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1.
Harm Reduct J ; 21(1): 76, 2024 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580997

RESUMO

BACKGROUND: Understanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision. METHODS: Between March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher's exact test. RESULTS: Most participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant's primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits). CONCLUSIONS: Findings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs-including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment.


Assuntos
Estimulantes do Sistema Nervoso Central , Cocaína Crack , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Humanos , Analgésicos Opioides/uso terapêutico , Redução do Dano , Vermont/epidemiologia , Xilazina , Fentanila , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle
2.
Prev Med ; 176: 107625, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37468073

RESUMO

The current overdose and broader public health crisis involving illicit drug use is often referred to as the "opioid" or "fentanyl" crisis. Clearly there is extensive data on the profound damage done by opioids over the past 20 years and specifically by fentanyl in the past 5 years. However, there is an extensive array of data that suggests there is more to the current crisis than opioids/fentanyl. Much recent evidence indicates that methamphetamine and cocaine are playing a substantial and increasing role in the illicit drug crisis in the US-the 4th wave. This paper reviews data that illustrate the role of psychomotor stimulants in fatal overdoses, nonfatal overdoses, and emergency department visits. Despite the major detrimental role that stimulants are having on the public health in the US in 2023, there is virtually no evidence-based treatment available in practice for people with stimulant use disorder (StimUD). Although there are no medications with FDA-approval for the treatment of StimUD, there is a behavioral treatment, contingency management (CM), with over 3 decades of robust research supporting its efficacy for individuals with StimUD. Despite the overwhelming evidence supporting CM, it is not being widely used in routine treatment outside the VA healthcare system. This paper reviews some of the (a) evidence for CM, (b) CM protocol design elements that require consideration, (c) current obstacles to the widespread implementation of CM, and (d) strategies for addressing these obstacles. Overcoming these obstacles is a priority to allow routine use of CM as a treatment for StimUD.


Assuntos
Overdose de Drogas , Drogas Ilícitas , Metanfetamina , Humanos , Fentanila , Analgésicos Opioides
3.
Prev Med ; 176: 107703, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37717741

RESUMO

OBJECTIVE: The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. METHODS: The Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. RESULTS AND CONCLUSIONS: The California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths.


Assuntos
Overdose de Drogas , Metanfetamina , Humanos , Motivação , Terapia Comportamental , Metanfetamina/urina , California
4.
Prev Med ; 128: 105785, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31362002

RESUMO

In 2013, Vermont leaders implemented the "hub-and-spoke" (H & S) system to increase access to medication treatment for opioid use disorder (MOUD). "Hubs" are licensed specialty opioid treatment programs (OTPs) with the authority to dispense buprenorphine/naloxone and methadone. "Spokes" are primary care practices that provide office-based opioid treatment, primarily with buprenorphine/naloxone. This report describes the qualitative component of an evaluation of the H&S system, conducted in 2016. The qualitative data collection assessed patient perspectives about the positive and negative aspects of treatment in the H & S system. The data collected included 80 responses to five open-ended questions and 24 in-depth interviews. Five open-ended questions were completed with hub (n = 40) and spoke (n = 40) participants. In-depth qualitative interviews were conducted with different hub (n =12) and spoke (n =12) participants. Findings from both data collection approaches suggest positive perceptions about treatment overall by patients treated in both settings. Participants treated in spokes reported a positive treatment environment, minimal stigma, and few obstacles to treatment and a strong positive relationship with their prescriber. Hub patients valued the MOUD and expressed gratitude for having access to MOUD, but reported the treatment environment was somewhat challenging, with long lines and drug talk in the clinic, high staff turnover and "cookie cutter" treatment. There appear to be some differences in patient perceptions of MOUD treatment between patients treated in primary care settings and specialized OTP settings.


