AOD Use Research Articles

Words and Images Matter: Perspectives on Suicide, Mental Health Concerns and Alcohol and Other Drug Use Depiction.

The way in which topics like suicide, mental health concerns and alcohol and other drug use are communicated matters. It has the potential to have either a positive or negative impact on people and communities, particularly those with a lived experience of these concerns. This article draws on the findings of a qualitative study designed to explore the experiences and perceptions of stakeholders on the imagery and language used to depict suicide, mental health concerns or alcohol and other drug use. The focus group method was used as a form of participatory action research to gain an in-depth understanding of the experiences and views of those who use or are impacted by language and imagery about suicide, mental ill-health and AOD use, including those with lived experiences of these topics. A series of 10 focus groups were created in February and March 2022 with media and other professional communicators; people identifying as having a lived experience of suicide, mental ill-health or alcohol and other drug use; mental health and suicide prevention sector professionals; and people from priority populations (n = 49). From these focus groups, principles were developed as well as exemplars of helpful and less helpful depictions. Rather than prescriptive or static rules, the participants indicated that safe representations require an ongoing engagement with the principle of "do no harm". A positive conclusion arose-that words and images have the potential to promote help-seeking, challenge stigma or stereotypes and create change.

Domestic Violence and Alcohol and Other Drug Use: Australian Pilot Intervention Findings

Purpose: Problematic alcohol and drug use (AOD) is a contributing factor to escalate domestic violence (DV). Yet, combined DV and AOD interventions remain limited. This article examines a combined pilot intervention for men with comorbid AOD and DV use. Methods: Mixed methods with concurrent triangulation design. Data comprises victim-survivors' reports of abuse at intake and exit, interviews with men and victim-survivors at exit and 6-month followup, and 12-month follow-up court data. Study participants included 30 male program participants and 14 female victim-survivors. Results: Findings suggest reduced AOD and DV use at program exit, that appears maintained for most men at 6-month followup. The victim-survivor data suggests more positive outcomes among men who maintained or resumed their relationship with the victim-survivor than separated men. Conclusions: Findings indicate benefits of combined early interventions addressing comorbid AOD and DV use and highlight the importance of victim-survivor voices in program reviews.

Restructuring personal networks with a Motivational Interviewing social network intervention to assist the transition out of homelessness: A randomized control pilot study.

Social relationships play a key role in both substance use and homelessness. Transitioning out of homelessness often requires reduction in substance use as well as changes in social networks. A social network-based behavior change intervention that targets changes personal social networks may assist the transition out of homelessness. Most behavior change interventions that incorporate social networks assume a static network. However, people experiencing homelessness who transition into housing programs that use a harm reduction approach experience many changes in their social networks during this transition. Changes may include disconnecting from street-based network contacts, re-connecting with former network contacts, and exposure to new network members who actively engage in substance use. An intervention that helps people transitioning out of homelessness make positive alterations to their social networks may compliment traditional harm reduction housing program services. We conducted a pilot randomized controlled trial (RCT) of an innovative Social Network Intervention (MI-SNI), which combines network visualization and Motivational Interviewing to assist adults transitioning out of homelessness. The MI-SNI provides feedback to new residents about their social environments and is designed to motivate residents to make positive changes in both their individual behavior and their personal network. In a sample of 41 adult housing program residents with past year risky substance use, we examined whether participants randomized to receive a MI-SNI showed greater changes in their personal networks over 3 months compared to those receiving usual care. There were significant differences in the networks of the MI-SNI group compared to the group receiving usual care at follow-up, controlling for baseline network characteristics. The MI-SNI group had greater reductions in the proportion of their network members who influenced alcohol or other drug use (AOD) use, such as drinking partners, and more frequently changed their relationships in the direction of lower AOD risk with network members who were retained in their networks across waves. This study is the first pilot test of a MI-SNI customized for assisting the transition out of homelessness to test for personal network changes. Results indicate that MI-SNIs can have a positive impact on short-term network changes and thus may serve as a useful adjunct to behavioral change interventions. These findings suggest that a MI-SNI approach may help individuals experiencing homelessness and risky AOD use positively restructure their social networks while transitioning into supportive housing. These promising results suggest the need for a larger RCT test of this innovative intervention approach. ClinicalTrials.gov Identifier: NCT02140359.

