Transitions in Mental Health and Addiction Care for Youth and their Families: A Scoping Review of Needs, Barriers, and Facilitators

Journal: BMC Health Services Research, 2023, doi: 10.1186/s12913-023-09430-7

Authors: Roula Markoulakis, Hinaya Cader, Samantha Chan, Sugy Kodeeswaran, Tracey Addison, Cathy Walsh, Amy Cheung, … Anthony Levitt


Introduction: Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care.

Methods: This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12–29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking).

Results: A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families’ needs are met, barriers are mitigated, and facilitators are enhanced.

Conclusion: This review provides essential contextual information regarding TAY with MHA concerns and their families’ needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population’s needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

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National Institute on Drug Abuse Clinical Trials Network Meeting Report: Advancing Emergency Department Initiation of Buprenorphine for Opioid Use Disorder

Journal: Annals of Emergency Medicine, 2023, doi: 10.1016/j.annemergmed.2023.03.025

Authors: Ethan Cowan, Jeanmarie Perrone, Steven L. Bernstein, Edouard Coupet Jr, David A. Fiellin, Kathryn Hawk, Andrew Herring, Kristen Huntley, … Gail D’Onofrio


Opioid use disorder and opioid overdose deaths are a major public health crisis, yet highly effective evidence-based treatments are available that reduce morbidity and mortality. One such treatment, buprenorphine, can be initiated in the emergency department (ED). Despite evidence of efficacy and effectiveness for ED-initiated buprenorphine, universal uptake remains elusive. On November 15 and 16, 2021, the National Institute on Drug Abuse Clinical Trials Network convened a meeting of partners, experts, and federal officers to identify research priorities and knowledge gaps for ED-initiated buprenorphine. Meeting participants identified research and knowledge gaps in 8 categories, including ED staff and peer-based interventions; out-of-hospital buprenorphine initiation; buprenorphine dosing and formulations; linkage to care; strategies for scaling ED-initiated buprenorphine; the effect of ancillary technology-based interventions; quality measures; and economic considerations. Additional research and implementation strategies are needed to enhance adoption into standard emergency care and improve patient outcomes.

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Evaluating Cannabis Exposure in Survey Items: Insights, Strategies, and Remaining Challenges Identified from Cognitive Interviewing

Journal: Drug and Alcohol Dependence Reports, 2023, doi: 10.1016/j.dadr.2023.100161

Authors: Claire A. Walsh, Cara A. Struble, Efrat Aharonovich, Dvora Shmulewitz, Jacob Borodovsky, Mohammad I. Habib, Alan Budney, Ofir Livne & Deborah S. Hasin


Background: The diversity in characteristics of cannabis products and behavior patterns make evaluation of cannabis exposure in population-based, self-report surveys challenging. Accurate identification of cannabis exposure and related outcomes necessitates a thorough understanding of participants’ interpretations of survey questions assessing cannabis consumption behaviors.

Objectives: The current study utilized cognitive interviewing to gain insight on participants’ interpretation of items in a self-reported survey instrument used to estimate the quantity of THC consumed in population samples.

Methods: Cognitive interviewing was used to evaluate survey items assessing cannabis use frequency, routes of administration, quantity, potency, and perceived “typical patterns” of use. Ten participants ≥18 years (n = 4 cisgender-men; n = 3 cisgender-women; n = 3 non-binary/transgender) who had used cannabis plant material or concentrates in the past week were recruited to take a self-administered questionnaire and subsequently answer a series of scripted probes regarding survey items.

Results: While most items presented no issues with comprehension, participants identified several areas of ambiguity in question or response item wording or in visual cues included in the survey. Generally, participants with irregular use patterns (i.e., non-daily use) reported more difficulty recalling the time or quantity of cannabis use. Findings resulted in several changes to the updated survey, including updated reference images and new quantity/frequency of use items specific to the route of administration.

Conclusion: Incorporating cognitive interviewing into cannabis measurement development among a sample of knowledgeable cannabis consumers led to improvements in assessing cannabis exposure in population surveys, which may otherwise have been missed.

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Examining Neurobehavioral Differences that Support Success in Recovery from Alcohol and other Substance Use Disorders

Journal: Journal of Substance Use and Addiction Treatment, 2023, doi: 10.1016/j.josat.2023.209007

Authors: Medha K. Satyal, Julia C. Basso, Hannah Wilding, Liqa N. Athamneh & Warren K. Bickel


Objective: Substance use disorders (SUDs) are brain disorders associated with impairments resulting from the recurrent use of alcohol, drugs, or both. Though recovery is possible, SUDs are chronic, relapsing-remitting disorders, with estimates of SUD relapse at 40–60%. Currently, we know little about the mechanisms underlying successful recovery processes and whether substance-specific mechanisms exist. The current study sought to examine delay discounting (a measure of future valuation), executive skills, abstinence duration, and health behaviors in a population of individuals in recovery from alcohol, stimulants, opioids, and other substances.

Methods: In this observational study, we utilized a cohort of individuals (n = 238) from the International Quit and Recovery Registry, an online registry for those in recovery from SUDs around the world. We assessed delay discounting through a neurobehavioral task, and assessed abstinence duration, executive skills, and engagement in positive health behaviors through self-report measures.

Results: We found that delay discounting, executive skills, and engagement in positive health behaviors were similar among individuals in recovery from different substances. Abstinence duration was associated with delay discounting and engagement in health behaviors. Additionally, executive skills and engagement in health behaviors were positively associated.

Conclusion: These findings suggest that common behavioral mechanisms support recovery from misuse of various substances. As both delay discounting and executive skills are dependent upon executive brain centers, such as the prefrontal cortex, strategies that target executive functioning, such as episodic future thinking, meditation, or exercise, may be efficient strategies for optimizing recovery from SUDs.

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Barriers to Opioid Use Disorder Treatment: A Comparison of Self-Reported Information from Social Media with Barriers Found in Literature

Journal: Front Public Health, 2023, doi: 10.3389/fpubh.2023.1141093

Authors: Whitney Bremer, Karma Plaisance, Drew Walker, Matthew Bonn, Jennifer S. Love, Jeanmarie Perrone & Abeed Sarker


Introduction: Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers.

Methods: In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described.

Results: On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%).

Conclusion: The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.

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