Substance use disorders are associated with significant disability and mortality in the United States. Treatment for substance use disorder is effective; however, screening is not a common practice in medical or psychiatric outpatient clinics. At a rural ambulatory behavioral health clinic, patients were not being screened for alcohol and drug misuse despite recommendations by the U.S. Preventive Services Task Force and the National Institute of Drug Abuse. This quality improvement project aimed to provide screening, brief intervention, and referral to treatment training for providers for new adult patients 18 and older presenting for initial medication management with the Alcohol Use Disorders Identification Tool (AUDIT) and Drug Abuse Screening Tool (DAST). Data were collected using a chart review to identify the incidence of patients with a positive AUDIT or DAST score and to identify if appropriate brief interventions were conducted or referrals placed. Fifty-two patients were screened. Seven patients had a positive DAST screening, four scored a one but <3, and two scored >3, representing substance use, and someone using substances at this level has experienced negative effects. Evaluation of the AUDIT tool screening identified five patients with a score of >8, representing harmful consumption or likelihood of dependence. Outpatient clinics should train all providers on the proper technique for screening, brief intervention, and referral to treatment with reliable and valid tools for patients seeking care to meet the U.S. Preventive Services Task Force and the National Institute of Drug Abuse recommendations to identify at-risk patients.
BACKGROUND:Stigma is a key barrier to accessing or receiving substance use services. Those with substance use disorders (SUD) who seek health care services experience stigmatizing attitudes and behaviors from health care providers, including nurses. Integrating substance use-related content into core courses for advanced practice nursing students may help reduce stigma and prepare them to assist patients with SUDs across various specialties where advanced practice nurses work. This exploratory descriptive study assessed advanced practice nursing students' attitudes and stigma perceptions related to caring for people with alcohol and drug use. METHOD:An online survey was used to obtain demographic information and responses to three established measures focusing on substance use-related attitudes, perceptions, and stigma. Data were collected from students (baseline group) scheduled to take core required "3P" courses (Physical Assessment, Pathophysiology, and Pharmacotherapy) into which enhanced substance use-related content was infused. A separate group (postcourse) completed the measures after the enhanced courses. Descriptive statistics were obtained for demographic data, and means and standard deviations were calculated for subscales and total scores of the Person-Centered Drug and Drug Problems Perception Questionnaire, the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire, and the Opening Minds Scale to examine differences before and after the enhanced content. RESULTS:Eleven students completed the baseline survey and 12 completed the postcourse survey. Although statistical comparison was not possible, postcourse responses reflected more favorable attitudes toward people with SUD. CONCLUSION:The more favorable attitudes following the 3P courses are promising. Future research should use more rigorous pre-post or longitudinal designs.
There is a high individual, family, community, and societal cost to substance use disorder (SUD). However, the real cost is the loss of lives. Nurses have an important role in combating the SUD epidemic. Nurses work in a variety of settings and have opportunities to interact with patients and families experiencing SUDs. These findings are part of a larger qualitative study that examined nurses' personal and professional experiences in caring for people with SUD and their families. This article reports on the nurses' experiences of challenges faced, treatment opportunities, and advice for nurses. After research board approval, nurses who had experience caring for patients with SUD and their families were recruited using purposive sampling. Individual, semi-structured interviews (n = 16) were conducted with nurses who worked in the following settings: emergency room, obstetrics, medical-surgical unit, pediatric intensive care unit, behavior/mental health, and home health. The interviews were audio recorded. Verified, deidentified transcripts were uploaded to NVivo 14. Thematic analysis was conducted concurrently with data collection until saturation was reached. The data were coded by two researchers independently, and coded text was discussed until a consensus was reached. Themes were described and supported by exemplars from the coded text. Findings contribute to the understanding of the nurses' challenges when caring for persons with SUD and their families and advice for other nurses. Additional research surrounding health care provider education, policy changes, and financial support are critical next steps.
Background: Adolescent use of electronic cigarettes (e-cigarettes) has surged despite declining traditional cigarette use among this demographic cohort. E-cigarettes have become the most popular tobacco product among middle and high school students in the United States, with over 2 million reporting current use. Social media plays a critical role in this trend, offering pervasive marketing and positive portrayals that normalize e-cigarette use. Purpose: This study examines the specific features of e-cigarette-related content on social media platforms that attract adolescents and influence both their initiation and continued use of e-cigarettes. Methods: A qualitative descriptive design was used. Semi-structured interviews were conducted with 21 adolescents aged 15–18 who were current or past e-cigarette users. Participants, recruited via social media, shared their experiences with e-cigarette-related content. Thematic analysis identified key themes and patterns in their narratives. Results: The study revealed how social media e-cigarette-related features appeal to adolescents, influencing their initiation and continued use of e-cigarettes. The thematic analysis identified three primary themes: the appeal of product features, influencers’ and celebrities’ endorsements, and entertainment and engagement (such as vape tricks). Conclusions: These findings underscore the complex interplay between social media exposure and adolescent e-cigarette use, highlighting the need for targeted public health interventions and stricter advertising regulations to address the rising e-cigarette use among adolescents.
Opioid overdose is a leading cause of death in the United States. While buprenorphine reduces mortality by 76% for people with opioid use disorder, the rising prevalence of fentanyl and other high-potency synthetic opioids has complicated traditional induction methods. Even when best practices are followed, patients can experience increased withdrawal symptoms due to the interaction between buprenorphine and fentanyl. Withdrawal negatively affects treatment engagement, retention, and outcomes. In an addiction treatment unit at a large, southeastern academic medical center, various induction methods are used without a standardized protocol. Using Define-Measure-Analyze-Design-Verify and the CDC's Framework for Programmatic Evaluation, the team evaluated best practices for buprenorphine induction through retrospective chart analysis and focused literature review. This led to the development of an evidence-based practice protocol. In the chart review ( n = 21), 71.4% ( n = 15) of patients completed induction; withdrawal symptoms ( n = 6) were the main reason for treatment discontinuation. Only 42% of patients had a documented Clinical Opiate Withdrawal Scale score, which limited the ability to measure withdrawal. Since withdrawal symptoms pose a major barrier to successful induction, our team created a method selection and titration protocol for low-dose buprenorphine induction with overlapping opioid agonism with stakeholder feedback. Inconsistent Clinical Opiate Withdrawal Scale documentation identified in the review also supports the need to standardize withdrawal assessment.
BACKGROUND:Alcohol is the most prevalent psychoactive substance in the Indian context. This affects the individual, family, and society extensively. Despite numerous advances in the treatment of alcoholism, relapse remains a common cause of concern. The present study aimed to determine the effectiveness of tele-nursing intervention (TNI) to improve alcohol-related outcomes among rural men with alcohol use disorder. METHODS:This two-arm randomized controlled trial (RCT) was conducted in an addiction treatment unit of tertiary mental care setting, India, between January 2022 and April 2023. One hundred sixty-four participants diagnosed with alcohol dependent syndrome were randomly assigned to receive TNI ( n = 81) or treatment as usual (TAU) ( n = 83). Participants of both groups were initially assessed for craving, quantity, and frequency of alcohol consumption and severity of alcohol use. TNI participants received 8 video-enabled cue exposure group sessions, periodic mobile phone interventions, and text message reminders after discharge along with routine treatment (TAU) at de-addiction wards. TAU group participants received only routine treatment, which includes detoxification and long-term medication to deal with craving along with individual educational sessions on harmful effects of alcohol use and advice about quitting alcohol. All the participants were followed up over 6 months postdischarge. RESULTS:Over 6 months follow-up TNI group subjects (vs. TAU group) reported significantly decreased craving scores ( F = 6.677, p < .000, η2 = 0.134), drinking days ( F = 17.26, p < .000, η2 = 0.254), quantity of alcohol consumption ( F = 26.32, p < .000, η2 = 0.252), AUDIT scores ( F = 13.97, p < .000, η2 = 0.152), and lesser relapse rates ( p < .007). CONCLUSIONS:The present study demonstrated that TNIs are effective in improving alcohol-related outcomes among rural men with alcohol use disorder. This study provides empirical evidence for the use of TNIs in the management of alcohol dependence. These low-cost approaches could overcome barriers to implement face-to-face interventions in clinical setting.
