Journal of substance use and addiction treatment最新文献

{"title":"Identifying emergency department patients at high risk for opioid overdose using natural language processing and machine learning","authors":"Amanda Sharp ,&nbsp;Gareth J. Parry ,&nbsp;Gabriel Ríos Pérez ,&nbsp;Brian O. Mullin ,&nbsp;Xinyu Yang ,&nbsp;Anika Kumar ,&nbsp;Timothy Creedon ,&nbsp;Michael Flores ,&nbsp;Christopher M. Fischer ,&nbsp;Zev Schuman-Olivier ,&nbsp;Margo Moyer ,&nbsp;Nathaniel M. Tran ,&nbsp;Benjamin L. Cook","doi":"10.1016/j.josat.2025.209718","DOIUrl":"10.1016/j.josat.2025.209718","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency departments (ED) are potential sites for identifying and treating individuals at high risk for opioid overdose. This study used machine learning (ML)-based models to predict opioid overdose death in the 12 months after an ED visit.</div></div><div><h3>Methods</h3><div>The study merged electronic health records (EHR), including clinical notes, of adult patients admitted to an urban safety net ED from 2011 to 2018 with opioid overdose-related mortality tables from 2012 to 2019. The sample includes all patients who experienced an opioid overdose related death (<em>n</em> = 729) and a subset of ED patients that did not (<em>n</em> = 4927). A mutual information classification algorithm was employed for feature selection. Predictive XGBoost, random forest, and regression models trained on 70 % of the sample with the reduced feature matrix and validated on a test set (30 % of sample).</div></div><div><h3>Results</h3><div>Feature selection reduced the feature matrix from 1336 to 50 features, with 37 originating from EHR clinical notes. Using a probability of &gt;0.5 as a predictor of opioid overdose death, all models demonstrated satisfactory calibration and excellent accuracy, precision, and recall across all models (averaging 92 % accuracy, 75 % precision and 57 % recall).</div></div><div><h3>Conclusion</h3><div>ML algorithms based on structured and unstructured EHR can successfully classify patients at risk of fatal opioid overdose. Prospectively, these tools can be used to identify patients that may benefit from interventions to reduce their risk of opioid overdose death. The development of these predictive models may improve the timeliness and efficacy of clinical decision making and ED-initiated services for opioid use disorders.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"175 ","pages":"Article 209718"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929639","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":"Missouri naloxone distribution 2017–2023: Evaluation and implications of applying a naloxone saturation model","authors":"Kyle Vance B.A. ,&nbsp;Brandon Park B.A. ,&nbsp;Rithvik Kondai B.A. ,&nbsp;Lauren Green MSW ,&nbsp;Traci C. Green Ph.D. ,&nbsp;Brandon D.L. Marshall Ph.D. ,&nbsp;Rachel P. Winograd Ph.D.","doi":"10.1016/j.josat.2025.209708","DOIUrl":"10.1016/j.josat.2025.209708","url":null,"abstract":"<div><h3>Introduction</h3><div>Overdose deaths have increased sharply in the past five years. States have implemented overdose education and naloxone distribution (OEND) initiatives to mitigate overdose deaths at a population level. <span><span>Irvine et al. (2022)</span></span> proposed a model to estimate amounts of naloxone needed to meaningfully reduce opioid overdose mortality (defined as naloxone saturation) by distributing it through: 1) community-based, 2) pharmacy-initiated, and 3) provider-based access points. In the most recent rounds of State Opioid Response grant applications, the Substance Abuse and Mental Health Services Administration (SAMHSA) required plans to reach naloxone saturation. Though SAMHSA funding has supported the growth of Missouri-based OEND, the outcomes of applying such a model are yet to be evaluated.</div></div><div><h3>Methods</h3><div>We used descriptive statistics and visual inspection to evaluate Missouri's naloxone distribution across agency types and years. Missouri's naloxone output was compared to observed opioid overdose fatalities and the naloxone need estimated by the model, which was at least 31,000 two-dose kits distributed through community-based settings to reach saturation.</div></div><div><h3>Results</h3><div>Missouri distributed over 400,000 naloxone kits from 2017 to 2023. In 2021, Missouri distributed 32,486 kits, passing the annual saturation threshold. Overall, street outreach/harm reduction services received the most naloxone (38.9 %), followed by treatment providers (13.6 %), recovery community centers (12.6 %), and social service providers (11.6 %). Missouri's opioid overdose death rate slowed in 2022 and began to discernibly decrease in 2023.</div></div><div><h3>Conclusions</h3><div>Missouri's naloxone distribution exceeded established saturation targets and evolved to include a wide variety of community access points, eventually coinciding with opioid overdose mortality reductions. Given the significant variability in overdose risk across populations and regions, the increasingly potent and volatile drug supply emerging since 2017, and the persistent risk of solitary drug use, more comprehensive response strategies are needed and saturation models should be updated to incorporate more specific geographic, racial/ethnic, and programmatic distribution targets.