Journal of substance use and addiction treatment最新文献

{"title":"Cost and cost-effectiveness of abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder","authors":"Stephen Orme ,&nbsp;Gary A. Zarkin ,&nbsp;Laura J. Dunlap ,&nbsp;Jackson Luckey ,&nbsp;Forrest Toegel ,&nbsp;Matthew D. Novak ,&nbsp;August F. Holtyn ,&nbsp;Kenneth Silverman","doi":"10.1016/j.josat.2024.209569","DOIUrl":"10.1016/j.josat.2024.209569","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol use disorder, unemployment, and risk of homelessness are linked and often co-occurring, but most interventions do not address both alcohol use disorder and unemployment. The Abstinence-Contingent Wage Supplement (ACWS) model of the Therapeutic Workplace offers participants stipends or wage supplements contingent on both their abstaining from alcohol and engaging with an employment specialist or working in a community job. Wearable biosensors continuously tracked alcohol use.</div></div><div><h3>Methods and data</h3><div>The study randomized participants to Usual Care (UC) (<em>n</em> = 57) and ACWS (<em>n</em> = 62). We used micro-costing methods to identify the resources and costs of the 6-month ACWS intervention. The study team tracked the cost of incentives for wearing biosensors, stipends, and wage supplements. We used 6-month cost and effectiveness data to calculate incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.</div></div><div><h3>Results</h3><div>Over the 6-month study period, average intervention costs per participant were $7282, with contingent stipends and wage supplements accounting for 50 % of intervention costs. We also reported average per participant costs for healthcare (UC: $17,785; ACWS: $26,734), justice system (UC: $131; ACWS: $153), and public welfare (UC: $1107; ACWS: $1275). The incremental cost-effectiveness ratios (ICERs) at 6 months were $80,911 for an additional participant abstinent, $3894 for an additional drinking free day, $22,756 for an additional participant employed, and $1514 for an additional day worked.</div></div><div><h3>Conclusions</h3><div>The ACWS intervention for adults with an alcohol use disorder and experiencing homelessness increased costs and improved alcohol use and employment outcomes compared with Usual Care. For policymakers seeking a solution to alcohol use and unemployment with populations experiencing homelessness, ACWS may be a cost-effective solution.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209569"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634175","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":"Development of a brief stigma and perceptions questionnaire for pharmacists: An exploratory factor analysis approach in New York state counties enrolled in the healing communities study","authors":"Dawn Goddard-Eckrich ,&nbsp;Kyle Grealis ,&nbsp;Nabila El-Bassel ,&nbsp;David W. Lounsbury ,&nbsp;Nishita Dsouza ,&nbsp;Jennifer Bhuiyan ,&nbsp;Melissa Cervantes ,&nbsp;Angelo Angerame ,&nbsp;Daniel J. Feaster ,&nbsp;Erin Kim ,&nbsp;Terry T.K. Huang ,&nbsp;Nasim S. Sabounchi ,&nbsp;Louisa Gilbert ,&nbsp;Frances R. Levin ,&nbsp;Kevonyah Edwards ,&nbsp;Ohshue S. Gatanaga ,&nbsp;Tara McCrimmon ,&nbsp;James L. David ,&nbsp;Timothy Hunt ,&nbsp;Edward V. Nunes ,&nbsp;Raymond Balise","doi":"10.1016/j.josat.2024.209566","DOIUrl":"10.1016/j.josat.2024.209566","url":null,"abstract":"<div><h3>Introduction</h3><div>Little is known about how pharmacists' attitudes and stigma toward naloxone and Medication for opioid use disorder (MOUD) influence effective linkage to treatment. We examine the psychometrics of a new Pharmacist Opioid Use Disorder Perceptions Questionnaire (P-OUDP-Q), a multidimensional measure to examine pharmacists' stigma and perceptions related to MOUD in the New York State (NYS) site of the HEALing Communities Study.</div></div><div><h3>Methods</h3><div>The study recruited a sample of 324 pharmacists from 16 counties in NYS between January and June 2022. A 74-item questionnaire assessed pharmacists' familiarity with opioid-related medications, protocols, policies and attitudes regarding their role, confidence, and beliefs centered around delivery of MOUD and naloxone in the community. Exploratory factor analysis assessed individual and community-level factors associated with four underlying constructs. Factor scores were compared across the demographic predictors. Variables factor loadings &lt;0.4 were eliminated from the factor analysis and the process was reiterated.</div></div><div><h3>Results</h3><div>Eighty-six percent (<em>n</em> = 280) of the pharmacists were white. A little over half, 57 % (<em>n</em> = 186), were female, 35 % (<em>n</em> = 113) were 30–35 years old. The mean number of years practicing (SD) was 18 (SD: 13). Exploratory factor analysis identified four underlying constructs: (1) practice confidence, (2) practice familiarity, (3) practice attitudes, and (4) methadone attitudes. Statistically significant (<em>p</em> &lt; .05) mean factor scale score differences by race were observed for practice familiarity (white reporting higher than non-white); by pharmacy size for practice familiarity (across all groups; non-significant Tukey post-hoc) and practice attitudes (hospital/clinic greater than big chain pharmacies); by gender (males greater than females) for practice familiarity and methadone attitudes; by poverty quartile for practice attitudes (lowest less than highest quartile); and urban versus rural pharmacist county setting for practice familiarity (rural greater than urban).