Treatment For Substance Use Problems Research Articles

Development of a brief inpatient curriculum to enhance trainee skills in assessment and treatment of adolescents with substance use and co-occurring mental health problems

Background Adolescence is a critical period for substance use intervention, yet few youth receive evidence-based treatment for both co-occurring substance use and mental health problems. Gaps in professional training limit adequate assessment and treatment of substance use problems among youth receiving psychiatric treatment. Methods We developed a two-session curriculum, integrated into a child/adolescent psychiatry inpatient rotation, to improve knowledge and skills in evidence-based practices for screening, brief intervention, psychoeducation, and care coordination, among multidisciplinary mental health clinicians. A pre/post survey evaluated perceived helpfulness, confidence in clinical skills, and intentions to engage in evidence-based practices. Results Trainees perceived the content as helpful and reported significant increases in confidence and intention to engage in the targeted evidence-based practices. Conclusions Implementation of a brief, focused, skills-based curriculum in clinical settings can effectively introduce trainees to core concepts not currently adequately covered in existing curricula.

Reliability of online self-report versions of the Australian Treatment Outcome Profile (ATOP) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) among people in residential treatment for substance use problems

BackgroundOnline self-report measures are resource-efficient and widely used for monitoring substance use, yet few studies have assessed their reliability. This study assessed the reliability of online self-report versions of the Australian Treatment Outcomes Profile (ATOP) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) among people seeking treatment for substance use problems. ProceduresOne-hundred and five clients entering residential treatment for substance use problems (Mage = 33.34, 65% male) were recruited from two facilities in Queensland, Australia. Using a repeated-measures design, we compared online self-report with the original interview versions of the ASSIST, which measured (i) lifetime substance use and (ii) past 3-month substance-use and related harms, and the ATOP, which measured (i) past month frequency of substance use and (ii) the typical quantity used per day. Assessments were administered 1–7 days apart. FindingsThe ATOP demonstrated moderate-excellent inter-rater reliability for the past month use (yes/no) for all substance types, but had poor reliability for alcohol and cannabis. ATOP reliability was high-excellent for the total number of days used in the past month for all substances. The ASSIST demonstrated moderate-excellent inter-rater reliability for substance-use and related harms for all substances except tobacco, however was poor for lifetime use for most substances due to greater reporting in the interview assessment. ConclusionsReliable responding was observed for the frequency of substance use in the past month on the ATOP, and past 3-month substance-use and related harms on the ASSIST. These findings support use of online-self report measures a resource-efficient method to monitor substance use. Underreporting of lifetime use was found in self-report online version of the ASSIST, highlighting the need for improved instruction or interviewer/clinician assistance for lifetime use.

Long-Term Outcomes for Young People With Substance Use Problems in Outpatient Treatment: Gender-Specific Patterns.

This study presents the results of a longitudinal research project focusing on long-term outcomes among young people after initiation of outpatient treatment for substance use problems (SUP) in Sweden. Young people are defined with the age group 13–25 years. A clinical sample of 451 young people (29% girls, median age 17 years) completed a structured interview at baseline and was followed using official records one, two, and 3 years after initiation of treatment. Gender-specific patterns at intake were described and bivariate associations and logistic regressions were calculated to analyse the links between risk factors at treatment start and indications of substance use problems 3 years later. Significantly more boys than girls displayed indications of continued SUP at 3-year follow-up. More specifically, 49% of the boys vs. 35% of the girls were identified through records as still having problems with substance use. Predictive risk factors also displayed gender-specific patterns. Primary drug use frequency and age at intake predicted indications of SUP among boys but not among girls. Placement in foster care/residential homes, depression, and early drug debut had significant predictive value regarding indications of SUP among females but not among males. Girls also displayed a greater psychosocial burden at treatment start, but a more favorable treatment outcome at follow-up. Youths with a heavy risk load at treatment start (i.e., over six risk factors) did not display a greater risk of SUP at 3-year follow-up, although our results suggest that this subgroup has indications of continued problems with mental health. Consequently, future studies should further explore gender-specific treatment pathways for young people with substance use problems. Since women and girls seem to have different risk factors, co-occurring psychiatric problems and more experiences of trauma compared to men, they might need multidimensional and more comprehensive treatment interventions that run over a longer period of time.

