Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health.

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.

Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals.

Introduction: The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods: Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results: Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion: Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.

Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021.

BACKGROUND AND OBJECTIVES: The current study examines regional differences in Black/White fatal drug overdoses. METHODS: Black/White overdose mortality data (2012-2021; N = 537,085) were retrieved from CDC WONDER. We used death counts and corresponding Census Bureau population estimates by the decedent's age and race/ethnicity to calculate mortality rate ratios. RESULTS: From 2012 to 2021, there were 537,085 reported overdose deaths among White (85%) and Black (15%) individuals in the United States. In the South, Black individuals had lower fatal drug overdose deaths than their same-aged White counterparts. In the Northeast, Midwest, and West regions, Black individuals had around 10%-60% lower likelihood of overdoses among younger ages (15-24, 25-34, 35-44) but about 60%-300% higher likelihood of overdoses among older adults (55-64). Increases in overdose deaths during the pandemic (2020-2021) led to changes in Black/White overdose death patterns, whereas Black individuals of all ages in the Midwest and West regions had approximately 15%-425% higher likelihood of fatal overdoses than their same-aged White counterparts. Sex-stratified analysis suggests that Black females in the South had overdose death rates around 50% lower than same-aged White females, and overdose deaths were relatively equal for Black and White females in the Midwest-patterns not seen among males. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The findings indicate that the Black/White overdose mortality gap changed after the COVID-19 pandemic across all regions and age cohorts, with state and regional variations in magnitude. Behavioral interventions and policies to curb drug overdose deaths among populations most impacted should consider regional, sex, and age-related differences.

Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them.

BACKGROUND: Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. OBJECTIVES: This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. DESIGN: This study is based on qualitative semi-structured interviews. METHODS: Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals. RESULTS: Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system. CONCLUSION: Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.

Pregnancy and parenting-related barriers to receiving medication for opioid use disorder: Interview themes from multiple perspectivesWomen face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. This study used one-on-one interviews to learn more about the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. Three different groups were interviewed: women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals (N = 42). Three parenting-related themes emerged from the interviews: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three pregnancy-related themes emerged from the interviews: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex health system. Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.

The Role of Substance Use Disorders on Suicidal Ideation, Planning, and Attempts: A Nationally Representative Study of Adolescents and Adults in the United States, 2020.

Few nationally representative studies examine suicidality and substance use during 2020; as such, we explored the role of substance use disorders (SUDs) on suicidality among adults and adolescents in 2020. Data were derived from N = 26,084 adult participants, representing 240 million U.S. adults weighted, and N = 5,723 adolescent participants, representing 25 million U.S. adolescents (12-17 years.). Separate logistic regressions for adults and adolescents were used to assess the association of DSM-5 SUDs, related factors, and suicidal thoughts and behaviors (ideation, planning, and attempts). In 2020, adults with SUDs were nearly 4 times more likely to seriously consider suicide (aOR = 3.94, 95% CI: 3.19, 4.86), 3 times more likely to make a suicide plan (aOR = 3.09, 95% CI: 2.25, 4.25), and nearly 4 times more likely to attempt suicide (aOR = 3.77, 95% CI: 2.29, 6.19) than adults without SUDs. Adolescents with SUDs were 4 times more likely to consider suicide (aOR = 3.69, 95% CI: 2.47, 5.51), 5 times as likely to make a suicide plan (aOR = 5.14, 95% CI: 3.25, 8.13) and to attempt suicide (aOR = 5.27, 95% CI: 2.91, 9.53) than adolescents without SUDs. Adult females and individuals experiencing poverty were twice as likely to attempt suicide than adult males and individuals not living in poverty. Adolescent females were 3-5 times more likely to seriously consider, plan, and attempt suicide than adolescent males. Interventions to curb suicidality among individuals with SUDs are crucial.

The role of polysubstance use on criminal justice involvement in the United States.

