Perceived Educational Needs of Substance Use Peer Support Specialists: A Qualitative Study.

The opioid crisis is an ever-growing issue nationwide. The role of peer support specialists has received widespread acceptance in the substance use and behavioral health spheres. However, there is a lack of standardization on the training required for peer support specialists to function as competent members of integrated behavioral health teams. We conducted qualitative focus groups with 14 practicing certified peer support specialists to determine their perceived educational needs. Inductive thematic analysis was used to analyze the data and six themes emerged: mental health and suicide prevention training, diversity, equity, and inclusion training, counseling skills training, family systems approach to care training, professionalism training, and taking care of self - mind, soul, and body training. To improve peer support specialists' confidence in their ability to competently perform their jobs, important topics need to be incorporated into their educational training and preparation.

Substance use treatment services for older adults in five states in the Southern United States: a state-by-state comparison of available treatment services.

Objectives: Substance use disorders (SUD) among older adults have become a serious public health concern. The purpose of this study was to assess which states in the Southern U.S. are more responsive to SUD treatment needs of older adults.Methods: This study is a secondary data analysis of the N-SSATS-2019 dataset.Results: There were 1,215 substance treatment facilities in the five states. Kentucky had the highest number of substance use treatment facilities (n = 449, 37%), followed by Georgia (357, 29%), Alabama (153, 13%), Louisiana (146, 12%) and then Mississippi (110, 9%). Out of the 1,215 facilities, only 20% (n = 244) indicated that they had programs specifically tailored for older adults. Kentucky had the largest number of facilities per 1 million older adults while Mississippi had the highest number of facilities per 1 million older adults offering detoxification services. Alabama had the lowest number of services per 1 million adults in all categories examined.Conclusion: Across the U.S., most adults with SUD do not have access to substance use treatment; in the southeastern region of the country, higher rates of poverty, rural geography and stigma, and lack of treatment availability may further complicate individuals' ability to access substance use-related medical care.

Social and structural determinants of recovery: The impact of race.

Relapse rates for substance use disorders (SUDs) after treatment are as high as 50%. Evidence suggests that social and structural determinants of recovery influence these outcomes. Important domains to consider include economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context are the major domains of social determinants of health. All these factors influence people's ability to reach their highest health potential. However, race and racial discrimination often compound the negative effects of these factors on substance use treatment outcomes. Moreover, research is urgently needed to examine the specific mechanisms through which these issues influence SUD and SUD outcomes.

Are We Witnessing a New Wave of Substance Use Disorders?: A Spotlight on Stimulant Use Disorders.

Stimulant use disorders are emerging as a serious global threat to health. Although research, clinical, and policy efforts have largely concentrated on opioid use disorders over the past decade, exponential rises in prevalence and overdose deaths attributable to stimulant use disorders warrant renewed attention. To date, no approved medications are available to treat stimulant use disorders; however, behavioral interventions have been effective and should be proactively promoted. Similarly, complementary and integrative therapies and harm reduction services have emerging evidence for effectiveness in treating these conditions. Research, practice, and policy interventions should address stigma for medications for stimulant use disorders when available, vaccine hesitancy if vaccines are approved and safe, environmental surveillance to reduce population exposure to toxic effects of methamphetamines, and educational interventions for health providers to increase competency to reduce the long-term effects on various body systems. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 13-18.].

Xylazine: The Drug Taking the World By Storm: What You Need to Know.

Xylazine has taken the world by storm and proactive strategies are urgently needed to combat its negative impacts on population health. Xylazine is an unscheduled non-opioid indicated as a veterinary tranquilizer, also known as "Tranq." This drug is commonly used in combination with other drugs, such as heroin, fentanyl, and cocaine. Xylazine can be used orally, intranasally, sniffed, smoked, and injected, but is mostly used intravenously. Adverse effects of xylazine are secondary to central nervous system (CNS), cardiovascular, and respiratory function depression. When alpha-2-receptors in the cardiovascular and respiratory systems are stimulated, physiological effects include bradycardia, hypotension, and respiratory and CNS depression. There are currently no U.S. Food and Drug Administration-approved medications for the treatment of xylazine withdrawal or reversal of its overdose. Therefore, it is imperative that health care providers are trained to recognize these signs and symptoms and intervene proactively. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 7-10.].

Development and implementation of a novel peer mentoring program for undergraduate nursing students.

