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1.
Curr Opin Psychiatry ; 34(4): 351-356, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1635161

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS: Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY: Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.


Subject(s)
COVID-19/complications , COVID-19/psychology , Mental Disorders/complications , Mental Disorders/psychology , Substance-Related Disorders/complications , Substance-Related Disorders/psychology , Drug Interactions , Humans , Mental Disorders/drug therapy , Pandemics , Risk Factors , SARS-CoV-2 , Vulnerable Populations/psychology
3.
PLoS One ; 17(1): e0262136, 2022.
Article in English | MEDLINE | ID: covidwho-1622352

ABSTRACT

BACKGROUND: As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. METHODS: We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. FINDINGS: While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. CONCLUSIONS: We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19/psychology , Emergency Service, Hospital/statistics & numerical data , Mental Disorders/psychology , Mental Health/statistics & numerical data , Substance-Related Disorders/psychology , Humans , Pandemics/statistics & numerical data
5.
Lancet ; 398(10303): 920-930, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1593950

ABSTRACT

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.


Subject(s)
Mental Disorders/epidemiology , Physicians/psychology , Suicide/statistics & numerical data , Burnout, Professional , COVID-19/epidemiology , Female , Humans , Male , Mental Disorders/prevention & control , Pandemics , Physicians, Women/psychology , Risk Factors , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Suicide/prevention & control , Work Schedule Tolerance
6.
Psychiatry Res ; 307: 114327, 2022 01.
Article in English | MEDLINE | ID: covidwho-1598218

ABSTRACT

This paper examines the mental health and substance use impacts of the COVID-19 pandemic among sexual and gender minority (SGM) populations as compared to non-SGM populations, and identifies risk factors for mental health and substance use impacts among SGM groups. Data were drawn from two rounds of a repeated cross-sectional monitoring survey of 6027 Canadian adults, with Round 1 conducted May 14-19, 2020 and Round 2 conducted September 14-21, 2020. Bivariate cross-tabulations with chi-square tests were utilized to identify differences in mental health and substance use outcomes between SGM and non-SGM groups. Separate multivariable logistic regression models were used to identify risk factors for mental health and substance use outcomes for all SGM respondents. Compared to non-SGM respondents, a greater proportion of SGM participants reported mental health and substance use impacts of the COVID-19 pandemic, including deterioration in mental health, poor coping, suicidal thoughts, self-harm, alcohol and cannabis use, and use of substances to cope. Among SGM respondents, various risk factors, including having a pre-existing mental health condition, were identified as associated with mental health and substance use impacts. These widening inequities demonstrate the need for tailored public mental health actions during and beyond the pandemic.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Substance-Related Disorders , Adult , Canada/epidemiology , Cross-Sectional Studies , Humans , Mental Health , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology
7.
Addict Behav ; 127: 107213, 2022 04.
Article in English | MEDLINE | ID: covidwho-1588557

ABSTRACT

BACKGROUND: We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates. METHODS: A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only. RESULTS: Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use. CONCLUSIONS: Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic. FUNDING: Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.


Subject(s)
COVID-19 , Substance-Related Disorders , Telemedicine , Humans , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology
8.
PLoS One ; 16(12): e0261115, 2021.
Article in English | MEDLINE | ID: covidwho-1574235

ABSTRACT

BACKGROUND: The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic. METHODS: The overall study uses a concurrent-embedded design. Aims 1-2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities. DISCUSSION: Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.


Subject(s)
COVID-19 , Delivery of Health Care/methods , Drug Overdose/drug therapy , Substance-Related Disorders/therapy , Disasters , Drug Overdose/mortality , Health Policy , Health Services , Humans , Outcome and Process Assessment, Health Care , United States
9.
Int J Environ Res Public Health ; 18(24)2021 12 07.
Article in English | MEDLINE | ID: covidwho-1554853

ABSTRACT

This research uses structural equation modeling to determine the influence of uncertainty due to the COVID-19 pandemic as an independent variable in the negative emotional states and resilience (as mediating variables) vs. drug addiction, alcoholism, and suicide ideation as dependent variables in 5557 students from a public state university in Northern Mexico. The five variables are related through eight hypotheses and tested using partial least squares. We used an adapted questionnaire sent by email in May 2020. Findings show that uncertainty facing the COVID-19 pandemic had a direct and significant influence on negative emotional states and a significant inverse effect on resilience; in the trajectory, drug addiction and alcoholism, and suicide ideation are explained.


