Luis J. Gómez Pérez , Stefano Cardullo , Giulia Carla Zaffaina , Diego Cuppone , Sonia Chindamo , Andrea Zattin , Nicola Cellini , Alberto Terraneo , Luigi Gallimberti
{"title":"Prognostic factors of a multidisciplinary rtms-based treatment for cocaine use disorder: A large cohort study","authors":"Luis J. Gómez Pérez , Stefano Cardullo , Giulia Carla Zaffaina , Diego Cuppone , Sonia Chindamo , Andrea Zattin , Nicola Cellini , Alberto Terraneo , 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}
Clare M. Rushton, Peter J. Kelly, Briony Larance, Camilla J. Townsend, Tamsin Thomas, Alison K. Beck
{"title":"A qualitative exploration of affected family members’ responses to methamphetamine use using the family resilience framework","authors":"Clare M. Rushton, Peter J. Kelly, Briony Larance, Camilla J. Townsend, Tamsin Thomas, 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}
{"title":"Integrated treatment programs for pregnant and parenting people support longer retention compared to standard treatment programs: A population-based cohort study","authors":"Karen Urbanoski , Tomisin Iwajomo , Tara Gomes , Claire de Oliveira , Karen Milligan","doi":"10.1016/j.josat.2025.209701","DOIUrl":"10.1016/j.josat.2025.209701","url":null,"abstract":"<div><h3>Background</h3><div>Integrated treatment programs for pregnant and parenting people seek to provide wrap-around services and supports to overcome the barriers and constraints associated with the gendered contexts of substance use and help-seeking. We investigated retention in outpatient treatment among pregnant people and mothers, comparing integrated treatment programs with standard treatment programs in Ontario, Canada.</div></div><div><h3>Methods</h3><div>We conducted a population-based retrospective cohort study of females (<em>n</em> = 4440) admitted to 11 integrated treatment programs (cases) and 10 standard treatment programs (controls) between 2008 and 2015. Data sources included linked administrative health data merged with primary data on program characteristics. Exposure was program type and outcomes included days in treatment and number of visits. Multi-level negative binomial regression estimated the effects of program type on retention measures, controlling for individual- and program-level covariates.</div></div><div><h3>Results</h3><div>Relative to standard treatment, integrated treatment programs offered more services in-house or through partnerships, with specific advantages around the availability of prenatal or primary care and child-minding. Controlling for individual- and program-level covariates, individuals in integrated treatment programs spent more days in treatment (adjusted incidence rate ratio [aIRR] = 5.41, 95 % CI 4.10–7.13) and had more visits (aIRR = 5.18, 95 % CI 4.305–6.23) than did controls in standard treatment programs.</div></div><div><h3>Conclusions</h3><div>This study contributes to a growing body of evidence on the implementation and effectiveness of wrap-around comprehensive service models, or integrated treatment programs, designed for pregnant and parenting people who use substances. Integrated treatment models constitute a promising approach to supporting families affected by substance use.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209701"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882904","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":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00067-0","DOIUrl":"10.1016/S2949-8759(25)00067-0","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209688"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837827","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":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(25)00068-2","DOIUrl":"10.1016/S2949-8759(25)00068-2","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209689"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837828","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}
Sarah A. Friedman , Paul Snyder , Denis Patterson , Sarah Y.T. Hartzell , Michelle S. Keller
{"title":"De-prescribing opioids among Medicaid patients with long-term opioid use","authors":"Sarah A. Friedman , Paul Snyder , Denis Patterson , Sarah Y.T. Hartzell , Michelle S. Keller","doi":"10.1016/j.josat.2025.209695","DOIUrl":"10.1016/j.josat.2025.209695","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines encourage deprescribing opioids for long-term opioid patients, especially those using opioids and benzodiazepines, z-drugs, or muscle relaxants (“other respiratory depressants”).</div></div><div><h3>Objective</h3><div>Were long-term opioid patients who were prescribed other respiratory depressants more likely to have deprescribing opioid trajectories?</div></div><div><h3>Design</h3><div>Cross-sectional retrospective study using pharmacy and professional claims from 2015 to 2019. Adjusted logistic regression models were stratified on low (<50 morphine milligram equivalents; MME) and high (>50 MME) starting opioid doses. We reported predicted probabilities with 95 % confidence intervals.</div></div><div><h3>Subjects</h3><div>Nevada and Colorado Medicaid beneficiaries 18–64 years old without cancer diagnoses with long-term (120 days' supply/6 months) opioid use (117,400 person-windows).