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To describe and evaluate a cost-effective, integrated model of service provision for people with Alcohol Related Brain Damage (ARBD). Participants identified by three large acute hospitals as having ARBD and suitable for recovery and rehabilitation were offered a 12-week recovery-focussed program at a residential unit. The unit is a collaboration between an NHS board, the local council, and a 3rd sector organization Participants' pre-admission and post-admission medical data was gathered to analyze the effectiveness of the unit's program on Emergency Department (ED) attendance and inpatient bed use. Improvement in cognition was measured by comparing the ACE-III results for all participants at admission and just prior to discharge from the program. Thirty-one participants met the inclusion criteria. Paired t-tests revealed the 12-week program overall significantly reduced attendance at ED, use of in-patient beds after discharge, and improved cognitive functioning. This integrated model of service provision provides clear benefits to residents' cognitive functioning and to the NHS by freeing up inpatient beds and ED capacity. Therefore, it should be considered by commissioners when addressing the needs of people with ARBD. [ABSTRACT FROM AUTHOR]

Background Process mining was widely used in healthcare settings to analyse patient pathways, providing insights about patient care and resource allocation. This study aimed to apply process mining to explore service utilization and pathways of patients with alcohol use disorders in receiving the community-based Drug and Alcohol Service to establish a baseline for evaluating improvement initiatives. Methods Patients' encounters with the Drug and Alcohol Service and their direct care activities (i.e. Intake, Assessment, and treatment service activities) that occurred in these encounters were analysed to depict the actual pathways. Patterns were uncovered from these actual pathways using a process mining tool Disco. Patients with alcohol use disorders were divided into two groups—patients who use polysubstance and those who do not—to compare their service utilization and pathway patterns. Results Five hundred seventy-one patients with alcohol use disorders incurred 1447 encounters, comprising 13,974 activities. The top three actual pathways with at least three activities were: (i) pathway 'Intake-> Withdrawal Management-> Withdrawal Management' (170 (11.7%) encounters and 130 (22.8%) patients); (ii) pathway 'Intake-> Adult Counselling-> Adult Counselling' (161 (11.1%) encounters and 126 (22.1%) patients); and (iii) pathway 'Intake-> Assessment-> Withdrawal Management' (155 (10.7%) encounters and 129 (22.6%) patients). However, 313 (21.6%) encounters did not proceed beyond the Intake stage. When the patients started their pathways from Intake, their immediate next activities were frequently Withdrawal Management, Assessment or Adult Counselling. Compared to those who do not use polysubstance, patients who use polysubstance had a higher proportion of Intake (19.3% vs 11.8%, P  < .001), Involuntary Treatment (4.0% vs 1.0%, P  < .001) and Magistrate Early Referral into Treatment (6.4% vs.3%, P  < .001), but a lower proportion of Withdrawal Management (31.2% vs 39.0%, P  < .001) and Adult Counselling (27.8% vs 37.6%, P  < .001). Conclusion This study contributes to an in-depth understanding of service utilization and pathways of patients with alcohol use disorders within the community-based Drug and Alcohol Service. Future studies should investigate their reasons for dropping out after Intake. [ABSTRACT FROM AUTHOR]

Aims Excessive alcohol consumption is a major global health concern, contributing to millions of deaths annually and a significant proportion of cirrhosis cases; however, standardized protocols for early identification of alcohol-associated liver disease are lacking. In this retrospective cohort study, we aimed to understand the prevalence and risk factors associated with elevated liver stiffness measurement (LSM) in high-risk patients with alcohol use disorder (AUD) and identify variables associated with longitudinal abstinence and outcomes. Methods Veterans with severe AUD without known liver disease admitted to a 35-day residential substance use treatment program were offered liver health screening, including Fibroscan evaluation. Assessment of AUD severity and liver health outcomes were evaluated longitudinally by chart review. Results and Conclusions In a cohort of 257 veterans with severe AUD admitted to residential treatment, 185 underwent Fibroscan evaluation, and 22 were identified to have elevated LSM concerning for compensated advanced chronic liver disease. Patients with elevated LSM were more likely to remain abstinent after 1 year. About 41% of patients with LSM ≥ 10 kPa (5% of all screened patients) were confirmed to have cirrhosis on follow-up and incorporated into routine hepatology care. Screening of liver disease in high-risk populations with non-invasive imaging modalities provides an opportunity to identify patients at risk for compensated advanced chronic liver disease before decompensation. Identification of increased risk for advanced chronic liver disease may promote abstinence in patients with severe AUD. Collaboration between mental health professionals and hepatologists is critical for the integration of care for patients with AUD and liver disease. [ABSTRACT FROM AUTHOR]

Introduction Current clinical guidelines recommend that patients with co-occurring psychosis and alcohol or substance use disorders (A/SUD) receive evidenced-based treatment for both disorders, including psychological intervention for psychosis. However, the efficacy of such treatments for individuals with co-occurring psychosis and A/SUD is unclear. Study Design Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population. Study Results Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation. Conclusion Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base. [ABSTRACT FROM AUTHOR]

Background and aims: Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people. Design, setting and participants: This study was a retrospective analysis of routinely collected data set in residential‐ and community‐based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10–24 years and accessed treatment between 2012 and 2023 (n = 17 474). Measurements: Variables included client‐related characteristics, service characteristics and baseline measures of clinical severity [Kessler‐10 (K10), EUROHIS–QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion. Findings Rates of treatment completion were highest among adolescents in community‐based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community‐based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth‐specific services was associated with higher treatment completion rates among adults in community‐based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts. Conclusions: In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity. [ABSTRACT FROM AUTHOR]

