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1.
Addiction ; 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34859519

RESUMO

BACKGROUND AND AIMS: Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. Study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via: (1) telephone, (2) smartphone, or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. DESIGN: Randomized controlled trial of 4 groups with 3, 6, 9, 12, and 18-month follow-ups. SETTING: University research center in Philadelphia, Pennsylvania, USA. PARTICIPANTS: Participants (N=262) met DSM-V criteria for AUD, were largely male (71%) and African-American (82%). INTERVENTIONS AND COMPARATOR: Telephone Monitoring and Counseling (TMC; N=59), Addiction Comprehensive Health Enhancement Support System (ACHESS; N=68), and TMC+ACHESS (N=70) provided for 12 months. The control condition received IOP only (TAU; N=65). MEASUREMENT: Primary outcome was percent days heavy drinking (PDHD) in months 1-12. Secondary outcomes were any drinking, any drug use, drinking consequences, and quality of life. FINDINGS: Mean PDHD in months 1-12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS, and 5.99 in TMC+ACHESS. PDHD was lower in TMC (d=.35, p=0.018, 95% confidence interval (CI) = [-1.42, -0.20]), ACHESS (d= .31, p= .031, 95% CI= [-1.27, -0.06]), and TMC+ACHESS (d= .36, p=0.009, 95% CI = [-1.40, -0.20]) than in TAU. Differences between TMC+ACHESS, TMC, and ACHESS were small (d< .06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on Any Drinking, which was higher in months 1-12 in TAU than in TMC (odds ratio (OR)= 3.02, standard error (SE)=0.43, 95% CI= [1.30, 6.99], p=0.01) and TMC+ACHESS (OR= 2.43, SE=0.39, 95% CI= [1.12, 5.27], p=0.03). No other significant effects were obtained on other secondary outcomes during or after treatment. CONCLUSIONS: A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.

2.
Front Public Health ; 9: 772236, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778197

RESUMO

Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic. Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18-72) who participated in a larger national online survey conducted from October 2020-June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety. Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety. Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.


Assuntos
COVID-19 , Vítimas de Crime , Racismo , Adolescente , Adulto , Idoso , Emprego , Habitação , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia , Adulto Jovem
3.
Hepatol Commun ; 5(9): 1616-1621, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34510833

RESUMO

The Coronavirus Disease 2019 (COVID-19) pandemic has exacted a heavy toll on patients with alcohol-associated liver disease (ALD) and alcohol use disorder (AUD). The collective burden of ALD and AUD was large and growing, even before the COVID-19 pandemic. There is accumulating evidence that this pandemic has had a large direct effect on these patients and is likely to produce indirect effects through delays in care, psychological strain, and increased alcohol use. Now a year into the pandemic, it is important that clinicians fully understand the effects of the COVID-19 pandemic on patients with ALD and AUD. To fill existing gaps in knowledge, the scientific community must set research priorities for patients with ALD regarding their risk of COVID-19, prevention/treatment of COVID-19, changes in alcohol use during the pandemic, best use of AUD treatments in the COVID-19 era, and downstream effects of this pandemic on ALD. Conclusion: The COVID-19 pandemic has already inflicted disproportionate harms on patients with ALD, and ongoing, focused research efforts will be critical to better understand the direct and collateral effects of this pandemic on ALD.

4.
Alcohol Alcohol ; 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414405

RESUMO

AIMS: This pilot study aimed to identify associations of loneliness and daily alcohol consumption among US adults during the Coronavirus Disease-2019 pandemic. METHOD: Participants completed daily assessments for 30 days. RESULTS: Results suggest people who feel lonelier on average drink more alcohol, however, people who feel lonelier than usual drink less. CONCLUSION: Findings highlight the need to disaggregate within- and between-person components of alcohol use.

