An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa.

The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.

Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa.

BACKGROUND: Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services. METHODS: Twenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35). RESULTS: Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized. CONCLUSIONS: Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.

Scoping review protocol exploring the relationship between food insecurity, mental health and diet intake among adolescents across the globe.

INTRODUCTION: Studies, exploring the effect of food insecurity on physical and mental health, have shown that food insecurity is associated with lower self-reports of physical and mental health. With the COVID-19 pandemic, food insecurity has increased leading to higher risks of poor mental health. Despite evidence of the negative implications of food insecurity on mental health, there is a paucity of research on these variables for adolescents specifically. The current evidence shows there is a gap in adolescent centred research linking mental health and food insecurity globally. Adolescence is a crucial period of development where habits, nutritional inadequacies linked to food insecurity and mental health problems formed due to these inadequacies can be conveyed into adulthood. The aim of this study is to systematically scope the literature exploring the relationship between mental health, food (in)security and/or diet intake of adolescents. METHODS: This review will be guided by Arksey and O'Malley's extended framework. The search strategy was developed by two of the authors and will be used to search literature from January 2012 to December 2022 in PubMed, Academic search complete, PsychARTICLES, Google, ScienceDirect, Scopus and Web of science core collection. Searching published and unpublished literature will be done in the chosen databases. References used in included literature will be reviewed for additional studies/sources. Articles will be assessed for eligibility by two reviewers, and any discrepancies reviewed by a third reviewer. The inclusion and exclusion criteria will be used for screening. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram will be used to document the selection process. A narrative summary and descriptive analysis will be used to summarise and report the extracted data. ETHICS AND DISSEMINATION: Approval for this study has been granted by the University of the Western Cape Biomedical Research Ethics Committee (BM21/8/3). Strict measures will be followed to ensure methodological rigour.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study.

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa.

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.

Substitute Addictions in Persons with Substance Use Disorders: A Scoping Review.

BACKGROUND: Substitute addictions, addictive behaviors that sequentially replace each other's functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O'Malley's framework for scoping reviews, a systematic search was conducted to identify publications that referenced substitute addictions up to April 2018. Study characteristics were extracted and summarized to provide an overview of the extant literature. Results: The 63 included studies show that substitute addictions are terminologically and conceptually ambiguous. Much of the available literature is concentrated in developed contexts - and in particular the United States of America. While presentations varied, at least two sub-types of substitute addictions appeared: long-term replacement and temporary replacement. Existing theories suggest a multifactorial etiology. Conclusions: The findings suggest a strong need for: increased awareness of substitute addictions and its potential consequences for recovery; interventions that structure prevention and pre-, during-, and post-treatment interactions as well as future research to explore its nature and dynamics drawing on multiple methods.

Substitute addictions in the context of the COVID-19 pandemic.

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter of the pandemic in Africa, and has issued an alcohol and cigarette ban. Historical examples suggest that responses to forced abstinence may include compliance and abstinence, but also seeking alternatives to the original addiction and substitution. Substitution of alternative activities/objects may provide similar appetitive effects to fill the void of the terminated addictive behavior, temporarily or in the long-term. While substitutes do not necessarily portend a relapse, coupled with isolation and reduced recovery support, they can potentiate relapse to the former or 'new' addictive behavior. Addiction professionals should be aware of the potential for such negative impacts during and after the COVID-19 pandemic.

The relation between subjective well-being and career aspirations amongst a sample of adolescents in low socioeconomic status communities in Cape Town.

The study aimed to determine the relation between adolescents' subjective well-being and career aspirations. The study further aimed to determine the extent to which social support mediates this relation. The sample comprised 1082 adolescents in Grades 8-11, selected from schools located in low socioeconomic status communities in Cape Town, South Africa. The overall model demonstrated a nonsignificant relation between adolescents' subjective well-being and career aspirations. Across gender, the results indicated a significant relation between subjective well-being and career aspirations for the male group, but not for females. The results further indicate that social support did not mediate the relation between adolescents' subjective well-being and career aspirations for the pooled sample. However, for females, the study found a significant negative relation between social support and aspirations. We recommend targeting interventions at an institutional level, inclusive of challenging gender roles and providing information about educational and career opportunities for young people.

