Addiction Services Research Articles

Critical Analysis of Tools for Measuring Recovery-Oriented Practice in Mental Health Facilities: A Scoping Review

Background: To implement recovery-oriented practice, it is important to have instruments capable of evaluating such practice. A number of different questionnaires have been developed in recent years which measure recovery orientation in mental health services. Objective: To identify and analyze patient-reported experience measures (PREMs) reported in the literature that are related to recovery-oriented practice in mental health services. Methodology: This study followed the Joanna Briggs Institute methodology for scoping reviews. Searches were carried out in the Web of Science, CINAHL, Medline (via Pubmed), and SCOPUS databases and in grey literature repositories (Google Scholar, Opengrey, Dart-Europe, Teseo). Papers on recovery services for adults suffering from mental disorders (MDs) were included. Those focusing on addiction and intellectual disability care services were excluded. Results: Sixteen papers met the inclusion criteria. The selected PREMs mainly identified recovery-oriented systems, treatment, community integration and support as the dimensions addressed most frequently in questionnaires. The average number of items included in the questionnaires was found to be 54. With regard to psychometric properties, 62% of the papers evaluated reliability (internal consistency) and 56% provided some kind of evidence of validity. Conclusions: This review aims to give an overview of the existing instruments in the literature and to highlight the characteristics of each one of them. Several different PREMs exist which evaluate recovery-oriented practice. No instrument currently exists which could be described as a benchmark tool, but there are quite a few with good psychometric properties capable of producing data that are useful when evaluating clinical services.

Protocolizing social prescribing in mental health and addiction services: barriers and opportunities

Abstract Issue Social Prescribing (SP) is a structured approach where health professionals recommend community activities to enhance well-being. Starting in Catalonia in 2012, it expanded to the entire primary care network by 2016. By 2023, 23,338 patients received SP, showing a 2.3-fold increase from 2022. Two-thirds experienced improvement in mental well-being. Now, efforts focus on applying SP to mental health and addiction services (MHAS), where SP can be used for restoring health and well-being. Description A literature review was conducted and a working group was initiated with MHAS professionals was initiated to exchange experiences and identify needs and best practices. This was done in preparation for designing a pilot experience, which will include a qualitative study through focus groups to validate the action plan and determine barriers and facilitators in MHAS. The groups will be segmented into MHAS users and frontline professionals. Results The results of the review process and the working group sessions demonstrated that SP can be useful and beneficial for the health MHAS users. However, barriers and opportunities were identified. The main barriers detected include: the need for strong support during referrals to community activities; increased awareness of addiction among activity providers to reduce stigmatization; define inclusion and exclusion criteria; determining monitoring and evaluation tools; and mapping and updating community assets. Regarding opportunities, the following were highligthed: the interest of MHAS professionals in promoting and implementing a SP program in this area; the existence of organizations already conducting community activities focused MHAS users; and political prioritization of this issue. Lessons The implementation of a SP program protocol in MHAS is considered beneficial. It is necessary to analyse barriers to effectively address them and to identify opportunities to leverage them. Key messages • Social Prescribing has significantly enhanced mental health outcomes in Primary Care, which can imply a potential improvement in well-being of mental health and addiction services users. • Implementing Social Prescribing in mental health and addiction services offers promising integrated care opportunities, requiring barriers resolution and maximizing existing prospects.

Exploring PrEP awareness among addiction service professionals: an Italian cross-sectional study

