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Outpatient treatment practices for adolescent substance users utilize retrospective self-report to monitor drug use. Cell phone-based ecological momentary assessment (CEMA) overcomes retrospective self-report biases and can enhance outpatient treatment, particularly among Latino adolescents, who have been understudied with regard to CEMA. This study explores compliance to text message-based CEMA with youth (n = 28; 93% Latino) in outpatient treatment. Participants were rotated through daily, random, and event-based CEMA strategies for 1-month periods. Overall compliance was high (>80%). Compliance decreased slightly over the study period and was less during random versus daily strategies and on days when alcohol use was retrospectively reported. Findings suggest that CEMA is a viable monitoring tool for Latino youth in outpatient treatment, but further study is needed to determine optimal CEMA strategies, monitoring time periods, and the appropriateness of CEMA for differing levels of substance use.

Urban drainage systems that use concrete gutters, pits and pipes have been adopted worldwide by drainage engineers. This study tested the hypothesis that treating a concrete pipe with a coating of epoxy resin is an effective method to reduce the concrete mineral leaching and associated contamination of water carried within the pipe. Four 20 litre samples of rainwater were individually circulated through the untreated and epoxy treated portions of the pipe for 100 minutes. After recirculation through the untreated portion of the pipe pH increased by almost two units, electrical conductivity doubled and there were significant increases in bicarbonate, calcium and other ions. In contrast, rainwater circulated through the epoxy treated portion of the pipe showed a minimal pH increase (0.32 pH units) but no other significant increases in any other water chemistry attributes. The epoxy resin greatly reduced mineral contamination of recirculated water, supporting the hypothesis. [ABSTRACT FROM AUTHOR]

This study examined utilization of mental health services and treatment outcomes among 1,091 patients with mental health problems recruited from 39 treatment programs in 13 California counties. We compared three groups: one that received dual treatment from drug and mental health programs (N=294), one that received mental health services only within drug treatment programs (N=578), and one that received no mental health services (N=219). Individuals who received dual treatment had more severe substance use and mental health problems, followed in severity by those who received mental health services within drug treatment, and those who received no services. All groups significantly reduced their psychiatric severity at the follow-up, although there were no group differences in treatment retention and drug use outcomes. These findings suggest that individuals with mental health problems can be successfully treated within drug treatment programs and/or in conjunction with mental health providers. [ABSTRACT FROM AUTHOR]

This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multisite study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Controlling for gender, compared to patients without CSA, patients reporting CSA were younger at entry into the current drug treatment, were more likely to be White, were more likely to have a comorbid mental disorder, be alcohol or cocaine dependent, had higher levels of criminal activities, had a higher level of problem recognition, and had a more negative peer influence. Controlling for these correlates, a history of abuse was related to a lower likelihood of posttreatment abstinence. [ABSTRACT FROM AUTHOR]

This study examined services received for HIV risk reduction among individuals in drug treatment. Analyses were conducted using data from 4,412 participants in the national Drug Abuse Treatment Outcome Study (DATOS), a prospective multisite study of drug treatment effectiveness. A higher percentage of individuals in long-term residential programs received HIV-related services, compared with clients in short-term inpatient, methadone maintenance, and outpatient drug-free programs. More men than women, and individuals at higher sex-risk as compared with those at lower sex-risk, received HIV services. Logistic regression analyses indicated that individuals who engaged in sex work had a higher likelihood than those who did not, of receiving HIV-related services, although individuals with high-risk or multiple sexual partners were no more likely than others to receive HIV services. More comprehensive service delivery is needed in order to reduce the risk for HIV among clients in drug treatment. [ABSTRACT FROM AUTHOR]

