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Johannessen DA, Nordfjærn T, Geirdal AØ. Substance use disorder patients’ expectations on transition from treatment to post-discharge period. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:208-226. [PMID: 35308318 PMCID: PMC8899264 DOI: 10.1177/1455072520910551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
Aim: There is limited knowledge about how inpatients anticipate factors that facilitate the transition between specialised inpatient treatment for substance use disorder (SUD) and the post-discharge period. This study explores factors that inpatients anticipated would facilitate such a transition period. Method: A focus group study, consisting of four group interviews with individuals in inpatient SUD treatment, was conducted to explore their expectations for the transition and post-discharge period ahead of them. The transcribed interview material was analysed using thematic analysis. Findings: The analytical process led to three themes: “Belonging”, “Intrapersonal processes” and “Predictability”. Correspondence between inpatients’ expectations and the services they are offered in the transition and post-discharge period may serve as proper support for inpatients ahead of a vulnerable phase, such as the transition and post-discharge period. Conclusions: Findings from the current study highlight overarching elements that inpatients envisioned to be facilitating, such as social support, motivation, self-efficacy, self-awareness and predictability in basic elements such as employment, housing and personal finances. Findings from this study and previous ones imply that certain factors appear to facilitate in vulnerable phases, such as service level transitions. These facilitating factors should be taken into consideration and used as steppingstones through the transition and post-discharge period after inpatient SUD treatment.
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Affiliation(s)
| | - Trond Nordfjærn
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Clinic of Substance Use and Addiction Medicine, Trondheim, Norway
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52
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Turnover intention among service providers in Chinese methadone maintenance treatment clinics. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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53
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Kelly P, Deane F, Baker A, Byrne G, Degan T, Osborne B, Townsend C, McKay J, Robinson L, Oldmeadow C, Lawson K, Searles A, Lunn J. Study protocol the Continuing Care Project: a randomised controlled trial of a continuing care telephone intervention following residential substance dependence treatment. BMC Public Health 2020; 20:107. [PMID: 31992258 PMCID: PMC6986107 DOI: 10.1186/s12889-020-8206-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. METHODS/DESIGN All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. DISCUSSION This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618001231235. Registered on 23rd July 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375621&isReview=true.
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Affiliation(s)
- Peter Kelly
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.
| | - Frank Deane
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Amanda Baker
- University of Newcastle, University Drive, School of Medicine and Public Health, Callaghan, New South Wales, 2308, Australia
| | - Gerard Byrne
- The Salvation Army, Chalmers Street, Redfern, New South Wales, 2016, Australia
| | - Tayla Degan
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Briony Osborne
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - James McKay
- University of Pennsylvania, Market Street, Philadelphia, PA, 19104, USA
| | - Laura Robinson
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Joanne Lunn
- We Help Ourselves, Rozelle, New South Wales, 2039, Australia
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Costello MJ, Li Y, Remers S, MacKillop J, Sousa S, Ropp C, Roth D, Weiss M, Rush B. Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment. Addict Behav 2019; 98:106055. [PMID: 31357071 DOI: 10.1016/j.addbeh.2019.106055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/22/2019] [Accepted: 07/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuing care is increasingly prioritized in the treatment of substance use disorders (SUDs). Ongoing engagement in continuing care, including mutual support (e.g., 12-step groups) and/or professional outpatient services, may enhance treatment outcomes and facilitate recovery. OBJECTIVE This study investigates how engagement in 12-step mutual support and professional outpatient services is associated with short-term substance use outcomes in a sample of patients who completed inpatient SUDs treatment. METHODS As part of the Recovery Journey Project - a longitudinal cohort study - participants completed questionnaires upon admission to an inpatient SUDs treatment program, and at 1- and/or 3-months post-discharge (n = 379). Baseline data were collected by self-administered, electronic questionnaires. Follow up data were collected by phone or email. Analyses involved multivariate Generalized Estimating Equations separately modelling self-reported abstinence and percent days abstinent (PDA) over the three time periods. RESULTS Overall, rates of self-reported abstinence and PDA increased significantly from baseline to 1- and 3-months follow up. Engagement in 12-step activities (i.e., attended 30 meetings in 30 days, had a home group, had a sponsor, did service work) and professional outpatient substance use support were each significantly associated with abstinence and PDA. Participants who reported a higher degree of 12-step involvement (defined as engagement in more 12-step activities) were also more likely to report being abstinence and greater PDA. CONCLUSIONS Engagement in continuing care, including 12-step activities and professional outpatient substance use support, was highly associated with substance use. Clinical teams should encourage participation in such activities to optimize treatment outcomes.
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55
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Coleman-Cowger VH, Mark KS, Rosenberry ZR, Koszowski B, Terplan M. A Pilot Randomized Controlled Trial of a Phone-based Intervention for Smoking Cessation and Relapse Prevention in the Postpartum Period. J Addict Med 2019; 12:193-200. [PMID: 29351139 PMCID: PMC5970014 DOI: 10.1097/adm.0000000000000385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down. METHODS One hundred thirty low-income pregnant women who were current or recently quit tobacco smokers were recruited at their first prenatal appointment and randomized to either a Control (standard care) or Experimental (standard care + PPCC) group. An intent-to-treat analysis was conducted on biochemically verified data from 6 in-person interviews during pregnancy and postpartum. Feasibility with regard to recruitment, randomization, assessment, and implementation of PPCC were assessed, along with acceptability among the target population. RESULTS PPCC was found to be feasible and acceptable to some participants, but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 vs 55 days, for Control and Experimental groups, respectively). CONCLUSIONS The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.
