Initial Validation of a Computerized Adaptive Test for Substance Use Disorder Identification in Adolescents.

PURPOSE: Computerized adaptive tests (CATs) are highly efficient assessment tools that couple low patient and clinician time burden with high diagnostic accuracy. A CAT for substance use disorders (CAT-SUD-E) has been validated in adult populations but has yet to be tested in adolescents. The purpose of this study was to perform initial evaluation of the K-CAT-SUD-E (i.e., Kiddy-CAT-SUD-E) in an adolescent sample compared to a gold-standard diagnostic interview. METHODS: Adolescents (N = 156; aged 11-17) with diverse substance use histories completed the K-CAT-SUD-E electronically and the substance related disorders portion of a clinician-conducted diagnostic interview (K-SADS) via tele-videoconferencing platform. The K-CAT-SUD-E assessed both current and lifetime overall SUD and substance-specific diagnoses for nine substance classes. RESULTS: Using the K-CAT-SUD-E continuous severity score and diagnoses to predict the presence of any K-SADS SUD diagnosis, the classification accuracy ranged from excellent for current SUD (AUC = 0.89, 95% CI = 0.81, 0.95) to outstanding (AUC = 0.93, 95% CI = 0.82, 0.97) for lifetime SUD. Regarding current substance-specific diagnoses, the classification accuracy was excellent for alcohol (AUC = 0.82), cannabis (AUC = 0.83) and nicotine/tobacco (AUC = 0.90). For lifetime substance-specific diagnoses, the classification accuracy ranged from excellent (e.g., opioids, AUC = 0.84) to outstanding (e.g., stimulants, AUC = 0.96). K-CAT-SUD-E median completion time was 4 min 22 s compared to 45 min for the K-SADS. CONCLUSIONS: This study provides initial support for the K-CAT-SUD-E as a feasible accurate diagnostic tool for assessing SUDs in adolescents. Future studies should further validate the K-CAT-SUD-E in a larger sample of adolescents and examine its acceptability, feasibility, and scalability in youth-serving settings.

User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study.

BACKGROUND: Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients' behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. OBJECTIVE: This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. METHODS: We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients' postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. RESULTS: Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging-delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients' behavioral health in the months after discharge. CONCLUSIONS: Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial.

Engagement With Mental Health Services Among Survivors of Firearm Injury.

Importance: Despite the prevalence of posttraumatic stress symptoms after firearm injury, little is known about how firearm injury survivors connect with mental health services. Objective: To determine facilitators and barriers to mental health care engagement among firearm injury survivors. Design, Setting, and Participants: A qualitative study of 1-on-1, semistructured interviews conducted within a community setting in Indianapolis, Indiana, between June 2021 and January 2022. Participants were recruited via community partners and snowball sampling. Participants who survived an intentional firearm injury, were shot within Indianapolis, were aged 13 years or older, and were English speaking were eligible. Participants were asked to discuss their lives after firearm injury, the emotional consequences of their injury, and their utilization patterns of mental health services. Data were analyzed from August 2022 to June 2023. Main Outcomes and Measures: Survivors' lived experience after firearm injury, sources of emotional support, mental health utilization, and their desired engagement with mental health care after firearm injury. Results: A total of 18 participants (17 were Black [94%], 16 were male [89%], and 14 were aged between 13 and 24 years [77%]) who survived a firearm injury were interviewed. Survivors described family members, friends, and informal networks as their main source of emotional support. Barriers to mental health care utilization were perceived as a lack of benefit to services, distrust in practitioners, and fear of stigma. Credible messengers served as facilitators to mental health care. Survivors also described the emotional impact their shooting had on their families, particularly mothers, partners, and children. Conclusions and Relevance: In this study of survivors of firearm injury, findings illustrated the consequences of stigma and fear when seeking mental health care, inadequate trusted resources, and the need for awareness of and access to mental health resources for family members and communities most impacted by firearm injury. Future studies should evaluate whether community capacity building, digital health delivery, and trauma-informed public health campaigns could overcome these barriers to mitigate the emotional trauma of firearm injuries to reduce health disparities and prevent future firearm violence.

