to integrate substance misuse and smoking cessation services. More conclusive evidence on the effectiveness of tackling both issues at the same time is also required.


Subject(s)
Smoking Cessation , Substance-Related Disorders , Adult , Female , Health Behavior , Humans , Male , Motivation , Residential Treatment , Smoking Cessation/psychology , Substance-Related Disorders/epidemiology
10.
BMC Pregnancy Childbirth ; 22(1): 505, 2022 Jun 22.
Article in English | MEDLINE | ID: mdl-35733125

ABSTRACT

BACKGROUND: This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). METHODS: A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. RESULTS: Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. CONCLUSION: Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.


Subject(s)
Adverse Childhood Experiences , Substance-Related Disorders , Birth Weight , Child , Female , Humans , Infant , Latent Class Analysis , Mothers , Pregnancy , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology
11.
PLoS One ; 17(6): e0270307, 2022.
Article in English | MEDLINE | ID: mdl-35727766

ABSTRACT

OBJECTIVES: Psychosis is a well established complication of non-prescription drug use. We sought to measure the 1-year mortality of emergency department patients with substance-induced psychosis (SIP). METHODS: This study was a multi-centre, retrospective electronic medical records review of patients presenting to the ED with substance-induced psychosis (SIP). We interrogated the hospital ED database from Jan 1, 2018 and Jan 1, 2019 to identify consecutive patients. All patients were followed for one year from index visit, and classified as alive/dead at that time. Patients were included in the study if they met the following criteria: 1) ED discharge diagnosis of psychosis NOS and a positive urine drugs of abuse screen (UDAS) or the patient verbally endorsed drug use, or 2) Mental disorder due to drug use and "disorganized thought", "bizarre behavior" or "delusional behavior" documented in the chart and one or more of the following criteria: a) arrival with police, b) mental health certification, c) physical restraints, d) chemical restraints. We excluded patients who were not British Columbia residents, since we were unable to ascertain if they were alive or dead at 1 year from their index ED visit. Primary statistical analysis was logistic regression for risk of death in 1 year, based on plausible risk factors, selected a priori. RESULTS: We identified 813 presentations for SIP (620 unique patients). The median age of the entire cohort was 35 years (IQR 28-44), and 69.5% (n = 565) were male. Thirty five patients (4.3%; 95% CI 3.2-5.9) had died one year after their initial presentation to the ED for SIP. Separate multivariable logistic regression analyses, controlling for age, demonstrated schizophrenia (OR 4.2, 95% CI 1.8-11.1) significantly associated with increased 1-year mortality. CONCLUSIONS: In our study of patients presenting to the ED with SIP, the 1-year mortality was 4.3%. Controlling for age, schizophrenia was a notable risk factor for increased 1-year mortality.


Subject(s)
Psychotic Disorders , Substance-Related Disorders , Adult , Emergency Service, Hospital , Female , Humans , Male , Psychotic Disorders/epidemiology , Retrospective Studies , Risk Factors , Substance-Related Disorders/complications , Substance-Related Disorders/diagnosis
13.
BMC Psychiatry ; 22(1): 412, 2022 Jun 21.
Article in English | MEDLINE | ID: mdl-35729517

ABSTRACT

BACKGROUND: Impulsivity and substance use disorders (SUD) have been both associated with changes in dopaminergic processes. In this study, we intended to evaluate the dopaminergic function in imprisoned SUD offenders through the determination of s-COMT activity. METHODS: The study included 46 male individuals from a Portuguese penal institution. The participants were assessed through a battery of standardised instruments: Psychopathy Checklist-Revised (PCL-R), Barratt Impulsivity Scale Version 11 (BIS-11), and the European version of the Addiction Severity Index (EuropASI). In addition, s-COMT erythrocyte activity was evaluated. RESULTS: Overall, 73.9% (n = 34) of the individuals had Antisocial personality disorder (ASPD) and 58.7% (n = 27) presented SUD. We evidenced, for the first time, that, in individuals with SUD, s-COMT activity was correlated with the severity of drug dependence (EuropASI) (p = 0.009), and with BIS-11 factors self-control (p < 0.0001) and non-planning (p = 0.002). CONCLUSIONS: This study opens new perspectives regarding the pharmacological intervention on substance dependence through the interference on dopamine pathways.


Subject(s)
Criminals , Substance-Related Disorders , Antisocial Personality Disorder , Case-Control Studies , Catechol O-Methyltransferase , Humans , Male
14.
Cien Saude Colet ; 27(7): 2843-2854, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35730851

ABSTRACT

The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.


