This study aimed to assess the prevalence of and factors associated with tobacco use among patients living with HIV/HCV co-infection. Patient reported outcomes (PROs) were analyzed of patients living with HIV/HCV co-infection (n = 313) who presented for clinical evaluation and treatment of HCV between 2013 and 2017 at a university-affiliated HIV/HCV Co-infection Clinic. The prevalence of tobacco use in patients living with HIV/HCV co-infection was 48%. Compared to non-smokers, a higher proportion of tobacco smokers had substance use disorders and concurrent alcohol and substance use. In the multivariate analysis, concurrent alcohol and substance use was positively associated with tobacco use. The findings suggest clinical interventions are urgently needed to reduce tobacco use among patients living with HIV/HCV co-infection—a doubly-vulnerable immunocompromised population. Otherwise, failed efforts to dedicate resources and targeted behavioral interventions for this respective population will inhibit survival—especially considering the recent and evolving COVID-19 pandemic.

The rapid spread of the coronavirus disease (COVID-19) has impacted the lives of millions around the globe. The COVID-19 pandemic has caused increasing concern among treatment professionals about mental health and risky substance use, especially among those who are struggling with a substance use disorder (SUD). The pandemic's impact on those with an SUD may be heightened in vulnerable communities, such as those living in under-resourced and rural areas. Despite policies loosening restrictions on treatment requirements, unintended mental health consequences may arise among this population. We discuss challenges that under-resourced areas face and propose strategies that may improve outcomes for those seeking treatment for SUDs in these areas.

Substance use is a serious and growing problem in the U.S. The impact of substance use disorders is vast and can affect more than the person with the disorder. Drug overdose deaths and related hospitalizations are positively associated with a rise in foster care case nationwide. When a child is removed from a home, social workers see first if there are biological family members who could provide a suitable home for the child as to make the transition less disruptive for the child. The average age of a kin caregiver was 59 years old in 2018, so this likely means grandparents are stepping in the caregiver role. Appalachia specifically has been hit hard by the opioid epidemic, and its rates of both overdose deaths and foster care cases have greatly increased. However, no research has analyzed the association between rates of grandparents as primary caregivers of children and county-level drug overdose mortality rates in Appalachia specifically and then compared that to the same association for non-Appalachian areas. Thus, this study decided to examine the association between those variables with a national dataset made from county-level data from multiple sources, mainly the CDC National Center for Health Statistics and the U.S. Census Bureau American Communities Survey (ACS). A cross-sectional analysis of 5-year estimates for drug overdose mortality on a county-level associated with the ACS data on grandparents acting as primary caregivers of grandchildren under the age of 18 was performed. There were three hypotheses: 1) counties with higher rates of drug overdose mortality will have higher rates of grandparents acting as primary caregivers of children under 18 years old, 2) the rate of grandparents serving as primary guardians of children under 18 years old will be higher in Appalachian counties than in non-Appalachian counties, 3) the correlation between grandparents serving as primary caregivers of children under 18 years old and drug overdose mortality will be stronger in Appalachian counties as opposed to non. For each hypothesis, a bivariate analysis was run independently, and by using multivariate modeling, the association between grandparents as primary caregivers and overdose mortality was evaluated. Running these analyses determined some statistically significant results: as overdose rates increase, rates of grandparent guardians increase; the rate of grandparent caregivers is higher in Appalachian counties than non-Appalachian counties; and there is a stronger correlation between overdose mortality rate increases and grandparents as caregivers increases in Appalachian counties as opposed to non-Appalachian counties. This is useful as there is a lack of research discussing this specific relationship, especially in rural areas such as in Appalachia. Furthermore, these results could help inform policies and programs to support grandparent guardians and help lessen the impacts of parental substance use for children.

