Journal of substance use and addiction treatment最新文献

{"title":"Patching holes and bridging gaps: Implementing Law Enforcement-Assisted Diversion (LEAD) in resource-scarce environments","authors":"Meret Hofer ,&nbsp;Reah Siegel ,&nbsp;Michele Easter ,&nbsp;Melissia Larson ,&nbsp;Allison Gilbert","doi":"10.1016/j.josat.2025.209751","DOIUrl":"10.1016/j.josat.2025.209751","url":null,"abstract":"<div><h3>Introduction</h3><div>Law Enforcement Assisted Diversion (LEAD) is a pre-arrest diversion program that allows police officers to refer individuals to LEAD's harm reduction case management services in lieu of arrest for most low-level, non-violent criminalized behaviors. The program assesses participants' needs for resources and services and facilitates referrals and ongoing support to meet these needs. In this qualitative study, we examine the influence of service availability and accessibility on the implementation of North Carolina's LEAD programs.</div></div><div><h3>Methods</h3><div>We conducted in-depth, semi-structured interviews with 49 participants across four well-established LEAD sites, including LEAD partners (<em>n</em> = 27) and LEAD participants (<em>n</em> = 22). We analyzed the data using a blended inductive/deductive coding strategy.</div></div><div><h3>Findings</h3><div>Participants' narratives highlighted several important challenges related to service provision and linkage in communities with a dearth of service options. Findings were captured in four main themes. First, in some communities, certain resources and services were completely unavailable. Second, even when community-based resources and services were available, they were often perceived as inaccessible by participants for a variety of reasons. Third, LEAD programs and staff worked intensely and flexibly to increase access to community-based resources and services. Finally, there was widespread agreement that resource scarcity disrupted the continuum of care, thereby causing some participants to disengage from LEAD and related services as their readiness for change fluctuated.</div></div><div><h3>Conclusions</h3><div>The efficacy of diversion programs, including LEAD, depends not only on their high-quality implementation and fidelity to existing models, but also on successful coordination and linkage to a range of comprehensive, easily accessible and sustainable community-based resources and services. When community-based resources are unable to meet basic needs and support the continuum of care for people with substance use disorders, LEAD staff and participants will struggle to meet expectations and programs will be unlikely to optimize outcomes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209751"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595410","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 is necessary for implementation science to actually improve the state of addiction treatment and research?","authors":"Mark P McGovern, Hélène Chokron Garneau, Heather J Gotham, Fernanda S Rossi","doi":"10.1016/j.josat.2025.209753","DOIUrl":"10.1016/j.josat.2025.209753","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209753"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610530","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":"Journal of substance use and addiction treatment formal and informal substance use treatment utilization amongst Asian Americans","authors":"Christopher Villongco ,&nbsp;Benjamin G. Druss","doi":"10.1016/j.josat.2025.209754","DOIUrl":"10.1016/j.josat.2025.209754","url":null,"abstract":"<div><h3>Introduction</h3><div>Asian Americans (AA) in need of treatment for alcohol or substance use utilize substance use treatment at lower rates than all other races/ethnicities. This study tested if the lack of utilization is offset by greater informal substance use treatment utilization.</div></div><div><h3>Methods</h3><div>Analysis utilized pooled data from 2015 to 2019 National Survey of Drug Use and Health (NSDUH) in individuals aged ≥18. Unadjusted proportions, confidence intervals, and adjusted multivariate logistical regression examined the relationship of race/ethnicity (Asian, White, Black, and Hispanic) and substance use treatment in individuals with 12-month substance/alcohol use or AUD/SUD. Classifications of treatment were formal (doctor's office, mental health center, hospital, rehabilitation facility) or informal (self-help group, home/family/friends, school/college, or Church/religious/spiritual influence).</div></div><div><h3>Results</h3><div>AA with AUD/SUD were significantly less likely to utilize formal substance use than individuals who were White (aOR = 0.28, <em>p</em> &lt; 0.05). There was no significant difference in informal treatment utilization between AA with alcohol use, substance use or AUD/SUD and individuals of any other race/ethnicity. AA with AUD/SUD utilized combined (both informal and formal) services significantly less than individuals who were White (aOR = 0.31, <em>p</em> &lt; 0.05).</div></div><div><h3>Discussion</h3><div>Informal services did not offset the limited substance use treatment engagement in AA. More work is needed to better and understand low rates of substance use treatment in this population.