OBJECTIVES: Given the dynamic and high-stress environment of nursing education today, the need arose for the development and implementation of a novel peer mentoring program to support undergraduate nursing students. Peer mentoring refers to a network of support in which a more skilled or experienced person serves as a role model for a less skilled person for professional development and personal growth. Peer mentoring provides a support system that encourages self-confidence and increases self-worth for both the mentee and the mentor. The undergraduate student peer mentoring program in a large, Southeastern United States, university-based, 4-year school of nursing was created in response to a desire for more support conveyed by upper-level nursing students. METHODS: A model was developed whereby each incoming nursing student (Semester 1) would be paired with a senior nursing student (Semesters 3, 4, or 5). This mentoring dyad was then assigned to a faculty mentor who ensured that the mentoring relationship was functioning in accordance with established guidelines and provided support to both the student mentee and the student mentor. RESULTS: The first cohort was comprised of 20 mentoring dyads. Subsequent cohorts have ranged from 20 to 45 mentoring dyads. To date, over 300 nursing students have participated in the undergraduate peer mentoring program. Based on feedback from student evaluation surveys, both mentors and mentees appreciate and find value in the program. Approximately 93% of student mentors indicated that they would have appreciated such a program when they were first semester nursing students. CONCLUSION: Some of the challenges of navigating nursing programs are not related to lack of academic aptitude. Rather, other challenges, including lack of social support and soft skills needed to successfully complete the first and second semesters of nursing school. These are critical challenges that a peer mentor could help to meet.

The Role of Nursing in Loosening the Pervasive Grip of Intersectional Stigma.

Stigma is a key driver of inequity and affects myriad health behaviors and outcomes, especially those related to substance use disorder, HIV, and mental illness. Intersectionality, theorized by Black feminist scholars, emphasizes the intersecting, structural processes that place people at risk for harm. As people's multiple identities are inseparable and non-additive, their experiences of stigma are complex and multifaceted. Nurse educators, scholars, and clinicians form the foundation of patient care and scientific advancements to improve the health and well-being of diverse patient populations. The nursing profession must contend with the underlying drivers of intersectional stigma, including systemic racism and White supremacy, classism, and gender inequality. Centering equity, strengthening recruitment/retention of minoritized nursing students, implementing stigma training in curricula, improving the nursing leadership pipeline, moving beyond implicit bias training and deficit models, and incorporating intersectional and implementation science approaches in research can help advance equity for clinicians and patient populations. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 9-15.].

Recovery Ecosystems: A Whole Health Approach to Substance Use Prevention and Treatment.

A recovery ecosystem is an evidence-based approach that creates the environment that individuals and families need by providing all the necessary tools, services, and supports for recovery to occur. Several models have been proposed in the literature, including the recovery-oriented systems of care model and Recovery Ready Ecosystems Model. A major concern with previous models is lack of focus on how the individual with substance use disorder (SUD) is a partner in the recovery process and interacts with the recovery ecosystem to optimize recovery wrap-around services and supports. Therefore, we propose the SUD Holistic Recovery Ecosystem Model (HREM), which uses a whole health approach to substance use prevention and treatment and builds on prior work by other researchers. The HREM has four domains: health support, social welfare support, occupational support, and legal and legislative support. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 10-14.].

Feasibility and Acceptability of a Mindfulness-Based Relapse Prevention Intervention for Opioid Use Disorders.

In 2021, drug overdose deaths exceeded 100,000 for the first time in U.S. history, mostly attributable to opioid overdoses. Medications for opioid use disorders are considered the gold standard for treatment; however, treatment initiation and adherence remain a challenge. Mindfulness-based interventions show efficacy for substance use disorders, and peer support has been shown to improve treatment outcomes. The purpose of the current study was to examine the feasibility and acceptability of the Minds and Mentors Program. Enrollment, randomization, and retention rates were 36%, 49%, and 57%, respectively. Client satisfaction scores ranged from 84.4% to 100%. Approximately 64% of participants attended 10 of 12 treatment sessions, representing treatment adherence. Qualitative analysis revealed four main domains: Permission to Be Honest and Open, Applicability for Everyday Life, Hope Restored, and Changing the Way I Think. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 11-14.].

Intensity and type of physical activity predicts depression in older adults.

