Substance Use Disorders Research Articles

Advancing readiness for change in substance use for people with substance use disorders using the Kawa model based intervention program: A quasi-experimental study.

Substance use disorders (SUDs) may cause severe social and health problems. Therefore, providing adequate treatments for people with SUDs to change their drug use behaviors is important. This study examined the effectiveness of Kawa Model based therapy among people with SUDs in Taiwan. Participants were recruited from people with SUDs who violated the Controlled Drugs Act in Taiwan were mandated to abstinence services by law from January 2016 through October 2021 in Southern Taiwan. Each participant selected a 2-hour for 4 times or 8-hour for one day compulsory treatments and received either the Kawa model based treatment (n = 55; 9 women; mean ± SD age = 36.73 ± 10.42years) or psychoeducation courses (n = 42; 8 women; mean ± SD age = 27.57 ± 5.78years), respectively. Stages of change was assessed using the University of Rhode Island Change Assessment before and after treatments. There were no significant differences in the stages of change scores at baselines between the 2 groups (p = .06-0.20). After treatments, participants who received the Kawa Model based treatment had higher scores in specific stages of change than did those who received the psychoeducation course in the domains of 'contemplation' (p = .001), 'action' (p = .001), and 'readiness' (p = .002). The present study demonstrated initial and preliminary findings that the Kawa Model based therapy may improve readiness for changing drug use behaviors in people with SUDs.

What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review.

Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category. PRISMA methods were followed and a PROSPERO protocol was registered (CRD42022323516). The search included a database search of peer-reviewed journal articles and dissertations, and also a hand-search of conference presentations and evaluation reports. Manuscripts were categorized as either workforce development-related and/or those containing potential economic evaluation parameters. Forty-two total manuscripts were included, with 22 related to the peer workforce and 26 containing potential economic evaluation parameters. Manuscripts with workforce-related findings covered peer worker characteristics, characteristics of PRSS delivery, or peer worker training-related outcomes. Economic evaluation parameters were primarily costs related to service utilization patters with some limited reporting on peer worker pay, as well as multiple sources that can be used to estimate averted medical costs. Effectiveness parameters were primarily substance use related, as virtually all quality of life and life functioning parameters are not readily convertible to estimating quality-adjusted life years. Future PRSS research can contribute to filling these gaps in the evidence base by addressing remaining questions about the interrelationship between peer worker job satisfaction, job tenure, and patient outcomes, as well as by using more consistent outcome measures, especially in the realm of quality of life and life functioning.

Magnitude, Extent, and Burden of Substance-use Disorders in West Bengal: Findings from the National Mental Health Survey (NMHS), 2016.

Substance-use disorders (SUDs) are a public health problem. The Global Adult Tobacco Survey (GATS) and National Family Health Survey (NFHS) provide evidence of high usage. Hence, the National Mental Health Survey (NMHS) WB data were analyzed to estimate the prevalence, pattern, disability burden, and service utilization of SUD. The usual NMHS methodology was used. Four districts were selected, and thereafter, a multistage random sampling was done. The validated Bengali version of the Mini International Neuropsychiatric Interview (MINI) and other instruments like the Fagerstrom Test for Nicotine Dependence (FTND), disability, and health care utilization modules were used. A total of 2,646 eligible members (age >18 years as per 2011 census) were interviewed. It was found that alcohol use as per MINI at least 3 drinks of alcohol within 3 hours on 3 or more occasions was 3.9%, and the weighted prevalence of alcohol-use disorder (AUD) and tobacco-use disorder (TUD) was 3.04% and 14%, respectively. The AUD and TUD prevalence was lower than the national prevalence, yet they were more prevalent in urban areas than in the national trend. The ratio of women to men suffering from AUD in WB (1:5) was one of the highest in the country (all India average 1:18). Also, the treatment gap of 89.2% was more than the national average. SUDs are an important public health problem in the state of WB, which requires further research, particularly among women, comorbid psychiatric disorders, and in urban areas.

Resilience and relapse risk in Emirate adult patients with substance use disorder: a national cross-sectional study from the United Arab Emirates.