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17–10.25, aPR 2.46, 95% CI 1.14–5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19–4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56–12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63–14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission. / amfAR, The Foundation for AIDS Research / Revisión por pares

Substance use disorders are a prominent issue within the United States that must be addressed given the high prevalence, economic cost, and negative health consequences of these medical conditions. Current treatments are inadequate due to the limited success of behavioral therapies and the lack of pharmacological interventions geared towards preventing the neuroplastic changes initiated by substances of abuse that lead to addiction. Sigma-1 receptors represent promising pharmacological targets for treatment of substance use disorders involving cocaine and methamphetamine use. A review of recent studies suggests that sigma-1 receptors contribute to the underlying mechanisms of action utilized by cocaine. Yet the use of sigma-1 receptor antagonists shows promising results of mitigating the physiological effects induced by cocaine. In contrast to cocaine, sigma-1 receptors have yet to be linked to the underlying mechanisms of action utilized by methamphetamine. However studies indicate that the use of sigma-1 receptors agonists creates a neuroprotective effect against the physiological effects induced by methamphetamine. Currently the pharmacological targeting of sigma-1 receptors is not utilized to treat substance use disorders. A review of literature was conducted in order to elucidate the mechanistic role that sigma-1 receptors play in mediating the physiological effects induced by cocaine and methamphetamine that lead to addiction. Using this information, the potential use of sigma-1 receptors as therapeutic targets was discussed in order to provide insight about the benefits and limitations of utilizing such an intervention as treatment for substance use disorders involving cocaine and methamphetamine use.

In 2017, approximately 8.5% of pregnant women nationwide used illicit substances during their pregnancies, up from 6.3% just one year prior (NSDUH, 2017). The trends associated with substance misuse and pregnancy are alarming given the risks to both the mother and her child (Behnke et al., 2013). Pregnant women with substance use disorders (SUDs) are thus in critical need of support during the prenatal period (American Society of Addiction Medicine, 2011). However, they also contend with stigma and the possibility of punitive responses (Terplan et al, 2015), which can result in avoidance of treatment. Prenatal care and positive patient-provider relationships are essential to improved health outcomes (Lori et al, 2011). Yet, little is known about the patient-provider relationship for pregnant women with SUDs and what facilitates trust and women’s willingness to engage in care. Informed by recognition theory and intersectionality, this qualitative study aims to fill that gap, emphasizing the ways patients and providers develop and maintain their relationships, as well as their perceptions of each other. Semi-structured interviews were conducted with N=19 postpartum women with SUDs and N=10 prenatal care providers (not matched pairs). Using a two-layered thematic analytical approach – both data- and theory-driven – this research offers a comprehensive examination of prenatal care in the context of SUDs. Women entered into prenatal care feeling ambivalent about their pregnancy, with co-existing emotions such as guilt and excitement. They were also newly motivated to protect their child, and in need of clear medical information that was free of moral judgment. Women and providers identified provider traits that facilitated trust and connection in the patient-provider relationship, such as being nonjudgmental and supportive. Women also emphasized the value of being fully acknowledged as having worth and dignity. Finally, providers discussed the challenges of working with pregnant patients with SUDs, including the limits of their compassion, as well as the limitations of the health care system. Cumulatively, these findings highlight critical needs in prenatal care for women with SUDs, such as acknowledging women’s dignity, and supporting providers with comprehensive training and a health care system better suited to meet their patients’ needs.

Submitted in fulfillment of the requirements for the degree Doctor of Education in the Department of Educational Psychology in the Faculty of Education at the University of Zululand, South Africa, 2006. / The aim of this study was to investigate the effect of substance abuse by senior primary school learners on their development This was achieved via a literature study and an empirical study. In the light of the findings certain recommendations which can assist educators, principals, parents and the Department of Education to plan and take action in order to combat drug abuse and addiction amongst senior primary school learners, were formulated. Schools have always had and will always have significant influence on learners' lives and must therefore be the focus of any effective implementation of arresting strategies. The senior primary school community has in the past and to a certain extent in the present not treated the increasing use of drugs as a priority. This could possibly be because of the many types of legitimate drugs that are available, and which are said to cure, prevent or slow down-diseases and enable people to lead longer, healthier and happier lives. Antibiotics have improved the treatment of infections and vaccines have prevented the spread of diseases such as measles, while analgesics have lessened or eliminated pain. However, it should be the harmful and illegal drugs that parents and the community should be made aware of. Illegal and harmful drugs infiltrate all levels of society, asking no name, title or gender. They come in many names and forms and they will negatively impact on health, sanity, families and finally people's lives. The literature study found that substance abuse affected the physical, psychological (cognitive and affective), social and normative development of the senior primary school learner. For the purpose of the empirical investigation, a self-structured questionnaire for educators was utilized. The data obtained from the completed questionnaires was processed and analyzed by means of descriptive statistics. The findings