Equivalence and Bias in the South African Substance Use Contextual Risk Instrument.

This article forms part of a larger study that sought to develop and validate a scale to measure individual and contextual factors associated with adolescent substance use in low-socio-economic status South African communities. The scale was developed to inform the process of designing preventative interventions in these communities. This study assessed the construct equivalence and item bias across different language versions of the scale. Exploratory factor analysis, equality of reliabilities, and the Tucker's phi coefficient of congruence were employed to assess whether the two language versions were equivalent at a scale level. Differential item functioning analysis was conducted using ordinal logistic regression and the Mantel-Haenszel method at an item level. The findings revealed that there are significant differences between the two groups at a scale level. Items were flagged as presenting with moderate to large differential item functioning. The biased items have to be closely examined in order to decide how to address the bias.

Diagnostico de la condición de salud bucal de la población que asiste a las clínicas odontológicas de: Hospital militar central, Cruz roja salvadoreña, clínica asistencial corazón de María y unidad de salud de Panchimalco en el año 2009 / Diagnosis of the oral health condition of the population that attends the dental clinics of: Central Military Hospital, Salvadoran Red Cross, Corazón de María care clinic and Panchimalco health unit in 2009

El presente estudio busca realizar el diagnóstico de salud bucal como paciente colectividad de la población que asiste a las clínicas odontológicas y unidad de salud de: Hospital Militar Central, Cruz Roja Salvadoreña, Clínica Asistencial Corazón de María y Unidad de Salud de Panchimalco; así como determinar las variables socioeconómicas de la población, identificar el motivo de consulta del paciente, detectar la existencia de problemas en cara, cuello y osteomucofibrosas, determinar los índices dentoperiodontales; así como también las oclusopatías de la población con todo ello se pudo establecer el problema principal estomatológico de la colectividad. Esta investigación es de tipo descriptiva, la cual fue realizada en el año 2009, utilizándose los instrumentos de cédula de entrevista y guía de observación como método de recolección de datos en el período de septiembre a noviembre de dicho año. De las clínicas antes mencionadas se toma una muestra de 333 pacientes entre hombre y mujeres cuyas edades oscilan de 0 a 61 a más, dividiéndose éstas por diferentes rangos. Teniendo como resultados principales, que el género femenino fue el más predominante. Y el rango de edad donde se ubica la mayoría de la población es de 20 a 40 años. El motivo de consulta principal fueron los problemas dentales. Dando como conclusión que el problema principal encontrado en la población estudiada es el de caries dental el cual representa el 91.21%, mostrando así un nivel alto de índice CPOD/CEOD en la población.

This study seeks to make the diagnosis of oral health as a patient group of the population that treated the dental clinics and health unit of: Central Military Hospital, Salvadoran Red Cross, Corazón de María Assistance Clinic and Panchimalco Health Unit; as well as determining the socioeconomic variables of the population, identifying the reason for the patient's consultation, detecting the existence of problems in the face, neck and osteomucofibroses, determining the dentoperiodontal indices; as well as the occlusopathies of the population with all this it was possible to establish the main stomatological problem of the community. This research is descriptive, which was carried out in 2009, using the interview card and observation guide instruments as a data collection method in the period from September to November of said year. From the aforementioned clinics, a sample of 333 patients is taken between men and women whose ages range from 0 to 61 and over, dividing these by different ranges. Taking as main results, that the female gender was the most predominant. And the age range where the majority of the population is located is between 20 and 40 years old. The main reason for consultation was dental problems. Concluding that the main problem found in the studied population is dental caries, which represents 91.21%, thus showing a high level of the CPOD / CEOD index in the population.