Substance Use Disorder Treatment Research Articles

Use of psychotropic medications in the specialist health service for mental health care and substance use disorders in 2012-23.

Data on the use of psychotropic medications in specialist mental health services and interdisciplinary specialised treatment for substance use disorders (SUDs) are useful both as cross-sectional indicators and as time series data for monitoring trends. The figures can help form a basis for evaluating rational use of medications in hospitals. Purchasing data for anxiolytics, antidepressants, mood stabilisers and antipsychotics from the Hospital Pharmacies Drug Statistics for the period 2012-23 were used. The data are sourced from sales to specialist mental health clinics and for SUD treatment. Defined daily doses and the number of defined daily doses per 100 bed-days were used as units of measurement. Use of anxiolytics increased by 127% from 2012 to 2023, while decreasing by 24% for antidepressants. The use of mood stabilisers and lithium decreased by 26% and 16%, respectively. Total use of antipsychotics increased by 29%, while rising by 79% for depot injections. Significant changes in medication use were observed during the reference period. Further studies are needed to identify the causes and effects of the changed prescribing patterns.

Systematizing peer recovery support services for substance use disorder: a taxonomy for measuring recovery milestones

BackgroundRecovery from substance use disorder (SUD) is a complex and individualized process requiring multifaceted support systems. Peer recovery support services (PRSS), provided by Peer Workers, bridge the gap between formal intervention and personal recovery experiences. Drawing on shared lived experience, Peer Workers offer essential support to fellow Peers navigating recovery. However, variability in PRSS roles, training, and settings creates challenges for consistent evaluation and measurement of effectiveness.ObjectiveIntroduce a systematic taxonomy to clarify the roles, functions, and activities within PRSS, providing a structured framework for evaluating their impact on key SUD recovery milestones.MethodsThe taxonomy was developed through a rapid narrative literature review, expert consultation, and an iterative consensus process informed by a Delphi-like approach. A multidisciplinary task group of PRSS scientists and practitioners, SUD treatment providers, and individuals in recovery contributed to its refinement. The framework aligns with key components from SAMHSA’s national standards (SAMHSA, 2023) to enhance consistency across practice settings.ResultsComprising six primary taxons and 20 branches, the taxonomy organizes PRSS components into structured categories. It classifies variations in lived experience (e.g., direct, indirect, and hybrid), training levels (e.g., basic, specialized, continuous education, and formal education), support approaches (e.g., Peer Worker-led services), and support settings (e.g., community-based, clinical, and justice system). Additionally, it categorizes peer support activities into four core domains: emotional, informational, instrumental, and affiliational support. The taxonomy integrates a structured model for PRSS evaluation, identifying mediators (e.g., support approaches) and moderators (e.g., training levels) that influence recovery outcomes.ConclusionThe proposed taxonomy and integrated evaluation model provide a standardized framework for researchers and practitioners to systematically assess PRSS impact on recovery milestones. By establishing a common language, the taxonomy enhances consistency in PRSS research, identifies empirically supported peer support practices, and informs targeted training and strategic implementation. Future research should prioritize empirical testing of this framework to refine its applicability across diverse PRSS settings and enhance intervention effectiveness and scalability.

Feasibility Trial of a Mindfulness-Based Workshop for Caregivers of Young Adults with Substance Use Disorders

ABSTRACT Substance use disorders (SUDs) are a widespread, increasingly common public health concern. Parents and other caregivers often take an important role in the management of the SUDs, particularly for young adults. And, in recent years, this family caregiving component of SUDs has come into public awareness and gained attention in SUD treatment. The purpose of the present paper is to present the development and initial feasibility testing of a workshop (PRISM-C) focused on unique needs of caregiving family members of young adults with a substance use disorder. The PRISM-C program focuses on reducing the family caregiver burden associated with caring for a young adult with an SUD through increasing awareness of interactions, regulating emotion, and tolerating distress. We implemented PRISM-C with a small sample in a community-based SUD treatment center. The workshop demonstrated initial key indicators of feasibility. Results indicate further development, and larger-sample testing are warranted.

