Substance use & addiction journal最新文献

{"title":"Association of Food and Housing Insecurity on Outcomes in Pregnant Patients With Substance Use Disorder.","authors":"Pranaya Chilukuri, Neil Patel, Cynthia Cockerham, Leon Su, Arnold Stromberg, John O'Brien, Barbara Parilla","doi":"10.1177/29767342241254587","DOIUrl":"10.1177/29767342241254587","url":null,"abstract":"<p><strong>Objectives: </strong>Food insecurity (FI) may be associated with worsened neonatal abstinence syndrome severity in infants born to individuals with substance use disorder. This study evaluates FI and housing insecurity (HI) influence on maternal and neonatal outcomes.</p><p><strong>Methods: </strong>This was a cohort study of patients receiving obstetric care through a multispecialty program in Kentucky from 2015 to 2023. Inclusion criteria were: (1) program participants over age 18 consenting to observational research, (2) delivering at University of Kentucky, and (3) not withdrawing from research at any time. Initially, a subset of patients for whom FI and HI concerns were heightened were screened. In 2019, FI and HI screening became standard of care at the clinic. Housing was assessed on enrollment. A validated 2-question Hunger Vital Sign FI screen was utilized for a subset of patients. Maternal and neonatal outcomes, including adverse delivery outcomes, maternal comorbidities, and birth complications, were observed. Fisher's exact and 2 sample <i>t</i> tests were performed.</p><p><strong>Results: </strong>Of 494 participants, 188 (38%) identified at risk for HI. At enrollment, 221 (45%) individuals reported owning their primary residence, 85 (17%) were in group residential treatment, 34 (6.9%) had no housing, and 134 (27%) lived at another's residence. Disposition of a child to a relative or not the patient's own care was greater with HI, 51% versus 47%. Of 155 respondents, 96 (62%) reported FI, associated with increased neonatal intensive care unit (NICU) admission, 86% versus 74%. Using the validated tool, Abuse Assessment Screen, abuse was significantly greater with FI, 76% versus 58%. Edinburgh Postpartum Depression Scales >12 indicating depression were more common with FI, 63% versus 32%, <i>P</i> < .05. Anxiety scores were also higher with FI, <i>P</i> < .05. Patients with FI were more likely to experience abuse.</p><p><strong>Conclusions: </strong>FI and HI were health-related needs associated with increased anxiety, depression, infant NICU admission, and loss of child custody.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perception and Correlates of Opioid Overdose Risk Among Overdose Survivors Who Use Nonprescribed Opioids in San Francisco and Boston.","authors":"Yi-Shin Grace Chang, Vanessa M McMahan, Xochitl Luna Marti, Emily Pope, Shae Wolfe, Adam Majeski, Gabriela Reed, Alexander Y Walley, Phillip O Coffin","doi":"10.1177/29767342241237202","DOIUrl":"10.1177/29767342241237202","url":null,"abstract":"<p><strong>Background: </strong>Understanding opioid overdose risk perception may inform overdose prevention strategies.</p><p><strong>Methods: </strong>We used baseline data from a randomized overdose prevention trial, in San Francisco, CA, and Boston, MA, among people who used nonprescribed opioids, survived an overdose in the past 3 years, and had received naloxone. Participants were asked how likely they were to overdose in the next 4 months. We combined \"extremely likely\" and \"likely\" (higher risk perception) and \"neutral,\" \"unlikely,\" and \"extremely unlikely\" (lower risk perception). We performed bivariate analyses and separate multivariable logistic regression models of risk perception across (1) sociodemographic, (2) substance use, and (3) overdose risk behavior measures. Covariates were selected <i>a priori</i> or significant in bivariate analyses.</p><p><strong>Results: </strong>Among 268 participants, 88% reported at least 1 overdose risk behavior; however, only 21% reported higher risk perception. The adjusted odds ratio (AOR) of higher risk perception was 2.41 (95% confidence interval [CI]: 1.10-5.30) among those unhoused in the past 4 months, 2.06 (95% CI: 1.05-4.05) among those using opioids in a new place, and 5.61 (95% CI: 2.82-11.16) among those who had overdosed in the past 4 months. Living in Boston was associated with higher risk perception in all 3 models (AOR = 2.00-2.46, 95% CI: 1.04-4.88).</p><p><strong>Conclusions: </strong>Despite prevalent risk behaviors, a minority of participants perceived themselves to be at higher risk of overdose. Nonetheless, some known risk factors for overdose were appropriately associated with risk perception. Fentanyl has been prevalent in Boston for longer than San Francisco, which may explain the higher risk perception there.