</div></div><div><h3>Measures</h3><div>We used group-based trajectory modeling in Stata to identify characteristic 12-month dosing trajectories. Using the resulting trajectories, we assigned the outcome = 1 if the observation had a deprescribing trajectory (versus a constant trajectory). Binary exposure variables indicated that the patient had an opioid prescription overlapping with 1, 2, or 3 types of other respiratory depressants.</div></div><div><h3>Results</h3><div>Among patients with a low starting opioid dose, the predicted probabilities of a deprescribing trajectory were lower when the patient had overlapping other respiratory depressants compared to when they did not (0 respiratory depressants: 0.33, [0.32, 0.33]; vs. 1 respiratory depressant: 0.22, [0.20, 0.23]; 2 respiratory depressants: 0.18 [0.16, 0.20]; 3 respiratory depressants:0.20 [0.13, 0.27]). Among patients with a high starting opioid dose, we observed similar results.</div></div><div><h3>Conclusions and relevance</h3><div>Targeted provider-level interventions to support deprescribing for long-term opioid patients using opioids and other respiratory depressants may provide particularly high-value care.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"174 ","pages":"Article 209695"},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864914","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}
Leah K. Hamilton , Gwen T. Lapham , Anya Day , Mariah Black-Watson , Dawn Bishop , Darla Parsons , Cheryl A. Budimir , La'Tia Baulckim , Amy K. Lee , Megan Addis , Katharine A. Bradley
{"title":"Improving alcohol-related care in small-medium primary care practices: An evaluation of an adaptation of the SPARC trial intervention for small-medium sized practices","authors":"Leah K. Hamilton , Gwen T. Lapham , Anya Day , Mariah Black-Watson , Dawn Bishop , Darla Parsons , Cheryl A. Budimir , La'Tia Baulckim , Amy K. Lee , Megan Addis , Katharine A. Bradley","doi":"10.1016/j.josat.2025.209697","DOIUrl":"10.1016/j.josat.2025.209697","url":null,"abstract":"<div><h3>Introduction</h3><div>The Sustained Patient-centered Alcohol-Related Care (SPARC) trial demonstrated that 6 months of practice facilitation, decision support in electronic health records (EHRs) and performance feedback, increased identification and treatment of unhealthy alcohol use (UAU) in primary care (PC). The Michigan SPARC (MI-SPARC) study tested an adaptation of SPARC for small-medium PC practices.</div></div><div><h3>Methods</h3><div>PC practices were recruited for and participated in alcohol-related quality improvement (2/2020–2/2023). Outcomes collected for quality improvement were used for this evaluation, with data collected manually (“manual practices”) or electronically (“electronic practices”). The prevalence of EHR-documented brief intervention (BI) and AUD medication treatment (primary outcomes), and alcohol screening and AUD diagnosis (secondary outcomes) were measured at baseline and 6-months. Secondary data from formative evaluation and practice surveys were analyzed using PRISM domains: external environment, recipients, implementation infrastructure, and intervention.</div></div><div><h3>Results</h3><div>25 practices enrolled; 14 completed data collection. Neither primary outcome was consistently monitored or collected by practices. Mean prevalence of documented screening increased from 20 % to 55 % (manual practices) and from 3 % to 20 % (electronic practices). The mean prevalences of documented AUD diagnosis at baseline and follow-up, were 1.4 % and 3.8 % (manual) and 0.1 % and 0.05 % (electronic). At follow-up, 12 practices reported screening with validated questionnaires, and 13 and 8 offering BI and AUD medications respectively. Barriers identified were low resources, small PC teams, low EHR functionality, intervention complexity, stigma, and COVID-19.</div></div><div><h3>Conclusion</h3><div>Despite adaptions for smaller PC practices and improvements in screening, MI-SPARC did not increase documented BI or AUD medication treatment, largely reflecting mismatch between intervention complexity and implementation infrastructure in PC practices.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"173 ","pages":"Article 209697"},"PeriodicalIF":0.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850362","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}
Antoine Khati , Michael Copenhaver , Ran Xu , Frederick L. Altice , Jeffrey A. Wickersham , Kamal Gautam , Kiran Paudel , Roman Shrestha
{"title":"Oral pre-exposure prophylaxis (PrEP) receipt and persistence among opioid-dependent people who inject drugs initiating PrEP for HIV prevention","authors":"Antoine Khati , Michael Copenhaver , Ran Xu , Frederick L. Altice , Jeffrey A. Wickersham , Kamal Gautam , Kiran Paudel , Roman Shrestha","doi":"10.1016/j.josat.2025.209693","DOIUrl":"10.1016/j.josat.2025.209693","url":null,"abstract":"<div><h3>Background</h3><div>The opioid crisis in the United States has led to climbing overdose rates, alongside HIV outbreaks among people who inject drugs (PWID). One area of the pre-exposure prophylaxis (PrEP) cascade that has received little attention is the persistence of PrEP, especially among PWID. To address this gap, this study examined the receipt, persistence, and factors associated with PrEP persistence among opioid-dependent PWID.