Treatment of Adolescent Cannabis Use Disorders.

This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.

Associations of alcohol use disorder, cannabis use disorder, and nicotine dependence with concurrent opioid use disorder in U.S. adults.

Polysubstance use of alcohol, cannabis, and nicotine has been shown to be correlated with opioid use disorder (OUD). The goal of this study was to determine whether alcohol use disorder (AUD), cannabis use disorder (CUD), and/or nicotine dependence were associated with concurrent OUD. Data came from the 2015-2019 National Survey on Drug Use and Health (n = 282,768, 48.5% male). Weighted logistic regression was performed for experiencing OUD in the past year concurrent with AUD, CUD, nicotine dependence, all pairwise interactions, the three-way interaction, and demographic covariates. Compared to individuals with no substance use disorder (SUD), individuals with AUD had 5.24 times the odds (95% CI [4.25, 6.46]), individuals with CUD had 6.69 times the odds (95% CI [5.13, 8.72]), and individuals with nicotine dependence had 7.12 times the odds of experiencing OUD (95% CI [6.10, 8.32]). Individuals with either AUD and CUD or AUD and nicotine dependence had approximately 15 times the odds of having OUD than those with no SUD (95% CI [12.58, 19.53] and 95% CI [11.63, 18.19], respectively). Individuals with CUD and nicotine dependence had 27.35 times the odds of having OUD than those with no SUD (95% CI [21.88, 34.19]). Individuals with AUD, CUD, and nicotine dependence had 47.31 times the odds of having OUD compared to individuals with no SUD (95% CI [36.79, 60.83]). A multiplicative effect was present when two or more SUD occurred simultaneously and was greatest when all three occurred at once, which suggests that prevention programs or interventions aimed at OUD should focus on persons with multiple SUDs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neurophysiology of predictable unpleasant event processing in pre-adolescents and early adolescents, part II: Reflex and event-related potential markers of defensive reactivity and peripheral attention modulation.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/ emotional abilities. While the companion article focuses on neurophysiology of predictable event processing itself, the present article examines peripheral emotional response regulation and attention modulation that coincides with event processing. A total of 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain pictures, and here, blink reflexes and brain event-related potentials (ERPs) elicited by peripheral noise probes are analyzed. During the cue, blink reflexes and probe ERP (P200) amplitudes were increased when the cue predicted scary, compared to everyday, content. After picture onset, reflex enhancement by scary content then disappeared for predictable images, whereas ERP modulation was similar regardless of predictability. Patterns are similar to those in adults and suggest (1) sustained defensive response priming and enhancement of peripheral attention during aversive anticipation, and (2) an ability, even in pre-adolescents, to downregulate defensive priming while maintaining attentional modulation once an awaited predictable aversive event occurs.

Neurophysiology of predictable unpleasant event processing in preadolescents and early adolescents, part I: Event-related potential markers of unpleasant image anticipation and processing.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/emotional abilities. While the companion article focuses on emotion regulation and peripheral attention modulation in predictable unpleasant contexts, the current paper presents neurophysiological markers of predictable event processing itself. 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain image content; in this paper, cue- and picture-locked event-related potentials (ERPs) are analyzed. During the cue, early ERP positivities were increased and later slow-wave negativities were reduced when predicted content was scary as compared with mundane. After picture onset, a picture processing-related positivity was then increased for scary compared with everyday images regardless of predictability. Cue-interval data suggest enhanced processing of scary cues and reduced anticipatory processing of scary images-opposite to adults. After event onset, meanwhile, emotional ERP enhancement regardless of predictability is similar to adults and suggests that even preadolescent individuals maintain preferential engagement with unpleasant events when they are predictable.

