Substance Use Disorders Research Articles

Experiences of residents in a therapeutic community model of substance use disorder treatment in a mental hospital in Ghana

BackgroundIn Ghana, the use of illegal drugs and alcohol has been classified as endemic. To manage this menace, the Therapeutic Community model for Substance Use Disorders (SUD) was introduced in Ghana about a decade ago as an alternative to other existing strategies. However, the effectiveness of this treatment modality for substance use disorders in Pantang Mental Hospital and Accra Psychiatric Hospital has not been scientifically studied.ObjectiveThis study, therefore, sought to explore the experiences of substance users or residents enrolled in the Therapeutic Community programme toward recovery from substance use disorders.MethodThis research employed an explorative-descriptive design. Participants (N = 20) were enrolled purposively sampled and recruited into the study. Face-to-face interviews were conducted using a semi-structured guide and data were analyzed using Colaizzi’s descriptive phenomenology data analysis process.ResultsTwo main themes emerged from the data: “Why I stayed” (Motivation), and “All things are new” (Life transformation). The study pointed out that residents or participants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction.ConclusionIn conclusion, the study found that participants in the Therapeutic Community (TC) program generally had positive experiences and believed in its effectiveness for recovery. Factors such as a relaxed environment, supportive staff, and interactions with other residents contributed to their positive experience. The study discovered that motivation, a conducive environment for care, structured program activities, and relationships among residents were key factors that motivated participants to stay and actively participate in the therapeutic community program. These factors fostered hope and a sense of belonging, ultimately contributing to their recovery journey. However, participants expressed the need for self-actualization, which they hoped to achieve after completing the program and reintegrating into the community.

California Medicaid to cover traditional healing

Last week California announced that Medi‐Cal, the state's Medicaid program, will pay for substance use disorder (SUD) treatment with “traditional health care practices in use since time immemorial,” according to a press release from Gov. Gavin Newsom. The two types of treatment covered include those used by Native Americans.

Descriptive study of mental health care users 12 months pre- and post-COVID-19 lockdown.

Coronavirus disease 2019 (COVID-19) has impacted on a range of physical, mental and societal health indices. Increased levels of psychological stress are often reported following pandemics. To describe and compare the presentations of mental health care users pre- and post-initiation of the lockdown, with an emphasis on demographic profiles and final diagnoses. The study was conducted as a retrospective record review over the predetermined period at a large public hospital in Johannesburg and included all mental health care users requiring psychiatry consultation during the study period. Clinical records were traced via the emergency department registration desk, and information pertaining to demographics, presenting complaints, date of presentation and diagnosis was extracted. A significant increase was seen in patients with psychotic disorders from pre-COVID-19 to post-COVID-19. There was a reduction in presentations of mood disorders and substance-related disorders. Patients presenting in the post-COVID-19 time period were significantly younger than in the pre-COVID-19 time period. Pandemics result in notable negative mental health sequelae. Policies aimed at mitigating the spread of infective agents should be implemented with consideration of the burden of psychological distress following the pandemic. This study provides insights into clinical and demographic variables in a mental health care population serviced at a government hospital pre- and post-COVID-19 lockdown regulations.

Club Drugs and Psychiatric Outcomes: A Descriptive Case Series from Spain

Background: illegal drugs significantly contribute to global health issues, with health complications often occurring not only in regular users with Substance Use Disorders (SUDs) but also in first-time and occasional users. Methods: this study examines five clinical cases from a public hospital in Ibiza, Spain, where patients presented with acute psychiatric symptoms due to recreational drug use. Results: Contrary to previous studies on SUDs, our patients typically had higher education levels and stable employment. Most of them used multiple substances, with cannabis, cocaine, and alcohol being the most frequently used. There was also a common occurrence of consuming drugs with uncertain contents. Upon admission, typical symptoms included aggression, hallucinations, mood swings, and disorientation in time and space. Conclusions: Our findings underscore the significant mental health risks posed by illicit drugs, even for individuals with no prior psychiatric history. Factors like the drug’s potency, frequency and amount of use, past mental health issues, personality traits, and previous traumatic experiences might influence the onset of these symptoms.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Characterizing impulsivity in individuals with methamphetamine and methcathinone use disorders.