Abstract Background Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. Since 2023, in Italy, PrEP has been subject to reimbursement, making it freely available to individuals who meet specific criteria, including those who engage in substance use during sexual activity (chemsex). In this context, all healthcare professionals (HCPs) in Addiction Departments and Services (ADS) play a crucial role from the intake interview in identifying potential PrEP candidates, providing an essential gateway to services. Thus, this study primarily aimed to explore the knowledge of ADS professionals regarding PrEP. Methods In 2024, an ongoing nationwide cross-sectional study has been conducted in Italy, enrolling a convenience sample of HCPs employed in ADS. The online questionnaire comprised items assessing knowledge regarding PrEP, training on PrEP, and experiences related to daily practice. The primary outcome was the awareness of PrEP existence, while secondary outcomes included knowledge regarding reimbursement. Results Preliminary analyses were conducted based on 269 questionnaires. Participants had a median age of 52 years (IQR=45-59). Physicians represented 26.0% of the sample, followed by nurses (23.0%). Awareness of PrEP stood at 43.5%, while knowledge of the existence of reimbursement conditions was at 29.9%. A vast majority (93.7%) felt inadequately informed, while 97.0% believed HCPs in ADS should receive training. Physicians demonstrated significantly higher awareness of PrEP existence, whereas there were no significant differences in reimbursement knowledge compared with other HCPs. Conclusions Intermediate findings revealed substantial gaps in PrEP awareness and reimbursement knowledge. These results emphasize the critical importance of tailored education and training programs to bridge these gaps and facilitate effective PrEP implementation in diverse healthcare settings, ultimately advancing HIV prevention efforts and promoting equitable access to care. Key messages • Substantial knowledge gaps about PrEP among healthcare professionals working in Addiction Departments and Services in Italy were highlighted. • Effective PrEP implementation hinges on empowering professionals with the necessary expertise to identify and support PrEP candidates, underscoring the critical role of tailored education initiatives.

OASAS will deliver free test strips and naloxone to New Yorkers

New Yorkers can get free fentanyl test strips, xylazine test strips and/or naloxone from the state Office of Addiction Services and Supports (OASAS). These can be requested from the local Opioid Overdose Prevention Program or a pharmacy, according to OASAS, if supplies are needed immediately. For a directory of Opioid Overdose Prevention Programs, go here. Delivery will take two weeks, according to OASAS. To order the test strips and naloxone, submit a request through the website: https://forms.ny.gov/s3/Harm‐Reduction‐Order‐Form. The initiative is paid for by the Opioid Settlement Fund.

OASAS head named to NAM

Last week Chinazo Cunningham, M.D., commissioner of the New York State Office of Addiction Services and Supports (OASAS), announced her election to the National Academy of Medicine (NAM). “I am extremely honored to be one of the newest members of the National Academy of Medicine,” she said.

Design and development of a machine-learning-driven opioid overdose risk prediction tool integrated in electronic health records in primary care settings

BackgroundIntegrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system.MethodsWe used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs’ feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances.ResultsThe backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term “high risk” of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs’ workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability.ConclusionsThe final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability.

New York limits administrative discharge from OTPs

No longer can opioid treatment programs (OTPs) summarily discharge patients for non‐payment, use of drugs or other reasons having to do with anything other than safety, at least not in New York. Most OTPs never did this, especially in New York, but the publication last month of new guidance from the state's Office of Addiction Services and Supports (OASAS) clearly delineates the circumstances under which a patient can be discharged against their will.

Mental Health Care and Policy (In)justice in Ontario: Making Intersections Visible

This paper applies an Intersectionality Based Policy Analysis Framework to Ontario’s current mental health plan – The Roadmap: A Plan to Build Ontario’s Mental Health and Addictions Services – in order to identify the contextual influences, underlying values and assumptions, which promote or undermine the uptake of human rights and equity as a mental health policy priority in Ontario. We found that dominant framings of the “problem” of mental health (as lack of access, coordination or integration, as a fiscal drain, as an economic burden, and as a clinical or medical problem) served to obscure and ignore the underlying social and structural conditions that impact mental health and the human rights violations that routinely occur in the context of “care.” We discuss the implications of The Roadmap ignoring social and structural determinants of health, and by way of contrast, explore how citizen engagement and activism can support rethinking mental health policy so that it is more just and equitable.

Isolation to stabilization: A Housing First approach to address homelessness in Kingston, Ontario.

