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1.
J Subst Abuse Treat ; 109: 46-49, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31856950

RESUMEN

Cannabis use disorder (CUD) is the most common illicit substance use disorder in the United States and is related to a range of functional impairment. CUD is associated with comorbid mental health disorders and other substance use disorders, compounding impairment from either type of disorder alone. U.S. military veterans also experience CUD at high rates; however, less is known about comorbidity and its impact on service utilization among veterans. Better understanding of comorbidity in this group is important, given that the Veterans Health Administration is the largest U.S. healthcare provider and is uniquely positioned to potentially address the challenges of comorbid CUD. The current study aimed to examine rates of comorbidity among veterans with CUD and the impact of comorbidity on mental health service utilization. Data were obtained through national Veterans Health Administration administrative and clinical records from 2010 to 2016. 79.1% of veterans with CUD were also diagnosed with a mental health disorder, and 76.8% were diagnosed with another substance use disorder. Overall, veterans with CUD and a comorbid mental health disorder used more individual psychotherapy than those with CUD alone. These findings suggest that CUD among veterans is rarely diagnosed independent of other disorders and that comorbidity is associated with greater mental healthcare utilization. Improved screening for CUD and integration of its treatment within current models of care may be important to consider in large healthcare systems.

2.
J Rural Health ; 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31508861

RESUMEN

PURPOSE: To explore the feasibility and utility of using a workshop, and supervision-consultation plus external facilitation to disseminate and implement cognitive-behavioral therapy in Veterans Affairs (VA) community-based outpatient clinics (CBOCs). METHODS: This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3-phase (workshop, supervision-consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice. Qualitative data describe training activities and the feasibility and utility of each training phase in addressing challenges to adopting CALM. FINDINGS: All 3 phases of the model were feasible to use with our sample of CBOC mental health providers. Providers reported challenges learning CALM during the workshop and concerns about not having enough training post-workshop to use CALM in practice. Providers primarily utilized supervision-consultation to tailor CALM to their practice, including learning how to prioritize a target disorder, "switch" the focus of treatment to a different disorder when comorbidities were present, and modify CALM sessions to fit shorter treatment visits. Providers primarily utilized external facilitation to further tailor CALM to their practice through implementation (eg, concrete help) and support-oriented help. Key lessons for implementing CALM in CBOCs are presented and discussed. CONCLUSIONS: Findings provide initial evidence for the feasibility and utility of using each component of a facilitation-enhanced training model to promote CBOC VA providers' implementation of a computer and manual version of CALM in their practice.

3.
J Appl Dev Psychol ; 60: 96-104, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31548756

RESUMEN

This 3-year study examined associations among drug use stigma, life stage, treatment utilization and health among 710 US adults using stimulants. Consistent with substance use developmental frameworks, life stage was represented by Emerging adulthood (18-25 years old, n=223), Earlymid adulthood (26-44 years old; n=384), and Older adulthood (45-61 years old; n=103). Emerging adults experienced less enacted stigma (i.e., experiences of discrimination) and perceived less public stigma (i.e., unjust treatment) over the course of the study than other life stage groups. More baseline enacted stigma was associated with more mental health and substance use treatment, whereas more baseline self stigma (i.e., negative thoughts about the self) was associated with less treatment utilization. Life stage moderated stigma-outcome associations such that substance use outcomes were worse for Emerging adults reporting more enacted stigma. Although emerging adults experienced less drug use stigma, stigma had a more negative impact on adults in this life stage.

4.
Alcohol Clin Exp Res ; 43(9): 1986-1993, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31335974

RESUMEN

BACKGROUND: Poor functioning among Concerned Others (COs; family and friends of an individual with an alcohol or other substance use disorder) is a significant public health problem. The purpose of this study was to inform interventions for COs by examining potential correlates of 3 aspects of functioning: quality of life, mental health, and knowledge of how to handle problems related to their drinker. METHODS: This study collected data from 277 COs when their friend or family member (their "drinker") was entering treatment for an alcohol use disorder. Potential correlates were the drinker's substance use severity, the CO-drinker relationship and communication, and COs' coping and perceived stigma related to involvement with their drinker. RESULTS: In a summary analysis, only stressors in the CO-drinker relationship (the drinker's criticism, disagreement, anger, and demands) were consistently associated with poorer functioning as indicated by COs' poorer quality of life and mental health. In contrast, only COs' use of approach coping was associated with COs' knowing how to handle problems related to the drinker. CONCLUSIONS: Because reducing both relationship stressors and the link between stressors and poor functioning can be achieved through CO and drinker education and intervention, these findings inform how to effectively support COs' goals for better functioning.

