Substance Use Disorders Research Articles

Self-esteem mediates child abuse predicting adulthood anxiety, depression, and substance use symptoms 18 years later

According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0–100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse–adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.

Child maltreatment as a transdiagnostic risk factor for the externalizing dimension: a Mendelian randomization study.

Observational studies suggest that child maltreatment increases the risk of externalizing spectrum disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), antisocial personality disorder (ASPD), and substance use disorder (SUD). Yet, only few of such associations have been investigated by approaches that provide strong evidence for causation, such as Mendelian Randomization (MR). Establishing causal inference is essential given the growing recognition of gene-environment correlations, which can confound observational research in the context of childhood maltreatment. Evaluating causality between child maltreatment and the externalizing phenotypes, we used genome-wide association study (GWAS) summary data for child maltreatment (143,473 participants), ADHD (20,183 cases; 35,191 controls), CD (451 cases; 256,859 controls), ASPD (381 cases; 252,877 controls), alcohol use disorder (AUD; 13,422 cases; 244,533 controls), opioid use disorder (OUD; 775 cases; 255,921 controls), and cannabinoid use disorder (CUD; 14,080 cases; 343,726 controls). We also generated a latent variable 'common externalizing factor' (EXT) using genomic structural equation modeling. Genetically predicted childhood maltreatment was consistently associated with ADHD (odds ratio [OR], 10.09; 95%-CI, 4.76-21.40; P = 1.63 × 10-09), AUD (OR, 3.72; 95%-CI, 1.85-7.52; P = 2.42 × 10-04), and the EXT (OR, 2.64; 95%-CI, 1.52-4.60; P = 5.80 × 10-04) across the different analyses and pleiotropy-robust methods. A subsequent GWAS on childhood maltreatment and the externalizing dimension from Externalizing Consortium (EXT-CON) confirmed these results. Two of the top five genes with the strongest associations in EXT GWAS, CADM2 and SEMA6D, are also ranked among the top 10 in the EXT-CON. The present results confirm the existence of a common externalizing factor and an increasing vulnerability caused by child maltreatment, with crucial implications for prevention. However, the partly diverging results also indicate that specific influences impact individual phenotypes separately.

Modifiable risk factors and excess mortality in depression: Data from the UK Biobank

ObjectiveTo study the role of modifiable risk factors in explaining the excess mortality associated with depression using data from the UK Biobank, a middle-aged and elderly cohort recruited in 2006–2010. MethodsWe estimated the prevalence and relative mortality associated with modifiable risk factors and groups of risk factors (socioeconomic factors, diet and exercise, smoking and substance-related disorders, and cardiometabolic diseases) in a subsample of probable cases of lifetime/current depression (n = 51,302) versus non-cases. We also estimated the relative mortality associated with depression and the percentages of excess mortality associated with depression explained by modifiable risk factors in the total sample (499,762). ResultsIn our depression subsample, all modifiable risk factors were associated with increased prevalence and mortality. In our total sample, depression was associated with an age and sex-adjusted mortality hazard ratio of 1.63 (95% CI = [1.58–1.68]). Modifiable risk factors explained 70.5% [66.9%–75.0%] of the excess mortality associated with depression. ConclusionsIn the UK Biobank cohort, depression was associated with a higher prevalence of modifiable risk factors. These risk factors were associated with increased mortality in the depression subsample and explained most of the excess mortality risk associated with depression in the total sample.

Pathways between childhood mistreatment/victimization, posttraumatic stress, and lifetime substance use disorders among Latinx nationwide.