Gender differences in the factors associated with having a history of drug treatment were examined among 7,652 individuals admitted into the Drug Abuse Treatment Outcome Study (DATOS), a national multisite prospective study. Bivariate relationships were examined between a history of prior drug treatment and variables measuring demographic and background characteristics, addiction career, treatment career parameters, family and social relationships, criminal justice involvement, and mental health status. Stepwise discriminant function analyses (DFAs) were conducted separately for men and women to determine both the common and unique characteristics associated with a history of prior drug treatment. More severe drug use history and criminal behavior were related to prior treatment history for both men and women. Prior drug treatment among men was associated with factors related to family opposition to drug use and support for treatment, whereas for women prior drug treatment was associated with antisocial personality disorder and self-initiation into treatment. Moreover, treatment initiation among men appears to be facilitated by social institutions, such as employment, the criminal justice system, and one's family. In contrast, treatment reentry among women was associated with referral by a social worker, suggesting that contact with family service agencies can facilitate women's treatment entry. The findings suggest that different strategies for increasing treatment utilization may be appropriate for men and women. [ABSTRACT FROM AUTHOR]

This article examines a model of service delivery for homeless mentally ill women, a combined day center and shelter program. Using data from participant observation and in-depth interviews with 21 clients, four patterns of day center and shelter use are delineated. Overall, few women from the day center make the transition to the shelter, and then to permanent housing and mental health stability. In the absence of a comprehensive public mental health system and low-income housing, however, many more women benefit from periodic use of the shelter as respite from the streets and from daily support services provided by the day center. [ABSTRACT FROM AUTHOR]

Finding are presented from a survey of administrators of county departments of mental health and alcohol and drug programs in California regarding services for individuals with co-occurring mental and substance abuse disorders. A total of 47 counties responded (84% response rate). The survey findings indicate that collaboration across county mental health and alcohol and drug services primarily occurs through information sharing, coordination of services, and joint projects. Fewer than one-half of the counties responding provide integrated programs, and the most frequently provided services are outpatient counseling and case management. Administrators cited historical differences between the two service systems and societal stigma as the greatest barriers to service delivery. Two opposing strategies for state action were suggested, either establishing specific funding set-asides or blending funding for services. Counties varied widely in their ability to estimate unmet service needs. Implications for policy development related to the dually diagnosed are discussed. [ABSTRACT FROM AUTHOR]

This article provides a descriptive overview of the characteristics of a large metropolitan drug treatment system in relation to special populations of substance abusers enrolled in the system and the services provided. The findings are based on self-report responses to a comprehensive survey of 294 drug treatment programs in Los Angeles County. The special populations are grouped by health status, ethnic background, language needs, and gender-related needs. The groups are not mutually exclusive. Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients and most programs having some mix of special population clients in their current caseload. The types of services offered varied by modality and by special populations being served. Implications for program planning and service delivery include consideration of whether or not to offer specialized programs for unique client types. [ABSTRACT FROM AUTHOR]

Abstract Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Methods Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18–64 (N = 2,074). Results Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, lesbians and bisexual women were most likely to receive treatment and heterosexual men were the least likely. Moreover, a considerable proportion of sexual orientation minorities without any diagnosable disorder, particularly lesbians and bisexual women, also reported receiving treatment. Conclusion The study highlights the need to better understand the factors beyond meeting diagnostic criteria that underlie treatment utilization among sexual minorities. Future research should also aim to ascertain the effects of treatment provided to sexual minorities with and without diagnosable disorders, including the possibility that the provision of such treatment may reduce the likelihood of their progression to greater severity of distress, disorders, or impairments in functioning.

While outcomes for any single intervention are important to determine, the long term evaluation of multiple, sequential interventions is at least equally important. One strategy for examining this process is that of the treatment career. A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transitions in the course of, drug dependence and its treatment. After presenting an overview of the treatment careers perspective, this paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short durations of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. The treatment careers perspective provides a useful framework within which findings on drug treatment can be better integrated and critical issues can be identified for further research, leading to a better understanding of drug dependence and its treatment. [ABSTRACT FROM AUTHOR]

Prevalence of adverse childhood experiences (ACEs) and the extent to which they relate to health among young adults (ages 18-25) returning home from jail is underexamined. To build on the growing literature examining associations between ACE exposure among young people involved with carceral systems and health, we (1) measured ACE prevalence and (2) explored associations between ACEs and health/well-being indicators among young adults experiencing reentry. Using a telephone survey on reentry experiences, participants completed an ACE screening, single-item responses on health and social indicators, and five-item responses on substance misuse. Fisher's exact tests and t tests compared sociodemographic and health-related factors by the levels of ACEs. Among the 85 participants, 66 (78%) reported four or more ACEs and 48 (56%) reported six or more ACEs, including divorced parents ( n = 69, 81%), witnessing violence ( n = 63, 74%), and household member incarceration ( n = 60, 71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.

