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Substance Abuse Treatment, Prevention,... Jan 2024With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use... (Review)
Review
BACKGROUND
With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries.
METHODS
A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services.
RESULTS
This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients.
CONCLUSION
There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.
Topics: Male; Humans; Female; Health Services Accessibility; Inpatients; Hospitalization; Substance-Related Disorders; Africa South of the Sahara
PubMed: 38212834
DOI: 10.1186/s13011-023-00589-0 -
Medicina (Kaunas, Lithuania) Nov 2023: High rates of psychiatric disorders and comorbidities have been reported in juvenile detainees, which have been associated with repeat offenses. However, research into...
: High rates of psychiatric disorders and comorbidities have been reported in juvenile detainees, which have been associated with repeat offenses. However, research into this topic has been limited to Asian countries. This study aimed to examine the prevalence of psychiatric disorders and sexual differences among juvenile detainees in a detention center in South Korea. : The participants comprised 54 males and 46 females, with a minimum intelligence score of 80. Psychiatric diagnosis was determined using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). The Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2) was used to investigate gender differences. : Using the MINI-KID, the most frequent diseases were conduct disorder (CD), alcohol dependence, suicidal tendency, and attention-deficit/hyperactivity disorder (ADHD), with statistically significant differences between men and women. Only alcohol abuse was higher in males, while the rest were higher in females. The items with a statistically significant gender difference in MAYSI-2 were alcohol/drug use, feeling depressed/anxious, somatic complaints, suicidal ideation, and traumatic experiences. All items for which gender difference was statistically significant were higher in the proportion of women. : Juvenile detainees exhibit high rates of psychiatric disorders and comorbidities. CDs, alcohol dependence, and ADHD are the most common psychiatric disorders among juvenile detainees in South Korea. Assessment of and intervention in psychiatric disorders may help prevent further offenses. These findings highlight the importance of diagnosing and intervening in psychiatric disorders within juvenile detention systems.
Topics: Male; Adolescent; Child; Humans; Female; Sex Factors; Prevalence; Alcoholism; Substance-Related Disorders; Attention Deficit Disorder with Hyperactivity; Comorbidity
PubMed: 38138171
DOI: 10.3390/medicina59122068 -
The International Journal on Drug Policy Apr 2024Prison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of...
BACKGROUND
Prison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021.
METHODS
Thematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's 'wicked problems' conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving.
RESULTS
There was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two 'wicked problems' of increasing rates of drug use and mental illness which collide in the prison setting.
CONCLUSION
The PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons.
Topics: Humans; Prisons; Wales; England; Substance-Related Disorders; Drug Overdose; Health Policy
PubMed: 38401175
DOI: 10.1016/j.drugpo.2024.104358 -
Canadian Journal of Psychiatry. Revue... Aug 2023(1) To calculate the proportions of people who sought mental health and addiction (MHA) specialty services in Nova Scotia, overall and by sex and age. (2) To describe...
The Health and Psychosocial Profiles of Adults Who Sought Mental Health and Addiction Specialty Services Through a Centralized Intake Process in Nova Scotia in 2020 and 2021.
OBJECTIVES
(1) To calculate the proportions of people who sought mental health and addiction (MHA) specialty services in Nova Scotia, overall and by sex and age. (2) To describe the health and psychosocial profiles of the MHA Intake clients. (3) To identify factors associated with acceptance for MHA services.
METHODS
The data of the Nova Scotia MHA Intake clients aged 19 to 64 years old in 2020 ( = 10,178) and in 2021 ( = 12,322) were used. The proportions of unique clients in the general population were calculated based on 2021 census data. The percentages of primary presenting concerns, the presence and frequency of psychiatric symptoms in the past month, suicide risk levels, current or past provisional psychiatric diagnosis, medical problems, and psychosocial stressors were calculated. Logistic regression was conducted to identify factors associated with the acceptance of MHA services after the assessment.
RESULTS
It was found that 1.48% and 2.33% of Nova Scotians aged 19 to 64 contacted the MHA Intake in 2020 and 2021. Over 66% were self-referrals, followed by physician referrals (28.34%). Mood (28.3%), anxiety (25.17%), and substance use (19.81%) were the top three presenting concerns for the contact. Many clients had a current or past provisional psychiatric diagnosis (58.7% in 2020, 61.8% in 2021). Among the clients, 74.67% and 68.29% reported at least 1 psychosocial stressor in 2020 and 2021, respectively. The clients with a current or past psychiatric diagnosis, suicide risk, and 2 or more psychosocial stressors, those who lived outside of Central Zone, and who had employee assistance program benefits/private insurance, were more likely to be qualified and accepted for MHA services than others.
CONCLUSIONS
The Intake clients have complex health and psychosocial profiles. Future studies are needed to monitor the trajectories of the clients to reduce inequities in receiving MHA services and improve client outcomes.
Topics: Humans; Adult; Young Adult; Middle Aged; Mental Health; Nova Scotia; Mental Disorders; Mental Health Services; Substance-Related Disorders
PubMed: 36855805
DOI: 10.1177/07067437231159768 -
Differential risks of syringe service program participants in Central Ohio: a latent class analysis.Harm Reduction Journal Jul 2023Significant heterogeneity exists among people who use drugs (PWUD). We identify distinct profiles of syringe service program (SSP) clients to (a) evaluate differential...
BACKGROUND
Significant heterogeneity exists among people who use drugs (PWUD). We identify distinct profiles of syringe service program (SSP) clients to (a) evaluate differential risk factors across subgroups and (b) inform harm reduction programming.