Subject(s)
Alcoholism , COVID-19 , Substance-Related Disorders , Alcoholism/epidemiology , Humans , Pandemics , SARS-CoV-2 , Suicidal Ideation , Uncertainty
10.
Nurs Adm Q ; 46(1): 19-28, 2022.
Article in English | MEDLINE | ID: covidwho-1550630

ABSTRACT

Nurses are known to be at an increased risk of death by suicide, and recent studies have found links between nurse suicide, substance use, mental health issues, and job problems. Because of stigma, inaccessibility of resources, and regulatory and legal issues, nurses are unlikely to seek help unless a crisis forces them into treatment. The purpose of this article is to review the current understanding of nurse suicide, the psychological impact of the novel coronavirus (COVID-19) pandemic, the strategic planning approach to identify the needs of nurses, and promising interventions and practices. Evidence-based strategies to intervene at the personal, institutional, and regulatory levels should be employed to reduce nurse suicide by focusing not only on suicide but also on treatment of substance and mental health issues, as well as a renewed focus on disciplinary procedures that may place nurses in immediate danger of death by suicide. Nurse leaders have a moral obligation to provide proactive, meaningful interventions to reduce the risk of death by suicide among nurses.


Subject(s)
COVID-19 , Substance-Related Disorders , Suicide , Humans , Mental Health , SARS-CoV-2
11.
BMC Health Serv Res ; 21(1): 1279, 2021 Nov 27.
Article in English | MEDLINE | ID: covidwho-1538072

ABSTRACT

BACKGROUND: Peer workers (those with lived/living experience of substance use working in overdose response settings) are at the forefront of overdose response initiatives in British Columbia (BC). Working in these settings can be stressful, with lasting social, mental and emotional impacts. Peer workers have also been disproportionately burdened by the current dual public health crises characterized by the onset of the COVID-19 pandemic and rise in illicit drug overdose deaths. It is therefore critical to develop supports tailored specifically to their realities. METHODS: We used the six steps outlined in the Intervention Mapping (IM) framework to identify needs of peer workers and design an intervention model to support peer workers in overdose response settings. RESULTS: Eight peer-led focus groups were conducted in community settings to identify peer workers' needs and transcripts were analyzed using interpretive description. The strategies within the intervention model were informed by organizational development theory as well as by lived/living experience of peer workers. The support needs identified by peer workers were categorized into three key themes and these formed the basis of an intervention model titled 'ROSE'; R stands for Recognition of peer work, O for Organizational support, S for Skill development and E for Everyone. The ROSE model aims to facilitate cultural changes within organizations, leading towards more equitable and just workplaces for peer workers. This, in turn, has the potential for positive socio-ecological impact. CONCLUSIONS: Centering lived/living experience in the intervention mapping process led us to develop a framework for supporting peer workers in BC. The ROSE model can be used as a baseline for other organizations employing peer workers.


Subject(s)
COVID-19 , Drug Overdose , Substance-Related Disorders , Drug Overdose/epidemiology , Drug Overdose/prevention & control , Humans , Pandemics , Peer Group , SARS-CoV-2 , Substance-Related Disorders/epidemiology
12.
Clin Ter ; 172(6): 525-526, 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1534515

ABSTRACT

Abstract: Our lives and communities have been besieged by COVID-19 for almost two years, and society and its functioning have been turned upside down and upset, through limitations and restrictions aimed at stemming the spread of the SARS-CoV-2 virus. Severe levels of anxiety, distress and uncertainty have taken a huge toll on our daily lives from the social, professional and emotional perspectives, but it is still rather unclear how serious an impact the emergency has had on a class of particularly vulnerable individuals: those with substance abuse issues. Particularly, we would like to draw attention to a uniquely troublesome development: forced isolation resulting from pandemic-related restrictions and how it has impacted drug users and their efforts to achieve recovery.