5.
Addict Behav ; 122: 107034, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34246036

RESUMO

BACKGROUND: Substance use research has focused on family history of alcohol use disorders but less on other addictions in biological family members. We examined how parental substance use history relates to reward system functioning, specifically nucleus accumbens (NAcc) and putamen activation at age 9-10 in the Adolescent Brain Cognitive Development (ABCD) Study. This research hopes to address limitations in prior literature by focusing analyses on a large, substance-naïve sample. METHOD: We included ABCD participants with valid Monetary Incentive Delay task fMRI Baseline data and parent substance use history at project baseline from Data Release 2.0 (N = 10,622). Parent-history-positive (PH+) participants had one or both biological parents with a history of two+problems with alcohol (n = 741; PH+A) and/or other drugs (n = 638; PH+D). Of participants who were parent-history-negative (PH-) for alcohol and/or drugs, a stratified random sample based on six sociodemographic variables was created and matched to the PH+group (PH-A n = 699; PH-D n = 615). The contrast of interest was anticipation of a large reward vs. neutral response. RESULTS: PH+A youth had more activation in the right NAcc during large reward anticipation than PH-A. PH+D youth showed enhanced left putamen activation during large reward anticipation than PH-D youth. Bayesian hypothesis testing showed moderate evidence (BF > 3) in favor of the null hypothesis. CONCLUSION: These findings suggest that pre-adolescents whose biological parents had a history of substance-related problems show small differences in reward processing compared to their PH- peers.


Assuntos
Alcoolismo , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Antecipação Psicológica , Teorema de Bayes , Encéfalo/diagnóstico por imagem , Criança , Cognição , Família , Humanos , Imageamento por Ressonância Magnética , Motivação , Núcleo Accumbens , Pais , Recompensa
6.
Alcohol Clin Exp Res ; 45(5): 1091-1099, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33966283

RESUMO

BACKGROUND: Although alcohol breath testing devices that pair with smartphones are promoted for the prevention of alcohol-impaired driving, their accuracy has not been established. METHODS: In a within-subjects laboratory study, we administered weight-based doses of ethanol to two groups of 10 healthy, moderate drinkers aiming to achieve a target peak blood alcohol concentration (BAC) of 0.10%. We obtained a peak phlebotomy BAC and measured breath alcohol concentration (BrAC) with a police-grade device (Intoxilyzer 240) and two randomly ordered series of 3 consumer smartphone-paired devices (6 total devices) with measurements every 20 min until the BrAC reached <0.02% on the police device. Ten participants tested the first 3 devices, and the other 10 participants tested the other 3 devices. We measured mean paired differences in BrAC with 95% confidence intervals between the police-grade device and consumer devices. RESULTS: The enrolled sample (N = 20) included 11 females; 15 white, 3 Asian, and 2 Black participants; with a mean age of 27 and mean BMI of 24.6. Peak BACs ranged from 0.06-0.14%. All 7 devices underestimated BAC by >0.01%, though the BACtrack Mobile Pro and police-grade device were consistently more accurate than the Drinkmate and Evoc. Compared with the police-grade device measurements, the BACtrack Mobile Pro readings were consistently higher, the BACtrack Vio and Alcohoot measurements similar, and the Floome, Drinkmake, and Evoc consistently lower. The BACtrack Mobile Pro and Alcohoot were most sensitive in detecting BAC driving limit thresholds, while the Drinkmate and Evoc devices failed to detect BAC limit thresholds more than 50% of the time relative to the police-grade device. CONCLUSIONS: The accuracy of smartphone-paired devices varied widely in this laboratory study of healthy participants. Although some devices are suitable for clinical and research purposes, others underestimated BAC, creating the potential to mislead intoxicated users into thinking that they are fit to drive.

7.
J Med Internet Res ; 23(5): e26933, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-33882014

RESUMO

As of March 2021, the SARS-CoV-2 virus has been responsible for over 115 million cases of COVID-19 worldwide, resulting in over 2.5 million deaths. As the virus spread exponentially, so did its media coverage, resulting in a proliferation of conflicting information on social media platforms-a so-called "infodemic." In this viewpoint, we survey past literature investigating the role of automated accounts, or "bots," in spreading such misinformation, drawing connections to the COVID-19 pandemic. We also review strategies used by bots to spread (mis)information and examine the potential origins of bots. We conclude by conducting and presenting a secondary analysis of data sets of known bots in which we find that up to 66% of bots are discussing COVID-19. The proliferation of COVID-19 (mis)information by bots, coupled with human susceptibility to believing and sharing misinformation, may well impact the course of the pandemic.