Respiratory infections in children, ranging from mild to severe, are a leading cause of school absences and medical visits, creating significant socio-economic burdens for families. Recent interest has focused on resveratrol, a natural polyphenol known for its antioxidant, anti-inflammatory, and antiviral properties. When combined with carboxymethyl-β-glucan (CM-glucan), a modified polysaccharide with immunostimulatory effects, this formulation has shown potential benefits in managing respiratory diseases.Our research examines five randomized clinical trials investigating the efficacy of resveratrol and CM-glucan nasal solutions in children. The trials included children with recurrent respiratory infections (RRIs) and allergic rhinitis. The results demonstrate significant reductions in key respiratory symptoms, including nasal congestion, sneezing, coughing, and fever. In addition to symptomatic relief, the treatment was associated with fewer medical visits, decreased medication use, and reduced school absences. Importantly, the combination also showed efficacy in decreasing wheezing episodes in non-atopic children with RRIs and improving symptoms of allergic rhinitis. While these findings are promising, the studies are limited by small sample sizes and short-term follow-up periods, raising questions about the long-term efficacy and safety of the treatment. Mild and transient nasal irritation was the only reported side effect. Based on these concepts, the combination of resveratrol and carboxymethyl-β-glucan could be considered a valuable add-on strategy, complementing standard pharmacological treatments for pediatric respiratory infections and allergic conditions., Competing Interests: The authors declare no conflict of interest.

Background: Organ transplantation in children is a vital procedure for those with end-stage organ failure, but it has been linked to the development of post-transplant allergies, especially food allergies. This phenomenon, known as transplant-acquired food allergy (TAFA), is becoming increasingly recognized, though its mechanisms remain under investigation. Pediatric transplant recipients often require lifelong immunosuppressive therapy to prevent graft rejection, which can alter immune function and heighten the risk of allergic reactions. Our review aimed to gather the latest evidence on TAFA., Methods: We conducted a PubMed search from 25 June to 5 July 2024, using specific search terms, identifying 143 articles. After screening, 36 studies were included: 24 retrospective studies, 1 prospective study, 2 cross-sectional researches, and 9 case reports/series., Results: Most studies focused on liver transplants in children. The prevalence of food allergies ranged from 3.3% to 54.3%. Tacrolimus, alongside corticosteroids, was the most commonly used immunosuppressive therapy. In addition to food allergies, some patients developed atopic dermatitis, asthma, and rhinitis. Allergic symptoms typically emerged within a year post-transplant, with common allergens including milk, eggs, fish, nuts, soy, wheat, and shellfish. Both IgE-mediated and non-IgE-mediated reactions were observed, with treatment often involving the removal of offending foods and the use of adrenaline when necessary., Conclusions: Consistent immunological monitoring, such as skin prick tests and IgE level assessments, is essential for early detection and management of allergies in these patients. Understanding the link between transplantation and allergy development is crucial for improving long-term outcomes for pediatric transplant recipients.

Background: Opioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs., Methods: The research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups., Discussion: Findings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions., Trial Registration: ClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341., (© 2024. The Author(s).)

The role of obesity as risk factor for chronic kidney disease (CKD) has been well-recognized. As previously demonstrated in adults, emerging data highlighted the relevant impact of obesity on renal function since childhood. As a matter of fact, obesity also affects renal health through a complex pathogenic mechanism in which insulin resistance (IR) plays a pivotal role. Worthy of note, the vicious interplay among obesity, IR, and renal hemodynamics clinically translates into a plethora of kidney function impairments potentially leading to CKD development. Therefore, renal injury needs to be added to the well-known spectrum of cardiometabolic obesity comorbidities (e.g., type 2 diabetes, IR, metabolic syndrome, cardiovascular disease)., Conclusion: Taking this into account, a careful and timely monitoring of kidney function should not be neglected in the global assessment of children with obesity. We aimed to provide a comprehensive overview on the relevance of kidney evaluation in children with obesity by shedding lights on the intriguing relationship of obesity with renal health in this at-risk population., What Is Known: • Obesity has been found to be a risk factor for chronic kidney disease. • Unlike adults, pediatric data supporting the association between obesity and renal function are still limited., What Is New: • As observed in adults, obesity might affect renal function since childhood. • Kidney function should be carefully evaluated in children with obesity., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Importance: Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap., Objectives: To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt., Design, Setting, and Participants: This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023., Exposure: Demographic and clinical factors potentially associated with posthospitalization MOUD receipt., Main Outcomes and Measures: The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually., Results: Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates., Conclusions and Relevance: This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.