Background: People with dual diagnosis die prematurely compared to the general population, and general practice might serve as a setting in the healthcare system to mend this gap in health inequity. However, little is known about which interventions that have been tested in this setting. Aim: To scope the literature on interventions targeting patients with dual diagnosis in a general practice setting, the outcomes used, and the findings. Design and setting: A scoping review of patients with dual diagnosis in general practice. Methods: From a predeveloped search string, we used PubMed (Medline), PsychInfo, and Embase to identify scientific articles on interventions. Studies were excluded if they did not evaluate an intervention, if patients were under 18 years of age, and if not published in English. Duplicates were removed and all articles were initially screened by title and abstract and subsequent fulltext were read by two authors. Conflicts were discussed within the author group. A summative synthesis of the findings was performed to present the results. Results: Seven articles were included in the analysis. Most studies investigated integrated care models between behavioural treatment and primary care, and a single study investigated the delivery of Cognitive Behavioral treatment (CBT). Outcomes were changes in mental illness scores and substance or alcohol use, treatment utilization, and implementation of the intervention in question. No studies revealed significant outcomes for patients with dual diagnosis. Conclusion: Few intervention studies targeting patients with dual diagnosis exist in general practice. This calls for further investigation of the possibilities of implementing interventions targeting this patient group in general practice. [ABSTRACT FROM AUTHOR]

Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14–19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2–9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members. [ABSTRACT FROM AUTHOR]

Background: Effective screening for alcohol‐associated liver disease is relevant in the context of chronic, excessive alcohol consumption. Patients with alcohol‐associated liver disease are often not diagnosed until their liver disease is decompensated. We analyzed the prevalence and associations of Fibrosis‐4 index (FIB‐4) values suggestive of advanced liver fibrosis in patients referred for their first treatment of alcohol use disorder (AUD). Methods: We conducted a cross‐sectional, multicenter study of noncirrhotic individuals referred for their first AUD treatment between March 2013 and April 2021. We obtained sociodemographic data, substance use characteristics, and blood samples at admission. We considered a FIB‐4 value ≥2.67 suggestive of advanced liver fibrosis and used logistic regression analyses to identify features associated with this value. Results: We included 604 patients (67% male), with a median age at admission of 48 years [IQR: 41–56 years]. The median duration of regular alcohol consumption was 21 years [IQR: 18–30 years] and the median alcohol consumption was 105 standard drink units (SDU)/week [IQR: 63–160 SDU/week]. A FIB‐4 value ≥ 2.67 was present in 19.3% of cases. These patients reported more frequent binge drinking (75.4% vs. 66%, p = 0.05) than those with FIB‐4 values below 2.67. In multivariate analysis, a history of binge drinking (OR 1.9, 95% CI, 1.05–3.47), anemia (OR 2.95, 95% CI, 1.42–6.11), leukopenia (OR 7.46, 95% CI, 2.07–26.8), and total serum bilirubin >1 mg/dL (OR 6.46, 95% CI, 3.57–11.7) were independently associated with FIB‐4 values ≥2.67. Conclusions: One in five patients admitted to treatment for AUD without evidence of decompensated liver disease have FIB‐4 values suggestive of advanced liver fibrosis. The presence of a binge drinking history, anemia, leukopenia, and elevated bilirubin levels is associated with high FIB‐4 values. [ABSTRACT FROM AUTHOR]

We conducted a parallel-group randomized controlled trial in three HIV clinics in Mexico to evaluate a user-centred habit-formation intervention to improve ART adherence among MSM living with HIV. We randomized 74 participants to the intervention group and 77 to the control group. We measured adherence at one, four, and ten months through medication possession ratio and self-reported adherence. Additionally, we measured viral load, CD4 cell count, major depression disorder symptoms, and alcohol and substance use disorder at baseline, fourth and tenth months. We found no statistically significant effect on adherence between groups. However, the intervention demonstrated positive results in major depression disorder symptoms (21% vs. 6%, p = 0.008) and substance use disorder (11% vs. 1%, p = 0.018) in the fourth month. The latter is relevant because, in addition to its direct benefit, it might also improve the chances of maintaining adequate adherence in the long term. This trial was retrospectively registered at ClinicalTrials.gov (trial number NCT03410680) on 8 January 2018. Trial registration: ClinicalTrials.gov identifier: NCT03410680. [ABSTRACT FROM AUTHOR]

Substance use contributes to significant individual and social harms. Although psychosocial treatment is effective, early treatment discontinuation is common. Despite this, exploration of clinicians' perspectives on barriers and facilitators to attendance has been limited in scope (e.g. specialized settings, written responses). The current study used an in-depth approach to explore the views of clinicians on barriers and facilitators to attendance in psychosocial alcohol and other drug (AOD) treatment, with a view to translating these views to clinical practice. Semi-structured interviews were conducted with AOD clinicians from a range of professional backgrounds (n = 15: 7 female; 8 male) working in treatment settings in Australia. Thematic analysis was used to analyze interview content. Themes relating to attendance included client-related factors (motivation, expectations, beliefs; complexity, access, level of support), clinician-related factors (therapeutic relationship), organizational and systemic factors (individual service factors; systemic/sector wide factors), and stigma (experienced across clinician-related, organization and systemic domains). A complex combination of practical, psychosocial, and systemic/organizational factors intersect with, and influence, client attendance. These findings speak to the importance of client-centered and flexible approaches from clinicians and organizations. Such approaches might simultaneously mitigate a key barrier to attendance: stigma. This study highlights the impact of the therapeutic relationship on attendance despite organizational and funding constraints. [ABSTRACT FROM AUTHOR]

