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Artigos no Europe PMC

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• Europe PMC · 2026

  An Examination of Breastfeeding Support Services in Perinatal Substance Use Disorder Treatment Programs in the United States.

  Narbey LT, Demirci JR, Lee JH, Niemczyk NA, Sereika SM, Krans EE, Standish KR.

  Background Many perinatal substance use disorder (PSUD) programs are providing services to women with substance use disorders (SUDs) in the United States. Breastfeeding is associated with improved maternal and infant outcomes, yet breastfeeding rates are low in this population, and our understanding of breastfeeding support in PSUD programs is limited. Research aim To describe breastfeeding support services, and barriers and facilitators to improving breastfeeding support and breastfeeding outcomes within PSUD programs in the United States. Methods From January to April 2024, a 61-item survey was sent electronically to a convenience sample of PSUD programs. Quantitative survey responses were analyzed using descriptive statistics to report frequencies. Open-ended survey responses were analyzed using content analysis. Results Representatives from 35 programs across 16 states reported limited within-program lactation support with 10 (29%) having a lactation consultant on staff. Barriers to breastfeeding support include: complex medical and social challenges individuals with SUDs face, lack of provider/staff education, referral-based lactation consultants not attuned to the specific challenges of SUDs, disagreement among providers regarding breastfeeding support, and no or outdated policies which restrict breastfeeding. Suggestions for enhancing breastfeeding support included increasing postpartum support, inclusion of peer support, increasing provider/staff education on breastfeeding and SUDs, increasing understanding of lactation support during the birth hospitalization, and updating policies to allow more individuals with SUDs to breastfeed. Conclusion Programs reported limited support for breastfeeding individuals with SUDs. More research is needed to explore how breastfeeding interventions tailored for programs may improve outcomes for individuals with SUDs.

• Europe PMC

  Tracking the longitudinal course of physiologic and mental health functioning among individuals in substance use disorder treatment

  Insalaco W, Clapham C, Gelino B, Barney J, Billings B, Ellis J, Hobelmann J, Huhn A, Zipunnikov V, Rabinowitz J.

  A fonte não publicou resumo para este artigo. O BETARUBI não abre o texto noutro site.

• Europe PMC · 2026

  Integration of Mental Health Services among Substance Use Disorder Treatment Programs in the United States.

  Frimpong JA, Kipyegon Z, Kong Y, Wang S.

  Substance use disorders (SUDs) represent a critical public health challenge, frequently compounded by co-occurring mental health conditions. While integrated care is the evidence-based standard of care, implementation gaps persist. This study utilized data from 3764 outpatient facilities from the 2023 National Substance Use and Mental Health Services Survey to evaluate mental health service integration and identify key predictors. Despite treating highly comorbid populations, 33% of facilities offered no mental health assessments. Integration levels varied sharply by facility type; opioid treatment programs (OTPs) served more clients with co-occurring disorders and were over twice as likely to provide comprehensive integration (43%) compared to non-OTPs (20%). Generalized ordered logistic regression revealed that private non-profit and public ownership, Joint Commission (TJC) accreditation, private insurance acceptance, and a higher co-occurring client volume were strong positive predictors of integrated care in the full sample. Conversely, CARF accreditation, Medicaid acceptance, and being in the Midwest were associated with a lower likelihood of integrated care. Stratified analysis uncovered critical variations by program type. Medicaid acceptance specifically lowered odds of integration in OTP. Furthermore, CARF accreditation was a negative predictor for OTPs but a positive predictor for non-OTPs. At the state level, location in a Medicaid managed care organization state significantly reduced integration odds solely for OTPs, while an increasing proportion of adults with a drug use disorder significantly increased likelihood of integration for non-OTPs. These results underscore how organizational structures, including facility type, accreditation, and state-level funding mechanisms shape care delivery. Addressing these systemic barriers, particularly financial and regulatory, is essential to closing the implementation gap and ensuring comprehensive care.

• Europe PMC · 2026

  Evaluating the effectiveness of substance use disorder treatment centers: a systematic review of international standards and outcomes.

  Sameri MJ, Alizadeh M, Moradi-Joo E, Azizi N, Far SST.