Evidence-based Treatment for Substance Use Disorders in Community Mental Health Centers: the ACCESS Program.

A significant gap remains in the availability and accessibility of evidence-based treatments (EBTs) in community substance use disorder (SUD) treatment. This study describes a 2-year statewide training initiative that sought to address this gap by training community-based therapists in motivational enhancement/cognitive behavioral therapy (MET/CBT). Therapists (N = 93) participated in a 2-day MET/CBT workshop followed by bi-weekly clinical consultation, fidelity monitoring, guided readings, and online resources. Therapists completed pre-training and follow-up assessments measuring knowledge, attitudes, confidence, and implementation barriers. Most therapists attended 10 or more consultation calls. Submission of session recordings for feedback was the least utilized training element. Therapists reported increased confidence in their ability to implement MET/CBT for SUD and demonstrated improvement in MI and CBT knowledge. Therapists reported several implementation barriers, including lack of time and opportunity to treat patients with MET/CBT. Recommendations for future training initiatives and addressing the barriers identified in this study are discussed.

Treatment of Adolescent Cannabis Use Disorders.

This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.

Promoting best practices for managing opioid overdoses in the field: A novel project Extension for Community Healthcare Outcomes program for first responders.

As the opioid overdose epidemic persists in the United States, it is important to provide specific first responder-oriented continuing education opportunities on interacting with, treating, and assessing individuals who overdose or who have Opioid Use Disorder (OUD). This research brief describes the first Extension for Community Healthcare Outcomes (ECHO) program focused on first responders and opioids, including the content covered and concomitant popularity and the registrants' objective knowledge and attitudes about opioids. Participation in the 'First Responders and Opioids ECHO' was free with no attendance requirements. Data include secondary assessment and description of the 9-session curriculum developed to address first responders' continuing education needs on OUD and overdose as well as objective knowledge and attitudes collected at program registration and granular attendance data by topic. Of 158 registrants, 102 attended at least one program session, with participants attending an average of 3.26 sessions (SD = 2.62). Registrants reported mixed knowledge levels, but even among this voluntary cohort of early adopters, objective knowledge about OUD and best-practice overdose response was only moderate. Registrants generally displayed non-stigmatizing and affirming attitudes and beliefs (e.g., substance use disorder is a treatable illness [M = 1.56, SD = 0.73]), with somewhat less agreement with items focused on harm reduction and medication-based treatment. A plausible case can be made that there is a need for evidence-based continuing education on opioids for first responders and related professionals. A motivated cohort of registrants displayed moderate but inconsistent knowledge and generally favorable attitudes. We encourage further systematic process and outcomes research on this topic.

Neighborhood Disadvantage Associated With Blunted Amygdala Reactivity to Predictable and Unpredictable Threat in a Community Sample of Youth.

BACKGROUND: Childhood socioeconomic disadvantage is a form of adversity associated with alterations in critical frontolimbic circuits involved in the pathophysiology of psychiatric disorders. Most work has focused on individual-level socioeconomic position, yet individuals living in deprived communities typically encounter additional environmental stressors that have unique effects on the brain and health outcomes. Notably, chronic and unpredictable stressors experienced in the everyday lives of youth living in disadvantaged neighborhoods may impact neural responsivity to uncertain threat. METHODS: A community sample of children (N = 254) ages 8 to 15 years (mean = 12.15) completed a picture anticipation task during a functional magnetic resonance imaging scan, during which neutral and negatively valenced photos were presented in a temporally predictable or unpredictable manner. Area Deprivation Index (ADI) scores were derived from participants' home addresses as an index of relative neighborhood disadvantage. Voxelwise analyses examined interactions of ADI, valence, and predictability on neural response to picture presentation. RESULTS: There was a significant ADI × valence interaction in the middle temporal gyrus, anterior cingulate cortex, hippocampus, and amygdala. Higher ADI was associated with less amygdala activation to negatively valenced images. ADI also interacted with predictability. Higher ADI was associated with greater activation of lingual and calcarine gyri for unpredictably presented stimuli. There was no three-way interaction of ADI, valence, and predictability. CONCLUSIONS: Neighborhood disadvantage may impact how the brain perceives and responds to potential threats. Future longitudinal work is critical for delineating how such effects may persist across the life span and how health outcomes may be modifiable with community-based interventions and policies.