Childhood mistreatment (CM)/victimization, posttraumatic stress disorder (PTSD), and lifetime substance-use disorders (LT-SUD) are major behavioral health concerns. Their associations were established in mainstream populations but remain under-investigated in Latinx Americans. This study aimed to model the mediating effect of PTSD in the link between CM and LT-SUD among Latinx Americans. Using a nationally representative sample (N = 2,554) from the National Latinx and Asian American Study, three path models were performed for the whole-group, U.S.-born, and foreign-born Latinx (aged 18 or over), controlling for known predictors for Latinx' mental health. Latinx reported high rates of childhood physical (32%) and sexual (11.8%) abuse. Latinx subgroups significantly varied in educational attainment, LT-SUD, income, English proficiency, and self-reported discrimination. A fully constrained multiple group path analysis demonstrated direct effects of childhood physical mistreatment (CPM) and childhood sexual mistreatment to lifetime PTSD; PTSD significantly mediated the relationship between CPM with LT-SUD. No significant differences in path coefficients were observed among the Mexican, Cuban, and Puerto Rican subgroups. Findings suggest that CPM may contribute to using substance to avoid physical and emotional pain, which lends support for the self-medication hypothesis. Latinx who were traumatized by both physical and sexual abuse are more likely to use substances as a negative coping strategy. The study underscores the need for assessing the role of substance use as a coping mechanism for Latinx individuals who have experienced childhood traumatic victimization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors associated with presentation to the emergency department during an intensive post-discharge intervention in patients with substance use disorders

BackgroundEarly identification of patients with substance use disorders (SUDs) with a higher risk of emergency department (ED) presentations after being discharged can be useful. We performed a chart review of patients from the Intensive Recovery Discharge Team (IRDT) program, which provides two weeks of outpatient support for patients with SUDs discharged from a mental health hospital. MethodDemographic, service utilization, and clinical data from 716 patients enrolled in IRDT from February 2021–February 2023 were extracted from electronic health records. Receiver operating characteristic (ROC) analysis was performed to identify risk factors associated with increased ED presentations during the two weeks of IRDT follow-up with five-fold cross validation. ResultsIn two years, 10.7% of IRDT patients presented to the ED during the 2 weeks of follow-up. Having been enrolled in IRDT more than once, not having opioid use disorder (OUD), and self-identifying as male was associated with ED presentations, where an average of 20.1% of patients with all three risk factors presented to the ED. The presence of comorbid mental disorders did not emerge as a significant predictor. DiscussionOur results suggest that patients who had previous inpatient admissions, a SUD other than OUD, and/or self-identify as male have a higher risk of presenting to the ED post-discharge and may benefit from more intensive follow-up. Larger studies involving multiple sites are required to validate the generalizability of our findings. Findings from our study can be used to guide future studies examining post-discharge programs in patients with SUDs with and without comorbid mental disorders.

Effects of isolation stress and voluntary ethanol exposure during adolescence on ethanol and nicotine co-use in adulthood using male rats

BackgroundAlcohol use in adolescence may increase susceptibility to substance use disorders (SUDs) in adulthood. This study determined if voluntary ethanol (EtOH) consumption during adolescence, combined with social isolation, alters the trajectory of EtOH and nicotine intake during adulthood, as well as activating brain neuroinflammation. MethodsAdolescent male isolate- and group-housed rats were given 0.2 % saccharin/20 % EtOH (Sacc/EtOH) or water using intermittent 2-bottle choice; controls were given water in both bottles (n=17–20 per group). Some rats from each group (n=5–6) were euthanized one week later to measure autoradiographic [3H]PK-11195 binding, an indicator of microglial reactivity, and the remainder (n=11–14 per group) were tested in adulthood in 2-bottle choice, followed by nicotine self-administration using an incremental fixed ratio (FR) schedule with Sacc/EtOH and water concurrently available. ResultsIsolation housing increased adolescent intake of Sacc/EtOH, but the increase did not produce an observable neuroimmunological response in brain. Adolescent EtOH exposure decreased adult intake of both Sacc/EtOH and unsweetened EtOH, with isolate-housed rats showing a greater effect than group-housed rats. In the co-use model, a cross-price economic demand analysis revealed a substitutional relationship between Sacc/EtOH and nicotine, but no effect of adolescent Sacc/EtOH exposure. Compared to group-housed rats, isolate-housed rats were more sensitive to the changing price of nicotine and showed greater substitutability of Sacc/EtOH for nicotine. ConclusionThe current results suggest that adolescent EtOH exposure per se, with or without isolation stress, does not likely explain the enhanced risk for either alcohol or nicotine use later in life.