Individuals with substance use disorder (SUD) are characterized by loss of control in drug use, such as increased impulsivity. Methamphetamine and methcathinone are psychostimulants, the use of which is accompanied by a high level of impulsivity. Whether individuals with methamphetamine use disorder (MUD) and methcathinone use disorder (MCUD) differ in different aspects of impulsivity is unclear. We investigated impulsivity traits and behaviors in individuals with MUD and MCUD. The Barratt Impulsiveness Scale (BIS), Sensation Seeking Scale (SSS), and delay discounting task (DDT) were assessed in individuals with MUD and MCUD and in healthy controls (HCs); then, we performed network-based analysis and computational modeling to understand the potential differences among the three groups. MUD subjects scored higher than MCUD subjects in terms of motor impulsivity, nonplanning impulsivity, and total BIS scores. The network analysis revealed that there were no significant differences between MUD and MCUD subjects in any centrality indices. The discount rate of MUD and MCUD subjects was significantly greater than that of HCs, whereas there was no difference in the discount rate between the two addiction groups. These findings suggest that MUD and MCUD participants differ in impulsivity traits but not in impulsive behaviors, implying that impulsive traits and behaviors represent different aspects of impulsivity.

Considerations for the application of polygenic scores to clinical care of individuals with substance use disorders.

Substance use disorders (SUDs) are highly prevalent and associated with excess morbidity, mortality, and economic costs. Thus, there is considerable interest in the early identification of individuals who may be more susceptible to developing SUDs and in improving personalized treatment decisions for those who have SUDs. SUDs are known to be influenced by both genetic and environmental factors. Polygenic scores (PGSs) provide a single measure of genetic liability that could be used as a biomarker in predicting disease development, progression, and treatment response. Although PGSs are rapidly being integrated into clinical practice, there is little information to guide clinicians in their responsible use and interpretation. In this Review, we discuss the potential benefits and pitfalls of the use of PGSs in the clinical care of SUDs, highlighting current research. We also provide suggestions for important considerations prior to implementing the clinical use of PGSs and recommend future directions for research.

Dyspnea, respiratory muscle strength, cough capacity, and sleep quality in individuals with substance use disorder

There is evidence that substance use and smoking cause some adverse effects on the respiratory system. The aim of this study was to assess dyspnea severity, respiratory muscle strength, cough capacity, and sleep quality in people with substance use disorder (SUD). Forty eight individuals with SUD and 28 active cigarette smokers participated in the study. Participants’ dyspnea severity was assessed using the Modified Medical Research Council Scale, respiratory muscle strength was measured with a portable electronic mouth pressure device, peak cough flow was assessed with a Peak Flow Meter, and sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI). The amount of daily cigarette smoking and dyspnea severity were significantly higher in individuals with SUD (p < .001). Peak cough flow values, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), MIP (%predicted), and MEP (%predicted) were not significantly different between the SUD patients and the active cigarette smokers (p > .05). However, PSQI sub-parameters such as subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, and total scores showed significant differences between the SUD patients and the active cigarette smokers (p < .05, p < .001, p = .03, p < .001, p < .001, respectively). Individuals with SUD were found to have higher dyspnea and poorer sleep quality than active smokers. However, respiratory muscle strength and cough capacities were similar.

Identifying and Characterizing Models of Substance Use Treatment in Outpatient Substance Use Treatment Facilities.

