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Grove JL, April LY, Evan MK. Social Support as Protective Factor for Suicidal Ideation during Treatment for Substance Abuse: Differential Effects across Treatment Modalities. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2022. [DOI: 10.1016/j.crbeha.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Maina G, Marshall K, Sherstobitof J. Untangling the Complexities of Substance Use Initiation and Recovery: Client Reflections on Opioid Use Prevention and Recovery From a Social-Ecological Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211050372. [PMID: 34675526 PMCID: PMC8524687 DOI: 10.1177/11782218211050372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Background: In Canada, the rate of opioid use, opioid use disorder (OUD), and associated
mortality and morbidity are higher among Indigenous Peoples than the general
population. Indigenous Peoples on medications for opioid use disorders
(MOUD) often face distinct barriers that hinder their clinical progress,
leading to treatment attrition. Methods: We used a social-ecological model to inquire into clients’ experiences with a
history of treatment failure for OUD. We used exploratory qualitative
research to engage 22 clients with a history of OUD treatment dropouts and
who are currently on MOUD. In-depth, semi-structured interviews lasting an
average of 30 minutes were conducted on-site. Results: We identified 4 themes from the study: (a) risk for substance use; (b)
factors sustaining substance use; (c) factors leading to treatment, and (d)
treatment failure and re-enrollment. Conclusion: Using a socio-ecological model helps to understand factors that influence an
individual’s risk for OUD, decision to pursue treatment, and treatment
outcomes. Furthermore, social ecological model also creates possibilities to
develop supportive, multilevel interventions to prevent OUD risks and
support for clients on MOUD. Such interventions include mitigating adverse
childhood experiences, supporting families, and creating safe community
environments.
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Shen NT, Kaplan A, Fahoum K, Basu E, Shenoy A, Wahid N, Ivatorov A, Pisa J, Salajegheh A, Dawod E, Rosenblatt R, Fortune B, Safford M, Brown RS. Identification of Quantifiable Predictors of Relapse in Patients with Alcohol-Associated Liver Disease. Hepatol Commun 2021; 5:1156-1164. [PMID: 34278166 PMCID: PMC8279469 DOI: 10.1002/hep4.1704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
Abstinence in patients with alcohol-associated liver disease (ALD) reduces mortality. Most predictors of relapse are not quantifiable, preventing objective analysis of relapse risk and targeted intervention to improve clinical outcomes. We prospectively enrolled patients with ALD from November 2016 to December 2019 and administered a survey with two previously published scales to assess insight into alcohol-use disorder (Hanil Alcohol Insight Scale [HAIS]) and social support (Community Assessment Inventory Scale [CAIS]). Relapse was assessed using surveys and metabolite testing. Unadjusted and prespecified adjusted regression analyses identified predictors of relapse. We enrolled 81% of eligible patients (n = 136), of whom 58 had follow-up data available at the time of analysis. Over a median follow-up of 1 year (interquartile range: 0.5-1.4), 10 patients relapsed (17%). Patients who relapsed were more likely to continue drinking despite either a diagnosis of liver disease or a decompensating event, and were less likely to have been transplanted (all P < 0.05). In unadjusted regression, the HAIS and the "support inside the home" subcategory of the CAIS were predictive of relapse, with odds ratio (OR) = 0.84 (95% confidence interval 0.72-0.97) and 0.85 (0.74-0.97). In adjusted regression, the HAIS was no longer significant, with adjusted OR = 0.70 (0.49-1.00, P = 0.05), whereas the "support inside the home' subcategory of CAIS remained significant, with adjusted OR = 0.69 (0.51-0.92, P = 0.01). Conclusions: Risk factors for relapse in patients with ALD were identified and quantified prospectively, suggesting opportunities to objectively identify patients at risk for relapse as well as to intervene to prevent relapse.