Asthma, a prevalent chronic respiratory condition characterized by inflammation of the airways and bronchoconstriction, has demonstrated a potential association with hemoglobinopathies such as thalassemia and sickle cell disease (SCD). Numerous studies have highlighted a higher prevalence of asthma among thalassemia patients compared to the general population, with rates ranging around 30%. Similarly, asthma frequently coexists with SCD, affecting approximately 20-48% of patients. Children with SCD often experience heightened lower airway obstruction and airway hyper-reactivity. Notably, the presence of asthma in SCD exacerbates respiratory symptoms and increases the risk of severe complications like acute chest syndrome, stroke, vaso-occlusive episodes, and early mortality. Several studies have noted a decrease in various cytokines such as IFN-γ and IL-10, along with higher levels of both IL-6 and IL-8, suggesting an overactivation of pro-inflammatory mechanisms in patients with hemoglobinopathies, which could trigger inflammatory conditions such as asthma. The exact mechanisms driving this association are better elucidated but may involve factors such as chronic inflammation, oxidative stress, and immune dysregulation associated with thalassemia-related complications like chronic hemolytic anemia and iron overload. This review aims to comprehensively analyze the relationship between asthma and hemoglobinopathies, with a focus on thalassemia and SCD. It emphasizes the importance of interdisciplinary collaboration among pulmonologists, hematologists, and other healthcare professionals to effectively manage this complex interplay. Understanding this link is crucial for improving care and outcomes in affected individuals., Competing Interests: The authors declare no conflicts of interest.

Early life stress (ELS) is defined as an acute or chronic stressor that negatively impacts a child's development. ELS is associated with substance use and mental health problems. This narrative literature review focuses on sex and gender differences in the effects of ELS on 1) adolescent neuroendocrine development; 2) pubertal brain maturation; and 3) development of internalizing symptoms and subsequent substance use. We posit that ELS may generate larger hormonal dysregulation in females than males during puberty, increasing internalizing symptoms and substance use. Future research should consider sex and gender differences in neuroendocrine developmental processes when studying the link between ELS and negative health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work was funded by the National Institutes of Health, National Institute on Drug Abuse Substance Abuse Research Training (SART) program (R25DA050723) and National Institute on Minority Health and Health Disparities grant to the Urban Health Institute (S21 MD000103), both at Charles R. Drew University., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Reentry is a difficult juncture for young adults (ages 18-24 years), who simultaneously face challenges of emerging adulthood. Although their health-related needs may be substantial, little is reported on young adults' reentry health care and social service needs. Furthermore, empirical measurements of factors affecting their engagement in reentry services after jail are lacking. We sought to describe health needs and predictors of linkages to reentry services for the 2,525 young adult participants in the Whole Person Care-LA Reentry program (WPC Reentry). Descriptive statistics were calculated and chi-square tests, t tests, and logistic regression were performed to identify factors associated with linkage to WPC Reentry postrelease compared with only engaging with WPC Reentry prerelease. Most participants (72.6%) were male, 80.2% were Hispanic or Black, and 60.9% had been unhoused. Mental health (57.2%) and substance use disorders (45.8%) were common, physical health was overall good (mean Charlson Comorbidity Index score 0.53), and social needs, especially housing, were high (40.7%). Older age (i.e., closer to 25 years) and history of being unhoused were associated with higher postrelease engagement in WPC Reentry (age: odds ratio [OR] = 1.06, p  = .01; history of being unhoused: OR = 1.18, p  = .05). Attentiveness to younger clients and to addressing housing needs may be key for successful reentry care linkages.