Addressing substance use disorder (SUD) requires intricate solutions, usually involving several organizations within a complex institutional environment. Alcoholics Anonymous (AA) shares the recovery ecosystem with other organizations, is ubiquitous across communities, and is notably inexpensive as an intervention; yet the exact nature of the connections between AA and other organizations in the recovery ecosystem is underexplored. Explore relationships AA has with other recovery ecosystem organizations and guide future research. Data were gathered via ethnographic participant observations, which were triangulated and contextualized via semi-structured interviews with key informants and archival documents. Though AA does not formally link itself with other organizations, findings point toward strong relationships at the individual level and of an informal nature. Individual members who also have affiliation with other organizations (e.g., legal institutions, treatment services) create bridges, enabling efficient solving of complex issues. Services wishing to leverage AA (or other mutual-aid) attendance will likely benefit from fostering informal relationships with individual AA members, including lowering barriers to disclosure of recovery status, and contacting local AA service elements capable of making these connections. Similarly, research to advance community-level SUD services and the knowledge-base would benefit from incorporating and partnering with people in recovery. [ABSTRACT FROM AUTHOR]

Background: Alcohol and illicit substance use remain significant public health issues in the United States. In this analysis, we assessed differences in the use of primary care and emergency departments (EDs) for treatment of substance use among rural and urban sexual minorities (SMs). Methods: Data come from the National Survey on Drug Use and Health (NSDUH, 2015-2019). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between sexual identity and the use of primary care settings or EDs for treatment of substance use, stratified by urbanicity of residence. Results: Among the entire sample, 7.9% reported residing in rural environments with slightly more SMs living in urban (7.3%) relative to rural (5.4%) locales. Both rural (β=-0.20; 95% CI: −0.29, −0.10) and urban SMs (β=-0.13; 95% CI: −0.16, −0.11) self-reported worse overall health. Urban SMs, but not rural SMs, had significantly higher odds of reporting use of primary care treatment for substance use (aOR 2.80; 95% CI: 2.13, 3.68). ED treatment for substance use was greater among both rural (aOR = 2.99; 95% CI: 1.01, 8.87) and urban SMs (aOR = 3.02; 95% CI: 2.12, 4.30) as was overall number of ED visits among both rural (β = 0.48; 95% CI: 0.24, 0.72) and urban SMs (β = 0.23; 95% CI: 0.19, 0.28). Conclusion: These findings suggest increased reliance on EDs for treatment of alcohol or substance use among rural SMs. Future research should examine whether increasing culturally competent primary care services for SMs in rural areas may be a key intervention point for reducing health disparities. [ABSTRACT FROM AUTHOR]

Background and aim: Craving research have often seen debates over the qualities, and significance of the same in Alcohol Dependence Syndrome (ADS). Objective measures for intensity, frequency and characteristics of craving are widely used to understand and treat ADS, however, research has indicated a gap in the treatment. Hence, the study was undertaken to understand craving from a subjective perspective, with the aim of addressing the same in a cultural setting. Design: The study used a qualitative, phenomenological design. Participants: In-depth interviews were carried out for seven participants with ADS, currently abstinent. The sample belonged to the southern region of India. Findings: Data was subjected to thematic analysis, leading to two themes, “Determinants of experience” and “Course of experience,” along with 10 subthemes. Conclusion: Craving was found to be multidimensional, varying in qualities and influenced by the attitude toward craving itself. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of several pharmacological and nonpharmacological treatments, a significant proportion of patients with alcohol dependence relapse to alcohol use after treatment. The objectives of this study were to determine the 6-month course and outcome in treatment-seeking individuals with alcohol dependence syndrome and to determine the sociodemographic and clinical correlates of the outcome in these patients. Materials and Methods: A longitudinal observational study was conducted in treatment-seeking male patients with alcohol dependence syndrome. Baseline sociodemographic and clinical details were gathered using a structured pro forma. The patients were followed up at 2 weeks, 1 month, 3 months, and 6 months. During the follow-up evaluation, abstinence status, number of abstinent days, and number of heavy drinking days were noted. Logistic regression was conducted to evaluate the factors associated with abstinence at 6 months. Results: Ninety-four patients were recruited for the study. The mean age of the participants was 43.98 years (standard deviation (SD) 10.68). Two patients were lost to follow-up. At the end of 2 weeks, 74 (80.43%) out of 92 participants remained abstinent. At the end of 1 month and 3 months, 59 (64.13%) and 38 (41.3%) participants of 92 were abstinent, respectively. At the end of 6 months, 26 (30.23%) of 86 patients were abstinent. Among those who were not abstinent at 6 months, the mean number of abstinent days was 113 (SD 51.62) days and the mean number of heavy drinking days was 56 (SD 51.62) days. Outpatients were found to have 2.91 times higher odds of remaining abstinent at 6 months when compared to inpatients. Conclusion: Nearly one-third of treatment-seeking patients with alcohol dependence syndrome remained abstinent at the end of 6 months. The locus of treatment was associated with abstinence at 6 months. [ABSTRACT FROM AUTHOR]

Objective: The overarching goal of this study was to analyze qualitatively how parents in a state‐mandated family treatment court (FTC) intervention revised and performed their parental role while navigating a novel recovery role. Background: A large proportion of parents are involved with the child welfare system for reasons related to substance misuse. Prior literature makes clear that navigating child welfare interventions is incredibly challenging given the many requirements and expectations parents must meet to resume parenting without state oversight. No work to date has explored the role strain arguably inherent to the experience of being tasked with simultaneously revising the parental role and adopting and performing a new recovery role in the context of nonvoluntary state intervention. Method: Data came from transcripts of in‐depth, semistructured interviews with 21 parents who were former participants in FTC. Interview questions were designed to elicit rich, personal narratives, with probes for concrete examples wherever possible. Results: Variation in parents' role definitions and trajectories of both parental and recovery role performance were used to develop a typology of roles: role enactors, role revisors, and role rejectors. The three groups differed in how closely their views around substance misuse, parenting, and recovery aligned with the role expectations put forth by the state, leading to varying degrees of role strain and conflict across groups. Conclusion: Findings shed light on the experiences of parents involuntarily participating in both child protective interventions and substance use treatment—a growing proportion of parents that have been largely ignored in prior literature. [ABSTRACT FROM AUTHOR]