The United Arab Emirates is among the countries affected by substance use disorders (SUDs), which have economic and social impacts. Relapse after successful rehabilitation is a major issue in the treatment of SUD. Several factors increase the risk of relapse in patients with SUD, such as craving and negative social experiences. Resilience could empower patients struggling with SUD. This study aims to explore levels of resilience and relapse risk in adult Emirati patients diagnosed with SUD, and also the possible correlation between the two variables. Two hundred eighty-six Emirati adult patients with SUD completed a self-administered questionnaire for demographics, resilience (Connor and Davidson Resilience Scale), and relapse risk (Stimulant Relapse Risk Scale). Descriptive statistics (frequency, percentage, mean, SD, etc.) were used to describe study participants and variables. Inferential statistics were used to analyze the relationships, associations, and correlations between resilience and relapse risk, the main variables, and the participants demographics. Participants' mean total score for resilience was 72.92 out of a maximum possible score of 100 (SD = 16.99), while their mean total score for relapse risk was 59.07 out of a maximum possible score of 105 (SD = 12.23). Furthermore, examining the correlation between the resilience subscales and the relapse risk subscales revealed similar significant, negative, low-to-moderate correlations between all the subscales (r = -0.486). Protective and risk factors to enhance resilience and reduce relapse risk in patients with SUD were discussed.

Psychosocial well-being needs of alcohol/drug sufferers and therapeutic architectural solutions in rehabilitation centre, Nigeria: a cross-sectional study

Background In a rehabilitation centre designed for drug and alcohol recovery, the therapeutic environment may enhance the psychosocial well-being of sufferers and facilitate a speedy recovery. This study aims to investigate the psychosocial well-being needs (PWNs) of users in an alcohol and drug rehabilitation centre (ADRC) and how therapeutic architectural solutions (TASs) can promote a healing environment through design. Methods The study employed a mixed research method (qualitative and quantitative). The research strategy was a case study of four rehabilitation centres in Nigeria’s busiest cities; Lagos, Abuja, Port Harcourt, and Enugu. Data were collected via survey questionnaires, an in-depth interview guide, an observation guide, and a checklist of TACs in a healthcare facility. We first investigated what the PWNs of alcohol and drug sufferers (ADSs) are, then identified the therapeutic architectural components (TACs) of an ADRC, before determining what effect TACs have on the recovery process of substance abuse patients. Results The findings identify eight PWNs and nine TACs essential in an ADRC. The result indicates that TACs have a significant effect on the recovery process of ADSs. However, based on the study results, a framework (framework here refers to using an intelligent and sensitive conceptual design structure as a standard guide for the building archetype rehabilitation facility, which supports mental health service delivery) may be recommended for rehabilitation facilities with TASs for Substance Abuse Disorder (SUD). Conclusion The study result presents a correlation between ADSs’ recovery rates and a well-designed therapeutic environment. So, there is a need for evidence-based design (EBD) of rehabilitation centres with full compliments of a therapeutic architectural environment and integration of mental health services into routine care in sub-Saharan Africa. Limitations include that analyses were cross-sectional and thus may not deduce causal directions, and the authors based the result on self-report.

Histone deacetylase 5 in prelimbic prefrontal cortex limits context-associated cocaine seeking.

Repeated cocaine use produces neuroadaptations that support drug craving and relapse in substance use disorders (SUDs). Powerful associations formed with drug-use environments can promote a return to active drug use in SUD patients, but the molecular mechanisms that control the formation of these prepotent drug-context associations remain unclear. In the rat intravenous cocaine self-administration (SA) model, we examined the role and regulation of histone deacetylase 5 (HDAC5) in the prelimbic (PrL) and infralimbic (IL) cortices in context-associated drug seeking. To this end, we employed viral molecular tools, chemogenetics, RNA-sequencing, electrophysiology, and immunohistochemistry. In the PrL, reduction of endogenous HDAC5 augmented context-associated, but not cue-or drug prime-reinstated cocaine seeking, whereas overexpression of HDAC5 in PrL, but not IL, reduced context-associated cocaine seeking, but it had no effects on sucrose seeking. In contrast, PrL HDAC5 overexpression following acquisition of cocaine SA had no effects on future cocaine seeking. We found that HDAC5 and cocaine SA altered the expression of numerous PrL genes, including many synapse-associated genes. HDAC5 significantly increased inhibitory synaptic transmission onto PrL deep-layer pyramidal neurons, and it reduced the induction of FOS-positive neurons in the cocaine SA environment. Our findings reveal an essential and selective role for PrL HDAC5 to limit associations formed in cocaine, but not sucrose, SA environments, and that it alters the PrL excitatory/inhibitory balance, possibly through epigenetic regulation of synaptic genes. These results further position HDAC5 as a key factor regulating reward-circuit neuroadaptations that underlie common relapse triggers in SUD.

Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas

Abstract Introduction: Tobacco use intervention in healthcare settings is consistent with best practice guidelines and has been shown to facilitate tobacco cessation. Such intervention is particularly important in rural and medically underserved areas (MUAs), where tobacco use is elevated, as is cancer mortality. Providers’ knowledge and attitudes about the danger of tobacco use and their role in mitigating the same may play a role in whether their patients receive guideline-compliant care. This study investigates knowledge and attitudes toward tobacco use and cessation care delivery among providers at substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) in rural and/or MUAs of Texas to identify modifiable barriers to effective tobacco cessation treatment. Methods: Providers from healthcare centers (12 SUTCs, 9 MHCs) participating in a tobacco-free workplace program responded to a baseline solicitation assessing, among other things, their interest in receiving tobacco cessation care training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 49.6% of Texas’ counties responded to face-valid items assessing their knowledge and attitudes about tobacco use and provision of tobacco cessation care. Generalized or linear mixed models were used to analyze differences between SUTCs and MHCs. Results: More SUTC than MHC providers accurately identified that adults with mental health and/or non-nicotine substance misuse disorders are 2x more likely to smoke cigarettes than the general population (69% vs. 57%, p<0.008) and that quitting smoking can improve associated mental health symptomatology/substance misuse (61% vs. 54%, p<0.05), but also that patients’ tobacco product use is a personal decision that does not concern the direct service provider (30% vs. 19%, p<0.03). Conversely, more MHC than SUTC providers agreed that smoking cessation counseling is an important part of their job (66% vs. 41%, p<0.001), that their patients who smoke want to quit (38% vs. 21%, p<0.002), that providers should advise patients to quit even if it is not the reason for the visit (65% vs. 43%, p<0.001), that counseling by a provider motivates tobacco product users to quit (68% vs. 50%, p<0.005), and that providers should make appointments to specifically help patients quit tobacco product use (59% vs. 39%, p<0.003). Overall, only 48.4% of providers felt somewhat or completely prepared to help patients quit (56% MHC vs. 41% SUTCs, p<0.03). Conclusion: Addressing tobacco use in rural and/or MUAs of Texas where patients receive healthcare is critical to cancer prevention and achieving health equity. Responding SUTC and MHC providers evinced a need for training to enhance their understanding of tobacco use and to elevate the importance of cessation care provision. This is particularly the case in SUTCs, where providers primarily treat addiction. Findings will inform workplace interventions and their adaptation for use in each setting to facilitate guideline-compliant care provision. Citation Format: Sriya N. Kakarla, Brian J. Carter, Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Hector Sanchez, Lorraine R. Reitzel. Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A090.

Substance use disorder risk assessment: positive emotional experiences with first time use and substance use disorder risk.

Substance Use Disorder (SUD) screening tools used in current practice are designed to identify SUD once patients have begun regular dangerous drug use. While these screening tools are valuable, prevention and avoidance of SUD would save countless lives. The climbing number of deaths due to drug overdose make screening for and prevention of SUD imperative. This study addresses this care gap. The aim was to develop a simple screening tool for patients who may be prone to develop Alcohol Use Disorder (AUD) and/or SUD prior to addiction. It was hypothesized that participants with initially positive emotional experiences would be correlated with a future SUD diagnosis. The study involved a self-administered survey using a cross-sectional design and was carried out over one-month in the spring of 2021. Those patients who presented to the MAT clinic (SUD group) were seen in a separate area than the patients presenting for urgent care (Comparison group). Participants (N=259) were voluntarily recruited from MAT and Urgent care: Patients receiving acute care were assigned to the Comparison (N = 126, 50.8% female, 5.7% non-white, 27.2% age < 34) and those receiving treatment for SUD were assigned to the MAT group (N =133, 40.8% female, 4.8% non-white, 36.8% ≤34). The survey questioned demographics (4 items), risk factors for AUD/SUD (6items), information about first alcohol/opioid experiences (16 items), and factors for seeking AUD/SUD treatment and recovery (2 items). Feelings were categorized as positive (e.g., euphoria, happiness, self-confident), neutral (e.g., nothing, normal), or negative (e.g., depressed, sad, sick). The MAT group felt more positive feelings with first usage of alcohol and opioids compared to the comparison group (p<.001). With first usage of opioids specifically, MAT (0.13 ± 0.04) and comparison (0.29 ± 0.07) groups differed (p <.001). Over half (55.3%), of the MAT participants reported feeling self-confident with first use of alcohol while only 29.7% of the comparison reported this (p<.001). Over three-fifths (63.7%) of the MAT group reported feeling of euphoria with the first usage of opioids compared to one-tenth (9.8%) in the comparison group (p<.001). This retrospective cross-sectional report shows the first affective responses to substances may predict risk for future SUD and could be a prevention screening tool. Asking patients about positive feelings with first usage of alcohol/opioids could be a simple screening tool employed for prevention.

Difficulties in emotion regulation and attachment styles among Kurdish individuals in Eastern Turkey with substances use disorders

The aim of this study was to investigate the relationship between attachment style and emotion dysregulation in Kurdish individuals with substance use disorders (SUDs) in Eastern Turkey, a non-Western, Islamic society, in a descriptive cross-sectional design. This study was conducted with 216 individuals with SUDs who were treated at the SBU Van Training and Research Hospital Alcohol and Substance Addiction Treatment Center in Eastern Turkey between April 2023 and June 2023. Almost half of the participants (44.5%, n = 96) were between 18 and 30 years old and almost all were men (96.3%, n = 208). The most commonly used substances were heroin (46.3%, n = 100), marijuana (28.7%, n = 62) and synthetic cannabinoids (7.9%, n = 12). The results showed that higher levels of emotion dysregulation were associated with increased avoidant attachment and anxious attachment style. The study found that anxious and avoidant attachment styles were a significant predictor of emotion dysregulation. These findings suggest that attachment styles may play an important role in emotion dysregulation in Kurdish individuals with SUDs. Future research should investigate whether interventions targeting attachment-based interventions could be effective in reducing emotion dysregulation in Kurdish individuals with SUDs.

Exploring Teachers' Perspectives on Utilizing Local Resources to Address Substance Abuse within Schools

The purpose of this study was to identify the conceptual foundations that underlie school teachers' preferences for the utilization of personal resources to address the problem of substance abuse at the school level. Also, it was examined whether there is a relationship between the school teachers’ perceived approaches with their gender, school type, and socioeconomic status. The participants in the study consisted of school teachers working in secondary schools located in four densely populated districts of Karachi, Pakistan. The research was conducted using a mixed-method methodology. Data were collected by using semi-structured interviews through personal visits. A qualitative analysis method was used to find out the perceptions of school teachers regarding their preferred approach to deal the issue of drug abuse. In addition, a quantitative analysis was performed to ascertain the relationship, if any, between participants' demographics and their preferred approach. The results show that the school teachers selected effective strategies to address this issue at the school level within their means, including emotional competence, psychological competence, religion, and monitoring.

High prevalence of alcohol use disorder & psychiatric comorbidity among coal mine workers: Observations from a cross-sectional study in West Bengal.

