The Substance Use Disorder Treatment Gap Among US College Students: Findings from the 2021 National Survey on Drug Use and Health

Journal: Drug and Alcohol Dependence Reports, 2024, doi: 10.1016/j.dadr.2024.100279

Authors: Emily Pasman, Lisa Blair, Marvin A. Solberg, Sean Esteban McCabe, Ty Schepis, & Stella M. Resko

Abstract:

Background: Substance use and substance use disorders (SUD) are prevalent among college students. Information about the gap between substance use treatment need versus treatment receipt can guide efforts to increase service access. This study examined past-year DSM-5 SUD and receipt of treatment among US college students.

Methods: Past-year DSM-5 SUD and treatment receipt were estimated among a sample of 6115 college students aged 16 and older and a comparison group of non-students from the 2021 National Survey on Drug Use and Health, weighted to be nationally representative. Among the college student sample, multiple logistic regression was used to identify factors associated with past-year SUD. Bivariate analyses were used to compare socio-demographic and substance use differences between college students who received treatment and those who had an SUD but did not receive treatment.

Results: Weighted prevalence of past-year SUD among college students was 21.8 %. Only 4.6 % of students who had an SUD received treatment in any setting. Relative to non-students with SUD, proportionately fewer college students with SUD received treatment. Among college students, age, sex, past-year psychological distress, and past-year substance use were significantly associated with past-year SUD; and receipt of treatment differed significantly by age, insurance type, level of education, and enrollment status. College students who received treatment had greater prevalence of stimulant, opioid, tranquilizer, and poly-SUDs and more severe SUD symptomology than those who did not receive treatment.

Conclusion: Additional efforts are needed to engage college students with SUDs in acceptable, evidence-based treatment services.

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Tailoring Opioid Use Prevention Content for Juvenile Diversion Programs with Adolescents and Their Caregivers

Journal: Journal of Substance Use and Addiction Treatment, 2024, doi: 10.1016/j.josat.2024.209470

Authors: Sarah A. Helseth, Lauren Micalizzi, Kaitlin Piper, Ashley Gomez, A. Rani Elwy, Sara J. Becker, Kathleen Kemp, & Anthony Spirito

Abstract:

Introduction: Opioid use (OU) skyrockets as youth transition into young adulthood, indicating adolescence is a critical time for prevention. The juvenile legal system (JLS) presents an ideal setting for OU prevention, as it is the single largest referral source for youth outpatient OU treatment, after self-referral. However, no OU prevention programs have been developed for youth in JLS diversion programs or their families. The current formative study established specific OU prevention needs and preferences of families in JLS programs, to guide future tailored prevention efforts.

Methods: We interviewed 21 adolescents with substance use and 20 of their caregivers referred by a JLS diversion program in the northeastern United States to explore their OU-related knowledge, personal experiences, motivations, and behavioral skills. We used a deductive qualitative analysis approach wherein data were analyzed using an a priori coding framework based on the Information Motivation Behavioral Skills model.

Results: Caregivers knew more about OU than youth, several of whom misidentified both opiates and non-opiates. Few participants reported a history of personal OU, though many knew of others’ OU. Participants perceived several potential motivations for OU: mental health problems, relationships, life stressors, difficulty accessing preferred substances, and experimentation. Though often unfamiliar with the symptoms, participants were eager to learn skills to identify and manage a suspected overdose.

Conclusions: Youth involved in a JLS diversion program and their caregivers were open to and eager for tailored opioid use prevention content to help them reduce risks. We discuss implications for OU prevention and intervention program development.

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Lower Distress Intolerance Is Associated with Higher Glutathione Levels in Adolescent Cannabis Users

Journal: Pharmacology Biochemistry and Behavior, 2024, doi: 10.1016/j.pbb.2024.173861

Authors: Punitha Subramaniam, Andrew Prescot, James Yancey, Erin McGlade, Perry Renshaw, & Deborah Yurgelun-Todd

Abstract: Cannabis (CB) use and psychological stressors increase oxidative stress in the brain. Glutathione (GSH), the most abundant antioxidant in the brain, protects against oxidative stress. Furthermore, distress intolerance, the inability to tolerate psychological or physiological stress is a risk factor for CB use. The relationship between CB use, brain GSH levels and distress intolerance remains unknown. Therefore, we examined GSH levels in the anterior cingulate cortex (ACC), as a measure of oxidative stress, and its relationship with distress intolerance in adolescent CB users and healthy controls (HC). Sixteen HC and 17 CB-using adolescents were included in the analysis. GSH levels were measured in the ACC using a metabolite-edited proton magnetic resonance spectroscopy sequence on a 3 T scanner. Distress intolerance was assessed using the Distress Intolerance Index (DII) and CB use was evaluated using a structured clinical interview. In the CB group, lower CSF-corrected GSH levels in the ACC were correlated with higher DII scores. However, no significant between group differences were observed for ACC CSF-corrected GSH levels or on DII scores. No significant correlations were observed in the HC group between GSH levels and DII. Our findings suggests that the association between lower GSH levels and greater distress intolerance in CB users might reflect alterations in the balance between protective and oxidative stress conditions linked to the ability to tolerate distress. Further examination into this relationship can provide important insights into neurobiological correlates and risk factors associated with CB use to help inform preventive and treatment targets in the future.

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Linkage Facilitation for Opioid Use Disorder in Criminal Legal System Contexts: A Primer for Researchers, Clinicians, and Legal Practitioners

Journal: Health & Justice, 2024, doi: 10.1186/s40352-024-00291-8

Authors: Milan F. Satcher, Steven Belenko, Anthony Coetzer-Liversage, Khirsten J. Wilson, Michael R. McCart, Tess K. Drazdowski, … L. A. R. Stein

Abstract:

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

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