</div></div><div><h3>Conclusions</h3><div>Findings show the P-OUDP-Q is a concise measure of pharmacists' perceptions of their role in dispensing MOUD and naloxone, including distinct “stigma” dimensions, which is valuable for use with pharmacists in communities highly impacted by the opioid epidemic. The development and validation of a reliable measure to assess pharmacists' perceptions of stigma and barriers represents a valuable contribution to the field, to inform the design/implementation of targeted interventions and support systems.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209566"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634177","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":"Clinician perspectives on barriers and facilitators to the treatment of adolescent cannabis use: A qualitative study","authors":"Maha N. Mian ,&nbsp;Jay Annam ,&nbsp;Andrea Altschuler ,&nbsp;Monique B. Does ,&nbsp;Stacy A. Sterling ,&nbsp;Derek D. Satre ,&nbsp;Cynthia I. Campbell ,&nbsp;Asma H. Asyyed ,&nbsp;Lynn D. Silver ,&nbsp;Sarah F. Cunningham ,&nbsp;Kelly C. Young-Wolff","doi":"10.1016/j.josat.2024.209559","DOIUrl":"10.1016/j.josat.2024.209559","url":null,"abstract":"<div><h3>Introduction</h3><div>Cannabis use among adolescents is prevalent, and clinicians who work with adolescents have unique insights about how to treat cannabis use in this population.</div></div><div><h3>Methods</h3><div>This qualitative study interviewed 32 clinicians from addiction medicine recovery services (AMRS), the emergency department (ED), mental health (MH), and pediatrics in an integrated healthcare system to understand their perspectives and experiences regarding barriers and facilitators to treating adolescent cannabis use. The analysis was developed using thematic analysis of interviews.</div></div><div><h3>Results</h3><div>Thirty-two clinicians (Mean age = 45.9, SD =7.6; 56.3 % Female; 56.3 % White) were recruited from AMRS (<em>n</em> = 13; 41.6 %), the ED (<em>n</em> = 7; 21.9 %), MH (n = 7; 21.9 %) and pediatrics (<em>n</em> = 5; 15.6 %). Clinicians discussed several key barriers and facilitators of treating adolescent cannabis use. Facilitators include the use of multiple screening tools for adolescent cannabis use (i.e., self-report and toxicology testing) which provide more comprehensive information; patient-centered treatment approaches; and discussing cannabis use in the context of adolescents' mental health. Barriers discussed included adolescents' and parents' minimization of adolescent cannabis use risks. Several factors were discussed as potential facilitators or barriers, depending on context, including the influence of peers, virtual treatment, and parental involvement or lack thereof in treatment.</div></div><div><h3>Conclusions</h3><div>Interviews with clinicians who work with adolescents across settings highlighted factors that serve as barriers and facilitators to treating adolescent cannabis use. These findings have important implications for guiding future research and intervention efforts, including the inclusion of universal screening practices, addressing stigma, reducing adolescents' and parents' minimization of cannabis use-related harms, and improving adolescent and parent engagement in treatment.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209559"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634172","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":"Medications for opioid use disorder and other evidence-based service offerings in faith-affiliated treatment centers: Implications for implementation partnerships","authors":"Kim Gannon ,&nbsp;Charles A. Warnock","doi":"10.1016/j.josat.2024.209572","DOIUrl":"10.1016/j.josat.2024.209572","url":null,"abstract":"<div><h3>Introduction</h3><div>Amidst an ongoing surge of opioid use disorder (OUD) incidence, clinicians and policymakers are seeking partnerships with faith communities – including with faith-affiliated treatment centers (FATCs) – to expand access to evidence-based OUD treatment. However, little is known whether FATCs differentially offer such evidence-based treatment services, particularly medications for opioid use disorder (MOUD) and co-occurring mental health care.</div></div><div><h3>Methods</h3><div>We use the 2021 National Substance Use and Mental Health Services Survey (N-SUMHSS) to examine differences in provision of several OUD services, including MOUD, psychological treatments, mental health services, medical services, recovery support services, and services related to treatment accessibility, between self-identified FATCs and non-FATCs. We also explored differences in characteristics related to insurance, licensure, and accreditation.