PURPOSE OF REVIEW: Polysubstance use, broadly defined as using more than one type of substance, disproportionately impacts those involved in the criminal justice system (CJS). This review synthesizes recent findings on polysubstance use among those involved in the CJS and highlights areas of particular concern and interventions. RECENT FINDINGS: We use 18 recent articles to identify the prevalence and types of criminal justice involvement and correlates of polysubstance use and criminal justice involvement. We highlight latent patterns of polysubstance use among various criminal justice populations (adults, pregnant women, and youth) and differential associations with adverse substance use and criminal justice outcomes. Lastly, we discuss substance use treatment in the justice system, the role of polysubstance use in treatment access and outcomes, and substance use-related services for previously incarcerated individuals reentering society. SUMMARY: Current research provides further evidence of the syndemic nature of polysubstance use, criminal justice involvement, and adverse outcomes, which are complicated by significant barriers to accessing evidence-based treatment in justice settings. Yet, current research is limited due to methodological inconsistency and limited focus on the social determinants of health, racial/ethnic disparities, and interventions to increase treatment and reentry services.

Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers.

BACKGROUND: Women with substance use disorders experience multifaceted barriers in accessing substance use treatment. Little is known about how these barriers may aggregate. Using a person-centered approach, this study evaluates patterns of treatment barriers and the factors associated with experiencing distinct sets of barriers among women. METHODS: Data were from the NSDUH (2015-2019). 461 adult women with an unmet need for substance use treatment in the last year reported on 14 treatment barriers. Latent class analysis examined classes of barriers; multinomial logistic regression assessed predictors of class membership. RESULTS: Three classes were identified: just not ready to abstain (71.2%), logistical barriers and stigmatization (18.2%), and barriers across all dimensions (10.6%). Higher education (aOR:1.94, p = 0.03) and psychological distress (aOR:2.19, p = 0.02) predicted higher odds-and identifying as African American predicted lower odds (aOR:0.17, p = 0.02)-of belonging to the "Logistics and Stigma Barriers" class relative to the "Just Not Ready" class. Similarly, higher education (aOR: 2.57, p = 0.02) and having children (aOR:2.28, p = 0.03) predicted higher odds-and marriage predicted lower odds (aOR:0.22, p = 0.02)-of belonging to the "High and Diverse Barriers" class relative to the "Just Not Ready" class. Having children predicted higher odds (aOR: 2.93, p = .02), and marriage predicted lower odds (aOR:0.19, p = 0.02) of belonging to the "High and Diverse Barriers" class relative to the "Logistics and Stigma" class. CONCLUSION: A lack of readiness to abstain, socioeconomic circumstances, and family obligations are main barriers to SUD treatment among women. Interventions incorporating motivational interviewing, family systems, and social networks are needed.

Validation and Psychometric Properties of the Original Grit Scale (Grit-O) Among Cambodian Adolescents.

Background: Cambodian youth face many unique challenges, such as high instances of poverty and intergenerational trauma. Grit, a person-level trait defined as having "perseverance and passion for long-term goals", may be particularly important in helping Cambodian youth to succeed despite the extreme challenges they face. To date, the Original Grit Scale (Grit-O) has not been translated in Khmer or validated for a sample of Cambodian youth. Purpose: This study aimed to assess the reliability and validity of a Khmer translation of the Original Grit Scale (Grit-O) among urban Cambodian youth. Research Design: A cross-section survey battery -including Grit-O and other relevant covariates -was administered to Cambodian youth. Study Sample: Data were collected from 580 Cambodian adolescents (Mage = 15.85 years, SDage = 2.05, 63.7% female). Data Collection and Analysis: Paper and pencil surveys were sent home from school with each participant and returned to the study team the next day. Analyses included calculating Cronbach's alphas, interitem correlations, correlations with relevant covariates and both a confirmatory and exploratory factor analysis. Results: Cronbach's alphas and interitem correlations indicated that the full scale was not reliable for this sample, and that reliability improved when two items (I become interested in new pursuits every few months -reverse-scored and I finish whatever I begin) were excluded. The subscales Consistency of Interests and Perseverance of Effort were more reliable than the full scale. Correlations with relevant covariates indicated that the full scale was moderately valid. Factor analyses suggested that items 6 and 7 did not load well onto either identified factor. Conclusions: Investigators measuring grit in a sample of Cambodian youth should consider excluding items 6 and 7 of Grit-O, and assessing the two subscales on their own, rather than treating them as indicators of a single higher-order construct.

