Addiction is a national problem in the United States that impacts public health and social and economic welfare. The purpose of this case study was to identify barriers that impede treatment and hinder the success of client recovery from addiction. The research question focused on social work clinicians' perceptions of barriers to effective treatment with substance abuse clients in Coastal South Mississippi. The theoretical framework for this research was the reasoned action theory. Data was collected from a focus group, personal interviews, and the review of literature. Purposeful sampling was used to select 13 social workers for interviews and for a focus group. The social workers needed to have obtained a bachelor or higher degree and a minimum of one year professional experience working with substance abuse clients. Data analysis was conducted by evaluating transcripts of audio recordings from the focus group. The results were then further developed using common words and phrases among the participants to assist in the development of themes. Three themes emerged from this research study: the counselor attitudes/perceptions to treatment, client identified barriers to successful treatment, and the identification of environmental barriers to treatment. The findings of this study might bring about social change by helping social workers to identify factors that influence substance abuse treatment delivery and adapt successful treatment approaches to serve clients by providing social workers with the knowledge and awareness of practitioners' perceptions on treating substance abuse clients. This should lead to enhanced clinical practices by empowering treatment outcomes for the benefit of substance abuse clients.

This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n = 18 studies), buprenorphine (n = 3 studies), or naltrexone (n = 3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n = 3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n = 4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n = 3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n = 4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.

Many pregnant women in the Appalachian Highlands region utilize buprenorphine as medication-assisted treatment (MAT) for opioid use disorder. This treatment is a tool used by medical teams to minimize patients’ drug cravings and optimize chances for a healthy pregnancy. Providers in our region have posited a relationship between MAT use and poor pregnancy weight gain based on clinical experience and observation. Appropriate weight gain in pregnancy is a critical determinant of pregnancy health; without it, pregnant mothers will possibly need nutritional supplementation. Therefore, understanding the association between buprenorphine use and weight gain may contribute to healthier pregnancies. In order to evaluate the association between buprenorphine use and weight gain in pregnant women using MAT, we conducted a retrospective chart review. A list of potential participants was generated by ETSU Population Health using ICD-10 codes. We enrolled patients who were cared for by ETSU Health and delivered babies between July 1, 2019 and June 30, 2021: a total of 504 patients. Of these, 96 were participants in the ETSU low-dose MAT clinic (Group 1), 109 were receiving MAT from other community clinics (Group 2), 97 were non-smoking women in the regular OB clinic (Group 3), and 202 were smoking women in the regular OB clinic (Group 4). Participants’ medical records were screened for inclusion and exclusion criteria. All patients were over age 18 with singleton pregnancies, had pregnancy care initiated in the first trimester, and delivered at or after 37 weeks’ gestation. Patients with confounding medical conditions including (but not limited to) Crohn’s disease, diabetes, heart disease, hypertension, fetal anomalies, or IUFD were excluded. In addition, patients were also excluded with BMI >30 or undocumented BMI, prenatal care initiated after the first trimester, transfer to another practice or lost to follow up, or other documented drug abuse other than opiate use disorder. After consideration of the above criteria, 262 patients were excluded and 242 patients remained in the study. Of these, 53 were in Group 1, 53 in Group 2, 45 in Group 3, and 90 in Group 4. All protected health information was stored in the ETSU HIPAA-compliant REDCap server. At this time, the project is in the data analysis stage, with results expected by the end of March 2023. If an association between buprenorphine use and lower weight gain in pregnancy is discovered, these results can be used to recommend additional measures such as nutritional supplementation to optimize maternal and fetal health during pregnancy. Final conclusions will be drawn after data analysis is complete and associations, or lack thereof, can be fully evaluated. Based on observations of obstetric providers in the region, some association between lower weight gain and buprenorphine use is anticipated.

Opioid abuse and opioid related deaths continue to affect families and communities across the United States. Medication-assisted treatment shows advantages over other types of interventions for opioid use disorder (OUD) (Bart, 2012). While buprenorphine, an approved medication for the treatment of OUD, has a wide research base to support its efficacy, there is little research or guidance on behavioral interventions to use in conjunction with the medication. Investigating clients' experiences in treatment can provide helpful and necessary information for improving treatment efforts. The following qualitative study used a phenomenological approach to explore the client experience of group therapy with buprenorphine for OUD. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for self-disclosure. This research highlights the importance of the therapeutic alliance, the 11 therapeutic factors of groups, and the necessity of building authentic relationships in treatment. / Doctor of Philosophy / As opioid overdoses continue to rise in the United States, it is essential that we improve addiction treatment. Medication-assisted treatment (MAT) combines the use of medications and counseling to treat the whole person. This type of approach shows advantages over counseling only interventions for opioid use disorder (OUD) (Bart, 2012). While MAT shows promise over counseling only approaches, there is little research or guidance on how to implement counseling with the medication. Investigating clients’ experiences in treatment can provide helpful and necessary information for improving counseling in MAT. The following qualitative study used in-depth interviews with participants who are currently in a MAT program to better understand their experiences in treatment. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for sharing. This research helps further knowledge of treatment for OUD to better serve those affected by addiction, as well as adding to the gaps in group therapy and addiction’s literature.