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Affiliation(s)
| | - Katrina S. Mark
- University of Maryland Baltimore, 11 S Paca Street, Suite 40, Baltimore, MD 21201
| | - Zachary R. Rosenberry
- Battelle Public Health Center for Tobacco Research, 6115 Falls Road, Suite 200, Baltimore, MD 21209
| | - Bartosz Koszowski
- Battelle Public Health Center for Tobacco Research, 6115 Falls Road, Suite 200, Baltimore, MD 21209
| | - Mishka Terplan
- Virginia Commonwealth University, Box 980034 Richmond VA 23298
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56
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Johnston DC, Mathews WD, Maus A, Gustafson DH. Using Smartphones to Improve Treatment Retention Among Impoverished Substance-Using Appalachian Women: A Naturalistic Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819861377. [PMID: 31312084 PMCID: PMC6614935 DOI: 10.1177/1178221819861377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
Abstract
Objectives: Longer retention in treatment is associated with positive outcomes. For
women, who suffer worse drug-related problems than men, social technologies,
which are more readily adopted by women, may offer promise. This
naturalistic study examined whether a smartphone-based relapse-prevention
system, A-CHESS (Addiction-Comprehensive Health Enhancement Support System),
could improve retention for women with substance use disorders in an
impoverished rural setting. Methods: A total of 98 women, age 18 to 40, in southeastern Kentucky and mandated to
treatment, received A-CHESS with intensive outpatient treatment for
6 months. For comparison, data were obtained for a similar but
non-equivalent group of 100 same-age women also mandated to treatment in the
same clinics during the period. Electronic medical record data on
length-of-stay and treatment service use for both groups were analyzed, with
A-CHESS use data, to determine whether those using A-CHESS showed better
retention than those without. Results: Women with A-CHESS averaged 780 service units compared with 343 for the
comparison group. For those with discharge dates prior to the study’s end,
A-CHESS patients stayed in treatment a mean of 410 vs 262 days for the
comparison group. Conclusions: Given associations between retention and positive outcomes, mobile health
technology such as A-CHESS may help improve outcomes among women, especially
in settings where access to in-person services is difficult. The findings,
based on a non-equivalent comparison, suggest the need for further
exploration with rigorous experimental designs to determine whether and to
what degree access to a smartphone with A-CHESS may extend and support
recovery for women.
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Affiliation(s)
- Darcie C Johnston
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Adam Maus
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Peterson C, Liu Y, Xu L, Nataraj N, Zhang K, Mikosz CA. U.S. National 90-Day Readmissions After Opioid Overdose Discharge. Am J Prev Med 2019; 56:875-881. [PMID: 31003811 PMCID: PMC6527476 DOI: 10.1016/j.amepre.2018.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose. METHODS In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project National Readmissions Database yielded the national estimated proportion of patients with opioid overdose stays that had all-cause readmissions within ≤90 days. A multivariable logistic regression model assessed index stay factors associated with readmission by type (opioid overdose or not). Number of readmissions per patient was assessed. RESULTS More than 24% (n=14,351/58,850) of patients with non-fatal index stays for opioid overdose had at least one all-cause readmission ≤90 days of index stay discharge and 3% (n=1,658/58,850) of patients had at least one opioid overdose readmission. Less than 0.2% (n=104/58,850) of patients had more than one readmission for opioid overdose. Patient demographic characteristics (e.g., male, older age), comorbidities diagnosed during the index stay (e.g., drug use disorder, chronic pulmonary disease, psychoses), and other index stay factors (Medicare or Medicaid primary payer, discharge against medical advice) were significantly associated with both opioid overdose and non-opioid overdose readmissions. Nearly 30% of index stays for opioid overdose included heroin, which was significantly associated with opioid overdose readmissions. CONCLUSIONS A quarter of opioid overdose patients have ≤90 days all-cause readmissions, although opioid overdose readmission is uncommon. Effective strategies to reduce readmissions will address substance use disorder as well as comorbid physical and mental health conditions.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Yang Liu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Likang Xu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nisha Nataraj
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina A Mikosz
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, Benson V, Davidson L. Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study. Subst Abuse 2019; 13:1178221819844996. [PMID: 31065215 PMCID: PMC6487766 DOI: 10.1177/1178221819844996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 12/20/2022]
Abstract
Relatively few individuals with a substance use disorder (SUD) seek or receive treatment, and knowledge about the effective ingredients in SUD treatment, from the perspective of those who receive it, is scarce. Our study purpose was to explore the experiences of those with long-term SUDs and the aspects they found helpful during treatment and long-term recovery. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a long-term SUD, and who had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to study planning, preparation, and initial analyses. Participants preferred individualized, long-term treatment, and support from both therapists and other clients. They further acknowledged the importance of their own sense of responsibility for their treatment and recovery success. Greater focus should be placed on viewing long-term SUD as a long-term condition, similar to somatic diseases, and SUD treatment services should place greater emphasis on developing partnership care models, long-term monitoring and support, and actively engaging recovered clients in the care of others in SUD treatment.
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Affiliation(s)
- Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
- SERAF – Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Ivar Skeie
- SERAF – Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- District Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Brumunddal, Norway
| | - Stian Biong
- Faculty for Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
| | - Victoria Benson
- Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
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Passetti LL, Godley MD, Greene AR, White WL. The Volunteer Recovery Support for Adolescents (VRSA) experiment: Recruiting, retaining, training, and supervising volunteers to implement recovery monitoring and support services. J Subst Abuse Treat 2019; 98:1-8. [PMID: 30665598 DOI: 10.1016/j.jsat.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/24/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Alison R Greene
- Indiana University, 1025 E. 7th St., Bloomington, IN 47405, United States of America; The University of Arizona, Southwest Institute for Research on Women, 181 S. Tucson Blvd., Ste. 101, Tucson, AZ 85716, United States of America.
| | - William L White
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
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60
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Godley MD, Passetti LL, Hunter BD, Greene AR, White WL. A randomized trial of Volunteer Recovery Support for Adolescents (VRSA) following residential treatment discharge. J Subst Abuse Treat 2019; 98:15-25. [PMID: 30665599 DOI: 10.1016/j.jsat.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/24/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Brooke D Hunter
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Alison R Greene
- Indiana University, 1025 E. 7th St., Bloomington, IN 47405, United States of America; The University of Arizona, Southwest Institute for Research on Women, 181 S. Tucson Blvd., Ste. 101, Tucson, AZ 85716, United States of America.
| | - William L White
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
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Stahler GJ, Mennis J. Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas? Drug Alcohol Depend 2018; 190:170-178. [PMID: 30041092 DOI: 10.1016/j.drugalcdep.2018.06.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. METHODS Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission. RESULTS Only 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting). CONCLUSION This study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States.