Profiles of future expectations among urban adolescents in Cambodia.

Adolescents are tasked with navigating competing priorities, including whether to marry, have children, pursue a job/career, go to college, and contribute to society. The developmental task of building expectations for the future is especially complex for Cambodian adolescents living within a society that strongly prioritizes family obligations yet increasingly provides educational and professional opportunities. The current study, guided by Seginer's (2003) future orientation model, applied latent profile analysis (LPA) to explore patterns of Cambodian adolescents' (N = 580, 64% female, Mage = 15.85) future expectations across key life domains and predictors of those patterns. LPA identified four profiles: Low Expectancy (low expectations across all domains; 12%), Family Focused (high expectations to get married and have children; 31%), Professional/Service Focused (high expectations across education, employment, and societal contribution domains; 27%), and High Expectancy (high expectations across all domains; 30%). Females were more likely than males to be in the Professional/Service Focused than High Expectancy profile. Adolescents with greater internal locus of control and family obligation were less likely to be in the Low Expectancy and Family Focused than High Expectancy profile, whereas adolescents in higher grade levels were more likely to be in the Family Focused than High Expectancy profile. Adolescents with closer relationships with mothers were less likely to be in the Professional/Service Focused than High Expectancy profile; adolescents with closer relationships with fathers were more likely to be in the Professional/Service Focused than High and Low Expectancy profiles. Findings elucidate configurations of adolescents' future expectations, and factors distinguishing among adolescents with different configurations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing knowledge about recovery-related life domains among pregnant and parenting women in comprehensive substance use disorder treatment: The Art of Addiction Recovery Program.

BACKGROUND: Group treatments designed specifically for pregnant and parenting women with substance use disorders are lacking. This study provides a preliminary assessment of the Art of Addiction Recovery Program, a manualized group treatment imbedded within a comprehensive substance use disorder treatment program for pregnant and parenting women. METHODS: The Program consists of 14 sessions, each focusing on a different topic, including health, social relationships, the recovery process, well-being, and introspection. Each session includes both the presentation of information by a facilitator, group discussions guided by the facilitator, and a creative project. A single-group pretest-posttest design provides an initial evaluation of the Art of Addiction Recovery Program. RESULTS: Participants were 51 women with an average age of 28.7 (SD = 5.0) with most (69%) having a primary opioid use disorder and 82% reporting tobacco use. Significant (ps < 0.001) pre- to post-session increases in session-specific knowledge occurred for all 14 sessions with a measure of multivariate association indicating that these changes were substantial. Ratings of learning and effectiveness were generally high, with 19/28 means at 3.7 or above (maximum score = 4). CONCLUSIONS: Findings suggest that The Art of Addiction Recovery Program was effective in conveying knowledge about substance use and recovery, and that participants increased their knowledge and generally strongly agreed that the sessions provided high levels of learning and were highly effective. The Art of Addiction Recovery Program provides an option for those seeking a manual-based group treatment program as an aid in the treatment process for this subpopulation.

Within-person methodology to study the addiction recovery process of women.