Homelessness is a significant and growing public health concern across Canada. In Kingston, Ontario, the number of people experiencing chronic homelessness has more than doubled from 136 people in 2020 to 296 in 2023. An emergency shelter-in-place hotel program was established in April 2020 to provide non-congregate shelter to people experiencing homelessness and vulnerable to SARS-CoV-2 infections. Beyond preventing COVID transmission, the unintentional consequence was that a population that experienced chronic homelessness reduced drug consumption and became stable. In 2022, with increased funding from the Ministry of Health and the City of Kingston, a new Housing First program was implemented to transition individuals from homelessness to long-term stable housing. Between November 2022 and June 2023, a total of 34 clients initiated the program. Of these clients, 10 completed the program and were successfully housed, 10 remained active participants, and 14 were discharged before completion. Strengths and challenges were identified. Diverse services provided to meet the population's needs and strong collaborations with various community partners were facilitating factors. Inadequate external resources, a lack of evening and prosocial activities, and outside peers (not part of the program) who influenced recovery plans were identified as challenges. This program illustrates that simultaneously integrating housing, community building, mental health, and addiction services is possible and provides an innovative way to stabilize this vulnerable population of people experiencing homelessness. Results from this program and the knowledge generated through implementation are being used to further scale up the program.

The Mental Suffering of Cocaine-Addicted Patients: A Retrospective Analysis of Personality Disorders' Prevalence and Their Association with Psychopathological Symptoms.

(1) Background: The observational retrospective study aimed to investigate the prevalence of personality disorders (PDs) and their association with psychopathological symptoms in a group of patients with cocaine addiction. (2) Methods: Ninety-five medical records of the Pathological Addictions Service of the National Health Service of Lecce (Italy) were analyzed. PDs were diagnosed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and psychopathological symptoms were investigated through the Symptom Checklist 90-Revised (SCL-90-R). (3) Results: Ninety-two out of ninety-five patients met the criteria for at least one PD (96.8%), almost 35% had two Cluster B PDs, and over 25% had three Cluster B PDs. Nine out of ninety-five people met the criteria for all Cluster B PDs. Among the Cluster B PDs, it emerged that the most frequent diagnosis was that of narcissistic-borderline-antisocial (over 20% of the total sample). The analysis highlighted that mental suffering is prevalent in those with multiple comorbid Cluster B PDs. Specifically, depression and psychoticism exceed the clinical cut-off (T score > 63) in all patient groups. At the same time, anxiety and obsessions-compulsions are complained of only by those with more than two PDs as well as the level of general distress. Furthermore, anxiety, hostility, and paranoid ideation are significantly higher in the group of patients with more than three PDs. (4) Conclusions: Further studies should better investigate the relationship between the two aspects and describe the causal effects of PDs on psychopathological symptoms or, on the contrary, the effects of the substance on mental health and the worsening of personality alterations.

Managing Cancer Pain in Hospitalized Patients with Comorbid Opioid Use Disorder with Buprenorphine: A Case Series.

Data indicate that one in five patients with cancer might be at risk for nonmedical opioid use and its extreme form, opioid use disorder (OUD). Buprenorphine is one of the few medications available for the management of patients with co-occurring OUD and chronic pain. Care for these patients can be challenging and require the expertise of specialist clinicians with a deep understanding of addiction and cancer pain. Regrettably, these specialist clinicians may not always be available and accessible when patients are admitted to the hospital. Reports on how primary non-specialist clinicians without access to specialist addiction services navigate the care of such patients in the inpatient setting are limited. We hereby describe the care of three patients with OUD receiving buprenorphine who were hospitalized for cancer pain.

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study

ObjectivesThe objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to...

Recovered or Not Recovered? A First Person Narrative Case for Non-Abstinent Recovery.

The purpose of this paper was to explore interlocking questions relating to how we deal with drugs and medication in crisis residential mental health settings. In particular, it examines issues related to overly medical and simplistic explanations of the relationship between cannabis and psychosis, the positive effects of drugs, the effects of having standard rules for diverse groups of people and the concept of non-abstinent recovery. I have used mental health and addiction services for 25 years and I have 6 years' experience as a peer worker, working with many people who use drugs. This is an opinion piece built around a first-person narrative. Drugs can have positive effects and an appreciation and understanding of these effects is essential to understanding persistent drug use. How can we integrate non-abstinent recovery as a valid and positive choice of recovery pathway?

Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives.