Impact of alternative income assistance disbursement on substance use disorder treatment adherence among people who use drugs

ABSTRACT Background: The synchronized disbursement of income assistance payments is associated with increased drug-related harms and substance use disorder (SUD) treatment interruptions. Desynchronizing and splitting these payments can mitigate escalations in drug use, suggesting that downstream effects on SUD treatment may be impacted as well. Objectives: To understand the effect of desynchronizing and splitting income assistance payments on treatment patterns, including adherence to medications for opioid use disorder (MOUD). Methods: Data came from The Impact of Alternative Social Assistance on Drug Related Harm (TASA) study, conducted in Vancouver, Canada. This parallel arm, multi-group, randomized controlled trial assigned participants for six payment cycles to the synchronized monthly government schedule control or one of two intervention arms receiving payments desynchronized from the government schedule: a “staggered” group receiving monthly payments or a “split & staggered” group receiving semimonthly payments. Multivariable generalized estimating equations assessed the effect on overall SUD treatment adherence, MOUD adherence, and non-MOUD SUD treatment adherence. Results: Between October 2015 and January 2019, 194 participants were randomized and followed, including 89 (45.8%) women and 83 (42.8%) who self-identified as a person of color. In both intent-to-treat (ITT) and modified per-protocol (MPP) analyses, neither intervention arm was associated with decreased adherence to SUD treatment (ITT staggered arm adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.36–1.55, split and staggered arm AOR 0.83, 95% CI 0.44–1.57; MPP staggered arm AOR 0.72, 95% CI 0.38–1.39, split and staggered arm AOR 0.89, 95% CI 0.54–1.46), including MOUD and non-MOUD. Conclusions: Alternative income assistance disbursement did not positively impact SUD treatment adherence, contrary to the hypothesis. Changing payment schedules also did not negatively impact SUD treatment adherence, suggesting that changes to payment delivery could be completed without impacting treatment.

Subtypes and service utilization among opioid use disorder patients at a community health center: findings from a medically underserved urban area of the Northeastern United States

BackgroundOpioid use disorder often co-occurs with other mental health and substance use disorders. Identifying clusters of individuals receiving treatment for opioid use disorder based on co-diagnosed conditions, healthcare plans, and service utilization over a seven-year treatment period provides insight into service needs. Objectives included [1] characterizing the sample [2], examining subtypes of the sample using cluster analysis, and [3] identifying differences in Current Procedural Terminology by subtype to examine service utilization among identified clusters.MethodsThis study uses secondary data from the electronic medical records of a community health center in a large urban area in the Northeastern United States from 2015 to 2021. The study sample included N = 705 adults who had an opioid use disorder diagnosis as indicated by the community health center’s electronic medical records. Measures include [1] age [2], race and ethnicity [3], sex [4], healthcare plan(s) [5], co-occurring mental health disorder [6], co-occurring substance use disorder [7], co-occurring mental health disorder or substance use disorder, and [8] Current Procedural Terminology codes for behavioral health service utilization. Cluster analysis was used to examine the sample. These clusters were then analyzed for service utilization with a one-way analysis of variance.ResultsThe cluster analysis identified six clusters with an average silhouette of 0.5, indicating good clustering. These six clusters were operationalized as [1] Medicare/Medicaid healthcare plan with substance use disorder needs [2], Private pay and charity care healthcare plan with cocaine use disorder needs [3], Medicare/Medicaid and other publicly-funded healthcare plans with mood disorder needs [4], Private healthcare plan with low co-occurring disorder needs [5], Other publicly-funded healthcare plan with cannabis use disorder needs [6], Medicare/Medicaid healthcare plan with mental health disorder needs. Service utilization differed between these clusters with cluster mean differences for psychotherapy sessions (F = 8.55, p < 0.001), psychiatric sessions (F = 22.72, p < 0.001), and group therapy sessions (F = 10.76, p < 0.001).ConclusionsThis study highlights the importance of comprehensive and integrated treatment for substance use disorders and mental health disorders, particularly for those in underserved communities. Healthcare coverage, a socioeconomic factor that impacts access to care, is critical in distinguishing treatment needs and utilization.

Development and usability of VRainSUD’s cognitive training virtual reality platform for substance use disorders

Cognitive deficits have been shown to increase the likelihood of relapse in individuals with substance use disorders (SUD). As such, cognitive training programs are important interventions for this population. In this study, we describe the development and test the usability of a virtual reality (VR)-based cognitive training program for individuals with SUD – VRainSUD. A total of 17 patients receiving inpatient treatment for SUD at an Addiction Treatment Center agreed to participate in the study. Participants completed 9 tasks designed to test the platform’s usability. The key performance indicators (e.g., time to complete the task) as well as any relevant observations were recorded. Finally, each participant completed a brief survey and the Post-Study System Usability Questionnaire (PSSUQ). VRainSUD was considered easy and pleasant to use but additional instructions were required on certain cognitive training tasks. The total PSSUQ score confirmed an overall high level of satisfaction concerning the platform’s usability (2.72 ± 1.92). Among the three subscales, system usefulness presented the most satisfactory score (1.76 ± 1.37) and information quality presented the least satisfactory score (3.00 ± 1.95). Changes were made to the platform to improve the on-screen information and instructions. Overall, participants showed interest in integrating VRainSUD into their standard treatment. Despite limited prior VR experience, they quickly adapted to the controllers and navigation. VRainSUD can be a potentially successful add-on to SUD treatment.