PURPOSE:This research was conducted to evaluate the effect of a solution-focused stress management program on emotional eating and digital game addiction in nursing students. DESIGN AND METHODS:A pretest-posttest control group, randomized controlled study design was employed. The sample of the study consisted of 60 nursing students, including n = 30 in the intervention and n = 30 in the control group. Data were collected using a personal information form, the emotional eating scale, and the game addiction scale. RESULTS:While there was no statistically significant difference between the mean scores of the intervention and control groups on the emotional eating and game addiction scales before the implementation of the solution-focused stress management program ( p > .05), the mean scores of the study group on these two scales decreased significantly compared with the control group after the intervention ( p < .05). A significant negative increase was observed in the mean emotional eating scale score of the control group, but no significant difference was detected in the mean game addiction score in the posttest. CONCLUSIONS:The solution-focused stress management program reduced the emotional eating and gaming addiction behaviors of the students in the intervention group. The program can be used to develop effective stress-coping behaviors and prevent emotional eating and gaming addiction in risky adolescents within the scope of community mental health practices. PRACTICE IMPLICATIONS:Based on the results of this study, solution-focused stress management programs can be implemented by psychiatric nurses to prevent emotional eating and digital gaming addiction.
BACKGROUND:The knowledge and attitudes toward tobacco control among nurses are important factors in ensuring appropriate management of the tobacco dependence. Therefore, we aimed to evaluate the predictors of developing positive attitudes toward tobacco control and increasing perceptions of tobacco-related training received during the nursing degree, among a cohort of Catalan nursing students. METHODS:Observational prospective study of 1,097 Catalan nursing students. Participants completed a paper-and-pencil questionnaire at baseline (2015-2016) and an online survey at follow-up (2018-2019). We examined predictors of developing positive attitudes and increasing perceptions of training using Poisson regression models to compute the adjusted prevalence ratios (aPRs). RESULTS:Students in their last years of studies at baseline were less likely than those in the first years to develop a positive attitude towards the exemplary role of nursing students in tobacco control at follow-up (aPR = 0.74). Former smokers were more likely than current smokers to develop positive attitudes towards the exemplary role of health care professionals (aPR = 1.55) and, together with never smokers, to come to recognize the importance of nursing students setting a good example (aPR = 2.23 and aPR = 2.32, respectively). Last year's students were also less likely than those in the first years to increase their perceptions of tobacco-related training received (all aPR < 0.71). Never smokers were less likely than current smokers to increase their perception of training in pharmacological treatments other than nicotine replacement therapy (aPR = 0.81) and to consider themselves capable of helping smokers quit (aPR = 0.78). CONCLUSIONS:The year of school and smoking status were strong predictors of developing positive attitudes and increasing perceptions of training in tobacco control.
Opioid use presents a pressing public health concern throughout the United States, with growing disparities related to overdose deaths and access to treatment. Neighborhoods, as built and social environments, are an essential domain of the social determinants of health that impact people's well-being. Historical and current policies impact neighborhoods and can contribute to persistent health disparities. Integrating complex factors within the areas where people work, play, learn, and socialize, neighborhoods can contribute to opioid use in various ways. This scoping review describes, synthesizes, and summarizes the existing literature examining neighborhood-level factors on opioid use in the United States. Four databases were searched, and 39 studies were included. Over 90% of the studies were observational study designs. Despite heterogeneous operational definitions between studies, worsening neighborhoodlevel socioeconomic status was associated with worsening opioid use outcomes. Ethnoracial disparities were associated with both opioid-related overdoses and treatment availability. Implications from the scoping review highlighted a need for examining lived experiences to highlight essential variables, the use of conceptual models to guide research, greater consensus on operational definitions, and diversification of study designs. Neighborhood-level factors and opioid use disorder warrant further investigation. Future research should examine structural components and policy impacts on neighborhoods and include studying lived experiences and underrepresented ethnoracial populations, such as Native American and Alaska Native peoples. Findings can inform policies, guide place-based interventions, and support individual treatment.
