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1.
J Acquir Immune Defic Syndr ; 85(4): 475-482, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136748

RESUMO

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Infecções por HIV/psicologia , Saúde Mental/tendências , Pneumonia Viral/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Infecções por Coronavirus/complicações , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Feminino , Infecções por HIV/complicações , Humanos , Violência por Parceiro Íntimo/tendências , Análise dos Mínimos Quadrados , Modelos Logísticos , Solidão , Masculino , Serviços de Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Resiliência Psicológica , Fatores Sexuais , Isolamento Social/psicologia , Apoio Social , Transtornos de Estresse Traumático Agudo/etiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento , Adulto Jovem
3.
Lancet Psychiatry ; 7(10): 851-864, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32866459

RESUMO

BACKGROUND: The effectiveness of digital psychological interventions in low-income and middle-income countries (LMICs) remains unclear. We aimed to systematically investigate the available evidence for digital psychological interventions in reducing mental health problems in LMICs. METHODS: In this systematic review and meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane databases for articles published in English from database inception to March 9, 2020. We included randomised controlled trials investigating digital psychological interventions in individuals with mental health problems in LMICs. We extracted data on demographics, inclusion and exclusion criteria, details of the intervention, including the setting, digital delivery method, control group conditions, number of sessions, therapeutic orientation (eg, cognitive therapy or behaviour therapy), presence or absence of guidance, and length of follow-up, and statistical information to calculate effect sizes. If a study reported insufficient data to calculate effect sizes, the corresponding authors were contacted to provide data that could be aggregated. We did random-effects meta-analyses, and calculated the standardised mean difference in scores of digital psychological interventions versus control conditions (Hedges'g). Quality of evidence was assessed by use of the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was post-intervention mental health problems, as measured by self-reporting instruments or clinical interviews. This study is registered with PROSPERO, CRD42019137755. FINDINGS: We identified 22 eligible studies that were included in the meta-analysis. The included studies involved a total of 4104 participants (2351 who received a digital psychological intervention and 1753 who were in the control group), and mainly focused on young adults (mean age of the study population was 20-35 years) with depression or substance misuse. The results showed that digital psychological interventions are moderately effective when compared with control interventions (Hedges'g 0·60 [95% CI 0·45-0·75]; Hedges'g with treatment as usual subgroup for comparison 0·54 [0·35-0·73]). Heterogeneity between studies was substantial (I2=74% [95% CI 60-83]). There was no evidence of publication bias, and the quality of evidence according to the GRADE criteria was generally high. INTERPRETATION: Digital psychological interventions, which have been mostly studied in individuals with depression and substance misuse, are superior to control conditions, including usual care, and are moderately effective in LMICs. However, the considerable heterogeneity observed in our analysis highlights the need for more studies to be done, with standardised implementation of digital psychological intervention programmes to improve their reproducibility and efficiency. Digital psychological interventions should be considered for regions where usual care for mental health problems is minimal or absent. FUNDING: None. TRANSLATIONS: For the Persian, Chinese, Hindi, Portuguese, Bahasa, Turkish, Romanian, Spanish and Thai translations of the abstract see Supplementary Materials section.


Assuntos
Transtorno Depressivo/terapia , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina/métodos , Países em Desenvolvimento , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32928988

RESUMO

CONTEXT: Adolescents with problematic substance use (SU) are at risk for far-reaching adverse outcomes. OBJECTIVE: Synthesize the evidence regarding the effects of brief behavioral interventions for adolescents (12-20 years) with problematic SU. DATA SOURCES: We conducted literature searches in Medline, the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo through October 31, 2019. STUDY SELECTION: We screened 33 272 records and citations for interventions in adolescents with at least problematic SU, retrieved 1831 articles, and selected 22 randomized controlled trials of brief interventions meeting eligibility criteria for meta-analysis. DATA EXTRACTION: We followed Agency for Healthcare Research and Quality guidelines. We categorized brief interventions into components, including motivational interviewing (MI), psychoeducation, and treatment as usual. Outcomes included SU (abstinence, days used per month) for alcohol and cannabis, and substance-related problem scales. Strength of evidence (SoE) was assessed. RESULTS: Both pairwise and network meta-analyses were conducted by using random effects models. Compared to treatment as usual, the use of MI reduces heavy alcohol use days by 0.7 days per month (95% credible interval [CrI]: -1.6 to 0.02; low SoE), alcohol use days by 1.1 days per month (95% CrI -2.2 to -0.3; moderate SoE), and overall substance-related problems by a standardized net mean difference of 0.5 (95% CrI -1.0 to 0; low SoE). The use of MI did not reduce cannabis use days, with a net mean difference of -0.05 days per month (95% CrI: -0.26 to 0.14; moderate SoE). LIMITATIONS: There was lack of consistently reported outcomes and limited available comparisons. CONCLUSIONS: The use of MI reduces heavy alcohol use, alcohol use days, and SU-related problems in adolescents but does not reduce cannabis use days.