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is chronic, lasting a person's lifetime. An increase in driving under the influence of alcohol, as well as emergency department (ED) visits, has been reported. The Alcohol Use Disorder Identification Test Consumption (AUDIT-C) is utilized to assess hazardous drinking. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model assists in early intervention and referral for treatment. The Transtheoretical Model standardized instrument assesses individual readiness to change. These tools may be used by nurses and nonphysicians in the ED to help reduce alcohol use and the consequences of its use. [ABSTRACT FROM AUTHOR]

Background: Alcohol and other substance use disorders and major depression often co-occur. A sedentary lifestyle is related to major depression and even moderate exercise may prevent and contribute to the treatment of depression. Studies have found an effect of physical activity on depression in alcohol and other substance use disorder patients even in clinical settings. Aim: To investigate the relationship between level of physical activity and depressive symptoms over time in alcohol and substance use disorder inpatients. Methods: Eighty-nine substance use disorder inpatients were followed for 6 months during treatment. The International Physical Activity Questionnaire was used to categorize 3 groups of low, moderate, or high level of physical activity. In addition to background variables and alcohol and drug use measures, data on biometric measures and on sleep were gathered. Becks Depression Inventory version II (BDI-II) measured depressive symptoms. A multilevel logistic regression was used to analyze the longitudinal relationship between physical activity and depressive symptoms. Results: Most patients (57%) reported low activity, while 24% reported moderate and 19% high activity. Few changed their activity level during treatment. Moderate physical activity was related to lower score on BDI-II (P =.029). Level of physical activity was closely related to insomnia (P =.024). In the multivariate analysis the relationship between depressive symptoms and physical activity did not withstand the adjustment for insomnia. However, in the multilevel logistic regression higher physical activity was related to lower BDI-II score in a dose dependent manner. Conclusions: Among these alcohol and other substance use disorders patients in treatment, there was a relationship between depressive symptoms and physical activity. The low level of physical activity identified among these patients was related to a high level of depressive symptoms. The level of depressive symptoms declined over time; but this change was not related to an increase in physical activity. [ABSTRACT FROM AUTHOR]

The article presents an editorial focuses on advancing treatment and recovery approaches for addictive disorders, emphasizing the need for innovative strategies in addressing Alcohol Use Disorder (AUD) and substance use disorders (SUDs). Topics include the evaluation of recovery definitions and treatment complexities, the exploration of new pharmacological and behavioral interventions, and the significance of educational and community-based support in enhancing recovery outcomes.

The article reviews research on both the addictive aspects of social media and its interconnection with other addictive behaviors including substance misuse and alcohol abuse. Cited are a summary of the clinically relevant similarities and differences among social media, drugs and alcohol, the common neuronal pathways of social media use and the use of addictive substances, and the challenges presented by social media addiction to clinicians.

Objective: Client centered care (CCC) is strongly advocated for improving the quality of health care. The aim of the current study was to explore client and staff perspectives of a new model of CCC implemented in a residential alcohol and other drug (AOD) treatment service. Specifically, the study aimed to (i) describe the defining features of CCC, and (ii) describe the benefits and challenges of implementing CCC at the service. Methods: Participants were 18 clients and eight staff who took part in focus groups and interviews. Thematic analysis of four client focus groups and eight staff individual interviews was conducted. Results: Staff identified the defining features of CCC as flexible, comprehensive, open-minded, and inclusive. Clients and staff shared predominantly positive views on the CCC model. Shared themes included the challenge of balancing flexibility and structure, and delivering comprehensive and individualized care within the limits of staff knowledge, skills, and resources. Conclusions: Results suggest that implementing CCC across an AOD treatment setting has clear benefits to staff and clients, along with challenges that require careful consideration and planning. Future research should evaluate the effectiveness of providing guidelines that address many of the challenges associated with implementing CCC. [ABSTRACT FROM AUTHOR]

