Substance Abuse Treatment Research Articles

What We Know About Homeless Veterans With Other-than-honorable and Punitive Discharges: Data From the Grant and Per Diem (GPD) Program.

The U.S. DVA Grant and Per Diem (GPD) program funds community agencies to provide housing and case management services to Veterans experiencing homelessness. GPD is one of the few VA programs that can enroll Veterans with Other-than-Honorable (OTH) military discharges. The characteristics of OTH Veterans and their outcomes in GPD are unknown. We linked the Homeless Operations and Management Evaluation System database and VA Corporate Data Warehouse to identify Veterans with complete GPD enrollment and discharge data between 2018 and 2020. We categorized Veterans into three military discharge groups: Honorable, OTH, or Punitive. We evaluated key GPD process and outcomes measures: days enrolled in GPD, use of VA-funded emergency department care while in GPD, and whether a Veteran was successfully discharged from GPD, their housing status at program exit, employment status at program exit, and connection to mental health and substance abuse treatment at discharge. We conducted multivariable regressions to determine the adjusted association (controlling for demographics and comorbidities) between military discharge status and process and outcome measures. Among 21,646 Veterans in the GPD program, 20,517 (95%) were honorably discharged; 811 (4%) had an OTH discharge; and 318 (1%) had a Punitive discharge. There was no difference in GPD length of enrollment by discharge status. Compared to honorably discharged veterans, OTH and Punitive discharged Veterans were less likely to successfully exit GPD, more likely to be homeless and employed at program exit, and were less likely to have a VA-funded emergency department visit while in GPD and less likely to be connected to mental health care or substance use treatment at program exit. The GPD program serves hundreds of homeless Veterans with OTH and Punitive discharges every year, but they seem to be at greater risk for negative health and psychosocial outcomes and do not have the same access to VA services as other Veterans. These findings may inform policy considerations about expanding VA care and opportunities for community providers to serve Veterans with OTH and Punitive discharges.

The need for Hispanic cultural competency in drug abuse treatment training programs: An empirical and ethical evaluation of US universities

Ethical clinical practice requires cultural competency. In the United States, Hispanics report stronger attitudinal barriers to drug abuse treatment than any other racial/ethnic group. Hispanics report feeling that drug abuse treatment providers do not understand their unique cultural needs and are unfamiliar with their experiences of discrimination and immigration. Using this case study to explore broader ethical and policy issues, this study investigates the extent to which US universities train counselors to address the culturally specific needs of Hispanic patients and how this is reflected in practice in Los Angeles County. Based on a content analysis of the required courses, syllabi, and course descriptions at 30 universities related to culture/race/racism/ethnicity/diversity at the undergraduate and graduate levels on the addiction therapist track, and thematic analysis of eight in-depth interviews with counselors working in outpatient rehabilitation centers in Los Angeles, I argue that cultural competency education for drug abuse counselors is too surface level and infrequent to adequately prepare students for a career in addiction counseling for Hispanic clients. Significant changes must be made to how cultural diversity is valued and prioritized in the field of psychology to provide better care for Hispanic people with a substance use disorder and fulfill the moral obligation to eliminate this health disparity. Although this study focuses on counselors in Los Angeles, these findings are relevant for professionals and healthcare systems across the United States and beyond who seek to provide equitable and effective care for Hispanic patients.

“Be All That You Can Be”: The Role of Identity, Pro‐Social Labeling, and Narratives in Veterans Treatment Courts*

Veterans Treatment Courts (VTCs) are one of the ever‐developing brands of specialty or problem‐solving courts that have emerged in recent decades. These courts recognize that the criminal behavior stems from a variety of issues, and that punishment should represent a therapeutic jurisprudential approach in its strategies. As such, VTCs treat substance abuse and mental health issues and address criminality in a manner that recognizes a need for individualized treatment and accountability in structure. This research provides an in‐depth institutional ethnography of one Southern California VTC (SC VTC). To understand the powerful transformative tools of identity and narrative, this research utilized over 3 years of non‐participant observation at 117 court sessions in the SC VTC, and 23 in‐depth interviews with both current court participants and graduates and a judge, exploring participants' experiences with and perceptions of the SC VTC. This study demonstrates the utility of identity‐based narratives to navigate legal systems and potentially desist from crime. These mechanisms of narrative and identity provide a powerful illumination of these courts that have ramifications for successful reintegration into society post‐criminal justice interaction.