Assuntos
Entrevista Motivacional , Psicoterapia Breve , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Humanos
5.
PLoS One ; 15(9): e0238286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898141

RESUMO

BACKGROUND: Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers. AIM: The SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care. METHODS: We recruited young people in care aged 12-20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up). RESULTS: Of 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions. CONCLUSION: By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services.


Assuntos
Terapia Comportamental/métodos , Cuidadores/estatística & dados numéricos , Educação de Pacientes como Assunto , Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários/normas , Adolescente , Adulto , Criança , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Humanos , Masculino , Saúde Mental , Projetos Piloto , Autocuidado , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
8.
West J Emerg Med ; 21(5): 1102-1104, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32970561

RESUMO

The isolation that comes from social distancing during the COVID-19 pandemic can be particularly detrimental to the United States' population of people who use drugs. People with substance use disorders may be at risk for return to use, exacerbation of existing mental health disorders, and risky drug practices. In this commentary, we review the risk to people who use drugs and how emergency department providers can best support these individuals during the unprecedented time of social distancing.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Serviço Hospitalar de Emergência , Pneumonia Viral/psicologia , Isolamento Social/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos/epidemiologia
9.
Nervenarzt ; 91(11): 1025-1031, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32897391

RESUMO

Homelessness is an expression of marked social exclusion phenomena and often particularly affects people with mental disorders. Mental disorders often precede the onset of homelessness but can also be a result of homelessness. Different forms of therapeutic and social support interventions have been evaluated in various countries, predominantly with an outreach treatment approach. These interventions were often combined with low threshold availability of housing programs. These showed positive effects on housing stability and reduction of psychiatric symptoms but not in reduction of substance use disorders. Peer support strategies and the use of digital media are possible options for future therapeutic strategies.


Assuntos
Pessoas em Situação de Rua , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Habitação , Humanos , Internet , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia
10.
J Subst Abuse Treat ; 118: 108103, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32972644

RESUMO

In response to the novel coronavirus 2019 (Covid-19) pandemic, many people experiencing homelessness and substance use disorders entered respite and recuperation facilities for care and to isolate and prevent subsequent SARS-CoV-2 transmission. However, because drug use was officially prohibited in these facilities, we observed people who use substances leaving isolation temporarily or prematurely. The initial Covid-19 surge magnified the need for harm reduction access for those who use substances to ensure their safety and well-being and that of their local communities. In this commentary, we argue that expanding harm reduction access is crucial for subsequent waves of SARS-CoV-2 infection and also for patients who use substances and are hospitalized for other reasons.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoas em Situação de Rua , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Infecções por Coronavirus/prevenção & controle , Redução do Dano , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/terapia
11.
Pediatrics ; 146(Suppl 1): S86-S92, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737239

RESUMO

Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.


Assuntos
Bem-Estar da Criança , Coerção , Saúde da Família , Tratamento Involuntário/legislação & jurisprudência , Complicações na Gravidez/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Grupo com Ancestrais do Continente Africano , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/etnologia , Gestantes/etnologia , Cuidado Pré-Natal , Classe Social , Sociedades Médicas , South Carolina , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos
12.
FP Essent ; 495: 31-37, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757564

RESUMO

The primary care office is an essential part of the mental health system. Overall, at least half of all visits to clinicians for mental health conditions are to primary care physicians. The collaborative care model, which integrates behavioral health services into the primary care office, has been shown to improve patient outcomes and is cost-effective. The five essential components of the collaborative care model include team-driven care, population-focused care, measurement-guided care, evidence-based care, and accountable care. To assist with counseling patients during office visits, multiple brief interventions have been created and/or adapted from longer interventions. Some of these tools include the Five As behavioral change model; the background, affect, troubling, handling, empathy (BATHE) technique; the feedback, responsibility, advice, menu of strategies, empathy, self-efficacy (FRAMES) model, and the stages of change model (ie, transtheoretical model). Use of brief interventions has been shown to result in modest improvements in mental health outcomes in the short-term. These interventions can be applied to patients with anxiety, depression, and substance use disorders.


