Treatment of insomnia associated with alcohol and opioid use: a narrative review.

Substance use disorders (SUDs) are associated with profound sleep disturbances, including insomnia, sleep fragmentation, and circadian rhythm dysfunction resulting in serious mental and physical consequences. This minireview presents an overview of the neurocircuitry underlying sleep disturbances in SUDs and elaborates on treatment options with emphasis on alcohol use disorder (AUD) and opioid use disorder (OUD). A PubMed, Embase, CINAHL Plus, Cochrane, and Scopus search were conducted using sleep- and AUD/OUD related keywords from January 1st, 2000, to January 31st, 2023, with preferences for recent publications and randomized-controlled trials. A bidirectional relationship exists between insomnia and addiction with the status of each condition impacting the other in dictating clinical outcome. Existing evidence points to a resurgence of insomnia during detoxification, and unless treated satisfactorily, insomnia may lead to relapse. The discussion summarizes the strengths and limitations of cognitive behavioral therapy and pharmacological treatment for insomnia in SUDs covering evidence from both animal and clinical studies. The assumption of reestablishing normal sleep patterns by attaining and maintaining sobriety is misguided. Comorbid insomnia in patients with SUDs should be approached as an independent condition that requires its own treatment. Future clinical trials are needed with the aim of providing a resource for guiding clinical management of the many patients with insomnia and SUD.

Persistently high HIV incidence among men who have sex with men and people who inject drugs attending integrated care centres in India: a longitudinal assessment of clinic-based data.

INTRODUCTION: Globally, there have been significant declines in HIV incidence over the past two decades, but this decline is slowing, and in some settings, declines have stalled or are growing-particularly where epidemics are concentrated in key populations (KPs). Understanding temporal changes in HIV incidence among KP is critical yet, due to logistical constraints, there are few sources of longitudinal incidence data, particularly among KP. METHODS: We present HIV incidence rates from June 2014 to December 2022 among cisgender men who have sex with men (MSM) and people who inject drugs (PWID) attending community-based integrated care centres (ICCs) in 15 Indian cities. ICCs, established between 2014 and 2017, provide HIV testing and other services to MSM (eight sites) or PWID (eight sites). Client HIV testing data were included in the analysis if they had ≥2 tests and were not positive on the first test. We calculated incidence rates per 100 person-years (PY), stratified by KP, city/site and year. Poisson regression explored associations of incidence with time, age, gender (PWID only) and ICC use. RESULTS: From June 2014 to December 2022, 13,501 clients (5722 MSM, 7779 PWID) had ≥2 HIV tests over a median of 1.8 years. There were a total of 1093 incident HIV acquisitions. Overall incidence rates for MSM and PWID were 1.9/100 PY (95% CI: 1.7-2.2) and 4.1 (3.9-4.4), respectively. Among MSM sites, incidence ranged from 0.4 to 3.5 and in PWID sites from 0.6 to 17.9. From adjusted models, incidence increased by 17% annually among MSM. Among PWID, incidence increased by 11% annually up until 2020 and then decreased by 29% after 2020; when excluding the outlier of New Delhi, incidence was stable among PWID. MSM and PWID 21-25 years old had the highest risk of HIV and among PWID, those more consistently engaged in medication for opioid use disorder were at the lowest risk. CONCLUSIONS: While there was substantial geographic variability, MSM and PWID engaged in a free community-based clinic experienced persistently high HIV incidence (>2/100 PY). KP in low- and middle-income countries should be a focus when considering novel strategies such as long-acting pre-exposure prophylaxis to curtail incidence.

Perception, experience, and practice of Iraqi community pharmacists towards customers with substance use disorder.

