Suchergebnisse

Abstract

Aims
Asian Americans are the fastest growing racial and ethnic subgroup in the USA but are underrepresented in the alcohol literature, partially due to misconceptions and racial stereotypes. We estimated any alcohol screening/discussions with providers among Asian Americans and other racial and ethnic subgroups and tested associations with alcohol treatment.


Methods
Weighted prevalences of any alcohol screening or discussions with providers included US adults reporting past-year alcohol use and > =1 healthcare visit in the 2015–2019 National Survey on Drug Use and Health (n = 123,002). Multinomial logistic regressions estimated adjusted associations between alcohol use screening/discussions (ref: no screening/discussion) comparing Asian Americans to other racial and ethnic adult subgroups. Among adults with alcohol use disorder (AUD), we estimated adjusted odds of alcohol treatment and perceived treatment need by screening/discussions and racial and ethnic subgroup.


Results
Among Asian American adults who reported past-year alcohol use and a healthcare visit, 24.7% reported any screening only and 51.4% discussed alcohol with providers. All racial and ethnic subgroups were more likely than Asian Americans to report alcohol screening/discussions (e.g. white adults, screening adjusted relative risk ratio [aRRR] = 1.48, 95% CI: 1.28–1.72; discussions aRRR = 1.92, 95% CI: 1.74–2.10). AUD treatment use and perceived need were about two times higher among people reporting alcohol discussions.


Conclusions
Asian Americans were less likely to report discussing alcohol with providers than all other racial and ethnic subgroups. Alcohol discussions were associated with treatment use and perceived need. Efforts to increase equitable alcohol screening and discussions with clinicians are needed.

BACKGROUND: Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma. METHODS: A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention. RESULTS: Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers. CONCLUSION: IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

BackgroundSocial support is consistently associated with reduced risk of depression. Few studies have investigated how this relationship may be modified by alcohol use, the effects of which may be particularly relevant in traumatized populations in which rates of alcohol use are known to be high.MethodsIn 2008 a representative sample of 1622 Jewish and Palestinian citizens in Israel were interviewed by phone at two time points during a period of ongoing terrorism and war threat. Two multivariable mixed effects regression models were estimated to measure the longitudinal association of social support from family and friends on depression symptoms. Three-way interaction terms between social support, alcohol use and time were entered into the models to test for effect modification.ResultsFindings indicated that increased family social support was associated with less depression symptomatology (p=<.01); this relationship was modified by alcohol use and time (p=<.01). Social support from friends was also associated with fewer depression symptoms (p=<.01) and this relationship was modified by alcohol use and time as well (p=<.01). Stratified analyses in both models revealed that the effect of social support was stronger for those who drank alcohol regularly than those who did not drink or drank rarely.ConclusionsThese findings suggest that social support is a more important protective factor for depression among regular drinkers than among those who do not drink or drink rarely in the context of political violence. Additional research is warranted to determine whether these findings are stable in other populations and settings.

AbstractBackgroundPopulations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings.MethodsUNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies.ResultsParticipants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical 'do no harm' approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings.ConclusionsResults from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings.

Abstract
Background
Evidence on patterns of alcohol and other drug (AOD) use and how to effectively deliver services to address AOD use in humanitarian settings is limited. This study aimed to qualitatively explore the patterns of AOD use among Congolese refugees in Mantapala Refugee Settlement and members of the surrounding host community and identify potential appropriate intervention and implementation approaches to address AOD use disorders among conflict-affected populations.

Methods
Fifty free listing interviews, 25 key informant interviews, and four focus group discussions were conducted among refugees, host community members, humanitarian implementing agency staff, and refugee incentive workers. These participants were selected based on their knowledge of AOD use and related problems in the settlement and the surrounding host community in northern Zambia.

Results
Cannabis and home-brewed alcohol were the substances that were perceived to be most commonly used and have the greatest impact on the community. Participants reported that self-medication, boredom, and relief of daily stressors associated with lack of housing, safety, and employment were reasons that people used AODs. Participants recommended that programming include components to address the underlying causes of AOD use, such as livelihood activities. Stigma due to the criminalization of and societal ideals and religious beliefs regarding AOD use was identified as a substantial barrier to accessing and seeking treatment.

Conclusions
Our study's findings indicate the need for services to address AOD use in Mantapala Refugee Settlement. Interventions should consider the social and structural determinants of AOD use.