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209708"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906561","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":"Use of harm reduction practices by state-licensed specialty substance use treatment programs","authors":"Isha K. Desai ,&nbsp;Kathryn Burke ,&nbsp;Yuzhong Li ,&nbsp;Valerie Ganetsky ,&nbsp;Olivia K. Sugarman ,&nbsp;Noa Krawczyk ,&nbsp;Kenneth A. Feder","doi":"10.1016/j.josat.2025.209711","DOIUrl":"10.1016/j.josat.2025.209711","url":null,"abstract":"<div><h3>Introduction</h3><div>Specialty substance use treatment programs may adopt harm reduction practices to protect the health of their patients with opioid use disorder (OUD). Two such harm reduction strategies are distributing naloxone to clients and refraining from discharging clients if they have positive urine drug screens for drugs. The purpose of this study was to understand the prevalence of programs that adopt each of these harm reduction practices and the characteristics of clients attending programs that adopt both practices in a sample of state-licensed substance use treatment programs in New Jersey.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of specialty treatment programs in New Jersey about a) naloxone dispensing and b) use of urine toxicology screens in client discharge decisions. We linked this survey to the treatment programs' administrative records of client admissions for OUD treatment between July 2021 to June 2022 (<em>n</em> = 14,838). We estimated the proportion of programs that reported that they adopted each practice. We then examined program and client characteristics associated with applying these harm reduction practices using regression methods.</div></div><div><h3>Results</h3><div>Of 108 programs included in this analysis, 55.6 % dispensed naloxone and 50.9 % did not consider toxicology screens in discharge decisions. Opioid treatment programs (OTP) were significantly more likely to adopt both harm reduction practices than non-OTPs. Clients referred by correctional programs, as opposed to self-referred to treatment, were significantly less likely to attend a program that used either harm reduction practice.</div></div><div><h3>Conclusions</h3><div>Our findings suggest efforts are needed to increase adoption of harm reduction practices in SUD treatment settings, especially that are not OTPs, and programs serving clients referred by the criminal justice system.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209711"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887697","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 of treatment providers overseeing substance use disorder treatment among transition-age adults, aged 18–25 years","authors":"Josh Aleksanyan ,&nbsp;Zobaida Maria ,&nbsp;Diego Renteria ,&nbsp;Adetayo Fawole ,&nbsp;Ashly E. Jordan ,&nbsp;Vanessa Drury ,&nbsp;Sam Kowala ,&nbsp;Jamie del Rosario ,&nbsp;Patricia Lincourt ,&nbsp;Maria L. Morris-Grove ,&nbsp;Sueun Hong ,&nbsp;Sugy Choi ,&nbsp;Charles J. Neighbors","doi":"10.1016/j.josat.2025.209704","DOIUrl":"10.1016/j.josat.2025.209704","url":null,"abstract":"<div><h3>Introduction</h3><div>Transition-age (TA) adults, aged 18–25, have the highest prevalence of substance use disorder (SUD) among all age groups yet they are less likely to seek treatment and more likely to discontinue it than older adults, making them a high-priority treatment population. While structural barriers and varying expectations of recovery may affect treatment initiation, insights from providers working with TA adults can reveal what further impels and impedes treatment engagement.</div></div><div><h3>Methods</h3><div>We conducted two focus groups with 14 front-line treatment providers, representing urban and rural outpatient, residential, and inpatient SUD care settings across New York State. Providers were selected through stratified sampling using restricted-access treatment registry data. A semi-structured interview guide facilitated discussions, and transcripts were analyzed to identify key themes.</div></div><div><h3>Results</h3><div>Providers report that TA adults prefer briefer, innovative treatment approaches over traditional modalities like A.A./12-step recovery, driven by a desire to rebuild their lives through education and career. Post-pandemic social disruptions were cited as exacerbating engagement challenges and increasing the need for integrating mental health support. Providers highlighted the potential of technology to enhance treatment engagement, though expressed concerns regarding social isolation and the fraying of childhood safety nets and support systems (e.g., housing) undermining successful treatment outcomes and transitions to adulthood more broadly.</div></div><div><h3>Conclusions</h3><div>Providers report and perceive various challenges—unmet mental health needs, social alienation, and housing insecurity—that impede TA adults from successful SUD treatment. Understanding providers' perceptions of the needs of young adults can inform patient and clinical decision-making, lead to the development of innovative treatment approaches tailored to TA adults and contribute to improved health outcomes over the life course.