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"177 ","pages":"Article 209754"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602398","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":"Accessibility of methadone treatment via public transit for syringe services program participants in Miami-Dade County, Florida","authors":"Marina Plesons ,&nbsp;Eileen Malecki ,&nbsp;Katrina Ciraldo ,&nbsp;Emilie Ashbes ,&nbsp;Edward Suarez Jr. ,&nbsp;Hansel E. Tookes ,&nbsp;Tyler S. Bartholomew","doi":"10.1016/j.josat.2025.209755","DOIUrl":"10.1016/j.josat.2025.209755","url":null,"abstract":"<div><div>Methadone is an opioid receptor agonist medication used in the treatment of opioid use disorder (OUD). Geographic distance to opioid treatment programs (OTPs) is a major barrier to treatment, given requirements for direct observation of dosing and periodic drug screens, and ‘methadone treatment deserts’ are defined as a public transit threshold of 30 min. The purpose of this study was to examine public transit access to methadone treatment for participants of a syringe services program (SSP) in Miami-Dade County, Florida. Public transit times were calculated using the R library r5r, which facilitates multi-modal transportation network routing. General Transit Feed Specification data was combined with street network data from OpenStreetMap for Miami-Dade County. Transit times were estimated from the population-weighted centroid of each zip code (<em>n</em> = 73) with participants of Miami's only SSP (<em>n</em> = 1549) to the nearest OTP (<em>n</em> = 4) using 24 departure windows aligned with OTP service hours. The mean one-way transit time from zip codes with SSP participants in Miami-Dade County to the nearest OTP was 79 min. Over 95 % of SSP participants in Miami-Dade County have a mean one-way transit time &gt;30 min, classifying them as residing in ‘methadone treatment deserts.’ Likewise, 69 of the 73 (95 %) zip codes with SSP participants have a mean transit time to the closest OTP &gt;30 min. Transit times differ substantially between zip codes with different numbers of SSP participants, but not between departure windows. Geographic isolation of methadone treatment from public transit routes represents a significant barrier to equitable OUD treatment.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209755"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595409","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":"Beyond frequency of use: Exploring additional metrics for quantifying cocaine use and their relation to life functioning and treatment outcome","authors":"Samantha Ellis ,&nbsp;Rachel Sun ,&nbsp;Angela Heads ,&nbsp;Jin Ho Yoon ,&nbsp;Heather Webber ,&nbsp;Joy Schmitz ,&nbsp;Margaret Wardle","doi":"10.1016/j.josat.2025.209752","DOIUrl":"10.1016/j.josat.2025.209752","url":null,"abstract":"<div><h3>Background</h3><div>Frequency of use – the number of days of use – is the most common metric for quantifying cocaine use and the most common target of treatment. However, frequency may not capture all important aspects of cocaine use. This study examined how other aspects of cocaine use (typical amount spent, variability etc.) relate to life functioning and cocaine use disorder (CUD) treatment outcomes.</div></div><div><h3>Method</h3><div>This is a secondary analysis of 3 clinical trials for CUD, <em>N</em> = 207 for the life functioning analysis and <em>N</em> = 173 for the outcomes analysis. Eight metrics of use were calculated from baseline 30-Day Timeline Followback (TLFB) data and entered into multiple regression and hierarchical Poisson regression analyses predicting domains of the Addiction Severity Index and treatment outcomes, respectively.</div></div><div><h3>Results</h3><div>Greater typical dollar amount used (i.e., generally greater amounts of cocaine used per occasion) related to better employment functioning, while better treatment outcomes were associated with: 1) less frequent use, 2) greater typical dollar amount used, 3) more variability in dollar amount, 4) less weekday use, 5) greater variability in days between uses, and 6) a downwards trajectory in frequency of use and upwards trajectory in typical dollar amount over the month leading into treatment.</div></div><div><h3>Conclusions</h3><div>Beyond days of use, other aspects of use also relate to life functioning and treatment outcomes, although these aspects predicted treatment outcomes better than life functioning. Future work should explore whether other aspects of cocaine use are important targets for harm-reduction-focused treatment.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209752"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568187","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":"Perspectives on medication for opioid use disorder (MOUD) access and service delivery among a community sample of people who use opioids in Los Angeles","authors":"Maria Bolshakova ,&nbsp;Kelsey A. Simpson ,&nbsp;Siddhi S. Ganesh ,&nbsp;Steven Sussman ,&nbsp;Ricky N. Bluthenthal","doi":"10.1016/j.josat.2025.209742","DOIUrl":"10.1016/j.josat.2025.209742","url":null,"abstract":"<div><h3>Introduction</h3><div>Medications for opioid use disorder (MOUD) such as buprenorphine and methadone are effective in reducing overdoses, drug use, and drug-related harms. Despite the benefits, MOUD is under-utilized among people who use opioids (PWUO) and this access and service delivery gap is more pronounced among community recruited PWUO who experience greater barriers to treatment entry. Limited qualitative studies have explored MOUD service and delivery barriers among this population. To address this gap, our study investigates the MOUD experiences, preferences, perceived benefits, and unmet treatment needs of a community sample of PWUO in Los Angeles.