BACKGROUND:Although there is substantial evidence of the negative impact of caffeine use on sleep quality, few studies focus specifically on adolescents' patterns of use. This study aimed to identify patterns of caffeine use among adolescents and analyze their association with sleep quality. METHOD:A cross-sectional study was conducted in southern Sweden including 1,404 adolescents aged 15-17 (56.3% girls). The frequency of use for coffee, tea, and energy drinks was evaluated, as well as the quality of sleep and its dimensions. Latent class analysis and multivariate analyses were conducted. RESULTS:The weekly prevalence of caffeine use in adolescents reached 85% (n = 1189), with 40% (n = 559) drinking almost every day. Three caffeine-using patterns were identified: low probability caffeine use (28.1%; n = 393) characterized by sporadic use of coffee/tea, caffeinated soda use (55.2%; n = 784) related to high soda weekly consumption, and mixed caffeine use (16.7%; n = 227) that includes drinking diverse caffeine products almost every day including soda and energy drinks. Mixed caffeine pattern was associated to worse sleep followed by the soda pattern (p < .05), with significant differences observed in difficulties falling asleep (OR = 1.4; 95% CI = 1.1-1.7) or waking up (OR = 1.8; 95% CI = 1.4-2.4), greater daytime dysfunction (OR = 1.3; 95% CI = 1.1-1.7), and shorter sleep duration on schooldays (OR = 1.9; 95% CI = 1.5-2.4). CONCLUSION:Distinct severity levels were found for caffeine use patterns among adolescents based on their association with sleep quality. Findings emphasize the need for addressing caffeine misuse among adolescents to promote health and adequate sleep habits in the transition to adulthood.
Substance misuse among college students continues to rise, with polysubstance use becoming increasingly common. Alcohol remains the most prevalent substance, with heavy episodic and high-quantity drinking linked to serious consequences, including injuries, assaults, and deaths. Concurrent use of alcohol and cannabis, as well as other illicit drugs, further compounds risks to health, safety, and academic functioning. Colleges have responded with a range of recovery and harm reduction initiatives, such as Campus Recovery Communities, Collegiate Recovery Programs, and bystander-oriented efforts like the Red Watch Band Program. While these programs provide critical support, they remain limited by accessibility, scope, and their often retroactive nature. Student health services and community partnerships extend intervention capacity, but gaps persist in reaching the broader student population. To address these challenges, innovative strategies are needed that complement traditional models. Digital health tools, particularly mobile applications, present a scalable, cost-effective approach with potential to extend harm reduction, prevention, and recovery support in ways that align with student needs and behaviors. We are calling for expanded research, investment, and program development to integrate evidence-based digital solutions with campus initiatives, positioning higher education institutions to better respond to the evolving landscape of substance use.
INTRODUCTION:Health professionals may be susceptible to misusing alcohol due to stress and burnout. This is especially true in states with high alcohol consumption. Health care organizations can implement evidence-based policies, programs, and solutions that identify, address, and help prevent adverse outcomes and burnout for health workers. Recommendations for health care professionals are learning to recognize signs of distress, mental challenges, and burnout. Staying connected and reaching out for help is a start to getting back to basic good health habits instead of developing unhealthy habits such as the misuse of alcohol consumption. However, misuse of alcohol consumption should be seen as an occupational hazard for health professionals i high-consumption communities. METHODS:A convenience sampling of nurses in one institution was surveyed online. Professional Quality of Life Questionnaire Health and Alcohol Use Disorders Identification Test (AUDIT) surveys were transcribed into RedCap and an invitation link was made available to registered nurses and graduate students through internal announcements. RESULTS:Eighty-two nurses completed the survey. This study found a medium association between burnout scores and AUDIT scores (η = 0.506). Our study showed a rate of 26.5% on the Pro-QOL Health secondary trauma subscale scores, with a small association (η = 0.304) between secondary trauma scores and AUDIT scores. CONCLUSIONS:One call to action is to further coordinate research to develop tools assessing nurses on a regular basis. In communities where drinking is known to be high, misuse among health professionals should be viewed as an occupational hazard. To support nurses, we must continue to examine predictors of substance misuse at regular intervals in the work environment. Inclusive research examining and analyzing the use of alcohol by ethnicity, gender, age, and community setting is important in developing culturally appropriate interventions.
