Literally means having no name. In the addiction field, it is closely linked with the concept of confidentiality because people typically prefer not to have their name or addiction status known due to potential stigma and discrimination. The assurance of anonymity can help with help-seeking, as individuals are more inclined to seek help for a stigmatized condition like substance use disorder if they know such help-seeking will be kept completely private.
2-phase: when consuming alcohol, the body first experiences an energizing or positive effect; this is subsequently followed, with continued consumption, by a depressant or negative effect of alcohol. Therefore, there is a point of diminishing returns (a blood alcohol level between .05-.06%) at which ceasing alcohol consumption will minimize negative consequences. This effect counters cultural myths and often personal beliefs that increasing alcohol consumption will continue to lead to increasing euphoria and energy.
(stigma alert) Immoderate emotional or psychological reliance on a partner. Often used with regard to a partner requiring support due to an illness or disease (e.g. substance use disorder).
(stigma alert) A reference to a urine test that is positive for substance use. A person still using substances. This term is viewed as stigmatizing because of its pejorative connotation. Instead, it is recommended to use proper medical terminology such as an individual having positive test results or currently to exhibit symptoms of substance use disorder.
(stigma alert) Actions that typically involve removing or diminishing the naturally occurring negative consequences resulting from substance use, increasing the likelihood of disease progression. Term has a stigma alert, due to the inference of judgement and blame typically of the concerned loved-one.
Scales and tools look to screen for and diagnose substance use disorder, measure severity, and monitor disease progression or improvement at every point of care, akin to the management of other chronic diseases such as hypertension and diabetes.
(stigma alert) Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders (see agonist; antagonist).
(stigma alert) This term may be stigmatizing when used to describe tolerance and withdrawal, as the term implies true dependence. However, this term does not meet the World Health Organization (WHO) International Classification of Diseases (ICD-10) diagnostic criteria for dependence, which would include at lease one psychological component.
(stigma alert) Relapse often indicates a recurrence of substance use. More technically, it would indicate the recurrence and reinstatement of a substance use disorder and would require an individual to be in remission prior to the occurrence of a relapse.
Mamatoto Village works to combat racial disparities in maternal and infant health by providing comprehensive, culturally competent services to women and families, including community birth workers; classes on childbirth, breastfeeding, and family wellness; and connections to community resources.163 A 2017 review of women who received services through Mamatoto Village showed that 74 percent gave birth vaginally,164 89 percent were able to breastfeed,165 92 percent attended their six-week postpartum follow-up appointment, and there were zero maternal or infant losses.166
Mental health screenings, another key improvement to service delivery, should be routine and integrated into other health care settings for pregnant and postpartum women, as recommended by the U.S. Preventive Services Task Force (USPSTF).249 USPSTF is an independent panel of national experts working to improve health by making evidence-based recommendations about preventive health services and medications.250 Studies show that integrated behavioral health and primary health care models not only lead to improvements in quality care and access but also improved physical and mental health of patients.251 The American Academy of Pediatrics (AAP), the ACOG, and the American Academy of Family Practitioners (AAFP) also advocate that perinatal depression screenings be conducted during pediatric developmental screenings to ensure women have increased access to mental health services during a natural point of engagement. Unfortunately, one-third of state Medicaid programs still do not permit reimbursement for maternal depression screenings provided during pediatric visits.252 253While routinized screening, integration, and expansions in coverage have helped some people gain access to important mental health services, evidence suggests that more can be done on this front. Barriers to accessing behavioral health providers and treatment, including prescription drugs, therapy sessions, and alternative therapies, still exist for many and have a disproportionate impact on people of color with mental health challenges. Policymakers should fund research to examine the barriers to screenings, the uptake of follow-up mental health care, as well as whether disparities exist in the implementation of mental health services.
As parents encounter the financial strain of a new infant, they find themselves waking throughout the night to feed and care for their infant, which leaves them sleep deprived or exhausted throughout the day. Postpartum sleep difficulties are common and insidious, and research points to a vicious cycle between sleep and postpartum depression.266 Financial strain and poor sleep mean that the perinatal period is ripe for mental health challenges for many families. It should come as no surprise then that perinatal mood disorders affect approximately 20 percent to 25 percent of mothers from all backgrounds.267 As maternal mental health plays a role in maternal and infant health, its prevalence is a potential public health concern. However, there are few programs that treat it as such.
Screening for substance use should be part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Screening based only on factors, such as poor adherence to prenatal care or prior adverse pregnancy outcome, can lead to missed cases, and may add to stereotyping and stigma. Therefore, it is essential that screening be universal.
In most situations, pregnant women initiate methadone induction in a licensed outpatient opioid treatment program. Some obstetric services initiate opioid agonist therapy with methadone or buprenorphine in an inpatient setting. Although this may allow closer monitoring of medication response, it is not always necessary or available. In cases when a pregnant woman initiates methadone treatment as an inpatient, an arrangement should be made before discharge for next-day admission to an opioid treatment program so that there are no missed days. Patients started on buprenorphine as an inpatient may receive a prescription until their appointment with a licensed buprenorphine prescriber. Identification of the ongoing buprenorphine provider and scheduling of an appointment should be done before discharge.
The buprenorphine monoproduct has a higher potential for misuse, such as intravenous injection and diversion, and a higher street value when compared with the combination product. Thus, all patients should be monitored for the risk of diversion of their medication, especially if the monoproduct is prescribed. Unlike methadone, which may be administered only through tightly controlled programs, buprenorphine may be prescribed for the treatment of opioid use disorder by trained and U.S. Drug Enforcement Administration-approved health care providers in a medical office setting, which potentially increases the availability of treatment and decreases the stigma 47. The Substance Abuse and Mental Health Services Administration publishes a directory of health care providers registered to prescribe buprenorphine www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator. There are currently more than 37,000 health care providers from a variety of specialties who are trained and able to prescribe buprenorphine in the United States 53.
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