Mental Health Facilities With Ketamine Infusion Therapy in the United States in 2020: Co-Location of Dual Diagnosis Mental Health and Substance Use Disorder Treatment

Ketamine is an anesthetic that has been identified as an effective therapy for depressive disorders and related symptoms. Some studies have identified ketamine as having the potential to reduce substance use among individuals with a substance use disorder (SUD)-alongside psychotherapy. Further, SUDs often co-occur with depressive disorders. Using the National Mental Health Services Survey 2020, this study examined a national sample of N = 134 U.S. mental health treatment facilities that provide ketamine infusion therapy (KIT) to identify their geographic locations; availability of individual, couples/family, and group counseling; payment options; and capacity to provide treatment for dually diagnosed mental health (MH) and substance use disorders. Approximately 63% (n = 85) of the facilities in this sample had dual diagnosis MH and SUD treatment. Having group therapy was associated with having dual diagnosis MH and SUD treatment. Alternatively, accepting Medicaid was not associated with having dual diagnosis MH and SUD treatment. This exploratory study estimates dual diagnosis MH and SUD treatment availability among MH treatment facilities offering KIT. Given evidence of KIT's ability to effectively treat depressive disorders and that SUDs often co-occur with them (ketamine's effectiveness in treating substance use disorders warrants further study), the present study's up-to-date information about the distribution salient characteristics of MH facilities that offer this effective treatment can inform future efforts to identify the potential of these facilities to treat co-occurring disorders with ketamine and psychotherapy

Higher stress during admission predicts shorter treatment retention in residential treatment

Background: Over one million people in the United States received residential treatment for a substance use disorder (SUD) in 2020. Shorter treatment retention is associated with adverse outcomes compared to individuals retained in treatment longer. Entering treatment with higher stress may be associated with leaving prematurely. This study aims to examine the impact of perceived stress during admission on treatment retention in a short-term residential treatment facility. Methods: This study used de-identified data of 357 treatment episodes of adults entering a short-term (28-day) urban Mid-Atlantic residential facility between October 2019 through February 2020. The dataset included demographic characteristics, substance use characteristics, treatment completion status, treatment retention, and perceived stress. Perceived stress was measured by the 10-item perceived stress scale, with higher scores indicating greater perceived stress. Treatment completion status is a binary variable that identifies individuals as completing treatment or prematurely discharging from treatment. Treatment retention is the number of days completed during treatment. Univariate and bivariate analyses were used to describe the sample. A multivariable Cox regression model was used to examine premature treatment discharge as the event and the number of days in treatment as time. Results: The sample was primarily male (72.0%) and non-Hispanic Black (71.4%). Most of the sample had heroin as their primary substance (55.4%), and alcohol was the second most identified primary substance (23.0%). Most of the sample were polysubstance users (68.9%). A slight majority (53.5%) completed the full 28 days of treatment, with the average length of treatment for the full sample being 19.1 days. The number of days in treatment and perceived stress were negatively associated (rs = -.155, p \u3c .01). The Cox regression model found higher perceived stress (aHR = 1.031, 95% CI = 1.008-1.054, p = .008) and younger age (aHR = .985, 95% CI = .971-.999, p = .033) was associated with a shorter treatment retention. Conclusions: Early stress management interventions during treatment admission may increase treatment retention in short-term residential treatment

Frequent Use of Contingency Management and Opioid Treatment Programs that Provide Treatment for More than Only Opioid Use Disorder

Contingency management is an effective behavioral intervention for treating substance use disorders that provides patients with incentives for objective verification of completed targeted recovery behaviors including abstinence from substances, attending treatment, and medication adherence. Accredited/licensed opioid treatment programs provide effective, medications for opioid use disorder. This study evaluated the prevalence of frequent contingency management use among a national sample of opioid treatment programs in the U.S. (N= 672). A binary logistic regression model examined factors associated with providing contingency management, including state-level fatal overdoses, number of pharmacotherapies, outpatient treatment, facility ownership, and residential treatment. Most evaluated facilities provided contingency management (n=440; 65.5%). Facilities that prescribed more pharmacotherapies, were located in states with high drug overdose death rates, and for-profit (compared to nonprofit) providers were more likely to offer contingency management. Because contingency management effectively treats substance use disorders, contingency management should be offered more broadly across opioid treatment program