</div></div><div><h3>Methods</h3><div>Between September 2021–April 2022, qualitative interviews were conducted with PWUO in Los Angeles, California (N = 22) recruited from two community sites. Participants were at least 18 years old and self-reported opioid and injection drug use in the last 30 days. Participants answered questions related to general experiences with MOUD. We followed a thematic analysis approach to identify common themes that emerged from qualitative interview data.</div></div><div><h3>Results</h3><div>Nearly a third of the sample was male (64 %), Hispanic/Latino (64 %), and the majority (73 %) reported an income of less than $1400 in the prior month. Participants reported: 1) hesitance initiating methadone treatment due to stigma 2) initiating MOUD to manage withdrawal and meet self-determined goals 3) comparing buprenorphine and methadone for withdrawal management to determine future treatment plans 4) being able to reduce interactions with the risk environment due to MOUD treatment and 5) recommending expanded MOUD access and improving delivery.</div></div><div><h3>Conclusions</h3><div>Our findings support expanded and low to no barrier access and delivery of MOUD for socially disadvantaged PWUO who receive treatment in community settings.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209742"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568188","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":"Contemporary developments in treatment services for youth substance use disorders: Introduction to the special issue.","authors":"Aaron Hogue, Sara J Becker, Craig E Henderson, Timothy J Ozechowski","doi":"10.1016/j.josat.2025.209750","DOIUrl":"https://doi.org/10.1016/j.josat.2025.209750","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209750"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565496","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":"A participatory photovoice investigation of community assets, barriers, and opportunities to curb the opioid epidemic","authors":"P. Balvanz ,&nbsp;R.G. Olvera ,&nbsp;M. Booty ,&nbsp;J. McSwiggan ,&nbsp;C. Damato-MacPherson ,&nbsp;S. Ellison ,&nbsp;A. Farmer ,&nbsp;K. Klingler ,&nbsp;A. Kuntz ,&nbsp;N. Lewis ,&nbsp;C.B. Oser ,&nbsp;L. Sprague Martinez ,&nbsp;S. Stitzer ,&nbsp;H. Surratt ,&nbsp;O. Yamoah ,&nbsp;A. Berkshire ,&nbsp;T. Carter ,&nbsp;K. Campbell ,&nbsp;S. Dynes ,&nbsp;B. Gealy ,&nbsp;M. McGladrey","doi":"10.1016/j.josat.2025.209741","DOIUrl":"10.1016/j.josat.2025.209741","url":null,"abstract":"<div><div>The opioid epidemic remains an entrenched issue in communities due to its multiple and interrelated risk factors. As part of the HEALing Communities Study, we recruited people with lived experience of substance use disorder and practitioners in the field to participate in multi-session Photovoice projects to contextualize the opioid use landscape in their respective communities. Photovoice combines photography and group discussion to explore concerns and strengths in a community. Researchers facilitated 21 Photovoice projects (<em>N</em> = 127 participants) across 19 communities in the Kentucky, Massachusetts, and Ohio HCS sites. We performed template analysis on the Photovoice discussion transcripts to develop a codebook organized by the Socioecological Model domains, analyzed the transcripts, and developed themes reflecting barriers to and facilitators of responding to the opioid crisis at each socioecological level. We engaged a subset of participants across sites to prioritize these results by importance in addressing the opioid epidemic in their communities. A comprehensive list of themes from the 64 photo discussion sessions are presented, with a focus on the themes prioritized by participants that included the importance of peer recovery support, diverse and collaborative services, advocacy and education to diminish stigma, and the need for resources to address social determinants of health such as housing, recreation, and transportation. Our findings offer key insights to address the opioid crisis within communities. Using participatory methods such as Photovoice to engage experts with lived experience and/or direct work with substance use disorder can help identify gaps and opportunities for potential solutions.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209741"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534119","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":"Reducing stigma in primary care toward people who use drugs: A pilot study exploring the promise and limits of stigma training","authors":"Erin Fanning Madden ,&nbsp;Fares Qeadan ,&nbsp;Felicia Frabis ,&nbsp;Jonathan Cohn ,&nbsp;William Barbeau ,&nbsp;Mark K. Greenwald","doi":"10.1016/j.josat.2025.209748","DOIUrl":"10.1016/j.josat.2025.209748","url":null,"abstract":"<div><h3>Background</h3><div>Primary care can improve health for people who use drugs (PWUD), but stigma among healthcare professionals impedes patient engagement. Past research suggests training reduces stigmatizing professional attitudes, but effects on other aspects of healthcare stigma are largely unknown. This pilot study tests whether stigma reduction training changes three stigma processes toward PWUD in primary care: attitudes, intentions to provide care, and workplace culture.