Background & objectives Tobacco (30%), alcohol (21.4%) and cannabis (3%) are the three most commonly abused substances in India. Tobacco and alcohol abuse have higher prevalence rates among different occupational groups as compared to that in general population in the country. Both tobacco and alcohol lead to significant occupational harm in terms of absenteeism, injuries, sickness and lost productivity. This study estimated the patterns of substance use and associated common psychiatric comorbidity in a sample of coal mine workers. Methods Coal mine workers at the age of 18 yr or above engaged in mining activities (skilled/semi-skilled/unskilled) were recruited from the Raniganj - Asansol coal mining areas of Eastern Coalfields Limited (ECL). Participants were screened to identify patterns of substance use and other common mental health problems. All participants were administered ASSIST (The Alcohol, Smoking and Substance Involvement Screening Test); GENACIS (Gender, Alcohol and Culture: An International Study) modified questionnaire; and Hospital Anxiety and Depression Scale (HADS) for primary screening for anxiety and depression. Results Out of 202 participants 69 per cent (n=140) were found with either 'hazardous and harmful' (moderate risk); or 'dependent' (high risk) patterns of use of either tobacco or alcohol or cannabis or of more than one substance. Only 31 per cent (n=62) were 'low-risk' for all substances. Almost 65 per cent (n=132) and 49 per cent (n=99) participants out of the whole sample (n=202) belonged to 'hazardous and harmful' (moderate risk) and 'dependent' (high risk) pattern of tobacco and alcohol consumption, respectively. About 28.8 per cent (n=38) and 23.7 per cent (n=31) of all participants had anxiety and depression, respectively. Combined moderate to high use of both alcohol and tobacco use was significantly associated with the risk of having anxiety [adjusted odds ratio (AOR)=4.896, P<0.015] and depression (AOR=5.335, P<0.012). Interpretation & conclusions Alcohol and tobacco are major substance abuse problems among coal mine workers. This population requires early community and primary care based brief intervention as well as additional community-based pharmacotherapy for substance dependence problems as well as intervention for common mental health issues.

National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management.

Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic. A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings. Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination. Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.

How life events may confer vulnerability to addiction: the role of epigenetics.

Substance use disorder (SUD) represents a large and growing global health problem. Despite the strong addictive potency of drugs of abuse, only a minority of those exposed develop SUDs. While certain life experiences (e.g., childhood trauma) may increase subsequent vulnerability to SUDs, mechanisms underlying these effects are not yet well understood. Given the chronic and relapsing nature of SUDs, and the length of time that can elapse between prior life events and subsequent drug exposure, changes in SUD vulnerability almost certainly involve long-term epigenetic dysregulation. To validate this idea, functional effects of specific epigenetic modifications in brain regions mediating reinforcement learning (e.g., nucleus accumbens, prefrontal cortex) have been investigated in a variety of animal models of SUDs. In addition, the effects of epigenetic modifications produced by prior life experiences on subsequent SUD vulnerability have been studied, but mostly in a correlational manner. Here, we review how epigenetic mechanisms impact SUD-related behavior in animal models and summarize our understanding of the relationships among life experiences, epigenetic regulation, and future vulnerability to SUDs. Despite variations in study design, epigenetic modifications that most consistently affect SUD-related behavior are those that produce predominantly unidirectional effects on gene regulation, such as DNA methylation and histone phosphorylation. Evidence explicitly linking environmentally induced epigenetic modifications to subsequent SUD-related behavior is surprisingly sparse. We conclude by offering several directions for future research to begin to address this critical research gap.

Unhoused patients admitted to inpatient psychiatry at an academic, safety-net hospital: a cross-sectional study

ABSTRACT Introduction: There is a lack of data regarding unhoused patients admitted to inpatient psychiatry in the United States. The authors describe demographic and diagnostic features of unhoused patients admitted to an acute psychiatric inpatient unit (PIU) at an academic, safety net hospital. Methods: This is a cross-sectional, retrospective chart review of 57,902 adult patients admitted to the hospital between January 1, 2018 and May 31, 2023. Eleven percent (n = 6304) were admitted to the PIU and were part of further subgroup analysis examining housing status and primary behavioral health diagnoses. Chi-square tests of independence were used to determine associations between categorical variables. Results: The proportion of patients admitted to the PIU who were unhoused (33%, n = 2065) was 3 times greater than the proportion of patients admitted to non-psychiatric inpatient units who were unhoused (11%, n = 5450). On the PIU, unhoused patients compared to housed patients were more likely to be male (67 and 51%), have a psychotic disorder (35 and 19%) or a substance-related disorder (19 and 8%), and were less likely to have a mood disorder (22 and 44%). Conclusion: Understanding demographic and diagnostic factors is important to develop effective interventions to address the needs of unhoused patients on a PIU.

