Laura Lander

The Impact of Substance Use Disorders on Families and Children: From Theory to Practice

The effects of a substance use disorder (SUD) are felt by the whole family. The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder. Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family. In addition, understanding the current developmental stage a family is in helps inform assessment of impairment and determination of appropriate interventions. SUDs negatively affect emotional and behavioral patterns from the inception of the family, resulting in poor outcomes for the children and adults with SUDs. Social workers can help address SUDs in multiple ways, which are summarized in this article.

Guidelines for the Management of Pregnant Women With Substance Use Disorders

BACKGROUND Women of reproductive potential with substance use disorders, especially those who are pregnant, present many clinical challenges to healthcare providers, including comorbid psychiatric disorders, a history of trauma and abuse, avoidance of or poor access to prenatal care, fear of legal consequences, and countertransference reactions. METHODS In November 2013, members of the Womens Mental Health Special Interest Group of the Academy of Psychosomatic Medicine presented a Workshop reviewing substance abuse in pregnancy, highlighting the specific contributions that psychosomatic medicine specialists can make in the care of these patients. The discussion focused on epidemiology; maternal and fetal risks; and screening and treatment considerations for tobacco, alcohol, cannabis, opioids, benzodiazepines, stimulants, and several other substances. OBJECTIVE Our purpose in publishing this review is to provide clinicians and educators with the most up-to-date summary in this field to better engage these patients in care and break the intergenerational cycle of abuse and addiction.

Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-year Retrospective Data Analysis

Objectives: To retrospectively review clinic records to assess the difference between face-to-face and telepsychiatry buprenorphine medication-assisted treatment (MAT) programs for the treatment of opioid use disorder on 3 outcomes: additional substance use, average time to achieve 30 and 90 consecutive days of abstinence, and treatment retention rates at 90 and 365 days. Methods: Medical records of patients (N = 100) who were participating in telepsychiatry and in face-to-face group-based outpatient buprenorphine MAT programs were reviewed and assessed using descriptive statistical analysis. Results: In comparison with the telepsychiatry MAT group, the face-to-face MAT group showed no significant difference in terms of additional substance use, time to 30 days (P = 0.09) and 90 days of abstinence (P = 0.22), or retention rates at 90 and 365 days (P = 0.99). Conclusions: We did not find any significant statistical difference between telepsychiatry buprenorphine MAT intervention through videoconference and face-to-face MAT treatment in our Comprehensive Opioid Addiction Treatment model for individuals diagnosed with opioid use disorder in terms of additional substance use, average time to 30 and 90 days of abstinence, and treatment retention rates.

Neonatal abstinence syndrome in West Virginia substate regions, 2007-2013

PURPOSE The opioid epidemic is a public health threat with consequences affecting newborns. Neonatal Abstinence Syndrome (NAS) is a constellation of withdrawal symptoms resulting primarily from in utero opioid exposure. The purpose of this study was to examine NAS and drug-specific trends in West Virginia (WV), where rurality-related issues are largely present. METHODS The 2007-2013 WV Health Care Authority, Uniform Billing Data were analyzed for 119,605 newborn admissions with 1,974 NAS diagnoses. NAS (ICD9-CM 779.5) and exposure diagnostic codes for opioids, hallucinogens, and cocaine were utilized as incidence rate (IR) per 1,000 live births. FINDINGS Between 2007 and 2013, NAS IR significantly increased from 7.74 to 31.56 per 1,000 live births per year (Z: -19.10, P < .0001). During this time period, opioid exposure increased (Z: -9.56, P < .0001), while cocaine exposure decreased (Z: 3.62, P = .0003). In 2013, the southeastern region of the state had the highest NAS IR of 48.76 per 1,000 live births. NAS infants were more likely to experience other clinical conditions, longer hospital stay, and be insured by Medicaid. CONCLUSIONS Statewide NAS IR increased 4-fold over the study period, with rates over 3 times the national annual averages. This alarming trend is deleterious for the health of WV mother-child dyads and it strains the states health care system. Therefore, WV has a unique need for prenatal public health drug treatment and prevention resources, specifically targeting the southeastern region. Further examination of maternal drug-specific trends and general underutilization of neonatal exposure ICD-9-CM codes is indicated.

Medication-Assisted Treatment for Pregnant Women: An Interdisciplinary Group Based Model

ABSTRACT The treatment needs of pregnant women with opioid use disorders are increasing drastically. Medication-assisted treatment with buprenorphine is emerging as relatively a safe and effective treatment for pregnant women. New comprehensive models of treatment need to be developed to engage this high-risk, highly stigmatized population. The group modality is ideal for increasing access to treatment and addressing the specialized clinical needs experienced by pregnant women with substance use disorders while promoting interpersonal connection. A group-based model of treatment delivery for pregnant women with substance use disorders is presented here with preliminary outcomes data.