Subject(s)
COVID-19 , Substance-Related Disorders , Humans , Mental Health , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology
13.
CMAJ Open ; 9(4): E988-E997, 2021.
Article in English | MEDLINE | ID: covidwho-1524571

ABSTRACT

BACKGROUND: The extent to which heightened distress during the COVID-19 pandemic translated to increases in severe mental health outcomes is unknown. We examined trends in psychiatric presentations to acute care settings in the first 12 months after onset of the pandemic. METHODS: This was a trends analysis of administrative population data in Ontario, Canada. We examined rates of hospitalizations and emergency department visits for mental health diagnoses overall and stratified by sex, age and diagnostic grouping (e.g., mood disorders, anxiety disorders, psychotic disorders), as well as visits for intentional self-injury for people aged 10 to 105 years, from January 2019 to March 2021. We used Joinpoint regression to identify significant inflection points after the onset of the pandemic in March 2020. RESULTS: Among the 12 968 100 people included in our analysis, rates of mental health-related hospitalizations and emergency department visits declined immediately after the onset of the pandemic (peak overall decline of 30% [hospitalizations] and 37% [emergency department visits] compared to April 2019) and returned to near prepandemic levels by March 2021. Compared to April 2019, visits for intentional self-injury declined by 33% and remained below prepandemic levels until March 2021. We observed the largest declines in service use among adolescents aged 14 to 17 years (55% decline in hospitalizations, 58% decline in emergency department visits) and 10 to 13 years (56% decline in self-injury), and for those with substance-related disorders (33% decline in emergency department visits) and anxiety disorders (61% decline in hospitalizations). INTERPRETATION: Contrary to expectations, the abrupt decline in acute mental health service use immediately after the onset of the pandemic and the return to near prepandemic levels that we observed suggest that changes and stressors in the first 12 months of the pandemic did not translate to increased service use. Continued surveillance of acute mental health service use is warranted.


Subject(s)
COVID-19/epidemiology , Mental Health Services/statistics & numerical data , Mental Health Services/trends , Pandemics/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/epidemiology , Child , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Mood Disorders/epidemiology , Ontario/epidemiology , Psychotic Disorders/epidemiology , SARS-CoV-2 , Self-Injurious Behavior/epidemiology , Substance-Related Disorders/epidemiology , Young Adult
14.
JMIR Public Health Surveill ; 7(11): e29319, 2021 11 09.
Article in English | MEDLINE | ID: covidwho-1506455

ABSTRACT

BACKGROUND: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. OBJECTIVE: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. METHODS: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon's Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. RESULTS: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=-0.24, 95% CI -0.44 to -0.05) and nonusers (B=-0.57, 95% CI -0.76 to -0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=-0.16, 95% CI -0.30 to -0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. CONCLUSIONS: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.


Subject(s)
COVID-19 , Electronic Nicotine Delivery Systems , Substance-Related Disorders , Adult , COVID-19 Testing , Centers for Disease Control and Prevention, U.S. , Cross-Sectional Studies , Female , Gender Identity , Humans , Internet , Male , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control , United States/epidemiology
15.
Int J Environ Res Public Health ; 18(21)2021 11 03.
Article in English | MEDLINE | ID: covidwho-1502429

ABSTRACT

The main objective of the research was to examine the associations between problematic alcohol use, tobacco use and cannabis use among Czech and Slovak university students during the early COVID-19 pandemic. The research sample consisted of 1422 participants from the Czech Republic (CZ) and 1677 from the Slovak Republic (SK). The analyses included university students who drank alcohol in the past year (CZ: 1323 (93%); SK: 1526 (91%)). Regarding the analysed measures, the Alcohol Use Disorders Identification Test (AUDIT) and its subscales, the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ) and the Cannabis Abuse Screening Test (CAST) were selected to identify substance-related behaviour. Age, gender and residence were included in the analyses as socio-demographic variables. Correlation and regression analyses were used to achieve the main objective of the research. The main results revealed that the use of tobacco and cannabis were positively associated with alcohol use disorders among Czech and Slovak university students. Additionally, males were more likely to report alcohol use disorders. In the Czech Republic, it was found that students living in dormitories were characterized by a lower AUDIT score. The opposite situation was found in the Slovak Republic. Czech and Slovak policy-makers are encouraged to develop alcohol use prevention programs for university students in line with these findings.


