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.

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.

Indiana University-Purdue University Indianapolis (IUPUI) / The United States is experiencing a severe opioid use epidemic with more than 2 million people currently suffering from opioid use disorder (OUD), of which, over 1 million need treatment. Opioid treatment programs (OTPs) are evidence-based modality providing comprehensive care to individuals experiencing OUD. OTPs provide counseling, medical assessments, and medication-assisted treatment, which decrease the use of illicit opioids, reduce associated deaths, criminality, and improve the psychosocial wellbeing of its patients. However, OTPs have been extensively regulated at the federal, state, and local levels with little consistency and varying degrees of enforcement across the country, particularly at the state level, creating a “regulatory fog”. This complex regulatory environment has made it challenging to study new or changing regulations and their impact on health outcomes. In order to better understand the variation of OTP regulation, this dissertation: (1) employs public health law research methods to map the entire landscape of state-level regulation of OTPs and associated state characteristics in effect on January 1, 2017; (2) examine how state-level regulations affect the delivery of care from the perspective of OTP administrators through key-information interviews; and (3) examines associations between regulatory burden and related health outcomes of individuals experiencing OUD, by state.

Substance use disorders (SUD) are among the most significant worldwide public health challenges. Isolation and separation are some of the more common indicators of SUD. Even though various music therapy interventions are used to address clinical goals when working with clients with SUD, voicework, specifically, has not been abundantly researched with this client group. Research has shown that the use of the voice has the ability to turn isolation into connection. This qualitative study therefore examined whether voicework with this client group could facilitate connection. Seven clients participated in six group music therapy sessions held at a halfway house over three weeks. The sessions as well as the one focus group were transcribed, and thick descriptions were written of musical excerpts; all were then analysed thematically. From the data, the following four themes were developed: (1) multiple forms of connection were afforded through voicework in music therapy; (2) music therapy offered multiple opportunities for facilitating connection; (3) particular techniques were useful for enhancing connection; (4) a music therapy process, centred around voicework, offered participants an experience in which they could reflect on connection and disconnection. The findings suggest that voicework can be a useful intervention within music therapy to create opportunities for connection to both the self and other. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2021. / Music / MMus (Music Therapy) / Unrestricted

Exercise training for clients at out-patient drug rehabilitation centers likely helps with coping skills. However, a better examination of the mechanisms producing changes may help identify effective interventions. PURPOSE: To test the effect of a vigorous exercise prescription on drug abstinence in voluntary rehabilitation patients. METHODS: 25 surveyed participants in a male drug treatment program underwent a 12-week minimum training program. The program included moderate-rigorous exercise and psychotherapy. Three days per week all subjects participated in EP for 90 minutes. Subjects also participated in ABIT 3 days per week where each session lasted 2 hours. Subjects also participated in ESM which ran for 90 minutes 5 days per week. Within each week, program participants also completed between 2-3 hours of psychotherapy (individual and/or group) per day, varying depending on level of care and phase of the treatment process. Exercise performance and adherence, sobriety and relapse rates, and emotional coping skills were collected. RESULTS: Subjects experienced frequent relapse (5±8 occurrences) prior to admission; however, 84% were currently sober on completion of the program, 8% relapsed during treatment, and 36% relapsed after treatment. The longest duration of sobriety a subject achieved was 273±111 days. Post-treatment survey results indicate 84% of subjects still exercised regularly, 68% continued to practice yoga or meditation, and 60% followed a diet that required disciplined awareness. Bench press max improved significantly throughout the program (39%; p<.001), as did squat (55% improvement; p<0.001) and deadlift (69.8%; p<0.001). On completion of the survey 91% of patients who exercised regularly were sober; 50% of patients who did not engage in regular exercise were sober on completion of the program (P=0.043). Owing to a small sample of patients who relapsed during treatment (N=2), the difference in exercisers who relapsed during treatment (5%) and non-exercisers who relapsed (25%) was not significant (P=0.171). Twenty-nine percent of exercisers relapsed after treatment; 75% of non-exercisers relapsed after treatment (P=0.076). The odds of managing adverse emotional states when they arose increased 20-fold among subjects who reported regular participation in exercise (Nagelkerke R2=0.333; P=0.036). Similarly, each additional day per week that a patient practiced yoga predicted a 20-day increase in duration of sobriety (R2=0.227; P=0.016). CONCLUSION: Exercise training exerts a statistically significant positive effect for sobriety and coping skills within a population that previously struggled with perpetual relapse.

