The role of brain-derived neurotrophic factor in the link between physical activity and psychosocial recovery from alcohol use disorder

Objective: Alcohol Use Disorder (AUD) is a common, chronically relapsing condition with substantial health and economic costs. United States federal agencies have put out calls in the last decade to expand the scientific evidence base for broad biopsychosocial recovery from AUD and other substance use disorders (SUD). The present study examined the role of physical activity and exercise in early recovery from AUD, with specific attention to changes in brain-derived neurotrophic factor (BDNF) as a marker of neuroplasticity and a potential mechanism for instantiation of recovery-aligned behaviors. Method: Individuals in the first year of recovery from AUD were recruited into a 12-week study with exercise sessions and pre/post-exercise blood sample collection performed in a laboratory setting at baseline, 6 weeks, and 12 weeks. Data analyses included BDNF enzyme-linked immunosorbent assays (ELISA) to establish pre/post-exercise BDNF concentrations, estimation of the magnitude of the effect of exercise on BDNF, and prospective associations of exercise-induced BDNF change with coping, craving, consumption and mood outcome measures. Results: 26 participants were screened, 22 were eligible, 7 had entered the study, and 6 had provided at least one set of pre/post-exercise blood samples when student research ceased on March 23rd, 2020 due to COVID-19 precautions. Participants with at least one set of pre/post-exercise blood samples demonstrated a statistically significant (p=.014) increase from baseline in BDNF levels after exercise, with a large effect size (Cohen's d=1.519;Hedges' g=1.019 ). The impact of this increase from baseline on subsequent measures of coping, craving, mood, and substance use is unclear due to lack of statistical power. Conclusions: This study is the first to demonstrate that individuals recovering from AUD can increase serum levels of BDNF from baseline levels via sessions of physical exercise. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of COVID-19 on rural and nonrural recovery housing in the United States

This study aimed to assess the impact of COVID-19 on recovery housing (RH), an important resource for individuals in recovery from substance use disorder (SUD). A cross-sectional survey was disseminated electronically between June and July of 2020 to RH owners and operators affiliated with Oxford House or the National Alliance of Recovery Residences nationwide. The survey intended to develop an understanding of the impact of COVID-19 on RH in terms of (a) resident housing access, (b) mitigation strategies to reduce COVID-19 spread, (c) RH financials, and (d) health and well-being of residents and staff. Impacts were assessed among all houses in the sample and then by rurality of RH location (rural vs. nonrural). Among 1,419 respondents, only 4.6% reported positive COVID-19 cases, and 85% reported having implemented centers for disease control-recommended policies. More than half (59%) reported financial impacts, and close to half (49%) reported COVID-19 had "a lot of impact" on residents attending meetings. Rural RH represented only 9% of respondents and a greater fraction of rural RH respondents reported spending more on all COVID-19 expense categories compared to nonrural RH respondents. Compared to nonrural RH, rural RH were significantly more likely to report having a process for evaluating COVID-19 (p = .007), wearing masks (p = .047), taking temperatures (p = .042), and spending more on food due to COVID-19 (p = .015). With SUD rates and the associated morbidity and mortality from SUD continuing to rise, addressing the financial viability of RH, an important resource supporting individuals in recovery is crucial. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This study suggests that recovery housing, an important resource for individuals seeking or in recovery from a substance use disorder (SUD), is proactive in ensuring resident safety during national emergencies such as COVID-19. The most prominent impacts found in this study were financial (for the recovery home) and residents' ability to attend mutual aid recovery support meetings. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Mental Health and Coping Strategies among University Staff during the COVID-19 Pandemic: A Cross–Sectional Analysis from Saudi Arabia