“That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa

BackgroundSouth Africa has the largest number of people living with HIV in the world. Concurrently, problematic alcohol and other drug use (AOD) is prevalent in the country and associated with poor HIV treatment outcomes. Further, the high rates of stigma surrounding HIV and AOD contribute to poor HIV outcomes. Yet, how HIV stigma and AOD stigma together may affect HIV care has not been extensively studied in this context. Thus, we explored HIV and AOD providers’ and patients’ experiences of HIV and AOD stigma. MethodsWe conducted 30 semi-structured interviews with patients living with HIV who were struggling with HIV medication adherence and problematic AOD use (n = 19), and providers involved in HIV or AOD treatment (n = 11) in Cape Town, South Africa to assess how HIV and AOD stigmas manifest and relate to HIV care. FindingsTwo main themes around the intersection of HIV and AOD and their related stigmas were identified: (1) how patients use AOD to cope with HIV stigma; and (2) enacted/ anticipated AOD stigma from HIV care providers, which acts as a barrier to HIV care. ConclusionsIntersecting HIV and AOD stigmas exist at multiple levels and increase barriers to HIV care in this setting. Accordingly, it is important that future interventions address both these stigmas at multiple levels.

The Influence of Substance Use on Engagement in Non-Suicidal Self-Injury (NSI) in Adults

Background: Adults engaging in non-suicidal self-injurious (NSI) behaviors often report the use of substances; however, little research explores the relationship between substance abuse and NSI. Thus, this study examined the influence of substance use on patterns of NSI among adults. Objectives: This study seeks to answer the following questions: (a) Is AOD use predictive of more frequent self-injurious behaviors? and (b) Does the use of AODs predict injuring more severely than expected? Methods: An observational cross-sectional design was used to examine the relationship between drug use and NSI behaviors. Participants were recruited through Amazon Mechanical Turk (Mturk). Results: Results indicated opiates, barbiturates and sedatives all had a small but statistically significant influence on the frequency of NSI behaviors, while marijuana, PCP and anti-anxiety medications had a small but statistically significant relationship to severity. Conclusion/Importance: This study indicates that future research should take into account substance use patterns in adults engaging in NSI behaviors.

The prevalence of religiosity and association between religiosity and alcohol use, other drug use, and risky sexual behaviours among grade 8-10 learners in Western Cape, South Africa.

BackgroundAlcohol and other drug use (AOD) and risky sexual behaviours remain high among adolescents in South Africa and globally. Religiosity influences, mitigates and provides resilience against engaging in risky behaviours among young people but few South African studies have explored potential associations between religiosity, AOD use and risky sex. We report the prevalence of religiosity and association between religiosity and AOD use and risky sexual behaviours among learners in the Western Cape Province, South Africa.MethodsBetween May and August 2011, a cross sectional survey was conducted among 20 227 learners from 240 public schools randomly selected through a stratified multistage sampling design to determine the prevalence of AOD use and sexual risk behaviours. We performed univariate and multivariate logistic regression analyses to assess the association between religiosity, AOD use and risky sexual behaviours.ResultsThe learners were aged 10–23 years. Almost three quarters (74%) of learners reported high religiosity (defined as attending religious services or activities at least 1–2 times a month). More female than male learners had high religiosity. The prevalence of past 30 day reported alcohol, tobacco and cannabis use was 23%, 19% and 8% respectively. Compared to learners with low religiosity, those with high religiosity were less likely to engage in AOD use: specifically alcohol use, (AOR = 0.86, 95%CI: 0.76–0.97), tobacco use (AOR = 0.76, 95%CI: 0.67–0.87), cannabis use (AOR = 0.57, 95%CI: 0.48–0.68) in the last 30 days. They were also less likely to engage in risky sexual behaviours (AOR = 0.90, 95%CI: 0.81–0.99).ConclusionReligiosity was associated with lower odds of reported AOD use and risky sexual behaviours among learners in the Western Cape. This calls for further exploration on how to incorporate religiosity into AOD use and risky sexual behaviour interventions.

A randomized trial of Volunteer Recovery Support for Adolescents (VRSA) following residential treatment discharge

Research on continuing care treatment for adolescents following discharge from primary treatment has demonstrated benefit, yet treatment providers encounter multiple barriers in its implementation. Less formal recovery support following treatment is promising, but controlled trials of effectiveness are lacking. This study reports results of a randomized trial of recovery support provided by student volunteers via telephone to youth discharged from residential treatment. Both direct and indirect effects were predicted for proximal (pro-recovery peers, recovery management activities) and distal (AOD use and problems, AOD remission) outcomes. MethodPrior to treatment discharge, participants were randomized to either 9 months of post-treatment Volunteer Recovery Support for Adolescents (VRSA; n = 201) or continuing care services as usual (SAU; n = 201) and assessed over 12 months post- discharge. ResultsThere were significant direct effects for VRSA to have more involvement with pro-recovery peers and recovery management activities than SAU. VRSA also had significant indirect effects on reducing AOD use and problems and increasing remission via increases in pro-recovery peers and recovery management activities at 9- and 12-month assessments. Dose-response analyses demonstrated significant increments of improvement in proximal and distal outcomes as VRSA session completion rate increased, but effectiveness attenuated at the post-VRSA (12- month) follow-up assessment. ConclusionFindings suggest that VRSA is a promising option for post-treatment recovery support, especially in the higher dose range. Additional research is needed to test the feasibility of providing VRSA in the higher dose range to a larger proportion of intent to treat samples and extending VRSA duration.

