Journal of substance use and addiction treatment最新文献

{"title":"An initial randomized controlled trial of a Combined Medication and Behavioral Activation Treatment (CoMBAT) for people with opioid use disorder","authors":"Jaclyn M.W. Hughto ,&nbsp;Landon D. Hughes ,&nbsp;Kimberly M. Nelson ,&nbsp;Nicholas S. Perry ,&nbsp;Matthew J. Mimiaga ,&nbsp;Katie B. Biello ,&nbsp;Amelia Bailey ,&nbsp;David W. Pantalone","doi":"10.1016/j.josat.2024.209602","DOIUrl":"10.1016/j.josat.2024.209602","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid use disorder is a chronic, relapsing disease and a major source of morbidity and mortality in the U.S. Medications for opioid use disorder (MOUD) have been shown to reduce opioid use; however, MOUD maintenance is often suboptimal. Depression is a well-documented risk factor for MOUD treatment disengagement; thus, behavioral interventions to address depression and support ongoing MOUD use in community settings are warranted.</div></div><div><h3>Methods</h3><div>We evaluated the feasibility, acceptability, and preliminary efficacy of the CoMBAT (Combined Medication and Behavioral Activation Treatment) intervention via a pilot randomized controlled trial. We hypothesized that the CoMBAT intervention, which uses behavioral activation, motivational interviewing, and problem-solving techniques, would be feasible and acceptable to participants and decrease depression, increase goal-directed activity, improve MOUD care engagement, and reduce opioid use among adults with depressive symptoms who had a missed dose or clinical MOUD visit in the past 30 days. We enrolled 32 participants prescribed methadone or buprenorphine in the community; each received 2 health navigation and substance use counseling sessions (HN_SUC) before being randomized into (a) the 8-session CoMBAT intervention + HN_SUC + treatment as usual or (b) HN_SUC + treatment as usual only. The primary outcomes were intervention feasibility and acceptability. Preliminary efficacy measures included self-reported past-30-day MOUD doses and clinical visits, depressive symptoms, behavioral activation; and opioid-positive urinalysis; each assessed at baseline and 3- and 6-month follow-up visits.</div></div><div><h3>Results</h3><div>The intervention was feasible (88 % of intervention sessions completed; 100 % retention at 6 months) and acceptable (86 % of intervention participants were satisfied/very satisfied with the intervention at 3-months; and intervention participants had a high level of alliance with their counselor at the mid-point: mean = 5.7 out of 7 [SD = 1.3] and end of their treatment: mean = 5.5 out of 7 [SD = 1.1]. At 6-months, intervention participants reported fewer missed MOUD doses and visits, less depressive symptoms, greater behavioral activation scores, and a lower percentage of opioid-positive toxicology screens relative to the control condition.</div></div><div><h3>Conclusion</h3><div>Findings provide evidence of intervention feasibility and acceptability and demonstrate initial efficacy for ongoing MOUD care engagement, depressive symptom reduction, increased behavioral activity, and reduced opioid use. Future intervention testing in a fully-powered efficacy trial is warranted.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"169 ","pages":"Article 209602"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822739","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":"Siyakhana: A hybrid type 2 effectiveness-implementation stepped-wedge trial to reduce stigma towards substance use and depression among community health workers in HIV/TB care in South Africa","authors":"Jessica F. Magidson ,&nbsp;Kristen S. Regenauer ,&nbsp;Kim Johnson ,&nbsp;Tianzhou Ma ,&nbsp;Jennifer M. Belus ,&nbsp;Alexandra L. Rose ,&nbsp;Imani Brown ,&nbsp;Nonceba Ciya ,&nbsp;Sibabalwe Ndamase ,&nbsp;Caroline Sacko ,&nbsp;John Joska ,&nbsp;Goodman Sibeko ,&nbsp;Ingrid V. Bassett ,&nbsp;Bronwyn Myers","doi":"10.1016/j.josat.2025.209634","DOIUrl":"10.1016/j.josat.2025.209634","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Substance use (SU) and other mental health conditions, such as depression, contribute to poor engagement in HIV and TB care in South Africa, a country with the highest global prevalence of HIV and a significant TB burden. Yet, community health workers (CHWs)—frontline lay health workers who play a central role in re-engaging patients in HIV/TB care—receive little-to-no training on supporting patients with SU or other mental health concerns. CHWs also display stigma towards patients with SU and depression, which may contribute to HIV/TB care disengagement. We developed and tested a CHW training (&lt;em&gt;“Siyakhana”&lt;/em&gt;) to reduce CHW stigma towards SU and depression in HIV/TB care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cluster randomized, stepped-wedge hybrid type 2 effectiveness-implementation trial (&lt;em&gt;N&lt;/em&gt; = 82 CHWs) evaluated &lt;em&gt;Siyakhana&lt;/em&gt; across six clinics in a low-resource area of Cape Town, SA. The three-day &lt;em&gt;Siyakhana&lt;/em&gt; training included psychoeducation, self-care strategies, non-judgmental communication, problem solving, and contact-based stigma reduction using lived experience narratives. Pre-training and three- and six-month post-training assessments were conducted. Primary effectiveness outcomes were CHW stigma towards SU and depression, assessed using the Social Distance Scale. Primary implementation outcomes were guided by Proctor's model, including fidelity, acceptability, appropriateness, and feasibility, assessed using structured coding of role plays and a validated quantitative measure for assessing implementation outcomes in low- and middle-income countries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Participants were on average 46.8 years old (&lt;em&gt;SD&lt;/em&gt; = 8.9), 99% female, and 100% Black African. Ninety-five percent of CHWs completed the &lt;em&gt;Siyakhana&lt;/em&gt; training, with approximately 90% retention over six months. A linear mixed effects model showed a significant effect of the &lt;em&gt;Siyakhana&lt;/em&gt; training on reducing SU stigma over six months after adjusting for time (β = −1.46, &lt;em&gt;SE&lt;/em&gt; = 0.67, &lt;em&gt;p&lt;/em&gt; &lt; 0.05), but no effect on depression stigma (β = −0.20, &lt;em&gt;SE&lt;/em&gt; = 0.57, &lt;em&gt;p&lt;/em&gt; &gt; 0.05). CHW fidelity was 89.4% (&lt;em&gt;SD&lt;/em&gt; = 11.3%) at six-months. Quantitative implementation outcomes indicated high acceptability (&lt;em&gt;M&lt;/em&gt; = 2.85, &lt;em&gt;SD&lt;/em&gt; = 0.27), appropriateness (&lt;em&gt;M&lt;/em&gt; = 2.77, &lt;em&gt;SD&lt;/em&gt; = 0.31), and feasibility (&lt;em&gt;M&lt;/em&gt; = 2.41, &lt;em&gt;SD&lt;/em&gt; = 0.38).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;&lt;em&gt;Siyakhana&lt;/em&gt; was associated with reductions in CHW SU stigma in the context of HIV/TB care, with promising implementation outcomes. Findings will inform a larger randomized trial evaluating the effectiveness and implementation of &lt;em&gt;Siyakhana&lt;/em&gt; and examine whether shifting CHW stigma improves patient-level health outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Trial registration&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;: &lt;span&gt;&lt;span&gt;NCT0528","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209634"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076726","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 are the risk factors of non-fatal overdose among persons who use opioids? A systematic review and meta-analysis","authors":"Neil Dunne,&nbsp;Maire-Brid Casey,&nbsp;Jo-Hanna Ivers","doi":"10.1016/j.josat.2025.209630","DOIUrl":"10.1016/j.josat.2025.209630","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-fatal opioid overdose (NFOD) is a concerning public health issue that is a risk factor for subsequent fatal overdose.</div></div><div><h3>Methods</h3><div>This systematic review aimed to evaluate all the previous literature using a self-report method to investigate the risk factors of NFOD. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRSIMA) and its 27-item checklist guided the conduct and reporting of this systematic review. The review used the population, risk factor, and outcome (PRO) framework. The population was studies with a majority of participants that regularly used opioids. Risk factors were demographic, medical, and behavioral characteristics. The outcomes were self-reported recent (&lt;12 months) or lifetime presence of NFOD. The study explored seven databases: PubMed, Embase, Cochrane Library, PsycINFO, CINAHL, ProQuest, and Web of Science and used Google Scholar to search for grey literature. A risk of bias assessment was carried out using ROBANS-E and meta-analysis was performed using STATA.</div></div><div><h3>Results</h3><div>The review discovered 53 studies using the self-report experience of persons who use opioids assessing different factors associated with NFOD. Involvement in the sex trade, having a lower than typical education, previous incarceration, experiencing homelessness, unemployment, psychiatric co-morbidity, suicidal ideation or behavior, polysubstance use, especially benzodiazepine use and problematic alcohol use, needing help injecting, former opioid agonist therapy (OAT) engagement, previous treatment experiences, and a hepatitis-C diagnosis were associated with an increased likelihood of NFOD. Current engagement in OAT was protective against NFOD. Gender, relationship status, needle exchange use, symptoms of anxiety, and being HIV positive were not strongly associated with a difference in NFOD likelihood.