Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey.

BACKGROUND: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.

Psychometric properties of a Recovery Empowerment Scale: Testing emotional, cognitive, behavioral, and relational domains.

Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.

Alcohol sales during COVID-19 social restrictions: Initial evidence from Alcoholic Beverage Control states.

Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted life around the globe and has the potential to seriously impact alcohol consumption for individuals experiencing social isolation and pandemic-related stress. Evidence from prior epidemics suggests increased alcohol consumption during quarantine and times of high stress are associated with a greater chance of developing an alcohol use disorder (AUD). This study examines alcohol sales data to ascertain how individuals are interacting with alcohol during the pandemic.Materials and method: Monthly off premises alcohol sales data for select US alcoholic beverage control states were used to construct monthly sales patterns from 2015 to 2020. An independent samples t-test was used to determine if COVID-19 era alcohol sales were higher than those that occurred from 2015 to 2019.Results: Alcohol sales from March to August 2020 were significantly higher than sales from the same span of months from 2015 to 2019 (t=-2.47, p<.05). The associated monthly percentage increase in sales ranged from 14 to 44% with the overall trend indicating a move toward pre-pandemic sales totals.Conclusion: As COVID-19 continues to disrupt typical ways of being across the globe, the implications of increased sales of alcohol should not be overlooked. Taken together, the evidence on increased use during isolation and later AUD diagnosis coupled with the ABC state sales figures here, point to a potential increase in the development of AUD and an increase in alcohol-related harms.

Community social deprivation and availability of substance use treatment and mutual aid recovery groups.

BACKGROUND: The spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services. METHODS: This is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services. RESULTS: Community social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services. CONCLUSIONS: Contrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.

What Are Youth Asking About Drugs? A Report of NIDA Drug Facts Chat Day.

The current study analyzes a sample of questions about drugs asked online by youth who participated in the National Institute on Drug Abuse's (NIDA) "Drug Facts Chat Day." The types of drugs youth asked about were coded into 17 substance categories, and the topics they raised were coded into seven thematic categories. The top five queried drugs were marijuana (16.4%), alcohol (8.5%), tobacco (6%), cocaine (5.7), and pharmaceutical drugs (4.5%). The effects of drug use, experience of being high, the addictiveness of drugs, pharmacology, and drug sales were among the more common types of questions to emerge but varied depending on the substance. These findings show the types of information young people are seeking about drugs and have clear implications to inform youth drug education programs.

Neighborhood alcohol outlet density and rates of child abuse and neglect: moderating effects of access to substance abuse services.

This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed.

Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?

PURPOSE: We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.

Examining tobacco outlet concentration in New Jersey: does income and ethnicity matter?

This study examined the geographic association between tobacco outlet density and the demographic indicators of median household income and percentage of Hispanic residents in New Jersey. Tobacco outlet density was assessed by examining all tobacco retailers licensed in 2004 in New Jersey, and demographic variables were based on the 2000 United States Census. Results indicated that the percentage of Hispanic residents and median household income were both salient predictors of tobacco outlet density. We also observed that income level moderated the relationship between the percentage of Hispanics residents and tobacco outlet density. Implications for environmentally based tobacco prevention and control initiatives are discussed.

The Moderating Effect of Substance Abuse Service Accessibility on the Relationship between Child Maltreatment and Neighborhood Alcohol Availability.

This study investigates how the relationship between dense concentrations of alcohol retailers and high rates of child maltreatment may be moderated by the presence of substance abuse service facilities. Using a cross-sectional design, the study utilized data from Bergen County, New Jersey on child maltreatment reports, alcohol-selling retailers, substance abuse service facilities, and the United States Census. Findings indicate child maltreatment rates were higher in neighborhoods with lower socioeconomic status and those with greater alcohol outlet density. Neighborhoods with easily accessed substance abuse service facilities had lower rates of child maltreatment. Additionally, the relationship between child maltreatment and alcohol outlet density was moderated by the presence of substance abuse service facilities. The study findings highlight the relevance of making primary prevention approaches readily available and using multi-sector collaboration to reduce child maltreatment.

The importance of income in the link between tobacco outlet density and demographics at the tract level of analysis in New Jersey.

This study analyzed associations between tobacco outlet density and demographic correlates (median household income and minority population percentages) within two New Jersey counties. The study was conducted using variables developed from state licenses for tobacco outlets and data from residential census tracts. Results showed that tracts with lower median household income and higher percentages of minority residents had greater densities of tobacco-selling retail outlets. Results also demonstrated that median household income was the strongest predictor of tobacco outlet density across both counties. Implications of the study and directions for future research, specifically the interaction between income and race/ethnicity, are discussed.