Basal forebrain-lateral habenula inputs and control of impulsive behavior.

Deficits in impulse control are observed in several neurocognitive disorders, including attention deficit hyperactivity (ADHD), substance use disorders (SUDs), and those following traumatic brain injury (TBI). Understanding brain circuits and mechanisms contributing to impulsive behavior may aid in identifying therapeutic interventions. We previously reported that intact lateral habenula (LHb) function is necessary to limit impulsivity defined by impaired response inhibition in rats. Here, we examine the involvement of a synaptic input to the LHb on response inhibition using cellular, circuit, and behavioral approaches. Retrograde fluorogold tracing identified basal forebrain (BF) inputs to LHb, primarily arising from ventral pallidum and nucleus accumbens shell (VP/NAcs). Glutamic acid decarboxylase and cannabinoid CB1 receptor (CB1R) mRNAs colocalized with fluorogold, suggesting a cannabinoid modulated GABAergic pathway. Optogenetic activation of these axons strongly inhibited LHb neuron action potentials and GABA release was tonically suppressed by an endogenous cannabinoid in vitro. Behavioral experiments showed that response inhibition during signaled reward omission was impaired when VP/NAcs inputs to LHb were optogenetically stimulated, whereas inhibition of this pathway did not alter LHb control of impulsivity. Systemic injection with the psychotropic phytocannabinoid, Δ9-tetrahydrocannabinol (Δ9-THC), also increased impulsivity in male, and not female rats, and this was blocked by LHb CB1R antagonism. However, as optogenetic VP/NAcs pathway inhibition did not alter impulse control, we conclude that the pro-impulsive effects of Δ9-THC likely do not occur via inhibition of this afferent. These results identify an inhibitory LHb afferent that is controlled by CB1Rs that can regulate impulsive behavior.

Start-Up and Implementation Costs for the Trust Based Relational Intervention.

Capturing costs associated with prevention activities related to substance use disorders (SUD) and mental health (MH) is critical. In this study, Trust Based Relational Intervention (TBRI®), an attachment-based, trauma-informed intervention, is conceptualized as a preventive intervention to reduce substance and opioid use among youth involved with the legal system. When implemented alongside community reentry, TBRI leverages family systems as youth transition from secure residential care into communities through emotional guidance and role modeling. Activity-based cost (ABC) analysis was used to guide cost data collection and analysis for both start-up and implementation of the TBRI intervention. Start-up costs were estimated using data across eight sites during their start-up phase. All components, activities, personnel involved, and time associated with implementation of TBRI sessions according to protocol were defined. National wages were extracted from O*NET and utilized to calculate total costs for each TBRI component. Total and average TBRI intervention costs were calculated with a breakdown by TBRI sessions and number of staff and participants. A sensitivity analysis was conducted to estimate TBRI implementation costs with travel. The total cost for the TBRI intervention, representing 42 sessions, ranges from $6,927, without travel expenses or $12,298, with travel expenses. The average per family cost ranges from $1,385 (without travel) to $2,460 (with travel). Costs are primarily generated by time investments from primary interventionists. The sensitivity analysis shows costs for responsive coaching would double with travel costs included. Results aim to show that using ABC for prevention activities, like TBRI, to understand cost drivers can facilitate future intervention sustainability.Clinical Trail.gov ID: NCT04678960.