In the United States, approximately 20 million individuals, age 12 and older, have a substance use disorder (SUD), with an average age of first-time use at 13 years old. Evidence has shown that many SUDs begin in adolescence, and involvement with the legal system can ensue. Adolescents with first-time drug and alcohol arrests can be referred to an Adolescent Intervention Program (AIP) as an alternative to jailtime from the juvenile court system. The purpose of this quality improvement project was to evaluate the effectiveness of an AIP, a faith-based drug and alcohol prevention program for adolescents. The W.K. Kellogg's Step-by-Step Guide to Evaluation (2017) was utilized to evaluate the program. Kellogg's Empowerment and Culturally Responsive Evaluation approaches influenced the development of key stakeholder structured interviews (n = 5). The total number of adolescent program participants during the evaluation period was N = 2,437, with an estimated 98% program completion rate. Stakeholder interviewees reported that "for every 100 AIP participants, there is an average of 1-2 returning for a second try." And, "For every 100 AIP participants, an average of 5 or 6 are sent back to court, or a 5% AIP recidivism rate." AIP program recommendations included the development of a participant data tracking system, facility leadership succession plan, a volunteer orientation and policy manual, educational tool kits for parents and adolescents, and increasing the number of parent-involved sessions. Faith-based drug and alcohol recovery programs for adolescents can be an effective means of SUD prevention and an alternative to jail.
Perspectives about cannabis use have changed for society, clinicians, and researchers over time, and many new lines of research investigate potential health benefits versus risks of different cannabinoids. This overview for clinical practice summarizes research on cognitive effects of cannabis use across the lifespan and in clinical populations of interest, including clinical implications for nurses and other health care providers.
BACKGROUND:E-cigarette use among youth in the United States has become a public health epidemic. Adults who regularly interact with youth-such as coaches, mentors, counselors, trainers, and caregivers-can significantly influence youth perceptions and behaviors related to e-cigarette use, either positively or negatively. PURPOSE:The study purpose was to examine the effectiveness of a nurse-led educational presentation among youth-serving adults about e-cigarette products and their negative health effects through knowledge assessment. METHODS:A 30-minute educational session was delivered using adapted materials from the Stanford REACH Lab's You & Me, Together Vape-Free curriculum within their Tobacco Prevention Toolkit. Participants (N = 24) completed a 20-question knowledge assessment before and after the presentation. RESULTS:A paired t test revealed a statistically significant improvement in knowledge scores from preintervention (mean = 13.9, SD = 1.8) to postintervention (mean = 17.1, SD = 1), t(22) = 7.9, p < .001. Participants demonstrated an average increase of 3.21 correct responses (16.1%). CONCLUSIONS:The nurse-led educational presentation significantly improved participants' understanding of e-cigarettes and their harmful effects. By equipping youth-serving adults with accurate information, this approach supports informed conversations that may prevent youth e-cigarette use. School nurses are well positioned to lead such efforts, with national organizations endorsing their role in tobacco prevention. Further research is needed to assess long-term knowledge retention and behavioral outcomes.
BACKGROUND:Using quality improvement (QI) methods, we sought to improve the inpatient screening of opioid withdrawal symptoms using the Clinical Opioid Withdrawal Scale (COWS), an industry validated instrument that is not widely used in the inpatient setting. By educating nurses and providers on the clinical manifestations of opioid withdrawal and implementing an evidence-based Opioid Withdrawal Screening Pathway, we sought to improve outcomes for those at risk for opioid withdrawal during hospitalization. METHODS:The pre-post test design using Plan-Do-Study-Act cycles involved two implementation phases. Phase I consisted of a 2-week formal education program for nurses and providers, including topics such as opioid use disorder, opioid withdrawal symptoms, COWS, opioid withdrawal treatment options, and criteria for consultation with the Inpatient Pain Management Team. Phase II involved a 12-week implementation of the Opioid Withdrawal Screening Pathway using COWS assessments and QI chart audits of pathway compliance data. RESULTS:Screening of illicit drug use rates were low, yet significantly increased during the QI pilot. Education completion rates were high. Discharge against medical advice rates and average length of stay were significantly reduced. Transfers to a higher level of care did not involve illicit opioid use and were not significant for two units. The incidence of workplace violence events was equal between baseline and implementation data. CONCLUSIONS:Through the implementation of an education program and screening pathway, the health care organization improved its screening rates of illicit opioid use and number of COWS assessments.