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209704"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906560","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":"Integration of harm reduction principles and practices within specialty substance use treatment programs in New Jersey: A qualitative study of program leadership","authors":"Valerie S. Ganetsky ,&nbsp;Kenneth A. Feder ,&nbsp;Kathryn N. Burke ,&nbsp;Isha K. Desai ,&nbsp;Samantha J. Harris ,&nbsp;Noa Krawczyk","doi":"10.1016/j.josat.2025.209703","DOIUrl":"10.1016/j.josat.2025.209703","url":null,"abstract":"<div><h3>Introduction</h3><div>Harm reduction is a philosophical approach to improve the health of people who use drugs (PWUD) that integrates risk reduction, evidence-based treatment, and person-centered care. Specialty substance use treatment programs have historically been siloed from, and often misaligned with, harm reduction principles, but this trend has begun to shift in recent years. This study explored the ways in which some specialty treatment settings are adopting harm reduction principles and practices.</div></div><div><h3>Methods</h3><div>We conducted qualitative interviews with leaders of 14 New Jersey specialty treatment programs around their opioid use disorder treatment practices. Using thematic analysis, we assessed how aligned treatment practices were with the core pillars, principles, and practice areas outlined in the 2023 Harm Reduction Framework developed by the Substance Abuse and Mental Health Services Administration.</div></div><div><h3>Results</h3><div>Programs described integrating a range of harm reduction principles, including respect for autonomy, low-barrier treatment, and nonpunitive care, into their approach to care. However, several ongoing practices conflicted with these principles, including imposing attendance requirements, lacking an on-site provider to facilitate same-day medication initiation, and use of urine toxicology testing as a major marker of treatment success. Additionally, while many programs were engaging in some overdose prevention practices (e.g., naloxone distribution), few programs offered other risk reduction services.</div></div><div><h3>Conclusions</h3><div>Findings highlight that significant opportunities remain to better integrate harm reduction principles and practices into specialty substance use treatment facilities to improve the quality of care provided to PWUD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209703"},"PeriodicalIF":0.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887696","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":"Experiences of healthcare discrimination and treatment outcomes among pregnant and postpartum people with opioid use disorder","authors":"Joyce H. Xu ,&nbsp;Emily A. DeFranco ,&nbsp;Aaron W. Murnan ,&nbsp;Mishka Terplan ,&nbsp;Stephanie L. Merhar ,&nbsp;Nichole L. Nidey","doi":"10.1016/j.josat.2025.209707","DOIUrl":"10.1016/j.josat.2025.209707","url":null,"abstract":"<div><h3>Introduction</h3><div>Experiences of discrimination among pregnant and postpartum people with opioid use disorder likely affect utilization of medications for opioid use disorder (MOUD), which reduce the risk of overdose and death. We evaluated experiences of discrimination in this population by healthcare setting and estimated their effects on MOUD treatment outcomes.</div></div><div><h3>Methods</h3><div>Participants who had received MOUD at least once during pregnancy were enrolled into this retrospective cohort study. A modified Healthcare Discrimination Scale assessed discrimination within prenatal care (PNC) and substance use disorder treatment (SUD) settings. Patient-members from the Empower project co-designed survey items to measure treatment outcomes: MOUD misuse, discontinuation, return to use, and overdose. We examined the proportion of participants who endorsed each item on the Healthcare Discrimination Scale and summed the total scores by healthcare setting. Relative risk (RR) and 95 % confidence intervals (CI) were estimated using log-binomial models.</div></div><div><h3>Results</h3><div>Among 100 participants, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD clinics. Discrimination in the SUD setting was associated with an over two-fold increased risk of MOUD discontinuation (RR 2.56, CI 1.19—5.54) and return to use (RR 2.36, CI 1.18—4.73). Increased risk of misusing MOUD was associated with discrimination in both PNC (RR 2.6, 95 % CI 1.06—6.40) and SUD (RR 3.26, CI 1.59—6.70) settings.