Substance misuse disorder in Saudi Arabia: A comprehensive examination of current demographic patterns, trends, and intervention requirements

IntroductionThis review examines substance misuse disorder (SMD) in Saudi Arabia, drawing insights from 43 prior studies. It explores the prevalence and patterns of SMD across diverse demographics. MethodologyOur analysis integrated data from various studies involving adolescents, university students, psychiatric patients, and the general population as well as postmortem cases. It identifies key risk factors and challenges in managing SMD, underscoring the importance of comprehensive data collection for evidence-based policymaking. ResultsSMD in Saudi Arabia were categorized into two groups: common traditionally abused drugs (such as Captagon, khat, heroin, ethanol, and cannabis) and substances that have emerged in recent years (e.g., methamphetamine “Shabu”, pregabalin, and benzodiazepines). Trends in SMD include early substance initiation and increased amphetamine and polysubstance use. Conclusion and recommendationsDrug-related challenges persist in Saudi Arabia; however, because of limited data from recent epidemiological studies on drug disorders, the full extent is unknown. Saudi Arabia is unique because it as an Islamic country with strict regulations against drug trafficking and a religious prohibition on drugs and alcohol, which contributes to distinct trends in substance misuse disorder (SMD). Although some aspects mirror global patterns, others exhibit regional characteristics specific to the country. Despite data variability, actionable recommendations have emerged for SMD prevention and treatment. During the COVID-19 pandemic, a high number of reports was evident; however, SMD publications often reiterate old findings and overlook emerging psychoactive substances (EPS), such as ‘Shabu”, pregabalin, and benzodiazepines. Further studies are needed, including educational initiatives, national surveys, stricter drug regulations, and an early warning system for traditional SMD and EPS.

Changes in Substance Use Diagnoses in the Great Plains during the COVID-19 Pandemic.

As drug overdose mortality rises in the United States, healthcare visits present critical opportunities to mitigate this trend. This study examines changes in healthcare visits for substance use disorders (SUDs) and remission prior to and during the COVID-19 pandemic in the Great Plains, with a focus on identifying the characteristics of those served. Data were analyzed from 109,671 patient visits (mode = one visit per patient), encompassing diverse demographics, including sex, age, race, ethnicity, and geographic location. Visits analyzed included those for Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), or Stimulant Use Disorder (StUD) and those in remission of these disorders between March 2019 and March 2021. Patient demographic information and geographic factors, like rurality and Medicaid expansion status, were considered, and logistic regression was utilized. Visits were primarily by White (70.83%) and Native American (21.39%) patients, non-Hispanic (91.70%) patients, and males (54.16%). Various demographic, geographic, and temporal trends were observed. Findings indicated that males were more likely to receive an AUD diagnosis, while females were more likely to receive an OUD or StUD diagnosis. Metropolitan-residing patients were more likely to receive an AUD diagnosis, while non-metropolitan patients were more likely to receive an OUD diagnosis. Remission odds increased for StUD during the pandemic but decreased for AUD and OUD. These findings illuminate the demographic and geographic patterns of SUD-related healthcare visits, suggesting critical touchpoints for intervention. The results emphasize the urgent need for targeted healthcare strategies, especially in rural and underserved areas, to address persistent health disparities.

Substance Use Disorder, Opioid Use Disorder, and Symptom Management in Palliative Care: A Rapid Review of Evidence.

Substance use disorder (SUD) affects more than 1 in 6 Americans older than 12 years and has become an increasingly relevant topic in palliative care. Lack of clear guidelines and fragmented care results in patient safety concerns and poor outcomes. This rapid review aims to present the current literature on opioid contracts/agreements, prescription drug monitoring database access, opioid risk assessment tools, and urine drug screening in the palliative care setting. Through a systematic process, we identified 19 articles published between 2018 and 2023 that pertained to substance use disorder and palliative care. Current risk mitigation strategies include prescription drug monitoring, opioid use agreements, risk assessment tools, urine drug screening, and the use of buprenorphine to manage pain. Prescription drug monitoring programs are state-based electronic databases that track controlled substances, and there are numerous risk assessment tools. Urine drug screening involves the use of both immunoassay and confirmatory chromatography to determine the presence or absence of either the prescribed controlled substance or unexpected findings including illicit drugs or prescription-controlled substances that are not prescribed to the patient. The goal of mitigating risk and reducing harm while providing expert symptom management is the challenge that palliative care transdisciplinary teams face as they continue to care for patients with substance use disorder. This review points to the need for further research on how to incorporate these harm-reducing strategies into clinical practice.

