The Relationship Between Non-Medical Use of Prescription Opioids and Sex Work Among Adults in Residential Substance Use Treatment

Highlights

• Sex work (SW) is common among patients in residential substance use treatment.
• SW among individuals in addictions treatment is associated with more extensive substance use and greater psychiatric severity.
• Non-medical use of prescription opioids is widespread among individuals involved in SW.

High rates of substance use (e.g., alcohol, cocaine, heroin) have been documented among individuals who engage in sex work (SW), and adults seeking substance use disorder (SUD) treatment frequently report prior engagement in SW. Non-medical use of prescription opioids (NMUPO) has increased over the last decade, but little is known about the relationship between NMUPO with sex exchange. 

The purpose of this study was to describe the prevalence of recent SW among patients at a large residential SUD treatment center and examine the association between NMUPO and SW. Approximately 14% of 588 adults reported involvement in SW in the month prior to treatment. NMUPO was more common among those with a history of SW (95% of sex workers vs. 74% of non-sex-workers), and this association remained statistically significant after controlling for demographic factors, other substance use and psychiatric symptom severity (odds ratio=3.38). SW is relatively common among patients in residential SUD treatment, and is associated with greater psychiatric severity and more extensive substance use, including alarming rates of NMUPO. 

Addiction treatment for individuals involved in SW may benefit from the addition of content related to NMUPO.

Purchase full article at:   http://goo.gl/gTfjJp

By:  Matusiewicz AK1, Ilgen MA2, Bonar EE3, Price A3, Bohnert AS2.

• VA Center for Clinical Management Research (CCMR), 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor MI 48109 USA. Electronic address: amatusie@uvm.edu.
• 2VA Center for Clinical Management Research (CCMR), 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA; Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA.
• 3Department of Psychiatry, University of Michigan, 2800 Plymouth Rd. Building 16, Ann Arbor MI 48109 USA. 
• J Subst Abuse Treat. 2016 May;64:24-8. doi: 10.1016/j.jsat.2016.01.010. Epub 2016 Feb 13.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Personal Networks of Women in Residential & Outpatient Substance Abuse Treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. 

The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. 

Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. 

These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse...

Upon treatment entry, women report child related concerns, psychosocial difficulties, physical/sexual abuse, health issues and mental health problems to a far greater degree than their male counterparts (Wechsberg et al., 1998). These complex problems present difficulties for women in accessing social support and developing supportive personal network relationships (Tracy & Martin, 2007), thereby compromising their recovery (Warren, Stein, & Grella, 2007; Wenzel, Tucker, Golinelli, Green, & Zhou, 2010). Although different clinical profiles have been identified between women in residential and outpatient substance abuse treatment, no previous studies have examined or identified differences in personal network characteristics between these two groups of women. The purpose of this study was to identify differences in personal network characteristics between women entering residential substance abuse treatment and those entering intensive outpatient treatment. A deeper understanding of these differences may add an important dimension to substance abuse treatment planning, and may be utilized to inform treatment interventions for women in residential and outpatient treatment settings.

Clinical characteristics by treatment modality (N = 377).

	n (%)
	Residential (n = 119)	Outpatient (n = 258)	χ2 or t	p
Substance use disorder (SUD)
Marijuana	44 (37.9)	105 (41.0)	0.32	0.574
Amphetamine	3 (2.6)	1 (0.4)	3.62	0.092†
Sedatives	5 (4.3)	14 (5.5)	0.22	0.638
Cocaine	78 (67.2)	135 (52.7)	6.87	0.009
Opiates	35 (30.2)	51 (19.9)	4.72	0.030
Hallucinogens	0 (0.0)	9 (3.5)	4.18	0.062†
Inhalants	0 (0.0)	1 (0.4)	0.45	>0.999†
Phencyclidine	3 (2.6)	9 (3.5)	0.22	0.761†
Alcohol	63 (54.3)	112 (43.8)	3.57	0.059
Multiple SUD (yes)	74 (63.8)	132 (51.8)	4.67	0.031
Mental health disorder
Generalized anxiety	21 (17.6)	68 (26.5)	3.50	0.062
Posttraumatic	39 (32.8)	108 (42.0)	2.92	0.087
Major depressive episode	68 (57.1)	149 (58.0)	0.02	0.879
Dysthymia	5 (4.2)	7 (2.7)	0.57	0.531†
Manic episode	27 (22.7)	91 (35.4)	6.11	0.013
Hypomanic episode	9 (7.6)	31 (12.1)	1.73	0.188
Dual diagnosis	89 (74.8)	186 (72.7)	0.19	0.664
Previous treatment	90 (75.6)	185 (72.3)	0.47	0.493
HIV test result (positive)	1 (0.9)	5 (2.0)	0.66	0.669†
Multiple chronic health condition (2 or more)	26 (22.0)	65 (25.2)	0.44	0.507
Trauma symptom checklist, M(SD)	49.40 (20.94)	42.51 (21.29)	2.93	0.004