5.
Am J Emerg Med ; 2019 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-31221474

RESUMEN

BACKGROUND: The most recent guidelines on prescribing opioids from the United States Centers for Disease Control recommend that clinicians not prescribe opioids as first-line therapy for chronic non-cancer pain. If an opioid prescription is considered for a patient already on opioids, prescribers are encouraged to check the statewide prescription drug monitoring database (PDMP). Some additional guidelines recommend screening tools such as the Current Opioid Misuse Measure (COMM) which may also help identify drug-aberrant behaviors. OBJECTIVE: To compare the PDMP and the Current Opioid Misuse Measure (COMM), a commonly-recommended screening tool for patients on opioids, in detecting drug-aberrant behaviors in patients already taking opioids at the time of ED presentation. METHODS: Patients on opioids were enrolled prospectively in a mixed urban-suburban ED seeing approximately 65,000 patients per year. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratios of the PDMP and COMM were compared against objective criteria of drug-aberrant behaviors as documented in the electronic medical record (EMR) and medical examiner databases. RESULTS: Compared to the COMM, the PDMP had similar sensitivity (36% vs 45%) and similar specificity (79% vs 55%), but better positive predictive value, better negative predictive value, and better diagnostic odds ratio. The combination of the PDMP and the COMM did not improve the detection of drug-aberrant behaviors. CONCLUSIONS: The PDMP alone is a more useful as a screening instrument than either the COMM or the combination of the PDMP plus COMM in patients already taking opioids at time of ED presentation. However, the PDMP misses a majority of patients with documented drug-aberrant behaviors in the EMR, and should not be used in isolation to justify whether a particular opioid prescription is appropriate.

6.
Subst Abus ; 40(3): 363-370, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30810499

RESUMEN

Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.

8.
Fam Process ; 58(2): 431-445, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-29663337

RESUMEN

This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18-61 living in the rural Midwest and Mid-south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders.


Asunto(s)
Salud de la Familia , Relaciones Padres-Hijo , Salud Rural , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Padre , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Madres , Responsabilidad Parental , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
9.
J Stud Alcohol Drugs ; 79(5): 799-807, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30422794

RESUMEN

OBJECTIVE: Studies show that stimulant users have varied substance use patterns and that polysubstance use is associated with poorer past or concurrent medical, mental health, and substance use outcomes. This study examined outcomes of substance use patterns prospectively. METHOD: A latent class analysis was conducted to examine substance use patterns among adults using stimulants (n = 710; 38.6% women) at baseline, and the health and treatment utilization outcomes of different use patterns over the subsequent 3 years. To examine associations between latent class membership and outcomes, generalized estimating equation modeling was conducted. RESULTS: Four classes of substance use patterns at baseline were identified, involving high use of (a) methamphetamine and marijuana (23%); (b) crack cocaine and alcohol (25%); (c) powder cocaine, alcohol, and marijuana (23%); and (d) nonprescribed opioids, alcohol, marijuana, crack cocaine, and powder cocaine (i.e., polysubstance [29%]). Polysubstance class members had poorer physical health and mental health status, and more severe substance use, over the subsequent 3-year period, than other class members. Regarding treatment utilization, polysubstance class members had more medical care utilization than crack cocaine class members, and more substance use treatment utilization than powder cocaine class members. The methamphetamine, crack cocaine, and powder cocaine classes did not differ from each other on any health or treatment utilization outcome. CONCLUSIONS: People using stimulants commonly use other substances, and those whose polysubstance use includes nonprescribed opioids have especially poor health outcomes.


Asunto(s)
Estimulantes del Sistema Nervioso Central/efectos adversos , Salud Mental/tendencias , Metanfetamina/efectos adversos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto , Analgésicos Opioides/efectos adversos , Cannabis/efectos adversos , Femenino , Estudios de Seguimiento , Alucinógenos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trastornos Relacionados con Sustancias/diagnóstico , Factores de Tiempo , Adulto Joven
10.
Subst Abuse ; 12: 1178221818805980, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30349283

RESUMEN

Unhealthy substance use is a public health problem facing rural communities across the United States. Unfortunately, numerous challenges including stigma, perceived need for care, and perceived accessibility of substance use treatment serve as barriers to many rural adults using substances in obtaining the care they need. It is therefore important to examine whether accessing health care options other than substance use treatment is associated with improved substance use. In a recent study published in the American Journal of Drug and Alcohol Abuse, we explored whether use of outpatient medical care (OMC) was associated with reductions in substance use among rural stimulant users over a 3-year period. Overall, the results showed that, among rural adults using stimulants, those with at least one OMC visit had fewer days of alcohol, crack cocaine, and methamphetamine use over time. However, most participants reported not having any use of an OMC over the 3-year period, suggesting the need for identifying innovative opportunities to provide substance use help for persons living in rural settings. In this commentary, we discuss opportunities for detecting and addressing unhealthy substance use in retail clinics, via clergy and pharmacists.