Assuntos
COVID-19/epidemiologia , Comunicação , Mídias Sociais/estatística & dados numéricos , Humanos , Pandemias , SARS-CoV-2/isolamento & purificação
8.
Psychopharmacology (Berl) ; 238(6): 1513-1529, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33558983

RESUMO

RATIONALE: Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS: We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS: Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS: People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/psicologia , Fissura/fisiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Estresse Psicológico/psicologia , Afeto/efeitos dos fármacos , Buprenorfina/uso terapêutico , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Recidiva , Smartphone
9.
Arch Sex Behav ; 50(4): 1641-1650, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32078710

RESUMO

Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Confidencialidade , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Assunção de Riscos , População Rural , Comportamento Sexual , Tecnologia
10.
Ethics Behav ; 30(7): 481-495, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33041608

RESUMO

Online research has become a critical recruitment modality for understanding and reducing health disparities among hidden populations most at risk for HIV infection. There is a lack of consensus and guidelines for the responsible conduct of online recruitment for HIV risk populations. Using semi-structured phone interviews, this study drew on the experiences of principal investigators (PIs) engaged in online HIV research to illuminate scientific and ethical benefits and challenges of social media recruitment. Using Thematic Analysis five major themes emerged: sampling advantages and disadvantages; challenges of data integrity; control of privacy protections; researcher competence and responsibility; and resources.

11.
Harm Reduct J ; 17(1): 41, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527276

RESUMO

BACKGROUND: Methamphetamine use poses a barrier to antiretroviral therapy (ART) adherence. Black and Hispanic men who have sex with men living with HIV (PLWH) shoulder much of the health burden resulting from the methamphetamine and HIV syndemic. Smartphones are nearly ubiquitous in the USA and may be promising vehicles for delivering interventions for ART adherence and drug use cessation. However, the acceptability of using applications to collect sensitive information and deliver feedback in this population has not been adequately explored. OBJECTIVE: This study examined minority PLWH's appraisals of the risks of participating in smartphone-based research to promote ART adherence in the context of methamphetamine use and explored their views on appropriate steps to mitigate perceived risks of participation. METHODS: Three focus groups were conducted among Black and Hispanic PLWH who use methamphetamine. Of the 13 participants, 5 had previously participated in a smartphone-based observational study of ART adherence and substance use. Discussants provided feedback on smartphone-based research, including receiving probes for HIV medication adherence, mood, and substance use as well as feedback on passive location-tracking for personalized messages. Transcribed audio-recordings were thematically coded and analyzed using the qualitative software MAXQDA. RESULTS: Participants expressed confidentiality concerns related to potential unintentional disclosure of their HIV status and methamphetamine use and to possible legal consequences. They additionally expressed concerns around the invasiveness of daily assessments and the potential of methamphetamine use questions to trigger cravings. To mitigate these concerns, they suggested maintaining participant privacy by indirectly asking sensitive questions, focusing on positive behaviors (e.g., number of days sober), allowing user-initiated reporting of location to tailor messages, and ensuring adequate data protections. In addition to financial compensation, participants cited altruism (specifically, continuing a tradition of volunteerism in HIV research) as a motivator for potentially engaging in such research. CONCLUSIONS: Minority PLWH have concerns regarding the use of smartphones for ART adherence and methamphetamine sobriety intervention research. However, minority PLWH are likely to participate if studies include appropriate protections against risks to confidentiality and experimental harm and are designed to offer future benefit to themselves and other PLWH.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Antirretrovirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Telemedicina/métodos , Adulto , Afro-Americanos/estatística & dados numéricos , Grupos Focais , Redução do Dano , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Metanfetamina , Pessoa de Meia-Idade , Risco , Smartphone
12.
NPJ Digit Med ; 3: 26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32195362

RESUMO

Just-in-time adaptive interventions (JITAIs), typically smartphone apps, learn to deliver therapeutic content when users need it. The challenge is to "push" content at algorithmically chosen moments without making users trigger it with effortful input. We trained a randomForest algorithm to predict heroin craving, cocaine craving, or stress (reported via smartphone app 3x/day) 90 min into the future, using 16 weeks of field data from 189 outpatients being treated for opioid-use disorder. We used only one form of continuous input (along with person-level demographic data), collected passively: an indicator of environmental exposures along the past 5 h of movement, as assessed by GPS. Our models achieved excellent overall accuracy-as high as 0.93 by the end of 16 weeks of tailoring-but this was driven mostly by correct predictions of absence. For predictions of presence, "believability" (positive predictive value, PPV) usually peaked in the high 0.70s toward the end of the 16 weeks. When the prediction target was more rare, PPV was lower. Our findings complement those of other investigators who use machine learning with more broadly based "digital phenotyping" inputs to predict or detect mental and behavioral events. When target events are comparatively subtle, like stress or drug craving, accurate detection or prediction probably needs effortful input from users, not passive monitoring alone. We discuss ways in which accuracy is difficult to achieve or even assess, and warn that high overall accuracy (including high specificity) can mask the abundance of false alarms that low PPV reveals.