  Background Substance Use Disorder represents a complex global public health challenge, yet the effectiveness of treatment centers remains debated due to lack of consensus on standardized international indicators and heterogeneity of treatment modalities. This systematic review aimed to identify and synthesize key international indicators for measuring treatment success, compare effectiveness of different modalities, and assess impact on social reintegration. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Population, Intervention, Comparison, Outcome frameworks, we conducted systematic searches of PubMed, Scopus, Web of Science, and Cochrane Library. Two reviewers independently screened 4,234 records, extracted data from 28 included studies, and assessed quality using Cochrane Risk of Bias 2 and Newcastle-Ottawa Scale. Heterogeneity was quantified using I-squared and tau-squared statistics. Results Core indicators emerged in three domains: physiological (abstinence, daily functioning), psychological (reduced anxiety/depression, craving reduction), and social (employment, family relations). Medication-Assisted Treatment with methadone and buprenorphine demonstrated consistent effectiveness in reducing substance use and preventing relapse. Psychosocial interventions, particularly Cognitive Behavioral Therapy and Mindfulness-Based Relapse Prevention, significantly enhanced quality of life. Integrated models combining pharmacological and psychosocial approaches outperformed single-modality treatments. However, 78.6% of studies originated from four high-income countries, and only 17.9% reported outcomes beyond 12 months. Conclusions Effective Substance Use Disorder treatment requires integrated models with standardized, multidimensional outcome indicators. Future research must prioritize long-term outcomes and address the substantial evidence gap in low- and middle-income countries. Clinical trial number Not applicable.

• Europe PMC · 2026

  Digital Therapeutic Content for Substance Use Disorder Treatment: Development and Evaluation Study.

  Bormann NL, Kalata A, Arndt S, Oesterle TS.

  Background Substance use disorders (SUDs) are a major public health concern, contributing to significant individual and societal costs. Despite this, the uptake of evidence-based pharmacologic and behavioral interventions remains limited. The digital delivery of SUD treatment has emerged as a potentially scalable way to reduce access barriers and increase treatment use. Existing digital therapeutic interventions are often created without clinician involvement, evidence-based materials, interdisciplinary input, or content review. The implementation of a structured and methodologically rigorous development process is needed across digital health interventions to help ensure patient-facing materials are validated, understandable, and actionable for the end user. Objective This early report seeks to describe and evaluate an iterative, interdisciplinary, platform-agnostic process for adapting and refining existing print materials for digital therapeutic modules in SUD treatment. The a priori goal was to evaluate if a structured, human-centered approach would generate digital modules that were rated as understandable and actionable based on a validated assessment for written materials. Methods Fourteen therapeutic modules were adapted from existing Mayo Clinic-written, patient-facing education materials originally developed by a board-certified addiction psychiatrist and a doctoral-level education specialist for clinical use. A team of 4 purposively recruited licensed alcohol and drug counselors with lived experience with a SUD, all in recovery, and a doctoral-level therapeutic specialist met weekly for one hour over a 6-month period to iteratively adapt this existing content for smartphone delivery (2-3 hours per module). The process flow included selecting source material, restructuring content for viewing on a phone screen, simplifying language, improving organization and flow to promote understanding, and including specific actions users could take based on the content. The counselors then independently evaluated the modules using the Patient Education Materials Assessment Tool for printable materials (PEMAT-P). PEMAT-P scores for understandability and actionability were calculated as percentages, and descriptive statistics were used to summarize scores in aggregate and across modules. A target of >70% was set for each PEMAT-P domain, consistent with accepted benchmarking standards. Results Mean understandability and actionability for all modules were 87.2% (SD 4.8%; range 81.4%-96.9%) and 75.1% (SD 12.3%; range 57.1%-95.0%), respectively, exceeding the recommended threshold. While all modules were adequately understandable, 35.7% (5/14) scored below the actionability threshold. Conclusions This early report highlights the value of a human-centered, iterative process for adapting therapeutic materials for digital delivery in SUD treatment. Although the modules performed well overall on PEMAT-P benchmarks, actionability was less consistent than understandability, and aggregate scores masked weaknesses in several individual modules. This indicates that a standardized process does not guarantee actionable material across all content types. Involving current patients in this process may improve the end product by incorporating a perspective that was previously missed.

• Europe PMC · 2026

  ¿Ves lo Que Veo? Experiences of Substance Use Disorder Treatment and Recovery for Latinos in a Local Community.