Objectives: The present study aims to assess the relationship between substance use disorders (SUD) and intersectional discrimination, the intersection of racial/ethnic discrimination, and gender discrimination. Further, this study aims to determine if the relationship between SUD and discrimination varies by race/ethnicity and gender., Method: This cross-sectional study analyzes data from a diverse sample of American Indian, Asian, Black, Latinx, and White adult respondents ( N = 34,547) from Wave 2 of the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions. Multinomial logistic regression was used to test the association between intersectional discrimination and SUD. Intersectional discrimination was assessed using an interaction term between racial/ethnic discrimination and gender discrimination. Alcohol use disorders (AUD) only and alcohol plus drug use disorders (SUD) were assessed separately. Analyses were stratified by race/ethnicity and gender., Results: Overall, intersectional discrimination was associated with increased predicted probabilities of SUD relative to those with no discrimination and was more often associated with SUD than AUD. Intersectional discrimination was associated with increased predicted probabilities of AUD and SUD among women, Black, Latinx, and White adults. Intersectional discrimination was associated with increased predicted probabilities of SUD but not AUD among men, American Indian, and Asian adults., Conclusions: Intersectional discrimination consistently elevated AUD and/or SUD across subgroups defined by gender or race/ethnicity; however, effects were variable across gender, race/ethnicity, and disorder. Findings demonstrate the negative health implications of intersectional discrimination for men and women and American Indian, Asian, Black, Latinx, and White adults. Study findings have implications for the development of policies and interventions that are centered around intersectionality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Combination therapy (CT) (desmopressin plus oxybutynin) has been considered for the treatment of monosymptomatic nocturnal enuresis (MNE). We designed our study with the aim to evaluate the response rate to CT compared with desmopressin alone (primary outcome) and to identify factors associated with the response to CT (secondary outcome). We prospectively enrolled children with MNE with absent/partial response after 3 months of evening treatment with 240 mcg of desmopressin. We defined the response rate to CT compared with desmopressin alone according to the standardization of terminology document of the International Children's Continence Society: no-response, < 50% reduction; partial response, 50 to 99% reduction; and complete response, 100% reduction of wet nights. Both partial response and complete response to CT were clustered for the analyses of this manuscript. The enrolled children treated with 240 mcg/evening of desmopressin had also an additional evening administration of 0.3 mg/kg oxybutynin. A follow-up was scheduled at 3 and 6 months after the beginning of CT. At 3 months, oxybutynin dose was augmented to 0.5 mg/kg in case of absent/partial response to CT. Nocturnal diuresis was measured in 5 wet nights prior the beginning of therapy with desmopressin. Nocturnal polyuria (NP) was defined as nocturnal urine production > 130% of the expected bladder capacity. All patients with constipation were treated with macrogol. We enrolled 81 children (35.8% females) with a mean age of 8.4 ± 2.3 years. Seventy-eight patients completed the follow-up. After the CT, 59/78 (75.6%) patients showed an improvement of the response with CT compared with desmopressin alone. At multivariate analysis, both NP in more than 1 night (OR = 8.5; 95% CI, 1.4-51.6; p = 0.02) and absence of constipation (OR = 7.1; 95% CI, 1.6-31.0; p = 0.009) resulted significant after Bonferroni correction., Conclusions: CT determines an improvement of response compared to therapy with desmopressin alone in 75.6% of patients. Significant predictive factors of response to CT were presence of NP and absence of constipation., What Is Known: • Combination therapy (CT) (desmopressin plus anticholinergic drug) has been described as a therapeutic option for patients with monosymptomatic nocturnal enuresis (MNE) not responding to desmopressin alone as first-line treatment. • Variable protocols and variable combination of drugs have been described with a response rate ranging from 44 to 76%., What Is New: • We found that 59 patients (75.6%) treated with evening administration of 240 mcg of sublingual desmopressin plus 0.3-0.5 mg/kg of oxybutynin had an improvement of response compared to treatment with desmopressin alone. • We add evidence that presence of frequently recurring nocturnal polyuria and absence of constipation are predictors of response to CT., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment., Design and Setting: A multi-centre, longitudinal, two-group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA., Participants: A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days., Intervention and Comparator: A motivation-based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364)., Measurements: Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end-point 3 months post-baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12-month follow-up and the use of addiction treatment services., Findings: Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48-0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50-0.66) at the 3-month follow-up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3-month follow-up (OR = 0.93; 95% CrI = 0.85-1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services., Conclusions: Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use., (© 2020 Society for the Study of Addiction.)