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

Codeine and promethazine: Exploratory study on “lean” or “sizzurp” using national survey data and an online forum

Background The concoction known as "lean" containing codeine and promethazine, holds a prominent cultural presence and is often referenced in mass media platforms (e.g., music and social media). Surprisingly, there’s a scarcity of national data characterizing the use of lean. Therefore, the current study investigated the use of lean using national survey data and online forum participant input, and focused on identifying concurrent substance use, exploring co-administration with other substances (e.g., alcohol, cannabis), and determining lean-related experiences. Methods We analyzed data from the National Survey on Drug Use and Health (NSDUH) spanning 2007–2019, identifying persons who used lean (weighted N = 42,275). Additionally, we conducted a Reddit-based study to gather insights about lean consumtion (N = 192). Results The NSDUH data indicated that lean use was most prevalent among teenagers and young adults (ages 13–21), accounting for 66% of the sample. This trend was more pronounced in male respondents (75%) compared to females. Additionally, the use was predominantly observed among Black/African American (29%), Hispanic (28%), and White (33%) populations, with these groups also reporting higher levels of concurrent alcohol and cannabis use. Similarly, findings from Reddit showed that individuals who used lean were predominantly male (67%) and exhibited elevated concurrent rates of alcohol (83%) and cannabis (46%) use in the past 30 days. Moreover, approximately 66% of respondents met criteria for severe lean use disorder, and 37% acknowledged driving under its influence. Conclusion The NSDUH data found that mostly young adult males reported consuming lean in the past twelve months, though the racial/ethnic breakdown of persons who used lean was diverse. The Reddit data found that most individuals in the sample met the criteria for a substance use disorder pertaining to their lean consumption. These findings underscore the clinical significance and necessity for further controlled research on lean

Examining facilitative services for entry into substance use disorder treatment: A cluster analysis of treatment facilities

Objectives We examined services to facilitate access to entering substance use disorder (SUD) treatment among a national sample of SUD treatment facilities. Methods We analyzed data from the National Survey of Substance Abuse Treatment Services (N-SSATS) 2020. Facilities were included in the sample based on criteria such as SUD treatment provision and being in the U.S. Cluster analysis was conducted using variables including ownership, levels of care, and whether facilities provide services or accept payment options aimed at reducing treatment barriers. National and state-level data on the percentage of facilities in each cluster were presented. Results Among N = 15,788 SUD treatment facilities four distinct clusters were identified: Cluster 1 consisted of for-profit and government outpatient facilities with high proportions of services to reduce barriers (22.2%). Cluster 2, comprised of non-profit outpatient facilities, offered the most comprehensive array of services to minimize barriers to treatment among all four clusters (25.2%). Cluster 3 included facilities with diverse ownership and care levels and provided a moderate to high degree of services aimed at reducing entry barriers to treatment (26.0%). Cluster 4 was primarily for-profit outpatient facilities with a low proportion of these services (26.6%). Conclusions This study revealed facility-level groupings with different services to reduce barriers to SUD treatment across various clusters of SUD treatment facilities. While some facilities offered extensive services, others provided fewer. Differences in cluster distributions point to possible facilitators to treatment access for some persons seeking admission to specific treatment facilities. Efforts should be made to ensure that individuals seeking SUD treatment can access these services, and facilities should be adequately equipped to meet their diverse needs

Operational definition of precipitated opioid withdrawal

Background Opioid withdrawal can be expressed as both a spontaneous and precipitated syndrome. Although spontaneous withdrawal is well-characterized, there is no operational definition of precipitated opioid withdrawal.MethodsPeople (N = 106) with opioid use disorder maintained on morphine received 0.4 mg intramuscular naloxone and completed self-report (Subjective Opiate Withdrawal Scale, SOWS), visual analog scale (VAS), Bad Effects and Sick, and observer ratings (Clinical Opiate Withdrawal Scale, COWS). Time to peak severity and minimal clinically important difference (MCID) in withdrawal severity were calculated. Principal component analysis (PCA) during peak severity were conducted and analyzed with repeated measures analyses of variance (ANOVA).ResultsWithin 60 min, 89% of people reported peak SOWS ratings and 90% of people had peak COWS scores as made by raters. Self-reported signs of eyes tearing, yawning, nose running, perspiring, hot flashes, and observed changes in pupil diameter and rhinorrhea/lacrimation were uniquely associated with precipitated withdrawal. VAS ratings of Bad Effect and Sick served as statistically significant severity categories (0, 1–40, 41–80, and 81–100) for MCID evaluations and revealed participants' identification with an increase of 10 [SOWS; 15% maximum percent effect (MPE)] and 6 (COWS; 12% MPE) points as meaningful shifts in withdrawal severity indicative of precipitated withdrawal.ConclusionData suggested that a change of 10 (15% MPE) and 6 (12% MPE) points on the SOWS and COWS, respectively, that occurred within 60 min of antagonist administration was identified by participants as a clinically meaningful increase in symptom severity. These data provide a method to begin examining precipitated opioid withdrawal