This study examined psychological health and coping strategies among faculty and staff at a Saudi Arabian university. A web-based self-administered survey was used to assess probable anxiety, depression, post-traumatic stress disorder (PTSD), and coping strategies by using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Impact of Event Scale-Revised (IES-R), and Brief-COPE scale, respectively. Of 502 participants (mean age 36.04 ± 10.32 years, male: 66.3%), 24.1% (GAD-7 ≥ 10) had probable anxiety. Anxiety score was significantly higher in females (p < 0.001), those with a history of COVID-19 infection (p = 0.036), and participants with less work experience (p = 0.019). Approximately 40% of participants met the criteria of probable depression, with females (p < 0.001) and participants with less experience having more depressive symptoms. Around one-fourth (27.7%) of study participants indicated probable PTSD (score ≥ 33), with higher symptoms in females (p <0.001), less experienced staff (p < 0.001), and academic staff (p = 0.006). Correlation analysis indicated a significant positive correlation between anxiety and depression (r = 0.844, p < 0.001), anxiety and PTSD (r = 0.650, p < 0.001), and depression and PTSD (r = 0.676, p < 0.001). Active coping, religious/spiritual coping, and acceptance were common coping strategies, while substance use was the least adopted coping method among the study participants. This study indicated a high prevalence of probable psychological ailments among university staff.

Digital interventions for substance use disorders in young people: Rapid review

This rapid review provides an overview of recent literature on the nature of digital interventions for young people in terms of technologies used, substances and populations targeted, and theoretical or therapeutic models employed. A keyword search was conducted using MEDLINE and other databases for 2015-2021. Following a title/ and full-text screening of articles and consensus decision on study inclusion, data extraction proceeded using an extraction grid. Data synthesis relied on an adapted conceptual framework (Stockings et al., 2016) that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment). The review identified 43 articles describing 39 digital interventions. Most were early interventions (n = 28), followed by prevention (n = 6) and treatment (n = 5). Of the five technologies identified, web-based interventions (n = 14) were most common. Digital interventions have mainly focused on alcohol use (n = 20), reflecting limited concern for other substance use and co-occurring use. Yet the rise in substance use and related harms during the Covid-19 pandemic highlights a critical need for more innovative substance use interventions. Technologies with more immersive and interactive features, such as VR and game-based interventions, call for further exploration. Only one intervention was culturally tailored and purposefully designed for gender minority youth, and another was geared to young men. As well, most interventions used a personalized or normative feedback approach, while a harm reduction approach guided only one intervention. The incorporation of culturally tailored interventions and harm reduction approaches may promote uptake and stronger engagement with digital interventions amongst youth.

We Are Living It

The Centers for Disease Control and Prevention (CDC) identified certain populations as being particularly vulnerable during the COVID-19 pandemic, including racial and ethnic minority populations, people living in rural or frontier areas, people experiencing homelessness, essential and frontline workers, people with disabilities, people with substance use disorders, people in incarcerated populations, and individuals born outside of the United States (CDC 2020). Because the pandemic is affecting people and communities disproportionately, we knew students needed to explore the social and historical dimensions of the pandemic that resulted from systemic inequalities. Throughout the unit, they work toward a better understanding of the following ideas: * How the COVID-19 virus is transmitted between individuals and within communities * How mitigation strategies lower the chance of transmitting the COVID-19 virus between individuals and across communities * An understanding that there are differences in how diseases spread across different communities that cannot be explained without taking social, historical, and economic factors into account and that understanding the larger social context, policies, and practices can help us understand disproportionate impacts within and between communities * How others are affected during a public health crisis and how empathizing with them can help us better protect ourselves and the people in our communities Our commitment to providing the information that young people need to understand COVID-19 and other pandemics led to an interesting discovery about the NGSS. Attempt to make sense of the phenomenon or problem Students share the patterns they observed from the data and create initial models to explain how and why communities were affected by COVID-19 differently (see Figure 1). [...]social awareness is defined as the ability to (1) take the perspective of and empathize with others, including those from diverse backgrounds and cultures;(2) understand social and ethical norms for behavior;and (3) recognize family, school, and community resources and supports.