Building and Beta-Testing Be Well Buddy Chatbot, a Secure, Credible and Trustworthy AI Chatbot That Will Not Misinform, Hallucinate or Stigmatize Substance Use Disorder: Development and Usability Study.

Artificially intelligent (AI) chatbots that deploy natural language processing and machine learning are becoming more common in health care to facilitate patient education and outreach; however, generative chatbots such as ChatGPT face challenges, as they can misinform and hallucinate. Health care systems are increasingly interested in using these tools for patient education, access to care, and self-management, but need reassurances that AI systems can be secure and credible. This study aimed to build a secure system that people can use to send SMS with questions about substance use, and which can be used to screen for substance use disorder (SUD). The system will rely on data transfer via third party vendors and will thus require reliable and trustworthy encryption of protected health information . We describe the process and specifications for building an AI chatbot that users can access to gain information on and screen for SUD from Be Well Texas, a clinical provider affiliated with the University of Texas Health Sciences Center at San Antonio. The AI chatbot system uses natural language processing and machine learning to classify expert-curated content related to SUD. It illustrates how we can comply with best practices in HIPPA (Health Insurance Portability and Accountability Act) compliance in data encryption for data transfer and data at rest, while still offering a state-of-the-art system that uses dynamic, user-driven conversation to dialogue about SUD, screen for SUD and access SUD treatment services. Recent calls for attention to user-friendly design concerning user rights that honor digital rights and regulations for digital substance use offerings suggest that this study is timely and appropriate while still advancing the field of AI.

Engaging Health Professional Doctoral Students in Research Training to Expand Evidence-Based Practice in Rural Substance Use Prevention and Treatment: Curriculum for the Culturally-Centered Addictions Research Training (C-CART) Program

In Arizona, United States, long distances to services, diverse populations, and medical provider shortages impact substance use disorder (SUD) prevention and treatment for Indigenous and historically excluded populations. To address these issues, the Culturally-Centered Addictions Research Training Program (C-CART) is designed to engage doctoral students and future and practicing clinicians in culturally-centered, community-engaged, interdisciplinary team-based research. C-CART Scholars engage in team-based projects designed in collaboration with community partners and academic mentors, focusing on culturally-responsive interventions for SUD. Evaluation of the C-CART program indicates significant growth in Scholars’ research skills, cultural competency, and collaboration experiences. The C-CART Curriculum is designed with the goal of advancing health equity and improving SUD treatment outcomes in diverse healthcare settings. This paper describes the C-CART Curriculum with the hope that it will serve as a model for future initiatives that aim to train students in culturally-centered methodologies and further the interests of other diverse communities that are under or improperly served. C-CART’s model is a step toward connecting rural, community-based programs and clinics with university researchers, thereby building trust and improving practice through strong networks and culturally-centered clinical research training.

Pharmaceutical and Non-Pharmaceutical Therapies in Substance Use Disorder

The use of substances for recreational and other non-medical purposes is alarming in the society. The trend of substance use globally has been phenomenally startling in the last five decades, and has assumed epidemic and worrisome proportions in recent times. A significant number of these substances are used in the treatment of diverse clinical conditions. Objective: The work discussed the protocols for rehabilitation and recovery from substance addiction, strategies for prevention, principles underlying the treatment of substance use disorder, and the various therapeutic measures for containing substance use disorder. Method: The literature search included databases of google scholar, directory of open access journals, cross reference, pubmed, web of science, etc. Articles on substance abuse and addiction were identified and reviewed for selection. The keywords used in the search were: drug abuse, drug addiction, substance abuse, substance misuse, drug dependence and drug use disorders. There was also a scan of the references of identified journal articles. Only works written in English were extracted. Result and Discussion: One hundred and eighteen journal articles and other materials were sourced, while thirty-six (36) articles and other works were identified, extracted and reviewed. Findings show that substance abuse is not immune to any societies. It is a global problem and is responsible for millions of crime and criminality, and their sustenance, as well as many of the deaths, especially violent crimes (e.g., domestic violence, sexual assault, gangsterism, robbery, banditry, insurgency, etc.) in many countries. Substance addiction is preventable and can be treated. No single modality of treatment adequately fits all forms of substance addiction. Relapse frequently occurs during rehabilitation and treatment programmes, and sometimes after many years of abstinence from substance use. Conclusion: The indiscriminate and inappropriate use of legal and prohibited substances is now a serious public health and social concern. Addiction is the most severe form of substance use disorder. It is a chronic and complex, but treatable disease that affects the human brain structure, function, and behaviour. Prevention reduces the scourge of the menace through public health enlightenment programmes. Several modalities are available for treating substance use disorder, and they include psychotherapy or talk therapy (e.g., counselling, cognitive behavioural therapy, guided self-help, etc.), medical detoxification, pharmacotherapy, and traditional (herbal) remedies. None of these therapeutic approaches works for everyone. In most cases, a combination of these treatment modalities is used during therapy of substance abuse and addiction. Treatment disrupts the cycle of addiction, which is often times prolonged and intensive.