It is increasingly important to understand the factors associated with individuals struggling with addiction and their quality of life, especially with those struggling with co-occurring diagnoses (CODs). The purpose of this study was to explore the extent to which meaning, and CODs of anxiety and depression predict an individual's attitudes and beliefs about addiction among persons receiving treatment for substance use disorders (SUDs). The theoretical foundation used to guide this study was logotherapy, which emphasizes the importance of increasing meaning in life through choices, while also centering on being able to find meaning in all situations. A cross-sectional correlation design was employed, using a sample of patient admission records from a dual diagnosis treatment center in the western United States. The responses on 4 assessments related to meaning, symptoms of anxiety and depression, and attitudes about substances were analyzed using a multiple linear regression. There was no statistically significant relationship between an individual's attitudes and beliefs about addiction as predicted by that individual's meaning and CODs symptoms of anxiety and depression. A significant negative correlation existed between depression and meaning (p < .01), while a significant positive correlation existed between the depression and anxiety (p < .05) as well as the anxiety and attitudes about substances (p < .01). The findings from this study can assist counselor educators in understanding the correlation between SUD, increased depressive symptoms, and low personal meaning.

There has been a dramatic increase in opioid-related overdoses and deaths that have had extensive health impacts in Delaware County, New York. Social workers play a crucial role in working with individuals who have substance use and co-occurring disorders. The study was guided by ecological systems theory and the generalist intervention model focused on the engagement process between social workers and local young people. The current action research study explored the social work practice problem of challenges encountered by clinical social workers who engage in services with young adults ages 18-25 who have or are at risk for substance use disorders in Delaware County. It is essential to identify these challenges to help improve social work services that may potentially reduce substance use rates. The practice focused research question asked the participants their perception of the challenges in providing substance use services for young adult's ages 18-25 who reside in Delaware County. A focus group took place with 4 local private practice, licensed clinical social workers and 1 agency-based, licensed master-level social worker who all have experience working with Delaware County residents. Content analysis was used to explore and organize the data. The study revealed 7 themes that included client resistance, cultural issues, economic factors, professional competence, practitioner limitations, resource gaps, and client engagement. According to the participants, greater advocacy efforts are needed for clinical social work services because of the focus on both the environmental and emotional aspects of service provision. Possible implications for social change will be reduced service gaps that will result in more support options for those struggling with substance use.

Substance use disorders represent a consistent threat to our health care and financial resources. Although mental health professionals are likely to encounter individuals diagnosed with substance use disorders, they are less likely to receive formal graduate training in the area. Furthermore, 12-step groups like Alcoholics Anonymous and Narcotics Anonymous are popular, evidence-based recovery options, yet little is known about perceptions of such groups among clinical trainees. In addition, quantitative evaluations of substance use training modules have seldom been conducted, including a notable lack of methodologically rigorous approaches. To fill these gaps in the literature, the current study examined the efficacy of a brief computer-mediated training intervention, or e-training, designed to increase future clinicians' knowledge and intentions to engage in 12-step-related professional activities (e.g., making an appropriate referral to a 12-step group). Secondary outcomes were beliefs and attitudes about 12-step groups. Fifty participants were randomly assigned to receive the e-training, a brief audio/visual presentation reviewing 12-step recovery philosophy but focusing on academic 12-step literature. Fifty-three participants were randomly assigned to read comparison materials, which were comprised of online readings geared toward professionals, made available by Alcoholics Anonymous and Narcotics Anonymous. Outcomes were assessed at pretest, posttest (i.e., immediately following exposure to intervention or comparison materials), and 4-week follow-up periods. Results of random effects regression analyses showed that the e-training led to significantly greater increases in 12-step recovery knowledge than comparison readings, and that these gains were maintained through follow-up. An intervention effect on intentions to perform 12-step-related professional activities also emerged by follow-up. Exploratory moderation analyses revealed that the intentions effect was more pronounced for women and for trainees who had never attended a 12-step meeting. Secondarily, the e-training led to significantly greater increases in 12-step-positive beliefs and attitudes, though the beliefs effect attenuated by follow-up. Taken together, these data suggest that future clinicians may benefit from a brief e-training about 12-step recovery. More broadly, the study supports the notion that e-trainings are easily disseminated and may help address current limitations in graduate-level substance use clinical training.