Assuntos
Buprenorfina/uso terapêutico , Acessibilidade aos Serviços de Saúde , Metadona/uso terapêutico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Satisfação do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Vermont/epidemiologia , Adulto Jovem
5.
Ann Intern Med ; 168(1): 10-19, 2018 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-29159398

RESUMO

Background: Only 1 in 5 of the nearly 2.4 million Americans with an opioid use disorder received treatment in 2015. Fewer than half of Californians who received treatment in 2014 received opioid agonist treatment (OAT), and regulations for admission to OAT in California are more stringent than federal regulations. Objective: To determine the cost-effectiveness of OAT for all treatment recipients compared with the observed standard of care for patients presenting with opioid use disorder to California's publicly funded treatment facilities. Design: Model-based cost-effectiveness analysis. Data Sources: Linked population-level administrative databases capturing treatment and criminal justice records for California (2006 to 2010); published literature. Target Population: Persons initially presenting for publicly funded treatment of opioid use disorder. Time Horizon: Lifetime. Perspective: Societal. Intervention: Immediate access to OAT with methadone for all treatment recipients compared with the observed standard of care (54.3% initiate opioid use disorder treatment with medically managed withdrawal). Outcome Measures: Discounted quality-adjusted life-years (QALYs) and discounted costs. Results of Base-Case Analysis: Immediate access to OAT for all treatment recipients costs less (by $78 257), with patients accumulating more QALYs (by 0.42) than with the observed standard of care. In a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, total lifetime savings for this cohort could be as high as $3.8 billion. Results of Sensitivity Analysis: 99.6% of the 2000 simulations resulted in lower costs and more QALYs. Limitation: Nonrandomized delivery of OAT or medically managed withdrawal. Conclusion: The value of publicly funded treatment of opioid use disorder in California is maximized when OAT is delivered to all patients presenting for treatment, providing greater health benefits and cost savings than the observed standard of care. Primary Funding Source: National Institute on Drug Abuse.


Assuntos
Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , California/epidemiologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
6.
Subst Abus ; 37(1): 54-62, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26158698

RESUMO

BACKGROUND: Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to increase access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake. METHODS: A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX-referring agencies across Los Angeles County. RESULTS: Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County. CONCLUSIONS: These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.


Assuntos
Naltrexona/uso terapêutico , Desenvolvimento de Programas , Adulto , Preparações de Ação Retardada/uso terapêutico , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Los Angeles , Masculino , Naltrexona/administração & dosagem , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto Jovem
7.
Am J Addict ; 24(3): 246-251, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25907813

RESUMO

BACKGROUND AND OBJECTIVES: This paper expands on a study investigating depression outcomes in response to an 8-week exercise intervention among methamphetamine (MA) dependent individuals in early recovery. METHODS: A total of 135 MA-dependent individuals enrolled in residential treatment were randomly assigned to either a structured exercise intervention or a structured health education control group. Both groups were similar in format: 60-minute sessions, offered three times a week over an 8-week study period. RESULTS: Results showed that at the 8-week trial endpoint, participants randomized to the exercise intervention showed significantly greater reduction in depression symptom scores than participants randomized to the health education group, and that participants who attended the greatest number of exercise sessions derived the greatest benefit. This paper further analyzes study data to uncover individual predictors of depression response to exercise and finds that among participants randomized to exercise treatment, individuals with the most severe medical, psychiatric, and addiction disease burden at baseline showed the most significant improvement in depressive symptoms by study endpoint. CONCLUSIONS: Our findings suggest that exercise in moderate dose is effective at treating depressive symptoms in individuals in early recovery from addiction, and furthermore, that treatment with exercise appears to be particularly beneficial to individuals who suffer from severe medical, psychiatric, and addictive disorders.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Transtornos Relacionados ao Uso de Anfetaminas/reabilitação , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Terapia por Exercício , Metanfetamina , Adulto , Depressão/diagnóstico , Transtorno Depressivo/terapia , Feminino , Educação em Saúde , Humanos , Individualidade , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Resultado do Tratamento
8.
Subst Use Misuse ; 49(13): 1759-63, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24827867

RESUMO

BACKGROUND: Reports suggest increased use of alcohol, prescription drugs, and illicit drugs in Iraq in the past decade, which may portend an increase in substance use disorders (SUDs) and, thus, an increased need for treatments. OBJECTIVES/METHODS: To develop better information on the nature and extent of drug and alcohol use in Iraq, the Iraqi Ministry of Health, with support from the US government and technical assistance from US researchers, held an initial Iraqi Community Epidemiology Work Group meeting in May 2012 in Baghdad. Drug seizure data were the primary data source, provided by Iraqi law enforcement and customs officials. Ministry of Health officials presented data from hospitals (medical and psychiatric), outpatient clinics, and health centers, as well as from surveys of medical patients, pharmacy patients, and prisoners. RESULTS: The data suggest that the most commonly used substances are alcohol, hashish, and prescription drugs. New drugs in Iraq's drug use scene include the amphetamine-type substances "Captagon" and crystal methamphetamine, and the painkiller tramadol. Seizures of Captagon, methamphetamine, Afghan opium, teriac (a crude form of opium), and heroin at border crossings may indicate that these substances are becoming more popular. A plan for an ongoing program of CEWG meetings was developed. CONCLUSIONS: Drug and alcohol use in Iraq is increasing and new drugs are appearing in the country. An ongoing program for monitoring drug use trends and informing Iraqi policy makers is important for public health planning, including the development of strategies to identify citizens with SUDs and provide them treatment.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Iraque/epidemiologia , Masculino , Vigilância da População
9.
Am J Addict ; 22(3): 206-11, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23617860

