1. Mitchell, Ann M. PhD, RN, AHN-BC, FIAAN, FAAN

Article Content

Welcome to the Winter/Spring issue of the Journal of Addictions Nursing. In this issue, we have a number of international articles related to substance use in differing populations, nursing educational initiatives in light of COVID, and treatment outcomes in a number of settings. We also have a column in this issue, the Clinical Review Column. There are also a number of articles that have been published ahead of print that will now be included in this issue online.


Dr. Timothy Joseph Sowicz and colleagues have collaborated with members of the American Society of Pain Management Nursing and the International Nurses Society of Addictions to write a joint position paper on pain management and substance use disorders (SUDs). These organizations hold the position that persons with co-occurring pain and SUD have the right to be treated with dignity and respect and to receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Institutions should establish policies and procedures that support these efforts.


Next, Dr. Min Sohn and colleagues present their retrospective descriptive study that explores the determinants of self-reported smoking cessation among out-of-school Korean adolescents who participated in a counselor-visiting smoking cessation program. Participants consisted of 807 adolescents (70.3% male) with a mean age of 16.9 +/- 1.2 years. Multiple logistic regression analysis showed that female gender, cohort year, smoking more than half a pack a day, strong motivation to quit, and number of counseling sessions were statistically significant independent contributors to quitting based on follow-up assessments. More research is necessary to evaluate the efficacy of such smoking cessation programs for marginalized populations.


Dr. Garcia and colleagues examine the moderating effects of social motivation for Internet use on the relationship between problematic Internet use and alcohol use among adolescents through a cross-sectional survey design. Participants answered questions related to demographics/background, problematic Internet use, and alcohol use. Social Internet use and problematic Internet use accounted for a significant amount of variance in alcohol use, highlighting the role that social connections may play in contributing to problematic Internet use and alcohol use among adolescents. They conclude that interventions aimed at preventing problematic and addictive behaviors among adolescents should address the role of social motivations.


In the next article, Ahmad H. Rayan and colleagues worked with a sample of people who smoked waterpipes (WPs) exclusively, to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The significant predictors of WPS dependence were age, depression, age of starting WPS, duration of WPS, income, smoking WP daily, and the desire to stop WPS, to name a few. These predictors explained 35% of the variance in WPS dependence. Factors associated with WPS dependence provide useful information that can be used to tailor prevention efforts.


Hannah Roisin Roncallo, MSN, and Barbara Aronson, PhD, seek to determine the effectiveness of an educational intervention, grounded in theory, toward changing nursing student attitudes regarding patients with an SUD. Nursing students participated in a teaching intervention, developed using the experiential learning theory that utilizes modalities for each kind of learner aimed at reducing bias toward this population. Students' postparticipation attitudes were significantly more positive than attitudes before participation. Students found the educational intervention and debriefing highly satisfactory. This educational intervention can provide a cost-effective, easy-to-replicate activity that could be added to undergraduate nursing curricula.


Dr. Keenan and colleagues state that the number of women experiencing opioid use disorder in Canada continues to increase. They describe the lived experiences of Canadian women with opioid use disorder who were receiving methadone treatment. The conceptual framework of self-care of chronic illness was used to examine this phenomenon. Four major themes emerged: learning how to be you again, reaching out for help, finding your way to methadone, and going down the path of methadone. Family, friends, and healthcare providers influenced women's experiences. Accessibility and self-determination were important factors in entering and sustaining treatment. More research is needed for uncovering practice changes that can attract and retain women in treatment.


Kimberly Dion and colleagues examine the concept of dignity in people who inject drugs (PWID). Autonomy, self-sufficiency, respect, and equality are concepts used to define dignity. Their study aimed to determine how PWID maintain or have their dignity threatened during hospitalization in an acute care unit. The qualitative descriptive study was a deductive thematic analysis of secondary data on PWID experiences with received nursing care. The three most common threats to dignity during hospitalization were lack of equality compared with other patients, not feeling valued as an individual, and not feeling respected by the healthcare workers providing care. The three most common protectors of dignity were feeling respected by healthcare workers, having autonomy in treatment choices, and feeling valued as an individual. Preserving dignity in PWID during their hospitalizations can encourage this population to seek care earlier.


Norayda Garcia and a number of nurse colleagues aim to determine the influence of predisposing, reinforcing, and enabling factors of nicotine dependency among young adults in a rural community. A quantitative, predictive-correlational cross-sectional study was conducted with 190 young adults in a rural community utilizing an adapted determinants of smoking questionnaire and Fagerstrom test to assess nicotine dependence. Reinforcing and enabling factors influenced nicotine dependency. The influence of other relatives, radio advertisements, and access to cigarettes were significant predictors of nicotine dependency in the rural community. These factors may be useful to form the basis for future interventions.


