126
|
Gryczynski J, Mitchell SG, Ondersma SJ, O'Grady KE, Schwartz RP. Potential radiating effects of misusing substances among medical patients receiving brief intervention. J Subst Abuse Treat 2015; 55:39-44. [PMID: 25812927 DOI: 10.1016/j.jsat.2015.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/17/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired. METHODS This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range). RESULTS 12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01). CONCLUSION This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users.
Collapse
|
127
|
Mitchell SG, Schwartz RP, Alvanzo AAH, Weisman MS, Kyle TL, Turrigiano EM, Gibson ML, Perez L, McClure EA, Clingerman S, Froias A, Shandera DR, Walker R, Babcock DL, Bailey GL, Miele GM, Kunkel LE, Norton M, Stitzer ML. The Use of Technology in Participant Tracking and Study Retention: Lessons Learned From a Clinical Trials Network Study. Subst Abus 2015; 36:420-6. [PMID: 25671593 DOI: 10.1080/08897077.2014.992565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The growing use of newer communication and Internet technologies, even among low-income and transient populations, require research staff to update their outreach strategies to ensure high follow-up and participant retention rates. This paper presents the views of research assistants on the use of cell phones and the Internet to track participants in a multisite randomized trial of substance use disorder treatment. METHODS Preinterview questionnaires exploring tracking and other study-related activities were collected from 21 research staff across the 10 participating US sites. Data were then used to construct a semistructured interview guide that, in turn, was used to interview 12 of the same staff members. The questionnaires and interview data were entered in Atlas.ti and analyzed for emergent themes related to the use of technology for participant-tracking purposes. RESULTS Study staff reported that most participants had cell phones, despite having unstable physical addresses and landlines. The incoming call feature of most cell phones was useful for participants and research staff alike, and texting proved to have additional benefits. However, reliance on participants' cell phones also proved problematic. Even homeless participants were found to have access to the Internet through public libraries and could respond to study staff e-mails. Some study sites opened generic social media accounts, through which study staff sent private messages to participants. However, the institutional review board (IRB) approval process for tracking participants using social media at some sites was prohibitively lengthy. Internet searches through Google, national paid databases, obituaries, and judiciary Web sites were also helpful tools. CONCLUSIONS Research staff perceive that cell phones, Internet searches, and social networking sites were effective tools to achieve high follow-up rates in drug abuse research. Studies should incorporate cell phone, texting, and social network Web site information on locator forms; obtain IRB approval for contacting participants using social networking Web sites; and include Web searches, texting, and the use of social media in staff training as standard operating procedures.
Collapse
|
128
|
Gryczynski J, Kelly SM, Gwin Mitchell S, Kirk A, O’Grady KE, Schwartz RP. Validation and performance of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among adolescent primary care patients. Addiction 2015; 110:240-7. [PMID: 25311148 PMCID: PMC4301997 DOI: 10.1111/add.12767] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 10/02/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) has strong support as a clinical screening tool and research instrument, but has only been validated with adults. This study evaluated the ASSIST and ASSIST-Lite in an adolescent population. DESIGN Internal consistency, concurrent validity, discriminant validity and diagnostic accuracy were examined for tobacco, alcohol and cannabis ASSIST scores. An abbreviated version (the ASSIST-Lite) was evaluated for cannabis. SETTING Three community health centers in Baltimore, MD, USA. PARTICIPANTS A total of 525 primary care patients, ages 12-17 years. MEASUREMENTS Measures included the ASSIST, the CRAFFT screening tool and items from the Composite International Diagnostic Interview (CIDI) corresponding to substance use disorder criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. FINDINGS The ASSIST had good internal consistency (α = 0.68-0.88), good concurrent validity with the CRAFFT (r = 0.41-0.76; P < 0.001), and was able to discriminate between gradations of cannabis problem severity. In receiver operating characteristics analysis of optimal clinical cut-points, the ASSIST accurately identified tobacco, alcohol and cannabis use disorders (sensitivities = 95-100%; specificities = 79-93%; area under the curve [AUC] = 0.90-0.94), but did so at minimally low cut-points (indicative of any use in the past 3 months). The ASSIST-Lite performed similarly to the ASSIST in identifying cannabis use disorders (sensitivity = 96%; specificity = 88%; AUC = 0.92), also at a minimally low cut-point. However, confirmatory factor analysis of the ASSIST indicated poor model fit. CONCLUSIONS The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is promising as a research and screening/brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. The ASSIST-Lite is sufficiently informative for rapid clinical screening of adolescents for cannabis use disorders.
