North Carolina Specialty Courts, Treatment Access, and the Substance Use Crisis: A Promising but Underfunded Model

2021 ◽  
pp. appi.ps.2020008
Author(s):  
Michele M. Easter ◽  
Jeffrey W. Swanson ◽  
William E. Crozier ◽  
Allison G. Robertson ◽  
Brandon L. Garrett ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Treatment Access ◽  
Specialty Courts

scholarly journals Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

2021 ◽  
Author(s):  
Devon K Check ◽  
Christopher D Bagett ◽  
KyungSu Kim ◽  
Andrew W Roberts ◽  
Megan C Roberts ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Cancer Survivors ◽  
Low Income ◽  
Opioid Therapy ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

Substance Use Disorder Treatments

2017 ◽  
pp. 96-118 ◽  
Author(s):  
Liliane Cambraia Windsor ◽  
Douglas C. Smith ◽  
Kyle M. Bennett ◽  
Frederick X. Gibbons
Keyword(s):  
Substance Use ◽  
Emerging Adults ◽  
Substance Use Disorder ◽  
The United States ◽  
Drug Misuse ◽  
Future Research ◽  
Cultural Groups ◽  
Treatment Access ◽  
Effective Interventions ◽  
Diverse Groups

Today’s emerging adults belong to one of the most diverse generations in the United States and show the highest rates of alcohol and illicit drug misuse, facing significant health risks. Thus it is critical to develop effective interventions to reduce alcohol and illicit substance misuse and its related harms among this diverse group. This chapter examines the current literature on the development and effectiveness of existing culturally relevant substance use disorder treatments and makes recommendations for future research and best practices. We argue that given their unique needs, the severity of their substance use, and the low rates of treatment engagement among this population, it is critical that treatment efforts focus on increasing effective treatment access to all emerging adults. We further encourage substance use disorder treatment researchers and practitioners to move beyond addressing culture-bound intervention targets focused on specific cultural groups. The chapter advocates for the development, testing, and adoption of interventions that are responsive to cultural contexts and that (1) target social determinants of health, (2) are equally effective with privileged and marginalized emerging adults, and (3) prepare therapists to effectively deliver interventions to diverse groups and demonstrate cultural competence.

Why Should We Focus on Emerging Adults with Substance Use Disorders?

2017 ◽  
pp. 1-15
Keyword(s):  
Substance Use ◽  
Emerging Adulthood ◽  
Emerging Adults ◽  
Substance Use Disorders ◽  
First Language ◽  
Developmentally Appropriate ◽  
Age Groups ◽  
Treatment Access ◽  
Problematic Substance Use ◽  
Problematic Substance

Emerging adulthood (roughly ages 18–29) is the lifespan period when the peak prevalence of substance use disorders (SUD) and substance use occurs. Opportunities for prevention and intervention abound during these years. This chapter provides a brief introduction to the concept of emerging adulthood, as well as a laundry list of terms used to describe problematic substance use. The chapter argues that we must be mindful of using person-first language and, based on available stigma research, advocates for use of the term substance use disorder. The chapter then presents a strong rationale for creating more developmentally appropriate treatments for emerging adults. This rationale is based on three pillars: (1) emerging adults’ current underrepresentation in large outcome studies, (2) existing disparities in treatment outcomes between emerging adults and individuals in other age groups, and (3) the possibility of expanded substance use treatment access under healthcare reform.

scholarly journals Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic

2015 ◽  
Vol 76 (3) ◽  
pp. 148-155 ◽  
Author(s):  
L. M. Skalski ◽  
M. H. Watt ◽  
J. C. MacFarlane ◽  
R. J. Proeschold-Bell ◽  
J. E. Stout ◽  
...  
Keyword(s):  
Mental Health ◽  
North Carolina ◽  
Substance Use

Substance Use Disorder Treatment in the Reentry Environment: Service Receipt and Prisoner Community Reintegration

2019 ◽  
Vol 46 (9) ◽  
pp. 1295-1318 ◽  
Author(s):  
Leah Hamilton ◽  
Steven Belenko
Keyword(s):  
Substance Use ◽  
Health Services ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Transition Services ◽  
Behavioral Health Services ◽  
Treatment Access ◽  
Individual Motivation ◽  
Environment Service

Accessing substance use disorder (SUD) treatment after prison is a challenging process for released inmates. Pre-release behavioral health services appear to improve treatment access. However, a deeper understanding of pre-release services in facilitating treatment after release, as well as how pre-release services are affected by the introduction of post-release services, are needed to determine how to best facilitate SUD treatment access with this population. Using the Serious and Violent Offenders Reentry Initiative male dataset ( N = 1,697), the relationship between pre-release behavioral health services and SUD treatment at 3 and 9 months after release is examined. The results demonstrated that only a few pre-release services, along with individual motivation, maintained their influence on SUD treatment access over both follow-up time points; however, other services provided later into the post-release re-entry process also contributed to improved SUD treatment receipt. Implications for improving transition services for inmates with SUDs are discussed

Integration of an evidence-based tobacco cessation program into a substance use disorders program to enhance equity of treatment access for northern, rural, and remote communities

2020 ◽  
Vol 10 (3) ◽  
pp. 555-564
Author(s):  
Patricia M Smith ◽  
Lisa D Seamark ◽  
Katie Beck
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Access Point ◽  
Indigenous Communities ◽  
Well Being ◽  
Evidence Based ◽  
Treatment Access ◽  
Cessation Intervention

Abstract Integrating tobacco cessation interventions into substance use disorder (SUD) programs is recommended, yet few are implemented into practice. This translational research implementation study was designed to integrate an evidence-based tobacco cessation intervention into a 2-week hospital outpatient SUD program that served a rural municipality and 33 remote Indigenous communities. Objectives included determining tobacco use prevalence, intervention uptake, and staffing resources required for intervention delivery. A series of 1-hr tobacco and health/well-being interactive education and behavior-change groups were developed for the SUD program to create a central access point to offer an evidence-based, intensive tobacco cessation intervention that included an initial counseling/planning session and nine post-SUD treatment follow-ups (weekly month 1; biweekly month 2; and 3, 6, and 12 months). Group sign-in data included age, gender, community, tobacco use, and interest in receiving tobacco cessation help. Thirty-two groups (April 2018 to February 2019) were attended by 105 people from 22 communities—56% were female, mean age = 30.9 (±7.3; 93% <45 years), 86% smoked, and 38% enrolled in the intensive tobacco cessation intervention. The age-standardized tobacco use ratio was two times higher than would be expected in the general rural population in the region. Average staff time to provide the intervention was 1.5–2.5 hr/week. Results showed that a Healthy Living group integrated into SUD programming provided a forum for tobacco education, behavior-change skills development, and access to an intensive tobacco cessation intervention for which enrollment was high yet the intervention could be delivered with only a few staff hours a week.

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