A Comprehensive Literature Review of Digital Health Interventions in the Treatment of Substance Use Disorder with Special Focus on Mobile Applications

Journal: Cureus, 2023, doi: 10.7759/cureus.47639

Authors: Harrison R. Jordan, Sidharth Sahni, Mamun M. Ahmed, Joseph E. Fares, Binoy V. Desai, Christine N. Lenchur, & Richard T. Jermyn


COVID-19 quarantine showed an increase in opioid-related deaths partially due to the limited capacity of clinics and treatment centers. Digital health interventions (DHIs) such as telehealth have improved access to treatment, reduced psychosocial barriers, and helped patients with substance use disorder (SUD). An in-depth literature review was conducted to gauge the efficacy and usefulness of DHIs on substance use disorder. PubMed was used with string search terms to identify studies analyzing telehealth for substance use disorders. Studies were eligible and selected if they used health interventions (HIs) and reported outcomes on the efficacy of DHIs, benefits of DHIs, and limitations of DHIs. The Agency of Healthcare Research and Quality (AHRQ) was used to analyze the impact of DHIs on SUD. Lastly, Apple’s App Store was used to identify the current DHI available. The analysis indicated that mobile phone apps were the most appropriate sources to use for patients with substance use disorders. The search also found 36 mobile applications available on the market for patients, containing mainly pain medication diaries and trackers. The study did not find any apps for clinical usage that met the standards necessary for adequate healthcare in the opioid crisis, largely due to a lack of clinician involvement in using applications. Developing adequate DHIs has the potential to improve outcomes in patients with SUD and aid in recovery time. The research concluded that physicians looking to develop DHIs should take into consideration the mode of delivery of DHI, the aim to produce specific health outcomes as opposed to multiple outcomes, and clinician involvement in DHI development. DHIs can become a vital tool for medical professionals, especially during the COVID-19 crisis, as the use of healthcare technology has limited in-person contact, maintained current doctor-patient relationships, and allowed for contact tracing of the disease.

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The Association Between Cannabis Vaping and Other Substance Use

Journal: Addictive Behaviors Reports, 2023, doi: 10.1016/j.abrep.2023.100519

Authors: Ruoyan Sun, David Mendez, & Kenneth E. Warner


Introduction: The popularity of cannabis vaping has increased rapidly, especially among adolescents and young adults. We posit some possible explanations and, to evaluate them, examine whether cannabis vapers differ from non-vaping cannabis users in other substance use.

Methods: Using nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study wave 5 (Dec. 2018-Nov. 2019), we assessed the association between cannabis vaping and other substance use. A total of 1,689 adolescents and 10,620 adults who reported cannabis use in the past 12 months were included in the study. We employed multivariable logistic regressions to assess the association between cannabis vaping and other substance use.

Results: Among past 12-month cannabis users, compared with those who do not vape cannabis, participants who vape cannabis had higher risks of using alcohol (adjusted relative risk [aRR] = 1.04, 95% CI, 1.01-1.07), cigarettes (aRR=1.09, 95% CI, 1.02-1.15), cigars (aRR = 1.17, 95% CI, 1.06-1.30), other tobacco products (aRR = 1.29, 95% CI, 1.14-1.45), electronic nicotine products (aRR = 4.64, 95% CI, 4.32-4.99), other illicit drugs (aRR = 1.53, 95% CI, 1.29-1.80), and misuse of prescription drugs (aRR = 1.43, 95% CI, 1.19-1.72). Compared to older cannabis vapers, younger cannabis vapers were at risk of using more other substances. Cannabis vaping was associated with all seven measures of substance use among young adults.

Conclusions: Compared to non-vaping cannabis users, cannabis vapers have higher likelihood of using other substances. Research is needed to understand why, as well as the implications of the association.

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The Effectiveness of a Telephone Smoking Cessation Program in Mental Health Clinic Patients by Level of Mental Well-Being and Functioning: A Secondary Data Analysis of a Randomized Clinical Trial

Journal: BMC Public Health, 2023, doi: 10.1186/s12889-023-16975-z

Authors: Sarah Swong, Andrew Nicholson, David Smelson, Erin S. Rogers, Omar El-Shahawy, & Scott E. Sherman


Background: Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms.