This study examined whether various levels of physical activity among older adults predicted levels of depression and whether there were racial differences in the levels and types of physical activities engaged in by adults aged 50 and older. METHOD: Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed for 2,474 adults aged 50 years and older. Variables of focus were demographics, physical activity and depression, assessed using the Physical Activity Questionnaire and the Mental Health - Depression Screener. RESULTS: There was a significant positive relationship between income and depression; individuals with higher income had lower levels of depression. Simple linear regression revealed income significantly predicted depression scores, b = -.20, F(1, 2296) = 96.35, p < .001, explaining 4% of the variance, R2 = .04. As age increased, all levels of physical activity declined, regardless of the category. Vigorous recreation-related activity and moderate recreation-related activity each made significant, unique contributions to depression scores. CONCLUSION: Findings from the current study suggest that physical activity interventions should be culturally appropriate and tailored to the needs and abilities of individual older adults to maximize benefits and minimize adverse events, particularly among community dwelling older adults.

Moderation Effects of Substance Use on Physical and Mental Well-Being in Adults.

BACKGROUND: Each year about one in five adults experiences mental illness. Although the independent physical and mental health consequences of alcohol misuse and cigarette smoking are well documented, little is known on how substance use moderates the relationship between physical and mental well-being. OBJECTIVE: The purpose of this study was to examine whether substance use moderates the relationship between physical activity and mental health in adults. METHODS: This was a secondary analysis of data provided by the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: Participants (N = 450,016) were adults who completed the BRFSS in 2017. Those who did not drink alcohol had fewer mental health problems when they indicated greater amounts of time spent doing physical activities each week. Last, smokers' number of mental health problems decreased as they engaged in more physical activity, whereas nonsmokers' number of mental health problems increased as they engaged in more physical activity. CONCLUSIONS: The relationship between physical activity and mental health outcomes is well established and cannot be overemphasized. Nonetheless, substance abuse can moderate this relationship and should be routinely screened for by health care providers regardless of treatment setting.

COVID-19 and opioid use disorder: Expanding treatment access in rural settings.

ABSTRACT: Substance use treatment inequities among rural populations are well documented and the COVID-19 pandemic has exacerbated these inequalities, forcing healthcare providers to be creative in the delivery of treatment. Systematic reviews on the use of telehealth to treat patients with substance use disorder indicate that it is a promising alternative to in-person services. This article examines the evidence supporting the use of telehealth in treating patients with opioid use disorder and explores other promising options that can help overcome pandemic-related barriers to treatment.

Engaging African-Americans in Research in the Era of Precision Medicine: An All of Us Research Program Initiative.

The purpose of this study was to increase awareness about the All of Us Research Program and to engage African-Americans who live in the Deep South in conversations about research. This was a quasi-experimental single group design with pre- and post-tests. Recruitment occurred via social media, radio and television advertisements, and in-person recruitment. A purposive convenience sample was used. Seventy adults (70) participated in the study. The social media campaigns reached 35,000 people. Prior to the study, 21% of participants had heard about the All of Us Research Program. After the event, there was a 10.8% increase in the likelihood of participants' willingness to share information about the program, and a 20% increase in the perception that the program was dedicated to engaging diverse communities in research. African-Americans are still skeptical about participating in research. However, with targeted intervention, many of them are willing to participate in research if it will improve their overall health and well-being.

Employment implications of nurses going through peer assistance programs for substance use disorders.

Nurses constitute approximately 36% of all healthcare providers, and 2% of the labor force in the United States (American Nurses Association [ANA], 2016). However, about 8% of nurses suffer from substance use disorders ([SUD]; Kunyk, 2015) and must participate in peer assistance programs to maintain their licenses (Darbro & Malliarakis, 2012). The purpose of this study was to describe the lived experiences of nurses with SUD participating in peer assistance programs and the subsequent employment implications. A Phenomenological approach was used to answer the research questions. Ten nurses were recruited from local support meetings and a thematic inductive approach was utilized to develop four overarching themes, which included stress from restriction, guilt and shame, gratitude for being caught, and keeping up with recovery. Understanding the challenges recovering nurses face when being incorporated into the workforce is important in implementing policies that facilitate a smooth transition.

Nanotechnology-Enhanced Naloxone and Alternative Treatments for Opioid Addiction.