Chronopharmacology: Optimizing drug therapy through biological rhythms

Digital therapeutics are evidence-based therapeutic interventions that utilize digital technologies to prevent, manage, or treat medical disorders. These interventions utilize digital technologies such as mobile applications or online platforms to deliver evidence-based therapeutic interventions and treatments for various health conditions. Digital therapeutics undergo rigorous clinical validation and regulatory processes to ensure their safety and efficacy. Digital therapeutics offer several benefits in health care, including improved accessibility, personalized treatment, cost-effectiveness, continuous monitoring and feedback, enhanced patient engagement, scalability, and support for various health conditions. They have practical applications in areas such as psychiatry, drug development, substance abuse treatment, chronic insomnia, Parkinson’s disease, cardiac rehabilitation, and oncology care. Digital therapeutics can significantly improve the quality of life for individuals across different populations by providing tailored interventions for mental health disorders and addressing health conditions related to different age groups. However, challenges to the widespread adoption of digital therapeutics include resistance to change within health-care systems, interoperability issues, privacy concerns, and limited reimbursement policies. Collaboration among health-care providers, regulators, technology developers, and patients is necessary to address these challenges and ensure the safety and effectiveness of digital therapeutics.

Harnessing the healing power of nature: a review of natural interventions in substance abuse treatment and prevention.

Substance abuse is a global problem that cuts across all sectors of society and requires innovative solutions that go beyond conventional treatments. Contact with nature could be a complementary tool to address drug-related problems. This review aimed to assess the impact of natural environments on drug-related outcomes. 8205 articles were screened between 2013 and 2023 from 6 databases, of which 21 met the inclusion criteria. Most studies (12) focused on treatment, followed by incidence/consumption (7), prevention (5) and mortality (1). The main drugs studied were drugs in general (12), followed by alcohol (6), tobacco (6), and other drugs, including cannabis and opioids (4). The results of 85% of the studies showed positive outcomes, supporting the effectiveness of nature-based interventions for drug dependence. While some studies produced neutral or negative results. The use of nature-based interventions for the prevention and treatment of drug addiction shows considerable potential. However, more research is needed to understand the underlying mechanisms and to improve evidence-based interventions. Integrating health and environmental policies is essential to promote a holistic approach to drug strategies at the national and international levels.

Torture and its sequelae among prostituted women in the United States.

Background: Extreme violence and psychological abuse have been extensively documented and are pervasive in prostitution. Survivors of prostitution report high levels of posttraumatic stress disorder, dissociation, depression, and self-loathing. These are the same sequelae reported by torture survivors.Objective: Severe forms of violence have been categorized as torture by experts. The authors note that torture is commonly suffered during prostitution and should be appropriately named.Method: Using standardized measures and including a new measure of torture, we interviewed 45 women in the United States about their torture experiences in prostitution and their symptoms of PTSD, dissociation, childhood trauma, health status and somatic symptoms. The interviewees had exited prostitution and were in supportive programmes.Results: Formerly prostituted interviewees reported acts of physical, sexual, and psychological torture, including strangulation, rape, beatings, restriction of movement, denial of privacy, sleep, or food, and being forced to witness the torture of others. The 45 women had high levels of PTSD and dissociation. They endorsed needs for individual counselling, substance abuse treatment, and other medical care.Conclusions: A recognition of the physical, sexual, and psychological torture experienced in prostitution would strengthen psychological and medical interventions for survivors. Naming specific acts of prostitution as torture will reduce the survivor's shame and self-blame. Holistic treatment includes medical and psychological interventions and peer support, as seen in torture rehabilitation programmes for survivors of state-sponsored torture. This research supports the perspective that private or non-state-sponsored torture against women and marginalized populations should be clinically and legally understood in the same way as state-sponsored torture.

Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs.

Drug overdose deaths among adolescents are increasing in the United States. Residential treatment facilities are one treatment option for adolescents with substance use disorders, yet little is known about their accessibility or cost. Using the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data, we identified 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. We called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose, to inquire about policies and costs. Eighty-seven facilities (54.4percent) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. We were unable to identify any facilities for adolescents in ten states or Washington, D.C. Access to adolescent residential addiction treatment centers in the United States is limited and costly.

The Implementation of Drug Abuse Rehabilitation to Prevent Relapse: A Systematic Literature Review

Rehabilitation is an integrated recovery program for individuals with drug abuse disorders. However, addiction is a chronic and relapsing condition. This study aims to explore how the implementation of rehabilitation programs can prevent relapse in individuals recovering from drug abuse. A systematic literature review methodology was employed in this study. Relevant literature was identified through electronic searches of valid databases using keywords related to drug rehabilitation and relapse prevention. The articles were retrieved and screened using the Watase UAKE website. Databases including MDPI, Frontiers Media, ScienceDirect, Elsevier, SAGE, OAMJMS, Mary Ann Liebert, BMC, Routledge, Springer, Emerald Insight, EASA, and Informa Healthcare were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), excluding meta-analysis, to obtain empirical studies published between 2014 and 2024. Out of the 489 articles collected, 27 were included in the analysis. The results showed that the successful implementation of drug rehabilitation programs is influenced by various factors, including intrinsic motivation, social support, and fulfillment of psychological needs during the rehabilitation process. Rehabilitation programs can shift clients’ perspectives, enabling a better understanding of life’s values and meaning. This is essential for relapse prevention after rehabilitation. Additionally, relapse prevention programs play a critical role in enhancing the effectiveness of rehabilitation efforts. While many factors contribute to relapse, therapeutic interventions are important for predicting retention in therapeutic communities for substance abuse treatment.

Substance abuse among new patients attending main government hospitals in Malaysia from 2018-2021: A comparison between before and during COVID-19 pandemic.

Substance abuse admission to health facilities following the pandemic is often met with challenges. COVID-19 is causing an insurmountable psychosocial impact on the whole of mankind. Marginalized communities, particularly those with substance use disorders (SUDs), are also likely to suffer from greater psychosocial burden. This study sought to evaluate substance abuse trends before and during the pandemic. A cross-sectional study was conducted among patients attending selected government hospitals in Malaysia. Data from the year 2018 to 2021 was utilized. A total of 9,606 patients consisting of 7881 males and 1725 females were identified. Most of the patients involved with substance abuse from 2018 to 2021 were males, aged between 26 and 44 years old, Malays, high school students, singles, workers of private sectors and those residing in urban areas. The most abused substances over the four years were tobacco (61.8%), followed by amphetamine-type stimulants (ATS) (43.1%), alcohol (39.7%), cannabis (17.2%), opioids (13.0%), and kratom (8.8%). Those who worked in the private sector and were self-employed or unemployed were more associated with substance abuse during the pandemic compared to those who worked in the government sector. Those with a history of psychiatric illness were more associated with abuse of substances during the pandemic than those without the history (adjusted OR: 1.18, 95% CI 1.09-1.29, p <0.001). Targeted exploration of factors affecting substance abuse in Malaysia is essential. The results of this study assist in identifying variations in substance abuse treatment characteristics for those admitted to treatment in Malaysia.