Methods: The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities. Participants were randomized to specialized telephone counseling (intervention) or state Quitline referral (control). Participants completed assessments at baseline and 6 months, including the BASIS-24, a self-report measure of behavioral health symptoms and functioning. We used the BASIS-24 median to dichotomize participants as having high or low scores. The primary outcome was 30-day self-reported abstinence at 6 months. We compared groups on outcomes by logistic regression and performed an interaction effect analysis between treatment assignment and groups.

Results: At baseline, those with high behavioral health symptoms scores reported heavier nicotine dependence and more sedative and/or antidepressant use, compared to participants with low behavioral health symptoms. At 6 months, participants with low behavioral health symptoms scores in the intervention reported higher rates of 30-day abstinence compared to those in the control arm (26% vs 13%, OR = 2.3, 95% CI = 1.8, 2.9). People with high behavioral health symptoms scores reported no difference in 30-day abstinence between the treatment assignments at 6 months (12% vs. 13%, OR = 1.1, 95% CI = 0.6, 2.0).

Conclusions: Only participants with low behavioral health symptoms scores reported higher abstinence rates in the intervention compared to the state Quitline. Future research can examine alternative approaches for people with worse mental well-being and functioning.

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Engaging Youth as Leaders and Partners Can Improve Substance Use Prevention: A Call to Action to Support Youth Engagement Practice and Research

Journal: Substance Abuse Treatment, Prevention, and Policy, 2023, doi: 10.1186/s13011-023-00582-7

Authors: Parissa J. Ballard, Heather K. Kennedy, Jessica J. Collura, Elena Vidrascu, & Chelsey Garcia Torres


Background: As a subfield of prevention science, substance use prevention researchers and professionals are increasingly focused on translating research into practice, developing the workforce of prevention specialists, and creating a robust prevention infrastructure. One critical need for professional development among the substance use prevention workforce is training and technical assistance around how to include young people in developing, implementing, and evaluating substance use prevention programs.

Main body: Amplifying youth voices can increase the quality and responsiveness of youth prevention research and practice, as well as hasten and improve the translation of prevention interventions into practice while also benefiting youth themselves. Yet, youth engagement is multi-layered and nuanced. Training prevention professionals who work with youth in youth development and youth/adult partnerships is critical to support meaningful youth engagement efforts. We assert that the substance use prevention workforce needs at least three specific competencies to engage youth meaningfully in prevention: 1) understand adolescent development and the core elements of youth-adult partnerships; 2) apply this knowledge to program design and practice; and 3) implement relational practices to share power with young people.

Conclusion: Incorporating the insights of young people can improve substance use prevention. The substance use prevention workforce should be supported in developing competencies to meaningfully engage youth. These competencies require training, and resources must be devoted to support appropriate training.

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Trends in Reported and Biologically Confirmed Drug Use Among People Who Use Ecstasy in the Nightclub/Festival-Attending Population, 2016-2022

Authors: Joseph J. Palamar, Alberto Salomone, Marta Massano, & Charles M. Cleland


Background: Nightclub/festival attendees are a population with high rates of party drug use, but research is needed to determine whether there have been shifts in unintended drug exposure in this population (e.g., via adulterants) to inform prevention and harm reduction efforts.

Methods: Adults entering nightclubs and festivals in New York City were asked about past-year drug use in 2016 through 2022, with a subset providing a hair sample for testing. We focused on the 1943 who reported ecstasy use (of which 247 had a hair sample analyzed) and compared trends in self-reported drug use, drug positivity, and adjusted prevalence (adjusting for unreported use).

Results: MDMA positivity decreased from 74.4 % to 42.3 %, and decreases occurred regarding detection of synthetic cathinones (“bath salts”; a 100.0 % decrease), MDA (a 76.9 % decrease), amphetamine (an 81.3 % decrease), methamphetamine (a 64.2 % decrease), and ketamine (a 33.4 % decrease) (ps < .05). Although prevalence of MDA and synthetic cathinone use was comparable between self-report and adjusted report in 2022, gaps in prevalence were wider in 2016 (ps < .01). Adjusted prevalence of synthetic cathinone use decreased more across time than prevalence based on self-report (a 79.4 % vs. 69.1 % decrease) and adjusted report for MDA use decreased more than prevalence based on self-report (a 50.6 % vs. 38.9 % decrease).

Conclusions: Combining self-report and toxicology tests helped us determine that decreases in drug use/exposure were steeper regarding adjusted prevalence. Underreported drug exposure-possibly due to exposure to adulterants-appears to have had less of an effect on prevalence in 2022 than it did in 2016.

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