Collapse
|
129
|
Schwartz RP, Kelly SM, Gryczynski J, Mitchell SG, O’Grady KE, Jaffe JH. Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research. J Addict Dis 2015; 34:151-61. [PMID: 26079104 PMCID: PMC4550504 DOI: 10.1080/10550887.2015.1059222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews research conducted in Baltimore over the past 15 years, examining the following: (1) What factors differentiate heroin-addicted individuals who enter methadone treatment from those who do not? (2) How difficult is gaining access to methadone treatment? (3) What are effective ways to overcome barriers to treatment entry? (4) Why do so many methadone patients drop out of treatment prematurely? (5) What are the added benefits of counseling when coupled with methadone or buprenorphine treatment? (6) Does increasing access to treatment have an impact on overdose deaths? Specific recommendations are made for policymakers concerned with addressing heroin addiction.
Collapse
|
130
|
Holtyn AF, Koffarnus MN, DeFulio A, Sigurdsson SO, Strain EC, Schwartz RP, Leoutsakos JMS, Silverman K. The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: a randomized controlled trial. Prev Med 2014; 68:62-70. [PMID: 24607365 PMCID: PMC4155024 DOI: 10.1016/j.ypmed.2014.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/22/2014] [Accepted: 02/25/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users. METHOD This study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N=98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay. RESULTS Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%). CONCLUSION The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users. Clinical trial registration number: NCT01416584.
Collapse
|
131
|
Teruya C, Schwartz RP, Mitchell SG, Hasson AL, Thomas C, Buoncristiani SH, Hser YI, Wiest K, Cohen AJ, Glick N, Jacobs P, McLaughlin P, Ling W. Patient perspectives on buprenorphine/naloxone: a qualitative study of retention during the starting treatment with agonist replacement therapies (START) study. J Psychoactive Drugs 2014; 46:412-26. [PMID: 25364994 PMCID: PMC4220245 DOI: 10.1080/02791072.2014.921743] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examines the barriers and facilitators of retention among patients receiving buprenorphine/naloxone at eight community-based opioid treatment programs across the United States. Participants (n = 105) were recruited up to three and a half years after having participated in a randomized clinical trial comparing the effect of buprenorphine/naloxone and methadone on liver function. Semi-structured interviews were conducted with 67 patients provided with buprenorphine/naloxone who had terminated early and 38 patients who had completed at least 24 weeks of the trial. Qualitative data were analyzed using the constant comparison method. Barriers to buprenorphine/naloxone retention that emerged included factors associated with: (1) the design of the clinical trial; (2) negative medication or treatment experience; and (3) personal circumstances. The facilitators comprised: (1) positive experience with the medication; (2) personal determination and commitment to complete; and (3) staff encouragement and support. The themes drawn from interviews highlight the importance of considering patients' prior experience with buprenorphine/naloxone and methadone, medication preference, personal circumstances, and motivation to abstain from illicit use or misuse of opioids, as these may influence retention. Ongoing education of patients and staff regarding buprenorphine/naloxone, especially in comparison to methadone, and support from staff and peers are essential.
Collapse
|
132
|
Holtyn AF, Koffarnus MN, DeFulio A, Sigurdsson SO, Strain EC, Schwartz RP, Silverman K. Employment-based abstinence reinforcement promotes opiate and cocaine abstinence in out-of-treatment injection drug users. J Appl Behav Anal 2014; 47:681-93. [PMID: 25292399 DOI: 10.1002/jaba.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/29/2014] [Indexed: 11/06/2022]
Abstract
We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatment. After participants met the methadone contingency for 3 weeks, they had to provide opiate-negative urine samples to maintain maximum pay. After participants met those contingencies for 3 weeks, they had to provide opiate- and cocaine-negative urine samples to maintain maximum pay. The percentage of drug-negative urine samples remained stable until the abstinence reinforcement contingency for each drug was applied. The percentage of opiate- and cocaine-negative urine samples increased abruptly and significantly after the opiate- and cocaine-abstinence contingencies, respectively, were applied. These results demonstrate that the sequential administration of employment-based abstinence reinforcement can increase opiate and cocaine abstinence among out-of-treatment injection drug users.
Collapse
|
133
|
Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O'Grady KE, Schwartz RP. A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: outcomes through 12 months. J Subst Abuse Treat 2014; 50:3-10. [PMID: 25282578 DOI: 10.1016/j.jsat.2014.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
This study examined outcomes through 12 months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N=360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p<.001), but there were no significant differences between conditions in overall change across 12 months of follow-up (p=.13). CBI produced greater overall reductions in alcohol (p=.04) and cocaine (p=.02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions.
Collapse
|
134
|
Gordon MS, Kinlock TW, Schwartz RP, Fitzgerald T, O’Grady KE, Vocci FJ. A randomized controlled trial of prison-initiated buprenorphine: prison outcomes and community treatment entry. Drug Alcohol Depend 2014; 142:33-40. [PMID: 24962326 PMCID: PMC4129444 DOI: 10.1016/j.drugalcdep.2014.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. METHODS This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. RESULTS There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%). CONCLUSIONS Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.
Collapse
|
135
|
Gryczynski J, Schwartz RP, Mitchell SG, O’Grady KE, Ondersma SJ. Hair drug testing results and self-reported drug use among primary care patients with moderate-risk illicit drug use. Drug Alcohol Depend 2014; 141:44-50. [PMID: 24932945 PMCID: PMC4080811 DOI: 10.1016/j.drugalcdep.2014.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/26/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study sought to examine the utility of hair testing as a research measure of drug use among individuals with moderate-risk drug use based on the internationally validated Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). METHODS This study is a secondary analysis using baseline data from a randomized trial of brief intervention for drug misuse, in which 360 adults with moderate-risk drug use were recruited from two community clinics in New Mexico, USA. The current study compared self-reported drug use on the ASSIST with laboratory analysis of hair samples using a standard commercially available 5-panel test with assay screening and gas chromatography/mass spectrometry (GC/MS) confirmation. Both self-report and hair testing covered a 3-month period. RESULTS Overall concordance between hair testing and self-report was 57.5% (marijuana), 86.5% (cocaine), 85.8% (amphetamines), and 74.3% (opioids). Specificity of hair testing at standard laboratory cut-offs exceeded 90% for all drugs, but sensitivity of hair testing relative to self-report was low, identifying only 52.3% (127/243) of self-disclosed marijuana users, 65.2% (30/46) of cocaine users, 24.2% (8/33) of amphetamine users, and 2.9% (2/68) of opioid users. Among participants who disclosed using marijuana or cocaine in the past 3 months, participants with a negative hair test tended to report lower-frequency use of those drugs (p<.001 for marijuana and cocaine). CONCLUSIONS Hair testing can be useful in studies with moderate-risk drug users, but the potential for under-identification of low-frequency use suggests that researchers should consider employing low detection cut-offs and using hair testing in conjunction with self-report.
Collapse
|
136
|
Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O’Grady KE, Schwartz RP. Concordance between DSM-5 and DSM-IV nicotine, alcohol, and cannabis use disorder diagnoses among pediatric patients. Drug Alcohol Depend 2014; 140:213-6. [PMID: 24793367 PMCID: PMC4070874 DOI: 10.1016/j.drugalcdep.2014.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/28/2014] [Accepted: 03/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The recently published Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) includes several major revisions to substance use diagnoses. Studies have evaluated the impact of these changes among adult samples but research with adolescent samples is lacking. METHODS 525 adolescents (93% African American) awaiting primary care appointments in Baltimore, Maryland were recruited for a study evaluating a substance use screening instrument. Participants were assessed for DSM-5 nicotine, alcohol, and cannabis use disorder, DSM-IV alcohol and cannabis abuse, and DSM-IV dependence for all three substances during the past year using the modified Composite International Diagnostic Interview-2, Substance Abuse Module. Contingency tables examining DSM-5 vs. DSM-IV joint frequency distributions were examined for each substance. RESULTS Diagnoses were more prevalent using DSM-5 criteria compared with DSM-IV for nicotine (4.0% vs. 2.7%), alcohol (4.6% vs. 3.8%), and cannabis (10.7% vs. 8.2%). Cohen's κ, Somers' d, and Cramer's V ranged from 0.70 to 0.99 for all three substances. Of the adolescents categorized as "diagnostic orphans" under DSM-IV, 7/16 (43.8%), 9/29 (31.0%), and 13/36 (36.1%) met criteria for DSM-5 disorder for nicotine, alcohol, and cannabis, respectively. Additionally, 5/17 (29.4%) and 1/21 (4.8%) adolescents who met criteria for DSM-IV abuse did not meet criteria for a DSM-5 diagnosis for alcohol and cannabis, respectively. CONCLUSIONS Categorizing adolescents using DSM-5 criteria may result in diagnostic net widening-particularly for cannabis use disorders-by capturing adolescents who were considered diagnostic orphans using DSM-IV criteria. Future research examining the validity of DSM-5 substance use disorders with larger and more diverse adolescent samples is needed.