Relationship Between Mental Health Literacy Level and Treatment Motivation in Alcohol and Drug Addicts

The primary objective of this research is to explore how the level of Mental Health Literacy influences the motivation for treatment among individuals dealing with alcohol or substance addiction. The study involved 128 subjects undergoing inpatient treatment at the Alcohol and Substance Abuse Treatment Center. To gather data, researchers utilized a Personal Information Form, Mental Health Literacy Scale, and Treatment Motivation (TM) survey. The scores obtained from the Treatment Motivation Questionnaire and Mental Health Literacy Scale were 94.21±12.2 and 108.03±11.7, respectively. The analysis revealed a statistically significant, albeit weak, positive correlation between the participants' Mental Health Literacy Scale-Knowledge of How to Seek Mental Health Information subscale mean score and both their total Treatment Motivation Questionnaire score and their Interpersonal Help-Seeking subscale mean scores (r=0.284). Conversely, a statistically significant weak negative correlation emerged between the participants' Mental Health Literacy Scale-Knowledge of Professional Help Available subscale mean score and their Treatment Motivation Questionnaire-Distrust in Treatment subscale mean score (r=−0.230). Conclusions drawn from the study indicate that a lack of knowledge regarding addiction and accessing professional assistance, coupled with concerns surrounding stigma, pose as significant barriers to motivation for seeking treatment.

Efficacy of Tramadol V/S Paroxetine for the Management of Premature Ejaculation Patients

Background: Premature ejaculation (PE) is a common sexual dysfunction in men, impacting relationships and quality of life. Current treatments include selective serotonin reuptake inhibitors (SSRIs) and opioid receptor agonists, but their comparative efficacy is not well-established. Objective: To compare the efficacy of tramadol (an opioid receptor agonist) with paroxetine (an SSRI) in the treatment of PE. Methods: This randomized control trial was conducted at Jinnah Postgraduate Medical Center, Karachi, from October 2020 to April 2021. Male patients aged 18-55 years, diagnosed with PE, were included. Exclusion criteria were erectile dysfunction, substance abuse, psychiatric illnesses, and ongoing PE treatment. Participants were divided into two groups: one receiving tramadol and the other paroxetine, taken 2-4 hours before intercourse. Efficacy was measured using Intravaginal Ejaculation Latency Time (IELT) over a six-week period. Data were analyzed using SPSS version 21, with a p-value of &lt;0.05 considered significant. Results: 200 participants were included, with 100 in each treatment group. Tramadol showed a higher efficacy (89% efficacy) compared to paroxetine (73% efficacy), with a significant p-value of 0.004. Stratified analyses by age, BMI, and duration of relationship also indicated higher efficacy for tramadol across different subgroups. Conclusion: Tramadol demonstrated superior efficacy in delaying ejaculation compared to paroxetine in the treatment of PE. These findings suggest that tramadol may be a more effective alternative for PE management, although further research is needed to confirm these results and explore long-term outcomes.

TEACHING ABOLITIONIST GERONTOLOGY IN INTERDISCIPLINARY LEARNING SPACES

Abstract The discourse surrounding population aging has now infiltrated prisons, jails, and the ‘institutional circuit’ of homeless services, mental health systems, substance abuse treatment, and safety-net healthcare. Students of gerontology must be prepared to consider the experiences of people most affected by the criminal-legal apparatus. Conversely, those training to be social service and healthcare professionals within and in opposition to these systems must be prepared to. Through a conceptual review of the literature and experiential knowledge gathered through curriculum design and implementation, this presentation will outline a pedagogical framework for understanding the effects of transcarceration across the life course and in later life. This framework will be presented in conjunction with tools and strategies for guiding and enhancing interdisciplinary dialogue about the intersections of eldercare and punishment. This presentation will prompt discussion on the responsibilities of aging care providers and gerontological researchers in realizing an abolitionist future.

OLDER ADULT SUBSTANCE USE DISORDER TREATMENT LANDSCAPE 2020: CLIENT-LEVEL AND FACILITY-LEVEL FACTORS

Abstract Older adult substance use disorders (SUD) care requires specialized clinical practice. This poster reviews two datasets to emphasize client-level and facility-level factors (overall and state-by-state) relevant to older adult treatment programming, co-occurring disorders care, and days waiting for admission to treatment. The 2020 data from the National Survey of Substance Abuse Treatment Services (N-SSATS), administered by The Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, collects data from public/private SUD treatment facilities in the United States. Data from 16,066 facilities demonstrated only 24.7% of all facilities reported programming tailored for older adult care, with state-by-state analysis showing a range of 4.6% to 61.4% of treatment programs reporting older adult tailored care. The deficits of older adult programming availability are explained against the context of the 2020 Treatment Episode Dataset-Admissions (TEDS-A), administered by the CBHSQ, that examines admissions data from all 50 states, as well as the District of Columbia, U.S. territories, and Compact of Free Association (COFA) partners. The TEDS-A data consisted of 1,416,357 admissions, of which 11.8% (n=167,200) were aged 55 years-old or older. Of this older adult sample, 32.8% reported a co-occurring SUD and mental health disorder and 13.9% reported some number of days waiting to enter treatment. These (and other) client-level and facility-level factors (overall and state-by-state) will be used to emphasize specific needs for older adult SUD care.

Drug transactions and the dark web: Public perceptions of the locational setting of offenders and support for drug policy outcomes

BackgroundBoth legal and extra-legal factors influence judicial and non-judicial opinions about persons who use drugs. Yet, how the locational setting of drug transactions influences public perceptions of drug control policies remains understudied. In particular, the public's view of drug exchanges on the dark web could directly and indirectly influence drug policy, legal decision making, and spending decisions. The study's aim is to identify whether the location of a drug exchange, specifically the dark web, influences public preferences for drug policy and police resourcing. MethodsA sample (n = 1359) from the United States of America was recruited and participated in a discrete choice experiment. The participants compared and repeatedly chose across five iterations between two drug offender profiles with nine set features, such as the location of drug transactions, all with randomized levels. The resulting sample included a total of 13,590 contest pairs. ResultsAveraging over the non-locational attributes, respondents indicated that, compared to the dark web, several locational settings for drug exchange (such as the street corner, social media, and an unknown location) needed fewer police resources and offenders were less deserving of longer punishments. No statistically significant difference was found for opinions about harm to communities, and offenders involved in drug exchanges on university campuses were considered more deserving of a substance abuse treatment program than offenders on the dark web. ConclusionThere appears to be a preference for more punitive criminal justice policies for drug transactions occurring on the dark web relative to some other common settings. Such preferences may indicate a novelty effect driven by negative sentiment surrounding the dark web or a perceived deficit in the police's ability to deal with drug crimes on the dark web. These findings suggest that the public may prefer supply-side policing efforts over demand-side policies, which emphasizes harm reduction.

Opioid, cannabinoid, cocaine, and methamphetamine epidemics: History, risk factors associated with them, and characteristics of drug action

In the last century, mankind has made significant progress in the search and study of new pain-relieving drugs through the targeted synthesis of chemical analogs of natural opioids, cannabinoids, cocaine, and amphetamines. Experience with the medical use of new synthetic opioids, cannabinoids, and amphetamines has shown not only their high analgesic efficacy but also their high danger because of the risks of drug dependence and addiction, which have caused drug epidemics. The paper described the history of relevant drug epidemics, and the pharmacodynamics and pharmacokinetics of the most dangerous drugs, as well as the risks associated with drug epidemics, were outlined. Specifically, the risk of drug dependence to opioids, cannabinoids, amphetamine, and cocaine was not recognized until too late. Therefore, the drug crisis was initially largely iatrogenic. In recent decades, controls on the prescription of narcotic drugs have tightened; thus, drug addiction as iatrogeny occurs less frequently. However, criminal elements of society have established clandestine production of drugs and their realization in the youth and LGBT community disguising as new, fashionable designer drugs and devices for their use. Moreover, new synthetic drugs differ from natural drugs in their stronger psychostimulant effects, ability to cause addiction after the first use, and high risk of fatal poisoning. Thus far, no drugs were the treatment of opioid, cannabinoid, amphetamine, and cocaine abuse. However, the development of specific vaccines for these drugs has begun in recent years. Active immunization of drug abusers with specially created vaccines is expected to assist doctors in treating drug abusers in the future.