</div></div><div><h3>Conclusion</h3><div>Using the findings from above to identify the individuals who are at high risk for NFOD, particularly those using opioids, will enable a targeted approach to outreach and education programs based on the identified risk factors- such as polysubstance use, socioeconomic associations, and psychiatric co-morbidities, which can help reduce the occurrence of NFOD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209630"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076727","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":"What apps and websites do those in treatment for substance-related problems use to help them in their recovery? A cross-sectional study of products and use patterns","authors":"Tyler B. Wray ,&nbsp;Gage Reitzel ,&nbsp;Chanda Phelan ,&nbsp;Jennifer E. Merrill ,&nbsp;Kristina M. Jackson","doi":"10.1016/j.josat.2025.209631","DOIUrl":"10.1016/j.josat.2025.209631","url":null,"abstract":"<div><h3>Background</h3><div>Given the global burden of substance use disorders (SUD), innovations in methods to achieve sustained recovery are critical. Digital health products (e.g., websites, smartphone apps) can complement and enhance existing SUD treatments or provide some assistance to those who cannot access formal treatment. One goal of the present study was to obtain descriptive information regarding the use of digital health products during SUD recovery. We also examined demographic and SUD-related correlates (e.g., severity, duration) of digital health product use and whether patterns of app use were related to perceived utility of the apps.</div></div><div><h3>Methods</h3><div>A sample of 255 participants (45 % female, <em>M</em>_age = 41.4 [9.6]) recruited at several outpatient addictions treatment facilities in the northeastern US completed an online survey.</div></div><div><h3>Results</h3><div>Forty-five percent of participants reported having used some kind of app or website to help them in recovery during their lifetimes. The most common motivations participants reported for using an app alongside treatment were to increase knowledge about addiction, hear advice from others in recovery, and to find motivation to stay sober. Those in most older age groups (35–40, 50+) had significantly lower odds of having used an app relative to 18–35 year-olds, and odds of reporting having used an app were 90 % higher among female participants versus others. Increased frequency of app use and using an app/website over a longer period of time were associated with higher ratings of perceived app helpfulness.</div></div><div><h3>Conclusion</h3><div>Future research is needed to determine whether using these products provides clinically meaningful benefits for patients, both in the presence and absence of traditional treatment.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209631"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070078","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 impact of buprenorphine prescriber data on geospatial access to treatment in HEALing Communities Study communities, 2022","authors":"Daniel R. Harris ,&nbsp;Shikhar Shrestha ,&nbsp;Peter Rock ,&nbsp;Anita Silwal ,&nbsp;Gia Barboza-Salerno ,&nbsp;Olivia Lewis ,&nbsp;Sumeeta Srinivasan ,&nbsp;Thomas J. Stopka","doi":"10.1016/j.josat.2025.209625","DOIUrl":"10.1016/j.josat.2025.209625","url":null,"abstract":"<div><h3>Introduction</h3><div>The location of buprenorphine treatment providers in the United States is pivotal to the understanding of regional factors associated with prescription and uptake. We evaluated how distinct data sources of treatment providers and their associated locations contribute to the differences observed when measuring buprenorphine accessibility.</div></div><div><h3>Methods</h3><div>We compared buprenorphine treatment provider data from the Drug Enforcement Administration (DEA) and data from the behavioral health treatment locator from the Substance Abuse and Mental Health Services Administration (SAMHSA) for July 2022. Both DEA and SAMHSA data, while similar in spirit, vary substantially in how and why each data set is collected. DEA registration was required by law, while SAMHSA data was an opt-in registry of provider-submitted details. Analyzing the underlying semantics of the data is important for understanding the contextual factors driving observable differences in analytical outputs. We measured accessibility using enhanced two-step floating catchment area (E2SFCA) analysis in three states participating in the HEALing Communities Study (Kentucky, Ohio, Massachusetts). Within communities, we compared decile rankings of accessibility per census tract using each data source. We linked prescribing data from Kentucky's prescription drug monitoring program (PDMP) to measure accessibility using providers prescribing buprenorphine. We explored the significance of localized rank exchanges using neighbor set local indicators of mobility association (LIMA).