Mixed-methods analysis of satisfaction during a 12-session mindfulness-based intervention for women with a substance use disorder and trauma symptomatology

Satisfaction with an intervention influences the uptake of behavior changes and the long-term efficacy of the intervention. Therefore, it is crucial to assess satisfaction by participant profile when creating and adapting behavior interventions for minoritized populations. Qualitative and quantitative data on participant trauma symptom severity and intervention satisfaction were collected through self-report surveys from 54 women. The sample was 59.3% Hispanic, with an average age of 33.21 (SD = 10.42), who were in residential treatment for substance use disorders (SUDs) and participated in a 12-session mindfulness-based intervention. Qualitative responses were coded using thematic analysis, and an integrative mixed-methods approach was used to compare qualitative theme frequency between high-trauma (N = 28) and low-trauma (N = 26) groups at session 2 and session 11. High- and low-trauma groups were determined by interquartile ranges (bottom 25% = low; top 75% = high). In session 2, the low-trauma group reported significantly higher satisfaction (M = 4.20, SD = 0.55) than the high-trauma group (M = 3.77, SD = 0.89); t(43) = 1.90, p = 0.03. In session 11, there was no significant difference between groups. The mixed-methods analysis revealed that “trouble focusing” appeared more frequently in the high-trauma group than in the low-trauma group during session 2, but the theme was not present in either group at session 11, suggesting that this might pose an initial barrier for individuals with high trauma but subsides as the intervention progresses. This speaks to the importance of retention strategies tailored for participants with SUDs and high trauma while they adjust to the intervention. Assessing initial challenges with satisfaction may help facilitators intervene to increase participant satisfaction

Prevalence of co-occurring conditions among youths receiving treatment with primary anxiety, ADHD, or depressive disorder diagnoses

Introduction: Anxiety disorders, depressive disorders, and attention-deficit/hyperactivity disorder (ADHD) are some of the most common conditions that youths (≤ 18 years old) receive mental health treatment for. These conditions are associated with high-risk substance use or substance use disorders (SUDs). This study sought to identify the proportion of youths (≤ 18 years old) with anxiety disorders, depressive disorders, or ADHD as a primary diagnosis in community mental health centers (CMHCs) having co-occurring high-risk substance use or a SUD. Methods: Analysis included binary logistic regression models using the Mental Health Client-Level Data 2017 to 2019 datasets which contains annual cross-sectional administrative data from mental health treatment facilities. The final sample included n = 458,888 youths with an anxiety disorder as a primary diagnosis, n = 570,388 youths with a depressive disorder as a primary diagnosis, and n = 945,277 youths with ADHD as a primary diagnosis. Results: In the subsample with anxiety as a primary diagnosis, approximately 5% of youth had high-risk substance use or a SUD. Approximately 10% of youth with depression as a primary diagnosis had high-risk substance use or a SUD. Among youth with ADHD as a primary diagnosis, 5% had high-risk substance use or a SUD. Odds of having a co-occurring high-risk substance use or SUD differed based on the youth's age, region, race and ethnicity, gender, and their number ofother mental health diagnoses. Conclusions: Effective care for this high-need youth population at CMHCs will require mental health clinicians to possess knowledge and skills related to substance use treatment

sj-doc-1-sat-10.1177_11782218231195226 – Supplemental material for Lean/Sizzurp Ingredients, Use, and Coping With Mental Health Symptoms

Supplemental material, sj-doc-1-sat-10.1177_11782218231195226 for Lean/Sizzurp Ingredients, Use, and Coping With Mental Health Symptoms by Orrin D Ware in Substance Abuse: Research and Treatment</p