No description available.

Background Opioid use has become a huge public health crisis and opioids are now one of the leading causes of deaths related to drugs worldwide. Identifying differences in predictors and treatment outcomes for people with opioid use disorder (OUD) that were introduced by prescription versus other means is important. It is also vital to understand what the goals are and needs that patients want to achieve out of OUD treatment. Methods We used systematic review methodology to first examine any adverse outcomes that may be associated with prescribing opioids for acute low back pain. We also conducted a systematic review and meta-analysis examining what are the differences in patients with OUD that were initially introduced to opioids by prescription in comparison to those introduced by recreational means. We then conducted an observational study using data obtained from the GENetics of Opioid Addiction (GENOA) research collaborative. We examined treatment outcome differences between individuals introduced to opioids through a licit prescription and those introduced through illicit means. We conducted a mixed-methods study asking what the desired goals of patients with OUD from the Pharmacogenetics of Opioid Substitution Treatment (POST) project are. Using data from POST, we also examined the treatment outcome differences between those that were receiving methadone treatment in comparison to those that were on buprenorphine. Results The systematic review examining adverse outcomes of prescribing opioids for acute low back pain found that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI 1.06,2.33). The second systematic review found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while in treatment. Our results from GENOA also showed that those introduced to opioids by prescription were more likely to have chronic pain, an older age of onset of opioid use, less likely to have hepatitis C and use cannabis. When we asked patients what goals they desired out of treatment, we found that the most frequently reported patient important outcomes were to stop treatment (39%) and avoid all drugs (25%). When comparing OUD patients by treatment we discovered that those receiving buprenorphine were less likely to consume illicit opioids and amphetamines but more likely to have used alcohol in comparison to those on methadone. Conclusion With this knowledge, we can recognize unique risk factors for each patient and provide more tailored treatment that can incorporate this into clinical practice to address specific concerns in various cohorts of OUD patients. Additionally, the variation in the selection of outcomes demand the need for further research to establish a set of outcomes that considers patients’ goals and preferences for OUD treatment. / Thesis / Candidate in Philosophy

Indiana University-Purdue University Indianapolis (IUPUI) / Heavy alcohol consumption and opioid overdose rates continue to increase in the United States (U.S.). Social workers provide approximately 70% of the behavioral healthcare in the U.S. Medication-assisted treatment (MAT) combines FDA-approved medications with psychosocial interventions to provide a comprehensive approach to recovery for alcohol use disorder (AUD) and opioid use disorder (OUD). However, stigmatized attitudes toward individuals with AUD, OUD, and MAT limit MAT’s use. Guided by critical social theory, this study explores factors that predict master’s-level social workers’ (MSWs) attitudes toward AUD and OUD and, by extension, factors that predict their acceptance of MAT. A repeated measures analysis of variance (ANOVA) identified MSWs from Indiana, Kentucky, and Ohio (N = 140) having more favorable statistically significant (p < 0.001) attitudes toward individuals with AUD than those with OUD. Multiple regression models used age, gender identity, political ideology, years working in addiction (tenure), social work licensure, and 12-step facilitation beliefs to predict AUD and OUD attitudes, with AUD and OUD attitudes included in the regression models for MAT acceptance. Increased years working in addiction (tenure) was a statistically significant predictor in elevating attitudes toward individuals with AUD (p < 0.05) and OUD (p < 0.01). A more liberal political ideology (p < 0.001), increased years working in addiction (tenure) (p < 0.05), and more favorable attitudes toward individuals with AUD and OUD (p < 0.001) were statistically significant predictors in MAT acceptance. These results warrant increasing MSWs’ education on addiction and research on factors that impact their acceptance of MAT. Increasing MSWs’ education on addiction may lower stigmatized attitudes toward individuals with AUD and OUD and increase MAT acceptance. MSWs’ increased acceptance of MAT could improve patient health outcomes.