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62
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Czyz EK, King CA, Biermann BJ. Motivational Interviewing-Enhanced Safety Planning for Adolescents at High Suicide Risk: A Pilot Randomized Controlled Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:250-262. [PMID: 30142300 DOI: 10.1080/15374416.2018.1496442] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This pilot randomized controlled trial examined the feasibility and acceptability of a motivational interview (MI)-enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13-17; 78.8% female) with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention (individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans, increasing self-efficacy and coping, and in fostering parents' motivation to encourage safety plan use. Our study also highlights the benefit of daily-level assessment of individuals' response to suicide-specific interventions.
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Affiliation(s)
- E K Czyz
- a Department of Psychiatry , University of Michigan
| | - C A King
- a Department of Psychiatry , University of Michigan
| | - B J Biermann
- a Department of Psychiatry , University of Michigan
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63
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Bagot KS, Kaminer Y. Harm Reduction for Youth in Treatment for Substance Use Disorders: One Size Does Not Fit All. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0217-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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64
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Eastwood B, Peacock A, Millar T, Jones A, Knight J, Horgan P, Lowden T, Willey P, Marsden J. Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. J Subst Abuse Treat 2018; 88:1-8. [DOI: 10.1016/j.jsat.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/29/2017] [Accepted: 02/06/2018] [Indexed: 01/05/2023]
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65
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Buckheit KA, Moskal D, Spinola S, Maisto SA. Clinical Course and Relapse among Adolescents Presenting for Treatment of Substance Use Disorders: Recent Findings. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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66
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Young LB, Grant KM, Pulido RD, Simpson JL, Tyler KA, Timko C. Intensive Referral of Veterans to Mutual-Help Groups: A Mixed-Methods Implementation Evaluation. ALCOHOLISM TREATMENT QUARTERLY 2018; 36:179-201. [DOI: 10.1080/07347324.2017.1407224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lance Brendan Young
- Communication Department, Western Illinois University-Quad Cities, Moline, Illinois, USA
| | - Kathleen M. Grant
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jamie L. Simpson
- Psychology Department, Midland University, Fremont, Nebraska, USA
| | - Kimberly A. Tyler
- Sociology Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative. Drug Alcohol Depend 2018; 185:278-284. [PMID: 29482052 DOI: 10.1016/j.drugalcdep.2017.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/02/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. METHOD We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. RESULTS Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. CONCLUSION Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa's SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa; Violence Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Blonigen DM, Cucciare MA, Timko C, Smith JS, Harnish A, Kemp L, Rosenthal J, Smelson D. Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration. BMC Health Serv Res 2018. [PMID: 29514649 PMCID: PMC5842602 DOI: 10.1186/s12913-018-2967-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Abstract
Background Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., “criminogenic thinking”). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established. Methods Using a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment. Discussion The primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings. Trial registration This trial is funded by the VA Health Services Research & Development Program (IIR 14–081) and is registered with ClinicalTrials.gov (ID: NCT02524171).
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Affiliation(s)
- Daniel M Blonigen
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA. .,Palo Alto University, Palo Alto, CA, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jennifer S Smith
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Autumn Harnish
- Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Lakiesha Kemp
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA
| | - Joel Rosenthal
- Veterans Justice Programs, Veterans Health Administration, Washington DC, USA
| | - David Smelson
- Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
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Agency-level financial incentives and electronic reminders to improve continuity of care after discharge from residential treatment and detoxification. Drug Alcohol Depend 2018; 183:192-200. [PMID: 29288914 PMCID: PMC5803317 DOI: 10.1016/j.drugalcdep.2017.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/08/2017] [Accepted: 11/03/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the importance of continuity of care after detoxification and residential treatment, many clients do not receive further treatment services after discharged. This study examined whether offering financial incentives and providing client-specific electronic reminders to treatment agencies lead to improved continuity of care after detoxification or residential treatment. METHODS Residential (N = 33) and detoxification agencies (N = 12) receiving public funding in Washington State were randomized into receiving one, both, or none (control group) of the interventions. Agencies assigned to incentives arms could earn financial rewards based on their continuity of care rates relative to a benchmark or based on improvement. Agencies assigned to electronic reminders arms received weekly information on recently discharged clients who had not yet received follow-up treatment. Difference-in-difference regressions controlling for client and agency characteristics tested the effectiveness of these interventions on continuity of care. RESULTS During the intervention period, 24,347 clients received detoxification services and 20,685 received residential treatment. Overall, neither financial incentives nor electronic reminders had an effect on the likelihood of continuity of care. The interventions did have an effect among residential treatment agencies which had higher continuity of care rates at baseline. CONCLUSIONS Implementation of agency-level financial incentives and electronic reminders did not result in improvements in continuity of care, except among higher performing agencies. Alternative strategies at the facility and systems levels should be explored to identify ways to increase continuity of care rates in specialty settings, especially for low performing agencies.
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McKay JR, Gustafson DH, Ivey M, McTavish F, Pe-Romashko K, Curtis B, Oslin DA, Polsky D, Quanbeck A, Lynch KG. Effects of automated smartphone mobile recovery support and telephone continuing care in the treatment of alcohol use disorder: study protocol for a randomized controlled trial. Trials 2018; 19:82. [PMID: 29382367 PMCID: PMC5791199 DOI: 10.1186/s13063-018-2466-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background New smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. One such system is the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS), which provides a range of automated functions that support patients. A-CHESS improved drinking outcomes over standard continuing care when provided to patients leaving inpatient treatment. Effective continuing care can also be delivered via telephone calls with a counselor. Telephone Monitoring and Counseling (TMC) has demonstrated efficacy in two randomized trials with alcohol-dependent patients. A-CHESS and TMC have complementary strengths. A-CHESS provides automated 24/7 recovery support services and frequent assessment of symptoms and status, but does not involve regular contact with a counselor. TMC provides regular and sustained contact with the same counselor, but no ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve automated mobile technology and counselor contact, but little is known about how best to integrate these services. Methods/Design To address this question, the study will feature a 2 × 2 design (A-CHESS for 12 months [yes/no] × TMC for 12 months [yes/no]), in which 280 alcohol-dependent patients in intensive outpatient programs (IOPs) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to A-CHESS produces fewer heavy drinking days than TMC or A-CHESS alone and test for TMC and A-CHESS main effects. We will determine the costs of each of the four conditions and the incremental cost-effectiveness of the three active conditions. Analyses will also examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects. Discussion The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact. Trial registration ClinicalTrials.gov, NCT02681406. Registered on 2 September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2466-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James R McKay
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia VAMC, Philadelphia, PA, 19104, USA.