13.
Artigo em Inglês | MEDLINE | ID: mdl-32053866

RESUMO

Excessive alcohol use in the US contributes to over 88,000 deaths per year and costs over $250 billion annually. While previous studies have shown that excessive alcohol use can be detected from general patterns of social media engagement, we characterized how drinking-specific language varies across regions and cultures in the US. From a database of 38 billion public tweets, we selected those mentioning "drunk", found the words and phrases distinctive of drinking posts, and then clustered these into topics and sets of semantically related words. We identified geolocated "drunk" tweets and correlated their language with the prevalence of self-reported excessive alcohol consumption (Behavioral Risk Factor Surveillance System; BRFSS). We then identified linguistic markers associated with excessive drinking in different regions and cultural communities as identified by the American Community Project. "Drunk" tweet frequency (of the 3.3 million geolocated "drunk" tweets) correlated with excessive alcohol consumption at both the county and state levels (r = 0.26 and 0.45, respectively, p < 0.01). Topic analyses revealed that excessive alcohol consumption was most correlated with references to drinking with friends (r = 0.20), family (r = 0.15), and driving under the influence (r = 0.14). Using the American Community Project classification, we found a number of cultural markers of drinking: religious communities had a high frequency of anti-drunk driving tweets, Hispanic centers discussed family members drinking, and college towns discussed sexual behavior. This study shows that Twitter can be used to explore the specific sociocultural contexts in which excessive alcohol use occurs within particular regions and communities. These findings can inform more targeted public health messaging and help to better understand cultural determinants of substance abuse.


Assuntos
Consumo de Bebidas Alcoólicas , Intoxicação Alcoólica , Características Culturais , Dirigir sob a Influência , Mídias Sociais , Consumo de Bebidas Alcoólicas/etnologia , Intoxicação Alcoólica/etnologia , Condução de Veículo , Feminino , Humanos , Masculino , Estados Unidos
14.
Shock ; 53(1): 71-77, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30672882

RESUMO

Maintenance of the commensal bacteria that comprise the gut microbiome is essential to both gut and systemic health. Traumatic injury, such as burn, elicits a number of changes in the gut, including a shift in the composition of the microbiome (dysbiosis), increased gut leakiness, and bacterial translocation into the lymphatic system and bloodstream. These effects are believed to contribute to devastating secondary complications following burn, including pneumonia, acute respiratory distress syndrome, multi-organ failure, and septic shock. Clinical studies demonstrate that advanced age causes a significant increase in mortality following burn, but the role of the gut in this age-dependent susceptibility has not been investigated. In this study, we combined our well-established murine model of scald burn injury with bacterial 16S-rRNA gene sequencing to investigate how burn injury affects the fecal microbiome in aged versus young mice. Of our treatment groups, the most substantial shift in gut microbial populations was observed in aged mice that underwent burn injury. We then profiled antimicrobial peptides (AMPs) in the ileum, and found that burn injury stimulated a 20-fold rise in levels of regenerating islet-derived protein 3 gamma (Reg3γ), a 16-fold rise in regenerating islet-derived protein 3 beta (Reg3ß), and an 8-fold rise in Cathelicidin-related antimicrobial peptide (Cramp) in young, but not aged mice. Advanced age alone elicited 5-fold higher levels of alpha defensin-related sequence1 (Defa-rs1) in the ileum, but this increase was lost following burn. Comparison of bacterial genera abundance and AMP expression across treatment groups revealed distinct correlation patterns between AMPs and individual genera. Our results reveal that burn injury drives microbiome dysbiosis and altered AMP expression in an age-dependent fashion, and highlight potential mechanistic targets contributing to the increased morbidity and mortality observed in elderly burn patients.