Background: Pharmacists are healthcare professionals who frequently encounter individuals struggling with addiction in their day-to-day practice. Studies critique pharmacists' competence in the detection, prevention, and management of substance use disorder. Objective: This study aimed to get in-depth information about the perception, experience, and practice of Iraqi pharmacists towards substance use disorder. Methods: A qualitative-study was performed through face-to-face individual-based interviews with community pharmacists in Baghdad/Iraq. Interviews were conducted from July 2023 till the saturation point (September 2023). Data analyzed by thematic-analysis approach. Results: Interviews were conducted with 21 pharmacists. Most participants reported that substance use disorder is common among young males. Pregabalin is the most commonly requested drug. Availability, euphoric-effect, and low cost are the main reasons for favoring a drug by persons with substance use disorder. Moreover, poverty and social problems are the main reasons for substance use disorder. Drug intoxication signs are the main clues in recognizing substance use disorder. Most participants refuse dispensing drugs without prescription and reported that the barriers for implementing regulations on drugs with high potential for dependence are related to the limited follow-up to pharmacists, presence of outsiders, and fear from reactions of persons with substance use disorder. Pharmaceutical services to persons with substance use disorder were performed by few pharmacists and limited to patient education about the risks of misusing drugs. Most participants reported that enhancing pharmacists' competence in substance use disorder is necessary. Conclusion: Substance use disorder is common among young Iraqi males. Pregabalin is a commonly requested drug. The current Iraqi regulations are not sufficient to prevent substance use disorder. Pharmaceutical services to persons with substance use disorder are weak and limited to patient education. Enhancing pharmacists' knowledge through educational courses is necessary to improve their role in facing substance use disorder.

The substance use disorder treatment gap among US college students: Findings from the 2021 National Survey on Drug Use and Health.

Background: Substance use and substance use disorders (SUD) are prevalent among college students. Information about the gap between substance use treatment need versus treatment receipt can guide efforts to increase service access. This study examined past-year DSM-5 SUD and receipt of treatment among US college students. Methods: Past-year DSM-5 SUD and treatment receipt were estimated among a sample of 6115 college students aged 16 and older and a comparison group of non-students from the 2021 National Survey on Drug Use and Health, weighted to be nationally representative. Among the college student sample, multiple logistic regression was used to identify factors associated with past-year SUD. Bivariate analyses were used to compare socio-demographic and substance use differences between college students who received treatment and those who had an SUD but did not receive treatment. Results: Weighted prevalence of past-year SUD among college students was 21.8 %. Only 4.6 % of students who had an SUD received treatment in any setting. Relative to non-students with SUD, proportionately fewer college students with SUD received treatment. Among college students, age, sex, past-year psychological distress, and past-year substance use were significantly associated with past-year SUD; and receipt of treatment differed significantly by age, insurance type, level of education, and enrollment status. College students who received treatment had greater prevalence of stimulant, opioid, tranquilizer, and poly-SUDs and more severe SUD symptomology than those who did not receive treatment. Conclusion: Additional efforts are needed to engage college students with SUDs in acceptable, evidence-based treatment services.

Smartphone-based drug testing in the hands of patients with substance-use disorder-a usability study.

Aim: A clinical study was performed to test the usability of a smartphone eye-scanning app at a needle exchange facility to detect drug use to support therapy. Methods: The study recruited 24 subjects who visited the facility one to three times, making a total of 40 visits. During each visit the subjects underwent testing for non-convergence (NC), nystagmus (NY), and pupillary light reflex (PLR) using a smartphone-based eHealth system. The collected eye data were transformed into key features that represent eye characteristics. During each visit, a time-line follow-back interview on recent drug use and a usability questionnaire were completed. Results: Technical usability of the smartphone eye-scanning app was good for PLR and NC, where key features were generated in 82%-91% of the cases. For NY, only 60% succeeded due to cognitive problems to follow instructions. In most cases, subjects were under the influence of drugs when participating in the tests, with an average of 2.4 different drugs ingested within the last 24 h. The key features from PLR could distinguish use of opioids from central stimulants. The usability questionnaire results indicate that 23 of the 24 subjects could perform the eye-scanning by themselves after a short training, even when under severe influence of drugs. The caregiver assessed that 20 out of the 24 challenging subjects could potentially perform these tests in an indoors, home-like environment. Conclusions: Smartphone-based eye-scanning is functional in a patient population with heavy drug use, also when under the influence of drugs. The use of central stimulants can be distinguished from the use of opioids.

Impulsivity, trauma history, and interoceptive awareness contribute to completion of a criminal diversion substance use treatment program for women.

Introduction: In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples. Methods: The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women's Risk/Needs Assessment (WRNA). Results: ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81). Discussion: Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.

'But Would I Be Able to Toast With Friends?' When Service Users Ask for New Care Pathways.