| | - David H Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Megan Ivey
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Fiona McTavish
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Klaren Pe-Romashko
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Brenda Curtis
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David A Oslin
- Center for the Study of Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia VAMC, Philadelphia, PA, 19104, USA
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew Quanbeck
- Department of Family Medicine & Community Health, and Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Kevin G Lynch
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Wimberly AS, Hyatt JM, McKay JR. Effect of continuing care for people with cocaine dependence on criminal justice sentences. BEHAVIORAL SCIENCES & THE LAW 2018; 36:116-129. [PMID: 29460440 PMCID: PMC6051697 DOI: 10.1002/bsl.2330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 05/26/2017] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
While continuing care for substance use treatment has been associated with reduced involvement in the criminal justice system, much of this research lacks random assignment to continuing care and so is limited by self-selection bias. This study sought to determine the impact of adding telephone-based continuing care to intensive outpatient programs on criminal justice outcomes for people with cocaine dependence. In three continuing care studies, spanning 1998-2008, participants were randomly assigned to an intensive outpatient program or an intensive outpatient program plus a telephone-based continuing care intervention. Cocaine-dependent participants from these three studies were included in the analyses, with outcomes derived from a dataset of jurisdiction-wide criminal sentences from a state sentencing agency. Multiple logistic regression was employed to examine the odds of a criminal conviction occurring in the 4 years after enrollment in a continuing care study. The results showed that, controlling for a criminal sentence in the previous year, gender, age, and continuing care study, people with cocaine dependence randomized to an intensive outpatient program plus a telephone-based continuing care intervention had 54% lower odds (p = 0.05, odds ratio = 0.46, 95% CI: 0.20-1.02) of a criminal sentence in the 4 years after enrollment in the continuing care study, compared with those randomized to an intensive outpatient program alone. We can conclude that adding telephone monitoring and counseling to intensive outpatient programs is associated with fewer criminal convictions over a 4-year follow-up period compared with intensive outpatient programs alone.
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Affiliation(s)
- Alexandra S Wimberly
- Social Intervention Group, School of Social Work and Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jordan M Hyatt
- Department of Criminology and Justice Studies, Drexel University, Philadelphia, PA, USA
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Behavioral Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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Munro A, Allan J, Shakeshaft A, Breen C. "I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy 2017; 12:49. [PMID: 29208008 PMCID: PMC5718008 DOI: 10.1186/s13011-017-0135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. METHODS This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program. RESULTS A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. CONCLUSION This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
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Rubinsky AD, Ellerbe LS, Gupta S, Phelps TE, Bowe T, Burden JL, Harris AHS. Outpatient continuing care after residential substance use disorder treatment in the US Veterans Health Administration: Facilitators and challenges. Subst Abus 2017; 39:322-330. [DOI: 10.1080/08897077.2017.1391923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anna D. Rubinsky
- Kidney Health Research Collaborative, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
| | - Laura S. Ellerbe
- Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Shalini Gupta
- Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Tyler E. Phelps
- Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Thomas Bowe
- Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Jennifer L. Burden
- Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
| | - Alex H. S. Harris
- Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
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Kramer Schmidt L, Bojesen AB, Nielsen AS, Andersen K. Duration of therapy - Does it matter?: A systematic review and meta-regression of the duration of psychosocial treatments for alcohol use disorder. J Subst Abuse Treat 2017; 84:57-67. [PMID: 29195594 DOI: 10.1016/j.jsat.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The recommendations in clinical guidelines for duration of therapy for alcohol use disorder (AUD) are based on consensus decisions. In reality, we do not know the optimal duration of an alcohol treatment course. METHODS A systematic review and meta-regression of randomized controlled trials of psychosocial treatment in alcohol outpatient treatment centers. The population consisted of adults suffering from AUD, treated in an outpatient facility with at least two sessions of therapy. Meta-regression analysis was performed with treatment outcome as a function of duration of therapy across studies. Treatment outcome was defined as long-term alcohol use measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), and/or proportion of participants abstinent (ABS). RESULTS 48 studies encompassing 8984 participants. Mean planned duration of therapy: 18 (8-82) weeks and 14 (2-36) sessions. Mean actual attended sessions: 9 (1-26). Mean follow-up time: 43 (8-104) weeks with a mean of 6 (2-18) research assessments. Neither planned weeks, duration of sessions, frequency of sessions per week, nor actual attended sessions were associated with long-term alcohol use outcomes. However, frequency of research assessments was positively associated with PDA and PHD. CONCLUSION No associations between long-term alcohol use outcomes and planned or actual attended duration of psychosocial treatment in outpatient care. Research assessments and, accordingly, the research project in itself may influence outcome in studies of psychosocial treatment for alcohol use disorder.
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Affiliation(s)
- Lotte Kramer Schmidt
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 20, entrance 220B, 5000 Odense C, Denmark.
| | - Anders Bo Bojesen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; OPEN Odense Patient data Explorative Network, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; Department of Mental Health, Region of Southern Denmark, Denmark
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Sharbafchi MR, Heydari M. Management of Substance Use Disorder in Military Services: A Comprehensive Approach. Adv Biomed Res 2017; 6:122. [PMID: 28989915 PMCID: PMC5627564 DOI: 10.4103/abr.abr_283_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. MATERIALS AND METHODS This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. RESULTS There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. CONCLUSIONS The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army.