  Sanders M, Santana C, Rivera R, McGillivray C, Alvarado A, Freeman J, Chin NP, Clark L, Colindres L, DeJesus E, Dukes F, Egloff E, Jordan J, Smith V, Lespier L,

  Objective Current rates of alcohol and substance misuse among Latinos are comparable to or surpass other U.S. ethnic groups, yet Latinos are less likely to complete treatment services. The reasons are not well understood. This study explored the barriers and facilitators to treatment and recovery among Latinos with multiple marginalized identities. Method Common Ground Health's Heroin and Opioid Work Group in Rochester, NY, used a community-based participatory research approach to develop a brief survey. It was administered to a convenience sample of adults in a predominantly Puerto Rican low-income neighborhood. Results All participants ( n = 69) reported current substance use, with an average duration of 18 years. Most had accessed at least one type of treatment or recovery service in the past year, with Medication Assisted Treatment and detox being the most utilized services. There were no statistically significant differences in types of healthcare services accessed or perceived helpfulness between Spanish-preferring and English/bilingual patients. There was a high prevalence of homelessness and unstable housing. Discussion Our study highlights the importance of exploring the role of multiple identities. We did not find any language-based differences in access or helpfulness, contrary to existing research. However, participants experiencing homelessness reported lower helpfulness and more barriers, especially with short-term in-patient care. Further research is needed to understand how, and which types of housing services are needed, especially for those experiencing and or facing homelessness.

• Europe PMC · 2026

  Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements.

  Feltus SR, Andrews CM, Peterson L, Grogan CM, Abraham AJ, Hinds OM, Stewart MT.

  Policy Points States contract with Medicaid managed care plans to administer benefits for roughly 70 million Medicaid enrollees, yet little is known about how plan benefit policies for substance use disorder (SUD) treatment medications align with state requirements. In this study, we found that among the population of 167 Medicaid managed care plans responsible for SUD pharmacy benefits in 2021, many did not align with state requirements to cover SUD treatment medications. Many plans imposed prior authorization requirements on these medications, even when prohibited from doing so. Alignment between state requirements and reported plan policies was less common among plans operating in Republican-leaning states. Context Medicaid is the largest payer of substance use disorder (SUD) treatment in the United States. Managed care plays an important role, administering benefits for more than 80% of Medicaid enrollees. While state governments have enacted coverage requirements for SUD treatment medications that managed care plans must follow, the extent to which managed care coverage policies align with these rules remains largely unknown. Methods We linked a national survey of state Medicaid officials regarding state requirements for SUD medication benefits in 2021 with data on SUD medication coverage and management from all 167 Medicaid managed care plans in 2021. We assessed the extent to which plans aligned with state requirements-overall, and by the dominant voter political lean in the state in which the plans were embedded. Findings In 2021, the proportion of Medicaid managed care plans aligned with state coverage requirements for alcohol use disorder treatment medications was slightly higher than that for opioid use disorder treatment medications. Alignment for coverage was more common than alignment with prior authorization prohibitions. Democratic-leaning states were more likely to require coverage of alcohol and opioid use disorder medications, except in the case of methadone. In Republican-leaning states, most managed care plans did not align with requirements to cover disulfiram and acamprosate and 45.4% did not align with methadone coverage requirements. Plans in Republican-leaning states were less likely to align with prior authorization bans on every SUD treatment medication. Conclusions Medicaid managed care plans located in Republican-leaning states were less likely to be subject to state requirements governing coverage and prior authorization of SUD treatment medications, with the exception of methadone, and were also less likely to align with requirements when imposed by states.

• Europe PMC · 2026

  Patients' Perceptions of the Role of Nursing in Substance Use Disorder Treatment Programs: Qualitative Study.

  Lucas Guerra C, Gómez de Quero Córdoba M, García Tardón B, González Naranjo G, Mayoral Gonzalo N.

  Background Substance use disorders are chronic conditions with significant personal and social consequences. Nursing care plays a key role in outpatient and community-based rehabilitation programs, yet patients' perspectives on this role remain underexplored. Objective This study aimed to explore how patients with substance use disorders perceive and interpret nursing care in community addiction treatment centers operated by the Spanish Red Cross in Madrid, Spain. Specifically, it sought to describe the organizational and care-related roles attributed to community addiction treatment centers and analyze patients' perceptions of nurses' technical and relational functions. Methods A phenomenological qualitative design was used. Fourteen in-depth, semistructured interviews were conducted with patients undergoing treatment at Red Cross centers. Participants were selected through purposive sampling to ensure diversity in age, gender, substance use, and treatment experiences. The data were analyzed using systematic text condensation and supported by the ATLAS.ti software. Results The center is perceived as a significant space not only for offering healthy leisure activities outside the context of substance use but also as a supportive environment that fosters a sense of belonging to a community. Patients valued the emotional support, empathy, and relational care provided by nurses, often highlighting their role in building trust and offering personalized attention. However, there was limited awareness of nurses' technical competencies. Conclusions These findings underscore the importance of holistic, patient-centered care and the need to enhance the visibility and recognition of nursing roles in addiction treatment settings.