RESUMO

BACKGROUND & OBJECTIVES: This study assessed the role of 14 specific relapse-prevention activities and their underlying factors in maintaining abstinence among subjects (N = 302) completing outpatient treatment for stimulant dependence. METHODS: We examined what broader dimensions might subsume the 14 items constituting the Drug Avoidance Activities checklist (Farabee et al. J Subst Abuse Treat 2002;23:343-350), and how well these derived factors predicted concurrent drug use at baseline and again 3 and 12 months later. RESULTS: Although four factors were identified consistently for the three time points, only avoidance strategies had sufficient internal consistency to be retained for further analysis. Controlling for age, gender, and ethnicity, the avoidance subscale was a significant predictor of UA results at all time periods: a one-point increase in the avoidance strategies scale was associated with an 86% increase in odds of a negative UA at baseline (OR = 1.86, 95% CI = 1.37-2.53, p < .001), a 77% increase at 3-month follow-up (OR = 1.77, CI = 1.37-2.29, p < .001), and a 37% increase at 12-month follow-up (OR = 1.37, CI = 1.04-1.81, p = .026). CONCLUSIONS: Although correlations of individual items with UA results showed statistically significant (p < .05) results for 8 of 14 items at one or more observation points, avoidance-related behaviors showed the strongest associations with sustained abstinence.


Assuntos
Comportamentos Relacionados com a Saúde , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Cocaína/urina , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Metanfetamina/urina , Pessoa de Meia-Idade , Análise de Componente Principal , Prevenção Secundária , Grupos de Autoajuda/estatística & dados numéricos , Índice de Gravidade de Doença , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários
10.
Subst Abus ; 34(2): 108-17, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23577903

RESUMO

BACKGROUND: This study evaluated the effectiveness of 3 approaches to transferring cognitive behavioral therapy (CBT) to addiction clinicians in the Republic of South Africa (RSA). METHODS: Clinicians (N = 143) were assigned to 3 training conditions: ( 1 ) an in vivo (IV) approach in which clinicians received in-person training and coaching; ( 2 ) a distance learning (DL) approach providing training via videoconference and coaching through teleconferencing; and ( 3 ) a control condition (C) providing a manual and 2-hour orientation. RESULTS: Frequency of use of CBT skills increased significantly with the IV and DL approaches compared with the C approach, and the IV approach facilitated greater use of CBT skills than the DL approach. During the active phase of the study, skill quality declined significantly for clinicians trained in the C condition, whereas those in the DL approach maintained skill quality and those in the IV approach improved skill quality. After coaching was discontinued, clinicians in the IV and DL approaches declined in skill quality. However, those in the IV approach maintained a higher level of skill quality compared with the other approaches. Cost of the IV condition was double that of the DL condition and 10 times greater than the C condition. CONCLUSIONS: In vivo supervision and distance learning methods appear to be effective dissemination and implementation strategies, and distance learning has significant potential to be less costly.


Assuntos
Terapia Cognitivo-Comportamental/educação , Aconselhamento/educação , Pessoal de Saúde/educação , Adulto , Competência Clínica , Serviços Comunitários de Saúde Mental/métodos , Educação a Distância , Feminino , Humanos , Masculino , Desenvolvimento de Programas , África do Sul , Transtornos Relacionados ao Uso de Substâncias/terapia
11.
J Subst Use Addict Treat ; 152: 209103, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37311520