</div></div><div><h3>Methods</h3><div>Between December 2020 and July 2022, we enrolled 100 opioid-dependent PWID. Eligible participants received a 90-day PrEP prescription from a community-based syringe services program and were followed up at 3 and 6 months. We assessed sociodemographic characteristics, PrEP use, and behaviors related to sex and drug use. We evaluated persistence on PrEP by calculating how many times each participant continued to pick up their PrEP prescription. To identify factors associated with persistence on PrEP, we used a multivariable ordinal logistic regression.</div></div><div><h3>Results</h3><div>On average, participants were in their early 40s (mean age: 44.5, SD: 10.0 years), male (63.0 %), and unemployed (89.0 %). The majority (64.0 %) reported injecting drugs at least once per week in the past month, and 79.0 % had never used PrEP before. A total of 60 participants picked-up PrEP at least once during the 6-month follow-up period, with 42 (70.0 %) retrieving it only once, 16 (26.7 %) twice, and 2 (3.3 %) picking it up three times. In the multivariable model, unemployment (aOR = 7.819; 95 % CI: 1.538–39.751) and prior PrEP use (aOR = 3.381; 95 % CI: 1.210–9.443) were associated with higher persistence on PrEP, whereas participants who injected drugs once a week or less (aOR = 0.039; 95 % CI: 0.008–0.182) or more than once a week in the past month (aOR = 0.098; 95 % CI: 0.029–0.329) were less likely to consistently retrieve PrEP.</div></div><div><h3>Conclusions</h3><div>Despite a high willingness to use PrEP among opioid-dependent, PrEP-naïve PWID in general, the adoption and persistence of PrEP were low in this study. Given that PWID represent a marginalized group at significant risk for HIV, these findings highlight the urgent need for comprehensive strategies to enhance the PrEP continuum of care by addressing the unique and diverse needs of this subgroup.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"173 ","pages":"Article 209693"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829153","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}
Joseph G. Rosen , Michelle Olding , Neena Joshi , Stacy Castellanos , Emily Valadao , Lauren Hall , Laura Guzman , Ju Nyeong Park , Kelly R. Knight
{"title":"“It's something we're connected to”: Acceptability and adoption of overdose detection technologies implemented in San Francisco permanent supportive housing","authors":"Joseph G. Rosen , Michelle Olding , Neena Joshi , Stacy Castellanos , Emily Valadao , Lauren Hall , Laura Guzman , Ju Nyeong Park , Kelly R. Knight","doi":"10.1016/j.josat.2025.209694","DOIUrl":"10.1016/j.josat.2025.209694","url":null,"abstract":"<div><h3>Introduction</h3><div>The transition from homelessness to permanent supportive housing (PSH) is associated with solitary drug use, which heightens the risk for fatal overdose. Overdose detection technologies show promise in reducing fatal overdose in supportive housing environments. We conducted a longitudinal, mixed-methods study in a 50-unit single-room occupancy PSH building in San Francisco, California—tracing the implementation of wall-mounted, push-activated technologies (Brave Buttons) that alert designated responders to potential onsite emergencies, including overdose.</div></div><div><h3>Methods</h3><div>Between May 2021 and February 2022, we conducted 35 days of naturalistic observation as well as serial, semi-structured interviews with 8 building staff (e.g., housing services coordinators, front desk clerks, custodians) and 5 tenant specialists, who promoted and sensitized residents to Brave Buttons prior to their installation. We administered surveys to all residents, assessing acceptability and uses of Brave Buttons. We calculated descriptive statistics regarding Brave Button installations and activations using administrative device data. Through inductive, iterative thematic analysis, we synthesized participant narratives to identify early expectations, implementation determinants, and adaptive strategies to bolster acceptability and adoption of Brave Buttons.</div></div><div><h3>Results</h3><div>Despite high demand for overdose prevention solutions, staff and tenant specialists initially expressed doubts towards the adoption potential of Brave Buttons in the PSH building, citing resident mistrust of novel technologies with surveillance properties, liability related to (failed) overdose responses, and building staff capacity and willingness to respond to Button activations. Responding to these anticipated implementation constraints, a group of staff and tenant specialists hosted “engagement sessions” to build resident affinity/trust with Brave Buttons and leveraged tenant specialists' rapport with residents for technology sensitization. By December 2021, Buttons were voluntarily installed in 72 % of resident rooms and were used for multiple purposes, including overdoses and safety/wellness checks. The Buttons also helped formalize informal systems of care among residents and strengthened connections between residents and building staff.</div></div><div><h3>Conclusion</h3><div>Adaptive strategic planning, responsive to emerging sources of implementation opposition, was critical to addressing perceived barriers to Brave Button acceptability and adoption in the PSH building.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"173 ","pages":"Article 209694"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838852","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}