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Affiliation(s)
- Nicole T. Shen
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Alyson Kaplan
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Khalid Fahoum
- Department of MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Elora Basu
- Department of MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Akhil Shenoy
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Nabeel Wahid
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Amanda Ivatorov
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Joseph Pisa
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | | | - Enad Dawod
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Russell Rosenblatt
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Brett Fortune
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Monika Safford
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Robert S. Brown
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
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Yang Y, Perkins DR, Stearns AE. “I Started to Feel Better now”: Qualitative Findings from Client Narratives on Early Recovery in Inpatient Substance Use Treatment. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Salari N, Jalali A, Abdam B, Abdi A, Daryoushi H. Validation and psychometric properties of the community assessment inventory in Iranian persons who use drug. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:46. [PMID: 32682438 PMCID: PMC7368702 DOI: 10.1186/s13011-020-00290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
Objective Social support is a key factor in the treatment and rehabilitation process of persons who use drug (PWUD). This highlights the need for a valid and reliable tool for assessing social support. The cultural and psychometric properties of community assessment inventory (CAI) in PWUDs under methadone therapy were examined in Iran in 2019. Methods The study was carried out as a validation and methodological study. At first, the original tool was translated into Farsi using forward-backward method. After ensuring face validity and content validity, construct reliability of the tool was supported using explorative and confirmatory factor analysis (EFA & CFA) using a sample group of 392 participants. The participants were selected through convenient-quota sampling from 24 drug clinics. Reliability of the questionnaire was supported using Pearson correlation coefficient and internal consistency based on Cronbach’s alpha. Results To determine content validity of the tool, CVI and CVR of it were obtained, which were on average equal to 0.79 and 0.59 respectively. The EFA supported correlation of the 37itmes of the tool (KMO = 0.975, Chi-square = 15,051.6, Pvalue=0.0001). The main indices of the model, based on CFA were higher than 0.9, which support goodness of fit of the model (χ2/DF = 2.98, CFI = 0.91, NFI, TLI = 0.905 GF = 0.92, REMSEA = 0.07, R2 = 0.99). Reliability of the tool based on internal consistency (Cronbach’s alpha) for the subscales were in 0.8–0.95 interval and equal to 0.85 for the whole tool. Conclusion As the results showed, CAI had acceptable indices for Iranian PWUDs under methadone therapy. The tool can be used for assessing social support level in the study population. It is a reliable and valid tool for studies in pertinent fields.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Behzad Abdam
- Student Research Committee, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Daryoushi
- Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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The Assessment of Recovery Capital (ARC) predicts substance abuse treatment completion. Addict Behav 2020; 102:106189. [PMID: 31778848 DOI: 10.1016/j.addbeh.2019.106189] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/13/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022]
Abstract
Recovery from addiction requires various personal and environmental resources. The purposes of this study were to determine if the Assessment of Recovery Capital (ARC) scores measured at admission could predict substance abuse treatment (SAT) completion and to identify personal and environmental factors associated with ARC scores. Participants (N = 2265) comprised clients entering a Midwestern SAT facility (August 2015 - June 2017). Logistic regression was used to predict SAT completion using ARC scores. Nonparametric group comparisons were used for personal and environmental covariates. ARC scores significantly predicted successful SAT completion (OR = 1.05, 95% CI = 1.04, 1.05, Wald z = 12.9, p < 0.001). Employment had a positive relationship with ARC scores (Kruskal-Wallis χ2 = 215.96, df = 8, p < 0.001). ARC scores varied according to primary substance (Kruskal-Wallis χ2 = 101.10, df = 6, p < 0.001); alcohol and marijuana showed the highest scores and heroin the lowest. ARC scores decreased as number of problem substances increased (Kruskal-Wallis χ2 = 70.57, df = 2, p < 0.001, rS = -0.163, p < 0.001). Living arrangement was also significant (Kruskal-Wallis χ2 = 146.36, df = 8, p < 0.001); clients who were homeless had the lowest ARC scores. A number of personal and environmental covariates were associated with the ARC scores and potentially with the outcome. After adjustment, the ARC remained a strong predictor of SAT completion. The ARC should be used in SAT facilities to guide treatment decisions and to create individualized treatment plans for clients.