INTRODUCTION: The WHO European Mental Health Action Plan (2013-2030) emphasises the need to generate services that are more inclusive and attentive to the co-construction of care practices. This exploratory research investigates the needs of young substance abusers shown during their stay in residential communities; in particular, it explores the idea that treatment may include a new phase focused on how to manage moderate or controlled alcohol intake during residential care. Interviews with young ex-users open up critical reflections on complete abstinence programmes from all substances, including alcohol, as a prerequisite for discharge and also provide examples of how to co-design a plan for mindful drinking. METHODS: Fourteen young adults, aged 19-32 years, non-alcoholists, treated at rehab in Fermo, in central Italy, were interviewed during a programme between 6 and 18 months of period. They were asked about exploring needs in preparation for the conclusion of the rehabilitation pathway. From this exploration emerged the need to introduce controlled alcohol intake during the rehabilitation stay. This request became the focus of the semi-structured interviews. RESULTS: Three main themes emerged, which are as follows: (1) difficulties in integrating the new identity with the past of consumption, (2) resistance to the idea of total abstinence in social relations and (3) uncertainties about post-community behaviour regarding alcohol intake. At the same time, three unexpected needs were expressed: (1) test the personal knowledge and skills on how to manage the alcohol intake, (2) receive support during the residential path to build up self-control competence given the post-discharge period and (3) build a personalised therapeutic path together with the supervisor and the operators while still at the rehab, according to the realistic lifestyle and routine outside the rehab. CONCLUSIONS: This research highlights the importance of personalising treatment based on each user's needs, going far beyond the standardised treatments for users previously considered unable of self-control and self-determination. For that purpose, the relationship between the users and the operators might be privileged, as it is able to cover the specific needs aimed for the new identity. INVOLVING THE PARTICIPANTS: The research sparked a discussion within the community, involving and initiating an open dialogue between the operators and the users, allowing them to focus on certain innovative strategies offered by the service, putting the users' needs at the very centre of the attention. The results were compared and discussed actively with the participants involved.

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Background: Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Methods: Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. Results: There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). Conclusions: The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Educating adolescents on preventing substance use: The role of 24-h movement behaviors ─ data from 2021 Youth Risk Behavior Surveillance.

BACKGROUND: Little is known about how adhering to the health guidelines for physical activity (PA), screen time (ST), and sleep duration (SD) relates to substance use in adolescents. Thus, this study aims to explore the potential association between adherence to the 24-h movement behavior (24-h MB) guidelines and substance use among adolescents. METHODS: Data from the 2019 Youth Risk Behavior Surveillance was analyzed. Participants reported their weekly PA, ST, SD, and substance use (alcohol and smoking) over the past 30 days. The mean age in the total participants was 15.56, and 48.03 % of the participants were females. Logistic regression was used in this study to explore the potential association between 24-h MB and substance use. Odds ratios (ORs) were reported alongside a 95 % confidence interval to enhance understanding of the observed association. RESULTS: Only 2.22 % participants adhered to all three 24-h MB guidelines, while 47.99 % did not follow any guidelines. Notably, there was no significant difference in the odds of cigarette smoking between participants who followed none of the guidelines and those who followed some or all of them. Nevertheless, adherence to one or more guidelines was found to be associated with higher odds of abstaining from alcohol consumption compared to non-adherence (one guidelines: OR = 1.17 [1.08, 1.28], two guidelines: OR = 1.28 [1.13, 1.44]). CONCLUSIONS: Adhering to 24-h MB guidelines may reduce adolescents' alcohol consumption, but the adherence was not significantly associated with smoking. Longitudinal studies are needed to confirm these findings. These results can inform adolescent health policies and interventions aimed at reducing substance use from the perspective of healthy time-use behaviors, which can be used for researchers and educator.

Childhood maltreatment and vulnerability to substance use disorders: The mediating role of psychological security.

Background: Understanding the factors associated with the propensity for drug dependence might be helpful in providing the best strategies for substance use prevention among youth. The present study was conducted to examine the association between childhood maltreatment (CM) and susceptibility to substance use disorders (SUDs), taking into account the mediating role of psychological safety. Methods: In this cross-sectional study, multistage cluster sampling was employed to recruit 400 male students from the three universities of Tabriz in 2019. Research instruments included the valid and reliable scales of substance abuse, childhood trauma, and mental safety. Data were analyzed using Pearson correlation, and structural equation modeling. Results: The results showed positive significant relationships between vulnerability to SUDs, CM, and low levels of psychological safety. The evaluation of our hypothetical research model using fit indices showed that the model fits well the measurement model (CFI=0.97, GFI=0.95, RMSEA=0.058). Conclusion: Our proposed theoretical model suggested psychological security as a mediator between CM and SUDs. CM explained addiction in college students through reducing psychological security. Investigating these interactive processes seems to be detrimental, considering that they may enhance our understanding of the ways to reduce the risk.