Subject(s)
Alcoholism , COVID-19 , Cannabis , Substance-Related Disorders , Alcohol Drinking , Cross-Sectional Studies , Czech Republic/epidemiology , Demography , Humans , Pandemics , SARS-CoV-2 , Slovakia/epidemiology , Students , Substance-Related Disorders/epidemiology , Tobacco Use , Universities
16.
Am J Addict ; 30(4): 330-333, 2021 07.
Article in English | MEDLINE | ID: covidwho-1494383

ABSTRACT

BACKGROUND AND OBJECTIVES: We sought to understand the impact of COVID-19 on emergency department (ED) overdoses and county coroner verified overdose deaths. METHODS: Electronic medical health record and county coroner data were gathered and comparisons were made between three 16-week time periods. In the three time periods, 873 individuals had an overdose diagnosis in the ED and 440 individuals in the county died of drug overdose. RESULTS: While total ED patient volume decreased substantially, the number of ED overdose patients increased between March 6 and June 25, 2020. Furthermore, during this same period, coroner data revealed an increase in overdose deaths. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This preliminary evidence provides a key insight into the impact of COVID-19 on both overdose presentations to the ED and county overdose deaths. These results emphasize the critical need for increasing vigilance to prevent overdose by continuously developing and optimizing both accessible and quality treatment as we navigate through this pandemic and its ongoing effects on persons with substance use disorder. (Am J Addict 2021;00:00-00).


Subject(s)
COVID-19/psychology , Drug Overdose/diagnosis , Drug Overdose/mortality , Emergency Medical Services/statistics & numerical data , Substance-Related Disorders/mortality , Adult , COVID-19/epidemiology , Female , Humans , Kentucky/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Socioeconomic Factors
17.
J Contin Educ Nurs ; 52(11): 505-510, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1497419

ABSTRACT

Health care providers are challenged to meet the simultaneous demands of delivering clinical care and acquiring new information, especially in the context of the coronavirus disease 2019 pandemic, the opioid epidemic, and concurrent escalation in alcohol and other drug use. To address the gap in knowledge related to substance use, screening, brief intervention, and referral to treatment (SBIRT), a self-paced online educational program, was developed and delivered to 169 learners. Posttest knowledge scores increased for all learners and did not differ based on their pace of completion. Results indicated that this module provides a means for busy clinicians to increase their ability to manage substance use, even if their learning occurs in multiple sessions interrupted by other pressing demands. Future iterations of this course could further enhance clinical competency by addition of an online clinical simulation component. [J Contin Educ Nurs. 2021;52(11):505-510.].


Subject(s)
COVID-19 , Substance-Related Disorders , Clinical Competence , Humans , Mass Screening , Referral and Consultation , SARS-CoV-2 , Substance-Related Disorders/diagnosis
18.
PLoS One ; 16(11): e0259525, 2021.
Article in English | MEDLINE | ID: covidwho-1496541

ABSTRACT

INTRODUCTION: Alcohol and substance misuse are a public health priority. The World Health Organisation (WHO) estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and that 35.6 million people worldwide are affected by substance misuse. The Coronavirus Disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has disrupted delivery of face-to-face alcohol and substance misuse interventions and has forced the development of alternative remote interventions or adaptation to existing ones. Although existing research on remote interventions suggests they might be as effective as face-to-face delivery, there has been a lack of systematic exploration of their content, the experience of service users, and their effectiveness for behavioural outcomes. This review will provide a narrative synthesis of the behaviour change techniques (BCT) contained in interventions for alcohol and/or substance misuse and their association with effectiveness. METHODS AND ANALYSIS: Systematic searches will be conducted in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library. Included studies will be those reporting remote interventions focusing on alcohol and/or substance misuse among adults living in the community and which have a primary behaviour change outcome (i.e., alcohol levels consumed). Data extraction will be conducted by one author and moderated by a second, and risk of bias and behaviour change technique (BCT) coding will be conducted by two authors independently. A narrative synthesis will be undertaken focussing upon the association of BCTs with intervention effectiveness using promise ratios. PATIENT AND PUBLIC INVOLVEMENT (PPI): The Public Involvement in Research Group (PIRG), part of the NIHR-funded PHIRST, will be involved in refining the review questions, eligibility criteria, data synthesis and dissemination. DISSEMINATION: Dissemination will be through an academic peer reviewed publication, alongside other outputs to be shared with non-academic policy, professional, and public audiences, including local authorities, service users and community organisations.