For patients with mental illnesses (MIs), emergency departments (EDs) are often the entry point into the healthcare system, or their only resort for quickly accessing mental health treatment. A better understanding of the various barriers justifying high ED use among patients with MIs may help recommend targeted interventions that better meet their needs. This explorative qualitative study aimed to identify such barriers and the solutions brought forth to reduce ED use based on the perspectives of clinicians and managers working in EDs, other hospital departments or the community sector. Interviews were conducted between April 2021 and February 2022; 86 mental health professionals (22% were nurses) from four large urban ED sites in Quebec (Canada) were interviewed. Barriers were identified in relation to patient profiles, healthcare system and organisational features and professional characteristics. The key barriers that were found to explain high ED use were patients having serious MIs (e.g., psychotic disorders) or social issues (e.g., poverty), lack of coordination and patient referrals between EDs and other health services, insufficient access to mental health and addiction services and inadequacy of care. Very few solutions were implemented to improve care for high ED users. Better deployment of ED interventions in collaboration with outpatient care may be prioritised to reduce high ED use for patients with MIs. Improvements to the referral and transfer processes to outpatient care, particularly through care plans and case management programs, may be implemented to reduce high ED use and improve outpatient care among patients with multiple health and social needs.

Illicit drug use in Limerick City: A stakeholder and policy analysis using multiple streams model.

The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development. The study is qualitative and uses a hybrid technique that combines document, content, and stakeholder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematic search for grey literature were adopted as the search strategy. Problem Stream: Illicit drug use and its related problems have changed. The increasing availability of drugs, increasing usage and changes in the types of drugs being used have led to increased drug-related crimes, adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug-related problems in the region. Policy Stream: The current national drug strategy 2017-2025 which informs action plans in Limerick is the first to focus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction-related services, which have evolved rapidly since their first introduction. The Mid-West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands-on approach has been adopted in the creation of strategies to tackle the drug problem. The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long-lasting drug policies.

Watch those OD numbers!

In a comment entitled “the new math,” Rob Kent, former general counsel for the federal Office of National Drug Control Policy, and before that general counsel for the New York Office of Addiction Services and Supports (OASAS), sent us this.

Innovative Approaches to the Training of Social Workers for Work with Psychoactive Substance Dependence: An Interdisciplinary Strategy

The article analyzes the need for implementing an interdisciplinary approach in the education of social workers specializing in assisting individuals, including those dependent on psychoactive substances and those living with HIV. The main focus is on integrating knowledge from medicine, psychology, law, and social work to improve the quality of training and enhance the professional competencies of these specialists. The study highlights existing deficiencies in the educational programs for social workers in the Kyrgyz Republic, particularly in addressing the specific needs of individuals dependent on psychoactive substances. The article proposes an educational module (a teaching and methodological complex) designed to fill the gaps in the education of social workers in the field of addiction services. The pilot testing of this educational module showed its relevance and effectiveness in raising the level of knowledge on issues related to addiction, methods of providing social support, and social accompaniment. It is important to note that the interdisciplinary approach, which combines theoretical knowledge with practical training, helps in understanding the complexities of the issue and improves the outcomes of social adaptation for individuals with psychoactive substance dependence. The main conclusion of the article is that the use of innovative educational models (teaching modules) significantly enhances the quality of social work within the continuum of addiction services. The author stresses the importance of further developing and implementing such educational programs/modules for social workers, as this will overall improve the rehabilitation and socialization process for individuals with psychoactive substance dependence.

Practical approaches for engaging the public in a population-level data analysis project.