Adoption of Electronic Health Record Among Substance Use Disorder Treatment Programs: Nationwide Cross-Sectional Survey Study.

Electronic health record (EHR) systems have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment and is considered important for addressing SUD crises, including the opioid epidemic. However, little is known about the adoption of EHR in SUD treatment programs or the organizational-level factors associated with the adoption of EHR in SUD treatment. We examined the adoption of EHR in SUD programs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors associated with EHR adoption. We used data from the 2014 and 2017 National Drug Abuse Treatment System Surveys. Our analysis included 1027 SUD programs (531 in 2014 and 496 in 2017). We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics. We also investigated differences in characteristics and barriers to adoption by EHR adoption status (adopted EHR vs had not adopted or were planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption. The adoption of EHR increased significantly from 57.6% (306/531) in 2014 to 69.2% (343/496) in 2017 (P<.001), showing that nearly one-third (153/496, 30.8%) of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use and ownership by a parent company (P=.01 and P<.001) and a decrease in the percentage of uninsured patients in 2017 (P<.001), compared to 2014. Our analysis further showed significant differences by adoption status for three major barriers to adoption: (1) start-up costs, (2) ongoing financial costs, and (3) privacy or security concerns (P<.001). Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95% CI 2.23-4.09) and billing systems (AOR 2.29, 95% CI 1.62-3.25) were more likely to adopt EHR. Similarly, ownership type, such as private nonprofit (AOR 1.86, 95% CI 1.31-2.65) and public (AOR 2.14, 95% CI 1.27-3.67), or interest in participating in a patient-centered medical home (AOR 1.93, 95% CI 1.29-2.92), were associated with an increased likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014 (AOR 1.44, 95% CI 1.07-1.94). Our findings highlighted that SUD programs may be on track to achieve widespread EHR adoption. However, there is a need for focused strategies, resources, and policies explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic and address factors at multiple organizational levels.

Introduction of Medicare coverage in opioid treatment programs: Findings from the first three years

BackgroundPrior to January of 2020, there was no Medicare reimbursement for services delivered in opioid treatment programs (OTPs). OTPs are the only authorized providers of opioid use disorder (OUD) treatment with methadone, a critical tool to address the opioid overdose crisis. While prior research has examined the availability of MOUD other than methadone for Medicare beneficiaries, research has not identified organizational and local Medicare beneficiary characteristics associated with Medicare insurance acceptance among OTPs. ObjectivesThis study has two objectives: 1) to determine the extent to which OTPs began accepting Medicare insurance in the first three years following the new Medicare OTP benefit; and 2) to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare. MethodsWe used data from the 2021–2023 National Directory of Drug and Alcohol Abuse Treatment Facilities to examine OTP acceptance of Medicare. We used logistic regression to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare (n = 4630 OTPs). ResultsBy 2022, about 78.7 % of OTPs accepted Medicare, compared to only 41.1 % of non-OTPs. The odds of Medicare acceptance were lower among for-profit OTPs, compared to non-profit OTPs, and higher among OTPs that accepted Medicaid and private insurance. Additionally, the odds of accepting Medicare were lower for OTPs located in the Northeast, Midwest, and South, compared to OTPs located in the West. Finally, the odds of accepting Medicare were higher for OTPs located in counties with higher percentages of Non-Hispanic White Medicare beneficiaries. ConclusionsWe found high rates of Medicare acceptance among OTPs in the first three years of the Medicare OTP benefit, suggesting increased access to OUD treatment via OTPs for Medicare beneficiaries. While promising, results indicate potential geographic and racial/ethnic disparities in access to OTPs.

