Welcome to the Spring/Summer issue of the Journal of Addictions Nursing. In this issue, we have a number of articles on topics related to injection drug use, screening, brief intervention, and referral to treatment (SBIRT), and nurses' perceptions of care and treatment outcomes. We also have the Pharmacology Corner in this issue.
Drs. Champion and Recto assess HIV risk, perceptions of risk, and potential adherence to preexposure prophylaxis (PrEP) for prevention of HIV infection among people who inject drugs (PWID). Participants (N = 93) completed self-report questionnaires on HIV risk behavior, perceived risk of HIV, and beliefs about medicines. PWID perceived themselves at a low risk for HIV with minimal concerns about contracting HIV. High levels of comorbidities, limited HIV protective behaviors, and limited social support existed, with women reporting significantly more risk behaviors and comorbidities. They conclude that addressing perceived and actual risk for contracting HIV, potential barriers to PrEP adherence, social support, and treatment of comorbidities in primary care has the potential to enhance PrEP maintenance among PWID.
Next, Dr. Keener and colleagues explore the perceptions of nurses regarding patients with a substance use disorder (SUD), healthcare provided, and desired resources to care for this population. Nurses with less than 1 year of experience reported significant challenges when caring for patients with SUD. These included difficulties in managing pain, implementing alternative pain management techniques, and knowing whom to contact when problems occurred. Findings indicate a need for education for nurses, especially novice nurses, who care for patients with SUDs.
Dr. Alexa Anderson and colleagues comment that traditional substance use treatment programs have not always taken women or marginalized populations into consideration. They suggest a holistic approach that addresses (a) how drugs may be used to cope with trauma caused by violence, poverty, and neglect and (b) that employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. The purpose of their qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program. Many women discussed how the program itself was an impetus in addressing substance use and how relationships with their children were vastly different pretreatment compared with during and after treatment, and regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professionals in ensuring effective and culturally relevant treatment for African American women, whereas nursing curricula should include more evidence-based practice education and training on mental health and substance misuse specific to marginalized communities.
Dr. Agapoff and colleagues educated and coached staff nurses in the use of screening, brief intervention, and referral to treatment (SBIRT) as well as to offer SBIRT to all admissions on a brief psychiatric inpatient unit and decrease readmission rates. Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Results indicate that 59% of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16-31 postdischarge. SBIRT can be an effective tool for nurses on psychiatric units to address substance use.
In the next article, Heejung Kim and Eun-Mi Kim's study aimed to identify the multilevel factors associated with lifetime, current, and binge drinking among Korean adolescents based on the ecological model. This cross-sectional study used data from the 2018 Korea Youth Risk Behavior Survey (N = 60,040). Hierarchal multinomial logistic regression analyses were performed using complex sample data. Overall, 15,030 (25.4%), 4,629 (8.0%), and 5,038 (8.9%) subjects were involved in lifetime, current, and binge drinking, respectively. They found many multilevel factors associated with lifetime, current, and binge drinking. They suggest that school nurses and community leaders are necessary to develop customized drinking prevention programs considering individual, family, school, and social factors.
T'Anya Carter, PhD, CRNA, and colleagues present a scoping review to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers. The Arksey and O'Malley framework was used to conduct a scoping review of the literature. The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. For anesthesia providers, immediate access to powerful anesthesia medications requires return-to-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment.
In the Pharmacology Corner column, Jennifer Hargett and colleagues discuss the use and misuse of tianeptine, an atypical antidepressant that has a significant potential for abuse. Recently, misuse and illicit use of tianeptine have become an increasingly common public health concern. They provide useful information for all nurses.