Nurses' experiences caring for patients with opioid use disorders

The purpose of this study was to examine nurses' experience of quality care for hospitalized patients with a history of opioid use disorder or self-injection of opioids and whether hospital, unit, or nurse characteristics impacted experiences of quality care. A secondary aim of the study was to understand how nurses' experiences of quality care for this population have been impacted by the COVID-19 pandemic. The Institute of Medicine's Six Domains of Health Care Quality were used to define quality care in this study. A national sample of 179 nurses completed an online survey regarding their experiences caring for patients with opioid use disorders. The majority of the participants were staff nurses who worked in emergency departments, critical care units, or mother baby units. Only 41.9% of the participants had received education regarding substance use disorders from their employers, and even less had participated in harm reduction education. Only 45% of the nurses had knowledge regarding harm reduction strategies for this population. The participants experienced a low number of restrictive safety measures and an average number of adverse events and effective care interventions when caring for patients with opioid use disorders. The nurses rated quality care and satisfaction as average. Correlation and linear regression analysis suggested trends in nurse, hospital and unit characteristics that are associated with nurses' experiences caring for this population;substance use disorder education, harm reduction education, and unit type were most often associated with nurses' experiences. Content analysis of open-ended questions regarding equity, patient-centeredness, timeliness and the impact of COVID-19 on experiences of quality care supported quantitative findings in the study and provided insight into the nurses' experiences. The findings in this study contribute to current evidence regarding the need for standardized hospital policies and practices aimed at improving quality care for patients with opioid use disorders. These policies and practices should incorporate harm reduction strategies that are patient-centered and evidence-based. Hospitals and nursing schools should provide education aimed at reducing stigma and improving care for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Loss of rural Appalachian recovery meetings from before to after COVID-19

Sharp rises in overdose deaths nationally coincided with the arrival of the COVID-19 pandemic. Rural Appalachia, known for high rates of substance use and barriers to health care in general, was suspected to be disproportionately impacted in terms of recovery supports such as 12-step recovery meetings. This study investigated the availability of recovery meetings in South Central Appalachia before and after COVID-19 lockdowns. The number of confirmed recovery meetings was compared before and after COVID-19 lockdowns by geographic location (i.e., rural/nonrural and medium metro/small metro/micropolitan/noncore). Recovery meeting data were systematically collected through interviews with community contacts, reviewing social media and websites, making phone calls, and sending emails and surveys and updated longitudinally. There was no significant change in the number of meetings from pre- (n = 189) to post-COVID-19 (n = 178). There was no significant shift in meeting location when dichotomizing by rural/nonrural classification, chi2(1) = 2.76, p = .097, pi = -0.087. Chi-square test of independence did reveal a significant change in number of recovery meetings by location when using four location classifications, chi2(3) = 7.97, p = .047, Cramer's V = 0.147. There was a noteworthy rise in the meetings in small metro (36.5%-51.1%), with all other locations declining. The establishment and reestablishment of recovery meetings in rural communities should be prioritized to address the longstanding scarcity of recovery resources in rural locations, recent decline in such support, and the rise in overdose deaths. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This study highlights a significant barrier to recovery from problematic substance use in rural areas. Strategically establishing recovery meetings in areas with few or no meetings and facilitating access through addressing transportation is critical. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Clinicians' perceptions of telehealth services during the Covid-19 pandemic in virginia

The onset of COVID-19 introduced unprecedented changes to how U.S. public health services were delivered. Many public and private agencies faced mandatory closures, social distancing mandates, and rapid transitions to telehealth interventions and treatment. Mental health clinicians witnessed disruptions in continuity of care and an increase in mental health risks overall. Although some studies have been conducted to survey clinicians' perceptions of the usefulness and ease of use of technology-based interventions, knowledge about mental health clinicians' experiences and perceptions in Virginia was sparse. The purpose of this generic qualitative study was to explore how mental health clinicians in Virginia described their experiences and perceptions of using telehealth in providing services to clients during the COVID-19 pandemic. The social-ecological systems and technology acceptance models were used to explore the experiences and perceptions of clinicians. Data analysis led to the identification of themes: (a) pre-COVID-19 treatment and services (b) adjustments to rapid implementation of telehealth, (c) convenience and flexibility to providing services following acclimation, (d) technological barriers to providing telehealth services, (e) challenges with limited understanding and exposure to technology, (f) protocols and managing expectations, (g) acceptance and aversion to telehealth service, and (h) lessons learned for future practice. The findings of this study have potential implications for positive social change by providing insight into the ease of use of telehealth models, encouraging ongoing training for clinical professionals, and informing future research and practice in the mental health field. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

What impact did the COVID-19 pandemic have on psychosis and the delivery of early intervention psychosis (EIP) services in Australia?

