Screening, brief intervention, and referral to treatment (SBIRT) for substance use in a school-based program: services and outcomes

BACKGROUND

Despite the advantages of using high schools for conducting school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs for adolescent substance misuse, there have been very few studies of Brief Interventions (BIs) in these settings.

OBJECTIVES

This multi-site, repeated measures study examined outcomes of adolescents who received SBIRT services and compared the extent of change in substance use based on the intensity of intervention received.

METHODS

Participants consisted of 629 adolescents, ages 14-17, who received SBIRT services across 13 participating high schools in New Mexico. The level of service received and number of sessions were collected through administrative records, while the number of self-reported days in the past month of drinking; drinking to intoxication; and drug use were gathered at baseline and 6-month follow-up.

RESULTS

BI was provided to 85.1% of adolescents, while 14.9% received brief treatment or referral to treatment (BT/RT). Participants receiving any intervention reported significant reductions in frequency of drinking to intoxication (p < .05) and drug use (p < .001), but not alcohol use, from baseline to 6-month follow-up. The magnitude of these reductions did not differ based on service variables. Controlling for baseline frequency of use, a BT/RT service level was associated with more days of drinking at 6-month follow-up (p < .05), but was no longer significant when controlling for number of service sessions received.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These findings support school-based SBIRT for adolescents, but more research is needed on this promising approach.

Implementing a statewide Screening, Brief Intervention, and Referral to Treatment (SBIRT) service in rural health settings: New Mexico SBIRT

This is a report on the New Mexico Screening, Brief Intervention, and Referral to Treatment (SBIRT) project conducted over 5 years as part of a national initiative launched by the Substance Abuse and Mental Health Services Administration with the aim of increasing integration of substance use services and medical care. Throughout the state, 53,238 adults were screened for alcohol and/or drug use problems in ambulatory settings, with 12.2% screening positive. Baseline substance use behaviors among 6,360 participants eligible for brief intervention, brief treatment, or referral for treatment are examined and the process of implementation and challenges for sustainability are discussed.

Opioid agonist maintenance for probationers: patient-level predictors of treatment retention, drug use, and crime

This study examined outcomes and their predictors among 181 probationers enrolling in opioid agonist maintenance with methadone or levo-alpha-acetylmethadol (LAAM). Participants were interviewed at treatment entry and 2-, 6-, and 12-month follow-ups. Treatment retention and frequency of heroin use, cocaine use, and income-generating criminal activity were examined using survival and longitudinal analyses. Participants reported marked reductions in drug use and crime relative to treatment entry. A number of patient characteristics associated with various outcomes were identified. The findings support engaging probationers in treatment and highlight patient factors that might influence outcomes.

African American patients seeking treatment in the public sector: characteristics of buprenorphine vs. methadone patients

BACKGROUND

To expand its public-sector treatment capacity, Baltimore City made buprenorphine treatment accessible to low-income, largely African American residents. This study compares the characteristics of patients entering methadone treatment vs. buprenorphine treatment to determine whether BT was attracting different types of patients.

METHODS

Participants consisted of two samples of adult heroin-dependent African Americans. The first sample was newly admitted to a health center or a mental health center providing buprenorphine (N=200), and the second sample was newly admitted to one of two hospital-based methadone programs (N=178). The Addiction Severity Index (ASI) and the Friends Supplemental Questionnaire were administered at treatment entry and data were analyzed with logistic regression.

RESULTS

BT participants were more likely to be female (p=.017) and less likely to inject (p=.001). Participants with only prior buprenorphine treatment experience were nearly five time more likely to enter buprenorphine than methadone treatment (p<.001). Those with experience with both treatments were more than twice as likely to enter BT (OR=2.7, 95% CI=1.11-6.62; p=.028). In the 30 days prior to treatment entry, BT participants reported more days of medical problems (p=.002) and depression (p=.044), and were more likely to endorse a lifetime history of depression (p<.001).

CONCLUSION

Methadone and buprenorphine treatment provided in the public sector may attract different patient subpopulations. Providing buprenorphine treatment through drug treatment programs co-located with a health and mental health center may have accounted for their higher rates of medical and psychiatric problems and appears to be useful in attracting a diverse group of patients into public-sector funded treatment.

The relationship between services delivered and substance use outcomes in New Mexico's Screening, Brief Intervention, Referral and Treatment (SBIRT) Initiative

BACKGROUND

Recent years have seen increased diffusion of Screening, Brief Intervention, Referral and Treatment (SBIRT) in healthcare environments. This study examined the relationship between substance use outcomes and service variables within the SBIRT model.

METHODS

Over 55,000 adult patients were screened for substance misuse at rural health clinics throughout New Mexico during the SBIRT Initiative. This naturalistic pre-post services study used administrative baseline, 6 month follow-up, and services data for adult participants in the New Mexico SBIRT evaluation (n=1208). Changes in self-reported frequency of illicit drug use, alcohol use, and alcohol intoxication were examined as a function of service level (brief intervention - BI vs. brief treatment/referral - BT/RT) and number of service sessions.

RESULTS

Participants reported decreased frequency of illicit drug use, alcohol use, and alcohol intoxication 6 months after receipt of SBIRT services (p<.001 for each). Compared to those who received BI, participants who received BT/RT had sharper reductions in frequency of drinking (IRR=.78; p<.05) and alcohol intoxication (IRR=.75; p<.05). Number of service sessions was associated with reduced frequency of alcohol use (IRR=.84; p<.01) and intoxication (IRR=.82; p<.05), but only among those who received BI.

CONCLUSIONS

Substance-using patients with disparate levels of use may benefit from SBIRT. In a real-world, multi-site rural SBIRT program, services of higher intensity and (within the BI modality) frequency were associated with greater magnitude of change in drinking behaviors. Reductions in illicit drug use, while substantial, did not differ significantly based on service variables. Future studies should identify the preferred service mix in the SBIRT model as it continues to expand.

Religiosity, Heavy Alcohol Use, and Vicarious Learning Networks Among Adolescents in the United States

Previous research has found that religiosity may protect against risky alcohol and drug use behaviors among adolescents, but the social mechanics underpinning the relationship are not well understood. This study examined the relationship between religiosity, heavy drinking, and social norms among U.S. adolescents aged 12 to 17 years, using the 2007 National Survey on Drug Use and Health ( n = 14,556). Based on a vicarious learning networks theoretical perspective, the effect of religiosity on heavy drinking behavior was hypothesized to be exerted indirectly through the norms of key reference groups in the social network (close friends and parents). Support was found for reference group norms as one underlying mechanism of the religiosity–alcohol relationship. Religiosity and nonpermissive drinking norms of parents, close friends, and peers maintained a strong protective association with adolescent heavy drinking. Supplementary analyses elaborated on the role of competing and complementary normative orientations among reference groups in the social network.

Patterns in admission delays to outpatient methadone treatment in the United States

Waiting lists for methadone treatment have existed in many U.S. communities, but little is known nationally about what patient and service system factors are related to admission delays that stem from program capacity shortfalls. Using a combination of national data sources, this study examined patterns in capacity-related admission delays to outpatient methadone treatment in 40 U.S. metropolitan areas (N = 28,920). Patient characteristics associated with admission delays included racial/ethnic minority status, lower education, criminal justice referral, prior treatment experience, secondary cocaine or alcohol use, and co-occurring psychiatric problems. Injection drug users experienced fewer delays, as did self-pay patients and referrals from health care and addiction treatment providers. Higher community-level utilization of methadone treatment was associated with delay, whereas delays were less common in communities with higher utilization of alternative modalities. These findings highlight potential disparities in timely admission to outpatient methadone treatment. Implications for improving treatment access and service system monitoring are discussed.

Challenges in public health research with American Indians and other small ethnocultural minority populations

As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.

Social Norms and the Relationship Between Cigarette Use and Religiosity Among Adolescents in the United States

This study investigated the social dynamics that underlie the negative association between religiosity and cigarette use among U.S. adolescents. Using data from the 2007 National Survey on Drug Use and Health, the authors used a theory-based conceptual model (vicarious learning networks [VLN]) to examine the role that key reference group norms play in the religiosity—smoking relationship. This relationship is partially mediated by parents’ and close friends’ perceived disapproval for smoking. However, religiosity maintains a strong negative association with smoking. Consistent with the VLN model, cigarette use varied substantively based on reference group normative configurations. To the extent that the protective effects of religiosity arise from its influence in structuring the social milieu, some of religiosity’s benefits could potentially be leveraged through interventions that promote healthy norms among reference groups within the social network. The VLN model may be a useful tool for conceptualizing the transmission of health behavior through social learning processes.

Contexts of tobacco use and perspectives on smoking cessation among a sample of urban American Indians

American Indians have the highest prevalence of cigarette use in the United States, but there is a shortage of knowledge about American Indians' own perspectives on smoking and cessation. The purpose of this exploratory qualitative study was to obtain information on American Indians' views that would be useful for subsequent intervention planning and development. Four focus groups were conducted with urban American Indians living in Maryland to explore the sociocultural contexts of tobacco use and their perspectives on various mainstream and culturally-specific smoking cessation strategies and service delivery models. Tobacco interventions targeting American Indians should increase service access, address negative experiences with medications, emphasize empowerment for behavior change, explicitly distinguish ceremonial tobacco from cigarette use, and send culturally-relevant messages. Smoking cessation programs and health promotion efforts may be perceived as more relevant by the target population if they incorporate an understanding of the social and cultural facets of smoking behavior.

Treatment entry among individuals on a waiting list for methadone maintenance

BACKGROUND

Many methadone programs in the United States have waiting lists for care.

OBJECTIVES

To examine specific predictors of treatment entry among individuals on a waiting list for methadone maintenance.

METHODS

Heroin users placed on a waiting list for methadone treatment (n = 120) were administered a urine screen for drug use and assessed with a battery of measures at study entry and at 4 month follow-up as part of a larger clinical trial. Logistic regression was used to examine hypothesized predictors of treatment entry. Outcomes for those failing to enter treatment were also examined.

RESULTS

Only 25 individuals (20.8%) entered treatment within four months of being placed on a waiting list. Intravenous drug users were more likely to enter treatment (p <.05) whereas cocaine users were less likely to do so (p <.01). Motivation did not predict treatment entry, and cocaine use did not moderate this relationship. There were some improvements in heroin use among those who did not enter treatment.

CONCLUSIONS

Additional research is needed on the relationship between motivation and treatment entry. Programs may need to make special efforts to facilitate entry for treatment-seeking heroin users who also use cocaine.

SCIENTIFIC SIGNIFICANCE

These findings have implications for improving access to methadone treatment.

Social learning theory and the effects of living arrangement on heavy alcohol use: results from a national study of college students

OBJECTIVE

This study examined the relationship between living arrangement and heavy episodic drinking among college students in the United States. Using social learning theory as a framework, it was hypothesized that vicarious learning of peer and family alcohol-use norms would mediate the effects of living arrangement on heavy episodic drinking.

METHOD

Analyses were conducted using data from the 2001 Harvard School of Public Health College Alcohol Study, a national survey of full-time undergraduate students attending 4-year colleges or universities in the United States (N = 10,008). Logistic regression models examined the relationship between heavy episodic drinking and various measures of living arrangement and vicarious learning/social norms. Mediation of the effects of living arrangement was tested using both indirect and direct methods.

RESULTS

Both student living arrangement and vicarious-learning/social-norm variables remained significant predictors of heavy episodic drinking in multivariate models when controlling for a variety of individual characteristics. Slight mediation of the effects of living arrangement on heavy episodic drinking by vicarious learning/social norms was confirmed for some measures.

CONCLUSIONS

Although vicarious learning of social norms does appear to play a role in the association between living arrangement and alcohol use, other processes may underlie the relationship. These findings suggest that using theory alongside empirical evidence to inform the manipulation of living environments could present a promising policy strategy to reduce alcohol-related harm in collegiate contexts.

HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: in their own words

A needs assessment funded by the Center of Substance Abuse Prevention was conducted in 2005-2006 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, Maryland. We used a community-based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths and uncovered the social and cultural contexts in which health risk behaviors unfold. The use of these methods within a participatory framework produced a more complete portrait of the service needs of the Native American population in Baltimore. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Native Americans.

Alcohol use and participation in organized recreational sports among university undergraduates

OBJECTIVE

The authors examined alcohol use among students involved in recreational sports. To the authors' knowledge, this is the first study of alcohol use in which researchers separate recreational sports participants from intercollegiate athletes and examine them as a separate group of interest.

PARTICIPANTS

The authors generated a random sample of 494 students from the undergraduate population at a 4-year university.

METHODS

They used a Web-based survey to collect data and stratified and weighted the sample by residence status to more accurately reflect the population.

RESULTS

Students who participated in recreational sports used alcohol at a greater frequency and intensity than did those who were not involved in recreational sports across a variety of measures, even alongside other variables, including race, sex, and Greek membership.

CONCLUSIONS

On the basis of these findings, alcohol consumption among those participating in recreational sports appears to be an area worthy of consideration in future research.

The healing forest metaphor revisited: the seen and "unseen world" of drug use

There is one world we live in. Its geographical and spatial boundaries tell us this. We see it on maps, we see it on television, and we see it when we walk out of the door. Children, adults, and people of all races and creeds live in this one world. The world we live in is viewed differently by these many individuals. Some see it as hostile, some see it as peaceful, and some go about their daily business and do not see it at all. This is the seen world. The one we can see with our eyes. The seen world is not the only one that exists, however, because there is also another world behind our eyes. When we close our eyes, it is in there. We have an imagination to tell us what it could be like, we have thoughts to tell us what we want it to be like, and we have dreams to tell us what we want it to be. Where is this unseen world? We carry it around with us every nanosecond of every day that we are alive. While we live in the seen world, the unseen world is alive in us. What could the unseen world be like for substance users? This is the topic of the current article.