Parental substance use disorders and psychiatric conditions in offspring: A Swedish population-based cohort study with over 1,000,000 individuals.

BACKGROUND: Exposure to parental substance use problems has been associated with offsprings poor health and adverse social outcomes. In this study, we examined the association between exposure to parental substance use disorder (SUD) during childhood, and adolescence and offspring psychiatric conditions in young adulthood. METHOD: This was a register-based cohort study comprising 562,095 males and 531,130 females born between 1981 and 1990 in Sweden. Parental SUD was captured between the offspring's birth and eighteenth birthday. Cox regression models were used to estimate the Hazard Ratio (HR) of psychiatric conditions from age 18 years to a maximum age of 35 years, from January 1, 1999 to December 31, 2016. RESULTS: About 4% of the study population was exposed to parental SUD during childhood and adolescence. The HR of psychiatric diagnosis was higher in males (1.80, 95% CI = 1.77-1.85) and females (1.56, 95% CI = 1.51-1.60) who were exposed to parental SUD, compared to those who were not; after adjusting for year of birth, domicile, origin, relative poverty, and other parental psychiatric diagnoses. The risks of psychiatric conditions were higher among males and females exposed to parental SUD during childhood compared to during adolescence. CONCLUSION: Exposure to parental SUD during childhood and adolescence was associated with an increased risk of psychiatric conditions in early adulthood for both males and females. Neither origin, poverty, municipality, or other parental psychiatric diagnoses fully explained the association. These risks seemed to be somewhat higher among males, and among those exposed during childhood when compared to during adolescence.

An introduction to the HEALthy Brain and Child Development Study (HBCD) study.

The fundamental organization of the human brain is established before birth, with rapid growth continuing over the first postnatal years. Children exposed before or after birth to various biological (e.g., substance exposure) or psychosocial hazards (e.g., maltreatment) are at elevated likelihood of deviating from a typical developmental trajectory, which in turn can be associated with psychological, behavioral, and physical health sequelae. In the HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, brain, physical, biological, cognitive, behavioral, social, and emotional development is being examined starting in pregnancy and planned through age 10 (data are sampled at varying degrees of granularity depending on age, with more dense sampling earlier in life). HBCD aims to determine the short- and long-term impacts of a variety of both harmful and protective factors, including prenatal substance use, on developmental trajectories through early childhood. Organized as a nationwide consortium across 27 sites, the HBCD Study will collect multimodal data that will be made publicly available on a yearly basis, through a data use application and approval process. Here we provide an overview of the HBCD Study design, sampling, protocol development, and data management. Data collected through HBCD will be fundamental to informing future prenatal and early childhood interventions and policies to promote wellbeing and resilience in all children.

Opioid-specific harm reduction in the emergency department: how staff provide harm reduction and contextual factors that impact their capacity to engage in harm reduction practice.

BACKGROUND: Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement. METHODS: Using a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (n = 99) and one-on-one semi-structured interviews (n = 15). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes. RESULTS: Study findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care. CONCLUSIONS: There is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.

National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management.

BACKGROUND: Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic. METHODS: A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings. RESULTS: Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination. CONCLUSION: Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.

Putting the capital in recovery capital: An exploration of universal basic income and the impacts for people who use drugs in Canada.

Many nations and communities have reinvigorated discussions around universal basic income (UBI) as a means to address growing inequity. Research to date suggests that such systems can have profound positive public health and social impacts. Substance use, however, has not been explored as an area that may be impacted by UBI. This essay explores the current UBI literature and suggests how such a program could impact substance use health concerns within the Canadian context. Specifically, a UBI program in Canada could significantly reduce the negative health concerns of substance use and reduce the nation's current expenditures on healthcare interventions. Canada and other nations should consider UBI as a means to address substance use concerns and future research should include reviewing substance use data as part of any basic income intervention.

Emergency Department Screening and Interventions for Adolescents With Substance Use: A Narrative Review.