†Fisher’s Exact Test.

Full article at:   http://goo.gl/lxtcy6

By:  HyunSoo Kim,1 Elizabeth Tracy,2 Suzanne Brown,3 MinKyoung Jun,4 Hyunyong Park,2 Meeyoung Min,2 and Chris McCarty5

¹Department of Social Welfare, Dongguk University, Gyeongju-si, Republic of Korea

²The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA

³School of Social Work, Wayne State University, Detroit, MI, USA

⁴Gyeonggido Family & Women’s Research Institute, Gyeonggido, Suwon, Republic of Korea

⁵Survey Research Center, University of Florida, Gainsville, FL, USA

Correspondence: Dr Elizabeth Tracy, The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland 44106, OH

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Factors Associated with Inability to Access Addiction Treatment among People Who Inject Drugs in Vancouver, Canada

BACKGROUND:

Addiction treatment is an effective strategy used to reduce drug-related harm. In the wake of recent developments in novel addiction treatment modalities, we conducted a longitudinal data analysis to examine factors associated with inability to access addiction treatment among a prospective cohort of persons who inject drugs (PWID).

METHODS:

Data were derived from two prospective cohorts of PWID in Vancouver, Canada, between December 2005 and November 2013. Using multivariate generalized estimating equations, we examined factors associated with reporting an inability to access addiction treatment.

RESULTS:

In total, 1142 PWID who had not accessed any addiction treatment during the six months prior to interview were eligible for this study, including 364 women (31.9 %). Overall, 188 (16.5 %) reported having sought but were ultimately unsuccessful in accessing addiction treatment at least once during the study period. In multivariate analysis, factors independently and positively associated with reporting inability to access addiction treatment included: binge drug use (Adjusted Odds Ratio [AOR] = 1.65), being a victim of violence (AOR = 1.77), homelessness (AOR = 1.99), and having ever accessed addiction treatment (AOR = 2.33); while length of time injecting was negatively and independently associated (AOR = 0.98) (all p < 0.05).

CONCLUSIONS:

These findings suggest that sub-populations of PWID were more likely to report experiencing difficulty accessing addiction treatment, including those who may be entrenched in severe drug addiction and vulnerable to violence. It is imperative that additional resources go into ensuring treatment options are readily available when requested for these target populations.

Reasons for being unable to access addition treatment among PWID in Vancouver, Canada (n = 250)

Reasons	Number of reports	% of reports
Waiting list	146	58.4
Don’t take couples	20	8.0
Turned down by program	19	7.6
Personal reasons/issues	13	5.2
Communication issues with the program	11	4.4
Behaviour problems	9	3.6
Missed appointments	9	3.6
Program is full	8	3.2
Don’t know of any program	7	2.8
Don’t have type of program I want or need	7	2.8
Can’t afford the fees	7	2.8
Failed too many times	2	0.8
No treatment program nearby	1	0.4
Methadone restrictions within the program	1	0.4
Other (in jail, no pets policy, medical issues, too many rules)	39	15.6

PWID people who inject drugs

Full article at:   http://goo.gl/7FjrLZ

By:  Prangnell A1, Daly-Grafstein B2, Dong H3, Nolan S4,5, Milloy MJ6,7, Wood E8,9, Kerr T10,11, Hayashi K12,13.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. aprangnell@cfenet.ubc.ca.
• 2Human Biology Program, University of Toronto, Wetmore Hall, Room 105, 300 Huron Street, Toronto, ON, M5S 3J6, Canada. bendgrafstein@gmail.com.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. hdong@cfenet.ubc.ca.
• 4British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. seonaidn@gmail.com.
• 5Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. seonaidn@gmail.com.
• 6British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
• 7Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
• 8British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 9Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 10British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 11Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 12British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• 13Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• Subst Abuse Treat Prev Policy. 2016 Feb 25;11(1):9. doi: 10.1186/s13011-016-0053-6. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Characteristics of Clients Using a Community-Based Drug Treatment Service (‘CAPS-AD’) in Brazil: An Exploratory Study