Mapping, assessing and promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems.

Aim:The recent nationally implemented clinical pathways for the treatment of substance use problems in Norway require mapping and assessing of patients’ needs, challenges, and resources. However, there is a lack of tools for systematically mapping and assessing patients’ social situations and social networks as part of the national guidelines. The aim of this article is to present a tool developed to map and assess the patient’s social situation, and to propose approaches for promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems.Methods:The proposed tool and approaches are developed based on findings in a previous in-depth collaborative study of MPSOC and recovery among people with substance use problems who received help and services from Norwegian municipalities.Findings:The findings suggest that multiple communities (geographical, relational and ideal) and senses of communities (within and outside treatment) simultaneously can influence individual recovery processes from problematic substance use in both positive as well as negative ways. As such, these community dimensions are of central importance to include in mapping and assessing of patients’ social situations, as well as in the promotion of MPSOC through clinical pathways.Conclusions:The suggested tool and approaches can increase the likelihood of achieving key aims of the national clinical pathways. Most important, mapping, assessing and promoting MPSOC through clinical pathways may promote long-term recovery processes and positive recovery capital for persons with substance use problems.

Fear of Stigma Mediates the Relationship between Internalized Stigma and Treatment-Seeking among Individuals with Substance Use Problems

ABSTRACT Background Despite the high prevalence and significant health consequences of substance use disorders, rates of treatment seeking are low. Identifying as an “addict” caries a mainstream connotation that the individual is blameworthy, which contributes to unique stressors and stigma that shape how they are viewed and treated. While substantial literature demonstrates this stigmatizing perspective may serve as a barrier to treatment-seeking, other studies present discrepant findings. The current study seeks to examine the role of fear of stigma and anticipation of being stigmatized in the relationship between internalized stigma and help-seeking for substance use disorders. Objective We examined substance use-related stigma, fear of stigma, and treatment-seeking behaviors in a national sample of young adults with a history of problematic substance use. Methods Participants (N = 171) completed an online, anonymous survey. Results When controlling for enacted stigma and severity of alcohol and other drug use problems, more fear of stigma significantly mediated the relationship between higher internalized stigma and more help-seeking intentions. The sequentially mediated paths between internalized stigma and both help-seeking intentions and previous behaviors through fear of stigma and anticipated stigma were not significant. Conclusions Findings highlight the importance of fear of substance-related stigma as one mechanism by which internalized stigma may motivate individuals to seek treatment for substance use problems.

Use of Amphetamine-Type Stimulants Among Emergency Department Patients With Untreated Opioid Use Disorder

Concurrent use of amphetamine-type stimulants among individuals with opioid use disorder can exacerbate social and medical harms, including overdose risk. The study evaluated rates of amphetamine-type stimulant use among patients with untreated opioid use disorder presenting at emergency departments in Baltimore, MD; New York, NY; Cincinnati, OH; and Seattle, WA. Emergency department (ED) patients with untreated opioid use disorder (N=396) and enrolled between February 2017 and January 2019 in a multisite hybrid type III implementation science study were evaluated for concurrent amphetamine-type stimulant use. Individuals with urine tests positive for methamphetamine, amphetamine, or both were compared with amphetamine-type stimulant-negative patients. Overall, 38% of patients (150/396) were amphetamine-type stimulant positive; none reported receiving prescribed amphetamine or methamphetamine medications. Amphetamine-type stimulant-positive versus -negative patients were younger: mean age was 36 years (SD 10 years) versus 40 years (SD 12 years), 69% (104/150) versus 46% (114/246) were white, 65% (98/150) versus 54% (132/246) were unemployed, 67% (101/150) versus 49 (121/246) had unstable housing, 47% (71/150) versus 25% (61/245) reported an incarceration during 1 year before study admission, 60% (77/128) versus 45% (87/195) were hepatitis C positive, 79% (118/150) versus 47% (115/245) reported drug injection during 1 month before the study admission, and 42% (62/149) versus 29% (70/244) presented to the ED for an injury. Lower proportions of amphetamine-type stimulant-positive patients had cocaine-positive urine test results (33% [50/150] versus 52% [129/246]) and reported seeking treatment for substance use problems as a reason for their ED visit (10% [14/148] versus 19% [46/246]). All comparisons were statistically significant at P<.05 with the false discovery rate correction. Amphetamine-type stimulant use among ED patients with untreated opioid use disorder was associated with distinct sociodemographic, social, and health factors. Improved ED-based screening, intervention, and referral protocols for patients with opioid use disorder and amphetamine-type stimulant use are needed.