Women are among the fastest growing populations of those with substance use disorders in the United States. Women face different social barriers than men in their access to treatment and recovery from these disorders. Differentially experienced barriers include greater child caregiving responsibilities, social sigma regarding motherhood and substance use, romantic partners who also use substances, experiences of violence and trauma, and, relatedly, symptoms of post-traumatic stress disorder. These barriers have been studied primarily by employing between-group approaches (e.g. comparing men and women) or between-persons approaches (e.g. cross-sectionally assessing the relationship between person-level PTSD symptoms and relapse). However, there are limited studies on women's gender-specific experiences in recovery with the aim of elucidating within-person effects. Employing within-person designs, such as daily diary or ecological momentary assessments, has many advantages. These advantages include reducing retrospective bias, assessing temporality of processes that occur on a short time scale, and analyzing processes that may occur when individuals deviate from their personally normative experiences. Studying women's experiences in recovery "as they are lived" will enable the development of interventions that are fine-tuned to the specific needs of each woman, and ultimately may help to reduce the suffering of women with substance use disorders.

Using daily diary methods to understand how college students in recovery use social support.

Collegiate Recovery Communities (CRCs) are important sources of support for college students building and maintaining recovery from substance use disorders. The current study used daily diary data from members of a CRC to examine with which sources of social support students engaged daily, and whether students connected with these sources more on days when they indicated higher-than-usual recovery difficulty, negative affect, and/or school stress. Results indicate that on days when students reported having greater difficulty with recovery maintenance than usual, they had higher odds of being in contact with family members and were expected to talk or spend time with family for longer than usual. Students also had higher odds of having recovery-focused conversations with both 12-step sponsors and CRC peers on days of greater-than-usual recovery maintenance difficulty. Recovery maintenance difficulty was uniquely associated with longer duration of family contact, above and beyond negative affect and school stress. Thus, the occurrence, amount, and nature of CRC members' interactions with important social network members varied in relation to perceived recovery challenges that same day. Findings highlight the importance of providing college students with multiple sources of support that they can use to maintain their recoveries despite daily challenges.

Longitudinal links between parents' mental health, parenting, and adolescents' mental health: Moderation by adolescent sex.

This study explored mothering and fathering as possible mediators of the relationship between parent and adolescent mental health concerns and considered the adolescents' biological sex as a potential moderator. Using structural equation modeling, the longitudinal links between parents' mental health, parental psychological control, parent-adolescent connectedness, and adolescent mental health in 500 families-including 338 fathers and 500 mothers-were explored over the course of 5 years. The mean age of the adolescents (51.8% female, 69.6% European American) at Time 1 was 13.3 years. Mothers' symptoms of anxiety directly predicted girls' depression 5 years later. This relation was not mediated by parenting behaviors. Fathers' symptoms did not directly or indirectly predict adolescent symptoms. Additionally, the relations of maternal parenting with adolescent mental health symptoms 4 years later were moderated by adolescent sex. Specifically, maternal connection was associated with decreased anxiety and depression for boys alone, whereas maternal psychological control was associated with increased anxiety and depression for girls. The father model was generally not moderated by adolescent sex. Limitations of this study include the discrepancy in the sample size of mothers and fathers; more significant findings may have emerged with a larger sample size of fathers. This study highlights the important role that adolescent sex plays in relationships surrounding parenting and mental health in the family system. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parental Differential Treatment of Siblings and Adolescents' Health-Related Behaviors: The Moderating Role of Personality.

Youth who receive comparatively poorer parental treatment than a sibling are at risk for maladaptive behaviors in a variety of domains, but research has yet to examine links with adolescents' health-related behaviors nor consider how those links may vary based on adolescents' personality traits, namely conscientiousness and agreeableness. Two siblings (n = 590 adolescents; 53% female; Mage = 15.86, SD = 1.73) from 295 families reported on their differential conflict and closeness with their fathers and mothers as well as on their personality, sleep habits, exercise habits, and general health habits. Multilevel modeling revealed that, generally, the less conscientious adolescents had better health habits when they had comparatively warmer relationships with their mothers. Less conscientiousness adolescents may be less distressed by inequality in the family, and thus may experience positive effects of relatively better treatment.