Background: The COVID-19 pandemic had a catastrophic impact worldwide, the significance of which continues to be explored. For EIP services the implications were two fold. First, that the pandemic and associated psychosocial stressors would lead to an increased incidence of psychosis and secondly, social distancing measures would negatively impact the detection and treatment of people with psychosis. 18 months on and we now have the data to explore these questions. Method(s): Participants included in this study are young people who attended one of the six headspace Early Psychosis (hEP) services across Australia and met the criteria for being at Ultra High Risk (UHR) of psychosis or experiencing a First Episode of Psychosis (FEP), were aged between 12 and 25 years, and provided informed consent for their data to be used. We will analyse the following routinely collected data from young people accessing EIP services and compared outcomes collected the year before the COVID-19 pandemic occurred (March 2019-February 2020) with data collected during the pandemic (March 2020 onwards): a. Clinical and functional outcomes of young people at UHR or with FEP, b. Duration of untreated psychosis (DUP), c. patterns of substance use, and d. source and rates of referrals. Results and Conclusion(s): I will present the differences in the above outcomes for those young people accessing treatment pre and during COVID-19 pandemic. Confounding factors such as age, gender, sexuality, ATSI status, CALD background will be controlled for. Discussion of the results ad implication for clinical practice will follow.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior;and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p <.001) and NSSI (past 6 months, 64% vs. 39%, p <.001);less depression, anxiety, posttraumatic stress, and substance use;and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p <.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.Copyright © 2023 Society of Clinical Child and Adolescent Psychology.

Substance Use-Associated Mortality among Heart Donors after the COVID-19 National Emergency Increased but Did Not Affect Peri-Transplant Outcomes.

INTRODUCTION: The COVID-19 pandemic and consequent social isolation prompted a surge in mental health disorders and substance use in the general population and, therefore, in potential organ donors. We aimed to evaluate if this led to a change in donor characteristics, including the mechanism and circumstance of death, and how this may have affected clinical outcomes following heart transplantation. METHODS: We identified all heart donors from the SRTR database between 18 October 2018 and 31 December 2021, excluding those who donated immediately after the US national emergency declaration. Donors were stratified into pre-COVID-19 (Pre-Cov; through 12 March 2020) and post-COVID-19 national emergency declaration cohorts (Post-Cov; 1 August 2020 through 31 December 2021) based on the heart procurement date. Relevant demographics, cause of death, and substance use history were collected in addition to graft cold ischemic time, the incidence of primary graft dysfunction (PGD), and recipient survival at 30 days post-transplant. RESULTS: A total of 10,314 heart donors were identified; 4941 were stratified into the Pre-Cov and 5373 into the Post-Cov cohorts. There was no difference in demographics, but illicit drug use was significantly higher in the Post-Cov group, leading to an increased incidence of death from drug intoxication. Fatal gunshot wounds were also more common. Despite these changes, the incidence of PGD remained similar (p = 0.371), and there was no difference in 30 days recipient survival (p = 0.545). CONCLUSION: Our findings confirm that COVID-19 had a major impact on mental health and psychosocial life with an associated increase in illicit substance use and fatal intoxication rates in heart transplant donors. These changes did not alter peri-operative mortality following heart transplantation. Future studies are needed to ensure that long-term outcomes remain unaffected.

The prospective relations of substance use frequency to social distancing behaviors and intentions during the COVID-19 pandemic: the role of social distancing self-efficacy.

To identify factors that increase risk for nonadherence to recommended health protective behaviors during pandemics, this study examined the prospective relations of substance use frequency to both adherence to social distancing recommendations and social distancing intentions during the COVID-19 pandemic, as well as the role of social distancing self-efficacy in these relations. A U.S. community sample of 377 adults completed a prospective online study, including an initial assessment between March 27 and April 5, 2020, and a follow-up assessment one-month later. Results revealed a significant direct relation of baseline substance use frequency to lower adherence to social distancing recommendations one-month later. Results also revealed significant indirect relations of greater substance use frequency to lower levels of both social distancing behaviors and intentions one-month later through lower social distancing self-efficacy. Results highlight the relevance of substance use and social distancing self-efficacy to lower adherence to social distancing during the COVID-19 pandemic.

Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs.

The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.

Capturing and Documenting the Wider Health Impacts of the COVID-19 Pandemic Through the Remember Rebuild Saskatchewan Initiative: Protocol for a Mixed Methods Interdisciplinary Project.

BACKGROUND: In the Canadian province of Saskatchewan, the global COVID-19 pandemic appeared amidst existing social health challenges in food insecurity, housing precarity and homelessness, poor mental health, and substance misuse. These chronic features intersected with the pandemic, producing a moment in time when the urgency of COVID-19 brought attention to underlying shortcomings in public health services. OBJECTIVE: The objectives of the program of research are (1) to identify and measure relationships between the pandemic and wider health and social impacts, namely, food insecurity, housing precarity and homelessness, and mental health and substance use in Saskatchewan, and (2) to create an oral history of the pandemic in Saskatchewan in an accessible digital public archive. METHODS: We are using a mixed methods approach to identify the impacts of the pandemic on specific equity-seeking groups and areas of social health concern by developing cross-sectional population-based surveys and producing results based on statistical analysis. We augmented the quantitative analysis by conducting qualitative interviews and oral histories to generate more granular details of people's experiences of the pandemic. We are focusing on frontline workers, other service providers, and individuals within equity-seeking groups. We are capturing digital evidence and social media posts; we are collecting and organizing key threads using a free open-source research tool, Zotero, to trace the digital evidence of the pandemic in Saskatchewan. This study is approved by the Research Ethics Board at the University of Saskatchewan (Beh-1945). RESULTS: Funding for this program of research was received in March and April 2022. Survey data were collected between July and November 2022. The collection of oral histories began in June 2022 and concluded in March 2023. In total, 30 oral histories have been collected at the time of this writing. Qualitative interviews began in April 2022 and will continue until March 2024. Survey analysis began in January 2023, and results are expected to be published in mid-2023. All data and stories collected in this work are archived for preservation and freely accessible on the Remember Rebuild Saskatchewan project's website. We will share results in academic journals and conferences, town halls and community gatherings, social and digital media reports, and through collaborative exhibitions with public library systems. CONCLUSIONS: The pandemic's ephemeral nature poses a risk of us "forgetting" this moment and the attendant social inequities. These challenges inspired a novel fusion among health researchers, historians, librarians, and service providers in the creation of the Remember Rebuild Saskatchewan project, which focuses on preserving the legacy of the pandemic and capturing data to support an equitable recovery in Saskatchewan. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46643.

Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population.

Purpose of review: Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults. Recent findings: PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population. Summary: This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.

The Efficacy of Telepsychiatry in Addiction Patients: A Systematic Review.

Psychiatry is one of the many medical subspecialties that have benefited from the advent of telemedicine. Substance abuse treatment via telepsychiatry expeditiously increased with the start of the pandemic and has brought changes to its rules and regulations. In this study, we focused on the prognosis of substance abuse patients treated with telepsychiatry, the various changes that occurred during the pandemic, and the difficulties faced by clinicians using telepsychiatry. PubMed and Google Scholar were searched for relevant articles between January 2010 and July 2022 using both broad and narrow keywords in addition to the MeSH (Medical Subject Heading) approach. The total number of records found was 765. Strict criteria for inclusion and exclusion ensured that only relevant information was collected. After removing duplicates, irrelevant studies, and research that did not meet the inclusion criteria, we were left with 373 studies from both electronic databases. From those, we ultimately retrieved 35 studies, which were subjected to a thorough content search and quality evaluation with the help of specialized instruments, and a total of 19 papers were included in our systematic review. We concluded that telepsychiatry use for substance abuse patients increased during the pandemic, and the prognosis of these patients treated with telepsychiatry was similar to that of in-person treatment. However, a combination of telepsychiatry with in-person sessions showed much better results.