</div></div><div><h3>Results</h3><div>FATCs were less likely than non-FATCs to offer almost all measure of MOUD and more likely to refuse to accept clients who use MOUD. They were also less likely to report using telemedicine. However, they were more likely to offer residential treatment, Twelve Step facilitation, and transitional housing. We find little evidence that FATCs offer co-occurring mental health treatments at different rates than non-FATCs.</div></div><div><h3>Conclusion</h3><div>More research is needed to examine the factors that drive these differences, especially in MOUD and transitional housing. When partnering with FATCs, clinicians and policymakers should seek common ground with FATCs and recognize the philosophies, values, and concerns that may potentially be driving these differences.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209572"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634185","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":"Exploring the potential of Self-Management and Recovery Training (SMART Recovery) mutual-help groups for supporting people who use methamphetamine: A qualitative study examining participant experience of initiation and engagement","authors":"Alison K. Beck ,&nbsp;Briony Larance ,&nbsp;Victoria Manning ,&nbsp;Frank P. Deane ,&nbsp;Amanda L. Baker ,&nbsp;Leanne Hides ,&nbsp;Anthony Shakeshaft ,&nbsp;Angela Argent ,&nbsp;Peter J. Kelly","doi":"10.1016/j.josat.2024.209570","DOIUrl":"10.1016/j.josat.2024.209570","url":null,"abstract":"<div><h3>Introduction</h3><div>Improving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training (‘SMART Recovery’) mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement.</div></div><div><h3>Methods</h3><div>A sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization.</div></div><div><h3>Results</h3><div>Participant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the ‘fit’ of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change.</div></div><div><h3>Discussion and conclusions</h3><div>SMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209570"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634213","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":"An interrupted time series analysis of fentanyl, naloxone, and opioid-involved deaths in five counties in Eastern Missouri","authors":"Schyler T. Newman ,&nbsp;Ian A. McNamara ,&nbsp;Kaytryn D. Campbell ,&nbsp;Brandon Park ,&nbsp;Ryan W. Carpenter ,&nbsp;Brittany A. Blanchard ,&nbsp;Paul Thater ,&nbsp;Lauren Green ,&nbsp;Rachel P. Winograd","doi":"10.1016/j.josat.2024.209564","DOIUrl":"10.1016/j.josat.2024.209564","url":null,"abstract":"<div><h3>Introduction</h3><div>Rates of opioid overdose deaths (OOD) have increased since the introduction of illicitly manufactured fentanyl in the U.S. drug supply. Though community-based naloxone distribution efforts have been found to effectively reduce OOD, no studies to date have examined their effects during the fentanyl era, nor in the epicenter of a state's overdose crisis. Thus, the current study assessed the impacts of both fentanyl and of subsequent grant-funded community-based naloxone distribution on OOD across Missouri's St. Louis region.</div></div><div><h3>Methods</h3><div>Medical examiner data includes individuals who died within one of the five study counties (St. Louis City, St. Louis County, and Franklin, Jefferson, St. Charles counties [combined as “Collar Counties”]) between 2011 and 2022 due to an opioid overdose (<em>N</em> = 6,799). Naloxone distribution date and location data came from Missouri's university-based naloxone distribution team. We conducted a controlled interrupted time series using an autoregressive model via proc ARIMA to examine changes over time in the rate of OOD associated with the introduction of fentanyl (defined to be present in 25% of opioid overdose deaths; June 2015) and the start of naloxone distribution for each location (August 2017, October 2017, and January 2018, respectively).</div></div><div><h3>Results</h3><div>The introduction of fentanyl into the drug supply of St. Louis City was associated with an increased rate of OOD over time (<em>p</em> &lt; .001). Naloxone distribution in the City was associated with an immediate decrease in OOD (<em>p</em> &lt; .001) followed by a slowed increase in OOD (<em>p</em> &lt; .001). These findings were not replicated in St. Louis County nor the Collar Counties.</div></div><div><h3>Conclusions</h3><div>The effects of fentanyl and naloxone on OOD varied by region in Eastern Missouri. Specifically, fentanyl and naloxone effects were only found in a high-need urban area with existing harm reduction and street outreach programs, but not in surrounding suburban or rural areas. State-level naloxone distribution decision-makers should prioritize funding harm reduction services in both urban and non-urban settings to help increase targeted naloxone distribution to those actively using drugs. Additionally, interventions tailored for people who engage in solitary drug use - such as safe consumption spaces and overdose detection technologies - should receive increased investment and implementation, particularly in rural areas where harm reduction infrastructure is more scarce.