ObjectiveStewards of population-level data have an obligation to serve the public interest. As one such publicly funded data steward, our Public Advisory Council (PAC) co-led and determined the focus of an analysis project using population-level administrative health data. We describe our engagement strategies herein. ApproachThe 20-member PAC was involved in each stage of the project, from research question formulation to knowledge translation planning over 18 months, consisting of 12 meetings with both large and smaller groups. Our approach to engagement applied the International Association for Public Participation’s Framework as the foundation for an ‘empowerment’ level of engagement and adapted approaches from the James Lind Alliance and the ‘Plan-Do-Study-Act’ cycle. ResultsThe PAC chose to focus their analysis project on factors related to mental health and addiction service use. Four strategies were used and co-designed by members to foster engagement throughout: providing education and guidance, shared and guided brainstorming, building consensus, and responsiveness to feedback and evaluation. PAC members directed how and when these strategies were used, with challenges and lessons learned currently being co-developed into a publicly accessible report. ConclusionsOur work demonstrates the importance and value of public-driven research outputs and the feasibility of integrating public members in the work of data stewards. ImplicationsThe insights and practical strategies generated from this project will be used to guide effective engagement of the public for future analysis projects and to improve trust and social license for other initiatives using population-level data.

The Impact of COVID-19 on Mental Health Outcomes among Recipients of Ontario Social Assistance Benefits

Objectives/ApproachWe linked the Ontario Social Assistance (OSA) Benefit Unit file from the Ministry of Children, Community and Social Services to provincial health administrative datasets housed at ICES to examine the impact of COVID-19 on Mental Health and Addictions (MHA) service use among OSA recipients. Those receiving OSA benefits for February 2020 were matched to Ontario residents not receiving benefits based on age (±1 year), sex, income, expected resource utilization, and area of residence (N=771,891 matched pairs). We computed rates of MHA-related emergency department (ED) visits and hospitalizations in the 16-month period before (November 2018-February 2020) and after (March 2020-June 2021) pandemic onset. ResultsMHA-related ED visit rates were much greater among OSA recipients (8.82 per 1,000 person-months) compared with matched controls (1.83 per 1,000 person-months) in the post-COVID period (Relative Rate [RR]=4.82; 95% Confidence Interval [95%CI] 4.75-4.89). Comparatively, MHA-related ED visit rates were also greater among OSA recipients (9.85 per 1,000 person-months) compared with controls (2.38 per 1,000 person-months) during the pre-COVID period (RR=4.13; 95%CI 4.08-4.18). The pre-COVID and post-COVID period RRs comparing OSA recipients and matched controls were significantly different (p<0.001). Results were consistent when examining MHA-related hospitalizations. Conclusions/ImplicationsWhile MHA-related ED visits and hospitalizations rates were significantly higher in OSA recipients than matched controls in both time periods, this difference increased following the onset of COVID-19. Increased reliance on hospital-based MHA services post-COVID represents the greater ongoing need for, and/or reduced access to, MHA-related ambulatory care for OSA recipients during the pandemic.

Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals

BackgroundHazardous alcohol use and alcohol use disorder (AUD) are highly prevalent among clients in mental health services, yet significant gaps remain in the adequate assessment of alcohol use and provision of appropriate alcohol interventions. The aim of this study was to conduct an exploration of (i) alcohol intervention elements used in mental health services and (ii) professionals’ reported barriers and facilitators in identifying and intervening with hazardous alcohol use and AUD.MethodsQualitative data were obtained by conducting semi-structured interviews among a purposive sample of 18 professionals from 13 different Dutch mental health services organizations (i.e., five integrated mental health organizations with addiction services, five mental health organizations without addiction services, and three addiction services organizations without mental health services). Transcripts were qualitatively analyzed using inductive thematic analysis.ResultsIdentified alcohol intervention elements included conducting assessments, brief interventions, treatment, referrals of clients, collaborations with other parties, and providing information to professionals. Professionals mentioned nine barriers and facilitators in the identification and intervention with hazardous alcohol use and AUD, including three aspects of professionals’ behavior (i.e., professionals’ agenda setting, knowledge and skills, and attitudes), actions related to identification and intervening, client contact, collaboration with other parties, and three factors in a wider context (i.e., organizational characteristics, organizational resources, and governmental aspects).ConclusionsAlthough diverse alcohol intervention elements are available in Dutch mental health services, it remains unclear to what extent these are routinely implemented. To better address hazardous alcohol use and AUD in mental health services, efforts should focus on enhancing alcohol training, improving collaboration with addiction services, providing appropriate tools, and facilitating support through organizational and governmental measures.