Dr. Theresa Fay-Hillier and her colleagues state that vulnerable populations, such as those with SUDs, are at a higher risk for early morbidities and mortalities and, yet, are less likely to receive primary care and other necessary psychosocial services essential for comprehensive care. This has been magnified by the COVID-19 pandemic. Nursing education must change their curricular approach to meet the challenges in health services across the life span, and nursing education should include lessons learned during the pandemic. Nurses must be prepared to recognize and screen individuals for SUDs at the undergraduate level and to assess and treat individuals with SUDs at the advanced practice level in all areas of healthcare services. SUDs should be addressed in multiple specialties across the curricula and include health responses in regard to the impact that the pandemic is having on SUDs.


Dr. Okoli and a colleague examine the relationship between trauma and substance use in healthcare workers. Among healthcare workers, they examined (a) frequency of current tobacco use and risky alcohol use, (b) frequency and types of traumatic experiences, and (c) the associations between trauma experiences and current tobacco and risky alcohol use, controlling for demographic factors. This study is a secondary analysis of cross-sectional survey data from healthcare workers (N = 850) in an academic medical center. Demographic and work-related variables, trauma experience, and substance use were examined. Nearly 75% of respondents reported at least one lifetime traumatic experience, and one in 10 reported tobacco and risky alcohol use. When controlling for demographic and work-related variables, a dose-response relationship was observed-that is, the higher the number of traumatic experiences, the greater the likelihood of tobacco or risky alcohol use. Future research is needed to better delineate the relationship between specific traumas and risky substance use among healthcare providers.


Dr. Palmer and his colleagues conducted a quality assurance evaluation of a buprenorphine program that aimed to (a) evaluate the clinic's performance in illicit opioid abstinence and (b) identify patient risk and resilience characteristics to improve patient success in recovery with buprenorphine. A retrospective chart review of open (n = 35) and closed (n = 21) cases and a cross-sectional survey in open cases were completed. Clinical performance was measured with percentages of opioid-negative urines and completed monthly urine drug tests (UDTs) for the first 6 months. Open cases were surveyed regarding risk and resilience characteristics (frequency of opioid cravings and triggers, therapy participation, and coping skills). Average opioid-negative urine was significantly higher in open cases than closed cases, and there was no significant association between open cases and closed cases in completed monthly UDTs. Most individuals reported therapy participation, minimal opioid cravings, and use of distraction to cope with chronic pain-induced cravings. Recommendations for future work include regular evaluations of UDTs, cravings, chronic pain, therapy participation, and participation in continuous quality assurance activities.


Next, in the Clinical Review Column, Drs. Onderdonk and Goldstein discuss substance use treatment through telemedicine in the age of COVID-19. Specifically, they discuss provider perspectives of benefits and barriers to telemedicine for SUD treatment during the COVID-19 pandemic.


We also have a number of informative articles that have been published ahead of print that will now be moved into this volume and issue online. These include Drs. de Vargas and Naegle's article on the reliability and validity of the Attitudes Scale on Alcohol, Alcoholism, and Persons with Alcohol Use Disorders in an English-speaking group; Dr. Mirinda Brown Tyo and colleagues' article "Predictors of Burden and Resilience in Family Caregivers of Individuals with Opioid Use Disorder"; and Marya Schulte and Annemarie Kelleghan's article "Adolescent, Parent, and Provider Perspectives of a Social-Media-Based Support Tool for Parents of Teens in Treatment for Substance Use." In the article "Identification of the Obstetric Factors Increasing Tendency to Smoking Cessation during Pregnancy," Burcu Avcibay Vurgec aims to identify pregnancy-related factors that affect the tendency of smoking cessation during pregnancy. Mo-Kyung Sin and Kum Hee Ro present a qualitative study entitled, "Factors Influencing Smoking Decisions among Older Korean American Men." Finally, Jean Bernhardt presents "Nurse-Sensitive Indicators in the Care of Individuals with Opioid Use Disorder."


I would also like to extend my heartfelt thank you to all of our 2021-2022 Editorial Board members and all of our outstanding peer reviewers. It is only with their continued input and hard work that the Journal of Addictions Nursing will continue to grow and improve. I look forward to working with you all, including our new Editorial Board members, namely, Marissa Adams, PhD, PMHNP-BC, CARN-AP, FIAAN; Devon Noonan, PhD, MPH, FNP-BC; and Ruthanne Palumbo, DNP, CNE, CARN, in the New Year.