Assuntos
Fezes/microbiologia , Microbioma Gastrointestinal/fisiologia , Proteínas Citotóxicas Formadoras de Poros/metabolismo , Animais , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Filogenia , RNA Ribossômico 16S/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa
15.
J Subst Abuse Treat ; 109: 50-55, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31856951

RESUMO

BACKGROUND: Recovery support services, including in vivo (i.e., face to face) peer-based supports and social networks, are associated with positive effects on substance use disorder recovery outcomes. The translation of in vivo supports to digital platforms is a recent development that is mostly unexamined. The types of users and their engagement patterns of digital recovery support services (D-RSS), and the utility of objective and self-report data in predicting future recovery outcomes require further study to move the recovery support field forward. METHODS: De-identified individual user data from Sober Grid, a recovery social network site (R-SNS) smartphone application, for the years 2015-2018 was analyzed to identify the demographics, engagement patterns, and recovery outcomes of active users. Analysis of variance (ANOVA) tests were used to examine between generational group differences on activity variables and recovery outcomes. Logistic and linear regressions were used to identify significant predictors of sobriety length and relapse among users. RESULTS: The most active tercile of users (n = 1273; mAge = 39 years; 62% male) had average sobriety lengths of 195.5 days and had experienced 4.4 relapses on average since sign-up. Users have over 33,000 unilateral and nearly 14,000 bilateral connections. Users generated over 120,000 unique posts, 507,000 comments, 1617,000 likes, 12,900 check-ins, and 593,000 chats during the period of analysis. Recovery outcomes did not vary between generations, though user activity was significantly different between Generations (Millennials, Generation X, and Baby Boomers), with baby boomers and generation X having higher levels of engagement and connection among all activity markers. Logistic regression results revealed gender (female) was associated with a lower likelihood of reporting loneliness or sexual feelings as an emotional trigger. Linear regressions revealed generation, number of unilateral connections, and number of check-ins was associated with sobriety length, while generation and number of check-ins was associated with number of relapses. CONCLUSIONS: Active users of Sober Grid engage in several platform features that provide objective data that can supplement self-report data for analysis of recovery outcomes. Most commonly uses features are those similar to features readily available in open-ecosystem social network sites (e.g., Facebook). Prediction model results suggest that demographic factors (e.g., age, gender) and activity factors (e.g., number of check-ins) may be useful in deploying just-in-time interventions to prevent relapse or offer additional social support. Further empirical examination is needed to identify the utility of such interventions, as well as the mechanisms of support that accompany feature use or engagement with the D-RSS.


Assuntos
Recuperação da Saúde Mental , Aplicativos Móveis , Smartphone , Rede Social , Apoio Social , Adulto , Feminino , Humanos , Masculino
16.
Alcohol Treat Q ; 37(2): 257-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31551647

RESUMO

Background: Previous research has found initial evidence that word choice impacts the perception and treatment of those with behavioral health disorders. These previous studies have relied on vignette-based methodologies, however, and a more quantifiable index of the stigma words can produce is needed. Method: The current study uses the Go/No-Go Association Task to calculate a d-prime (sensitivity) indexed score of automatic attitudes to two terms, "substance abuser" and "person with substance use disorder". Results: Participants have significantly more negative automatic attitudes towards the term "substance abuser", as compared to "person with a substance use disorder". Conclusion: Consistent with previous research, implicit bias does exist for terms commonly used in the behavioral health field. "Substance Abuser" and its derivatives should not be used in professional or lay settings.

17.
JMIR Ment Health ; 6(8): e13352, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31452520

RESUMO

BACKGROUND: Research suggests that digital recovery support services (D-RSSs) may help support individual recovery and augment the availability of in-person supports. Previous studies highlight the use of D-RSSs in supporting individuals in recovery from substance use but have yet to examine the use of D-RSSs in supporting a combination of behavioral health disorders, including substance use, mental health, and trauma. Similarly, few studies on D-RSSs have evaluated gender-specific supports or integrated communities, which may be helpful to women and individuals recovering from behavioral health disorders. OBJECTIVE: The goal of this study was to evaluate the SHE RECOVERS (SR) recovery community, with the following 3 aims: (1) to characterize the women who engage in SR (including demographics and recovery-related characteristics), (2) describe the ways and frequency in which participants engage with SR, and (3) examine the perception of benefit derived from engagement with SR. METHODS: This study used a cross-sectional survey to examine the characteristics of SR participants. Analysis of variance and chi-square tests, as well as univariate logistic regressions, were used to explore each aim. RESULTS: Participants (N=729, mean age 46.83 years; 685/729, 94% Caucasian) reported being in recovery from a variety of conditions, although the most frequent nonexclusive disorder was substance use (86.40%, n=630). Participants had an average length in recovery (LIR) of 6.14 years (SD 7.87), with most having between 1 and 5 years (n=300). The most frequently reported recovery pathway was abstinence-based 12-step mutual aid (38.40%). Participants reported positive perceptions of benefit from SR participation, which did not vary by LIR or recovery pathway. Participants also had high rates of agreement, with SR having a positive impact on their lives, although this too did vary by recovery length and recovery pathway. Participants with 1 to 5 years of recovery used SR to connect with other women in recovery at higher rates, whereas those with less than 1 year used SR to ask for resources at higher rates, and those with 5 or more years used SR to provide support at higher rates. Lifetime engagement with specific supports of SR was also associated with LIR and recovery pathway. CONCLUSIONS: Gender-specific and integrated D-RSSs are feasible and beneficial from the perspective of participants. D-RSSs also appear to provide support to a range of recovery typologies and pathways in an effective manner and may be a vital tool for expanding recovery supports for those lacking in access and availability because of geography, social determinants, or other barriers.