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Best DW, Haslam C, Staiger P, Dingle G, Savic M, Bathish R, Mackenzie J, Beckwith M, Lubman DI. Social networks and recovery (SONAR): characteristics of a longitudinal outcome study in five therapeutic communities in Australia. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-04-2016-0012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sheikh Fathollahi M, Torkashvand F, Najmeddin H, Rezaeian M. Predictors of One-Year Retention in Methadone Maintenance Treatment (MMT) in Iran, Rafsanjan. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e29121. [PMID: 27803890 PMCID: PMC5086576 DOI: 10.5812/ijhrba.29121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retention in treatment is a key factor to the success of methadone maintenance treatment (MMT) and considered an important measure in evaluation of treatment effectiveness. OBJECTIVES This study aimed to investigate the retention rate and predictors of retention in MMT in Rafsanjan. PATIENTS AND METHODS This was a historical cohort study. A total of 1396 patients admitted between March 2011 and March 2012 in 16 MMT clinics (13 private and 3 state clinics) in Rafsanjan, entered the study and their retention rate was examined for one year. The patients' data abstracted from their medical records using checklists and collected by clinics' staff. Data analyses were performed using SPSS 15.0 and SAS 9.1. Kaplan-Meier method and Cox proportional hazards model were used to determine the retention rate and identify predictors of retention, respectively. RESULTS The mean age of 1396 patients was 37.65 ± 10.77 years and most patients were men (93.8%). The mean and median of retention duration were 193.22 ± 3.83 and 153 ± 9.54 days, respectively. Three-month and one-year retention rates were 66.0% and 34.4%, respectively. Predictor variables of one-year retention in Cox proportional hazards model were high methadone dosage, polysubstance abuse and treatment under state clinics. CONCLUSIONS In this study, retention rate was lower compared to previous studies from other countries. The results suggested that program related factors are better predictors of retention than individual related ones.
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Affiliation(s)
- Mahmood Sheikh Fathollahi
- Occupational Environment Research Center, Department of Epidemiology and Biostatistics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
| | - Fateme Torkashvand
- Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
| | - Hamid Najmeddin
- Department of Public Relations, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
| | - Mohsen Rezaeian
- Occupational Environment Research Center, Department of Epidemiology and Biostatistics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
- Corresponding author: Mohsen Rezaeian, Occupational Environment Research Center, Department of Epidemiology and Biostatistics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran. Tel: +98-3434331315, E-mail:
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Windsor LC, Jemal A, Benoit E. Community Wise: paving the way for empowerment in community reentry. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:501-11. [PMID: 24630737 PMCID: PMC4142095 DOI: 10.1016/j.ijlp.2014.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Theoretical approaches traditionally applied in mental health and criminal justice interventions fail to address the historical and structural context that partially explains health disparities. Community Wise was developed to address this gap. It is a 12week group intervention informed by Critical Consciousness Theory and designed to prevent substance abuse, related health risk behaviors, psychological distress, and reoffending among individuals with a history of incarceration and substance abuse. This paper reports findings from the first implementation and pilot evaluation of Community Wise in two community-based organizations. This pre-posttest evaluation pilot-tested Community Wise and used findings to improve the intervention. Twenty-six participants completed a phone and clinical screening, baseline, 6- and 12-week follow-ups, and a focus group at the end of the intervention. Measures assessed participants' demographic information, psychological distress, substance use, criminal offending, HIV risk behaviors, community cohesion, community support, civic engagement, critical consciousness, ethnic identification, group cohesion, client satisfaction, and acquired treatment skills. Research methods were found to be feasible and useful in assessing the intervention. Results indicated that while Community Wise is a promising intervention, several changes need to be made in order to enhance the intervention. Community Wise is a new approach where oppressed individuals join in critical dialogue, tap into existing community resources, and devise, implement and evaluate their own community solutions to structural barriers.
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Affiliation(s)
- Liliane Cambraia Windsor
- Rutgers, State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07104, USA.
| | - Alexis Jemal
- Rutgers, State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07104, USA
| | - Ellen Benoit
- National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY 10010, USA
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Wooditch A, Tang LL, Taxman FS. WHICH CRIMINOGENIC NEED CHANGES ARE MOST IMPORTANT IN PROMOTING DESISTANCE FROM CRIME AND SUBSTANCE USE? CRIMINAL JUSTICE AND BEHAVIOR 2014; 41:276-299. [PMID: 24910480 PMCID: PMC4045616 DOI: 10.1177/0093854813503543] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Andrews and Bonta identified the following criminogenic needs as important to reducing offending: substance use, antisocial cognition, antisocial associates, family and marital relations, employment, and leisure and recreational activities. This study examines dynamic criminogenic need changes across a 12-month period and identifies which need changes are the best predictors of criminal offending and illicit drug use among a sample of drug-involved probationers who participated in an intervention (N = 251). Probationers had significant changes in several need areas, and treatment participation moderated some changes. Probationers who had reductions in criminally involved family members they associate with, improved work performance, and decreased alcohol use had the greatest reductions in offending. Those who increased time spent engaged in leisure and recreational activities were less likely to self-report subsequent drug use. These findings suggest that certain dynamic need changes may be more important than others, and designing interventions to impact these needs might improve outcomes.