Highlights

• ‘CAPS-AD’ is a novel vehicle of community-based treatment for alcohol and drugs in Brazil.
• We assessed a ‘snapshot sample’ of CAPS-AD clients in Brasilia (capital of Brazil).
• Most clients were male, middle-aged, unemployed, with alcohol or crack-cocaine problems.
• Half engaged in their first-ever treatment episode, suggesting effective reach by the CAPS-AD.
• Concerns about care structures, logistics and staff attitudes may compromise client retention.

Abstract

Background

Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) – providing community-based care – have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients.

Methods

N = 143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week ‘snapshot’ assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information.

Results

Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p < .05).

Conclusion

CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.

Purchase full article at:   http://goo.gl/GrJYEZ

By:  Andrea Donatti Gallassi, Eduardo Yoshio Nakano, Gabriela Arantes Wagner, Maria de Nazareth Rodrigues Malcher de Oliveira Silva, Benedikt Fischer

Affiliations

Center of Drugs and Associated Vulnerabilities, Faculty of Ceilândia, University of Brasilia, Brazil

Science and Health Technology Program, Faculty of Ceilândia, University of Brasilia, Brazil

Correspondence

Corresponding author at: Center of Drugs and Associated Vulnerabilities, University of Brasília (UNB), Faculty of Ceilândia, Centro Metropolitano 1, Conjunto A – Ceilândia Sul Zip 72220-900, Brasília DF, Brazil. Tel.: +55 6133770615.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Substance Use Outcomes Following Treatment: Findings from the Australian Patient Pathways Study

OBJECTIVE:

Adolescent substance use is an area of concern because early substance use is associated with a higher risk of adverse outcomes. Parenting style, defined as the general style of parenting, as well as substance-specific parenting practices may influence children's substance use behaviour. The present study aims to probe the impact of parenting style on adolescent substance use.

METHOD:

A cohort of 1268 adolescents (48% girls), aged 12-13 years at baseline, from 21 junior high schools was assessed in the first semester of junior high school, and then again in the last semester of the 9th grade, 32 months later. Parenting style, operationalised as a fourfold classification of parenting styles, including established risk factors for adolescent substance use, were measured at baseline.

RESULTS:

Neglectful parenting style was associated with worse substance use outcomes across all substances. After adjusting for other proximal risk factors in multivariate analyses, parenting style was found to be unrelated to substance use outcomes with one exception: authoritative parenting style was associated with less frequent drinking. Association with deviant peers, delinquent behaviour, provision of alcohol by parents, and previous use of other substances were associated with substance use outcomes at follow-up.

CONCLUSIONS:

The results of the present study indicate that parenting style may be less important for adolescent substance use outcomes than what has previously been assumed, and that association with deviant peers and delinquent behaviour may be more important for adolescent substance use outcomes than general parenting style.

Below:  Non-linear association between the deviant peers scale and illicit drug use at follow-up. Values on the y-axis denote log odds ratio (solid line) and 95% confidence intervals (dotted lines).

Full article at:  http://goo.gl/KaouP5

By:  Berge J1, Sundell K2, Öjehagen A1, Håkansson A1.

• 1Lund University, Lund, Sweden.
• 2Medical Management Center Department of Learning, Informatics, Management & Ethics Karolinska Institutet, Stockholm, Sweden. 
• BMJ Open. 2016 Jan 14;6(1):e008979. doi: 10.1136/bmjopen-2015-008979.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Web-Based Cognitive Behavioral Relapse Prevention Program with Tailored Feedback for People with Methamphetamine and Other Drug Use Problems: Development and Usability Study

BACKGROUND:

Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches.

OBJECTIVE:

The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability.

METHODS:

We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions.

RESULTS:

In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested.

CONCLUSIONS:

The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.

Below:  Video page screenshot

Full article at:   http://goo.gl/lGDKYC

By:  Takano A¹, Miyamoto Y, Kawakami N, Matsumoto T.

¹Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan. ayumi-takano@umin.ac.jp.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health