Stress and substance use disorders: risk, relapse, and treatment outcomes.

Stress has long been associated with substance misuse and substance use disorders (SUDs). The past two decades have seen a surge in research aimed at understanding the underlying mechanisms driving this association. This Review introduces a multilevel "adaptive stress response" framework, encompassing a stress baseline, acute reaction, and recovery with return-to-homeostasis phase that occurs at varying response times and across domains of analysis. It also discusses evidence showing the disruption of this adaptive stress response in the context of chronic and repeated stressors, trauma, adverse social and drug-related environments, as well as with acute and chronic drug misuse and with drug withdrawal and abstinence sequelae. Subjective, cognitive, peripheral, and neurobiological disruptions in the adaptive stress response phases and their link to inflexible, maladaptive coping; increased craving; relapse risk; and maintenance of drug intake are also presented. Finally, the prevention and treatment implications of targeting this "stress pathophysiology of addiction" are discussed, along with specific aspects that may be targeted in intervention development to rescue stress-related alterations in drug motivation and to improve SUD treatment outcomes.

Housing and supportive services for young mothers experiencing substance use disorder and homelessness: Cost-effectiveness analysis of a randomized trial

BackgroundMothers experiencing homelessness and caring for young children struggle with high rates of substance use and mental health problems. A comprehensive supportive housing intervention was implemented to assist young mothers experiencing substance use disorder (SUD) and homelessness. The cost-effectiveness of this intensive intervention could inform future dissemination. MethodsA cost-effectiveness analysis was conducted alongside a randomized controlled trial that lasted from May 2015 to October 2018. Mothers experiencing homelessness between the ages of 18–24 years with a SUD were randomly assigned to housing+support services (HOU + SS) (n = 80), housing-only (HOU) (n = 80), or services as usual SAU (n = 80). Using incremental cost-effectiveness ratios (ICERs), the study compared the costs of HOU + SS and HOU to SAU for three outcomes: housing stability (percent days of stable housing), substance use (percent days of substance use), and depressive symptoms (Beck Depression Inventory score). Direct intervention costs of HOU + SS and HOU from both payor and societal perspectives were estimated. Cost data were collected from detailed study financial records. Outcomes were taken from 6-month assessments. ResultsThe average societal cost of HOU + SS per participant was $5114 [CI 95 %, $4949-5278], while the average societal cost of HOU was $3248 [CI 95 %, $ 3,140–$3341] (2019 U.S. dollars). The calculated ICERs show that HOU was more cost-effective than HOU + SS and SAU for housing outcome. For illicit drug use, HOU + SS was more cost-effective than HOU. Finally, for depressive symptoms, neither HOU + SS or HOU were more cost effective than SAU. ConclusionWhile HOU is more cost-effective for increasing housing, HOU + SS is more cost-effective for reducing illicit drug use. However, housing without improvements in substance use may not be sustainable, and supportive services are likely essential for improved well-being overall beyond the housing outcome alone.

Analyzing Dropout in Alcohol Recovery Programs: A Machine Learning Approach.

Background: Retention in treatment is crucial for the success of interventions targeting alcohol use disorder (AUD), which affects over 100 million people globally. Most previous studies have used classical statistical techniques to predict treatment dropout, and their results remain inconclusive. This study aimed to use novel machine learning tools to identify models that predict dropout with greater precision, enabling the development of better retention strategies for those at higher risk. Methods: A retrospective observational study of 39,030 (17.3% female) participants enrolled in outpatient-based treatment for alcohol use disorder in a state-wide public treatment network has been used. Participants were recruited between 1 January 2015 and 31 December 2019. We applied different machine learning algorithms to create models that allow one to predict the premature cessation of treatment (dropout). With the objective of increasing the explainability of those models with the best precision, considered as black-box models, explainability technique analyses were also applied. Results: Considering as the best models those obtained with one of the so-called black-box models (support vector classifier (SVC)), the results from the best model, from the explainability perspective, showed that the variables that showed greater explanatory capacity for treatment dropout are previous drug use as well as psychiatric comorbidity. Among these variables, those of having undergone previous opioid substitution treatment and receiving coordinated psychiatric care in mental health services showed the greatest capacity for predicting dropout. Conclusions: By using novel machine learning techniques on a large representative sample of patients enrolled in alcohol use disorder treatment, we have identified several machine learning models that help in predicting a higher risk of treatment dropout. Previous treatment for other substance use disorders (SUDs) and concurrent psychiatric comorbidity were the best predictors of dropout, and patients showing these characteristics may need more intensive or complementary interventions to benefit from treatment.