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Introduction: Alcohol dependency is a multifaceted issue influenced by various socio-cultural factors. Understanding these factors is crucial for developing effective psychosocial interventions. This study aims to investigate the socio-cultural elements contributing to alcohol dependency and to devise a tailored intervention strategy. Aim: The primary aim of this study was to explore the socio-cultural factors associated with alcohol dependency in a female patient and to provide a psychosocial intervention to aid in her recovery. Methodology: A single-subject case study design was employed for an in-depth qualitative analysis. Data was collected through interviews, case record files, observations, and home visits. The participant was a female with Alcohol Dependence Syndrome (ICD-10), selected purposefully from the outpatient department of LGBRIMH, Tezpur, Assam, India. The study focused on recognizing the client's illness and developing coping mechanisms. Special attention was given to the client's spiritual beliefs and practices at her thaan (religious prayer house) as a central element of her recovery process. Conclusion: The study highlighted the significance of socio-cultural factors in understanding and treating alcohol dependency. It was found that acculturation and cultural shifts could contribute to psychological stress and substance use disorder. Conversely, cultural identification and spirituality emerged as personal strengths aiding in recovery. The findings underscore the importance of incorporating socio-cultural dimensions into psychosocial interventions for effective treatment of alcohol dependency. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the current study is to conduct a systematic review of peer-reviewed work on culturally tailored interventions for alcohol and drug use in Indigenous adults in North America. Substance use has been reported as a health concern for many Indigenous communities. Indigenous groups experienced the highest drug overdose death rates in 2015, the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to any other racial group. However, few Indigenous individuals report participating in treatment for alcohol or drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective and culturally integrative. Design/methodology/approach: Electronic searches were conducted from 2000 to April 21, 2021, using PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed. Two reviewers classified abstracts for study inclusion, resulting in 18 studies. Findings: Most studies were conducted in the USA (89%). Interventions were largely implemented in Tribal/rural settings (61%), with a minority implemented in both Tribal and urban contexts (11%). Study samples ranged from 4 to 742 clients. Interventions were most often conducted in residential treatment settings (39%). Only one (6%) intervention focused on opioid use among Indigenous people. Most interventions addressed the use of both drugs and alcohol (72%), with only three (17%) interventions specifically intended to reduce alcohol use. Originality/value: The results of this research lend insight into the characteristics of culturally integrative treatment options for Indigenous groups and highlight the need for increased investment in research related to culturally tailored treatment across the diverse landscape of Indigenous populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Alcohol and other substance use disorders and major depression often co-occur. A sedentary lifestyle is related to major depression and even moderate exercise may prevent and contribute to the treatment of depression. Studies have found an effect of physical activity on depression in alcohol and other substance use disorder patients even in clinical settings. AIM: To investigate the relationship between level of physical activity and depressive symptoms over time in alcohol and substance use disorder inpatients. METHODS: Eighty-nine substance use disorder inpatients were followed for 6 months during treatment. The International Physical Activity Questionnaire was used to categorize 3 groups of low, moderate, or high level of physical activity. In addition to background variables and alcohol and drug use measures, data on biometric measures and on sleep were gathered. Becks Depression Inventory version II (BDI-II) measured depressive symptoms. A multilevel logistic regression was used to analyze the longitudinal relationship between physical activity and depressive symptoms. RESULTS: Most patients (57%) reported low activity, while 24% reported moderate and 19% high activity. Few changed their activity level during treatment. Moderate physical activity was related to lower score on BDI-II (P = .029). Level of physical activity was closely related to insomnia (P = .024). In the multivariate analysis the relationship between depressive symptoms and physical activity did not withstand the adjustment for insomnia. However, in the multilevel logistic regression higher physical activity was related to lower BDI-II score in a dose dependent manner. CONCLUSIONS: Among these alcohol and other substance use disorders patients in treatment, there was a relationship between depressive symptoms and physical activity. The low level of physical activity identified among these patients was related to a high level of depressive symptoms. The level of depressive symptoms declined over time; but this change was not related to an increase in physical activity. [ABSTRACT FROM AUTHOR]

The article focuses on various aspects of personal growth within the context of recovery from substance use disorder, exploring themes such as the impact of new relationships, psychosocial factors influencing relapse, and philosophical perspectives on autonomy and moral agency during the recovery journey. It emphasizes empirical findings that highlight the roles of forgiveness, resentment.

Alcoholism, more professionally termed alcohol use disorder (AUD), is a widespread and costly behavioral health condition. The aims of this paper are draw attention to systemic gaps in care for patients with AUD and advocate for patient safety leaders to partner with both the mainstream medical and substance abuse treatment communities to reduce harm in this patient population. The authors performed a narrative review of the literature on the current state of AUD treatment and patient safety, finding extensive evidence that patients with AUD usually go undiagnosed, unreferred and untreated. When they do receive AUD treatment, little evidence was found to indicate that a patient safety approach is incorporated into their care. Behavioral medicine is virgin territory for the patient safety movement. Medical care and behavioral medicine in the United States currently constitute two separate and unequal systems generally lacking in pathways of communication or care coordination for AUD patients. Significant barriers include institutional culture, individual and systemic bias against those with AUD, and health care infrastructure, especially the separation of medical and behavioral treatment. It is the authors' conclusion that care of patients with AUD is unsafe. We advocate for the patient safety approach common in American hospitals to be extended to AUD treatment. Experienced patient safety leaders are in the strongest position to initiate collaboration between the mainstream medical and substance abuse treatment communities to reduce harm for this patient population. [ABSTRACT FROM AUTHOR]

Background and aim: Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed to estimate the effectiveness of psychosocial interventions at reducing parental substance use. Design We used systematic methods to identify trials; pooling data using a random‐effects model. Moderator analyses examined influence of parent gender, presence of child in treatment and intervention type. Setting: No restrictions on setting. Participants: Substance using parents of children below the age of 21 years. Interventions: Psychosocial interventions including those that targeted drug and alcohol use only, and drug and alcohol use in combination with associated issues. Measurements Frequency of alcohol use and frequency of drug use. Findings We included eight unique studies with a total of 703 participants. Psychosocial interventions were more effective at reducing the frequency of parental alcohol use than comparison conditions at 6‐month [standardized mean difference (SMD) = – 0.32, 95% confidence interval (CI) = –0.51 to −0.13, P = 0.001] and 12‐month follow‐up (SMD = –0.25, 95% CI = –0.47 to −0.03, P = 0.02) and frequency of parental drug use at 12 months only (SMD = –0.21, 95% CI = –0.41 to −0.01, P = 0.04). Integrated interventions which combined both parenting and substance use targeted components were effective at reducing the frequency of alcohol use (6 months: SMD = –0.56, 95% CI = –0.96 to −0.016, P = 0.006; 12 months: SMD = –0.42, 95% CI = –0.82 to −0.03, P = 0.04) and drug use (6 months: SMD = –0.39, 95% CI = –0.75 to −0.03, P = 0.04; 12 months: SMD = –0.43, 95% CI = –0.80 to −0.07, P = 0.02). Interventions targeting only substance use or parenting skills were not effective at reducing frequency of alcohol or drug use at either time‐point. Conclusion: Psychosocial interventions should target both parenting and substance use in an integrated intervention. [ABSTRACT FROM AUTHOR]