18.
Addict Behav ; 98: 106037, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31330467

RESUMO

BACKGROUND: Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS: This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS: Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS: Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Aconselhamento/métodos , Redução do Dano , Grupo Associado , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Estudos Transversais , Feminino , Florida , Humanos , Masculino
19.
Addict Behav ; 98: 106031, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31326776

RESUMO

Opioid use disorder (OUD) and opioid-related overdose mortality are major public health concerns in the United States. Recently, several community-based and professional innovations - including hybrid recovery community organizations, peer-based emergency department warm handoff programs, emergency department buprenorphine induction, and low-threshold OUD treatment programs - have emerged or expanded in an effort to address significant obstacles to providing patients the care needed for OUD and to reduce the risk of overdose. Additional innovations are needed to address the crisis. Building upon the foundational frameworks of each of these recent innovations, a new model of OUD pharmacotherapy is proposed and discussed: the Recovery Community Center Office-Based Opioid Treatment model. Additionally, two potential implementation scenarios, the overdose and non-overdose event protocols, are detailed for communities, peers, and practitioners interested in implementing the model. Potential barriers to implementation of the model include service reimbursement, licensing regulations, and organizational concerns. Future research should seek to validate the model and to identify actual implementation and sustainability barriers and best practices.


Assuntos
Centros Comunitários de Saúde , Overdose de Drogas/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Antagonistas de Entorpecentes/uso terapêutico , Encaminhamento e Consulta , Estados Unidos
20.
J Burn Care Res ; 40(6): 785-791, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31102437

RESUMO

Gastrointestinal hormones are essential in postburn metabolism. Since near 50% of burn victims test positive for blood alcohol levels at hospital admission and have inferior outcomes compared to nonintoxicated burn patients; we hypothesized that the gastrointestinal hormone secretion is compromised in intoxicated burn victims. To test our theory, we quantified gastrointestinal hormones serum levels in a combine ethanol intoxication and burn injury mouse model. Thus, mice received a daily dose of ethanol for 3 days, rested 4 days, and were given ethanol 3 additional days. Mice underwent 15% TBSA scald burn 30 minutes after their last ethanol dose. Serum samples were collected 24 hours after burn injury. Nonintoxicated burned mice exhibited an increase in glucose, insulin, ghrelin, plasminogen activator inhibitor-1, leptin, and resistin by 1.4-, 3-, 13.5-, 6.2-, 9.4-, and 2.4-fold, respectively, compared to sham vehicle mice (P < .05). Burn injury also reduced serum gastric inhibitory polypeptide (GIP) by 32% compared to sham-injured, vehicle-treated mice. Leptin, resistin, glucagon-like peptide-1, as well as insulin, were not different from sham groups when intoxication preceded burn injury. Nevertheless, in burned mice treated with ethanol, gastric inhibitory polypeptide and glucagon serum levels exhibited a significant fold increase of 3.5 and 4.7, respectively. With these results, we conclude that 24 hours after burn injury, mice developed significant changes in gastrointestinal hormones, along with hyperglycemia. Moreover, the combined insult of burn and ethanol intoxication led to additional hormonal changes that may be attributed to a potential pancreatic dysfunction. Further multiday studies are required to investigate the etiology, behavior, and clinical significance of these hormonal changes.


Assuntos
Intoxicação Alcoólica , Queimaduras/sangue , Animais , Glicemia/análise , Etanol/administração & dosagem , Polipeptídeo Inibidor Gástrico/sangue , Grelina/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Insulina/sangue , Leptina/sangue , Camundongos Endogâmicos C57BL , Modelos Animais , Inibidor 1 de Ativador de Plasminogênio/sangue , Resistina/sangue
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