Collapse
|
137
|
Schwartz RP, Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O’Grady KE. Computerized versus in-person brief intervention for drug misuse: a randomized clinical trial. Addiction 2014; 109:1091-8. [PMID: 24520906 PMCID: PMC4086904 DOI: 10.1111/add.12502] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/05/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Several studies have found that brief interventions (BIs) for drug misuse have superior effectiveness to no-treatment controls. However, many health centers do not provide BIs for drug use consistently due to insufficient behavioral health staff capacity. Computerized BIs for drug use are a promising approach, but their effectiveness compared with in-person BIs has not been established. This study compared the effectiveness of a computerized brief intervention (CBI) to an in-person brief intervention (IBI) delivered by a behavioral health counselor. METHODS Two-arm randomized clinical trial, conducted in two health centers in New Mexico, United States. Participants were 360 adult primary care patients with moderate-risk drug scores on the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) who were randomly assigned on a 1 : 1 basis to a computerized brief intervention (CBI) or to an in-person brief intervention (IBI) delivered by a behavioral health counselor. Assessments were conducted at baseline and 3-month follow-up, and included the ASSIST and drug testing on hair samples. RESULTS The IBI and CBI conditions did not differ at 3 months on global ASSIST drug scores [b = -1.79; 95% confidence interval (CI) = -4.37, 0.80] or drug-positive hair tests [odds ratio (OR) = 0.97; 95% CI = 0.47, 2.02]. There was a statistically significant advantage of CBI over IBI in substance-specific ASSIST scores for marijuana (b = -1.73; 95% CI = -2.91, -0.55; Cohen's d = 0.26; P = 0.004) and cocaine (b = -4.48; 95% CI = -8.26, -0.71; Cohen's d = 0.50; P = 0.021) at 3 months. CONCLUSIONS Computerized brief intervention can be an effective alternative to in-person brief intervention for addressing moderate drug use in primary care.
Collapse
|
138
|
Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O'Grady KE, Schwartz RP. Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use. Pediatrics 2014; 133:819-26. [PMID: 24753528 PMCID: PMC4006430 DOI: 10.1542/peds.2013-2346] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad. METHODS Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs. RESULTS One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001). CONCLUSIONS The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention.
Collapse
|
139
|
Gordon MS, Kinlock TW, Schwartz RP, Couvillion KA, Sudec LJ, O’Grady KE, Vocci FJ, Shabazz H. Buprenorphine Treatment for Probationers and Parolees. Subst Abus 2014; 36:217-25. [PMID: 24701967 PMCID: PMC4185269 DOI: 10.1080/08897077.2014.902787] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pharmacotherapy studies involving buprenorphine have rarely been conducted with U.S. community corrections populations. This is one of the first reports of buprenorphine treatment outcomes of adult opioid-dependent probationers and parolees. METHODS This longitudinal study examined the 3-month treatment outcomes for a sample of probation and parole clients (N = 64) who received community-based buprenorphine treatment. RESULTS Approximately two thirds of the sample (67%) were still in treatment at 3 months post baseline. Furthermore, there was a significant decline in the number of self-reported heroin use days and crime days from baseline to 3 months post baseline. Although there was not a significant reduction in reincarcerations, there was no evidence that they had increased. CONCLUSIONS Given that buprenorphine is approved by the Food and Drug Administration (FDA) as a safe, effective treatment for opioid use disorders, individuals on parole or probation should have the opportunity to benefit from it through community-based programs.