&lt;p&gt;Gender Differences in Problem Gamblers in an Online Gambling Setting&lt;/p&gt;

BackgroundProblem gambling traditionally is markedly more common in men than in women. However, recent data in online gamblers have indicated at least a comparable risk of problem gambling in women in this sub-group. The present study aimed to compare the characteristics of male and female moderate-risk and problem gamblers in online gamblers in Sweden.MethodsIn a web survey addressing online gamblers (past-year online gambling on 10 or more occasions), women and men with moderate-risk or problem gambling (n=327) were compared with respect to gambling severity, financial consequences, comorbidity, socio-demographic characteristics, and fulfilled screening items.ResultsFemale gender was associated with psychological distress, over-indebtedness, higher problem gambling severity and with screening items indicating financial consequences and guilt, with no gender difference for the self-reported need to seek treatment for substance use problems. In the sub-group of problem gamblers, female gender remained associated with psychological distress.ConclusionIn a setting displaying high rates of online gambling and novel findings of a higher risk of problem gambling in women than previously seen, psychological distress appears to separate female and male problem gamblers. Given the higher level of severity and financial consequence, these findings call for screening and early intervention in female at-risk gamblers.

Mental health problems among young people in substance abuse treatment in Sweden

BackgroundYoung people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity.MethodsThe study is based on structured interviews with 1970 young people enrolled at outpatient clinics in 11 Swedish cities. The data was analysed through frequency- and averages-calculations, Chi-square tests and multivariate logistic regression analyses.ResultsSelf-reported mental health problems were common among the young people in the study. A relatively large percentage of the total group (34–54%) reported problems such as concentration difficulties, sleeping difficulties, anxiety and depression. At the same time, many of the young people did not report any symptoms and only a small group, about 20%, reported diagnosed mental health disorders. The results show substantial gender differences, with girls reporting significantly higher levels of mental health problems.Multivariate logistic regression analyses demonstrated significant associations between severity of drug use problems and anxiety, concentration difficulties, aggression, hallucinations and mental stress caused by experiences of trauma.ConclusionsTreatment needs are diverse within this group of young people who use drugs. Since girls report higher levels of all mental health problems, and a larger burden of psychosocial risk factors than boys, they are likely to require more comprehensive treatment interventions. The link between more severe drug problems and mental health problems points to the importance of exploring this relationship in treatment. A multidisciplinary approach, in which co-occurring problems can be addressed simultaneously, may be the best treatment form for many young people with drug problems.

General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

BackgroundIn Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP), and at higher, specialist care levels by the Treatment Demand Indicator (TDI) surveillance. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving concurrent specialist treatment compare to those who did.MethodsBoth surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on individuals starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression.ResultsAccording to TDI-data (n = 16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13–1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15–1.41), recent employment (OR 1.71; 1.56–1.88), recent stable accommodation (3.62; 95% CI 3.08–4.26), first treatment episode (OR 1.72; 95% CI 1.57–1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33–1.59) and mono substance use (OR 1.23; 95% CI 1.04–1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04–1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62–0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n = 314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36–4.91), first treatment episode (OR 2.78; 95% CI 1.39–5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06–3.66).ConclusionsThis study provides a useful insight into the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.

Substance use among treatment seeking Indian adolescent girls: Are they unique?

Substance use among adolescents is on the rise across the globe along with a diminution of gender gap observed earlier posing a huge public health burden. Unfortunately, there is a paucity of literature on adolescent substance use. The literature is even sparse about substance use among adolescent girls. The current study aims to provide a glimpse of the profile and pattern of substance use among Indian adolescent girls seeking treatment for substance use problems in a specialty addiction treatment centre in India. This study is retrospective in design. Information regarding socio-demographics and substance use were extracted from the medical records of adolescent girls (≤ 19 years) who sought treatment for substance use problems during 2004-2018, at the adolescent clinic of a tertiary addiction treatment centre located in north India was retrieved carried out. The data was statistically analysed using SPSS. A total of 28 girls sought treatment during this period. The mean age of the girls was 15.89 ± 2.72 years. Most of the girls were students (6/28) or had never started working (12/28). Majority of them were coming from an urban background (89.3%) and were educated up to 10th class (85.5%). A total of 17 (60.7%) girls sought treatment for opioids use of which 11 were using illicit opioids like heroin and five (29.9%) of them reported taking opioids by injecting route primarily. History of past abstinence attempts, and treatment attempt were present in very few of them (10.7% and 14.3%). Our study suggests a distinct substance use profile of adolescent girls. There is a need for further systematic studies to assess their clinical needs.

Nonmedical Use of Stimulants Is Associated With Riskier Sexual Practices and Other Forms of Impulsivity.

Background:This study sought to examine the occurrence of the nonmedical use of prescription stimulants (amphetamines and methylphenidate) in a university sample and their associated physical and mental health correlates, including potential relationships with risky sexual practices.Methods:A 156-item anonymous online survey was distributed via e-mail to a sample of 9449 university students. Current use of alcohol and drugs, psychological and physical status, and academic performance were assessed, along with questionnaire-based measures of impulsivity and compulsivity.Results:A total of 3421 participants (59.7% female) were included in the analysis. 6.7% of the sample reported current/recent nonmedical use of prescription stimulants, while an additional 5.8% reported misuse in the past. Nonmedical use of prescription stimulants was associated with lower grade point averages, and with taking a broad range of other drugs (including alcohol, nicotine, illicit substances, and consumption of caffeinated soft drinks). Nonmedical use of stimulants was also significantly associated with impulsivity (Barratt scale), prior treatment for substance use problems, and elevated occurrence of disordered gambling, post-traumatic stress disorder, and anxiety; but not depression symptoms or binge-eating disorder (though it was associated with using drugs to lose weight). The relationship with probable attention-deficit/hyperactivity disorder (ADHD) on screening was not significant but was numerically elevated. Finally, those using nonmedical prescribed stimulants were significantly more sexually active (including at a younger age), and were less likely to use barrier contraception.Conclusions:Nonmedical use of prescription stimulants is common in young adults and has profound public health associations including with a profundity of other drug use (licit and illicit), certain mental health diagnoses (especially gambling, anxiety, and post-traumatic stress disorder ), worse scholastic performance, and riskier sexual practices. The majority of people with nonmedical use of prescription stimulants do not have ADHD, and its link with current ADHD symptoms was less marked than for certain other disorders. Clinicians should screen for the misuse of prescription stimulants as they may be associated with a range of problematic behaviors. Risk of diversion (which may be higher for those living in shared accommodation and those with substance use disorder history) merits careful assessment before prescribing stimulant medication.

Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users

Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identify risk factors for first-onset SI among a high-risk group: individuals receiving treatment for substance use disorders. Data were drawn from the National Treatment Improvement Evaluation Study, a prospective study examining the impact of addiction treatment programs. Patients with no lifetime history of suicide attempts or ideation (n = 2560) were assessed at baseline and one year later for prospectively-occurring SI. Sociodemographic variables, mental health indices, interpersonal factors, and substance use severity indicators were evaluated as prospective predictors of first-onset SI in linear regression models. Current mental health problems (OR = 1.54, 95% CI = 1.19–2.01), current substance use problems (OR = 1.33, 95% CI = 1.04–1.70), and difficulty accessing treatment for substance use problems (OR = 1.90, 95% CI = 1.16–3.11) emerged as significant predictors of first-onset SI in a multivariate analysis, suggesting that individuals with current mental health or substance use related symptoms are among the most at risk for developing SI. Difficulty obtaining treatment remained significant, highlighting the importance of treatment accessibility. Future clinical work and research would benefit by addressing these issues, potentially by focusing on mental health treatment in substance abuse programs and evaluating barriers to treatment.

Factors associated with retention in faith-based drug treatment centers in the Mexican-American border

Introduction. Faith-based centers are major providers of residential treatment for substance use problems in Mexico, but relatively few studies have been conducted in this context. Objective. To explore factors associated with treatment retention in two faith-based (with different religious orientation) residential treatment facilities for male drug users in Tijuana, Mexico. Method. We conducted an exploratory follow-up study of 328 clients admitted during 2014-2015 to either an Evangelical Pentecostal center or a faith-based center without a specific religious affiliation. The main outcome was retention, defined as remaining in treatment for at least three months. Results. Among participants, the retention rate was 38.7%. Multivariate logistic regression models showed that age (OR 1.04; 95% CI [1.01, 1.06]; p = .002) and having used heroin or opioids in the past 30 days (OR .50; 95% CI [.25, 1.00]; p = .049) were associated with retention. Having a personal religious affiliation was associated with retention in the Evangelical Pentecostal center, but not in the center without a specific religious affiliation. Discussion and conclusion. The retention rate was low, but within the previously reported range. The interaction of personal religious affiliation and the religious orientation of the center suggests that a match between a person’s religious convictions and those of the center could be important for retention. More research is needed to clarify the utility of faith-based centers for religious and non-religious drug users.

Prevalence of nonmedical use and routes of administration for prescription stimulant medications among adults in a substance abuse treatment population

The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV®) as part of the clinical intake process between January 2013 and March 2016. A cross-sectional observational study examined prevalence and prescription-adjusted prevalence of past 30-day NMU of prescription stimulants and compound-specific use by ROA (oral, snort, smoke, inject, other oral, and alternate ROA). Compounds of interest were amphetamine extended-release (ER), amphetamine immediate-release (IR), amphetamine mixed salts, methylphenidate ER, and methylphenidate IR. Of 198,411 respondents, 4,185 reported prescription stimulant NMU, prevalence ranged from 0.33% for methylphenidate IR to 1.61% for amphetamine mixed salts. Prescription-adjusted prevalence of NMU was highest for methylphenidate IR (0.51%) and lowest for amphetamine ER (0.28%). The most common ROA was oral, swallowed whole followed by snorting. There was a greater probability of nonmedical prescription stimulant use among respondents with higher drug severity ratings. Results suggest that one should not overlook the impact of prescription stimulant NMU in adults in treatment for substance use problems. NMU of prescription stimulants was associated with riskier routes of administration than reported for college student samples. A pattern of high-risk alternate ROA and increasing drug problem severity has important implications of substance use evaluation.

Why can’t patients last the wait?

One million people in North America are currently waiting for publicly funded substance use treatment. Unfortunately, long waiting times have been listed as the number one reason for not seeking treatment for substance use problems. While it is possible that successful abstinence during the waiting period convinces patients that they do not need treatment at all, more emphasis must be placed on interventions that can bridge the gap between initial contact by patients for substance use treatment and treatment intake. Recommendations in this review include: (1) decreasing the length of time between a patient’s initial contact for treatment and the pre-intake interview, (2) initiating regular phone contact with patients, and (3) decreasing resentful demoralization in patients who are ready for change but who are forced to wait for treatment.

Stigma and Self-Stigma in Addiction

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

Interactive Voice Response with Feedback Intervention in Outpatient Treatment of Substance Use Problems in Adolescents and Young Adults: A Randomized Controlled Trial

PurposeSubstance use disorders and problematic substance use are common problems in adolescence and young adulthood. Brief personalized feedback has been suggested for treatment of alcohol and drug problems and poor mental health. This repeated measurement randomized controlled trial examines the effect of an interactive voice response (IVR) system for assessing stress, depression, anxiety and substance use.MethodsThe IVR system was used twice weekly over 3 months after treatment initiation, with or without addition of a personalized feedback intervention on stress and mental health symptoms. Both IVR assessment only (control group) and IVR assessment including feedback (intervention group) were provided as an add-on to treatment-as-usual procedures (TAU) in outpatient treatment of substance use problems in adolescents and young adults (N = 73).ResultsBy using a mixed models approach, differences in change scores were analyzed over the three-month assessment period. Compared to the control group, the intervention group demonstrated significantly greater improvement in the Arnetz and Hasson stress score (AHSS, p = 0.019), the total Symptoms Checklist 8 score (SCL-8D, p = 0.037), the SCL-8D anxiety sub-score (p = 0.017), and on a summarized feedback score (p = 0.026), but not on the depression subscale. There were no differences in global substance use scores between the intervention group (feedback on mental health symptoms) and the control group.ConclusionIn conclusion, IVR may be useful for follow-up and repeated interventions as an add-on to regular treatment, and personalized feedback could potentially improve mental health in adolescents and young adults with problematic substance use.

General practice patients treated for substance use problems: a cross-national observational study in Belgium.

BackgroundGeneral Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems.MethodsObservational study by the Belgian Network of Sentinel General Practices (SGP) in 2013. Baseline (at the first encounter) and 7-month follow-up data were reported of all patients treated for substance use problems. Two main measurements were type of substance use and patient status at follow-up. Multiple logistic regression analysis was used to examine patient status at follow-up.ResultsOf 479 patients, 47.2% had problems with alcohol alone, 20.3% with prescription drugs, 16.7% with illicit drugs other than heroin or methadone and 15.9% with heroin or methadone. Problems with alcohol alone were more prevalent in Flanders (53.0%; 95% confidence interval (CI) 46.8–59.1%) than in Wallonia-Brussels (39.8%; 95% CI 33.1–46.8%), while problems with heroin or methadone were more prevalent in Wallonia-Brussels (27.0%; 95% CI 21.1–33.5%) than in Flanders (7.1%; 95% CI 4.3–10.9%). At follow-up, 32.8% of the patients had dropped out, 29.0% had discontinued GP treatment and 38.2% had continued GP treatment. Overall, 32.4% of 479 patients had continued GP treatment for substance use problems during the study period. In Wallonia-Brussels, this proportion was higher (42.7%; 95% CI 35.9–49.6%) than in Flanders (24.3%; 95% CI 19.2–29.8%).ConclusionsA continuous surveillance of the general practice population treated for substance use problems seems to be feasible and useful. The latter is suggested by the specific profile and the relative magnitude of the population. Inter-regional health system differences should be taken into account to estimate the epidemiology of substance use problems among general practice patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3885-0) contains supplementary material, which is available to authorized users.