This study seeks to investigate racial dynamics among clients in a female-only residential substance use disorder treatment facility in South Los Angeles and its effects on treatment experiences. Clients were interviewed about their interracial interactions, perceptions of clients of races and ethnicities different from their own and how racial dynamics might affect their experiences in treatment. Nine interviews were conducted and analyzed using thematic analysis. Participants recounted that racial differences do not play a significant role in their treatment experiences, although racial identities shape social group formation. Motivation to recover from addiction and other shared lived experiences facilitate interracial harmony.

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p  < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p  = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p  = 0.033 marijuana; AOR = 4.01, p  = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p  < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

The 2017 CALDAR Summer Institute on Longituidnal Research and International Conference Series to Promote Global Health will take place in Los Angeles Universal City, CA, USA from August 15 to August 17, 2017. The conference will present a selection of the lastest and most current reseach in the areas of addiction, HIV, and related treatment.

Background: Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services., Methods: This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention)., Results: Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time., Conclusions: Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.

Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

To examine the developmental timing of first drug treatment and its associations with 10-year drug use patterns, pooled data (N=1318) from four longitudinal studies conducted in California was used to compare individuals first treated during young adulthood (26%) to those first treated at an older age. Treatment timing was associated with particular participant characteristics and experiences. Matched data showed that most people in both age groups exhibited a low level of drug use after first treatment, albeit fewer who were first treated during young adulthood maintained a low drug use level over time. Receipt of more drug treatment over 10 years was associated with maintenance of low drug use levels among those first treated as young adults, but not among those first treated as older adults. Developmental timing of first drug treatment interacts with subsequent treatment experiences in ways that impact the course of drug use., (Published by Elsevier Inc.)

The study examined the prevalence and correlates of substance use disorders and treatment utilization among lifetime MDMA users. Secondary analyses were conducted on data from the 2001-2002 NESARC, a nationally representative survey of adults in the United States. Lifetime MDMA use was assessed, and MDMA users ( n = 562) were compared to a matched sample of non-MDMA users. Substance use diagnoses were made using the AUDADIS - DSM-IV, and data on treatment utilization were collected. MDMA use was significantly related to lifetime and past year substance use disorders as well as treatment utilization in bivariate analyses. Multivariate analysis, however, showed that MDMA use was not related to lifetime substance use diagnosis or to treatment utilization. MDMA use still had the strongest association with past year substance use disorders.

This study describes the prevalence of childhood traumatic events (CTEs) among adults with comorbid substance use disorders (SUDs) and mental health problems (MHPs) and assesses the relation between cumulative CTEs and adult health outcomes. Adults with SUDs/MHPs (N=402) were recruited from residential treatment programs and interviewed at treatment admission. Exposures to 9 types of adverse childhood experiences were summed and categorized into 6 ordinal levels of exposure. Descriptive analyses were conducted to assess the prevalence and range of exposure to CTEs in comparison with a sample from primary health care. Logistic regression analyses were conducted to examine the association between the cumulative exposure to CTEs and adverse health outcomes. Most of the sample reported exposure to CTEs, with higher exposure rates among the study sample compared with the primary health care sample. Greater exposure to CTEs significantly increased the odds of several adverse adult outcomes, including PTSD, alcohol dependence, injection drug use, tobacco use, sex work, medical problems, and poor quality of life. Study findings support the importance of early prevention and intervention and provision of trauma treatment for individuals with SUDs/MHPs.