Change in alcohol and other drug use during five years of continuous opioid substitution treatment

BackgroundEnglish national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change in use of alcohol and other drug use (AOD) following identification of heroin use trajectories during OST. MethodsAll adults admitted to community OST in 2008/09 and enrolled to 2013/14 (n = 7717). Data from 11 sequential, six-monthly clinical reviews were used to identify heroin and AOD use trajectories by multi-level Latent Class Growth Analysis. OST outcome in the sixth and seventh year was ‘successful completion and no re-presentation’ (SCNR) to structured treatment and was assessed using multi-level logistic regression. ResultsWith 'rapid decreasing' heroin use trajectory as referent, ‘continued high-level’ heroin use predicted ‘continued high-level’ crack cocaine use (relative risk ratio [RRR] 58.7; 95% confidence interval [CI] 34.2–100.5),‘continued high-level’ alcohol use (RRR 1.2; 95% CI 1.0–1.5), ‘increasing’ unspecified drug use (RRR 1.7; 95% CI 1.4–2.1) and less ‘high and increasing’ cannabis use (RRR 0.5; 95% CI 0.4–0.6). 'Increasing’ crack use was negatively associated with SCNR outcome for the ‘decreasing then increasing’ and 'gradual decreasing' heroin use groups (adjusted odds ratio [AOR] 0.5; 95% CI 0.3–0.9 and AOR 0.2; 95% CI 0.1–0.7, respectively). ConclusionsContinued high-level heroin use non-response during long-term OST is associated with high-level crack cocaine and alcohol use, increasing unspecified drug use, but less high and increasing cannabis use. Increasing use of crack cocaine is negatively associated with the likelihood that long-term OST is completed successfully.

Alcohol and other drug use among women seeking substance abuse treatment in the Western Cape, South Africa

Despite a high prevalence of alcohol and other drug use (AOD) in South Africa, little is known about AOD use among women, including those in treatment centres, and changes in use over time. This knowledge is important for the development of gender-sensitive interventions for the prevention and treatment of AOD problems. We aimed to describe changes in patterns of AOD use among women who accessed specialist AOD treatment centres in the Western Cape Province of South Africa. Data were collected from 51 specialist AOD treatment centres participating in the South African Community Epidemiology Network on Drug Use between 2000 and 2013. A total of 74 368 treatment episodes were recorded for the period, of which 22% involved women. The proportion of women seeking treatment increased from 4% to 11% over time. The most common primary substance of abuse among this sample was alcohol, followed by methamphetamine. Multinomial logistic regression analyses showed that young coloured (mixed race) women were almost 18 times more likely than other women to report methamphetamine as their primary substance of abuse (RRR=17.80; 95% CI=13.18–24.04). More than a quarter of women reported poly-substance abuse. Women treated for heroin were significantly more likely to be white and younger than 25 years old (RRR=1.62; 95% CI=1.19–2.21). These data portray an increasing use of AOD treatment services by women; particularly for alcohol and methamphetamine use disorders. Additional investigations into the service needs of women utilising AOD treatment is warranted.
 Significance:
 
 The study provides the prevalence of AOD use disorders among women in substance abuse treatment facilities in the Western Cape.
 The study reflects treatment admissions for poly-substance abuse and severe AOD problems among these women.
 The findings highlight the importance of women-specific treatment programmes to encourage utilisation of substance abuse treatment services.

Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers\u2014a type III hybrid effectiveness-implementation trial

BackgroundThe American College of Surgeons mandates universal screening for alcohol misuse and delivery of an intervention for those screening positive as a requirement for certification as a level 1 trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging. Our research team completed an implementation study supporting seven pediatric trauma centers’ compliance with the requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) policy for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers’ fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this study is to conduct a fully powered type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use (AOD) in pediatric trauma centers.MethodsOur implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers that consists of three core elements (i.e., didactic training + performance feedback + leadership coaching). Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. At six distinct time points, each of the 10 sites will provide data from 30 electronic medical records (n = 1800 in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month after hospital discharge. In addition, nurses, social workers, and leaders will report on organizational readiness for implementation at four distinct time points.DiscussionThis protocol proposes a unique opportunity to examine whether a comprehensive implementation strategy can improve the fidelity of SBIRT delivery across a national cohort of pediatric trauma centers. With injured adolescents, this could optimize the detection and intervention of AOD use and improve adolescent health.Trial registrationClinicaltrials.gov NCT03297060.

Are Women with Alcohol and Other Drug Use at Increased Risk of Placenta Praevia (PP)?

Objective: To correlate the incidence of Low Lying placenta with maternal alcohol and other drug use (AOD) among pregnant women attending the Women and Newborn Drug and Alcohol Service (WANDAS), a specialist obstetric Drug and Alcohol Service situated at Women and Newborn Health Service King Edward Memorial Hospital (KEMH). Methods: A retrospective audit was undertaken of 751 maternal records compromising of the women attending Women and Newborn Drug and Alcohol Service (WANDAS) from 2010 to 2014. All women were scanned at approximately 20 weeks and again between 32 to 34 weeks gestation. The incidence of, low lying placenta, placenta praevia and maternal drug use was analysed. The maternal outcomes including mode of delivery, foetal outcome and maternal complications were compared with the general obstetric population at KEMH. In order to determine if maternal AOD use increased the risk of placentation issues. Results: Higher incidence of placenta praevia in 2012 and 2013 when compared with results from hospital population, P=0.013 in 2012 and 2013. Conclusion: Maternal AOD use increases the risk of placenta praevia and other maternal and neonatal co-morbidities.

Universal Prevention and Addressing Gender Inequality in Classrooms

Universal Prevention and Addressing Gender Inequality in Classrooms Jason D. Fruth, Tessa L. Miracle, Patrick J. Fletcher, Alan Avila-John Abstract This study examines the changes in perceptions of diversity and specifically gender inequality by graduate preservice special education teacher candidates after receiving trauma-informed universal prevention training in the form of the PAX Good Behavior Game as a part of their behavioral management curriculum. Previous studies have detailed proximal and longitudinal outcomes for children exposed to adults trained in PAX Good Behavior Game including increased instructional time, academic performance, and graduation rates, as well as decreased problematic behavior, AOD use, and criminal behavior. Additionally, the intervention has shown to increase teacher efficacy in pre-service and in-service teachers. This study found that graduate pre-service teacher candidates showed an increased perception of gender inequality after training in the intervention. Full Text: PDF DOI: 10.15640/jpbs.v4n2a2

Alone on the Inside: The Impact of Social Isolation and Helping Others on AOD Use and Criminal Activity.

Because addiction is a socially isolating disease, social support for recovery is an important element of treatment planning. This study examines the relationship between social isolation, giving and receiving social support in Alcoholics Anonymous during treatment, and post-treatment outcomes among juvenile offenders court-referred to addiction treatment. Adolescents (N = 195) aged 14 to 18 years were prospectively assessed at treatment admission, treatment discharge, 6 months, and 12 months after treatment discharge. The influence of social isolation variables on relapse and severe criminal activity in the 12-months post-treatment was examined using negative binomial logistic regressions and event history methods. Juveniles entering treatment with social estrangement were significantly more likely to relapse, be incarcerated, and commit a violent crime in the 12-months post-treatment. Giving help to others in Alcoholics Anonymous during treatment significantly reduced the risk of relapse, incarceration, and violent crime in the 12-months post-treatment whereas receiving help did not.

How group factors affect adolescent change talk and substance use outcomes: implications for motivational interviewing training.

Clients who verbalize statements arguing for change (change talk [CT]) in psychotherapy are more likely to decrease alcohol and other drug use (AOD) compared with clients who voice statements in opposition of change (sustain talk [ST]). Little is known about how CT and ST are expressed in groups in which adolescents may vary in their AOD use severity and readiness to change. First, we examined how session content was associated with CT/ST, and then we looked at whether different subtypes of CT/ST were associated with subsequent AOD outcomes 3 months later. Audio recordings (N = 129 sessions) of a 6-session group motivational interviewing (MI) intervention, Free Talk, were coded. Session content was not associated with CT; however, some session content was associated with higher percentages of ST (e.g., normative feedback). Subtypes of CT (Commitment and Reason) were associated with improved AOD outcomes, whereas Ability subtype remarks were related to increased marijuana use, intentions, and consequences. Findings offer helpful guidance for clinical training and narrow in on the type of CT to try to elicit in Group MI sessions. Regardless of session content, adolescents can benefit from hearing CT during the group.

