Angela J. Nash

Background: There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use. Objective: The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns. Methods: This study was a secondary analysis of data from the 2017–2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption. Results: Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use. Conclusion: Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

In the U.S., 12.3% of children live with at least one parent who has a substance use disorder. Prior research has shown that men are more likely to seek treatment than women and that the barriers are different; however, there is limited research focusing specifically on opioid use disorder (OUD). We sought to understand the barriers and motivators for parents with OUD. We conducted a qualitative study by interviewing parents with OUD who were part of an outpatient treatment program. Interviews followed a semi-structured format with questions on access to and motivation for treatment. The interviews were recorded and transcribed using OpenAI software. Transcripts were coded by two separate reviewers and then analyzed for themes using Atlas.ti. We interviewed 14 individuals; 3 were men, and 3 of the women identified as LGBTQ+. The participants ranged in age from 27 to 54 years old. All participants had a least one child. Gender differences existed. Mothers reported experiencing more barriers—notably, a lack of childcare, shame, and guilt—while fathers reported higher levels of support from family. Both mothers and fathers identified their children as a motivation for recovery, albeit in differing ways. Mothers and fathers with OUD experience different barriers to treatment and also rely on different resources. Prior efforts to increase access to treatment for parents have focused on physical barriers; however, our research supports the need for expanded treatment services for families and efforts to address the stigma of substance abuse disorder, but more efforts are also needed to address stigma.

Background: The American health care system is facing a growing health care provider shortage in primary and specialty care settings. Research has established that nurse practitioners (NPs) match or exceed their physician colleagues in providing quality care in primary care settings. Objective: This systematic review aimed to compare the quality of NP versus physician-led care in outpatient specialty care setting for clinical outcomes patient satisfaction. Data sources: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the literature search (CINAHL, PubMed, and Cochrane Library) and interpretation of findings. Of the 228 articles that met the inclusion/exclusion criteria, 11 were selected for further review. Conclusions: Studies were conducted from 1995 to 2016 across four countries and spanned 10 distinct medical specialties. As a whole, these studies demonstrated that NPs in specialty settings perform as well as physicians terms of clinical safety and positive patient outcomes. Nurse practitioners matched or exceeded their physician counterparts in patient education and satisfaction. Implications for practice: Nurse practitioners are a feasible option for addressing specialty care shortages. Further research should investigate whether NPs and physicians are equally prepared to provide equivalent care immediately following their respective postbaccalaureate programs. If not, studies should explore specific training duration and elements NPs require to provide equivalent care.

In 2017, approximately 1.5 million American adolescents had a substance use disorder (SUD). Adolescents with SUD risk hindering their neurological development, which can result in problems with memory and self-regulation, and in turn disrupt their education, relationships, and life opportunities. Treating adolescents with SUD is challenging. Thus, effective models that help adolescents engage in long-term recovery are needed. The Alternative Peer Group (APG) is an adolescent recovery support model that incorporates pro-recovery peers and sober social activities into standard continuing care practices. In this qualitative study thematic content analysis methods were used to explore transcripts from in-depth interviews with adolescent APG participants collected in a prior study. The aim of this secondary analysis was to get a clear understanding of adolescents’ perceptions of the advantages and disadvantages of APGs for supporting SUD recovery. Findings suggest that pro-recovery peer and adult role models, structured activities and a positive social climate that promotes fun, a sense of belonging, and accountability are continuing care elements that are likely to help adolescents resolve their ambivalence about SUD recovery and increase their motivation to engage in the hard work of recovery. These findings can inform the design of effective recovery support model services that promote long-term recovery for adolescents with SUD.

Recovery and long-term remission are the goals of treatment for substance use disorders, yet the majority of treated adolescents never stop using or resume using substances quickly after treatment. Thus, continuing care or recovery support services are common post-treatment recommendations for this group. Almost half of people who resolved significant substance use problems did so through participation in 12-step programs like Alcoholics Anonymous or Narcotics Anonymous. These recovery support programs are available online and in communities around the world. Yet <2% of these programs’ members are under 21 years old. To help clinicians understand the 12-step explanatory model and facilitate clinical decision making on whether or when to refer individuals to these groups, this article summarizes the 12-step philosophy and practices and provides a concise review of research on adolescents’ involvement in 12-step groups, including qualitative work that illuminates adolescents’ reasons for resisting or engaging in 12-step practices.

Although 12-step participation is related to improved outcomes, young people’s 12-step involvement is rare. There is limited research on the role of 12-step philosophy and practices for supporting young people’s recovery or addressing why so few engage in 12-step practices. To explore these issues, content analysis was applied to qualitative data from two prior studies conducted with individuals who participated in an Alternative Peer Group (APG), a 12-step facilitated adolescent recovery support model. Findings revealed new information on barriers to 12-step involvement and suggest strategies for addressing barriers, boosting motivation, and changing young people’s perceptions of 12-step philosophy and practices.

The aim of this article is to report lessons learned from feasibility challenges faced in a mixed-methods study designed to test the feasibility of measuring recovery in participants of an Alternative Peer Group (APG). The APG integrates pro-recovery peers and social activities into clinical practice to engage adolescents in recovery. Though well established, APGs have never been tested. This study was one phase in a line of research that aims to develop an APG evidence base. The study used a mixed-methods design and naturalistic sampling of participants of one APG program. Repeated measures analysis with linear mixed models was planned to test the hypothesis that spending time in the APG builds recovery capital, resulting in progress in the processes of recovery, and improved symptoms. Semistructured interviews were conducted and framework analysis was used to explore feasibility challenges. Recruitment and retention challenges precluded meaningful measurement of change over time in recovery. Lessons learned from qualitative findings informed multiple strategies for revisions to strengthen future study protocols. Recruitment and retention of adolescents are common challenges that can threaten a study’s validity. Researchers seeking to recruit and retain adolescents with SUD in longitudinal studies may benefit from strategies derived from this study.