In the US, rural Native American communities (RNACs) experience excess morbidity in mental health disorders and mortality from opioid use disorder (OUD). This study used mixed methods to evaluate and analyze the primary data from 76 healthcare providers (HPs) from 24 states across the US (physicians = 7%), to identify HP knowledge and training regarding available prevention, treatment, and recovery (PTR) programs in treating OUD, assessment and management skills, and networking and collaboration capacity among the RNACs they serve. The HP completed the Opioid Survey for Health Care Providers online. A majority of HPs reported a need for knowledge and training regarding OUD treatments (92%). Less than half of the HPs provide intensive outpatient treatment; 40% contracted out for medication assisted treatment/medications for opioid use disorder (MAT/MOUD) services. Recovery support was low at 33% for adults and 38% for youth. HPs reported use of Narcan to be effective in reversing overdose (87%). Qualitative responses supported survey findings and described barriers, including lack of resources, inadequate staffing, insufficient funding, lack of training and OUD knowledge, stigma, and lack of tribal involvement and support. The study findings indicate HPs' need for information and training about OUD and networking and collaboration of healthcare settings to meet the needs of the RNAC they serve. Efforts are needed to improve on recovery programs with an emphasis on the youth. Culturally adapted MAT/MOUD approaches are needed to sustain long-term recovery care.

The primary purpose of this study is to determine the occurrence of drug therapy adjustment in people with substance use disorder receiving medication-assisted treatment when admitted to an acute care facility for a comorbid condition. The secondary purpose is to understand the correlation between the presence of adjustment of therapy for substance use disorder and influence on recovery from comorbid conditions. A literature review exploring drug therapy for addicted individuals during hospitalization was performed using various databases, search terms included *substance use disorder or *substance abuse or *illicit drug use or *drug abuse or *MAT or *maintenance therapy, combined with *inpatient or *hospital or *acute care or *admission. The data was conformed into tables that synthesized the relationship between drug therapy adjustment for individuals with substance use disorder during an acute care admission. Initial review of the articles revealed 78 articles relative to the topic, 16 of those articles met inclusion criteria and were selected for a detailed analysis. Studies suggest the need for provider education and guidelines for treating individuals receiving MAT in an acute care facility. While individuals with substance use disorder often use acute care services, their medication-assisted treatment is rarely acknowledged or adjusted. Many studies focus on individuals with substance use disorder, yet, addressing medication-assisted therapy is still inconsistent, and lacks official guidelines.

Opioid use disorder (OUD) and opioid overdose are pervasive public health problems in the U.S. Medications for opioid use disorder (MOUD) have been shown effective to reduce OUD morbidity and mortality. Two distinct approaches to MOUD are currently used: agonist therapy (methadone or buprenorphine) or antagonist therapy (naltrexone). Limited information is available about the patterns of use, adherence to therapy, and characteristics of those who use agonist vs. antagonist therapy. The objective of this study is to assess recent trends in MOUD, adherence in use of MOUD, and the characteristics of those who use agonist vs. antagonist therapy in a nationally representative population of commercially insured patients in the U.S. This retrospective descriptive study utilized data from Truven Marketscan Commercial Claims and Encounters database from years 2011 to 2016. All individuals aged 18 years and older who have a diagnosis of OUD and utilize MOUD at any point during the study period were included. Demographic characteristics of interest included age, gender, geographic region, and type of insurance coverage. Clinical characteristics of interest included diagnosis of OUD and type of MOUD used, including extended – release naltrexone for injection, oral naltrexone, buprenorphine in combination with naloxone, and buprenorphine alone. Descriptive analyses were employed to understand utilization patterns and trends over time and proportion of days covered was used to measure adherence. Frequency and percentage are presented for categorical variables. Adherence of MOUD will be estimated by measuring proportion of days covered. As this study uses de-identified commercial health claims data, it has been determined as not human subjects research by the University of Kentucky’s Office of Research Integrity. Agonist therapy with buprenorphine or buprenorphine/naloxone was the most common treatment, representing 75.7% of those receiving treatment. Between 2011 and 2016, the percentage of individuals receiving treatment with partial agonist therapy decreased 16.5% to 9.2%, respectively. Meanwhile, the percentage of individuals receiving treatment with antagonist treatment increased from 0.1% in 2011 to 0.3% in 2016. In the analysis of proportion of days covered, all MOUD reported a decrease at both 180 and 365 days. In the commercial population, younger female patients were more likely to be treated with injectable naltrexone. Specifically, in the North Central geographic region, commercial adult patients were more likely to be treated with buprenorphine monotherapy. Overall, this study found a decrease in use of agonist therapy from 2011 through 2016, with an increase in use of antagonist therapy in the same time period. However, the increase in use of antagonist therapy does not fully account for the decrease in use of agonist therapy, suggesting that since 2011 many patients with OUD still remain untreated. All MOUD types were analyzed and saw a decrease in proportion of days covered, as a measure of adherence, from 2011 to 2016 putting patients at an increased risk for relapse, further complications, emergency visits, and hospitalizations. More information is needed about characteristics of patients who not only seek out treatment for OUD, but also maintain their treatment overtime.