Oral Status in Relation to Demographic, Socioeconomic, Medical and Psychosocial Risk Factors Among Outpatients in Addiction Treatment Centers, Stockholm, Sweden.

To investigate oral status in relation to demographic, socioeconomic, medical and psychosocial risk factors among outpatients receiving treatment for Substance Use Disorder (SUD). This cross-sectional study included 91 outpatients from Stockholm, Sweden. Oral status was assessed using the Decayed, Missing, Filled Teeth (DMFT) index and Probing Pocket Depth (PPD). Psychosocial and functional factors were evaluated using the Addiction Severity Index (ASI), which measures problem severity in areas such as medical and social functioning, and the Global Assessment of Functioning Scale (GAF), which assesses overall social and occupational functioning. Data were analysed using non-parametric correlations and logistic regression. The mean DMFT was 12.4 (±8.1), with missing teeth (MT) as the dominant component. The median PPD was 28. The logistic regression analysis showed significant associations between risk factors and oral status variables. Age ≥ 40 years was associated with fewer teeth (OR: 3.52, 95% CI: 1.30-9.54), higher DMFT (OR: 8.88, 95% CI: 3.43-23.01) and more severe PPD (OR: 5.64, 95% CI: 1.95-16.32). Low education (< 9 years) was associated with fewer decayed teeth (DT) (OR: 0.23, 95% CI: 0.09-0.59) and lower PPD values (OR: 0.29, 95% CI: 0.10-0.86). These results highlight the significant influence of age and education on oral status among patients with SUD. This study identified relationships between oral status and several demographics, socioeconomic, medical and psychosocial risk factors among patients with SUD. Age was the strongest predictor of oral status, with low education being the only significant socioeconomic risk factor.

Brief Report: Effectiveness of two financial incentives on patient follow‐up after brief substance use disorder inpatient treatment

AbstractBackground and ObjectivesClinical follow‐up data after substance use disorder (SUD) treatment provides important information about treatment effectiveness, yet compliance is a challenge. We compared financial incentives for obtaining follow‐up data from adults receiving inpatient SUD treatment.MethodsParticipants (N = 237) were randomized to receive a guaranteed incentive, raffle‐based incentive, or no incentive for completing a 1‐month follow‐up assessment.Logistic regression tested the effect of incentives on follow‐up completion.ResultsThose in the raffle condition had &gt;2 times higher odds of completing a follow‐up assessment compared to those in the no‐incentive or guaranteed‐incentive conditions.Discussion and ConclusionsThe raffle‐based financial incentive was most effective in obtaining follow‐up data.Scientific SignificanceRaffle‐based incentives may improve follow‐up after treatment and help clinicians evaluate SUD treatment outcomes.

Involuntary Treatment for Severe Substance Use Disorders - Issues, Evidence and Considerations for its Use.

Involuntary Treatment for Severe Substance Use Disorders - Issues, Evidence and Considerations for its Use.

The relationship between patient-centred care for substance use disorders and patient outcomes: A scoping review.

The relationship between patient-centred care for substance use disorders and patient outcomes: A scoping review.

A Co-design approach to develop a motivational intervention to promote physical activity engagement and maintenance among individuals in residential substance use disorder treatment settings.

A Co-design approach to develop a motivational intervention to promote physical activity engagement and maintenance among individuals in residential substance use disorder treatment settings.

Efficacy of minocycline in substance use disorder: A systematic review of preclinical and clinical studies.