</div></div><div><h3>Results</h3><div>The number and rate of providers per capita differed substantially at the community level between data sources in the three states. These differences were less impactful in the spatial context of buprenorphine accessibility, which required both supply and demand in regions smaller than our intervention communities. Shifts did occur when measuring the intercommunity decile ranking of accessibility of census tracts, but LIMA results indicated that these rank exchanges were not significant.</div></div><div><h3>Conclusions</h3><div>When analyzing accessibility within a community using E2SFCA analyses, either DEA or SAMHSA data sources are acceptable; linkage to Kentucky's PDMP demonstrated that SAMHSA provider data is equally suitable to PDMP data for research studies involving spatial relationships with providers while being both significantly easier to obtain and less sensitive. When analyzing treatment provider rates per capita, results may vary substantially across these different data sources. Therefore, context must be considered when choosing an appropriate data source to use.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209625"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070077","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":"Sexual identity, sexual behavior, and drug use behaviors among people who use drugs in the rural U.S.","authors":"Wiley D. Jenkins ,&nbsp;Lauren B. Beach ,&nbsp;John Schneider ,&nbsp;Samuel R. Friedman ,&nbsp;Mai T. Pho ,&nbsp;Suzan Walters ,&nbsp;Jerel Ezell ,&nbsp;April M. Young ,&nbsp;Caitie Hennessy ,&nbsp;William C. Miller ,&nbsp;Vivian F. Go ,&nbsp;Christina Sun ,&nbsp;David W. Seal ,&nbsp;Ryan P. Westergaard ,&nbsp;Heidi M. Crane ,&nbsp;Rob J. Fredericksen ,&nbsp;Stephanie A. Ruderman ,&nbsp;Scott Fletcher ,&nbsp;Jimmy Ma ,&nbsp;J.A. Delaney ,&nbsp;Mike Winer","doi":"10.1016/j.josat.2025.209629","DOIUrl":"10.1016/j.josat.2025.209629","url":null,"abstract":"<div><h3>Introduction</h3><div>People who use drugs (PWUD) are at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within rural communities is not well understood. Further, while interventions designed to more explicitly affirm individuals' sexual orientation and behaviors may be more effective, descriptions of behavior variability by orientation are lacking. We sought to describe how disease transmission behaviors and overdose risk vary by sexual orientation and activity among rural PWUD.</div></div><div><h3>Methods</h3><div>From 01/2018–03/2020, rural PWUD participating in the Rural Opioid Initiative were surveyed across 8 sites. Collected data included: demographics; experiences with drug use, overdose, and healthcare; stigma; gender identity; and sexual orientation and partners. Participants were categorized as: monosexual by orientation and behavior (Mono-only), monosexual by orientation but behaviorally bisexual (Mono/Bi), and bisexual by orientation (Bi+). Analyses included descriptive summaries, bivariate examination (chi-square), and logistic regression (relative risk [RR] and 95 % confidence interval [CI]).</div></div><div><h3>Results</h3><div>The 1455 participants were 84.8 % Mono-only, 3.2 % Mono/Bi, and 12.0 % Bi+. Compared to Mono-only men, Mono/Bi and Bi+ men had greater risk of transactional sex (RR = 9.71, CI = 6.66–14.2 and RR = 5.09, CI = 2.79–9.27, respectively) and sharing syringes for injection (RR = 1.58, CI = 1.06–2.35 and RR = 1.85, CI = 1.38–2.47). Compared to Mono-only women, Mono-Bi and Bi+ women had greater risk of transactional sex (RR = 4.47, CI = 2.68–7.47 and RR = 2.63, CI = 1.81–3.81); and Bi+ women had greater risk of sharing syringes for injection (RR = 1.49, CI = 1.23–1.81), sharing syringes to mix drugs (RR = 1.44, CI = 1.23–1.69), and experiencing an overdose (RR = 1.32, CI = 1.12–1.56). Bi+ men and women both more frequently reported selling sex as a source of income (versus Mono-only, both <em>p</em> &lt; 0.050) and measures of perceived stigma (all p &lt; 0.050).</div></div><div><h3>Conclusions</h3><div>Rural PWUD who are bisexual by orientation or behavior are significantly more likely to engage in behaviors associated with infectious disease transmission and to experience stigma and drug overdose. Given the growing recognition of bisexuality as a distinct orientation that warrants individualized consideration, interventions that are specifically acknowledging and affirming to the circumstances of this group are needed.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209629"},"PeriodicalIF":0.