Improving Linkages Between Sexual and Reproductive Health and Substance Use Providers: The Partnership to Advance Integrated Referrals.

Women of reproductive age with substance use (SU) disorders have lower rates of contraceptive use and higher rates of unintended pregnancy than women without SU disorders and are less likely to access treatment than men. Integration of SU and sexual and reproductive health (SRH) services, using a model known as Screening, Brief Intervention, and Referral to Treatment (SBIRT), has been proven effective in reducing SU and improving health care equity. The SBIRT model includes screening, brief intervention (a short client-centered conversation providing an opportunity to identify/discuss concerns), and referral to treatment. The purpose of this study was to test whether an established quality improvement (QI) learning collaborative model could be used to support SU and SRH sites in implementing an SBIRT/SBIRT-like model to improve health outcomes for women. Five SRH sites and 4 SU sites across New York State participated in the Partnership to Advance Integrated Referrals (PAIR), an 18-month QI learning collaborative designed and implemented by Public Health Solutions. Six standardized mixed-methods data collection tools were used over 18months to gather process and outcome data from over 130 QI team members and site staff and over 5000 clients. By the end of PAIR, QI team members and site staff showed a reduction in bias, increased knowledge and comfort, increased rating of organizational practices related to client-centered care, and increased access to peer learning, information about best practices, and training and technical assistance. SU sites increased SRH screening from 47.9% in the first quarter of data collection to 67.4% in the final quarter and increased brief interventions from 92.5% in the first quarter to 100.0% in the final quarter. Similarly, SRH sites increased SU screening from 51.6% to 75.6% and increased brief interventions from 81.3% to 85.1%. The processes and outcomes were very different for the SU and SRH sites, and their varying successes and challenges are discussed. Making and verifying referrals remained challenging. The results of PAIR demonstrated the feasibility of SU and SRH sites implementing an SBIRT/SBIRT-like model when supported by a QI learning collaborative. Larger community and organizational challenges (COVID-19, staff turnover) still present barriers to improved reproductive health and SU outcomes for women.

Lost in transition: A protocol for a retrospective, longitudinal cohort study for addressing challenges in opioid treatment for transition-age adults.

In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.

Benzodiazepine use for anxiety disorders is associated with increased long-term risk of mood and substance use disorders: A large-scale retrospective cohort study

BackgroundBenzodiazepines (BZDs) are widely prescribed for anxiety disorders. However, the long-term implications on mental health remain uncertain, especially the potential association between chronic BZD use and subsequent diagnosis of mood and substance use disorders (SUDs). MethodWe conducted a 5-year retrospective cohort study by analyzing the TriNetX database, a real-time electronic medical record network. The study population was defined as patients aged 18–65 with anxiety disorders (ICD-10-CM: F40-F48). We employed propensity score matching to pair a BZD-exposed cohort (≥12 BZD prescriptions) with a BZD-unexposed control cohort. The outcomes were defined as depressive disorders, bipolar disorders, and SUDs. We employed Kaplan-Meier analyses to assess the survival probability over five years following diagnosis and BZD exposure; log-rank test to obtain the hazard ratio (HR) with 95 % confidence interval (CI). ResultsWe identified and matched 76,137 patients in the study and control cohorts. Compared to the control cohort, the BZD-exposed group exhibited significantly higher risks of being diagnosed with depressive disorders (HR, 2.64; 95 % CI, 2.59–2.68), bipolar disorders (HR, 4.39; 95 % CI, 4.15–4.64), overall substance use disorders (HR, 3.00; 95 % CI, 2.92–3.08), alcohol use disorder (HR, 3.38; 95 % CI, 3.20–3.57), stimulant use disorder (HR, 3.24; 95 % CI, 2.95, 3.55), cannabis use disorder (HR, 2.93; 95 % CI, 2.75–3.11), inhalant use disorder (HR, 4.14; 95 % CI, 3.38–5.06), and nicotine use disorder (HR, 2.72; 95 % CI, 2.63–2.81). ConclusionOur findings demonstrate a concerning association between BZD use and an increased risk of being diagnosed with various mood disorders and SUDs.