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209564"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591072","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":"Are virtual harm reduction interventions right for everyone?: A qualitative study of the appropriateness of overdose response hotlines and applications for different subgroups of people who use substances","authors":"Adrian Teare ,&nbsp;William Rioux ,&nbsp;Nathan Rider ,&nbsp;Stephanie Jones ,&nbsp;Pamela Taplay ,&nbsp;S. Monty Ghosh","doi":"10.1016/j.josat.2024.209567","DOIUrl":"10.1016/j.josat.2024.209567","url":null,"abstract":"<div><h3>Introduction</h3><div>Overdose response hotlines and apps are novel virtual harm reduction technologies that allow remote monitoring of individuals while they use substances (especially if they use alone) through electronic means. The authors explored partner perspectives to determine which groups of people who use substances (PWUS) these services would be most appropriate for, with the aim of better informing service providers on how to target their use to maximize benefit for clients.</div></div><div><h3>Methods</h3><div>The study conducted 64 semi-structured interviews with participants from a variety of backgrounds (individuals with lived or living experience of substance use, lay persons, health care providers, harm reduction workers, and operational experts). All information from interviews was kept confidential, de-identified, and stored on a secure server. Inductive thematic analysis identified major themes and subthemes. Two evaluators coded transcripts using Dedoose software. Once initial coding was complete, transcript coders selected quotes and shared them with a consulting project manager to cross-validate themes. The study conducted interviews until thematic saturation across all participants was reached based on the consensus of the two evaluators and the primary investigator.</div></div><div><h3>Results</h3><div>Overall, the study determined that overdose response hotlines and apps would potentially have at least some utility for any PWUS. However, some were found to have a varying level of appropriateness for specific subgroups of PWUS. There were 11 different subgroups identified in this study and of these subgroups, the majority were identified as groups for whom virtual harm reduction services would be appropriate interventions.</div></div><div><h3>Conclusions</h3><div>Overdose response hotlines and apps are helpful and potentially life-saving adjunctive options which may be more appropriate for some subgroups of PWUS than others. These results may help service providers to target groups with the most potential to benefit.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209567"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606785","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":"Staff perspectives of barriers and facilitators to implementation of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in New York City safety net hospitals","authors":"Amanda M. Bunting ,&nbsp;Adetayo Fawole ,&nbsp;Jasmine Fernando ,&nbsp;Noa Appleton ,&nbsp;Carla King ,&nbsp;Lauren Textor ,&nbsp;Daniel Schatz ,&nbsp;Jennifer McNeely","doi":"10.1016/j.josat.2024.209560","DOIUrl":"10.1016/j.josat.2024.209560","url":null,"abstract":"<div><h3>Background</h3><div>In response to the heavy burden of untreated substance use disorders (SUD) in hospital patients, many health systems are implementing addiction consult services staffed by interprofessional teams that diagnose SUD, make recommendations for SUD care in the hospital, and link patients to post-discharge treatment. In 2018, the New York City public hospital system began rolling out the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in six hospitals. CATCH teams are comprised of an addiction-trained medical provider, social worker or addiction counselor, and peer counselor.</div></div><div><h3>Methods</h3><div>The study conducted qualitative interviews with CATCH staff at all six participating hospitals as part of a pragmatic trial studying the effectiveness and implementation of CATCH. The Consolidated Framework for Implementation Research (CFIR) framework guided interviews conducted from 2018 to 2021 with 26 staff at the start of implementation and with 33 staff 9–12 months post-implementation. The study team created a codebook a priori and further refined it through additional coding of initial interviews. Codes were systematically analyzed using the CFIR.</div></div><div><h3>Results</h3><div>Barriers and facilitators spanned four CFIR domains: inner setting, outer setting, process, and individual characteristics. Barriers identified were primarily related to the outer and inner settings, including patient characteristics and limited resources (e.g. medical comorbidities, homelessness), insurance, CATCH team role confusion, and infrastructure deficits (e.g., availability of physical space). Additional barriers related to process (workload burden), and characteristics of individuals (stigma and lack of comfort treating SUD among medical teams). Facilitators were mostly related to the characteristics of individuals on the CATCH team (advantages and expertise of the CATCH peer counselor, CATCH team communication and cohesiveness) and inner setting (CATCH team relationships with hospital staff, hospital leadership buy-in and support, and infrastructure). Community networks (outer setting) and CATCH training resources (process) were also facilitators of program implementation.