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061622","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":"Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN): Study protocol for a type 2 hybrid effectiveness-implementation trial","authors":"Claire B. Simon ,&nbsp;Jacqueline B. Britz ,&nbsp;Brennan Keiser ,&nbsp;E. Marshall Brooks ,&nbsp;Alex H. Krist ,&nbsp;Nicholas Franko ,&nbsp;Benjamin Webel ,&nbsp;Mary A. Hatch ,&nbsp;Judith I. Tsui ,&nbsp;Kari A. Stephens ,&nbsp;Sebastian T. Tong","doi":"10.1016/j.josat.2025.209626","DOIUrl":"10.1016/j.josat.2025.209626","url":null,"abstract":"<div><h3>Background</h3><div>Unhealthy substance use (USU) is common and ranges from use above guideline-recommended levels to severe substance use disorder. USU results in substantial morbidity and mortality yet primary care practices rarely systematically screen, diagnose, and treat USU. Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN) tests whether the implementation of a co-designed change package for USU improves patient function. The protocol for SUSTAIN is presented here.</div></div><div><h3>Methods</h3><div>SUSTAIN is a cluster randomized controlled implementation trial of a customized approach to identify and treat USU in primary care. The sample includes 24 primary care clinics in two practice-based research networks (PBRNs). In phase one, primary care practice champions and patients with lived USU experience co-design a change package to identify and treat USU. In phase two, we test the effectiveness of the change package versus usual care and evaluate the implementation of the change package. Data will be collected from 24 clinics (50 patients per clinic for total of 1200 patients) through patient surveys and the electronic health record. Patients surveyed must be 18 or older and screen positive for USU using the Tobacco, Alcohol, Prescription medication and other Substance use part one (TAPS-1) tool. Primary outcomes include mental and physical health patient function scales measured using Patient Reported Outcomes Measurement Information System (PROMIS-29-v2). Secondary outcomes are prevalence of USU, recovery, health care utilization, USU screening rates, provision/referral to behavioral health services and prescription of appropriate medications. We will also evaluate implementation outcomes by surveying 96 practice representatives (4 at each clinic) and conduct qualitative interviews with 20 patients and 20 practice leaders to assess their experience with the intervention and its implementation.</div></div><div><h3>Conclusions</h3><div>The SUSTAIN trial creates and tests an implementation package approach to address USU in diverse primary care settings. The SUSTAIN change package aims to transform how primary care practices care for individuals with USU to improve patient outcomes and enhance community well-being.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209626"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054428","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":"Impacto — A single-arm open-label pilot trial of a digital-based integrated smoking cessation program for Spanish-speaking Hispanic individuals who smoke: Development, feasibility, engagement, and clinical outcomes","authors":"Michael J. Zvolensky ,&nbsp;Richard A. Brown ,&nbsp;Justin M. Shepherd ,&nbsp;Jason T. Brown ,&nbsp;Brooke Y. Redmond ,&nbsp;Sergio Alcocer","doi":"10.1016/j.josat.2025.209632","DOIUrl":"10.1016/j.josat.2025.209632","url":null,"abstract":"<div><h3>Introduction</h3><div>Hispanic/Latinx (hereafter Hispanic) individuals who smoke have challenges in quitting and a disproportionate risk of smoking-related health problems when compared to the general population. The smoking inequalities among the Hispanic population are influenced by limited treatment access and chronic stress exposure (e.g., racial/ethnic discrimination). The present study sought to culturally adapt and initially test a novel, Spanish-language mobile intervention entitled Impacto. Impacto helps address aversive psychosomatic stress (e.g., bodily symptoms, negative affect states) that can maintain smoking by targeting individual differences in anxiety sensitivity during the cessation process.</div></div><div><h3>Methods</h3><div>The current study utilized a single-arm open-label pilot trial of an integrated, anxiety sensitivity and smoking cessation Spanish language mobile health application for the Android platform, Impacto. Participants were 30 adults who engaged in daily combustible cigarette use (females <em>n</em> = 15, <em>M</em>_<em>age</em> = 40.2 years, <em>SD</em> = 11.1). The study evaluated effects of Impacto on 7-day point-prevalence smoking abstinence, cigarettes smoked per day, and anxiety sensitivity and examined feasibility, acceptability, and engagement.</div></div><div><h3>Results</h3><div>Results indicated that Impacto had a positive impact on smoking abstinence with over half of the sample (65.4 %) reporting smoking abstinence 4-weeks post-quit. Moreover, rates of cigarettes smoked per day and anxiety sensitivity levels significantly decreased from baseline through 4-weeks post-quit. High rates of feasibility, acceptability, and engagement were also observed.