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Affiliation(s)
- Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Heydari
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Baqiyatallah Hospital, Tehran, Iran
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Simoneau H, Kamgang E, Tremblay J, Bertrand K, Brochu S, Fleury MJ. Efficacy of extensive intervention models for substance use disorders: A systematic review. Drug Alcohol Rev 2017; 37 Suppl 1:S246-S262. [DOI: 10.1111/dar.12590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/23/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Joël Tremblay
- Department of Psychoeducation; University of Quebec at Trois-Rivières; Trois-Rivieres Canada
| | - Karine Bertrand
- Addiction Studies and Research Program, Faculty of Medicine and Health Sciences; Sherbrooke University; Longueuil Canada
| | - Serge Brochu
- University Institute on dependencies; Montréal Canada
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Proctor SL, Wainwright JL, Herschman PL. Patient adherence to multi-component continuing care discharge plans. J Subst Abuse Treat 2017; 80:52-58. [PMID: 28755773 DOI: 10.1016/j.jsat.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022]
Abstract
Intuitively, it is assumed that greater patient adherence to treatment recommendations in substance use disorder (SUD) treatment is associated with favorable outcomes, but surprisingly, there is limited research systematically examining the adherence-outcome relationship in the context of the continuing care phase post-discharge from residential treatment. This study sought to determine the effect of adherence to multi-component continuing care plans on long-term outcomes among patients following the primary treatment episode. Data were abstracted from electronic medical records for 271 patients (59.0% male) discharged from a U.S. residential program between 2013 and 2015. Patients were categorized based on their level of adherence to their individualized continuing care discharge plan, and studied through retrospective record review for 12months post-discharge. 12-month outcomes included past 30-day and continuous abstinence, re-admission, and quality of life. With the exception of re-admission rate, fully adherent patients demonstrated significantly better results on all study outcomes at 12months compared to patients who were partially or non-adherent. Fully adherent patients were 9.46 times (95% CI: 5.07-17.62) more likely to be continuously abstinent through 12months relative to the other adherence groups. Fully adherent patients were 7.53 times (95% CI: 2.41-23.50) more likely to report a positive quality of life at 12months relative to the other adherence groups. The findings support the widely held contention that greater adherence to continuing care discharge plans is associated with favorable long-term outcomes, and provide insight into realistic outcomes expectations for patients who are adherent to their multi-component continuing care discharge plans.
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Affiliation(s)
- Steven L Proctor
- Albizu University-Miami Campus, Institutional Center for Scientific Research, USA.
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Perlman DC, Jordan AE. Considerations for the Development of a Substance-Related Care and Prevention Continuum Model. Front Public Health 2017; 5:180. [PMID: 28770195 PMCID: PMC5513894 DOI: 10.3389/fpubh.2017.00180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 12/19/2022] Open
Abstract
There are significant gaps in the identification and engagement in care and prevention services of people who use illicit substances. Care continuum models have proven to be useful tools in the evaluation of care for HIV and other conditions; numerous issues in substance-related care and prevention resemble those identified in other continua models. Systems of care for substance misuse and substance use disorders (SUDs) can be viewed as consisting of a prevention and care continuum, reflecting incidence and prevalence of substance misuse and SUDs, screening and identification, medical and psychosocial evaluation for treatment, engagement in evidence-based treatment, treatment retention, relapse prevention, timeliness of step completion, and measures of overall and substance use-related specific morbidity and mortality. Care and prevention continuum models could potentially be applied at program, local, regional, state, and national levels. We discuss important lessons that can be drawn from applications of continuum models in other fields. The development and use of a substance-related care and prevention continuum may yield significant patient care, program evaluation and improvement, and population-level benefits.
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Affiliation(s)
- David C. Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
- Center for Drug Use and HIV Research, New York, NY, United States
| | - Ashly E. Jordan
- Center for Drug Use and HIV Research, New York, NY, United States
- Department of Epidemiology, School of Public Health, City University of New York, New York, NY, United States
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Busch AC, Denduluri M, Glass J, Hetzel S, Gugnani SP, Gassman M, Krahn D, Deyo B, Brown R. Predischarge Injectable Versus Oral Naltrexone to Improve Postdischarge Treatment Engagement Among Hospitalized Veterans with Alcohol Use Disorder: A Randomized Pilot Proof-of-Concept Study. Alcohol Clin Exp Res 2017; 41:1352-1360. [PMID: 28605827 DOI: 10.1111/acer.13410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/21/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injectable naltrexone for alcohol use disorders (AUDs) has been efficacious in several studies. It has not been (i) compared head-to-head with oral naltrexone or (ii) examined in the hospital setting as an intervention that might facilitate treatment attendance after hospital discharge. METHODS Fifty-four hospitalized veterans identified as having DSM-IV-TR alcohol dependence were randomized to receive (i) a 50 mg oral naltrexone plus a 30-day prescription or (ii) a 380 mg intramuscular naltrexone injection prior to discharge. Of 113 veteran inpatients deemed eligible based on screening criteria, 54 met final eligibility criteria and were enrolled and randomized. Baseline data included demographics, alcohol consumption, and comorbidity. Measures of treatment initiation and engagement and alcohol consumption were reassessed at 14- and 45-day follow-ups. RESULTS Thirty-five participants (64.8%) completed the entire study protocol (received a study medication and completed 14- and 45-day follow-ups). Among those who received a study medication (n = 45), 77.8% completed all follow-up interviews. This pilot study was not designed to have sufficient statistical power for hypothesis testing, and thus, as expected, there were no significant differences between groups in medication adherence (self-report of >80% of daily doses taken in oral group; receipt of second injection in the injection group), treatment engagement (at least treatment 3 visits in the 30 days postdischarge, and 2 or more visits per month in each of the 3 months following discharge) or alcohol consumption at 14 or at 45 days (p > 0.05). The median number of drinks among the entire cohort in the 2 weeks prior to hospitalization (128 drinks) was significantly higher than at day 14 (0 drinks, p < 0.001) or day 45 (0 drinks, p < 0.001). Rates of medication adherence were 62% in the oral group and 61% in the injection group. CONCLUSIONS Results indicate feasibility for larger, more definitive study. Both groups had significant reductions in alcohol consumption over time and high-treatment engagement rates. Both oral and injectable formulations are feasible to initiate prior to discharge for hospital inpatients identified as having an AUD.