Despite increasing numbers of older-adult mental health service users, few studies have examined their use of public mental health services. Using the 2018 and 2019 Mental Health-Client Level data for clients age 18+ (N = 4,291,737 in 2018 and N = 4,513,946 in 2019), we examined whether those age 50+ who received outpatient-only, both outpatient and inpatient, or inpatient-only services had greater odds of certain types of mental disorders, especially schizophrenia, than younger adults. Of all users, 25.3% were age 50–64 and 6.7% were age 65 +. Multivariable logistic regression results, controlling for gender, race/ethnicity, census region, and alcohol/substance use disorder, showed that compared to the 30–49 age group, the 50–64 and 65+ age groups had higher odds of having depressive disorder in outpatient-only settings; however, they had consistently higher odds of a diagnosis of schizophrenia or other psychotic disorder in all three service settings. Along with advocating for increased funding for publicly-financed mental health services, social workers in public mental health service systems should ensure that they utilize effective intervention skills for older adults with serious mental illness. [ABSTRACT FROM AUTHOR]

Justice-involved women frequently experience victimization histories, mental illness, and substance use disorders, which create challenges with completing probation sentences. Although most justice-involved women are on probation, research focuses on prisoners. Studies on treatment services for the population primarily have samples from prison, creating limited knowledge on programs for women on probation. This study examines the impact of mental health and substance use treatment on the probation outcomes of women with victimization histories. Findings showed those in treatment were more likely to become incarcerated, casting doubt on programs for women on probation with victimization histories, substance use disorders, and mental illness. Implication of these findings include providing accessible and evidence-based mental health and substance use treatment for justice-involved women with victimization histories, in addition to creating more therapeutic and rehabilitative probation supervision that does not penalize people who experience mental health and addiction issues. [ABSTRACT FROM AUTHOR]

When the COVID-19 pandemic began, many 12-step meetings rapidly transitioned from an in-person to an online format. In this qualitative focus group study, 17 attendees of 12-step programs from six U.S. states participated in one of two focus groups on Zoom platform in August 2021 in which their experiences of attending online versus in-person meetings were explored. Respondents praised the accessibility and convenience of online meetings, and the ability to interact with members from different geographic locations. However, they noted the loss of intensive social support found at in-person meetings and technological/procedural challenges that remain unsolved online. [ABSTRACT FROM AUTHOR]

Background: Alcohol dependence is a wide and extending social and physical problem in the world. It affects a person at the individual, family, and society levels. The aim is to study and compare the influence of motivational enhancement therapy (MET) and behavioral couple therapy on the level of motivation in a person with alcohol dependence. Methodology: Pre- and post-test with control group design was used. A total number of 60 subjects were selected using a purposive sampling method. The sample comprised twenty subjects in the behavioral couple therapy treatment as usual (Behavioral couple therapy BCT + TAU) group, twenty subjects in the control (TAU) group, and twenty subjects in the (MET + TAU) group, respectively. The subjects recruited were in the age range of 21-60 years, educated up to primary level and above, with no comorbid psychiatric, neurological disorder, physical problem, multiple substance use coming to outpatient department and inpatient department Department of Psychiatry IMS, BHU, Varanasi, and wife having age above 18 years, married for at least 1 year, educated up to primary level and above. Tools: sociodemographic datasheets, alcohol use disorder identification test, general health questionnaire-12, and stages of change readiness and treatment eagerness scale were utilized. Results: Psychotherapeutic intervention such as MET and behavioral couple therapy plays an effective role in raising motivation to change in alcohol-dependent person to quit alcohol, which is indicated by the significant rise in motivation for the change of alcohol-dependent person's recognition (F = 4.42, P < 0.05) and taking steps (F==3.78, P < 0.05). Conclusion: The present study suggests that combining pharmacological treatment with appropriate psychosocial therapies give fruitful result in the form of a desire to quit alcohol dependence. [ABSTRACT FROM AUTHOR]

Background: Although men and women who misuse substances have different needs, no rigorous systematic literature review has been conducted examining psychosocial substance use interventions for women across a broad range of types of therapeutic approaches and populations. Materials and Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review. English language, peer-reviewed research articles indexed in PubMed, PsycINFO, CINAHL Complete, and Web of Science through May 6, 2021, were searched. Peer-reviewed articles were included in the review if they were written in English; described a randomized controlled trial of a psychosocial intervention to reduce substance misuse and related problems in women; and reported quantitative data on alcohol or illicit drug use as an outcome that was linked to the interventions. Results: A total of 51 articles met eligibility criteria, reflecting a broad array of interventions with different levels of methodological rigor. Several, but not most, interventions were tailored to meet the needs of specific subgroups of women, but evidence regarding the efficacy of tailoring was inconclusive. Overall, 61% of studies reported one or more positive substance-related intervention effects, with target substance (alcohol only vs. other drugs only or both alcohol and other drugs) and intervention dosage associated with intervention success. Conclusions: Fewer studies targeting alcohol only reported one or more positive intervention outcomes. This warrants further study, given that polysubstance use is the norm, not the exception. Future research might also focus on reducing treatment barriers to women, as this has the potential to improve overall treatment outcomes for this population. [ABSTRACT FROM AUTHOR]

Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1). We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement. Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time. • Young people affected by substance use often attend many programs. • Participants who returned to services reported new goals and changed circumstances. • AoD treatment effects build as young people learn and engage with services. • The medical term 'incremental treatment' is useful in depicting this. • Outcomes should be measured through service system engagement over time. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUDs) are among the most prevalent behavioral and mental health diagnoses. Individuals with an AUD are at increased risk for numerous consequences across their social, health, and psychological functioning. Research suggests that differences may exist in the prevalence and consequences of AUD and in the efficacy of AUD treatment across demographic characteristics (i.e., sex/gender and race/ethnicity). This meta‐epidemiologic review examined the inclusion of diverse groups (sex/gender and race/ethnicity) in published randomized controlled trials of nonpharmacological treatments for AUD since 1994, following passage of the National Institutes of Health Revitalization Act of 1993. We systematically searched databases following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement criteria. The initial search strategy yielded 7931 articles. After excluding ineligible articles, 155 were included in the present review for synthesis. Of the articles included in this review, only 57 (36.8%) fully reported on both their sample's sex/gender and racial/ethnic breakdown. Of the total sample, seven articles specifically examined one racial/ethnic group and 32 specifically examined one sex/gender group. Six articles (3.9%) reported no information regarding the racial/ethnic breakdown of their sample and five articles (3.2%) reported no information regarding the sex/gender breakdown of their participants. Only two articles (1.3%) reported on subgroup analyses that examined differences in treatment outcomes by both sex/gender and race/ethnicity, despite guidelines set forth by NIH. Only 46 articles (29.7%) described the failure to include diverse sex/gender or racial/ethnic groups or concerns about the generalizability of study findings given their sample's sex/gender or racial/ethnic composition as methodological limitations. These results indicate that substantial efforts must be put forth by the scientific community to ensure the inclusion, analysis, and reporting of data focused on women/females and members of minoritized racial/ethnic groups. [ABSTRACT FROM AUTHOR]

It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non‐government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low‐level involvement consumer activities, there were fewer examples of mid‐ and high‐level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation. [ABSTRACT FROM AUTHOR]

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This article examines the nature and level of misconduct occurring in the alcohol and other drug (AOD) treatment sector in Australia between 2015 and 2020. Data were drawn from disciplinary decisions of statutory compliance bodies, Australian Health Practitioner Regulation Authority, Consumer Law and coronial findings in all Australian jurisdictions. The data indicate that the current regulatory framework for unregistered health practitioners is unsuitable to protect the public from future acts of misconduct. The response to misconduct varies between registered and unregistered health practitioners. This suggests that unregistered health practitioners pose a greater risk of harm to the public than registered health practitioners, yet the former are subject to the least rigorous regulation. Further, systemic issues within organisations related to poor adherence or lack of sound policies and procedures were found to contribute to the misconduct and the risk of harm within the AOD treatment sector. [ABSTRACT FROM AUTHOR]

Background Patient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an alternative approach, we examined the association between quality of mental healthcare and suicide in a national healthcare system. Methods We calculated regional suicide rates for Department of Veterans Affairs (VA) Healthcare users from 2013 to 2017. To control for underlying variation in suicide risk in each of our 115 mental health referral regions (MHRRs), we calculated standardised rate ratios (SRRs) for VA users compared with the general population. We calculated quality metrics for outpatient mental healthcare in each MHRR using individual metrics as well as an Overall Quality Index. We assessed the correlation between quality metrics and suicide rates. Results Among the 115 VA MHRRs, the age-adjusted, sex-adjusted and race-adjusted annual suicide rates varied from 6.8 to 92.9 per 100 000 VA users, and the SRRs varied between 0.7 and 5.7. Mean regional-level adherence to each of our quality metrics ranged from a low of 7.7% for subspecialty care access to a high of 58.9% for care transitions. While there was substantial regional variation in quality, there was no correlation between an overall index of mental healthcare quality and SRR. Conclusion There was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates. [ABSTRACT FROM AUTHOR]

Background and Aims: The configuration of alcohol and other drug treatment service systems has been influenced by the uptake of market mechanisms for treatment funding and purchasing. This study measured the impact of market mechanisms for funding and purchasing alcohol and drug treatment services on client outcomes. Design An observational cross‐sectional study, employing multi‐level analysis: episodes of care data, nested within person‐level data, nested within treatment site and nested within organization. Setting and participants: One hundred and seventy‐eight alcohol and other drug treatment service sites in Australia. Measurements Client outcome variables were length of stay and successful treatment completion. Predictor variables were competitive tendering, number of funding contracts, recurrent funding, the ratio of episodes to staff, type of professions, years of clinical experience, staff turnover and type of provider (government; non‐government). Analyses controlled for drug type, type of treatment received and client characteristics. Findings There were no significant associations between the procurement and contracting variables and length of stay [incidence rate ratios (IRRs) ranged between 1.01 and 1.07, all P > 0.05; Bayes factors (BF) < 0.03], and inconclusive results for treatment completion [odds ratios (ORs) ranged between 1.04 and 1.15, all P > 0.05, BF = 0.51–0.63]. Having an alcohol and other drug (AOD) work‐force relative to an 'other' work‐force (IRR = 0.79, P = 0.021) and lower case‐loads (IRR = 0.99, P = 0.047) may be associated with longer stay in treatment. Receiving services from a government compared to non‐government provider may also be associated with less treatment completion (OR = 0.34, P = 0.023, BF = 2.14). Conclusions: There appears to be no association between client outcomes and procurement and funding contract arrangements for alcohol and drug treatment services. [ABSTRACT FROM AUTHOR]

Background and aims: Up to 95% of pregnant women seeking treatment for alcohol and other drug (AOD) use smoke tobacco. Previous reviews indicate few effective smoking cessation treatments for this group. This updated review aimed to identify and measure the efficacy of smoking cessation interventions trialled among pregnant women in AOD treatment settings who smoke tobacco. Methods: A narrative synthesis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Studies involving psychological, behavioural or pharmacological interventions used to treat tobacco use, including electronic nicotine delivery systems, for pregnant women of any age, who smoked tobacco and were seeking/receiving treatment, or in post‐treatment recovery for AOD concerns, were reviewed. MEDLINE, PsycINFO, CINAHL, EMBASE and ProQuest databases, grey literature and reference lists were searched, and field experts were contacted for unpublished study data. The Effective Public Health Practice Project tool assessed study quality. The review was pre‐registered with PROSPERO no. CRD42018108777. Results: Seven interventions (two randomised controlled trials, two single‐arm pilot studies, two program evaluations and one causal comparative study) treating 875 women were identified. All were United States (US)‐based and targeted women with drug dependence, but not alcohol dependence. Three interventions used contingency management, five provided behavioural counselling, and one offered nicotine replacement therapy. All reported reductions in cigarette consumption; one contingency management‐based study demonstrated higher abstinence rates compared with controls at treatment‐end that were not maintained at follow‐up. Four of six studies were rated as methodologically weak and one unpublished study was not rated. Conclusions: Conclusions about the efficacy of smoking interventions for pregnant women with alcohol and other drug concerns who also smoke tobacco are hindered by the paucity of available data and poor methodological quality of included studies. [ABSTRACT FROM AUTHOR]