RESUMO

BACKGROUND: People with opioid use disorder (OUD) are overrepresented in US correctional facilities and experience disproportionately high risk for overdose after release. Medications for OUD (MOUD) are highly efficacious but not available to most incarcerated individuals. In 2018, Vermont began providing MOUD for all incarcerated individuals with OUD statewide. In 2020, the COVID-19 state of emergency began. We assessed the impact of both events on MOUD utilization and treatment outcomes. METHODOLOGY: Analyses linked Vermont Department of Corrections administrative data and Medicaid claims data between 07/01/2017 and 03/31/2021. The study used logistic regression to analyze treatment engagement among all incarcerated individuals in Vermont. Multilevel modeling assessed change in clinical outcomes among release episodes that occurred among individuals with an OUD diagnosis Medicaid claim. RESULTS: Prescriptions for MOUD while incarcerated increased from 0.8% to 33.9% of the incarcerated population after MOUD implementation (OR = 67.4) and subsequently decreased with the onset of COVID-19 to 26.6% (OR = 0.7). After MOUD implementation, most prescriptions (63.1%) were to individuals who had not been receiving MOUD prior to incarceration, but this figure decreased to 53.9% with the onset of COVID-19 (OR = 0.7). Prescriptions for MOUD within 30 days after release increased from 33.9% of those with OUD before to 41.0% after MOUD implementation (OR = 1.4) but decreased to 35.6% with the onset of COVID-19 (OR = 0.8). Simultaneously, opioid-related nonfatal overdoses within 30 days after release decreased from 1.2% before to 0.8% after statewide MOUD implementation (OR = 0.3) but increased to 1.9% during COVID-19 (OR = 3.4). Fatal overdoses within 1 year after release decreased from 27 deaths before to ≤10 after statewide MOUD implementation and remained ≤10 during COVID-19. CONCLUSIONS: This longitudinal evaluation demonstrated increased treatment engagement and a decrease in opioid-related overdose following implementation of MOUD in a statewide correctional system. In contrast, these improvements were somewhat attenuated with the onset of COVID-19, which was associated with decreased treatment engagement and an increase in nonfatal overdoses. Considered together, these findings demonstrate the benefits of statewide MOUD for incarcerated individuals as well as the need to identify and address barriers to continuation of care following release from incarceration in the context of COVID-19.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Estados Unidos/epidemiologia , Humanos , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Overdose de Opiáceos/tratamento farmacológico
12.
J Ambul Care Manage ; 46(2): 152-159, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36745163

RESUMO

The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.


Assuntos
Estimulantes do Sistema Nervoso Central , Transtornos Relacionados ao Uso de Substâncias , Humanos , Terapia Comportamental , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos
13.
J Psychoactive Drugs ; 44(4): 342-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23210383

RESUMO

This study examines the utility of several process-of-care performance measures (initiation, engagement, retention, and monitoring of drug use during treatment) as predictors of methamphetamine (MA) use outcomes at 12- and 36-month follow-ups. MA-dependent individuals (n = 871) participated in a randomized, controlled trial of outpatient psychosocial treatment from 1999-2002 and completed 12- and 36-month follow-up interviews. This sample included a treatment-as-usual group (n = 436) and a 16-week Matrix treatment (n = 435) group. Significant associations were observed between select process-of-care measures and MA use outcomes at both follow-ups. While correlational analyses showed an association between MA abstinence at follow-up and enhanced treatment engagement and retention, mixed logistic regression analyses indicated that sustained abstinence from MA during outpatient treatment was the strongest predictor of testing negative for MA use at both follow-ups. Results suggest that monitoring client drug use during treatment may be a useful process-of-care measure with MA-dependent users.


Assuntos
Assistência Ambulatorial , Transtornos Relacionados ao Uso de Anfetaminas/terapia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Metanfetamina/efeitos adversos , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/diagnóstico , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Recidiva , Medição de Risco , Fatores de Risco , Detecção do Abuso de Substâncias/métodos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Urinálise
14.
J Psychoactive Drugs ; 44(4): 325-33, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23210381

RESUMO

An environmental survey was conducted regarding substance abuse recovery supports and services (RSS) delivered across California, where these services are offered, and by whom. Inquiries were made regarding RSS measurement efforts, funding mechanisms, and technical assistance needs. A survey was disseminated to all 57 administrators of county alcohol and other drug or behavioral departments. Results indicate that 62% (23 of 37) of responding counties offer RSS. Overall, certified addiction counselors (CACs) were the staff most utilized to provide RSS, followed by peers, clinicians, and volunteers. Among recovery-community organizations (RCOs), peers, volunteers, and CACs were the most utilized staff. Sober living homes were the most prevalent type of RCO, followed by recovery centers, faith-based/recovery ministries, and recovery schools. Forty-five percent of counties reported funding RSS; 37.8% collect data. RSS may provide valuable support services for individuals recovering from alcohol/drug use; however, the field must further define RSS and develop measurement strategies to justify RSS funding.