Subject(s)
Mortality, Premature , Substance-Related Disorders , Cross-Sectional Studies , Female , Forensic Medicine , Humans , Iran/epidemiology , Life Expectancy , Male , Substance-Related Disorders/epidemiology
15.
Rev. SPAGESP ; 23(1): 117-130, jan.-jun. 2022.
Article in Portuguese | LILACS, Index Psychology - journals | ID: biblio-1356774

ABSTRACT

RESUMO Este estudo teve por objetivo realizar uma pesquisa teórica em psicanálise sobre a clínica da toxicomania. Trata-se pesquisa teórica em psicanálise, visando a novos encadeamentos conceituais a respeito do tema. O consumo, que se apresenta como toxicômano, é atribuído a um gozo mortífero, dinâmica que visa à satisfação total das pulsões do Sujeito. Concluímos ao longo desse escrito que as dinâmicas de gozo representadas pelo Suplemento e Suplência possuem uma análise diferencial para a compreensão do consumo de drogas. Sugerimos, como contraponto, que o movimento de Alienação e Separação, metaforizado pela dinâmica do Fort-Da, é de grande valia na condução do processo clínico para o tratamento desse Sujeito.


ABSTRACT This study aimed to conduct theoretical research in psychoanalysis on the clinical care for drug addiction. It is theoretical research in psychoanalysis, aiming at new conceptual chains on the theme. The consumption that presents itself as drug addiction is attributed to a deadly enjoyment, a dynamic that aims at the total satisfaction of the individual's drives. We concluded how the dynamics of jouissance represented by Replacement and Supplement play a differential role in comprehending drug consumption. We suggest, as a counterpoint, that the Alienation and Separation movement, which worked as a metaphor in the Fort-Da dynamic, is of great value in conducting the clinical process for the treatment of these individuals.


RESUMEN Este estudio tuvo como objetivo realizar una investigación teórica en psicoanálisis sobre una clínica de drogadicción. Se trata de una investigación teórica en psicoanálisis, apuntando a nuevas cadenas conceptuales sobre el tema. El consumo que se presenta como drogadicto se atribuye a un goce mortal, dinámica que apunta a la satisfacción total de los impulsos del Sujeto. Concluimos a lo largo de este artículo cómo la dinámica del goce representada por el Suplemento y el Reemplazo tiene un papel diferencial en la comprensión del consumo de drogas. Sugerimos, como contrapunto, que el movimiento de Alienación y Separación, metaforizado por la dinámica Fort-Da, es de gran valor en la conducción del proceso clínico para el tratamiento de estos sujetos.


Subject(s)
Personal Satisfaction , Psychoanalysis , Role , Therapeutics , Substance-Related Disorders , Drive , Pleasure
16.
BMC Health Serv Res ; 22(1): 719, 2022 May 31.
Article in English | MEDLINE | ID: mdl-35642025

ABSTRACT

BACKGROUND: Despite high morbidity and mortality, patients with injection drug use associated infective endocarditis (IDU-IE) lack standardized care, and experience prolonged hospitalization and variable substance use disorder (SUD) management. Our study's objective was to elicit perspectives of health care workers (HCWs) who deliver care to this population by understanding their perceived patient, provider, and system-level resources and barriers. METHODS: This qualitative study included interviews of HCWs providing care to patients with IDU-IE from January 2017 to December 2019 at a single Midwest academic center. Based on electronic medical record queries to determine high and low rates of referral to SUD treatment, HCWs were selected using stratified random sampling followed by convenience sampling of non-physician HCWs and a patient. Study participants were recruited via email and verbal consent was obtained. The final sample included 11 hospitalists, 3 specialists (including 2 cardiovascular surgery providers), 3 case managers, 2 social workers, 1 nurse, and 1 patient. Qualitative semi-structured interviews explored challenges and resources related to caring for this population. Qualitative Data Analysis (QDA) Minor Lite was used for thematic data using an inductive approach. RESULTS: Three major thematic categories emerged relative to patient-level barriers (e.g., pain control, difficult patient interactions, social determinants of health), provider-level barriers (e.g., inequity, expectations for recovery, varying levels of hope, communication style, prescribing medication for SUD), and system-level barriers (e.g., repeat surgery, placement, resources for SUD and mental health). The need to address underlying SUD was a prominent theme. CONCLUSION: Practical steps we can take to improve treatment for this population include training and coaching HCWs on a more person-centered approach to communication and transparent decision-making around pain management, surgery decisions, and expectations for SUD treatment.


Subject(s)
Endocarditis , Substance-Related Disorders , Endocarditis/surgery , Health Personnel , Humans , Pain Management , Qualitative Research , Substance-Related Disorders/therapy
17.
Addict Behav ; 132: 107364, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35653963

