Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States

Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use

Early Onset Bullous Emphysema Associated with Polysubstance Use

The burden of COPD in the United States is tremendous. This disease is not only among the leading causes of mortality annually, but also takes a heavy financial toll.1 Bullous emphysema is a severe variant of COPD. The primary identified risk factor for bullous emphysema is tobacco use; however, the impact of other substances is not clearly delineated.2 This case presents a patient diagnosed with severe bullous emphysema at age 33 with substantial disease progression over the course of 12 years associated with much scarcer tobacco use than would be expected but a prominent history of methamphetamine and marijuana use. Marijuana and amphetamine-type stimulants are the most widely used illicit substances in the world, and prevalence of both are increasing in the United States. In 2020, an estimated 14.2 million Americans had a marijuana use disorder and 1.5 million had a methamphetamine use disorder.3-7 A better understanding of how these substances may contribute to development and progression of chronic lung disease, both individually and perhaps synergistically, is necessary to guide discussions with patients and inform effective public health efforts

Youth Recruitment Specialist

There has been a major increase in youth substance abuse in the United States. Youth substance abuse reports mention that 2.08 million of 12 to 17-year-olds have reported using drugs in the past month. Many youth are not aware of the effects of consuming drugs and the psychological effects that arise. The project focus is on the lack of drug use education is an issue among youth. Friday Night Live is a non-profit organization that is designed to prevent alcohol, tobacco, and other drug use among youth. The project created a position that focuses on recruiting youth for the agency and recruiting guest speakers that have knowledge on substance use disorder. The project consisted of three, one hour meetings with guest speaker presentations on substance use prevention. More than twelve youths attended the presentations. The results were that the majority of the youth found the educational workshops very informative and useful. Having substance use education guest speakers made the youth gain knowledge and awareness, which reduces youth substance abuse in the United States

Assessing Provider Use of Veterans Health Administration Tobacco-Cessation Guideline

Cigarette use is more prevalent among veterans who have mental disorders than it is in the general population. Rates of tobacco use are also high among individuals who suffer from post traumatic stress disorder, addiction, and human immune deficiency disease. Approximately 22.7 million American veterans and their families are at risk of tobacco-related health problems. Concerned about heavy tobacco use among veterans, the U.S. Department of Veterans Affairs developed a Tobacco-Cessation Guideline to be used nationally. This guideline was updated in 2008 to include the \u275A\u27 mnemonic (ask, assess, advise, assist, and arrange) and is recommended for use by physicians, nurses, nurse practitioners, social service providers, and psychologists in Veterans Health Administration facilities when screening veterans for tobacco use. This doctoral capstone project involved evaluation of the Tobacco-Cessation Guideline by deploying a retrospective chart audit to assess implementation by first-line clinicians. Randomization of patient identifiers was used so that 18 Health Insurance Portability and Accountability Act patient identifiers were not recorded. The project was conducted at a Domiciliary and Residential Rehabilitation Treatment Program located in an urban area in the southern United States. Results of this project included raised awareness of first-line clinicians through electronic health record reminders, clinical outcome evaluations, and patient satisfaction surveys. These initiatives improved providers\u27 effectiveness in documenting interventions, in addition to substantially improving the treatment progress made by each veteran. The sustainability of this effort will require long-term organizational commitment that will help to drive a change in practice and encourage positive attitudes toward tobacco cessation in the general population

Mental Health Among Northern New Hampshire Young Adults

The highest rates of mental disorder are observed in young adulthood, and in the United States, young adult women suffer from higher rates of major depressive disorder and lower rates of substance use disorder than do young adult men. National estimates in 2010 find that, although rural (non-metropolitan) rates are similar to non-rural (metropolitan) rates nationwide, sex differences in depressive and substance abuse disorders are less apparent in rural America. Whereas non-rural young women show higher rates of depressive disorder than non-rural young men, such rates are comparable for rural young women and men nationwide. Likewise, rural young men abuse alcohol at higher rates than rural young women, but unlike their non-rural counterparts, rural young men are no more likely than rural young women to abuse tobacco, marijuana, or other illicit substances. Within rural contexts, then, it would appear that depressive and substance abuse disorders are more or less equally distributed across sex

Australia: Prevention of Tobacco use and Cigarettes

The use and abuse of Alcohol and Tobacco are two concerns of public health care system in Australia. In 1995, 3.2 adults in Australia were identified at risk of developing chronic conditions from smoking tobacco. This was equivalent to around 23.5% of the adult population (quitnow). Tobacco is associated with an increased risk of a wide range of health conditions, including heart disease, diabetes, stroke, cancer, renal disease, eye disease and respiratory conditions such as asthma, emphysema and bronchitis. Higher infant and young adult mortality rate. Tobacco products are also linked to habitual forming good making the user depending on their use. The epidemiologic research on the number of death tolls in Australia of men who smoke in 2010 where 15-19.9% which puts Australia at higher risk of mortality compared to countries in the developing regions. Young adults 18 and older are the most identifiable age characteristics of the population at risk. High income groups are another identifiable population characteristic that is affected by smoking and tobacco products (Australian Bureau of Statistics). The current laws in Australia advocates for the prevention of smoking through the anti-smoking mass media campaign between 2014-2016. No laws are set by the government to reach a completely smoke free environment. However, Australia’s health insurance partially covers all costs for his/her support tobacco dependences (WHO). Andrea’s research looks into behavioral patterns of the user with illicit substance disorder and compares that research with persons of the United States in developing a more effective health and clinical intervention to reduce smoking behavior. Persons of tobacco can be a preventative public health intervention with the proper implementation of legislative policies and clinical support systems to reduce the risk of specific identified persons on a demographic subgroup

Risk Assessment of Sleep Disorder and Disease Co-Morbidity Across Army Installations from OTSG Health of the Force Report

The impact of sleep disorders on active duty Soldiers’ medical readiness is clinically significant. Sleep disorders present high comorbidity with disease states directly impacting medical readiness, ranging from musculoskeletal injury (MSK-I), obesity, and drug dependence. Patient data generated from military health databases can be accessed to examine such relationships. The current study performed a risk assessment of sleep disorder comorbidity with MSK-I, obesity, and drug dependence across active duty United States Army installations through a comprehensive analysis of the Office of the Surgeon General Health of the Force (HoF) report, specifically for Fiscal Year (FY) 2017. Health incidences (percent active duty per installation) were queried from the HoF FY 2017 (n = 471,000; 85.5% male, > 70% between 18 -34). Nonparametric ranked tests identified active duty Army installations at low risk (green; 75% percentile relative to mean rank). Linear regressions determined extent of comorbidity of sleep disorders with MSK-I, obesity, and drug dependence (tobacco use and substance abuse). Mean rank comparisons for sleep disorders vs. injury index (p=0.499), obesity (p=0.306), tobacco use (p=0.378), and substance abuse (p=0.591) did not differ for each installation. Further, there was a high degree of co-morbidity for mean percentage of diagnosed sleep disorder with injury index (p 1 h each day. These risk assessments mirror geographical risk data from the Center for Disease Control (CDC) which is surprising because there is a large degree of inter-individual variability in geographical origin, race/ethnicity, and socioeconomic statuses within a single Army installation. Nevertheless, these data demonstrate strong geographical influences on health risk comorbidity in active duty Soldiers comparable to civilian sectors

Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods.

One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States

Barriers and solutions to addressing tobacco dependence in addiction treatment programs.

Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients