Addiction Treatment Programs Research Articles

Psychometric Properties of the Credibility/Expectancy Questionnaire in Individuals with Opioid Use Disorder

ABSTRACT Credibility and expectancy are important aspects of therapy/treatment processes. We aimed to perform cross-cultural validation and examine the psychometric properties of the Credibility/Expectancy Questionnaire (CEQ). Ninety-one patients with opioid use disorder from Tobacco, Alcohol, and Drug Addiction Treatment Program were included in the study. Sociodemographic data form, CEQ, Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), and Attitudes Toward Seeking Psychological Professional Help Scale-Short Form (ATSPPHS-SF) were filled out by participants. Confirmatory factor analyses showed that CEQ has two factors in our sample, similar to the original version. Reliability analyses showed that CEQ has a high internal consistency and test-retest reliability. Regarding convergent validity results, CEQ was correlated with ATSPPHS-SF. No significant correlation was found between CEQ and BDI and STAI regarding discriminant validity results. In conclusion, the Turkish version of CEQ is a valid, reliable scale and could be used in patients with opioid use disorder. In patients with opioid use disorder, we contributed to the addiction literature by adapting a short and effective survey that measures trust and expectation.

It takes a village: Feedback from personnel in addiction treatment programs indicates support for changing the intake process

IntroductionThe initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process. MethodsPersonnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process. ResultsParticipants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs). ConclusionsFindings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.

Legal framework for health policy to reduce the level of substance abuse in the United States

The purpose of this study was to identify and legally assess the key legal instruments and strategies employed in the United States of America to combat substance abuse and their impact on the development of national health policy in this area. The study used quantitative and qualitative methods of analysis, including the processing of statistical data on the financing of addiction prevention and treatment programmes, analysis of federal and regional legislative acts, and comparative analysis of the policies of different states on the regulation of psychoactive substances. The key findings showed a significant evolution of the legal approach to the problem of substance abuse. The study revealed a gradual shift from a purely punitive approach to a balanced strategy that combines elements of prevention, treatment, and harm reduction. Furthermore, the analysis of funding showed a 35% increase in federal support for prevention programmes between 2018 and 2022, which led to improved access to healthcare for drug users and the development of recovery programmes. The results of a comparative analysis of state policies on the regulation of psychoactive substances showed a considerable difference in approaches, specifically regarding the legalisation of marijuana, which creates legal and regulatory challenges due to contradictions between federal and local laws. Specifically, in states where marijuana is legalised for medical or recreational use, the level of trafficking offences has decreased, but questions arise concerning the regulation of cultivation and distribution. It was also found that the introduction of telemedicine has significantly increased the effectiveness of drug treatment in a pandemic, allowing more patients to be reached, but this approach needs further improvement in the field of regulation and control. The findings of the study point to the need for closer integration of prevention, healthcare, and legal measures at all levels of government, unification of legislation on the regulation of psychoactive substances at the federal and state levels, as well as decriminalisation of drugs for personal use, which can reduce the level of criminalisation of society and contribute to a more effective fight against substance abuse

Social Media Escapism in Poland: Adaptation of a Measure and its Relationship With Thought Suppression and Mental Health.

Research indicates that social media use can lead to addiction, fear of missing out, higher stress levels, anxiety, and experiencing symptoms typical of depression. The purpose of the present study was to conduct a Polish adaptation of the Social Media Escapism Scale and to assess its associations with fear of missing out, Facebook addiction, thought suppression, and the experience of stress, anxiety, and symptoms typical of depression. Two studies were conducted, the first adaptive and the second testing associations. The first study included 383 participants aged 18 to 63 (M = 23.51; SD = 5.7). To adapt the scale, the following were used: the Bergen Facebook Addiction Scale, the fear of missing out Scale, and the demographic questionnaire. The second study included 417 participants aged 18 to 60 (M = 26.33; SD = 9.7). The study tested relationships using the same three scales used in the first study, and also Depression, Anxiety, Stress Scale, and the White Bear Suppression Scale. The Polish version of the Social Media Escapism Scale revealed a univariate structure with strong internal consistency (α = .91). The adapted scale was associated with fear of missing out and Facebook addiction. In study 2, the structural equation modeling analyses revealed that fear of missing out, Facebook addiction and escapism were positively related to thought suppression and the experience of anxiety, stress, and depression symptoms. In addition, thought suppression partially mediated the relationship between harmful media use and anxiety, stress, and depression. Furthermore, the findings reveal a positive correlation between escapism and several psychological constructs, including fear of missing out, Facebook addiction, as well as aspects of depression and suppression, thereby lending support to the convergent validity of the adapted measure under investigation. The results can be used in psychological intervention and developing support and treatment programs for social network addiction.

Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic.

The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic. The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD. This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD. Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU." Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.

Positive and negative elements of short and long-term interventions during the Covid-19 pandemic period

ABSTRACT Background During crises, such as the covid-19 pandemic, addiction treatment programs have been called upon to respond to people’s treatment needs through new methods, such as distance treatment interventions. These methods proved to be sufficiently effective, but a significant reduction in seeking, initiation and retention of individuals in treatment was observed. Method This particular article presents the example of KETHEA IN ACTION, a therapeutic program in Greece.The method followed concerns the collection of data from two therapeutic settings.The data was collected through the access of the researchers to the records of the treatment programs after receiving the relevant permission. Results The results of the short and long-term interventions are presented. The results show the effectiveness of the mild outpatient intervention program as there were positive therapeutic effects and a high degree of treatment retention. Conclusion The results are discussed on the basis of the readiness and flexibility of the treatment programs to respond to different crisis conditions in the requests of the residents.

Scoping review of the role of equine assisted psychotherapy and learning in opioid abuse treatment

Opioid abuse is an epidemic in the United States with the number of deaths associated with this addiction growing each year, and yet, identification of a successful treatment plan is a major limitation to addressing this epidemic. Traditional treatment programs do not always fit for all addicts; however, equine assisted psychotherapy and learning (EAPL) shows promise as an alternative treatment option for those individuals where traditional treatment options have failed. Nevertheless, due to the novelty of this treatment option, literature concerning EAPL is limited. The purpose of this scoping review was to identify articles that address the characteristics and methodologies found in EAPL programs as it relates to opioid abuse treatment. Through the use of this scoping review, literature covering four key topics were gathered: 1) addiction treatment curriculums, 2) EAPL programs, 3) physiological effect of addiction treatment for humans, and 4) physiological effect of EAPL participation on the human and horse. Research associated with physiological effect was the most lacking of the topics covered during this review of literature. Reviewed literature pointed to a variety of populations that participate in addiction treatment programs that range from inpatient to long term recovery. EAPL programs offer an assortment of activity options to combat the challenges presented by the range of populations treated. Vital signs were mentioned in the literature reviewed as the leading way to track physiological changes but were not discussed in relation to addiction-specific treatment. Physiological measures showed change in both horses and humans who participated in equine programming but did not dictate concrete cause and effect instances. The limited literature identified through this scoping review validates the need to further explore the intentional relationship between EAPL and opioid abuse treatment programming.

Using Latent Profile Analysis to Characterize Clinical Heterogeneity and Impulsivity in a Large Residential Addiction Treatment Program

Objectives: Clinical heterogeneity among patients in addiction treatment settings represents a challenge as most of the treatment programs are designed to treat substance use disorders (SUD) generally rather than offering more tailored approaches addressing individual patient needs. Systematic characterization of clinical heterogeneity may permit more individualized care paths toward improving outcomes. Methods: Data were collected from a large inpatient SUD treatment program between April 2018 and March 2020 (n = 1519). Latent profile analysis (LPA) was applied to identify latent clusters based on differences in substance use and co-occurring depression, anxiety, and post-traumatic stress disorder. Results: Five distinct profiles emerged: Profile 1 (38%) exhibited the lowest substance use and lowest psychiatric severity (Overall Low); Profile 2 (39%) exhibited high alcohol and psychiatric severity; Profile 3 (13%) exhibited high opioid severity and low psychiatric severity. Profile 4 (8%) exhibited high cannabis use and high psychiatric severity, and profile 5 (3%) exhibited high polysubstance use other than alcohol and cannabis use. The latter two profiles were younger and exhibited higher self-regulatory deficits. The (High Alc/high psych) and the (High Cann/Psych) profiles exhibited differentially higher psychiatric severity. Profiles showing high polysubstance use, as well as high cannabis use and high psychiatric severity, showed significantly higher impulsive behavior than the others. Conclusions: LPA revealed five clusters of patients varying substantially in terms of SUD and psychiatric severity. Addressing common features of clinical heterogeneity for tailored care paths in a personalized treatment approach may improve treatment outcomes.

A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial

IntroductionCompared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women. MethodsFifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes. ResultsHigher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC. ConclusionsThe LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.

Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment.

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.