Examining the Efficacy of Project ECHO to Improve Clinicians' Knowledge and Preparedness to Treat Adolescent Vaping.

As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to medical knowledge on best practices for screening, assessing, and treating vaping-related substance use. The Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed to offer practical learning sessions focused on clinical management of adolescent vaping. This study describes the development, implementation, and evaluation of the program's impact on participants' knowledge, attitudes, and practices regarding treatment of adolescent vaping from registration to the end of the series. Participants were generally knowledgeable about vaping at registration and reported significant increases in comfort talking with patients about vaping, counseling patients on nicotine replacement products, and frequency of implementing best-practice screening strategies at the end of the series. This study suggests ECHO programs focused on improving clinical management of adolescent vaping may increase accessibility of evidence-based care and reduce harms associated with vaping in youth.

Sexual Risk Behavior among Adolescents Seeking Treatment for Posttraumatic Stress Disorder: Exploring Psychosocial & Symptom Correlates.

Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13-18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.

Doomscrolling during COVID-19: The negative association between daily social and traditional media consumption and mental health symptoms during the COVID-19 pandemic.

OBJECTIVE: Consumption of traditional and social media markedly increased at the start of the COVID-19 pandemic as new information about the virus and safety guidelines evolved. Much of the information concerned restrictions on daily living activities and the risk posed by the virus. The term doomscrolling is used to describe the phenomenon of elevated negative affect after viewing pandemic-related media. The magnitude and duration of this effect, however, is unclear. Furthermore, the effect of doomscrolling likely varies based on prior vulnerabilities for psychopathology, such as a history of childhood maltreatment. It was hypothesized that social and traditional media exposure were related to an increase in depression and PTSD and that this increase was moderated by childhood maltreatment severity. METHOD: Participants completed a baseline assessment for psychopathology and 30 days of daily assessments of depression, PTSD, and pandemic-related media use. RESULTS: Using multilevel modeling, social media exposure was associated with increased depression and PTSD. This association was stronger for those with more severe maltreatment histories. Furthermore, those with more severe baseline psychopathology used more social media during this period. These relations were not observed for traditional media sources. CONCLUSIONS: These results suggest that regular viewing of pandemic-related social media is associated with increases in psychopathology for those with existing vulnerabilities. Those with such vulnerabilities should adopt strategies to limit social media consumption. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development of a computerized adaptive substance use disorder scale for screening, measurement and diagnosis - The CAT-SUD-E.

Introduction: The Computerized Adaptive Test for Substance Use Disorder (CAT-SUD), an adaptive test based on multidimensional item response theory, has been expanded to include 7 specific Diagnostic and Statistical Manual, 5th edition (DSM-5) defined SUDs. Initial testing of the new measure, the CAT-SUD expanded (CAT-SUD-E) is reported here. Methods: 275 Community-dwelling adults (ages 18-68) responded to public and social-media advertisements. Participants virtually completed both the CAT-SUD-E and the Structured Clinical Interview for DSM-5, Research Version (SCID) to assess the validity of the CAT-SUD-E in determining whether participants met criteria for specific DSM-5 SUDs. Diagnostic classifications were based on 7 SUDs, each with 5 items, for current and lifetime SUDs. Results: For SCID-based presence of any lifetime SUD, predictions based on the overall CAT-SUD-E diagnosis and severity score were AUC=0.92, 95% CI = 0.88, 0.95 for current and AUC=0.94, 95% CI = 0.91, 0.97 for lifetime. For individual diagnoses, classification accuracy for current SUDs ranged from an AUC=0.76 for alcohol to AUC=0.92 for nicotine/tobacco. Classification accuracy for lifetime SUDs ranged from an AUC=0.81 for hallucinogens to AUC=0.96 for stimulants. Median CAT-SUD-E completion time was under 4 min. Conclusions: The CAT-SUD-E quickly produces similar results as lengthy structured clinical interviews for overall SUD and substance-specific SUDs, with high precision and accuracy, through a combination of fixed-item responses for diagnostic classification and adaptive SUD severity measurement. The CAT-SUD-E harmonizes information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD and provides both diagnostic classification and severity measurement.