12.
JMIR Ment Health ; 5(3): e10277, 2018 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-30135051

RESUMEN

BACKGROUND: A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. OBJECTIVE: The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program's acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. METHODS: An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. RESULTS: Key stakeholders suggested modifications to the original CALM program that altered its modules' appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. CONCLUSIONS: The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

13.
BMC Health Serv Res ; 18(1): 164, 2018 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-29514649

RESUMEN

BACKGROUND: Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., "criminogenic thinking"). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established. METHODS: Using a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment. DISCUSSION: The primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings. TRIAL REGISTRATION: This trial is funded by the VA Health Services Research & Development Program (IIR 14-081) and is registered with ClinicalTrials.gov (ID: NCT02524171 ).


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Crimen/prevención & control , Criminales/psicología , Principios Morales , Veteranos/psicología , Adulto , Protocolos Clínicos , Criminales/estadística & datos numéricos , Estudios de Seguimiento , Hospitales de Veteranos , Humanos , Servicios de Salud Mental , Tratamiento Domiciliario , Resultado del Tratamiento , Estados Unidos , United States Department of Veterans Affairs/organización & administración , Veteranos/estadística & datos numéricos
14.
J Subst Abuse Treat ; 86: 78-85, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29415855

RESUMEN

Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1-2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Visita a Consultorio Médico/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Arkansas/epidemiología , Femenino , Humanos , Kentucky/epidemiología , Masculino , Ohio/epidemiología , Población Rural , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/rehabilitación
15.
Am J Drug Alcohol Abuse ; 44(2): 235-243, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28662352

RESUMEN

BACKGROUND: Negative views toward substance use treatment among some rural substance users and limited treatment resources in rural areas likely affect substance use utilization. It is therefore important to determine whether accessing healthcare options other than substance use treatment, specifically outpatient medical care (OMC), is associated with reductions in substance use. OBJECTIVES: We examined whether use of OMC was associated with reductions in substance use among rural substance users over a three-year period. We also explored whether substance user characteristics, including substance-use severity and related-problems, moderated this potential relationship. METHODS: Data were collected from an observational study of 710 (61% male) stimulant users using respondent-driven sampling. Participants were recruited from rural counties of Arkansas, Kentucky, and Ohio. RESULTS: We found a significant main effect of having at least one OMC visit (relative to none) on fewer days of alcohol, crack cocaine, and methamphetamine use over time. Fewer days of alcohol, crack cocaine, and methamphetamine use were reported in participants with at least one OMC visit (relative to those with none) among those reporting higher Addiction Severity Index employment and psychiatric severity scores, and low education, respectively. CONCLUSION: Our findings extend the results from prior studies with urban substance users to show that contact with an outpatient medical care clinic is associated with reductions in substance use over time among rural substance users with especially poorer functioning. These findings highlight the potential importance of OMCs in addressing unhealthy substance use in rural communities.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Trastornos Relacionados con Anfetaminas/epidemiología , Fumar Cocaína/epidemiología , Población Rural/estadística & datos numéricos , Adulto , Arkansas/epidemiología , Femenino , Humanos , Kentucky/epidemiología , Masculino , Ohio/epidemiología , Adulto Joven
16.
Rural Ment Health ; 41(2): 110-122, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29051795

RESUMEN

There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.

17.
Mil Med ; 182(9): e1888-e1894, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28885951

RESUMEN

BACKGROUND: Unhealthy drinking is relatively common among women U.S. military Veterans. Primary care is often the setting where patients first come into contact with the health care system, and providers in this setting play a critical role in connecting unhealthy drinkers to appropriate care. Little is known about primary care providers' perspectives on factors that affect whether women Veterans presenting to primary care with unhealthy drinking connect to alcohol-related care. Understanding factors that affect whether patients connect to alcohol-related care may improve providers' ability to support women Veterans with unhealthy drinking get needed care. METHODS: This qualitative study used semi-structured interviews with 14 providers from two Veterans Administration Women's Health primary care clinics, including nurses, nurse practitioners, physicians' assistants, and physicians, and colocated mental health providers. The interviews were transcribed, and themes pertaining to providers' perspectives on barriers and facilitators to connecting women Veterans' with unhealthy drinking to alcohol-related care were identified through template analysis. FINDINGS: Primary care providers perceived numerous provider- and clinic-level factors as relevant to their ability to connect women Veterans to alcohol-related care. Barriers providers described were insufficient care resources, provider prioritization of alcohol-related care, insufficient knowledge of care options or the referral process among providers, time constraints during routine clinical visits, and the referral process for alcohol-related care. They also described resources available in primary care, primary care provider behaviors, and initiatives at the Veterans Administration as helpful. DISCUSSION: Although primary care providers are gatekeepers to specialty treatment services, ongoing education, and colocated mental health staff could help reduce barriers to these services, ultimately improving health outcomes for women Veterans and others with unhealthy drinking.