GOVERNMENT INVESTMENT FOR ADDRESSING THE INTERSECTION OF EDUCATION, LABOR MARKET MISMATCH, AND CRIMINAL BEHAVIOR: ANTICIPATED OUTCOMES AND IMPLICATIONS

Several expected results from government expenditure, education, and labour market regulations are revealed when one examines the complex interaction between education, labour market mismatch, and criminal behaviour. Government spending on education is projected to increase graduation rates and student performance, among other observable advantages. The likelihood of a mismatch between job capabilities and market demand may be decreased as a result of a more trained workforce. Investments in employment agencies and job placement services may also help job seekers find positions that fit their qualifications, enhancing job satisfaction and lowering instances of labour market mismatch. Additionally, government initiatives to lessen income disparity through progressive taxation and social safety nets may improve economic stability, so averting the economic unrest that is frequently associated with criminal activity. Initiatives for preventing crime, such as counselling, assistance with finding a job, and skill-building programmes, may provide those who may otherwise turn to crime out of job dissatisfaction an alternative route to success and a decrease in criminal activity. Investments in mental health services and addiction treatment programmes are anticipated to enhance mental health and decrease substance misuse, two factors linked to criminal behaviour. By providing prisoners with the knowledge and skills they need for successful work after release, education programmes within correctional facilities are expected to lessen recidivism rates. Last but not least, government-funded research initiatives may give light on the viability of various strategies, providing a foundation for evidence-based policies that concentrate on tackling the complex problems at the confluence of education, labour markets, and criminal behaviour. Although these anticipated results present a bright image, it is important to recognize that outcomes may differ depending on implementation strategies, local socioeconomic situations, and community demographics. To effectively handle the numerous difficulties within this sector, ongoing assessment and policy improvement are essential.

World addiction medicine reports: formation of the International Society of Addiction Medicine Global Expert Network (ISAM-GEN) and its global surveys.

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.

Predicting Substance Craving Based on Perceived Social Support and Attachment Styles in Addicts Attending the 60th Congress in Tehran

Background and Objective: This study examines the role of perceived social support and attachment styles in predicting substance craving among addicts attending Congress 60 in Tehran. Methods and Materials: This descriptive-correlational study involved a sample of 250 addicts selected through random sampling from those attending Congress 60 in Tehran. The research tools included the Craving Questionnaire by Franken et al., the Revised Adult Attachment Scale (RAAS) by Collins and Read, and the Multidimensional Scale of Perceived Social Support (MSPSS) by Zimet et al. Data were analyzed using SPSS software with Pearson correlation and regression tests. Findings: The findings showed that perceived social support had a negative and significant relationship with substance craving (P<0.01). Furthermore, secure attachment style had a negative relationship with substance craving, while avoidant and anxious attachment styles had a positive relationship with substance craving (P<0.01). Conclusion: Perceived social support and attachment styles are significant predictors of substance craving reduction in addicts. Strengthening social support and improving attachment styles should be included in addiction treatment programs.

An environmental scan of residential treatment service provision in Ontario

BackgroundOntario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options.MethodsBetween May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program’s OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively.ResultsA total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice.ConclusionsFindings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.

Clinical stakeholders' perceptions of patient engagement in outpatient medication treatment for opioid use disorder: A qualitative study

IntroductionMedications for opioid use disorder (MOUD) reduce risk of opioid overdose and promote recovery from opioid use disorder, but poor retention in MOUD limits these positive effects. This study explored patient engagement in MOUD from the perspective of clinical stakeholders within an outpatient addiction medicine program to identify program factors influencing patient engagement with treatment. MethodsWe conducted a qualitative case study of a multi-clinic outpatient addiction medicine program embedded within an integrated health system that serves a geographically diverse area of Pennsylvania. Collectively, the program's clinics provide MOUD (primarily buprenorphine) to ~2000 patients annually. From January to March 2021, we conducted semi-structured telephone/video interviews with three stakeholder groups involved in delivering MOUD: administrators (n = 4), providers (n = 7), and addiction care coordinators (n = 5). Data analysis utilized the framework method. ResultsWe identified five themes related to patient engagement. First, participants described health system integration as enhancing quality and offering opportunities for addressing patients' comprehensive health care needs. However, lack of knowledge about addiction and stigma among health system providers was felt to limit patient benefits from this integration, including access to MOUD. Second, participants viewed patient engagement as central to the program's policies, practices, and clinical environment. Adoption of a harm reduction approach and maintenance of a non-stigmatizing clinic environment were described as essential facilitators of engagement. Third, while clinics followed uniform operations, physician leads expressed differing philosophical approaches to treatment, which participants associated with variations in clinical practice and patient engagement. Fourth, participants identified key services that bolstered engagement in MOUD, including psychosocial services, psychiatric care, and telemedicine. Finally, staff well-being emerged as a key consideration for patient engagement. ConclusionsUnderstanding perceptions of those who administer and deliver care is critical for identifying barriers and facilitators to patient engagement in MOUD. Findings suggest potential opportunities for addiction treatment programs to improve patient engagement and ultimately MOUD retention, including integration with other healthcare services to meet comprehensive healthcare needs; adoption of a harm reduction approach; creation of non-stigmatizing clinical environments; investment in psychosocial services, psychiatric care, and telemedicine; and prioritization of staff wellness.