Subject(s)
Alcoholism/therapy , Behavior Therapy , Internet-Based Intervention , Substance-Related Disorders/therapy , Ethanol , Humans , Internet-Based Intervention/trends
19.
BMC Public Health ; 21(1): 1742, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1496156

ABSTRACT

BACKGROUND: Substance use among young people is a significant public health concern, particularly in Scotland. Primary prevention activities are essential in delaying young people's substance use and reducing the harms associated with use. However, such prevention activities are generally lacking. The Icelandic Model (IM) has received increasing attention and has been associated with improvements in substance use in Iceland since the 1990s. There is interest in implementing the IM in Scotland but concerns regarding transferability. This research study aimed to address a gap in the evidence base by providing insight into stakeholders' views of the IM in Dundee and more widely in Scotland. METHODS: Qualitative data were collected via semi-structured telephone interviews with 16 stakeholders. Data were analysed using Framework Analysis in NVivo, informed by the Consolidated Framework for Implementation Research. RESULTS: Participants were keen for more prevention activities to be delivered in Scotland and were generally supportive of the IM, given the high rates of substance use and related harm. A range of positive factors were identified, including the evidence base, the multi-component nature of the IM, and availability of current services that could be embedded into delivery. Several barriers were noted, relating to funding, the franchise model, support and buy-in and cultural differences. CONCLUSIONS: Our findings provide insight into the views of a range of stakeholders regarding the potential implementation of the IM in Scotland, and perceived barriers and facilitators. There is a desire for primary prevention activities in Scotland, driven by concerns about high rates of substance use and related harms, and a general lack of effective and evidence based prevention activities across the country. Several key barriers would need to be addressed in order for implementation to be successful, and participants were clear that initial piloting is required. Future research and evaluation is required to examine its potential and the outcomes of the approach in Scotland.


Subject(s)
COVID-19 , Substance-Related Disorders , Adolescent , Humans , Iceland , Primary Prevention , Qualitative Research , Scotland , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control
20.
BMJ Open ; 11(10): e049209, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1495463

ABSTRACT

OBJECTIVE: This study analyses longitudinal data to understand how youth mental health and substance use are evolving over the course of the COVID-19 pandemic, which is critical to adjusting mental health response strategies. SETTING: Participants were recruited from among existing participants in studies conducted in an urban academic hospital in Ontario, Canada. PARTICIPANTS: A total of 619 youth aged 14-28 years participated in the study (62.7% girls/young women; 61.4% Caucasian). MEASURES: Data on mood, substance use and COVID-19-related worries were collected over four time points, that is, every 2 months beginning in the early stages of the pandemic in April 2020. Latent class analyses were conducted on the longitudinal data to identify distinct groups of youth who have different trajectory profiles of pandemic impact on their mood, substance use and COVID-19-related worries. RESULTS: For the majority of participants, mood concerns increased early in the pandemic, declined over Canada's summer months and subsequently increased in autumn. Among the youth with the highest level of mood symptoms at the beginning of the pandemic, increases in mental health concerns were sustained. Substance use remained relatively stable over the course of the pandemic. COVID-19-related worries, however, followed a trajectory similar to that of mood symptoms. Girls/young women, youth living in urban or suburban areas, in larger households, and with poorer baseline mental and physical health are the most vulnerable to mental health concerns and worries during the pandemic. CONCLUSIONS: Youth mental health symptom levels and concerns are evolving over the course of the COVID-19 pandemic, in line with the evolution of the pandemic itself, and longitudinal monitoring is therefore required. It is also essential that we engage directly with youth to cocreate pandemic response strategies and mental health service adaptations to best meet the needs of young people.


Subject(s)
COVID-19 , Substance-Related Disorders , Adolescent , Female , Humans , Male , Mental Health , Ontario/epidemiology , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology
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