Asunto(s)
Alcoholismo/terapia , Personal de Salud/psicología , Percepción , Veteranos/psicología , Salud de la Mujer/tendencias , Adulto , Actitud del Personal de Salud , California , Femenino , Prioridades en Salud , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Investigación Cualitativa , Estados Unidos , United States Department of Veterans Affairs/organización & administración
18.
J Addict Dis ; 36(4): 252-263, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28863271

RESUMEN

BACKGROUND: Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making. AIMS: We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder. METHODS: We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis. RESULTS: Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Toma de Decisiones , Depresión/epidemiología , Grupos Focales , Conductas Relacionadas con la Salud , Aceptación de la Atención de Salud/psicología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Anciano , Comorbilidad , Estudios de Factibilidad , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Telemedicina/métodos , Teléfono , Estados Unidos/epidemiología , Veteranos/psicología , Salud de la Mujer
19.
J Subst Abuse Treat ; 77: 6-12, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28476274

RESUMEN

Outpatient medical care (OMC) settings are a care context in which effective management of unhealthy substance use can occur. However, no studies have documented rates of OMC use and characteristics of OMC use among rural substance users. This study sought to examine the rates and frequency of OMC use in a sample of rural drug users over a three-year period. We also explored characteristics of participants associated with use of OMCs over time. Data were collected from June 2005 to September 2007 from a natural history study of 710 stimulant users living in rural communities. Participants were adults, not in drug treatment, and reporting recent methamphetamine, crack cocaine or powder cocaine use. Between 34 and 39% of participants reported any use of an OMC over the three-year follow-up period, with a mean average number of visits ranging from one to two at each follow-up. Having medical insurance, reporting any use of substance use disorder-related care (including formal substance use treatment or mutual-help groups), and higher Addiction Severity Index (ASI) medical and psychiatric composite scores were associated with greater odds of any OMC use and higher frequency of OMC use over time. Being male and having higher ASI alcohol and drug composite scores were associated with lower odds of any OMC use and lower frequency of OMC use. Our findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance, and the need for public health efforts to increase the use of OMCs among rural drug users not experiencing more severe medical or psychiatric health problems.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Trastornos Relacionados con Anfetaminas/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Población Rural , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Cocaína Crack/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metanfetamina/administración & dosificación , Pacientes Ambulatorios , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto Joven
20.
Behav Cogn Psychother ; 45(3): 253-265, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28325175

RESUMEN

BACKGROUND: Computer-delivered cognitive behavioural therapy (cCBT) is an effective alternative to provider-delivered treatment for depression and anxiety, but high attrition poses a significant challenge to its use. Peer support is a feasible approach to improving cCBT engagement, but less is known about its acceptability among Veterans. AIMS: To obtain feedback from Veterans (n = 24) with depression and/or anxiety on their preferences for (a) activities of Veterans Administration Peer Support Specialists (VA PSS) in helping Veterans use Moving Forward, a cCBT-based protocol developed by VA, and (b) methods for delivering support to Veterans using this programme. METHOD: Four focus groups (5-7 Veterans per group) provided feedback to be used in the development of a peer-supported engagement intervention to help Veterans with depression and anxiety use Moving Forward. Content areas included roles that a VA PSS might play in supporting the use of and engagement in Moving Forward, as well as methods of delivering that support. RESULTS: Veteran preferences for PSS activity focused on practical aspects of using Moving Forward, including orientation to the programme, technical support, and monitoring progress. Feedback also suggested that Veterans preferred more personal roles for the PSS, including emotional support, as well as application of Moving Forward to 'real life' problems. CONCLUSIONS: The findings extend the literature on online, patient-facing mental health protocols by identifying emotional support and 'real life' skills application as Veteran-preferred components of a peer-support protocol designed to enhance use of and engagement in cCBT for depression and anxiety.


Asunto(s)
Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Internet , Grupo Paritario , Apoyo Social , Veteranos/psicología , Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Femenino , Grupos Focales , Retroalimentación Formativa , Humanos , Masculino , Salud Mental , Persona de Mediana Edad
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