</div></div><div><h3>Conclusion</h3><div>Addiction consult services have great potential for improving care for hospital patients with SUD, but as new programs in busy hospital settings they face barriers to implementation that could impact their effectiveness. Barriers may be particularly impactful for programs operating in safety-net hospitals, given limited resources within the health system and the multiple and complex needs of their patients. Understanding the strengths of these programs as well as the barriers to their implementation is critical to utilizing addiction consult services effectively.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209560"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591292","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":"Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020","authors":"Rachel Presskreischer ,&nbsp;Ramin Mojtabai ,&nbsp;Christine Mauro ,&nbsp;Zhijun Zhang ,&nbsp;Melanie Wall ,&nbsp;Mark Olfson","doi":"10.1016/j.josat.2024.209568","DOIUrl":"10.1016/j.josat.2024.209568","url":null,"abstract":"<div><h3>Introduction</h3><div>Medications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period.</div></div><div><h3>Methods</h3><div>Analyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period.</div></div><div><h3>Results</h3><div>Among outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC.</div></div><div><h3>Conclusions</h3><div>Medicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209568"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591221","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":"Which intervention works for whom: Identifying pre-treatment characteristics that predict who will benefit from a specific alcohol text message intervention from a randomized trial","authors":"Tammy Chung ,&nbsp;Brian Suffoletto ,&nbsp;Trishnee Bhurosy","doi":"10.1016/j.josat.2024.209562","DOIUrl":"10.1016/j.josat.2024.209562","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective interventions show heterogeneity in treatment response. Addressing this heterogeneity involves identifying which intervention works best for whom. One method to address this heterogeneity identifies treatment-subgroup interactions to determine which of two interventions has greater effect for certain individuals based on their profile of pre-treatment characteristics. This secondary analysis of a randomized clinical trial (RCT) to address binge drinking examined whether two of the RCT's interventions, GOAL and COMBO, which produced similar reductions in drinking outcomes, might have involved treatment-subgroup interactions. Identifying treatment-subgroup interactions can inform efficient patient-treatment matching that optimizes individual outcomes.</div></div><div><h3>Methods</h3><div>These secondary analyses included young adults (<em>n</em> = 344; 68.6 % female, ages 18–25) randomized to GOAL or COMBO 12-week alcohol text message interventions and who completed 3-month follow-up (end of intervention). GOAL provided weekly support for drinking limit goals. COMBO included all GOAL features, in addition to pre-event feedback on drinking plans and post-event feedback on alcohol consumption. QUINT, a tree-based algorithm, aimed to identify treatment-subgroup interactions using 21 pre-treatment (baseline) characteristics (e.g., demographics, perceived risk of binge-drinking related harm, perceived number of peers drinking to intoxication) that predicted the primary outcome of binge drinking at follow-up.</div></div><div><h3>Results</h3><div>The algorithm used five pre-treatment characteristics (sex, race, perceived risk of binge drinking-related harm, perceived number of peers drinking to intoxication, and any cannabis use in the past 3 months) to identify 7 treatment-subgroup interactions. COMBO had greater effectiveness than GOAL, for example, for females who reported lower risk of binge-drinking related harm and no cannabis use in the past 3 months, whereas GOAL had greater effectiveness for females who reported higher risk of binge-drinking related harm and more peers who drank to intoxication. In comparison, GOAL had greater effectiveness than COMBO among White males, whereas males of other racial backgrounds benefitted more from COMBO than GOAL.</div></div><div><h3>Conclusions</h3><div>The identified treatment-subgroup interactions involving GOAL and COMBO indicated which intervention had greater effectiveness for which subgroups of individuals based on pre-treatment characteristics. These findings can help efficiently match individuals to effective interventions, bringing the field closer to personalized, precision care.</div><div>Clinical trials registration number: <span><span>NCT02918565</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209562"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591375","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}