Given that individuals with substance use disorders (SUDs) have a variety of needs beyond substance use, it is critical to examine the comprehensiveness of services offered within outpatient SUD treatment facilities, where many individuals with SUDs receive care. This study's objective is to develop clusters of services offered, and assess organizational, policy, and environmental characteristics associated with having a more comprehensive treatment model. We conducted a principal component analysis (PCA) using data on SUD treatment facilities (n=8, 197) from the 2022 Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities. We applied a K-means cluster analysis on the generated components to cluster facilities by service offerings, and calculated the mean for different organizational, policy and environmental characteristics for each cluster. We retained five components from the PCA which represented the availability of different services (Pharmacotherapies, Infectious Disease and Harm Reduction, Supportive and Social Determinant of Health (SDOH) Services, Psychosocial Services, and General Healthcare.) The cluster analysis resulted in five SUD service models, with the most comprehensive having the highest percentage of accredited and Medicaid-accepting facilities, and facilities that were government-operated and located in a Medicaid expansion state, and the least comprehensive having lowest percentage of accredited, licensed and Medicaid-accepting facilities, and the highest percentage of private for-profit facilities. Our study found that SUD treatment facilities varied in the availability of five treatment components, but more comprehensive service models had a higher percentage of facilities that were licensed, accredited, and accepting Medicaid.

Can sheep help to improve positive emotions, mindfulness, and self-efficacy expectancy? A pilot study of animal-assisted intervention as an enhanced CBT-based therapy for substance use disorders.

Substance use disorders (SUDs) are common, and there is evidence of clinically significant benefit of cognitive behavioral therapy (CBT). The efficacy of CBT in SUDs has been confirmed, although relapse rates of 40%-60% have been reported. An enhancement of CBT-based therapy through an animal-assisted intervention (AAI) with sheep to normalize the occurrence of negative emotions and improve positive emotions as well as mindfulness and self-efficacy expectancy was investigated. A single-session AAI with sheep in a group setting was investigated against treatment as usual over time. N = 36 psychiatric inpatients with SUDs were examined by questionnaires before and 1 week after the intervention and additionally immediately after the intervention. Positive emotions improved significantly in the AAI group 1 week after the intervention with a medium effect size, but not in the control group. Similarly, mindfulness and self-efficacy expectancy improved over time in the AAI group. When exploratory results were evaluated immediately after the intervention while still on the farm, the effects in favor of AAI were even larger. AAI can thus be considered effective in improving positive emotions, mindfulness, and self-efficacy expectancy. The impressive effect sizes immediately after the intervention encourage us to consider what can be done to maintain these even greater effect sizes over time. https://drks.de/search/de/trial/DRKS00027539, identifier DRKS 00027539.

Nurse-Led Physical Screening of Patients With Substance Use Disorders: A Cross-Sectional Study.

Somatic comorbidity is the main cause of reduced life expectancy in patients with substance use disorders (SUDs). This study aims to investigate somatic health challenges in patients with SUDs using the USS. Patient self-management of somatic health and quality of life were also assessed. In our study, a stratified random sample of 136 clients who received treatment at a specialist addiction facility was drawn to investigate their physical health and lifestyle behaviours using the Utrecht Somatic Screening 2.0 (USS 2.0). The sample included three subgroups, that is, patients receiving outpatient treatment through Flexible Assertive Community Treatment (FACT), Heroin-Assisted Treatment (HAT) and Opioid Replacement Therapy (ORT). Pain, self-management and quality of life were also measured. Descriptive statistics were used to analyse the data. The findings indicate that many patients experience a large number of somatic health problems, including pain and exhaustion. The most prevalent conditions in this study are cardiovascular disease (25%) and COPD (20%), underweight and poor oral health. Tobacco smoking is prevalent among 88% of patients. Fifty percent of the patients expressed a need for support in managing their physical health. Somatic health care and lifestyle promotion should be tailored to the specific characteristics of patients. Patients with SUDs suffer from poor physical health and show unhealthy lifestyle behaviours, which demand the promotion of tailored somatic health.

Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment

BackgroundOverdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.MethodsWe conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care.Results61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs.ConclusionsThis project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.

Divergent gene expression patterns in alcohol and opioid use disorders lead to consistent alterations in functional networks within the dorsolateral prefrontal cortex

Substance Use Disorders (SUDs) manifest as persistent drug-seeking behavior despite adverse consequences, with Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) representing prevalent forms associated with significant mortality rates and economic burdens. The co-occurrence of AUD and OUD is common, necessitating a deeper comprehension of their intricate interactions. While the causal link between these disorders remains elusive, shared genetic factors are hypothesized. Leveraging public datasets, we employed genomic and transcriptomic analyses to explore conserved and distinct molecular pathways within the dorsolateral prefrontal cortex associated with AUD and OUD. Our findings unveil modest transcriptomic overlap at the gene level between the two disorders but substantial convergence on shared biological pathways. Notably, these pathways predominantly involve inflammatory processes, synaptic plasticity, and key intracellular signaling regulators. Integration of transcriptomic data with the latest genome-wide association studies (GWAS) for problematic alcohol use (PAU) and OUD not only corroborated our transcriptomic findings but also confirmed the limited shared heritability between the disorders. Overall, our study indicates that while alcohol and opioids induce diverse transcriptional alterations at the gene level, they converge on select biological pathways, offering promising avenues for novel therapeutic targets aimed at addressing both disorders simultaneously.

Patterns and Challenges in Help-Seeking for Addiction among Men: A Systematic Review.

Background/Objectives: Addictive and substance-related disorders represent a substantial public health challenge, marked by rising incidence and prevalence rates. Men and women exhibit different patterns of help-seeking for health and social issues including addictions. This research aimed to analyze the help-seeking process among men with addiction to improve understanding and develop more effective, person-centered treatments. Methods: This systematic review was performed based on the Cochrane Collaboration guidelines and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of the revision was registered in advance in PROSPERO. Searches were conducted in the PubMed, Scopus, and Web of Science (WOS) databases. Results: Based on the literature search, 16 studies were included in the current systematic review. The analyzed studies included seven on substance-use disorders, three on gambling disorder, two on tobacco-use disorder, two addressing substance-related disorders in general, one on opioid-use disorder, and one focused on marijuana use. Gender differences influenced help-seeking behavior, with women generally exhibiting a higher propensity to seek assistance for addiction-related issues than men. Seeking help for addiction-whether substance use or gambling-can be hindered by several barriers, particularly public stigma and discrimination, which tend to be more pronounced for alcohol and gambling compared to tobacco. Additional barriers in the help-seeking process include negative beliefs and attitudes toward seeking help, often associated with traditional male gender roles. Each substance-use disorder was analyzed in depth to gain a better understanding of the barriers faced by this population. Conclusions: Integrating a gender perspective into the diagnosis, prevention, and treatment of addiction is essential. As addiction patterns vary between men and women, approaches must be tailored accordingly. Recognizing men as a distinct group in research and clinical practice is also crucial for developing more effective and personalized treatments.

Characteristics associated with adult non-fatal opioid and stimulant overdose and substance use disorder emergency department visits in Michigan