</div></div><div><h3>Conclusions</h3><div>Experiences of discrimination were common, especially in prenatal care settings, and were associated with postpartum MOUD misuse. Addressing discrimination within healthcare settings may improve treatment outcomes for pregnant and postpartum people with OUD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209707"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869144","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":"Outcomes following two models of treatment linkage facilitation for women with a history of OUD following jail release","authors":"Michele Staton ,&nbsp;Martha Tillson ,&nbsp;Douglas Terrill ,&nbsp;Carrie Oser ,&nbsp;Carl Leukefeld ,&nbsp;Laura Fanucchi ,&nbsp;Kathryn McCollister ,&nbsp;Megan F. Dickson ,&nbsp;Erin Winston ,&nbsp;Jaxin Annett ,&nbsp;J. Matthew Webster","doi":"10.1016/j.josat.2025.209702","DOIUrl":"10.1016/j.josat.2025.209702","url":null,"abstract":"<div><h3>Introduction</h3><div>The Kentucky hub of the NIDA-funded Justice Community Opioid Innovation Network (JCOIN) examined implementation of a PreTreatment Telehealth model of assessment, both alone and in combination with Peer Navigation, to increase utilization of SUD treatment (including MOUD) among women with a history of OUD during community re-entry.</div></div><div><h3>Methods</h3><div>Participants included women (<em>N</em> = 900) randomly selected, screened for OUD, consented, and randomized to two levels of intervention, as well as a comparison group of women in jail-based treatment. About 90 % of women who were released from jail were followed in the community 3 months post-release to assess treatment outcomes.</div></div><div><h3>Results</h3><div>Findings indicated that almost half (44.2 %) of women entered SUD treatment during the 3 months post-release, and about one-fifth (22 %) entered MOUD treatment. In addition, days of substance use, including opioid use specifically, were significantly reduced among women who engaged with their Peer Navigator regularly in the community after jail release.</div></div><div><h3>Conclusions</h3><div>Study findings support the need for future research on treatment linkage facilitation for women that is not only tailored to their unique needs at re-entry, but also considers the systemic facilitating factors and barriers that may be associated with treatment utilization (including the limited use of MOUD during incarceration).</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209702"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873181","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":"The lived experience of navigating entry into residential treatment for alcohol use disorder while experiencing homelessness: A qualitative study","authors":"Katrina Hayes-Macaluso ,&nbsp;Marissa Coppola ,&nbsp;David Serota ,&nbsp;Hansel E. Tookes ,&nbsp;Katrina Ciraldo ,&nbsp;Tyler S. Bartholomew ,&nbsp;Edward Suarez Jr.","doi":"10.1016/j.josat.2025.209709","DOIUrl":"10.1016/j.josat.2025.209709","url":null,"abstract":"<div><h3>Introduction</h3><div>Alcohol use disorder (AUD) is highly prevalent among people experiencing homelessness with an estimated 29 %–63 % impacted by this disease. As the effects of alcohol further perpetuate cycles of homelessness, treatment of AUD among this population is an important area of research. Although treatment facilities and outpatient services exist, many unhoused individuals underutilize or lack engagement with these programs. To date, only a few studies have explored the lived experiences of individuals navigating pathways toward treatment for AUD from the streets. Therefore, a patient-centered understanding through the lens of individuals with lived experiences may help those embedded within addiction treatment networks better engage and care for people experiencing homelessness.</div></div><div><h3>Methods</h3><div>This study consisted of in-depth semi-structured interviews with people experiencing homelessness being treated at a residential treatment facility for AUD (<em>N</em> = 19). Thematic analysis was used to understand their perspectives regarding the intricacies of navigating into a residential treatment facility for AUD from the streets. Interview transcripts were analyzed using Nvivo software, and an open codebook which guided the analysis.</div></div><div><h3>Results</h3><div>Frequently described barriers to AUD treatment initiation, navigation, and maintenance were compiled into themes such as, “alcohol as a method of escapism”, “burden of navigation lies on the participant”, and “gaps in knowledge and function of community resources.” Facilitators to AUD treatment included, “need for housing,” “linkage by good samaritans,” “internal faith,” and “being a role model and productive citizen.” Attitudes that influenced engagement within the treatment network included “self-efficacy,” “recognition of AUD risks,” and “medical mistrust.”</div></div><div><h3>Discussion</h3><div>This study unveiled perceived internal and external structural barriers and facilitators that guide AUD treatment initiation, navigation, and maintenance from the streets. More so, it generated common attitudes that facilitate various levels of engagement within the AUD treatment network among people experiencing homelessness. Through the generosity of participants in sharing their stories, this study can aid in informing the development and implementation of effective treatment models focused on guiding people experiencing homelessness toward treatment and recovery.