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"They Ask Questions, But They Don't Want the Answers\"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder.","authors":"Alison Eckhardt, Dylan E Waller, Sarah Shull, Travis I Lovejoy, Benjamin J Morasco, Adam J Gordon, Jessica J Wyse","doi":"10.1177/29767342241251761","DOIUrl":"10.1177/29767342241251761","url":null,"abstract":"<p><strong>Background: </strong>Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients' care experiences, potentially having an impact on treatment retention and care decision-making.</p><p><strong>Methods: </strong>This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants.</p><p><strong>Results: </strong>Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment.</p><p><strong>Conclusions: </strong>Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Recovery Capital Among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder in a Telehealth Setting.","authors":"Christopher Rowe, Arthur Robin Williams, Adam Bisaga","doi":"10.1177/29767342241283174","DOIUrl":"https://doi.org/10.1177/29767342241283174","url":null,"abstract":"<p><strong>Background: </strong>Medications for the treatment of opioid use disorder (MOUD) such as buprenorphine are the most effective treatment available for OUD; yet, beyond drug testing results and retention in care, systematically measured clinical outcomes have proven elusive. There is growing interest in integrating systematic monitoring of patient-reported outcomes and measurement-based care as strategies to improve patients' success in treatment.</p><p><strong>Methods: </strong>We analyzed changes in recovery capital assessed via the Brief Assessment of Recovery Capital (BARC-10) from baseline to 30-120 days post-intake among patients initiating buprenorphine treatment from May to October 2023 at Ophelia, a telehealth MOUD provider, who were retained for ≥90 days. Differences in baseline characteristics were assessed between patients with and without high \"remission-predictive\" baseline scores (≥47) using chi-squared and <i>t</i>-tests. Changes in scores from baseline to follow-up were assessed using paired <i>t</i>-tests.</p><p><strong>Results: </strong>In all, 791 patients initiated treatment during the study period, 742 (93.8%) of whom had a baseline BARC-10 score, 542 (73.0%) of whom were retained in treatment for ≥90 days, and 477 of whom (88.0%) had a follow-up BARC-10 score and represent the analysis sample. Older patients, those not requiring buprenorphine induction, and those not using heroin or fentanyl at intake were more likely to have remission-predictive baseline BARC-10 scores (<i>P</i> < .05). Patients with remission-predictive baseline scores (n = 257) had a mean increase of 1.4 (SD = 5.9) from 52.7 (SD = 4.1) (<i>P</i> < .001), and 234 (91%) sustained remission-predictive scores throughout the assessment period. Patients without remission-predictive baseline scores (n = 220) had a mean increase of 9.2 (SD = 8.2) from 38.4 (SD = 6.6) (<i>P</i> < .001), and 129 (59.0%) achieved a remission-predictive score at follow-up.</p><p><strong>Conclusions: </strong>Most patients had increased or sustained already high levels of recovery capital, an established predictor of sustained remission. Further research is required to better understand variability across patients and how it may relate to long-term outcomes.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.","authors":"Melissa M Garrido, Kiersten Strombotne, PhiYen Nguyen, Steven D Pizer, Austin B Frakt","doi":"10.1177/29767342241279194","DOIUrl":"https://doi.org/10.1177/29767342241279194","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment.</p><p><strong>Background: </strong>Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years. The context in which these laws were passed has not been previously described. The extent to which states engaged in recovery residence regulation that also pass patient brokering and deceptive marketing laws is unknown.</p><p><strong>Methods: </strong>We conducted a descriptive study and identified state laws relating to patient brokering and deceptive marketing that were enacted and effective as of December 31, 2022. Using a model state law for addressing unethical SUD treatment practices as a guide, we developed a taxonomy to describe the laws' elements, including covered entities, prohibited activities, and penalties. We used descriptive statistics to characterize variation across current laws.