Three standardized screening instruments-the Global Appraisal of Individual Needs Short Screener (GSS), the Mini-International Neuropsychiatric Interview-Modified (MINI-M), and the Mental Health Screening Form (MHSF)-were compared to two shorter instruments, the 6-item Co-Occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD) and the 3-item CODSI for Severe Mental Disorders (CODSI-SMD) for use with offenders in prison substance-abuse treatment programs. Results showed that the CODSI screening instruments were comparable to the longer instruments in overall accuracy and that all of the instruments performed reasonably well. The CODSI instruments showed sufficient value to justify their use in prison substance-abuse treatment programs and to warrant validation testing in other criminal justice populations and settings.

This article describes the development of an instrument to screen male and female offenders for co-occurring substance use and mental disorders. This phase developed and pilot tested (N = 100) the Criminal Justice Drug Abuse Treatment Studies (CJDATS) Co-occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD), a 6-item instrument derived from three standard mental health screeners. The overall accuracy of the CODSI-MD (81%) compared favorably with the three standard instruments. A second 3-item instrument, developed to screen for severe mental disorders (the CODSI-SMD), had an overall accuracy of 82%. The results of this pilot study must be viewed cautiously, pending validation of the findings with a larger sample.

Objectives: We sought to describe the prevalence of childhood traumatic events among incarcerated women in substance abuse treatment and to assess the relation between cumulative childhood traumatic events and adult physical and mental health problems., Methods: The study was modeled after the Adverse Childhood Events study's findings. In-depth baseline interview data for 500 women participating in the Female Offender Treatment and Employment Program evaluation were analyzed., Results: Hypotheses were supported, and regression results showed that the impact of childhood traumatic events on health outcomes is strong and cumulative (greater exposure to childhood traumatic events increased the likelihood of 12 of 18 health-related outcomes, ranging from a 15% increase in the odds of reporting fair/poor health to a 40% increase in the odds of mental health treatment in adulthood)., Conclusions: Our findings suggest a need for early prevention and intervention, and appropriate trauma treatment, within correctional treatment settings.

Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system and patient outcomes. Except for San Francisco, treatment admissions increased during the first year of Proposition 36 implementation over the prior year (27% in Kern, 21% in Riverside, 17% in Sacramento, and 16% in San Diego), mostly in outpatient drug-free programs. Compared to non-Proposition 36 patients, Proposition 36 patients were more likely to be men, first-time admissions, treated in outpatient drug-free programs, employed full-time, and users of methamphetamine or marijuana. They were less likely to be treated in residential programs or methadone maintenance programs and fewer reported heroin use or injection drug use. Guided by the multilevel open systems framework, the study examines key issues of Proposition 36 that influence treatment systems and outcomes and empirically identifies "best practice" approaches in treating drug-abusing offenders.

Background: Little is known about outcomes of community-based treatment programs for adolescents with drug problems., Methods: We studied 1167 adolescents (age range, 11-18 years; 368 females, 799 males) from 4 US cities (Pittsburgh, Pa; Minneapolis, Minn; Chicago, Ill; and Portland, Ore) using a naturalistic, nonexperimental evaluation design. These adolescents were consecutive admissions during the period from 1993 to 1995 at 23 community-based treatment programs in the Drug Abuse Treatment Outcome Studies for Adolescents. Included were 418 admissions to 8 residential programs, 292 admissions to 9 outpatient drug-free programs, and 457 admissions to 6 short-term inpatient programs., Results: Adolescents in treatment typically had multiple problems (eg, 58.4% of them were involved in the legal system, and 63.0% met diagnostic criteria for a mental disorder). Nevertheless, less than half (43.8%) of all patients reported weekly marijuana use in the year following treatment (dropping from 80.4% in the year before admission). Similarly, there were decreases in heavy drinking (dropping from 33.8% to 20.3%), use of other illicit drugs (dropping from 48.0% to 42.2%), and criminal involvement (dropping from 75.6% to 52.8%). Additionally, patients reported better psychological adjustment and school performance after treatment. Longer stays in treatment were positively associated with several favorable outcomes, although length of time in treatment was generally short., Conclusions: Substance abuse treatment for adolescents is effective in achieving many important behavioral and psychological improvements. Strategies specific to adolescents to improve their treatment retention and completion are needed to maximize the therapeutic benefits of drug treatment.