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Taxman FS. Building effective service delivery mechanisms for justice-involved individuals: an under-researched area. HEALTH & JUSTICE 2014; 2:2. [PMCID: PMC5151799 DOI: 10.1186/2194-7899-2-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 06/05/2023]
Abstract
Background The Heath & Justice journal is devoted to addressing the unmet needs of those involved in or working in the justice system. With attention to both health and justice processes and outcomes, this journal is designed to provide a forum for scholarship and research that is usually dispersed across many different disciplines. Findings In this article, we focus on the need for more service related research to broaden our understanding of how to improve system, program, and client level outcomes. A review of pertinent research in each area is provided to illustrate contemporary findings. Conclusions Current research also makes the case for a focused discussion about processes, policies, and procedures that need further exploration. To better understand how to improve health and justice outcomes, research is needed in program fidelity, services, geographical and activity spaces, and other arenas that affect individual, program, and system level outcomes. Electronic supplementary material The online version of this article (doi:10.1186/2194-7899-2-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Faye S Taxman
- Department of Criminology, Law and Society, George Mason University, 4087 University Blvd, Ste 4100, Fairfax, VA 20030 USA
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Wooditch A, Lawton B, Taxman FS. The Geography of Drug Abuse Epidemiology Among Probationers in Baltimore. JOURNAL OF DRUG ISSUES 2013. [DOI: 10.1177/0022042612470643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Substance use is a pervasive health problem that contributes significantly to the recycling of offenders through the justice system. This study uses routine activities theory as a framework to determine whether the availability of illicit drugs in a probationer’s immediate residential environment is associated with their use of illegal substances. Combining narcotics-related calls for police service data, interviews with offenders, life history event calendars, and biological drug test results, a clustered-logit regression model of 250 drug-involved probationers indicates that the availability of drugs within the probationer’s immediate area is associated with a higher probability of testing positive for illicit substances. The results suggest a broader epidemiological framework to understand how environment affects drug use. Further research in this area will improve supervision practices of drug-involved individuals and interventions to reduce drug use.
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Groshkova T, Best D, White W. The Assessment of Recovery Capital: Properties and psychometrics of a measure of addiction recovery strengths. Drug Alcohol Rev 2012; 32:187-94. [DOI: 10.1111/j.1465-3362.2012.00489.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Teodora Groshkova
- National Addiction Centre; Institute of Psychiatry; King's College London; London; UK
| | - David Best
- Turning Point Drug and Alcohol Centre; Monash University; Melbourne; Australia
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Sarasvita R, Tonkin A, Utomo B, Ali R. Predictive factors for treatment retention in methadone programs in Indonesia. J Subst Abuse Treat 2011; 42:239-46. [PMID: 21943812 DOI: 10.1016/j.jsat.2011.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 07/23/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The sample consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client's belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses.
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Affiliation(s)
- Riza Sarasvita
- Directorate of Mental Health, Ministry of Health, Republic of Indonesia.
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Katz EC, Brown BS, Schwartz RP, O’Grady KE, King SD, Gandhi D. Transitioning opioid-dependent patients from detoxification to long-term treatment: efficacy of intensive role induction. Drug Alcohol Depend 2011; 117:24-30. [PMID: 21277704 PMCID: PMC3090541 DOI: 10.1016/j.drugalcdep.2010.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 12/21/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
Abstract
Despite findings that opioid detoxification serves little more than a palliative function, few patients who enter detoxification subsequently transition to long-term treatment. The current study evaluated intensive role induction (IRI), a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment. IRI was delivered either alone or combined with case management (IRI+CM) to determine the capacity of each condition to enhance transition and engagement in long-term treatment of detoxification patients. Study participants were 240 individuals admitted to a 30-day buprenorphine detoxification delivered at a publicly funded outpatient drug treatment clinic. Following clinic intake, participants were randomly assigned to IRI, IRI+CM, or standard clinic treatment (ST). Outcomes were assessed in terms of adherence and satisfaction with the detoxification program, detoxification completion, and transition and retention in treatment following detoxification. Participants who received IRI and IRI+CM attended more counseling sessions during detoxification than those who received ST (both ps<.001). IRI, but not IRI+CM participants, were more likely to complete detoxification (p=.017), rated their counselors more favorably (p=.01), and were retained in long-term treatment for more days following detoxification (p=.005), than ST participants. The current study demonstrated that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.