Influence of Posttraumatic Stress Disorder Severity on Return to Substance Use Immediately Following Residential Substance Use Treatment

AbstractThe period immediately following residential substance use disorder (SUD) treatment is characterized by high rates of return to substance use. Posttraumatic stress disorder (PTSD) is highly prevalent among individuals in residential SUD treatment and is a primary motive for substance use among individuals with co-occurring PTSD and SUD. Addressing important gaps in the literature, the current study examined the role of PTSD severity on days of substance use during the 30 days immediately following residential SUD treatment over and above demographic, SUD, and clinical factors associated with return to substance use. Participants (N = 65, Mage = 40.6, 52% women, 79% white) completed semi-structured diagnostic interviews for PTSD and SUD and self-report measures of demographics and depression while in residential SUD treatment (approximately one week before discharge), and then a follow-up assessment (timeline follow-back for substance use) approximately one month after discharge. Greater PTSD severity was associated with more days of substance use in the 30 days immediately following residential SUD treatment over and above demographic (i.e., race/ethnicity, gender, employment, housing insecurity), SUD (i.e., alcohol, stimulant, opioid, cannabis, and sedative/hypnotic/anxiolytic use disorder severity), and clinical (i.e., depression severity) factors. Findings underscore the importance of PTSD assessment and intervention during residential SUD treatment and re-entry planning to assist in mitigating return to substance use during community reintegration.

Final parity rule strengthens consumer protections, improves MH, SUD access

In the first update to the Mental Health Parity and Addiction Equity Act (MHPAEA) in nearly 10 years, the federal government on Sept. 9 enacted final federal rules to ensure that people with mental health and substance use disorders (SUDs) receive similar insurance coverage for their care as they would for physical health conditions.

Field urges Medicare to pay for residential treatment

Medicare's coverage for substance use disorder (SUD) care is “outdated,” and legislation is needed to fix it so that Americans aged 65 and older can be covered for residential treatment, the Legal Action Center urged in a statement last week, which included a long list of endorsing field organizations. The coverage gap is significant — residential treatment takes place in a safe and stable living environment, but it is not a hospital. Medicare also covers Americans with a disability.

Psychological rehabilitation versus deep brain stimulation for substance abuse disorders: economic viability for low-middle-income countries.

Psychological rehabilitation versus deep brain stimulation for substance abuse disorders: economic viability for low-middle-income countries.

Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV.

Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: "Few Co-occurring Diagnoses" (42.3%); "Multiple Pain Conditions" (21.3%); "Pain + SUD" (18.4%) and "Pain + SUD + Mental Health" (18.0%). Patients in the "Pain + SUD" class and "Pain + SUD + Mental Health" class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the "Few Co-occurring Diagnoses" class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.

Effects of behavioral interventions on stress reactivity in adults with substance use disorders.

Heightened reactivity to stress is associated with poor treatment outcome in people with substance use disorders (SUDs). Behavioral strategies can reduce stress reactivity; however, these strategies are understudied in people with SUDs. The objective of this study was to test the effect of two behavioral strategies (cognitive reappraisal and affect labeling) on stress reactivity in people with SUDs. Treatment-seeking adults with SUDs (N = 119) were randomized to receive brief training in cognitive reappraisal, affect labeling, or a psychoeducational control, followed by a standardized stress induction. Markers of stress reactivity were collected before and following stress induction and included self-reported negative affect and substance craving, as well as salivary cortisol, and skin conductance response. Analyses of covariance did not indicate a significant effect of treatment condition on negative affect, cortisol, or skin conductance response. Participants in the affect labeling condition had greater increase in craving than those in the cognitive reappraisal condition; neither condition differed from control. Results indicated that, although participants were able to implement behavioral skills following a brief training, training condition did not modify stress reactivity, on average, relative to control. Future directions include consideration of individual differences in response to training and determination of whether higher "dosing" of skills via multiple sessions or extended practice is needed to influence stress reactivity in people with SUDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).