Peer Support Services in Behavioral Health Facilities: Secondary Analysis From Two National Surveys.

Peer support providers are part of the behavioral health workforce. Research indicates that peer support helps care recipients achieve recovery and engage with behavioral health services. This article investigated how many U.S. behavioral health facilities offer peer support services and compared the frequencies of peer support services in facilities providing mental health and substance use services. The authors conducted a secondary analysis of facilities in the Substance Abuse and Mental Health Services Administration's National Mental Health Services Survey (N=11,582) and the National Survey of Substance Abuse Treatment Services (N=13,585), including descriptive and comparative analyses on reported mental health and substance use treatment services in the 50 U.S. states in 2017. The findings revealed state-to-state variation in the number and availability of mental health and substance use service facilities and in facilities that reported providing peer support services. Facilities providing substance use treatment services offered peer support services at more than twice the rate (56.6%) found in mental health facilities (24.7%). The authors also identified program characteristics associated with the inclusion of peer support services in behavioral health. Provision of peer support services was more frequently reported by public facilities than by for-profit and nonprofit facilities. Behavioral health facilities that serve individuals with serious mental illness and co-occurring substance use and mental health conditions reported offering peer support at a higher rate than did other facilities. Inconsistent definitions of peer support in the two surveys limited the comparability of the findings between the two reports.

State and Service Estimates of Substance Use Treatment Facilities That Receive Public Funds in the United States.

The Treatment Episode Data Set (TEDS) is a publicly available national dataset provided annually by the Substance Abuse and Mental Health Services Administration. TEDS contains sociodemographic and clinical characteristics of treatment episodes in substance use treatment facilities that receive public funds. Yet little is known about what proportion of facilities across states/jurisdictions and services/settings receive public funds to assist with interpreting TEDS. This study uses the National Survey of Substance Abuse Treatment Services 2020. Descriptive statistics were used to estimate percentages of facilities that receive public funds at national and state/jurisdiction levels across all services/settings. In the full sample, 51.4% (n = 8262) of facilities received public funds, and in the sample of states/jurisdictions included in TEDS 2020 data, 52.3% (n = 7659) of facilities received public funds. Across services/settings, the proportion of facilities receiving public funds ranges from 27.1% in rehab/residential, hospital (non-detox) settings to 58.0% in rehab/residential, short-term (30 days or fewer) services/settings. Variability was also identified within states and services/settings from 0.0% to 100.0% of facilities that receive public funds. This study estimates the proportions of substance use facilities that receive public funds to guide interpretations of TEDS. This study's findings, combined with TEDS, may assist advocates, clinicians, policymakers, researchers, service providers, service recipients, and other key stakeholders in reaching a shared goal: improving the well-being of individuals living with substance use disorders.

Communicating about online health information with patients: Exploring determinants among telemental health providers.

To investigate determinants of telemental health (TMH) providers' openness to discuss and confidence to use online mental health information with patients, focusing on providers' eHealth literacy and perceived usefulness of online MH information. TMH providers (N=472) completed a web-based survey with questions about discussing and using online health information with patients, perceived usefulness of the Internet as a source of patient information, and eHealth literacy. Providers were open to discussing online health information with patients if they were not treating substance abuse disorders (b=-0.83), felt the Internet was a useful resource (b=0.18), and felt confident in their skills to evaluate the online information (b=0.21). Providers were confident using online health information if they worked in a small clinic (b=0.37), felt the Internet was a useful resource (b=0.31), knew where to access relevant online health information (b=0.13), and had skills to help their patients find (b=0.17) and evaluate (b=0.54) online information. TMH providers are likely to use online health information resources if they know where and how to find them and perceive the Internet as a useful resource. To effectively discuss online health information with patients, providers require skills to evaluate the information with patients.