BackgroundUnderstanding risk factors for emergency department (ED) visits for overdose and substance use disorder (SUD) can inform prevention efforts. Few studies have considered non-fatal opioid overdoses, stimulant overdoses and SUD, and limited data exists by overdose intentionality and by sex. MethodsWe conducted a serial cross-sectional study with Healthcare Cost and Utilization Project Michigan (MI) 2019–2020 ED discharge data (n=5,716,716). Primary outcomes included non-fatal opioid overdoses, non-fatal stimulant overdoses, and SUD primary diagnoses in a single ED visit. We examined demographic and socioeconomic factors associated with study outcomes using binary and multinomial logistic regression (for overdose intentionality) models, which estimated adjusted odds ratios (AOR) and 95 % confidence intervals (CI). ResultsAmong all MI discharges, 13,908, 1,379, and 23,462 were nonfatal opioid, stimulant, or SUD overdose visits, respectively. Lower median household income (vs. higher income), male sex (vs. female), metropolitan county of residence (vs. small urban/rural), and Medicaid (vs. private insurance) were associated with increased odds of all outcomes. For example, ORs(95 % CIs) for Medicaid were 4.41(4.18,4.65), 2.25(1.95,2.60), and 2.80(2.70,2.91) for opioid overdoses, stimulant overdoses, and SUD, respectively. All outcomes had the highest increased odds in ages 28–32 years compared to 18–22 years. Stratification by sex and non-fatal overdose intentionality modified some associations, with the strongest associations observed for non-fatal opioid overdoses. ConclusionsMale sex, Medicaid, and race/ethnicity were consistently associated with all outcomes similarly, but other characteristics varied in patterns, strengths of association, and statistical significance by outcome groups, sex, and non-fatal opioid or stimulant overdose intentionality.

The Effect of Racial Concordance for Black Patients in Addiction Treatment: A Scoping Review of the Literature.

In the United States, Black people with substance use disorders (SUDs) have less access to treatment and worse treatment outcomes compared to White people. Though systemic racism is the root of these inequities, adapting treatment settings to serve this population may be a pragmatic way to improve access and outcomes. Shared racial identity between a patient and a provider, or racial concordance, is one feature of culturally tailored care that may improve treatment access, experiences, and outcomes for Black people. There is some evidence that racial concordance improves medical treatment for Black patients in non-addiction settings, but it is unknown whether racial concordance affects experiences or outcomes in addiction treatment. We conducted a scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-to understand the effect of racial concordance on Black patients in addiction treatment. Three reviewers read each title and abstract to identify eligible articles. The inclusion criteria were: (1) Black patients; (2) treatment access, experiences, or outcomes; and (3) patient-provider racial concordance in addiction treatment. One reviewer completed full-text reviews and data extraction. We identified 259 nonduplicate articles and completed full-text reviews of 77 articles. Eleven articles, published between 1971 and 2016, met criteria. Racial concordance was not associated with treatment access or engagement, though it was associated with some positive outcomes including increased perceived provider empathy. Few studies met the review criteria and there were no randomized controlled trials. The studies identified in this review did not provide adequate evidence that racial concordance improved treatment access, experiences, or outcomes for Black patients. Future research should include a wider range of outcome measures, including relational measures (eg, medical trust, discrimination) and examine whether and under what circumstances racial concordance improves experiences and outcomes for Black patients in addiction treatment.

Longitudinal trajectory classes and correlates of the Multidimensional Personality Questionnaire-triarchic psychopathy scales from adolescence to young adulthood.

The present study examined longitudinal trajectory classes and correlates of triarchic psychopathy domains (boldness, meanness, and disinhibition) from age 16 to 22, leveraging Multidimensional Personality Questionnaire (MPQ)-based triarchic scales data gathered on a large community sample (ns ranging between 483 and 775 across waves) oversampled for parental substance use disorder (SUD). Growth mixture models were conducted to examine longitudinal trajectory classes for each domain, and their associations with environmental covariates (e.g., neighborhood disadvantage and parental SUD) and outcomes at age 22 (e.g., violent behavior, antisocial personality disorder, and an overall problem index capturing internalizing symptoms and social problems). For boldness, all participants fell in the same class showing relative stability over time. Comparable solutions were recovered for meanness and disinhibition (high-stable/increasing, mid-range decreasing, and low-decreasing). Links with external correlates supported well-known differences between boldness and both meanness and disinhibition and additionally revealed interesting differences between meanness and disinhibition, suggesting that environmental covariates better discriminated meanness trajectory classes. These results demonstrate considerable developmental heterogeneity in these traits across adolescence into young adulthood, which relates to outcomes associated with antisociality and general life struggles. Further, these findings support the adequacy of the MPQ as an operationalization tool for longitudinal investigations on psychopathy.