Assuntos
Serviços de Saúde Comunitária , Aconselhamento , Custos de Cuidados de Saúde , Financiamento da Assistência à Saúde , Instituições Residenciais , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/terapia , California , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/estatística & dados numéricos , Aconselhamento/economia , Aconselhamento/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/economia , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde , Humanos , Avaliação das Necessidades/economia , Instituições Residenciais/economia , Instituições Residenciais/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/legislação & jurisprudência , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estados Unidos , United States Substance Abuse and Mental Health Services Administration/economia
15.
J Psychoactive Drugs ; 44(4): 299-306, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23210378

RESUMO

Integrating substance use disorder (SUD) services with primary care (PC) can improve access to SUD services for the 20.9 million Americans who need SUD treatment but do not receive it, and help prevent the onset of SUDs among the 68 million Americans who use psychoactive substances in a risky manner. We lay out the reasons for integrating SUD and PC services and then explore the models used and the experiences of providers as they have begun SUD/PC integration in California.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , California , Comportamento Cooperativo , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Objetivos Organizacionais , Inquéritos e Questionários , Recursos Humanos
16.
J Psychoactive Drugs ; 44(4): 292-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23210377

RESUMO

It is important to understand the perceptions of staff members who will be implementing the expected integration of mental health and substance use services into primary care. Surveys were administered to mental health/substance use disorder (MH/SUD) staff, support staff (SS), and primary care providers (PCPs) from three organizations (seven sites) that were participating in an initiative to promote the integration of MH/SUD services into primary care in Kern County, California. Results suggest that integration and MH/SUD services are highly valued among all staff types, and that staff are uniformly interested in further MH/SUD training. However, there were significant differences in staff perceptions. MH/SUD staff and services were valued by PCPs more than MH/SUD staff perceived being valued by PCPs, and MH/SUD staff were less likely to agree that communication with PCPs was good. Information seemed to flow better from MH/SUD staff to PCPs than in the other direction.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Saúde Mental , Prestação Integrada de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Mão de Obra em Saúde , Percepção , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/terapia , Análise de Variância , California , Comunicação , Serviços Comunitários de Saúde Mental/organização & administração , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/organização & administração , Pesquisas sobre Atenção à Saúde , Mão de Obra em Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Modelos Lineares , Objetivos Organizacionais , Atenção Primária à Saúde/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e Questionários
17.
Drug Alcohol Depend ; 231: 109229, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34979421

RESUMO

BACKGROUND: To date, no studies have reported the use of text messaging to deliver cognitive behavioral therapy (CBT) to people living with HIV and substance use disorders. OBJECTIVE: We developed and evaluated a 12-week, CBT-based text-messaging intervention (TXT-CBT) targeting drug use and adherence to antiretroviral therapy (ART) for adults with HIV and comorbid opioid and stimulant use disorders. MATERIALS AND METHODS: Participants were randomly assigned to receive either TXT-CBT (n = 25) or an informational pamphlet (INFO) discussing substance use and medication adherence (n = 25). ART adherence, drug use, and HIV-risk behaviors were assessed at baseline, monthly during treatment, and treatment-end, and were compared between groups using a mixed-model repeated-measures analysis. Injection drug use was examined as a moderator of outcomes. RESULTS: Relative to the INFO group, TXT-CBT participants evidenced increased ART adherence, measured by phone-based unannounced pill counts and biochemically by viral load and CD4 count. TXT-CBT participation was also associated with reductions in opioid use and HIV risk behaviors. While reductions in cocaine use were observed in the TXT-CBT group, relative to the INFO group, other stimulant use did not change. Among people who inject drugs, TXT-CBT produced increases in ART adherence and corresponding changes in viral load, relative to injection drug users in the control condition. CONCLUSIONS: Findings demonstrated promising preliminary evidence for the efficacy of TXT-CBT in improving ART adherence and reducing drug use and HIV-risk behaviors among people with HIV infection and comorbid opioid and stimulant use disorders.