</div></div><div><h3>Methods</h3><div>The study delivered a two-hour substance use stigma training to clinical (e.g., physicians) and non-clinical (e.g., reception staff) primary care professionals in Michigan. Pre- and post-training survey data were collected, and a one-hour qualitative focus group was conducted with a subset of respondents. Cohen's <em>d</em> and paired <em>t</em>-tests assessed changes in stigma. The study analyzed qualitative data using thematic analysis.</div></div><div><h3>Results</h3><div>Fifty-one professionals completed surveys, and five professionals participated in the focus group. Training reduced stigmatizing attitudes toward PWUD (e.g., improvement in the Medical Condition Regard Scale <em>d</em> = 0.499, <em>p</em> = 0.007), but did not change intention to enact stigma or workplace culture. Qualitative data suggested training promoted empathy toward PWUD and explained best practices, but training also revealed gaps between evidence and current clinic practices. Participants noted that external factors that training does not alter, e.g. controlled substance prescribing regulations, may disincentivize professional engagement with PWUD.</div></div><div><h3>Conclusions</h3><div>This pilot study explores the promise and limits of training for altering professional stigma toward PWUD in primary care. Although training readily reduces attitudinal forms of stigma, other interventions are likely needed to reduce stigmatizing professional behaviors and primary care environments.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209748"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531483","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":"“Treating me like a criminal”: A qualitative study of birthing parents' perspectives on racism and biases in newborn drug testing for substance exposure during pregnancy","authors":"Jamie L. Huizinga ,&nbsp;Lauren Oshman ,&nbsp;Regina Onishchenko ,&nbsp;Madgean Joassaint ,&nbsp;Emily Madlambayan ,&nbsp;Murphy Van Sparrentak ,&nbsp;Katharine McCabe ,&nbsp;Courtney Townsel ,&nbsp;Christopher J. Frank ,&nbsp;P. Paul Chandanabhumma ,&nbsp;Justine P. Wu","doi":"10.1016/j.josat.2025.209745","DOIUrl":"10.1016/j.josat.2025.209745","url":null,"abstract":"<div><h3>Introduction</h3><div>Black birthing people are more likely to have their newborns undergo testing for drug exposure with subsequent reporting to Child Protective Services (CPS) and termination of parental rights compared to White birthing people. The study aim was to describe the experiences of people who gave birth regarding newborn drug testing (NDT) and explore the impact of racism and other biases. A secondary aim was to elicit participant recommendations for policy changes to address racial inequities in NDT and CPS reporting.</div></div><div><h3>Methods</h3><div>This qualitative study is the third and last phase of an explanatory sequential mixed methods study (quantitative phase followed by qualitative phase). We conducted semi-structured interviews with 15 participants who had given birth within the last 12 months at a single academic hospital in the midwestern United States. We purposefully sampled racial minorities and those who went through NDT to ensure their perspectives were represented. Our interview guide, data collection, and reflexive thematic interpretation were informed by the Public Health Critical Race Praxis and the Levels of Racism framework. A six member Participatory Council and two external antiracist research consultants provided guidance on study activities and data interpretation.</div></div><div><h3>Results</h3><div>We identified four major themes: 1) being honest about substance use with healthcare providers can lead to punishment and CPS reporting; 2) historical and contemporary racism perpetuate negative stereotypes about Black patients, contributing to racial disparities in NDT; 3) the medical and legal risks of recreational cannabis use in pregnancy were not clearly explained by healthcare providers; 4) participants advocated for non-punitive, respectful, and early care for substance use during pregnancy, including a clear explanation of local NDT and CPS reporting policies.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the need for policy changes to decriminalize newborn drug testing and address systematic racism and bias against Black parents throughout the process. Participants identified a need to improve early access to non-judgmental substance use counseling and treatment that includes clear and consistent guidance about NDT and in particular, the health and legal implications of cannabis use during pregnancy.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"176 ","pages":"Article 209745"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531439","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}