Collapse
|
140
|
Mitchell SG, Gryczynski J, Kelly SM, O’Grady KE, Jaffe JH, Olsen YK, Schwartz RP. Treatment Outcomes of African American Buprenorphine Patients by Parole and Probation Status. JOURNAL OF DRUG ISSUES 2014; 44:69-82. [PMID: 25364037 PMCID: PMC4214068 DOI: 10.1177/0022042613491106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This secondary analysis compared outcomes of African-American adults newly-admitted to buprenorphine treatment who were on parole and probation to patients who were not under criminal justice supervision. Buprenorphine patients (N=300) were randomly assigned to receive either Intensive Outpatient Treatment (IOP) or Standard Outpatient Treatment (OP) treatment and were assessed at baseline, 3- and 6-months. There were no differences between groups in treatment retention. Among probationers/parolees, IOP was associated with lower 3-month treatment retention compared to OP, but among participants not on probation/parole the relationship was reversed (p=.004). Both conditions showed significant declines in heroin and cocaine use, illegal activity, and in meeting DSM-IV criteria for opioid and cocaine dependence. Probationers/parolees reported lower frequency of illegal activities at 3-months compared to non-probationers/parolees (p=.007). Buprenorphine treatment should be made more widely available to individuals on parole/probation as they respond as well to treatment as patients not supervised by the criminal justice system.
Collapse
|
141
|
Gordon MS, Kinlock TW, Schwartz RP, Couvillion KA, O’Grady KE. The Severity, Frequency, and Variety of Crime in Heroin-Dependent Prisoners Enrolled in a Buprenorphine Clinical Trial. THE PRISON JOURNAL 2013; 93:390-410. [PMID: 25392564 PMCID: PMC4225709 DOI: 10.1177/0032885513500753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Data were obtained on four dimensions of criminal activity (frequency, variety, severity, and income) from male and female prisoners (N = 200) with preincarceration heroin dependence who participated in a randomized clinical trial of buprenorphine treatment. The article examines the above-mentioned dimensions of crime and their relationships with demographic characteristics, substance use, legitimate employment, drug treatment episodes, and psychological problems. Results largely show several important similarities to results on previous prison inmate cohorts with histories of heroin addiction, although the present sample may have more of a tendency toward violent crime than earlier cohorts of heroin-dependent offenders. This study's findings may have implications for the design of appropriate treatment interventions for prisoners with preincarceration heroin dependence that address not only substance use but also criminal activity.
Collapse
|
142
|
Blanco C, Rafful C, Wall MM, Jin CJ, Kerridge B, Schwartz RP. The latent structure and predictors of non-medical prescription drug use and prescription drug use disorders: a national study. Drug Alcohol Depend 2013; 133:473-9. [PMID: 23962421 PMCID: PMC3818293 DOI: 10.1016/j.drugalcdep.2013.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite growing concerns about non-medical prescription drug use and prescription drug use disorders, whether vulnerability for these conditions is drug-specific or occurs through a shared liability and common risk factors is unknown. METHODS Exploratory and confirmatory factor analysis of Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the latent structure of non-medical prescription drug use and prescription drug use disorders. Multiple Indicators Multiple Causes (MIMIC) analysis was used to examine whether the effect of sociodemographic and psychiatric covariates occurred through the latent factor, directly on each drug class or both. RESULTS A one-factor model described well the structure of both non-medical prescription drug use and prescription drug use disorders. Younger age, being White, having more intense pain or one of several psychiatric disorders increased the risk of non-medical prescription drug use through the latent factor. The same covariates, except for anxiety disorders also significantly increased the risk of prescription drug use disorders through the latent factor. Older age directly increased the risk of non-medical use of sedatives, and alcohol use disorders decreased the risk of non-medical tranquilizer use. No covariates had direct effects on the risk of any prescription drug use disorders beyond their effect through the latent factor. CONCLUSION The risk for non-medical prescription drug use and prescription drug use disorders occurs through a shared liability. Treatment, prevention and policy approaches directed at these drugs as a group maybe more effective than those focused on individual classes of drugs.