Opioids are commonly prescribed to address intense, ongoing pain associated with cancer, as well as long-lasting noncancer-related pain when alternative methods have proven ineffective. Individuals who exhibit both chronic pain and misuse of opioids face a significant danger of experiencing adverse health outcomes and the potential loss of life related to opioid use. Thus, there is a current movement to prescribe naloxone to those considered high-risk for opioid overdose. Naloxone has been explored as an antidote to reverse acute respiratory depression. Conversely, naloxone can give rise to other problems, including hypertension and cardiac arrhythmias. Thus, the importance of nanotechnology-enabled drug delivery strategies and their role in mitigating naloxone side-effects are significant. In this review, we explore the latest advancements in nanotechnology-enabled naloxone and alternative methods for addressing the opioid crisis through the utilization of non-opioid natural alternatives for chronic pain management.

Original Research: Nurses' Knowledge and Attitudes Regarding the Sustainable Development Goals: A Global Study.

BACKGROUND: Nurses have a critical role to play in achieving the United Nations' 17 Sustainable Development Goals (SDGs). While Goal 3 (good health and well-being) is of particular importance to nursing, every SDG contributes to the advancement of universal health and well-being. Yet many nurses are unfamiliar with the SDGs and how they relate to everyday nursing practices. PURPOSE: The purpose of this study was to examine RNs' knowledge of and attitudes toward the SDGs. METHODS: This study used a descriptive correlational cross-sectional design. A convenience sample of RNs from multiple countries completed an anonymous online survey that included eight demographic items and 25 items exploring participants' knowledge of and attitudes toward the SDGs. Descriptive, parametric, and nonparametric statistics were used to analyze the data. RESULTS: The majority of nurses in this study perceived themselves as lacking knowledge of the SDGs. Most wanted to know more, including how they could take action to help achieve the goals. Overall, participants agreed that the SDGs are relevant to nursing practice and that nurses are integral to their advancement. Participants who were younger than age 50, those living in the United States, and those who practiced primarily in a clinical or community setting were more likely than others to self-report lower SDG knowledge scores. CONCLUSIONS: The study findings contribute to our collective understanding of RNs' knowledge and attitudes regarding the SDGs. They can assist nurse educators and leaders worldwide in developing targeted strategies to better inform nurses and prepare them for actions that will advance these goals. Increasing nurses' knowledge of the SDGs, especially as these goals relate to daily clinical practice, may lead to greater nursing engagement and impact.

The methods and baseline characteristics of a multi-site randomized controlled trial evaluating mindfulness-based relapse prevention in conjunction with peer support to improve adherence to medications for opioid use disorders.

Introduction: Medications for opioid use disorders (MOUD) remain the gold standard for treating OUD, but treatment initiation and adherence remain challenging. Exclusive utilization of pharmacotherapy as a treatment modality for OUD is sub-optimal, and a combination of psychotherapies and pharmacotherapies is recommended. General trends indicate the benefits of peer mentoring and MBRP separately. Therefore, we hypothesize that the combined effect of MBRP and Peer mentoring will produce synergistic improvements in MOUD adherence compared to an enhanced twelve-step facilitation (TSF). Methods: This paper describes the methods and baseline characteristics of a multi-site randomized controlled trial evaluating the effectiveness of a combination of MBRP and peer support (MiMP) compared to an enhanced TSF in improving adherence to MOUD. Both MiMP and TSF are 12-week manualized protocols that utilize licensed therapists. The interventions are delivered in weekly group sessions that last about 75-90 minutes per session. The primary outcome is MOUD adherence. Secondary and exploratory outcomes include relapse, cravings, depression, anxiety, stress, quality of life, and pain catastrophizing. Results: The participants' ages ranged from 21 years to 77 years, with a mean age of 44.5 (SD ± 11.5 years). There was an almost equal distribution of gender and place of residence. Overall, 51.9% (n=54) of participants identified as female and 48.1% (n=50) were male. Similarly, 51.9% (n=54) of participants resided in urban areas, while 48.1% (n=50) resided in rural areas. Participants identified as either black or white, with over three-quarters identifying as white (77.9%, n= 81) and 22.1% (n= 23) as black. Most participants randomized to the 12-step facilitation group were white (93.1%). Relationships and employment status were well distributed between categories. Over half of the participants reported some college or higher education. Over 90% of the participants made less than $75,000 per year. Some participants indicated that they had both public and private health insurance. Discussion and conclusion: This study is innovative in several ways including combining MBRP and peer support, addressing comorbid mental health issues among individuals with OUD, utilizing manualized protocols, and evaluating of both physiological and self-reported measures in assessing cortisol reactivity as a predictor of relapse and treatment outcomes.