Assuntos
Terapia Cognitivo-Comportamental , Infecções por HIV , Transtornos Relacionados ao Uso de Opioides , Envio de Mensagens de Texto , Adulto , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação/psicologia , Transtornos Relacionados ao Uso de Opioides/complicações , Assunção de Riscos
18.
Drug Alcohol Depend ; 231: 109247, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34999268

RESUMO

BACKGROUND: In a randomized controlled 8-week trial, we examined the efficacy of aerobic and resistance exercise in reducing craving for methamphetamine (MA) among individuals with MA-use disorder during residential treatment. METHODS: Individuals with MA use disorder (138) who were newly enrolled in residential treatment volunteered for random assignment to either an 8-week exercise intervention (EX) or health education control (HE), with both conditions meeting 3 times weekly; 3 dropped out of the trial, bringing the analysis sample to 135. The majority of participants were male (80%), and 48% were Latino/Hispanic. The mean age of the sample was 31.7 (SD = 6.9) years. Using multivariate mixed models, differences between conditions were examined in: (1) craving for MA, measured by self-reported ratings on a Visual Analog Scale over the 8-week trial and, (2) MA use, measured by self-report and urine drug screens at baseline and 30 and 60 days after discharge from the 8-week study. RESULTS: Results revealed significantly lower craving scores among the participants in the EX group than those in the HE group over the 8-week trial (median daily craving score for EX = 13.5, for HE = 21.8; p = .009). In addition, participants with less craving during treatment had significantly lower rates of MA use after discharge than participants with high craving measured at 30-days (p = .004) and 60-days post-discharge (p < .001). CONCLUSIONS: Results support the utility of incorporating a structured exercise program for individuals with MA-use disorder to reduce craving and improve MA-use outcomes.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Metanfetamina , Adulto , Assistência ao Convalescente , Transtornos Relacionados ao Uso de Anfetaminas/terapia , Fissura , Feminino , Humanos , Masculino , Alta do Paciente , Tratamento Domiciliar
19.
Am J Addict ; 20(4): 366-72, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21679268

RESUMO

As the number of men and women entering treatment for substance use disorders continues to increase across the country, it becomes vitally important to understand their quality of life (QOL) or perceived health status, in order to inform treatment efforts for improving such outcomes. To date, QOL assessments among methamphetamine (MA) dependent users are limited. This paper examines QOL health status among a sample of 838 treatment seeking MA users at admission. Using regression analysis, predictors of QOL are examined among MA users. Predictors of poor QOL among MA users at treatment admission included being female, white, high school educated or more, married, experiencing psychosocial dysfunction (lifetime trauma, suicide, social conflict), reporting a high frequency of both MA and polydrugs for 15 days or more in the past month, chronicity of MA and polydrug use, injection use, and having co-morbid medical and psychiatric impairment. Employment status was the only factor related to better health status perceptions. This study expands the scope of scholarly examination of MA-dependent users entering treatment, as there has not been a development of coherent profiles of QOL among representative samples of clinical MA-abusing populations to date.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Disparidades nos Níveis de Saúde , Metanfetamina , Qualidade de Vida , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/diagnóstico , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Transtornos Relacionados ao Uso de Anfetaminas/terapia , Estimulantes do Sistema Nervoso Central , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos , Centros de Tratamento de Abuso de Substâncias , Resultado do Tratamento
20.
J Psychoactive Drugs ; Suppl 7: 3-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22185034

RESUMO

Although some practices clearly have stronger supporting evidence than others, a single authoritative list of evidence-based practices (EBPs) that can be applied in the treatment of criminal justice clients does not exist. Nationally, use of EBPs is low, and such practices are generally only implemented under certain circumstances. To clarify these issues, experts from around the nation were invited to California for two research-to-policy meetings focused on EBP identification and implementation. Their presentations and the resulting series of articles in this special theme issue describe the current state of EBP research for criminal justice clients. To advance the field beyond the compilation of EBP lists, which can only represent a partial solution at best, next steps should include a greater focus on quality of implementation, intensity of quality assurance and monitoring, and training for underlying skills and principles.


Assuntos
Direito Penal , Prática Clínica Baseada em Evidências , Pesquisa , Transtornos Relacionados ao Uso de Substâncias/terapia , California , Humanos
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