Collapse
|
143
|
Gryczynski J, Jaffe JH, Schwartz RP, Dušek KA, Gugsa N, Monroe CL, O'Grady KE, Olsen YK, Mitchell SG. Patient perspectives on choosing buprenorphine over methadone in an urban, equal-access system. Am J Addict 2013; 22:285-91. [PMID: 23617873 DOI: 10.1111/j.1521-0391.2012.12004.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/27/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent policy initiatives in Baltimore City, MD significantly reduced access disparities between methadone and buprenorphine in the publicly funded treatment sector. OBJECTIVES This study examines reasons for choosing buprenorphine over methadone among patients with access to both medications. METHOD This study was embedded within a larger clinical trial conducted at two outpatient substance abuse treatment programs offering buprenorphine. Qualitative and quantitative data on treatment choice were collected for new patients starting buprenorphine treatment (n = 80). The sample consisted of predominantly urban African American (94%) heroin users who had prior experience with non-prescribed street buprenorphine (85%), and opioid agonist treatment (68%). Qualitative data were transcribed and coded for themes, while quantitative data were analyzed using descriptive and bivariate statistics. RESULTS Participants typically conveyed their choice of buprenorphine treatment as a decision against methadone. Buprenorphine was perceived as a helpful medication while methadone was perceived as a harmful narcotic with multiple unwanted physical effects. Positive experiences with non-prescribed "street buprenorphine" were a central factor in participants' decisions to seek buprenorphine treatment. CONCLUSIONS Differences in service structure between methadone and buprenorphine did not strongly influence treatment-seeking decisions in this sample. Personal experiences with medications and the street narrative surrounding them play an important role in treatment selection decisions. SCIENTIFIC SIGNIFICANCE This study characterizes important decision factors that underlie patients' selection of buprenorphine over methadone treatment.
Collapse
|
144
|
Schwartz RP, Alexandre PK, Kelly SM, O'Grady KE, Gryczynski J, Jaffe JH. Interim versus standard methadone treatment: a benefit-cost analysis. J Subst Abuse Treat 2013; 46:306-14. [PMID: 24239030 DOI: 10.1016/j.jsat.2013.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 09/23/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
A benefit-cost analysis was conducted as part of a clinical trial in which newly-admitted methadone patients were randomly assigned to interim methadone (IM; methadone without counseling) for the first 4 months of 12 months of methadone treatment or 12 months of methadone with one of two counseling conditions. Health, residential drug treatment, criminal justice costs, and income data in 2010 dollars were obtained at treatment entry, and 4- and 12-month follow-up from 200 participants and program costs were obtained. The net benefits of treatment were greater for the IM condition but controlling for the baseline variables noted above, the difference between conditions in net monetary benefits was not significant. For the combined sample, there was a pre- to post-treatment net benefit of $1470 (95% CI: -$625; $3584) and a benefit-cost ratio of 1.5 (95% CI: 0.8, 2.3), but using our conservative approach to calculating benefits, these values were not significant.
Collapse
|
145
|
Gryczynski J, Mitchell SG, Jaffe JH, O'Grady KE, Olsen YK, Schwartz RP. Leaving buprenorphine treatment: patients' reasons for cessation of care. J Subst Abuse Treat 2013; 46:356-61. [PMID: 24238714 DOI: 10.1016/j.jsat.2013.10.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/19/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Many opioid-dependent patients leave treatment prematurely. This study is a planned secondary analysis from a randomized trial of counseling for African Americans (N=297) entering buprenorphine treatment at one of two outpatient programs. This study examines: (1) whether patients' initial treatment duration intentions prospectively predict retention; and (2) patients' reasons for leaving treatment. Participants were queried about their treatment duration intentions at treatment entry, and their reasons for leaving treatment at 6-month follow-up. At baseline, 28.0% reported wanting to stay in buprenorphine treatment less than 6 months, while 42.1% actually left buprenorphine treatment within 6 months. However, participants intending short-term buprenorphine at the outset were not at elevated risk of early treatment discontinuation (OR=1.15; p=.65). Participants attributed treatment cessation predominantly to conflicts with staff, involuntary discharge, and perceived inflexibility of the program. Future research should examine patient-centered models of buprenorphine treatment that could improve retention.
Collapse
|
146
|
Kinlock TW, Gordon MS, Schwartz RP, O'Grady KE. Individual Patient and Program Factors Related to Prison and Community Treatment Completion in Prison-Initiated Methadone Maintenance Treatment. JOURNAL OF OFFENDER REHABILITATION 2013; 52:509-528. [PMID: 25580067 PMCID: PMC4287211 DOI: 10.1080/10509674.2013.782936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While prison-initiated methadone maintenance treatment is effective, it is largely unknown as to what patient and program factors are related to outcomes. These issues were studied in a secondary analysis of data from 67 male prerelease prison inmates with preincarceration heroin addiction. Three outcomes are examined: completed prison treatment; completed 1 year of community treatment; and number of days in community treatment. Being employed (p = .045) during the three years prior to index incarceration was significantly and positively related to community treatment completion. Increased frequency of urine tests taken was significantly associated with a greater number of days in community treatment (p < .001). Limitations, policy implications, and directions for future research are discussed.
Collapse
|
147
|
Schwartz RP, Gryczynski J, O’Grady KE, Sharfstein JM, Warren G, Olsen YK, Mitchell SG, Jaffe JH. Schwartz et al. Respond. Am J Public Health 2013; 103:e2-3. [DOI: 10.2105/ajph.2013.301428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
148
|
Blanco C, Iza M, Schwartz RP, Rafful C, Wang S, Olfson M. Probability and predictors of treatment-seeking for prescription opioid use disorders: a national study. Drug Alcohol Depend 2013; 131:143-8. [PMID: 23306097 PMCID: PMC3636152 DOI: 10.1016/j.drugalcdep.2012.12.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/30/2012] [Accepted: 12/12/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prescription opioid use disorders are the second most common drug use disorder behind only cannabis use disorders. Despite this, very little is known about the help-seeking behavior among individuals with these disorders. METHODS The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with a lifetime diagnosis of prescription drug use disorders (N=623). Unadjusted and adjusted hazard ratios are presented for time to first treatment-seeking by sociodemographic characteristics and comorbid psychiatric disorders. RESULTS The lifetime cumulative probability of treatment seeking was 42% and the median delay from prescription drug use disorder onset to first treatment was 3.83 years. Having an earlier onset of prescription opioid use disorder and a history of bipolar disorder, major depression disorder, specific phobia and cluster B personality disorders predicted shorter delays to treatment. CONCLUSIONS Although some comorbid psychiatric disorders increase the rate of treatment-seeking and decrease delays to first-treatment contact rates of treatment-seeking for prescription drug use disorder are low, even when compared with rates of treatment for other substance use disorders. Given the high prevalence and adverse consequences of prescription drug use disorder, there is a need to improve detection and treatment of prescription opioid use disorder.
Collapse
|
149
|
Schwartz RP, Stitzer ML, Feaster DJ, Korthuis PT, Alvanzo AAH, Winhusen TM, Donnard L, Snead N, Metsch LR. HIV rapid testing in drug treatment: comparison across treatment modalities. J Subst Abuse Treat 2013; 44:369-74. [PMID: 23021496 PMCID: PMC3577980 DOI: 10.1016/j.jsat.2012.08.219] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/21/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
Abstract
Despite high rates of risky behavior among patients, many drug abuse treatment programs do not provide on-site HIV testing. This secondary analysis examined differences in outcome by program modality from a multi-site trial in which 1281 HIV-negative patients in three methadone programs, seven non-methadone outpatient programs, and three residential programs were randomly assigned to: (1) off-site referral for HIV risk reduction counseling and testing; or on-site rapid testing (2) with or (3) without risk reduction counseling. The parent study using generalized estimating equations with site as a cluster variable found significantly higher rates of HIV testing and feedback of results by 1 month post-enrollment for the combined on-site conditions compared to the offsite condition [RR=4.52, 97.5% CI (3.57, 5.72)]. Utilizing the same statistical approach, we found neither significant treatment modality nor significant treatment modality by testing condition interaction effects either for receipt of HIV test results at 1 month or for sexual or drug use HIV-risk behaviors at 6-month follow-up. On-site HIV testing is effective across treatment modalities for achieving high rates of testing and results feedback. All programs should be encouraged to adopt or expand this service.
Collapse
|
150
|
Serpelloni G, Gomma M, Genetti B, Zermiani M, Rimondo C, Mollica R, Gryczynski J, O'Grady KE, Schwartz RP. Italy's electronic health record system for opioid agonist treatment. J Subst Abuse Treat 2013; 45:190-5. [PMID: 23518287 DOI: 10.1016/j.jsat.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
Abstract
Electronic health record systems (EHRs) play an increasingly important role in opioid agonist treatment. In Italy, an EHR called the Multi Functional Platform (MFP) is in use in 150 opioid-agonist treatment facilities in 8 of Italy's 23 regions. This report describes MFP and presents 2010 data from 65 sites that treated 8145 patients, of whom 72.3% were treated with methadone and 27.7% with buprenorphine. Patients treated with buprenorphine compared to methadone were more likely to be male (p < .01) and younger (p < .001). Methadone compared to buprenorphine patients had a higher percentage of opioid-positive urine tests (p < .001) and longer mean length of stay (p = .004). MFP has been implemented widely in Italy and has been able to track patient outcomes across treatment facilities. In the future, this EHR system can be used for performance improvement initiatives.
Collapse
|