A study of rural upbringing and education on the intent of health professional students to work in rural settings

Objectives To explore whether student rural upbringing, rural training were associated with their intent to practice in a rural health care setting after graduation in the disciplines of Dentistry, Dental Hygiene, Medicine, Nursing, and Pharmacy at a large university Health Sciences Center in Appalachia. Methods Graduating healthcare professional students were surveyed to determine student rural background and training competency as compared to location of intended practice after graduation (N= 145). Differences were identified using descriptive statistics within and between healthcare disciplines using Spearman’s rank correlation and Kruskal-Wallis tests, Univariate, Chi-square and Pearson analyses for emergent themes or trends. Results Positive attitudes towards rural rotations and competency training were found. Twenty-one percent respondents graduated from high school in a rural setting (<2,500), while 4% reported their intent to practice in that setting. Conversely, 52% reported intent to practice in >50,000 population, while 12% grew up in this community size. Conclusions Student attitudes towards learning rural competency are positive; however, this survey suggests rural upbringing and training may not be sufficient to encourage health care professionals to practice in rural settings. More investigation is needed to determine effective incentives, perceived advantages or disadvantages and deterrents to rural healthcare practice.

The West Virginia Prescription Drug Abuse Quitline: challenges and lessons learned from running a remote quitline.

The West Virginia Prescription Drug Abuse Quitline (WVPDAQ) is a resource that offers education and support to individuals and families affected by prescription drug abuse. The WVPDAQ began functioning September 11, 2008, through the use of mobile phone and laptop technology. Although some helplines and quitlines use some aspects of remote technology, most function through traditional call center and landline technology, making the WVPDAQ unique. This article describes the process evaluation of the WVPDAQ and outlines both the positive findings and challenges faced by the WVPDAQ. Lessons learned and future recommendations for remote quitline endeavors are also presented. It is hoped that the experiences and information regarding the WVPDAQ presented can provide best-practice insight for public health practitioners and evaluation personnel who are considering using alternative technologies to deliver quitline services.

Treating women with opioid use disorder during pregnancy in Appalachia: Initial neonatal outcomes following buprenorphine + naloxone exposure: Buprenorphine + Naloxone in Mat During Pregnancy

BACKGROUND AND OBJECTIVES Rising concerns regarding diversion and misuse of mono-buprenorphine for treatment of pregnant women with opioid use disorders have sparked interest in the use of buprenorphine + naloxone to reduce misuse and diversion rates. Examined the relationship of prenatal buprenorphine + naloxone exposure to neonatal outcomes. METHODS This is a retrospective chart review of 26 mother infant dyads in comprehensive medication-assisted treatment with buprenorphine + naloxone during pregnancy. RESULTS All neonatal birth outcome parameters were within normal ranges, albeit on the lower side of normal for gestational age and birth weight. Only 19% of neonates required morphine pharmacology for NAS. CONCLUSIONS Use of buprenorphine + naloxone shows relative safety in pregnancy. SCIENTIFIC SIGNIFICANCE These findings can help better guide prescribing practices for pregnant patients at risk for misuse or diversion of buprenorphine. (Am J Addict 2018;27:92-96).

Yoga as an Adjunctive Intervention to Medication-Assisted Treatment with Buprenorphine+Naloxone

Objective: According to the CDC, 2.6 million people in the United States have an opioid use disorder and drug overdose is the leading cause of accidental death. Opioids are involved in 63% of overdose deaths. It is imperative that we identify evidence based treatments to stem the tide of this epidemic. This pilot study serves to explore the feasibility and effectiveness of Yoga as an adjunctive intervention for individuals with opioid use disorder in active medication-assisted treatment (MAT). Methods: Participants (N=26) were recruited from a buprenorphine/naloxone MAT program to participate in this study. 13 participants engaged in a 12 week adjunctive yoga intervention while remaining in treatment as usual (TAU) MAT. 13 matched controls were recruited and remained in TAU MAT. Both groups were evaluated at baseline, 45 days and 90 days for changes in craving for opioids, treatment retention, relapse rates, sleep, and symptoms of anxiety and perceived stress. Results: A two-way treatment by time analysis of variance was performed using a mixed effects model. The treatment by follow-up time interaction effect was significant for perceived stress (p=0.026) indicating that the yoga intervention had a larger effect than TAU (MAT). Changes in perceived stress decreased significantly over time in both the yoga intervention group and the TAU MAT matched control group. Conclusion: This pilot study indicated strong evidence for Yoga being an effective adjunctive treatment to MAT TAU in reducing perceived stress. Further research with a larger population is needed to determine impact on other mental health symptoms and relapse and retention rates.