Barriers, perceived benefits and preferences to exercise in adults with an opioid use disorder in the U.S.

Introduction: Over 10 million Americans misuse opioids and more than 5 million have been diagnosed with an opioid use disorder (OUD). In 2021, over 100,000 Americans died of a drug overdose and more than 75% of these deaths involved an opioid. Exercise has been shown to increase abstinence and decrease anxiety and depression in people with a substance use disorder. However, only a few small trials have focused on persons with OUD who often experience additional challenges including chronic pain, mental health disorders and cardio-metabolic abnormalities. Methods: We aimed to describe the barriers, perceived benefits and preferences to exercise in adults with OUD in residential treatment in the U.S. as part of a larger study. We conducted 33 individually administered, semi-structured interviews and transcribed audiotapes verbatim, conducted coding and thematic analysis using NVivo v12 software (QSR International Inc.). Results: Our sample had nearly equal representation of males and females and, was predominantly Caucasian (88%) with a mean of age of 34.5 (s.d. 7.5) years old. Participants stated that exercise helps to reduce drug cravings, anxiety, depression and pain and improve mood, physical health and build "normalcy". Barriers included lack of time, access to resources, fear of poor health and triggering pain. Participants preferred moderate intensity exercise 3 times/week and 30-60 min sessions. Conclusions: Our findings indicate that adults with OUD believe exercise is a valuable tool to use in their recovery but they encounter several barriers. Many barriers, however, could be overcome with structured programs offered by residential treatment centers.

Open to interpretation: An integrated primary care behavioral health training approach for treating linguistically diverse patients.

INTRODUCTION: Integrated primary care settings serve an increasingly high volume of linguistically diverse patients. In English language-dominant countries, limited English proficiency (LEP) is associated with disparities in access and quality of behavioral health (BH) care. Interpretive services (IS) aim to address these disparities by assisting in the delivery of clinical care between patients and providers who speak different languages. Yet, there is a need for greater emphasis on the utilization of IS in clinical training for BH professionals (e.g., psychology, social work, counseling, and family therapy). METHOD: In this conceptual article, we describe a BH practicum rotation for predoctoral psychology trainees in a free, student-run integrated primary care clinic that largely serves uninsured adults with LEP. First, we discuss our training model which includes a 90-min didactic lecture on IS for BH and supervised applied clinical experiences (e.g., psychotherapy, warm handoffs, and consultation). Then, we present vignettes prepared by trainees about the challenges and benefits associated with delivering BH care with IS at the predoctoral level of training. RESULTS: From the practicum experience, clinical psychology trainees reported improved knowledge and competencies in utilizing IS as well as generalizable skills for delivering BH care with a focus on multicultural practice. DISCUSSION: We recommend that other integrated primary care BH training sites consider emphasizing training in IS. This article concludes with recommendations for implementation and dissemination of our training model on other sites. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Developing a novel treatment for patients with chronic pain and Opioid User Disorder.

BACKGROUND: It is critical to develop empirically based, community-treatment friendly, psychotherapy interventions to improve treatment for patients with comorbid chronic pain and Opioid Use Disorder. Understanding factors that increase patient adherence and attendance is important, along with strategies targeted to address those issues. METHODS: Based on initial psychophysiology research on adults with OUD and chronic pain, we created an integrated cognitive-behavioral, 12-week outpatient group therapy called STOP (Self-regulation Therapy for Opioid addiction and Pain). In this study, we pilot tested STOP in a Stage 1a feasibility and acceptability study to identify unique treatment needs and factors that increased session attendance, adherence to treatment, and improved outcomes. Fourteen individuals on medication for OUD with co-occurring chronic pain participated. RESULTS: STOP had high attendance rates (80%; and active patient engagement). Urine toxicology showed no illicit drug use after week 8. Data analysis from pre-intervention to a 3-month follow-up showed significant functional improvement (F(1,12) = 45.82;p < 0.001) and decreased pain severity levels (F(1,12) = 37.62;p < 0.01). Participants reported appreciation of the unique tools to counteract physiological activation during a pain flare or craving. Participants also reported benefit from in-session visual aids, applicable pain psychology information, take-home worksheets, tools for relaxation practice, learning to apply the therapy tools. DISCUSSION: STOP is a 90-min 12-week rolling-entry group therapy based on previous research identifying psychophysiological needs of pain and OUD patients that can be seamlessly incorporated into community addiction treatment clinics. CONCLUSION: Preliminary results of STOP are promising with high patient engagement and adherence and significant reductions in drug use and pain. TRIAL REGISTRATION: ClinicalTrials.Gov NCT03363243 , Registered Dec 6, 2017.

Making mental health a priority on college campuses: implementing large scale screening and follow-up in a high enrollment gateway course.

OBJECTIVES: We sought to evaluate a universal mental health screening program for undergraduate students using graduate student clinicians and online interviewing tools. Participants: Participants included 455 undergraduate students. Data were collected from October 2017 through January 2018. Methods: Participants completed a self-report mental health screening questionnaire. Students scoring "at risk" on any subscale were invited to participate in individual online follow-up interviews to assess risk level and provide referral information. Results: A majority of participants scored in an "at risk" range on at least one subscale. Follow-up interviews were conducted for 40% of students "at risk" and 33% of those interviewed were referred to the university counseling center. Participants' perceptions of campus mental health priorities improved over a three-month period. Conclusions: A pilot universal campus mental health screening using graduate student clinicians resulted in a meaningful number of referrals and enhanced perception that the university cared about student mental health.