Screening, Brief Intervention, and Referral to Treatment Education for Emergency Nurses in 5 Hospitals: Implementation Steps and Hurdles

The World Health Organization reported that mental and substance use disorders will surpass all physical diseases by 2020. 1 World Health Organization Promoting mental health: concepts, emerging evidence, practice. http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf Google Scholar More than 23.5 million individuals (9.4%) aged 12 years or older have been identified as needing treatment for substance use problems, yet only 2.3 million (<10%) received care. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 3 Office of Applied Studies. Results from the 2008 national survey on drug use and health: national findings. NSDUH Series H-36, HHS Publication No. SMA 09–4434. Substance Abuse and Mental Health Services Administration Web site. http://www.oas.samhsa.gov. Published 2009. Accessed May 9, 2014. Google Scholar Furthermore, the total estimated societal costs of substance abuse in the United States amount to approximately $510.8 billion annually. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 4 Miller T Hendrie D Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, MD2009 Google Scholar Such alarming statistics regarding alcohol and other drug (AOD) problems are compounded by the untold deleterious impact of substance misuse on the lives of individuals, families, communities, and society. Excessive alcohol use accounted for approximately 88,000 deaths per year from 2006 to 2010 and accounted for 1 in 10 deaths among adults aged 20 to 64 years. 5 CDC features, data & statistics Alcohol deaths. http://www.cdc.gov/features/alcohol-deaths Google Scholar This impact has garnered the attention of health professionals who are escalating assessment skills and services to individuals regarding harmful AOD use. 6 Hankin A Daugherty M Bethea A Haley L The emergency department as a prevention site: a demographic analysis of substance use among ED patients. Drug Alcohol Depend. 2013; 130: 230-233 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 7 Ong-Flaherty C Screening, brief intervention, and referral to treatment: a nursing perspective. J Emerg Nurs. 2012; 38: 54-56 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 8 Désy P Perhats C Alcohol screening, brief intervention, and referral in the emergency department: an implementation study. J Emerg Nurs. 2008; 34: 11-19 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 9 Désy P Howard PK Perhats C Li S Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: an impact evaluation. J Emerg Nurs. 2010; 36: 538-545 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 10 Barnard S Implementing an SBIRT (screening, brief intervention, and referral to treatment) program in the emergency department: challenges and rewards. J Emerg Nurs. 2009; 35: 561-563 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 11 Vadlamudi RS Adams S Hogan B Wu T Wahid Z Nurses’ attitudes, beliefs, and confidence levels regarding care for those who abuse alcohol: impact of educational intervention. Nurse Educ Pract. 2008; 8: 290-298 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar , 12 Gonzalez Castro F Garginkel J Critical issues in the development of culturally relevant substance abuse treatments for specific minority groups. Alcohol Clin Exp Res. 2003; 27: 1381-1388 Crossref PubMed Scopus (42) Google Scholar Irene Kane is Associate Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. Ann M. Mitchell is Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. James Aiello is Project Associate, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Holly Hagle is Director, National SBIRT Addiction Technology and Transfer Center and Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Dawn Lindsay is Director of Evaluation Services, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Kimberly S. Talcott is ELITE and SBIRT Project Manager, University of Pittsburgh School of Nursing, Pittsburgh, PA. Lynn Boucek is SBIRT Project Associate, University of Pittsburgh School of Nursing, Pittsburgh, PA.

Sex differences in resting state brain function of cigarette smokers and links to nicotine dependence.

Sex--a marker of biological and social individual differences--matters for drug use, particularly for cigarette smoking, which is the leading cause of preventable death in the United States. More men than women smoke, but women are less likely than men to quit. Resting state brain function, or intrinsic brain activity that occurs in the absence of a goal-directed task, is important for understanding cigarette smoking, as it has been shown to differentiate between smokers and nonsmokers. But, it is unclear whether and how sex influences the link between resting state brain function and smoking behavior. In this study, the authors demonstrate that sex is indeed associated with resting state connectivity in cigarette smokers, and that sex moderates the link between resting state connectivity and self-reported nicotine dependence. Using functional MRI and behavioral data from 50 adult daily smokers (23 women), the authors found that women had greater connectivity than men within the default mode network, and that increased connectivity within the reward network was related to increased nicotine tolerance in women but to decreased nicotine tolerance in men. Findings highlight the importance of sex-related individual differences reflected in resting state connectivity for understanding the etiology and treatment of substance use problems.