Substance use and psychiatric phenotypes of youth experiencing homelessness: A cluster analysis.

Due to the complex interactions of psychopathology, psychosocial stressors, and risk behaviors, characterizing high-risk phenotypic groups of transitional-age youth experiencing homelessness (TAY-EH) for targeted interventions remains difficult. We aimed to uncover specific phenotypes of TAY-EH based upon psychiatric and substance use disorder (SUD) diagnoses, and to assess relationships between these phenotypes and negative outcomes including suicidality and high-risk behaviors. Participants (N = 140; 57% male, 54% Black) were individuals aged 16-25 years accessing support at a psychosocial agency in the U.S. Northeast. Data were gathered via structured assessment. Cluster analysis identified sub-groups of TAY-EH with differing diagnostic patterns. Bivariate analyses examined associations between cluster membership and target outcomes. A four-cluster solution was identified. Cluster 1 (Co-occurring; N = 33) was characterized by high levels of comorbidity (i.e., major depressive disorder (MDD), SUD, and notable levels of other diagnoses). Clusters 2 (MDD alone; N = 47) and 3 (SUD alone; N = 18) were characterized by single diagnoses. Cluster 4 (None; N = 42) was characterized by low levels of psychopathology. Clusters differed significantly on several variables including suicidality, adverse childhood experiences, and social connectedness. Comorbid MDD and SUD were most strongly associated with high-risk behaviors and suicidality. These results highlight the importance of diagnosis and targeted interventions for co-occurring MDD and SUD to address the crisis of early mortality and other negative outcomes among TAY-EH. This study is the first to identify specific high-risk psychiatric and psychosocial phenotypes among the highly complex group of TAY-EH based upon structured diagnostic assessments.

Engagement in substance use disorder treatment after an emergency department visit among persons at high risk of opioid overdose: A prediction analysis

BackgroundCertified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown. MethodsThis secondary analysis included Rhode Island ED patients at high risk for opioid overdose participating in a randomized controlled trial comparing the effectiveness of CPRS and LCSWs services (2018–2021). SUD treatment engagement within 90 days post-discharge was identified using statewide administrative data. Potential predictors were obtained from baseline questionnaires. Classification and regression trees (CART) were used to identify predictors of treatment engagement. ResultsIn the ED, 323 and 325 participants received CPRS and LCSWs services, respectively, among whom 141 (43.7 %) and 137 (42.2 %) engaged in SUD treatment within 90 days post-discharge. For the CPRS group, predictors of treatment engagement included unhealthy alcohol use, prescription opioid or benzodiazepine use in past 6 months, and lifetime history of: unstable housing, barriers to treatment, bipolar disorder diagnosis, addiction treatment, and recovery services. In the LCSW group, predictors included health insurance, current pain, opioid overdose in past year, and lifetime history of anxiety disorder diagnosis and mental illness treatment. However, CART had low predictive accuracy (CPRS: 60.9 %, LCSW: 54.8 %). ConclusionsAmong ED patients at high risk of opioid overdose receiving behavioral services, 90-day SUD treatment engagement was high. Sociobehavioral and clinical patient characteristics did not accurately predict treatment engagement. Behavioral services should be offered to all ED patients at high risk of opioid overdose.

Recommendations for the Medical Treatment of ADHD in Comorbid, Substance-Related Disorders: Statement of the Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations

Recommendations for the Medical Treatment of ADHD in Comorbid, Substance-Related Disorders: Statement of the Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations Abstract: Objective: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often occur together in adolescents. The available guidelines give the group of children and adolescents with ADHD and comorbid SUD little consideration. Method: The Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations has drawn up a statement with treatment recommendations intended to provide orientation as a best-practice approach. Results: Early treatment with stimulants in adolescents with ADHD and SUD may.