substance use disorder

Background: The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention.

Methods: A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989-2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors.

Results: More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease.

Conclusions: The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.

Author/s:

Afuseh, Eric, Pike, Caitlin A., Oruche, Ukamaka M.

Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225

John Bayhi — Tue, 26 May 2020 22:01:32 +0000

Date Added:

May 26, 2020

Journal/Publication:

AHRQ Publication No. 20-EHC014

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

May 21, 2020

URL:

Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.23970/AHRQEPCCER225

Keywords

substance use disorder

adolescents

alcohol use disorder

cannabis use

motivational interviewing

pharmacological interventions

A concise summary of the findings of a systematic review of interventions to address substance misuse in adolescents. James W. Mold, MD, MPH

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Objectives. This systematic review (SR) synthesizes the literature on behavioral, pharmacologic, and combined interventions for adolescents ages 12 to 20 years with problematic substance use or substance use disorder. We included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms.

Data sources. We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO to identify primary studies meeting eligibility criteria through November 1, 2019.

Review methods. Studies were extracted into the Systematic Review Data Repository. We categorized interventions into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. We conducted meta-analyses of comparative studies and evaluated the strength of evidence (SoE). The PROSPERO protocol registration number is CRD42018115388 .

Results. The literature search yielded 33,272 citations, of which 118 studies were included. Motivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month, and overall substance use problems by a standardized mean difference of 0.5, compared with treatment as usual. Brief MI did not reduce cannabis use days (net mean difference of 0). Across multiple intensive interventions, Fam was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual. No intensive interventions reduced cannabis use days. Pharmacologic treatment of opioid use disorder led to a more than 4 times greater likelihood of abstinence with extended courses (2 to 3 months) of buprenorphine compared to short courses (14 to 28 days).

Conclusions. Brief interventions: MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE), and substance use–related problems (low SoE) but does not reduce cannabis use days (moderate SoE). Nonbrief interventions: Fam may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Intensive interventions did not appear to decrease cannabis use (low SoE). Some interventions (CBT, CBT+MI, and CBT+MI+CM) were associated with increased cannabis use (low SoE). Both MI and CBT reduce combined alcohol and other drug use (low SoE). Combined CBT+MI reduces illicit drug use (low SoE). Subgroup analyses of interest (male vs. female, racial and ethnic minorities, socioeconomic status, and family characteristics) were sparse, precluding conclusions regarding differential effects. Pharmacological interventions: longer courses of buprenorphine (2–3 months) are more effective than shorter courses (14–28 days) to reduce opioid use and achieve abstinence (low SoE). SRs in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for opioid, alcohol, and cannabis use disorders.

Author/s:

Steele, CW, Becker, SJ, Danko, KJ, Balk, EM, Saldanha, IJ, Adam, GP, Bagley, SM, Friedman, C, Spirito, A, Scott, K, Ntzani, EE, Saeed, I, Smith, B, Popp, J, Trikalinos, TA

Helping patients manage substance use disorder: Tobacco, alcohol, and other drugs

John Bayhi — Mon, 03 Feb 2020 20:04:07 +0000

Date Added:

February 3, 2020

Publisher:

Alosa Health

Publication Date:

January 1, 2020

Type:

Clinical Decision Aids

Format:

Article

Keywords

substance use disorder

alcohol use disorder

opioid-use disorder

tobacco use

This guide was prepared for use in the OPHIC implementation projects involving management of patients with substance use disorders. James W. Mold, MD, MPH

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Author/s:

Oklahoma Department of Mental & Substance Abuse Services, Oklahoma Primary Healthcare Improvement Cooperative, University of Oklahoma Health Sciences Center, Alosa Health