</p><p><strong>Results: </strong>All patient brokering laws explicitly mention referrals to SUD treatment facilities, and most specify that both individuals and facilities are prohibited from paying, receiving, or soliciting referrals in exchange for fees or commissions. All deceptive marketing laws prohibit making false or misleading statements about the nature of services provided. Beyond these common features, there is wide variability in the degree to which states specifically prohibit other patient brokering and deceptive marketing activities (e.g., indirect offerings, lead generation, or kickback schemes involving laboratories).</p><p><strong>Conclusions: </strong>State policies targeting patient brokering and deceptive marketing may be useful for preventing instances of unethical SUD treatment practices. We constructed a taxonomy to characterize elements of patient brokering and deceptive marketing laws and facilitate future evaluations of their effectiveness.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance.","authors":"Andrea Acevedo, Rachel Sayko Adams, Benjamin Lê Cook, Sage R Feltus, Lee Panas, Maureen T Stewart","doi":"10.1177/29767342241278871","DOIUrl":"https://doi.org/10.1177/29767342241278871","url":null,"abstract":"<p><strong>Background: </strong>Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender, and whether disparities varied by insurance. We also examined whether criminal legal history and socioeconomic status moderated disparities in treatment.</p><p><strong>Methods: </strong>We used data from the nationally representative 2017 to 2019 National Survey on Drug Use and Health, the most recent 3-year period available. The analytic sample included noninstitutionalized adults aged 18 to 64 who met criteria for past year AUD and identified as White, Black, or Latinx (<i>n</i> = 7782). We examined disparities in AUD treatment utilization by race, ethnicity, and gender subgroup and by insurance status, estimating weighted logistic regressions, and adjusting for indicators of clinical need in concordance with the Institute of Medicine definition of healthcare disparity.</p><p><strong>Results: </strong>Only 5.4% of adults with AUD in the United States utilized AUD treatment in the past year. AUD treatment utilization did not significantly differ between White males and other racial, ethnic, and gender groups; however, we did identify disparities among Medicaid enrollees and those who were uninsured. Among Medicaid enrollees, Latinx females (3.2%) had lower treatment utilization than White males (9.3%, <i>P</i> < .05). Among uninsured individuals, Latinx males (1.8%) had lower treatment utilization than White males (6.2%, <i>P</i> < .05).</p><p><strong>Conclusions: </strong>AUD treatment utilization was extremely low among adults in the United States aged 18 to 64 who met criteria for AUD. Ethnic and gender disparities in treatment utilization were revealed when examining differences in AUD treatment utilization by insurance status. Strategies for improving access to AUD treatment that address structural barriers to care are needed and should consider targeted approaches for Medicaid enrollees and those uninsured.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"We're Checking a Box and, You Know, Covering Our Own\": Health Professionals' Descriptions of Hospital-Policy Making Regarding Child Welfare Reporting Related to Birthing People's Drug Use.","authors":"Karen Alexander, Mishka Terplan, Sarah C M Roberts","doi":"10.1177/29767342241273416","DOIUrl":"https://doi.org/10.1177/29767342241273416","url":null,"abstract":"<p><strong>Background: </strong>Hospital policies play a role in healthcare providers' decision-making about reporting birthing people who use drugs to child welfare. This study sought to understand how these specific hospital policies are made.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with healthcare professionals involved in developing or revising hospital policies related to child welfare reporting for birthing people who use drugs. The interview guide was informed by an implementation science framework and focused on participants' experiences developing or revising these policies. We coded transcripts inductively, focusing on themes that emerged in the interviews themselves, and deductively, focusing on pre-determined aspects of the policy development process.