BACKGROUND: Adolescent substance use is a growing public health concern, particularly given rising mortality rates from drug overdose deaths. The emergency department (ED) provides a unique opportunity to screen adolescents for substance use and provide brief interventions and linkage to care. OBJECTIVE OF THE REVIEW: This article provides a narrative review of the current evidence for ED screening and brief interventions for adolescents with substance use and identifies important opportunities, challenges, and areas for future research. DISCUSSION: There are several validated substance use screening and assessment tools for use with adolescents that can be implemented into ED screening programs. Brief motivational interviewing interventions may reduce alcohol use, but evidence for reductions of other substances is limited due to insufficient research. Both screening and interventions are feasible and acceptable in the ED setting with the appropriate resources. Increased training and the use of emerging technology can provide emergency physicians with opportunities to incorporate these tools into practice to when treating adolescents. Linkage to outpatient care for adolescents with substance use is understudied. The research on adult patient ED interventions and linkage to care is more robust and can provide insights for future ED studies among adolescents. CONCLUSION: ED-based adolescent substance use screening and interventions are necessary, feasible, and acceptable, but understudied. Future studies, focusing on optimizing ED interventions and linkage to care, are important next steps in determining the best care for adolescents with substance use who present to the ED.

Retrospective study of hepatitis C screening and seroprevalence in the GHU Paris.

OBJECTIVES: The prevalence of hepatitis C virus (HCV) has been estimated to be approximately ten times higher in patients with psychiatric disorders, but European data are rare and only two French studies have recently been published on the subject. Our objective was to determine the HCV screening rate and the prevalence of HCV in adult patients hospitalised in the largest French psychiatric hospital. METHODS: We conducted a retrospective study of all adult patients hospitalised at GHU Paris, from 2019 to 2022, including age, gender, HCV screening, HCV serological status, and the existence of an ICD-10 diagnosis of psychoactive substance use disorder. Descriptive statistics used means±standard deviations and percentages. Bivariable comparisons used Student's t test and Chi-square test. RESULTS: The overall HCV screening rate was 55.4% and increased over the four years from 37.1% in 2019 to 69.4% in 2022. Patients screened were significantly younger people and with a substance use disorder than unscreened patients. The prevalence of HCV over this 4-year period was 2.8% and remained stable. The HCV-positive patients were significantly more male, older and more likely to have substance use disorders than the HCV-negative patients. CONCLUSIONS: We found a prevalence rate of HCV ten times higher than the prevalence in the general population, in line with findings in many other European countries. The eradication of HCV will not be possible without the elimination of this "forgotten reservoir" of the virus. Efforts must be made in psychiatric hospitals to test all patients in order to treat patients suffering from hepatitis C with direct-acting antivirals.

An examination of the protective role of internalizing symptoms in adolescent substance use.

Although psychological symptoms are broadly considered to be risk factors for substance use, internalizing symptoms may be associated with lower risk for adolescent substance use after controlling for co-occurring externalizing symptoms. The present study explored two potential mediators of this protective association between internalizing symptoms and adolescent substance use: popularity and harm avoidance. The study used data from the Colorado Longitudinal Twin Study (LTS) and Colorado Adoption Project (CAP). Annual assessments of internalizing and externalizing symptoms and social competence were completed by parents and teachers at participant ages 7 to 16. Harm avoidance and substance use were assessed at age 17. In this sample, internalizing symptoms were associated with less frequent substance use, controlling for externalizing symptoms. We did not find evidence that popularity or harm avoidance accounts for the protective association of internalizing symptoms with adolescent substance use. Teacher-reported popularity was associated with less frequent substance use, suggesting that social connectedness in the school context may be a protective factor for adolescent substance use. Harm avoidance was not associated with substance use after accounting for internalizing and externalizing symptoms.

Determinants of Poor Health among Workers in Criminal Justice, Community and Social Services, and Healthcare: Adverse Childhood Experiences, Workplace Trauma Exposure, and Gender Differences.

Adverse childhood experiences and workplace trauma exposure are associated with poor health. However, their differential impacts by gender are difficult to assess in studies of organizations with gender imbalances (e.g., law enforcement officers are more likely men whereas social workers are more likely women). Using a community-based participatory research framework, this study examines trauma exposure, mental and physical health, and substance use in an occupationally diverse sample (n = 391). Trauma exposure was high and associated with poor health. Even though women experienced more adversity, they were often more resilient than men. Implications for trauma-informed workplaces are discussed.

Association of duration of treatment on post-discharge mortality in forensic psychiatric patients in Finland.

Background: Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients. Materials and methods: The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates. Results: The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age. Conclusions: Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at higher mortality risk after release, but longer treatment duration may mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination.