Literature Collection

: In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.

Pregnancy can be a time of joy and hope but, for birthing parents struggling with a substance use disorder (SUD), it can be challenging. Social stigma, shame, and the potential legal ramifications present barriers to individuals seeking the care they need. Marginalized groups, in particular, face challenges that put them at even greater risk for substance misuse. Substance use during pregnancy can further impair the individual's level of functioning, and it has also been associated with problems in the social, emotional, and cognitive development of their children. Pregnancy and addiction each require guidance and good medical care. By integrating substance misuse treatment services under the umbrella of their medical care, clinics facilitate timely access to care, as well as help break the stigma associated with substance misuse. Our program offers a comprehensive and multidisciplinary approach to support pregnant individuals with SUDs. Interventions include support, education, case management, and mental health counseling. By providing optimal prenatal care early on, individuals can receive the treatment that they need so that they can achieve physical and emotional stability once the baby arrives, which ultimately has better outcomes for the parent and child's health and wellbeing.

BACKGROUND: Like many low- and middle-income countries, almost half of the proportion of the South African population is under the age of 25. Given the peak age of onset for most mental health problems is in adolescence, it is vital that adolescents have access to mental health counselling. There are several initiatives to increase access to mental health counselling in South Africa, primarily through the integration of counselling for common mental disorders (CMD) into primary health care services, but adolescents (15-18 years of age) generally do not utilize these services. To address this gap, we will undertake a study to explore the feasibility of conducting a trial of the effectiveness of a community-based mental health counselling intervention for adolescents at-risk for a CMD. METHODS: The study is a feasibility trial of the ASPIRE intervention, a four-session blended multi-component counselling intervention adapted for South African adolescents at risk for depression and alcohol use disorders. We will enrol 100 adolescents from community settings and randomly assign them to the ASPIRE intervention or a comparison condition. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, will be calculated. Qualitative interviews with participants and counsellors will explore the acceptability of the intervention. The primary outcomes for a subsequent trial would be reductions in symptoms of depression and days of heavy drinking which will be measured at baseline, 6 weeks, and 3 months post-randomization. DISCUSSION: This feasibility trial using a mixed-methods design will allow us to determine whether we can move forward to a larger effectiveness trial of the ASPIRE intervention. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020-retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795.