Background: Several studies have examined the occupational factors associated with alcohol use and dependence. However, there are very few studies that investigated the role of occupational factors associated with long-term abstinence among persons treated for alcohol dependence in India. Aim: To examine the occupational factors associated with long-term abstinence among persons treated for alcohol dependence. Methods: Sixty in-patients treated for alcohol dependence were selected using inclusion criteria from the Government-run de-addiction center, tertiary care teaching hospital, Bangalore. All patients were followed up periodically for 1 year. The semi-structured interview schedule was used for collecting data on occupational factors associated with long-term abstinence. Descriptive statistics, Chi-square test, and Fisher exact test were used for data analysis. Results: There was a positive trend showing self-employed (pf = 1.74, P = 0.45), having skilled work (pf = 1.52, P = 0.72), regular pattern of employment (pf = 1.21, P =.60), monthly mode of income (pf = 1.43, P =.76) were factors associated with abstinence. Among eight occupational variables, employment status (x² = 4.0, P =.04) and having well-defined working hours ((pf = 6.18, P =.04) were significantly associated with long-term abstinence among persons treated for alcohol dependence. Conclusion: Occupational factors seem to influence the outcome in alcohol dependence and appropriate vocational interventions would be effective in promoting long-term abstinence. [ABSTRACT FROM AUTHOR]

Treatment following detoxification is recommended to promote recovery from alcohol (AUD) and opioid use disorder (OUD) yet less than half of detoxification patients attend follow-up treatment post-discharge. The current scoping review focused on the landscape of interventions designed to improve post-detoxification outcomes. The aim was to guide next steps in research and intervention development. Of 6,419 articles screened, 100 met inclusion criteria. Studies' participant diagnoses, intervention type, design, and other methodological features including outcomes were extracted and compared. Studies focused on OUD (51%), AUD (36%), or both (13%), and on improving substance use and/or treatment engagement/linkage to care. Medication was the most common intervention (55%), followed by psychological (26%), combined approaches (14%), technology (4%), or mutual help (1%). These proportions differed significantly between OUD and AUD studies and over time (medication was more common for OUD). Significant variability was found regarding research design, statistical power, measured outcomes, and exclusion criteria across AUD/OUD-focused studies. Studies' focus on OUD is consistent with the rise of OUD and opioid overdose, but inconsistent with the higher prevalence and social impact of AUD. Although medication and psychological interventions were most common, emerging new intervention types, such as technology, warrant further attention. We provide recommendations to support future research based on the findings. [ABSTRACT FROM AUTHOR]

Despite existing interventions that have shown some promise for people with alcohol use disorder (AUD), there is a sizable number of patients that fail to respond to or complete treatment. In the current study, we analyzed data from the Treatment Episode Data Set (TEDS) to create profiles that indicate who may be more likely to resist treatment-as-usual. For the analysis, chi-square and logistic regression were used to associate personal characteristics with being at high and low risk of treatment resistance. Characteristics that put someone at higher risk of resisting treatment-as-usual include being unemployed, homelessness (or a dependent living arrangement), using daily, being male, and co-occurring mental and substance abuse disorders. The results suggest that general demographic information at patients' admission can be used to identify population groups where conventional strategies for standard AUD treatment may be insufficient. As such, the findings can help to inform, shape, and personalize treatment, leading to successful outcomes for the subgroup of individuals who will not benefit from typical AUD interventions. [ABSTRACT FROM AUTHOR]

Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use. Alcohol and other drug use is common in Australia and causes serious health and well-being issues. Collaborative care between GPs and specialist alcohol and other drug services may improve this. This is the first Australian study to address collaborative care between GPs and alcohol and other drug services. The study shows that collaborative care is feasible in the Australian setting and suggests that it could help people who use alcohol and other drugs to access care and improve their health and well-being outcomes. [ABSTRACT FROM AUTHOR]

Research and reviews to date suggest that community‐based residential treatments for substance use disorders (SUDs) have mixed effectiveness, with some studies finding positive outcomes while others finding no differences between intervention arms, including inpatient, outpatient, and control groups. In order to understand these mixed findings, reviews have underscored the importance of outlining the active treatment components of residential treatment, as well as treatment mechanisms and outcomes. Further, there is very little research on the underlying theories explaining how and for whom residential treatments are effective. The purpose of the present realist synthesis was to address this gap in the literature by exploring how, why, for whom, and in what circumstances, community‐based residential treatments are effective. Following the RAMESES Publication Standards, a search was undertaken for articles examining community‐based residential treatments in PsycINFO and PubMed from anytime to January 2020. The search generated 28 articles that met inclusion criteria and were extracted for relevant information. Results of the realist synthesis identified six Context‐Mechanism‐Outcome (CMO) configurations. Contextual factors that generated subsequent mechanisms and outcomes included substance‐related problem severity, psychiatric comorbidities, diverse populations, pre‐treatment relationships, lack of structure and lack of coping strategies. These CMO configurations provide important information for clinicians, treatment centres and policy makers, including the specific programme components that need to be offered in treatment to facilitate positive treatment outcomes. [ABSTRACT FROM AUTHOR]