Nurses' values when caring for persons suffering from substance use disorder: A hermeneutical study.

Persons suffering from a substance use disorder (SUD) in need of help from low-threshold centres have complex and severe conditions together with uncontrolled use of mainly illicit substances. Their sufferings are all-encompassing and demand ethically aware nurses with competence to take care of somatic, existential and spiritual needs. To explore and describe a new understanding of the ethical and ontological values upon which nurses base their work when caring for persons suffering from SUD. The study had a hermeneutical approach. A focus-group interview was conducted with five nurses working at a low-threshold centre in Norway. Data analysis was carried out through a hermeneutical reading based on Gadamer's hermeneutics. The study was approved by the Norwegian Agency for Shared Services in Education and Research (SIKT). Oral and written consent was obtained from the participants. The hermeneutical reading revealed three dimensions; A wish to be useful; Nurses' motive for caring for persons suffering from SUD is a wish to be useful and needed. Nurses are fighting a battle against injustice and stigmatisation. Neighbourly love, the core value; Neighbourly love serves as the basis for the nurses` work. Nurses feel humble towards their clients, they feel privileged to have the opportunity to help others through compassionate care. The value of being clients` advocate; Nurses are trying to ensure that clients receive the help they need. A large part of nurses` job is to monitor and take care of the clients` condition. This involves working close to death, trying to save lives. Nurses wish to care in accordance with their ethos of usefulness. Sacrifice stands out as the ultimate form of neighbourly love, empowering nurses with moral authority to act as advocates for their clients.

Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys.

The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?" The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations.

Exploring the interplay of abstinence self-efficacy, locus of control, and perceived social support in substance use disorder recovery

Introduction Substance use disorder (SUD) poses a significant public health challenge globally, with substantial impacts on physical and social well-being. This study investigates the interplay between abstinence self-efficacy (ASE), locus of control (LOC), perceived social support (PSS), and various socio-demographic and psychosocial factors among individuals undergoing SUD rehabilitation. Methods Researchers obtained permission from drug rehabilitation centers in Assam, India, and conducted orientation programs for prospective participants. A total of 144 participants, aged 18–65 years, predominantly from rural areas participated in the study. Data was collected through one-to-one interviews, covering socio-demographic history, drug abuse, and administering scales for ASE, LOC and PSS. Collected data underwent digitization and subsequent descriptive and inferential statistical analyses. Results Significant associations were found between ASE and socio-demographic variables, family dynamics, and drug use history, highlighting the importance of considering these factors in SUD rehabilitation. Disturbed family relationships were linked to diminished ASE and higher risk of relapse, emphasizing the role of family support in recovery. Additionally, a negative correlation was observed between ASE and LOC, suggesting that individuals with higher ASE tend to have a more internal locus of control, which positively influences recovery outcomes. Moreover, positive correlations were found between ASE and PSS, particularly from family members, underscoring the importance of social support in fostering recovery. Regression analysis further elucidated the relationships between ASE, LOC, and PSS, emphasizing the predictive value of LOC and the impact of family support on ASE. Conclusion Findings of this study have several implications for developing targeted interventions aimed at strengthening ASE, promoting internal locus of control, and enhancing social support systems.