Implementation of an office-based addiction treatment model for Medicaid enrollees: A mixed methods study

IntroductionMedications for opioid use disorder (MOUD) are the most effective treatment for opioid use disorder (OUD) but remain underutilized. To reduce barriers to MOUD prescribing and increase treatment access, New Jersey's Medicaid program implemented the Office-Based Addiction Treatment (OBAT) Program in 2019, which increased reimbursement for office-based buprenorphine prescribing and established newly reimbursable patient navigation services in OBAT clinics. Using a mixed-methods design, this study aimed to describe stakeholder experiences with the OBAT program and to assess implementation and uptake of the program. MethodsThis study used a concurrent, triangulated mixed-methods design, which integrated complementary qualitative (semi-structured interviews) and quantitative (Medicaid claims) data to gain an in-depth understanding of the implementation of the OBAT program. We elicited stakeholder perspectives through interviews with 22 NJ Medicaid MOUD providers and 8 policy key informants, and examined trends in OBAT program utilization using 2019–2020 NJ Medicaid claims for 5380 Medicaid enrollees who used OBAT services. We used cross-case analysis (provider interviews) and a case study approach (key informant interviews) in analyzing qualitative data, and calculated descriptive statistics and trends for quantitative data. ResultsProvider enrollment and utilization of OBAT services increased steadily during the first two years of program implementation. Interviewees reported that enhanced reimbursements for office-based MOUD incentivized greater MOUD prescribing, while coverage of patient navigation services improved patient care. Despite increasing enrollment in the OBAT program, the proportion of primary care physicians in the state who enrolled in the program remained limited. Key barriers to enrollment included: requirements for a patient navigator; concerns about administrative burdens and reimbursement delays from Medicaid; lack of awareness of the program; and beliefs that patients with OUD were better served in comprehensive care settings. Patient navigation was highlighted as a critical and valuable element of the program, but navigator enrollment and reimbursement challenges may have prevented greater uptake of this service. ConclusionsImplementation of an OBAT model that enhanced reimbursement and provided coverage for patient navigation likely expanded access to MOUD in NJ. Results support initiatives like the OBAT program in improving access to MOUD, but program adaptations, where feasible, could improve uptake and utilization.

Relationship between lead concentration in maternal and umbilical cord blood and some neonatal outcomes in primiparous opium-dependent mothers in Zahedan, Southeast of Iran in 2022

BackgroundThere are limited studies on maternal and umbilical cord blood lead levels and their relationship with each other and with pregnancy outcomes in women addicted to opium. The present study was conducted with the aim of investigating the relationship between lead concentrations in maternal blood and umbilical cord blood with some neonatal outcomes in primiparous opium-dependent mothers.MethodThe present study is a cross-sectional and analytical research. A total of 35 mothers addicted to opium and 35 women without addiction from Zahedan city of Iran participated in this study in 2022. Convenience sampling was done, lead levels were measured and pregnancy outcomes checked by a checklist to collect information. Data analysis was done by independent t-tests, Pearson’s correlation coefficient, Point-Biserial Correlation Coefficient, multivariate linear regression and multivariate logistic regression using SPSS version 26 software.ResultsThere was a significant difference in maternal blood lead levels (24.97 ± 8.45 in addicted mothers and 7.5 ± 4.25 in healthy mothers) and in umbilical cord blood lead concentrations (18.68 ± 6.95 in the addicted group and 5.7 ± 2.84 in the healthy group) between the two groups (P < 0.0001 and P < 0.0001, respectively).The lead concentration of all the samples in the addicted group was higher than the high-risk levels. Birth weight, Apgar score, admission to NICU and need for resuscitation were significantly different between the two groups (P < 0.0001, P < 0.0001, p = 0.03 and p = 0.04, respectively). Based on the results of multivariate linear regression test, only addiction can reversely predict the birth weight (Beta= -0.74, P < 0.0001), 1-minute Apgar score (Beta = -0.47, P = 0.004) and 5th minute (Beta= -0.62, P = 0.001). According to multivariate logistic regression test, OR of none of the predictor variables was significant with the outcomes. Maternal and umbilical cord blood lead concentrations were not predictors of pregnancy outcomes.ConclusionThe use of opium during pregnancy leads to an increase in the level of lead in maternal blood and umbilical cord blood. Addiction increased adverse pregnancy outcomes but lead concentration did not predict pregnancy complications. It is recommended that the addiction treatment program be included in pre-pregnancy and pregnancy care plans.