Assuntos
Aconselhamento , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Humanos , Transtornos Mentais/terapia , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
PLoS Med ; 17(8): e1003131, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810147

RESUMO

BACKGROUND: Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men's past-year substance use and women's reported depressive symptoms as measured at the individual level. METHODS AND FINDINGS: A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men's UBL, women's UBL, couples' UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women's depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014-2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017-2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36-0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37-6.96, p = 0.007), both observed in the couples' UBL arm at 24 months' follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women's UBL arm only (AOR = 1.65, 95% CI 1.13-2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors. CONCLUSIONS: The findings suggest that the UBL intervention was associated with a reduction in men's use of alcohol when delivered to couples, but there was no evidence of a decrease in reported symptoms of depression among women in any experimental arm, and some evidence of an increase in symptoms of moderate depression in the women's UBL arm. Further research should explore how to optimize IPV prevention interventions to target related risks of mental health and substance use. TRIAL REGISTRATION: Clinicaltrials.gov NCT02311699; Socialscienceregistry.org AEARCTR-0000211.


Assuntos
Depressão/psicologia , Depressão/terapia , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Análise por Conglomerados , Depressão/epidemiologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Autorrelato , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
16.
J Addict Med ; 14(5): e139-e141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32826619

RESUMO

: The COVID-19 pandemic has created an urgent need to expand access to substance use disorder (SUD) treatment through telehealth. A more permanent adoption of tele-SUD treatment options could positively alter the future of SUD treatment. We identify four steps that will help to ensure a broader transition to telehealth will be successful in improving the health outcomes of patients with SUDs. These steps are: (1) investing in telehealth infrastructure to enable health care providers and patients to use telehealth; (2) training and equipping providers to provide SUD treatment through telehealth; (3) providing patients with the financial and social support, hardware, and training necessary to use telehealth; (4) making temporary changes to telehealth law and regulation permanent. We believe these 4 steps will be critical to initiating SUD treatment for many persons that have yet to receive it, and for preserving SUD treatment continuity for millions of other patients both during and after the pandemic.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Desenvolvimento de Programas/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
17.
PLoS One ; 15(8): e0238096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853258

RESUMO

The benefits of involving patients as partners in research across diverse medical and psychiatric settings are well established in the literature. However, researchers continue to struggle to access, engage and retain participants from hard-to-reach populations. The main objective of this study was to co-create pet therapy activities with patients admitted for serious and complex mental illness to a large urban mental health and addiction hospital. Informed by the principles of participatory action research methodology, we conducted focus group discussions with 38 inpatients in seven different clinical units. An experienced volunteer handler and a certified therapy dog helped facilitate our discussions. Participating researchers, recreational therapists, volunteer handlers and our participants all reported that the presence of a certified therapy dog at each of our discussions was integral to their success. Certified therapy dogs increased the motivation to participate in our study, helped to build rapport with participants and created connections in our discussions that enriched our data. To our knowledge our study is the first to demonstrate the value of using a therapy dog as a participatory research tool in a healthcare setting. The authors believe that therapy dogs are a low-tech intervention that could be used effectively to engage hard-to-reach populations in research about their treatment and care in a diverse range of medical settings. These findings support the creation of a pilot study to test the value of including therapy dogs in patient-centered research with vulnerable and hard-to-reach populations.


Assuntos
Terapia Assistida com Animais/estatística & dados numéricos , Cidades/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Animais , Cães , Feminino , Masculino , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Projetos Piloto , Pesquisa Qualitativa
18.
J Subst Abuse Treat ; 118: 108102, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32854983

RESUMO

The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences.


Assuntos
Terapia Comportamental/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Populações Vulneráveis
19.
Subst Abus ; 41(3): 286-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697172

RESUMO

The COVID-19 pandemic disproportionately disrupts the daily lives of marginalized populations. Persons with substance use disorders are a particularly vulnerable population because of their unique social and health care needs. They face significant harm from both the pandemic itself and its social and economic consequences, including marginalization in health care and social systems. Hence, we discuss: (1) why persons with substance use disorders are at increased risk for infection with COVID-19 and a severe illness course; (2) anticipated adverse consequences of COVID-19 in persons with substance use disorders; (3) challenges to health care delivery and substance use treatment programs during and after the COVID-19 pandemic; and (4) the potential impact on clinical research in substance use disorders. We offer recommendations for clinical, public health, and social policies to mitigate these challenges and to prevent negative outcomes.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Betacoronavirus , Pesquisa Biomédica , Infecções por Coronavirus/fisiopatologia , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Serviços de Saúde Mental , Pandemias , Pneumonia Viral/fisiopatologia , Política Pública , Risco , Índice de Gravidade de Doença , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
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