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Affiliation(s)
- Elizabeth C. Katz
- Department of Psychology, Towson University, 8000 York, Rd, Towson, MD, 21252, USA,Friends Research Institute, Social Research Center, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Barry S. Brown
- Department of Psychology, University of North Carolina at Wilmington, 601 South College Road, Wilmington, NC 28403-7010, USA
| | - Robert P. Schwartz
- Friends Research Institute, Social Research Center, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, 20742, USA
| | - Stuart D. King
- Pulmonary and Critical Care Associates of Baltimore, Harry and Jeannette Weinberg Cancer Center, 9103 Franklin Square Drive, Suite 300, Baltimore, MD 21237, USA
| | - Devang Gandhi
- Department of Psychiatry, University of Maryland School of Medicine, 70 W. Pratt Street, 598, Baltimore, MD, 21201, USA
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Schwartz RP, Kelly SM, O'Grady KE, Mitchell SG, Brown BS. Antecedents and correlates of methadone treatment entry: a comparison of out-of-treatment and in-treatment cohorts. Drug Alcohol Depend 2011; 115:23-9. [PMID: 21126830 PMCID: PMC3059350 DOI: 10.1016/j.drugalcdep.2010.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/09/2010] [Accepted: 10/01/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of opioid-dependent individuals in the US in need of drug treatment are not receiving it. It would be useful to understand the characteristics of individuals entering and failing to enter methadone treatment. METHODS Participants were opioid-dependent adults in Baltimore Maryland recruited from new admissions to one of six methadone treatment programs (n=351) and from the streets from among non-treatment seekers (n=164). At study enrollment, participants were administered the Addiction Severity Index, AIDS Risk Assessment, Community Assessment Inventory, Attitudes toward Methadone Scale, Motivation for Treatment Scale and a urine drug test. A series of logistic regression analyses were conducted to determine the best model to predict treatment entry. RESULTS The final logistic regression analysis showed that predictors of treatment entry included: being African-American, being on parole or probation, having lower rates of self-reported cocaine use and criminal activity, higher employment functioning, and greater perceptions of support from family and community for behavioral change. In addition, in-treatment participants were more likely to have a more extensive prior history of drug abuse treatment, greater desire to seek help in coping with their drug problem, and more positive view of methadone. CONCLUSIONS The distinctions between those entering and those not pursuing MTP entry have significance for the structure of outreach programs and reaffirm the need to supplement the current practices of voluntary and coerced treatment entry with one of encouraged treatment entry through outreach.
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Affiliation(s)
- Robert P Schwartz
- Friends Research Institute, Inc. 1040 Park Avenue, Suite 103, Baltimore, MD 21201 USA.
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Mitchell SG, Morioka R, Reisinger HS, Peterson JA, Kelly SM, Agar MH, Brown BS, O'Grady KE, Schwartz RP. Redefining retention: recovery from the patient's perspective. J Psychoactive Drugs 2011; 43:99-107. [PMID: 21858956 PMCID: PMC3160714 DOI: 10.1080/02791072.2011.587392] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs. The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes. Differences in terms of the patients' goals and motivations for seeking treatment from those of the treatment programs, combined with difficulties encountered during the treatment process eventually led to discharge. However, these patients were then able to navigate their way through the treatment system in different ways in order to remain in treatment. The authors conclude that failure to abide by treatment clinic rules do not necessary constitute "treatment failure" from the perspective of patients, who often wish to remain in treatment even if it is not progressing optimally from the program's perspective. As a result, the recovery process can be more fragmented and is often characterized by a series of cyclical treatment episodes rather than continuous time in treatment, thereby impeding their progress towards recovery.