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Background: Sedatives and hypnotics are substances to calm or relieve anxiety and to induce sleep. Long term prescription of benzodiazepines/Z-drugs may lead to the development of tolerance and the need to increase the dose. It is important to be aware of the risks of uncontrolled use of these drugs, such as harmful interactions with other substances, side effects and potential for abuse or addiction. Aim: The aim of this research was to describe abuse of sedatives and hypnotics from the user's perspective, to focus on circumstances leading to drug abuse, to describe beginning and course of the use of these drugs and self-awareness of the problem. The aim was also to describe the current state of users and their needs. Sample: The research sample consisted of 6 participants, of which 4 women and 2 men currently or recently using sedatives and hypnotics (specifically benzodiazepines/Z-drugs). Methods: Data were collected through a qualitative approach using a semi-structured interview. Interviews were conducted, rewritten into protocol summary, further analysed using thematic analysis, modified using open and axial coding and categorization methods. Results: Respondents may have misused sedatives and hypnotics to self-medicate symptoms. These drugs were prescribed for the first time with...

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Despite the fact that more men are diagnosed with substance use disorder, women escalate their drug consumption faster, exhibit higher craving during withdrawal, and have poorer treatment outcomes. Furthermore, as our cultural expectations of men and women have changed, there has been an increase in drug use in women and this increase is likely to persist. Preclinically, female rodents show stronger behavioral responses to drugs of abuse during initiation, escalation, and reinstatement of drug seeking. These behavioral differences are accompanied by alterations in structural plasticity within the mesocorticolimbic reward system. However, little is known about what functional sex differences exist in glutamate transmission in these circuits. The goal of these experiments was to determine functional sex differences in reward circuitry that may underlie behavioral sex differences in substance use disorder. We found heightened glutamate transmission in both the medial prefrontal cortex and nucleus accumbens in females compared to males. These findings corresponded with the nucleus accumbens being less plastic in females. We then investigated the role of PKMζ, a glutamatergic AMPA receptor trafficking protein, in plasticity and opioid-taking. We found PKMζ plays a role in synaptic plasticity within the nucleus accumbens and it works to blunt oxycodone-taking and motivation in a dose-dependent manner. Taken together these findings suggest there are functional sex differences at many levels within the reward system and gaining a better understanding of these differences could provide insight into improved treatments for substance use disorder. / Psychology

The U.S. Department of Health and Human Services has declared the misuse of opioid prescription drugs as a public health emergency. The Affordable Care Act’s Medicaid expansion expanded the number of people with insurance and increased the demand for services related to substance abuse treatment. In the first part of this study, the researcher examines whether the Medicaid expansion reduced the likelihood of treatment delay. The second part of this study explores whether the length of stay for opioid use disorder treatment is significantly different in states that adopted Medicaid expansion versus states that did not. In both studies, the researcher analyzes administrative data from the Substance Abuse and Mental Health Services Administration to discover any treatment delays associated with the opioid treatments for the states that adopted the expansion versus the states that did not, and to determine whether there was a difference in the length of stay in the states that adopted the Medicaid versus the states that did not. A difference-in-difference approach is used in both studies to compare the states which adopted an optional Medicaid expansion to those non-adoption states. The evidence suggests that demand for opioid treatment services increased in expansion states as there is a decreased probability of obtaining treatment on the first day for initial requests for outpatient treatment. In addition, evidence suggests that Medicaid expansion increased the likelihood of staying longer in outpatient facilities, but not inpatient facilities. / Business Administration/Risk Management and Insurance