</div></div><div><h3>Conclusions</h3><div>Impacto represents a promising new smoking cessation intervention for Hispanic individuals with elevated psychosomatic symptoms who smoke.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209632"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049052","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":"Internet-based cognitive behavioral therapy for alcohol use disorder: A systematic review of evidence and future potential","authors":"Fernanda Gushken ,&nbsp;Gabriel P.A. Costa ,&nbsp;Anderson de Paula Souza ,&nbsp;Daniel Heringer ,&nbsp;Akhil Anand","doi":"10.1016/j.josat.2025.209627","DOIUrl":"10.1016/j.josat.2025.209627","url":null,"abstract":"<div><h3>Introduction</h3><div>While cognitive behavioral therapy (CBT) remains a highly effective psychotherapy approach for managing Alcohol Use Disorder (AUD), its potential is hindered by workforce shortages and access barriers. In response to these challenges, Internet-Based Cognitive Behavioral Therapy (iCBT) has emerged as an innovative solution that integrates the core CBT structure with technology. In iCBT, educational materials, therapist communication and progress dashboards can be centralized in a digital format, and delivered in a self-guided, therapist-guided or blended approach.</div></div><div><h3>Methods</h3><div>In this systematic review we aimed to summarize the current evidence of iCBT for AUD. The study performed a comprehensive literature search on PubMed, Embase, Cochrane, Web of Science, and Scopus in August 2023.</div></div><div><h3>Results</h3><div>Out of 497 studies that met our search criteria, five high-quality studies met our inclusion criteria. The studies presented a wide variation in the choice of outcomes and in the definition of controls or treatment as usual. When compared to treatment as usual, studies reported non-inferior to superior abstinence results of iCBT for AUD. Overall, most studies favor iCBT use as an adjunct to AUD treatment due to feasibility and access advantages. However, there were limitations identified in recruitment and implementation processes that warrant further studies. The review also showcases how studies on iCBT for AUD often neglect crucial variables such as insurance coverage, digital literacy and health equity. Clinical trials' investigators need to account for economic feasibility and external validity since the method design phase.</div></div><div><h3>Conclusion</h3><div>iCBT may be an effective adjunct treatment for AUD. However, further research is required. Research in the field should entail larger trials with standard controls and outcome measures. It is also important to actively recruit participants from diverse ethnic and cultural backgrounds and adapt iCBT materials to different languages. This will allow a wider population to benefit from the treatment and address existing health disparities.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209627"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054426","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 moral voice in addiction and the self","authors":"Sarel Ohayon,&nbsp;Natti Ronel","doi":"10.1016/j.josat.2025.209624","DOIUrl":"10.1016/j.josat.2025.209624","url":null,"abstract":"<div><h3>Background</h3><div>The robust literature on moral psychology research has often overlooked people struggling with addiction, partly due to social, theoretical, and methodological biases. This has created a gap in understanding the role of moral thinking and its influence on addiction and recovery. To address this, our hermeneutic phenomenological study, the first in a series, explores the moral voice of individuals contending with addiction.</div></div><div><h3>Methods</h3><div>The study interviewed 34 male participants from various ethnical backgrounds and ages with substance and behavioral addictions using semi-structured methods, focusing on factors shaping their moral thinking and behavior.</div></div><div><h3>Results</h3><div>The findings highlight that moral thinking is central to individuals with addiction, yet it fails to regulate behavior due to conflicting addictive drives, and its presence during active addiction can hinder recovery efforts. This misalignment often leads to tormenting internal conflict and a detrimental effect on both self and others. Participants attempted to establish a modus vivendi (a manner of living) but often failed, resulting in covert moral schemas that complicate their psychological states. This phenomenon, described as a moral spin, illustrates the complex interplay between addiction and morality.</div></div><div><h3>Conclusion</h3><div>To address rebuilding moral identity and recovery, we may support framing egocentrism positively through a self-compassionate moral inventory.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209624"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049168","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}