ABSTRACT

BACKGROUND: Several million Americans use illicit stimulants every month and national data suggest stimulant use is increasing. However, little evidence exists that examines the prevalence and correlates of driving under the influence of stimulants (DUIS). The present study aimed to provide new evidence on the prevalence of DUIS in the U.S. adult population. METHODS: This study examined data from 170,944 adults 18 and older in the 2016-2019 National Survey on Drug Use and Health. Using Stata and R, we estimated the prevalence and key correlates of DUIS among adults in the United States. RESULTS: The overall prevalence of DUIS was 0.7% among adults in general and 28.3% among past-year stimulant users. Among the full adult sample, the prevalence of DUI cocaine was 0.5% and the prevalence of DUI methamphetamine was 0.3%. More than one in five (21.6%) adults with past year cocaine use reported DUI of cocaine, while nearly one half (47.2%) of adults with past year methamphetamine use reported DUI of methamphetamine. There is also a substantially higher likelihood of driving under the influence of stimulants among individuals reporting early onset of use and among those meeting criteria for cocaine/methamphetamine use disorders. Among adults who used cocaine/methamphetamine, those who reported driving under the influence of stimulants were more than 2 times more likely to experience a depressive episode or psychological distress. CONCLUSION: Findings suggest that prevention/treatment approaches focused on multiple substances as well as mental health needs may be most appropriate for addressing the challenge of DUIS.


Subject(s)
Central Nervous System Stimulants , Cocaine , Driving Under the Influence , Methamphetamine , Substance-Related Disorders , Adult , Humans , Prevalence , Substance-Related Disorders/epidemiology , United States/epidemiology
18.
Subst Abus ; 43(1): 1260-1267, 2022.
Article in English | MEDLINE | ID: mdl-35670769

ABSTRACT

Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.


Subject(s)
Mental Health Services , Substance-Related Disorders , Adolescent , Comorbidity , Humans , Logistic Models , Medicaid , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , United States/epidemiology
19.
BMC Health Serv Res ; 22(1): 750, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35668408

ABSTRACT

BACKGROUND: 'Syndemic' refers to socially produced, intertwined, and co-occurring epidemics. Syndemic theory is increasingly used to understand the population-level relationships between sexual health (including HIV) and mental health (including problematic substance use) epidemics. Syndemic-informed clinical interventions are rare. METHODS: We therefore asked 22 sexual health practitioners from six sexual health clinics in British Columbia, Canada to define the word 'syndemic' and then asked how the theory related to their clinical practice. RESULTS: Responses to syndemic theory ranged widely, with some practitioners providing nuanced and clinically informed definitions, others expressing a vague familiarity with the term, and others still having no prior knowledge of it. Where practitioners acknowledged the relevance of syndemic theory to their practice, they articulated specific ways in which syndemics create moral distress, that is, feeling that the most ethical course of action is different from what they are mandated to do. While some practitioners routinely used open-ended questions to understand the social and economic contexts of patients' sexual health needs, they described an uneasiness at potentially having surfaced concerns that could not be addressed in the sexual health clinic. Many observed persistent social, mental health, and substance use-related needs among their patients, but were unable to find feasible solutions to these issues. CONCLUSIONS: We therefore propose that interventions are needed to support sexual health practitioners in addressing psychosocial health needs that extend beyond their scope of practice, thereby reducing 'syndemic moral distress'.


Subject(s)
Epidemics , HIV Infections , Sexual Health , Substance-Related Disorders , British Columbia/epidemiology , HIV Infections/epidemiology , Humans , Mental Health , Morals , Sexual Behavior/psychology , Substance-Related Disorders/epidemiology , Syndemic
20.
PLoS One ; 17(6): e0269340, 2022.
Article in English | MEDLINE | ID: mdl-35679248

ABSTRACT

OBJECTIVES: The burden of substance use in Kenya is significant. The objective of this study was to systematically summarize existing literature on substance use in Kenya, identify research gaps, and provide directions for future research. METHODS: This systematic review was conducted in line with the PRISMA guidelines. We conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) from inception until 20 August 2020. In addition, we searched all the volumes of the official journal of the National Authority for the Campaign Against Alcohol & Drug Abuse (the African Journal of Alcohol and Drug Abuse). The results of eligible studies have been summarized descriptively and organized by three broad categories including: studies evaluating the epidemiology of substance use, studies evaluating interventions and programs, and qualitative studies exploring various themes on substance use other than interventions. The quality of the included studies was assessed with the Quality Assessment Tool for Studies with Diverse Designs. RESULTS: Of the 185 studies that were eligible for inclusion, 144 investigated the epidemiology of substance use, 23 qualitatively explored various substance use related themes, and 18 evaluated substance use interventions and programs. Key evidence gaps emerged. Few studies had explored the epidemiology of hallucinogen, prescription medication, ecstasy, injecting drug use, and emerging substance use. Vulnerable populations such as pregnant women, and persons with physical disability had been under-represented within the epidemiological and qualitative work. No intervention study had been conducted among children and adolescents. Most interventions had focused on alcohol to the exclusion of other prevalent substances such as tobacco and cannabis. Little had been done to evaluate digital and population-level interventions. CONCLUSION: The results of this systematic review provide important directions for future substance use research in Kenya. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42020203717.


Subject(s)
Substance-Related Disorders , Adolescent , Child , Female , Humans , Kenya/epidemiology , Pregnancy , Qualitative Research , Substance-Related Disorders/epidemiology
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