Polyvictimization and Psychosocial Outcomes Among Trauma-Exposed, Clinic-Referred Youth Involved in the Juvenile Justice System.

Polyvictimization is a robust predictor of emotional and behavioral problems and is linked to involvement in juvenile justice and other public sector systems. This study extends prior research by employing person-centered methods for identifying polyvictimization patterns among trauma-exposed, clinic-referred, justice-involved youth (n = 689; ages 12-18 years) and how identified classes differ on psychosocial outcomes and demographic characteristics. Most participants had experienced multiple traumatic event (TE) types. Latent class analyses identified three classes: mixed trauma/bereavement exposure group (55.1%; Mean = 3.0 TE types); maltreatment polyvictimized group (29.3%; Mean = 5.7 TE types); and maltreatment plus extreme violence polyvictimized group (15.7%; Mean = 9.3 TE types). Polyvictimized youth were more likely to be female, in out-of-home placements, and experiencing negative psychosocial outcomes (e.g., Posttraumatic Stress Disorder). Hispanic/Latino youth were overrepresented in the extreme polyvictimized subgroup. Results underscore the need for cross-system coordination of trauma-informed, comprehensive services for clinic-referred, justice-involved youth.

Outpatient Opioid Prescriptions are Associated With Future Substance Use Disorders and Overdose Following Adolescent Trauma.

OBJECTIVE: This study aims to determine if outpatient opioid prescriptions are associated with future SUD diagnoses and overdose in injured adolescents 5 years following hospital discharge. SUMMARY OF BACKGROUND DATA: Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the 5 years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained. METHODS: This was a retrospective cohort study of patients ages 12-18 admitted to 2 level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing 5 years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, and depression and posttraumatic stress disorder diagnoses. RESULTS: We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (odds ratio: 1.55, confidence interval: 1.04-2.32). Odds of overdose increased with ongoing opioid use over 2-4 years post-discharge ( P = 0.016-0.025). CONCLUSIONS: Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose.

Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder.

Background: People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Methods: Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Results: Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Conclusions: Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.

Opioid use, motivation to quit, and treatment status related to COVID-19: a cross-sectional study.

OBJECTIVE: Persons who use opioids may be at elevated risk of harm from the coronavirus disease 2019 (COVID-19) pandemic, yet few data currently exist that can be used to examine this risk. As part of a rapid response survey, this study measured opioid users' perceptions of risk or harm from COVID-19, as well as potential changes in motivation to quit, frequency of use, and engagement with treatment. Data collected from Amazon's Mechanical Turk (n = 562) were analyzed. RESULTS: Participants perceived modest risk elevation from COVID-19 due to their opioid use, and perceived moderate risk to themselves or their community from COVID-19. Since learning about COVID-19, 31.2% reported decreasing their opioid use, and 26.0% reported increased motivation to quit. Thirty-seven percent of participants reported both their use and motivation to quit stayed the same; 16.6% reported decreased use and increased motivation to quit. Participants who reported that their opioid use increased after learning about COVID-19, or whose motivation to quit opioids decreased, were more likely to also be engaged in treatment than those whose use or motivation stayed the same. These preliminary findings suggest that there likely is an association between COVID-19, opioid use, and treatment engagement that merits further in-depth investigation.

Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities.

BACKGROUND: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.