Examining outcomes for service users accessing the Breaking Free Online computer-assisted therapy program for substance use disorders via a 'telehealth' approach: protocol for a two arm, parallel group randomized controlled trial.

BACKGROUND: Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and 'telehealth' approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services. METHODS: Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life. DISCUSSION: This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth. Trial registration registered with ISRCTN on 25th May 2021-registration number: 13694016. PROTOCOL VERSION: 3.0 05th April 2022. TRIAL STATUS: This trial is currently open to recruitment-estimated to be completed in May 2023.

A multicomponent psychosocial intervention to reduce substance use by adolescents involved in the criminal justice system: the RISKIT-CJS RCT.

Background: Substance use and offending are related in the context of other disinhibitory behaviours. Adolescents involved in the criminal justice system constitute a particularly vulnerable group, with a propensity to engage in risky behaviour that has long-term impact on their future health and well-being. Previous research of the RISKIT programme provided evidence of a potential effect in reducing substance use and risky behaviour in adolescents. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of a multicomponent psychosocial intervention compared with treatment as usual in reducing substance use for substance-using adolescents involved in the criminal justice system. Design: A mixed-methods, prospective, pragmatic, two-arm, randomised controlled trial with follow-up at 6 and 12 months post randomisation. Setting: The study was conducted across youth offending teams, pupil referral units and substance misuse teams across four areas of England (i.e. South East, London, North West, North East). Participants: Adolescents aged between 13 and 17 years (inclusive), recruited between September 2017 and June 2020. Interventions: Participants were randomised to treatment as usual or to treatment as usual in addition to the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme was a multicomponent intervention and consisted of two individual motivational interviews with a trained youth worker (lasting 45 minutes each) and two group sessions delivered over half a day on consecutive weeks. Main outcome measures: At 12 months, we assessed per cent days abstinent from substance use over the previous 28 days. Secondary outcome measures included well-being, motivational state, situational confidence, quality of life, resource use and fidelity of interventions delivered. Results: A total of 693 adolescents were assessed for eligibility, of whom 505 (73%) consented. Of these, 246 (49%) were allocated to the RISKIT-CJS intervention and 259 (51%) were allocated to treatment as usual only. At month 12, the overall follow-up rate was 57%: 55% in the RISKIT-CJS arm and 59% in the treatment-as-usual arm. At month 12, we observed an increase in per cent days abstinent from substances in both arms of the study, from 61% to 85%, but there was no evidence that the RISKIT-CJS intervention was superior to treatment as usual. A similar pattern was observed for secondary outcomes. The RISKIT-CJS intervention was not found to be any more cost-effective than treatment as usual. The qualitative research indicated that young people were positive about learning new skills and acquiring new knowledge. Although stakeholders considered the intervention worthwhile, they expressed concern that it came too late for the target population. Limitations: Our original aim to collect data on offences was thwarted by the onset of the COVID-19 pandemic, and this affected both the statistical and economic analyses. Although 214 (87%) of the 246 participants allocated to the RISKIT-CJS intervention attended at least one individual face-to-face session, 98 (40%) attended a group session and only 47 (19%) attended all elements of the intervention. Conclusions: The RISKIT-CJS intervention was no more clinically effective or cost-effective than treatment as usual in reducing substance use among adolescents involved in the criminal justice system. Future research: The RISKIT-CJS intervention was considered more acceptable, and adherence was higher, in pupil referral units and substance misuse teams than in youth offending teams. Stakeholders in youth offending teams thought that the intervention was too late in the trajectory for their population. Trial registration: This trial is registered as ISRCTN77037777. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.