METHODS
Latent class analysis (LCA) was applied to identify subgroups of participants (N = 3418) in a SSP in Columbus, Ohio, from 2019 to 2021. Demographics (age, sex, race/ethnicity, sexual orientation, housing status) and drug use characteristics (substance[s] used, syringe gauge, needle length, using alone, mixing drugs, sharing supplies, reducing use, self-reported perceptions on the impact of use, and treatment/support resources) were used as indicators to define latent classes. A five-class LCA model was developed, and logistic regression was then employed to compare risk factors at program initiation and at follow-up visits between latent classes.
RESULTS
Five latent classes were identified: (1) heterosexual males using opioids/stimulants with housing instability and limited resources for treatment/support (16.1%), (2) heterosexual individuals using opioids with stable housing and resources for treatment/support (33.1%), (3) individuals using methamphetamine (12.4%), (4) young white individuals using opioids/methamphetamine (20.5%), and (5) females using opioids/cocaine (17.9%). Class 2 served as the reference group for logistic regression models, and at the time of entry, class 1 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs, with persistently higher odds of sharing supplies and mixing drugs at follow-up. Class 3 was more likely to report history of overdose, sharing supplies, and mixing drugs, but outcomes at follow-up were comparable. Class 4 was the least likely to report history of overdose, HCV, and mixing drugs, but the most likely to report HIV. Class 5 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs at entry, and higher reports of accessing substance use treatment and testing positive for HCV persisted at follow-up.
CONCLUSIONS
Considerable heterogeneity exists among PWUD, leading to differential risk factors that may persist throughout engagement in harm reduction services. LCA can identify distinct profiles of PWUD accessing services to tailor interventions that address risks, improve outcomes, and mitigate disparities.
Topics: Humans; Male; Female; Needle Sharing; Substance Abuse, Intravenous; HIV Infections; Analgesics, Opioid; Latent Class Analysis; Ohio; Substance-Related Disorders; Methamphetamine; Drug Overdose; Hepatitis C
PubMed: 37507721
DOI: 10.1186/s12954-023-00824-8 -
Substance Abuse Treatment, Prevention,... Nov 2023Youth mortality from drugs is worryingly increasing in Europe. Little is so far known about what substance use services are available to young people. An out-of-home... (Review)
Review
BACKGROUND
Youth mortality from drugs is worryingly increasing in Europe. Little is so far known about what substance use services are available to young people. An out-of-home care placement is often used but does not suffice alone as an intervention in problematic substance use among youth. Additional interventions are needed.
OBJECTIVE
This narrative review investigated what has been done, what works, and what is needed in treating youth substance use in the Nordic countries from the viewpoint of social services. This study brought together previous Nordic studies on this topic and presented responses to youth substance use in Nordic social welfare system to the wider international audience.
METHODS
A search of the ProQuest and EBSCOhost databases revealed seven interventions reported in 17 papers. Narrative synthesis was used.
RESULTS
Interventions included the Cannabis Cessation Program (CCP), the Icelandic version of the Motivation to Change Inventory for Adolescents, the Norwegian multisystemic therapy program (MST), the Structured Interview Manual UngDOK implemented in the Swedish Maria clinics, the Finnish ADSUME-based intervention in school health care, and the Swedish Comet 12-18 and ParentStep 13-17 programs. Many interventions had originated in the US rather than in the Nordic countries and most of them were adapted from adult interventions when youth specificity was lacking. Parental involvement was deemed important, but ineffective without involving the adolescent themself. Interventions and ways for dealing with young offenders required reconsideration from the perspective of the best interests of the child. The current research focuses on universal prevention while more knowledge about selective and indicative prevention was called for.
CONCLUSIONS
Not enough is known about the cessation of problematic youth substance use and subsequent rehabilitation in social services. We would encourage further research on the multi-producer system, subscriber-provider-cooperation in youth substance use services, non-medical youth-specific substance use interventions in social services, and rehabilitative juvenile drug offense practices.
Topics: Child; Adult; Humans; Adolescent; Substance-Related Disorders; Social Work; Psychotherapy; Europe; Social Welfare
PubMed: 38001531
DOI: 10.1186/s13011-023-00580-9 -
Emergencias : Revista de La Sociedad... Apr 2024
Topics: Humans; Substance-Related Disorders; Risk Factors
PubMed: 38597614
DOI: 10.55633/s3me/007.2024 -
Frontiers in Public Health 2023Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments... (Review)
Review
Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment.
INTRODUCTION
Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches.
METHODS
PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes.
RESULTS
Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies ( = 10), with 25% of the articles discussing Maintenance/sustainability ( = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches.
CONCLUSION
Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.
Topics: Humans; United States; Implementation Science; Substance-Related Disorders; Canada; Australia; New Zealand
PubMed: 37915816
DOI: 10.3389/fpubh.2023.1265122 -
BMC Public Health Dec 2023Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority... (Review)
Review
Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.
BACKGROUND
Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality.
METHODS
Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.
RESULTS
Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.
CONCLUSIONS
Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
Topics: Adult; Adolescent; Humans; Female; Male; Gender Identity; Mental Health; Netherlands; Sexual Behavior; Sexual and Gender Minorities; Substance-Related Disorders
PubMed: 38110908
DOI: 10.1186/s12889-023-17466-x -
Psychological Medicine Nov 2023The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by...
BACKGROUND
The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'.
METHODS
Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed'].
RESULTS
A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired . Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault.
CONCLUSIONS
The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.
Topics: Humans; Female; Psychotic Disorders; Anxiety; Anxiety Disorders; Substance-Related Disorders; Phenotype
PubMed: 37092866
DOI: 10.1017/S0033291723001046