Differentiating cyber bullying perpetration from non-physical bullying: Commonalities across race, individual, and family predictors.

Objective: We are surprisingly limited in our understanding of mechanisms specific to cyber-bullying perpetration, and how these might be modified by subgroup differences such as race. Social learning theory was used to assess the role of maladaptive family social dynamics on cyber-bullying and nonphysical bullying (i.e., verbal and relational) involvement through individual risk and protective factors. Method: Moderated mediation models were analyzed using multiple regression analysis across three time points (each six months apart) to examine predictors of bullying perpetration among 1,023 early adolescents (5th through 7th grades). Students completed questionnaires assessing bullying perpetration, family conflict, parental monitoring, hostility, depressive symptoms, empathy, and alcohol and drug use (AOD). Two- and three-way interactions assessed moderation by race and gender. Results: At the simple bivariate level, cyber-bullying appears to have significant overlap with nonphysical bullying. Longitudinal analyses, however, reveal less overlap. Specifically, parental monitoring was associated with higher levels of cyber-bullying at wave 3, via AOD use (only for White females). Nonphysical bullying levels were associated with both higher family violence and lower parental monitoring, which were explained by hostility (for White males) and depressive symptoms (for African American males). Conclusions: Findings validate the importance of familial socialization but suggest that cultural context and gender modify the specific patterns. Further study is needed to determine the necessity of separate prevention strategies for cyber-bullying, as current findings suggest that comprehensive (universal) prevention programs that target self-regulation and social competencies would impact both forms of bullying, and are more feasible than family targets.

Understanding Risk Factors Contributing to Substance Use Among MTF Transgender Persons

Results from community-based research studies have shown that male-to-female transgender (MTF) persons have high rates of substance abuse. Multiple and unique psychological, economic, and societal factors contribute to this elevated rate of drug use. Cofactors, such as substance abuse and multiple environmental risk factors (e.g., discrimination, unemployment, homelessness), may contribute to the poor health outcomes observed in the MTF transgender community. In this article the authors review existing alcohol and other drug use (AOD) research and examine risk factors for AOD use in MTF transgender persons. Implications for counselors working with members of the MTF transgender community are explored and recommendations for future research are presented.

Buffering Effects of General and Medication-Specific Social Support on the Association Between Substance Use and HIV Medication Adherence

The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.

Table of Contents

AbstractStudy Examines Treatment Providers' Beliefs on Empirically Supported InterventionsAdded Risk of Opioid Problem Among Youth With Marijuana/Alcohol Use DisordersStudy Identifies Long‐Term Patterns of AOD Use for Treated YouthBrief Intervention Successfully Reduces Drinking Among At‐Risk College StudentsPosttreatment Depression Associated With Increased Drinking After Alcohol TreatmentDo Data Matter: Beliefs About the Empirical Support of Drug Abuse Treatment Interventions

Language-based measures of mindfulness: Initial validity and clinical utility.

This study examined relationships among language use, mindfulness, and substance-use treatment outcomes in the context of an efficacy trial of mindfulness-based relapse prevention (MBRP) for adults with alcohol and other drug use (AOD) disorders. An expert panel generated two categories of mindfulness language (ML) describing the mindfulness state and the more encompassing "mindfulness journey," which included words describing challenges of developing a mindfulness practice. MBRP participants (n = 48) completed baseline sociodemographic and AOD measures, and participated in the 8-week MBRP program. AOD data were collected during the 4-month follow-up. A word count program assessed the frequency of ML and other linguistic markers in participants' responses to open-ended questions about their postintervention impressions of mindfulness practice and MBRP. Findings supported concurrent validity of ML categories: ML words appeared more frequently in the MBRP manual compared to the 12-step Big Book. Further, ML categories correlated with other linguistic variables related to the mindfulness construct. Finally, predictive validity was supported: greater use of ML predicted fewer AOD use days during the 4-month follow-up. This study provided initial support for ML as a valid, clinically useful mindfulness measure. If future studies replicate these findings, ML could be used in conjunction with self-report to provide a more complete picture of the mindfulness experience.

Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: Role of experiencing violence, feeling safe on campus, and perceived stress

Objective To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns. Methods A random representative sample of university students ( n = 988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences. Results Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR = 2.0; 95% CI: 1.1–3.9), more frequent negative AOD consequences ( β = 5.5, SE = 1.4, p < 0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR = 6.6; 95% CI: 3.0–14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students. Conclusions Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students.