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209709"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873182","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":"Prognostic factors of a multidisciplinary rtms-based treatment for cocaine use disorder: A large cohort study","authors":"Luis J. Gómez Pérez ,&nbsp;Stefano Cardullo ,&nbsp;Giulia Carla Zaffaina ,&nbsp;Diego Cuppone ,&nbsp;Sonia Chindamo ,&nbsp;Andrea Zattin ,&nbsp;Nicola Cellini ,&nbsp;Alberto Terraneo ,&nbsp;Luigi Gallimberti","doi":"10.1016/j.josat.2025.209706","DOIUrl":"10.1016/j.josat.2025.209706","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigated psychological and clinical factors influencing treatment outcomes for Cocaine Use Disorder (CocUD) patients undergoing a multidisciplinary approach, including repetitive Transcranial Magnetic Stimulation (rTMS), addiction counseling, pharmacological treatment, and psychotherapeutic support. Multidisciplinary treatments appear to be more effective than stand-alone programs in addiction recovery.</div></div><div><h3>Methods</h3><div>This is a retrospective observational study of 1011 patients meeting DSM-5 criteria for CocUD undergoing a multidisciplinary treatment rTMS-based. The primary outcomes were (1) the time to the first lapse, (2) the time to dropout from the program, and (3) the monthly cocaine use pattern for up to one year since clinical admission. The secondary indices were the variations in the withdrawal symptoms. The influence of various factors on the time to first lapse and treatment dropout was analyzed using multivariate Cox proportional hazard models, which helps understand how different factors influence the time until an event, such as relapse or dropout, occurs. Concerning cocaine use patterns and secondary outcomes, linear mixed models were applied.</div></div><div><h3>Results</h3><div>Protective factors comprise personal initiative in seeking treatment, starting with inpatient care, a higher number of high frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC), and referral to psychotherapy. In contrast, risk factors were psychiatric comorbidity (e.g., personality disorder, other addictions, alcohol use disorder), craving intensity, last use before treatment admission, and number of pharmacological prescriptions. Moreover, an increase in the number of high frequency rTMS over the left DLPFC sessions was a significant predictor of the reduction of severity on self-reported measures of psychiatric symptoms.</div></div><div><h3>Conclusions</h3><div>Personal initiative in seeking treatment and psychotherapy emerged as protective factors along with high frequency rTMS over the left DLPFC in determining positive outcomes, including a reduction in the severity of co-occurring psychiatric CocUD symptoms, underlining the benefit of a multidimensional approach to treating CocUD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209706"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869143","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 qualitative exploration of affected family members’ responses to methamphetamine use using the family resilience framework","authors":"Clare M. Rushton,&nbsp;Peter J. Kelly,&nbsp;Briony Larance,&nbsp;Camilla J. Townsend,&nbsp;Tamsin Thomas,&nbsp;Alison K. Beck","doi":"10.1016/j.josat.2025.209710","DOIUrl":"10.1016/j.josat.2025.209710","url":null,"abstract":"<div><h3>Introduction</h3><div>Families affected by a loved one’s methamphetamine use experience substantial harm and burden. Pathologising views have been dominant in understanding families’ experiences, reinforcing stigma and limiting support provision and access. Using a family-resilience framework, this qualitative study aimed to identify adaptations in response to the stress and strain of supporting a loved one with methamphetamine use.</div></div><div><h3>Methods</h3><div>Recruitment occurred between March-October 2021 across Australia as part of a larger study assessing the feasibility of a program to support families affected by a loved one’s methamphetamine use. Twenty-four participants (21 women, 3 men) completed semi-structured phone interviews at baseline. Interviews were audio-recorded, transcribed, and thematically analysed, aided by iterative categorisation. A systematic manual of deductive codes guided analysis, with inductive codes integrated as identified in the data. The family-resilience framework informed final theme development.</div></div><div><h3>Results</h3><div>Participants identified changes to their belief systems guiding how they understood and responded to their loved one’s methamphetamine use. Analyses identified four key themes: (1) acceptance and resignation, (2) integrating alternate perspectives to foster compassion for self and others, (3) developing purpose and connection to larger values through spirituality, philanthropy, and/or reconnection with self-identity, and (4) enduring hope and a positive outlook while acknowledging ongoing challenges.</div></div><div><h3>Conclusions</h3><div>Adaptations in the belief systems of families affected by a loved one’s methamphetamine use may facilitate resilience. Treatment design should consider methods that facilitate resilience, such as providing different conceptualisations of addiction to support acceptance and facilitate reconnection with self-identity and personal wellbeing.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209710"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878975","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}