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Affiliation(s)
- Angela Christina Busch
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | | | - Joseph Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, Seattle, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Shalu P Gugnani
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Michele Gassman
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Dean Krahn
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Brienna Deyo
- Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
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80
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Proctor SL, Wainwright JL, Herschman PL. Importance of short-term continuing care plan adherence on long-term outcomes among patients discharged from residential substance use treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:734-741. [PMID: 28557531 DOI: 10.1080/00952990.2017.1329315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients adherent to their recommended treatment regimen demonstrate favorable outcomes. However, it is unclear whether there are specific short-term continuing care performance variables indicative of better long-term prognosis. OBJECTIVE This study determined the impact of attendance at an outpatient appointment within 7 days post-discharge from residential treatment on 12-month outcomes. METHOD Data were abstracted from electronic medical records for 275 patients (58.9% male) discharged from a single residential treatment program. All discharge plans included a 7-day outpatient appointment with a provider in their home community. Patients were dichotomized based on their attendance at the initial appointment to yield a re-engagement variable. Twelve-month outcomes included past 30-day and continuous abstinence rates, quality of life, and long-term adherence to continuing care plans. RESULTS Patients attending their initial outpatient appointment within 7 days of discharge evidenced better long-term outcomes relative to patients who did not with respect to continuous abstinence (75.4% vs. 37.3%), past-30-day abstinence (92.0% vs. 70.6%), quality of life (94.2% vs. 78.4%), and adherence (66.4% vs. 9.8%). Re-engagement remained a significant predictor of continuous abstinence and quality of life at 12 months after controlling for 12-month adherence and relevant demographic characteristics. CONCLUSION Treatment providers are encouraged to emphasize the relative importance of attending initial post-discharge appointments in achieving successful long-term outcomes. Allocation of resources to enhance engagement during residential treatment may be justified in that there may be value in actively encouraging patients to participate in continuing care activities, particularly shortly following discharge.
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Affiliation(s)
- Steven L Proctor
- a Albizu University-Miami Campus, Institutional Center for Scientific Research , Miami , FL , USA
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81
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Reyre A, Jeannin R, Largueche M, Moro MR, Baubet T, Taieb O. Overcoming professionals' challenging experiences to promote a trustful therapeutic alliance in addiction treatment: A qualitative study. Drug Alcohol Depend 2017; 174:30-38. [PMID: 28292690 DOI: 10.1016/j.drugalcdep.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/26/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them. DESIGN We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method. PARTICIPANTS Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed. FINDINGS The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust. CONCLUSIONS Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.
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Affiliation(s)
- Aymeric Reyre
- APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; Ile-de-France Regional Center for Bioethics, 1 rue Claude Vellefaux, 75010, Paris, France.
| | - Raphaël Jeannin
- APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France.
| | - Myriam Largueche
- Roger Prévot Psychiatric Hospital, Department of Psychiatry, 5 avenue du Docteur Fleming, 92600, Asnières sur Seine, France.
| | - Marie Rose Moro
- CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France; APHP-Cochin University Hospital, Department of Psychiatry, Paris 5 SPC University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Thierry Baubet
- APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
| | - Olivier Taieb
- APHP-Avicenne University Hospital, Department of Psychiatry and Addictology, Paris 13 SPC University, 125 rue de Stalingrad, 93000, Bobigny, France; CESP, INSERM U1178, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
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82
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Glass JE, McKay JR, Gustafson DH, Kornfield R, Rathouz PJ, McTavish FM, Atwood AK, Isham A, Quanbeck A, Shah D. Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders. J Subst Abuse Treat 2017; 77:57-66. [PMID: 28476273 DOI: 10.1016/j.jsat.2017.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/01/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking. METHODS We conducted secondary data analyses of the A-CHESS randomized controlled trial. Recruitment occurred in five residential treatment programs operated by two addiction treatment organizations. Participants were 349 adults with alcohol use disorders recruited two weeks before discharge from residential treatment. We provided intervention arm participants with a smartphone, the A-CHESS application, and an 8-month service plan. Control arm participants received treatment as usual. Telephone interviews at 4, 8, and 12-month follow-ups assessed past-month risky drinking days, past-month abstinence, and post-discharge service utilization (past-month outpatient addiction treatment and past-week mutual help including Alcoholics Anonymous and Narcotics Anonymous). Using mixed effects latent variable models, we estimated the indirect effects of A-CHESS on drinking outcomes, as mediated by post-discharge service utilization. RESULTS Approximately 50.5% of participants reported outpatient addiction treatment and 75.5% reported mutual help at any follow-up interview in the year following randomization. Assignment to the A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups, but not mutual help. This use of outpatient addiction treatment mediated the effect of A-CHESS on risky drinking days, but not abstinence. The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11%. CONCLUSIONS The mobile health (mHealth) intervention promoted the use of outpatient addiction treatment, which appeared to contribute to its efficacy in reducing risky drinking. Future research should investigate how mHealth interventions could link patients to needed treatment services and promote the sustained use of these services.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, Seattle, WA, USA.
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Rachel Kornfield
- Mass Communication Research Center, School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Fiona M McTavish
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy K Atwood
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Isham
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Quanbeck
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Dhavan Shah
- Mass Communication Research Center, School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, USA
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83
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Proctor SL, Wainwright JL, Herschman PL, Kopak AM. AiRCare: A naturalistic evaluation of the effectiveness of a protracted telephone-based recovery assistance program on continuing care outcomes. J Subst Abuse Treat 2017; 73:9-15. [DOI: 10.1016/j.jsat.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 11/24/2022]
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84
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You CW, Chen YC, Chen CH, Lee CH, Kuo PH, Huang MC, Chu HH. Smartphone-based support system (SoberDiary) coupled with a Bluetooth breathalyser for treatment-seeking alcohol-dependent patients. Addict Behav 2017; 65:174-178. [PMID: 27816043 DOI: 10.1016/j.addbeh.2016.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/22/2016] [Accepted: 10/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Relapse prevention in patients with alcohol dependence (AD) has long been a clinical challenge. It is vital to provide services with minial restrictions for patients to have access to continuous after-treatment care. The study was aimed to examine the benefits of a smartphone application (SoberDiary) coupled to a Bluetooth breathalyser to assist patients recovering from alcohol dependence (AD). METHODS This study recruited 38 patients that fulfilled the DSM-IV-TR criteria for AD and who were undergoing an outpatient maintenance program for abstinence. The participants were provided a breathalyser and smartphone-equipped SoberDiary and followed for 12weeks. The participants were divided into highly adherent (HA) and less adherent (LA) groups according to the medium number of reward points they were awarded for using the SoberDiary system throughout the follow-up period based on the average amount of time spent on using the application, the number of function modules they accessed, and the number of BrAC tests they completed each day. RESULTS 19 of the patients were classified as HA and 19 patients were classified as LA group. Members of the HA group recorded fewer drinking days and drinks consumed per week, a higher cumulative number of abstinence days, a higher abstinence rate, less pronounced anxiety, and superior quality of life. CONCLUSIONS The proposed smartphone-assisted support system coupled with a Bluetooth breathalyser might be a feasible supplement to conventional treatment for AD. Higher SoberDiary compliance appears to be associated with better clinical outcomes.