We explored how useful a psychological intervention was in reducing substance use among young people who had some involvement in the criminal justice system. We recruited young people aged between 13 and 17 years in four areas of England (i.e. South East, London, North West and North East). Young people were recruited from youth offending teams, pupil referral units and substance misuse teams. Those young people who were willing to participate were offered usual treatment and half, chosen at random, were offered an opportunity to take part in the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme had four distinct parts. The first was a 1-hour session that used an approach called motivational interviewing to explore the young person's substance use and discuss different strategies to change their behaviour. This was followed by two group sessions delivered over 2 consecutive weeks. These group sessions addressed risks associated with substance use, what triggers use and the health and social consequences. In addition, young people were taught new skills to help them manage in situations in which they might normally use substances. At the end of the group sessions, the young people had another motivational interview. Twelve months after participants started, we found that the frequency of substance use had decreased in both groups; however, the RISKIT-CJS intervention was no better than treatment as usual. When we spoke with young people who had taken part and staff involved with this population, we got a mixed picture. In some settings, particularly pupil referral units, the RISKIT-CJS intervention was well received by young people and staff, and staff felt that it was a useful additional resource to the work that they were currently undertaking. On the other hand, in the youth offending teams, the staff thought that the programme was too different from their normal work to be implemented easily and they considered the population they work with too established in their substance use and criminal activity to benefit from the programme.

Exploring the impact of the COVID-19 pandemic on healthcare and substance use service access among women who inject drugs: a qualitative study.

BACKGROUND: The COVID-19 pandemic disrupted healthcare and substance use services engagement, including primary and mental health services as well as residential and outpatient drug treatment. Women who inject drugs (WWID) face known barriers to healthcare and substance use service engagement, which pre-date the COVID-19 pandemic. The impact of COVID-19 on WWID's engagement with healthcare and substance use services, however, remains understudied. METHODS: To explore the impact of the COVID-19 pandemic on service-seeking and utilization, we conducted in-depth interviews with 27 cisgender WWID in Baltimore, Maryland, in April-September 2021. Iterative, team-based thematic analysis of interview transcripts identified disruptions and adaptations to healthcare and substance use services during the COVID-19 pandemic. RESULTS: The COVID-19 pandemic disrupted service engagement for WWID through service closures, pandemic safety measures restricting in-person service provision, and concerns related to contracting COVID-19 at service sites. However, participants also described various service adaptations, including telehealth, multi-month prescriptions, and expanded service delivery modalities (e.g., mobile and home delivery of harm reduction services), which overwhelmingly increased service engagement. CONCLUSION: To build upon service adaptations occurring during the pandemic and maximize expanded access for WWID, it is vital for healthcare and substance use service providers to continue prioritizing expansion of service delivery modality options, like telehealth and the provision of existing harm reduction services through alternative platforms (e.g., mobile services), that facilitate care continuity and increase coverage.

Fear of COVID and Physical Health Among People Living with HIV in China: Mediation Effects of HIV Stigma, Social Support, and Substance Use.

The COVID-19 pandemic has uniquely impacted people living with HIV (PLWH) worldwide. The negative impacts on PLWH's mental health from fear of COVID-19 are labeled as "a double stress." The association between fear of COVID-19 and HIV (internalized) stigma has been found among PLWH. Studies that explore the relationships between fear of COVID-19 and physical health outcomes are few, especially among PLWH. In this study, we explored the relationship between fear of COVID-19 and physical health among PLWH and the mediated effects of HIV stigma, social support, and substance use. A cross-sectional online survey of PLWH (n = 201) from November 2021 to May 2022 was carried out in Shanghai, China. The data on socio-demographics, fear of COVID-19, physical health, HIV-related perceived stigma, social support, and substance use were gathered and analyzed by structure equation modeling (SEM). In SEM analysis, fear of COVID-19 showed a significant and indirect effect on physical health (ß=-0.085) which was primarily mediated by HIV stigma. In SEM analysis, the final model had a good fit. Fear of COVID-19 showed a significant effect on HIV stigma (ß = 0.223) with the majority being direct effects (ß = 0.262) and a small indirect effect via substance use (ß=-0.039). Furthermore, HIV stigma showed a significant effect on physical health (ß=-0.382), the majority of which was direct (ß=-0.340), and a small indirect effect via social support (ß=-0.042). This is one of the first studies to explore how fear of contracting COVID-19 can affect PLWH's coping behaviors (e.g., using substances and obtaining social support) used to combat HIV stigma as well as to achieve better physical health in China.