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol

BackgroundClient discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained.PurposeTo describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR).MethodsThe study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client’s desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility.ConclusionThis trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed.Trial registration Clinicaltrials.gov identifier: NCT05489068

Medications for Opioid Use Disorder for Youth: Patient, Caregiver, and Clinician Perspectives

PurposeClinical trial data support use of medications for opioid use disorder (MOUD) in adolescents and young adults (“youth”), but qualitative data are lacking on the acceptability and importance of MOUD to youth, caregivers, and clinicians. We assessed how these stakeholders viewed the role of MOUD in treatment and recovery. MethodsWe recruited youth aged from 15 to 25 years with opioid use disorder who had received buprenorphine, naltrexone, or methadone and caregivers from a primary care-based youth addiction treatment program. We also recruited clinicians with addiction expertise from social work, nursing, pediatrics, internal medicine, and psychiatry. We conducted semistructured interviews assessing special considerations for MOUD use in youth. Three coders performed inductive and deductive thematic analysis of transcripts. ResultsAmong 37 participants, including 15 youth (age range, 17–25 years), nine caregivers, and 13 clinicians, we identified three themes. (1) Medications support recovery in the short term: Youth described MOUD as beneficial in managing withdrawal symptoms. Notably, some youth and caregivers preferred to limit MOUD duration. (2) Medication adherence is affected by type of medication, dosing regimen, and route of administration. Participants endorsed long-acting, injectable MOUD for ease of use and youth's ability to continue engagement in “normal activities” without daily medication. (3) Caregiver involvement can support medication decisions and adherence. Youth and some clinicians described the need to assess caregiver involvement before incorporating them into treatment; caregivers and other clinicians described caregivers as critical in supporting accountability. DiscussionMOUD is evidence-based, and its provision should be developmentally responsive and youth- and family-centered, incorporating caregivers when appropriate.

Psychotherapy Incorporating Equine Interaction as a Complementary Therapeutic Intervention for Young Adults in a Residential Treatment Program during the COVID-19 Pandemic

Substance use disorder has become an epidemic in the young adult population across the United States, and these numbers rose during the COVID-19 pandemic. Psychotherapy incorporating equine interaction has emerged to show promise in the mental health community as a complementary form of therapy for this age group and offered a viable treatment option during the pandemic due to the outdoor nature of the treatment environment. However, research concerning its use within a residential treatment program was lacking. The objective of this study was to evaluate the efficacy of psychotherapy incorporating equine interaction in a residential treatment program during the COVID-19 pandemic for developing an emotionally safe environment for learning for young adults. Participants (ages 18–25 years) were those in a substance abuse residential treatment program utilizing psychotherapy incorporating equine interaction during the COVID-19 pandemic. Participants were involved in weekly equine therapy for 2–7 weeks. Participants were divided according to length of stay at the residential facility and participation level with equine interactive activities. Assessment of emotional safety and long-term memory development was performed at the beginning and end of the treatment program. The development of memories centered around equine information that was covered during the treatment program. Semantic memory was assessed using a self-reporting knowledge exam and procedural memory was assessed using a skill evaluation. Emotional safety was determined using a self-reporting survey instrument. Paired t-tests determined significant improvement in emotional safety (p = 0.02) and semantic (p = 0.01) and procedural (p = 0.00) memory for all participants by the end of the program. The one-way analysis of variance indicated length of stay and participation level were not significant indicators of emotional safety (length of stay: p = 0.91, participation level: p = 0.98) and semantic (length of stay: p = 0.09, participation level: p = 0.60) and procedural (length of stay: p = 0.25, participation level: p = 0.09) memory development. These results suggest psychotherapy incorporating equine interaction was an efficient complementary therapeutic intervention for developing emotional safety and encouraging learning in a young-adult residential addiction treatment program during the COVID-19 pandemic.