</p><p><strong>Results: </strong>Participants (<i>N</i> = 16) were physicians (69%), registered nurses (19%), and social workers (12%). The sample was drawn from all regions of the United States. Two themes emerged in data analysis. The first theme was that urine drug testing policies for pregnant and birthing individuals are seen as part of hospital child welfare reporting policies. Specifically, participants often described child welfare reporting policies as including criteria for urine drug testing and explained that the connection between urine drug testing and child welfare reporting policies was by design. The second theme was that the content of hospital child welfare reporting policies is a result of hospital politics and a focus on legal compliance. They described the legal compliance aspects of the hospital policies as serving to protect the institution and, occasionally, individual employees from legal consequences.</p><p><strong>Conclusion: </strong>The content of hospital policies regarding birthing people who use drugs appears influenced by political and legal considerations more than considerations of patient or public health.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review.","authors":"Sierra Castedo de Martell, J Michael Wilkerson, Nalini Ranjit, Lori Holleran Steiker, Sheryl A McCurdy, H Shelton Brown","doi":"10.1177/29767342241281009","DOIUrl":"10.1177/29767342241281009","url":null,"abstract":"<p><strong>Background: </strong>Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category.</p><p><strong>Methods: </strong>PRISMA methods were followed and a PROSPERO protocol was registered (CRD42022323516). The search included a database search of peer-reviewed journal articles and dissertations, and also a hand-search of conference presentations and evaluation reports. Manuscripts were categorized as either workforce development-related and/or those containing potential economic evaluation parameters.</p><p><strong>Results: </strong>Forty-two total manuscripts were included, with 22 related to the peer workforce and 26 containing potential economic evaluation parameters. Manuscripts with workforce-related findings covered peer worker characteristics, characteristics of PRSS delivery, or peer worker training-related outcomes. Economic evaluation parameters were primarily costs related to service utilization patters with some limited reporting on peer worker pay, as well as multiple sources that can be used to estimate averted medical costs. Effectiveness parameters were primarily substance use related, as virtually all quality of life and life functioning parameters are not readily convertible to estimating quality-adjusted life years.</p><p><strong>Conclusion: </strong>Future PRSS research can contribute to filling these gaps in the evidence base by addressing remaining questions about the interrelationship between peer worker job satisfaction, job tenure, and patient outcomes, as well as by using more consistent outcome measures, especially in the realm of quality of life and life functioning.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Characteristics From Norway's First Heroin-Assisted Treatment Clinics.","authors":"Francesca Melis, Thomas Clausen, Charlotte Castel, Omid Dadras, Silvana De Pirro, Lars Henrik Myklebust, Ann Oldervoll, Linda Elise Wüsthoff, Desiree Eide","doi":"10.1177/29767342241271991","DOIUrl":"https://doi.org/10.1177/29767342241271991","url":null,"abstract":"<p><strong>Background: </strong>Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country's OUD treatment system. This study describes and compares patients' baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT.</p><p><strong>Methods: </strong>This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (<i>n</i> = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using <i>t</i>-tests, Mann-Whitney <i>U</i> tests, Chi-square, and Fisher's exact test.</p><p><strong>Results: </strong>The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, <i>P</i> < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment.</p><p><strong>Conclusion: </strong>This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems.","authors":"Diane K King, Steven J Ondersma, Bonnie G McRee, Jacqueline S German, Amy M Loree, Amy Harlowe, Daniel P Alford, Robyn N M Sedotto, Mary Kate Weber","doi":"10.1177/29767342241271404","DOIUrl":"https://doi.org/10.1177/29767342241271404","url":null,"abstract":"<p><strong>Background: </strong>The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies.</p><p><strong>Methods: </strong>We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers.</p><p><strong>Results: </strong>Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving.</p><p><strong>Conclusions: </strong>Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}