Efficacy of minocycline in substance use disorder: A systematic review of preclinical and clinical studies.

Women and men veterans' initiation, engagement, and retention in treatment for substance use disorders: A cross-sectional investigation using VHA administrative data.

Women and men veterans' initiation, engagement, and retention in treatment for substance use disorders: A cross-sectional investigation using VHA administrative data.

Patient Perspectives on a Rapid Access, Walk-in, Medication for Addiction Treatment Clinic.

Rapid access addiction medicine (RAAM) walk-in clinics offer low-barrier, prompt treatment for substance use disorders (SUDs). These models differ from bridge clinics, which primarily address the barriers of transitioning between inpatient and outpatient SUD treatment settings. Previous RAAM models have been shown to be effective in urban areas. Through patient interviews, this qualitative study sought to describe the unique challenges and successes of a RAAM clinic that serves a primarily rural area. Adult patients with a SUD who utilized a medication for addiction treatment (MAT) walk-in clinic participated in semi-structured, recorded interviews. Participants were asked about facilitators and barriers to attaining treatment, as well as their perspectives/experiences and unmet wants/needs. Interviewee responses were transcribed, qualitatively coded, and analyzed for prominent trends. Twelve patients participated. Stigma, lack of rural treatment options, and accessibility concerns were identified as general barriers to receiving SUD care. MAT walk-in clinic specific barriers included distance to clinic, clinic hours, and transportation. Patients identified the clinic's walk-in structure as a primary facilitator of receiving quality SUD care and felt the clinic offered a non-judgmental and accessible environment, differing positively from past treatments. Unmet wants and needs that patients identified included more extensive social services and communication after leaving the clinic. This MAT walk-in clinic is the only RAAM-style clinic offering same-day dual-diagnosis medication management in the state of Iowa. The walk-in structure was a key facilitator for patients accessing initial care. Expanding RAAM models in rural areas and incorporating telehealth may help address proximity barriers reported by patients.

Role of ketamine in the treatment of substance use disorders: A systematic review.

Role of ketamine in the treatment of substance use disorders: A systematic review.

Gist and detail memory in addiction: “unravelling the cognitive mechanisms of emotional memory processing”

ABSTRACT Background Substance dependency affects multiple aspects of cognitive ability, and memory is one of those. This paper investigates how the process of gist and detail retrieval of positive and negative experiences affects mood and memory diffrently in people with Substance use disorders. Method The research involved 30 participants diagnosed with Substance Use Disorder, comprising 5 females and 25 males, aged between 18 and 50 years, selected using a purposive sampling method. To compare the effects of event type (positive and negative), recall type (Gist and detail), and recall phases on emotions and memory accuracy, a repeated measures ANOVA within-subjects design was used. Results The analysis of the accuracy of gist recall for positive and negative events showed a statistically significant difference between these two factors. Positive emotions that were recalled had a higher mean value as compared to negative emotions. Whereas details recalled of negative events are more comparable to positive events. Conclusion The finding suggests that recalling the gist and detail of positive and negative memories influences both emotion and memory. This insight supports clinical practice and rehabilitation for the treatment of substance use disorder to improve emotion regulation and cognitive functioning.

Reducing Overdose Deaths and Mitigating County Disparities: Optimal Allocation of Substance Use Treatment Centers

Problem definition: Substance use disorder (SUD) is a pressing health concern in the United States, and connecting communities with treatment is a growing public health imperative. We study the optimal allocation of substance use treatment centers across counties within U.S. states over a multiyear time horizon. We use a three-part objective function that minimizes (i) statewide overdose deaths, (ii) mismatch between counties’ treatment center access and overdose death rates (inequity), and (iii) mismatch between counties’ treatment center access and population (inequality). We also consider the temporal interdependence of counties’ treatment center allocations and their death-rate-based equity targets. Methodology/results: We use a predict-then-optimize approach based on data from more than 2,500 U.S. counties between 1999 and 2016. We first estimate SUD treatment centers’ causal impact on county-level overdose death rates, using mental health parity laws as an instrument. We then use these estimates in a nonlinear program that reallocates states’ observed levels of SUD treatment funding. Results suggest that this approach can meaningfully reduce statewide overdose deaths and between-county disparities in treatment access. Managerial implications: Prioritizing death rate reductions over equity/equality results in more resources being directed to high-population counties, where treatment centers are most effective. Prioritizing equity/equality in treatment access results in more resources being directed to underserved, low-population counties. We also find that states differ in their Pareto-optimal trade-offs between death rates and inequity/inequality. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2024.0963 .