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Affiliation(s)
- Chuang-Wen You
- NTU IoX Center, National Taiwan University, Taipei, Taiwan
| | - Yen-Chang Chen
- Department of Computer Science and Information Engineering, Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao-Hui Lee
- Department of Clinical Psychology, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan Univeristy, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
| | - Hao-Hua Chu
- Department of Computer Science and Information Engineering, Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
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85
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Becker SJ, Hernandez L, Spirito A, Conrad S. Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial. Addict Sci Clin Pract 2017; 12:1. [PMID: 28049542 PMCID: PMC5210307 DOI: 10.1186/s13722-016-0067-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only. METHODS/DESIGN A two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12-17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change. DISCUSSION This study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.
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Affiliation(s)
- Sara J. Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Box G-121-5, Providence, RI 02912 USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Lynn Hernandez
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Box G-121-5, Providence, RI 02912 USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Selby Conrad
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
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86
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Blevins CE, Abrantes AM, Kurth ME, Gordon AL, Stein MD. Alcohol treatment outcomes following discharge from a partial hospital program. JOURNAL OF SUBSTANCE USE 2017; 22:643-647. [PMID: 30881219 DOI: 10.1080/14659891.2017.1296041] [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] [Indexed: 10/19/2022]
Abstract
Background Thousands of individuals in the United States seek alcohol treatment each year, typically in outpatient settings. Partial hospital programs provide a high level of structured, individualized outpatient care for individuals who are in treatment for alcohol use disorder. Previous research in other outpatient and inpatient settings has found that psychological distress, pain, and aftercare utilization are associated with treatment outcomes. Objectives The current study evaluates baseline characteristics and aftercare utilization predictors of alcohol use outcomes of individuals in a week-long partial hospital program. Methods The 113 participants (59.3% male) were interviewed during their time in the program and then were reassessed one month post-discharge. Results Results indicated that a greater number of mental health provider visits and 12-step attendance were associated with abstinence at follow-up such, while baseline characteristics did not consistently predict outcomes. Conclusions Findings highlight the importance of aftercare planning, particularly in our more severe, clinical sample.
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Affiliation(s)
- Claire E Blevins
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Ana M Abrantes
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Alan L Gordon
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael D Stein
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI.,Boston University School of Public Health, Boston, MA
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87
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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88
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Naeger S, Mutter R, Ali MM, Mark T, Hughey L. Post-Discharge Treatment Engagement Among Patients with an Opioid-Use Disorder. J Subst Abuse Treat 2016; 69:64-71. [PMID: 27568512 DOI: 10.1016/j.jsat.2016.07.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Opioid misuse is a growing public health problem, and estimates show a 150% increase in opioid-related hospital stays over the last two decades. This study examined factors associated with substance use treatment engagement following a hospitalization for opioid use disorder or overdose. METHODS This study analyzed the Truven Health Analytics MarketScan® Commercial Claims and Encounters (CCAE) database for 2010 through 2014 to study post-hospitalization substance use disorder (SUD) treatment of individuals aged 18-64 who had an inpatient admission for an opioid-use disorder or opioid overdose. Engagement in post-discharge SUD treatment was defined as having at least two unique outpatient visits within 30 days of a hospitalization. Generalized estimating equations (GEEs) with a binomial link were used to determine the factors associated with SUD treatment engagement. RESULTS Only 17% of patients engaged in SUD treatment within 30 days of hospital discharge. A behavioral health outpatient visit prior to the SUD admission increased the odds of engaging in SUD treatment by 1.34 (CI: 1.25-1.45), an antidepressant prescription drug fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07-1.21), a benzodiazepine fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07-1.21), a principal diagnosis for an SUD at index admission increased the odds by 2.13 (CI: 1.97-2.30), an alcohol-related disorder diagnosis at index admission increased the odds by 3.13 (CI: 2.87-3.42), and an additional SUD diagnosis at the index admission increased the odds by 2.72 (CI: 2.48-2.98). CONCLUSIONS We found low rates of SUD treatment engagement following hospitalizations for opioid use disorders and overdoses. Patients with prior engagements with behavioral health providers were more likely to engage in follow-up care; therefore, providers may need to focus additional efforts on patients admitted to the hospital with opioid-use disorders who do not have an existing provider relationship.
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Affiliation(s)
- Sarah Naeger
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857.
| | - Ryan Mutter
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857.
| | - Mir M Ali
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857.
| | - Tami Mark
- Truven Health Analytics, 7700 Old Georgetown Road, Bethesda, MD 20814.
| | - Lauren Hughey
- Truven Health Analytics, 7700 Old Georgetown Road, Bethesda, MD 20814.
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Bekkering GE, Zeeuws D, Lenaerts E, Pas L, Verstuyf G, Matthys F, Aertgeerts B, Matheï C. Development and Validation of Quality Indicators on Continuing Care for Patients With AUD: A Delphi Study. Alcohol Alcohol 2016; 51:555-61. [DOI: 10.1093/alcalc/agw044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/07/2016] [Indexed: 01/22/2023] Open
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90
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Parkman T, Lloyd C. How Intense Is Too Intense? A Qualitative Exploration of a Structured Day Treatment Program for Substance Dependency in the United Kingdom. ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1182816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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91
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Alshomrani AT. Saudi addiction therapeutic communities:Are they implementing the essential elements of addiction therapeutic communities. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2016; 21:227-31. [PMID: 27356653 PMCID: PMC5107288 DOI: 10.17712/nsj.2016.3.20150702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To investigate whether Saudi therapeutic communities (TCs) implement essential elements of TCs. Methods: This is a cross sectional study where the author visited all of the Saudi addiction TCs between September and December 2014. At least one week was spent in each TC, attending many therapeutic activities, reviewing patient files and program documents, and interviewing directors, treating teams and residents. At the end of each visit, a short version of the Survey of Essential Elements Questionnaire (SEEQ) was conducted, which is a reliable tool to evaluate the essential elements of TCs. Results: In 2014, there were only 5 TCs in Saudi Arabia. All of them were traditional TCs for adult male residents. The average total score was 3.72 out of 5 on the SEEQ. Regarding the 6 dimensions of the SEEQ, the TCs scored 4.15 on the TC perspective, 3.72 on the agency treatment approach and structure, 4.40 on community as therapeutic agent, 2.60 on educational and work activities, 3.50 on formal therapeutic elements, and 4.3 on process. There were no significant differences in dimensions scores among the 5 Saudi TCs. Conclusion: In general, all of the Saudi TCs scored fairly high on the SEEQ, which may reflect a sufficient implementation of the TC as a therapeutic model. Educational and work activities lagged behind the other dimensions and should be improved and re-evaluated.
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Affiliation(s)
- Abdulaziz T Alshomrani
- Department of Clinical Neuroscience, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Jaffe JH. Relapse: What Should We Do About It? Commentary on Flynn and Brown (2016). J Subst Abuse Treat 2016; 64:5-6. [PMID: 26906763 DOI: 10.1016/j.jsat.2015.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Jerome H Jaffe
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, MD USA; Friends Research Institute, Baltimore, MD USA.
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Elison S, Weston S, Dugdale S, Ward J, Davies G. A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616630013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.
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94
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Shepard DS, Daley MC, Neuman MJ, Blaakman AP, McKay JR. Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial. Drug Alcohol Depend 2016; 159:109-16. [PMID: 26718395 PMCID: PMC4744476 DOI: 10.1016/j.drugalcdep.2015.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/26/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse. METHODS Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes. RESULTS The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (-$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. CONCLUSIONS TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.
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Affiliation(s)
- Donald S Shepard
- Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States.
| | - Marilyn C Daley
- Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States
| | - Matthew J Neuman
- U.S. Department of Veterans Affairs, Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA 94025, United States; U.S. Department of Veterans Affairs, Health Care Financing & Economics, VA Boston Health Care System, 150 South Huntington Avenue, Boston, MA 02130, United States
| | | | - James R McKay
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, 3440 Market Street, Suite 370, Philadelphia, PA 19104, United States; U.S. Department of Veterans Affairs, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States
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95
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Flynn PM, Brown BS. Matching Treatment to Rhetoric - A Challenge to Policy and Programming. J Subst Abuse Treat 2016; 64:1-2. [PMID: 26774843 DOI: 10.1016/j.jsat.2015.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/05/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA.
| | - Barry S Brown
- University of North Carolina at Wilmington, Wilmington, NC USA
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96
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McCollister K, Yang X, McKay JR. Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults. Drug Alcohol Depend 2016; 158:38-44. [PMID: 26621551 PMCID: PMC4698077 DOI: 10.1016/j.drugalcdep.2015.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period. METHODS Intervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. RESULTS From the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. CONCLUSIONS Telephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. CLINICAL TRIAL REGISTRATION Clinical Trials.gov Number: NCT00685659.
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Affiliation(s)
- Kathryn McCollister
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Xuan Yang
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James R. McKay
- University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
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97
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Simioni N, Rolland B, Cottencin O. Interventions for Increasing Alcohol Treatment Utilization Among Patients with Alcohol Use Disorders from Emergency Departments: A Systematic Review. J Subst Abuse Treat 2015. [DOI: 10.1016/j.jsat.2015.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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98
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Hilton TF, Pilkonis PA. The Key to Individualized Addiction Treatment is Comprehensive Assessment and Monitoring of Symptoms and Behavioral Change. Behav Sci (Basel) 2015; 5:477-95. [PMID: 26529025 PMCID: PMC4695774 DOI: 10.3390/bs5040477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022] Open
Abstract
Modern health services now strive for individualized treatment. This approach has been enabled by the increase in knowledge derived from neuroscience and genomics. Substance use disorders are no exception to individualized treatment even though there are no gene-specific medications yet available. What is available is the ability to quickly and precisely assess and monitor biopsychosocial variables known to vary during addiction recovery and which place addicts at increased risk of relapse. Monitoring a broad spectrum of biopsychosocial health enables providers to address diverse genome-specific changes that might trigger withdrawal from treatment or recovery relapse in time to prevent that from occurring. This paper describes modern measurement tools contained in the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) and the NIH Toolbox and suggests how they might be applied to support recovery from alcohol and other substance use disorders in both pharmacological and abstinence-oriented modalities of care.
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Affiliation(s)
| | - Paul A Pilkonis
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street Pittsburgh, PA 15213, USA.
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99
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Elison S, Weston S, Davies G, Dugdale S, Ward J. Findings from mixed-methods feasibility and effectiveness evaluations of the “Breaking Free Online” treatment and recovery programme for substance misuse in prisons. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1090397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah Elison
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | - Samantha Weston
- School of Sociology and Criminology, University of Keele, Keele, Staffs, Staffs, UK
| | - Glyn Davies
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | | | - Jonathan Ward
- Breaking Free Group, 274 Deansgate, Manchester, UK and
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100
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Fleury MJ, Grenier G, Bamvita JM, Caron J. Profiles Associated Respectively with Substance Dependence Only, Mental Disorders Only and Co-occurring Disorders. Psychiatr Q 2015; 86:355-71. [PMID: 25433455 DOI: 10.1007/s11126-014-9335-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study sought to identify profiles associated with substance dependence only, mental disorders only and co-occurring disorder respectively, using a broad range of socio-demographic, socio-economic, health beliefs, clinical and health services utilization variables concurrently. Based on a broad analytic framework, 423 participants diagnosed with substance dependence only, mental disorders only or co-occurring disorders within a 12-months period were studied. The study used comparison analysis, and a multinomial logistic regression model. Participants with dependence only and mental disorders only were in contrast in terms of gender, age, marital status, self-perception of physical health, perception of the physical conditions of their neighbourhood, impulsiveness, psychological distress and visit with a family physician in previous 12-months, while those with co-occurring disorders were in an intermediary position between the other two groups. Public authorities should especially promote strategies that could increase the capacity of family physicians to take care of individuals with substance dependence only.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada,
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