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Affiliation(s)
- Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Myers BJ, Louw J, Pasche SC. Inequitable access to substance abuse treatment services in Cape Town, South Africa. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2010; 5:28. [PMID: 21073759 PMCID: PMC2992042 DOI: 10.1186/1747-597x-5-28] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/15/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. METHODS This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. RESULTS Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. CONCLUSIONS Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.
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Affiliation(s)
- Bronwyn J Myers
- South African Medical Research Council, Tygerberg, South Africa.
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Polcin DL, Galloway GP, Bond J, Korcha R, Greenfield TK. Confirmatory Factor Analysis and Test-Retest Reliability of the Alcohol and Drug Confrontation Scale (ADCS). JOURNAL OF DRUG ISSUES 2010; 39:931-948. [PMID: 20686635 DOI: 10.1177/002204260903900408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The addiction field lacks an accepted definition and reliable measure of confrontation. The Alcohol and Drug Confrontation Scale (ADCS) defines confrontation as warnings about the potential consequences of substance use. To assess psychometric properties, 323 individual entering recovery houses in U.S. urban and suburban areas were interviewed between 2003 and 2005 (20% women, 68% white). Analyses included test-retest reliability, confirmatory factor analysis, and measures of internal consistency. Findings support the ADCS as a reliable way of assessing two factors: Internal Support and External intensity. Confrontation was experienced as supportive, accurate and helpful. Additional studies should assess confrontation in different contexts.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute 6475 Christie Avenue, Suite 400 Emeryville, CA 94608-1010 Telephone (510) 597-3440 Fax (510) 985-6459 E-Mail:
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20
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Kelly SM, O'Grady KE, Schwartz RP, Peterson JA, Wilson ME, Brown BS. The relationship of social support to treatment entry and engagement: the Community Assessment Inventory. Subst Abus 2010; 31:43-52. [PMID: 20391269 DOI: 10.1080/08897070903442640] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study was conducted to determine the psychometric properties of a measure of social support, the Community Assessment Inventory (CAI), and to examine the role of social support in recovery. The CAI and the Addiction Severity Index (ASI) were administered to 196 opioid-dependent adults in (n = 135) or out of (n = 61) methadone treatment in Baltimore, Maryland, between 2004 and 2006. Baseline CAI scale scores indicated a generally high level of internal consistency (alpha scores). Pearson correlations showed that the scales were stable and had good discriminant validity with the ASI composite scores. One-way analysis of variance indicated that in-treatment participants reported significantly more support at baseline than out-of-treatment participants. This study's findings indicate the CAI may be a useful measure of social support and that such support is an important factor in treatment entry.
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Affiliation(s)
- Sharon M Kelly
- Friends Research Institute, Social Research Center,1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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21
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Polcin DL, Galloway GP, Bond J, Korcha R, Greenfield TK. How do residents of recovery houses experience confrontation between entry and 12-month follow-up? J Psychoactive Drugs 2010; 42:49-62. [PMID: 20464806 DOI: 10.1080/02791072.2010.10399785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of confrontation in recovery has been vigorously debated. Proponents suggest confrontation can break down denial and increase motivation. Critics point to counseling studies showing confrontation harms the therapeutic alliance and increases resistance. Frequently missing in these debates is an operational definition of confrontation that can be reliably measured. The Alcohol and Drug Confrontation Scale (ADCS) is a new 72-item measure that defines confrontation as "warnings about potential harm" that might result from substance use (e.g., arrests, loss of job, loss of relationships, etc.). Previous psychometric work indicated the ADCS had acceptable reliability and validity when administered to 323 individuals entering recovery houses. Confrontation from different sources (e.g., family, friends and professionals) was generally experienced as supportive and helpful. The goals of the current study were twofold: (1) to see if the psychometric properties of the ADCS among the same sample were maintained at six and 12 month follow-up, and (2) to see if experiences and perceptions of confrontation changed over time. Despite minor variations in the factor structure between baseline and follow-up, the ADCS generally maintained good reliability and validity. At follow-up, the amount of confrontation participants received declined, but it continued to be generally experienced as supportive and helpful.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
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SACKS STANLEY, CHANDLER REDONNA, GONZALES JUNIUS. Responding to the challenge of co-occurring disorders: suggestions for future research. J Subst Abuse Treat 2008; 34:139-46. [PMID: 17574790 PMCID: PMC2215390 DOI: 10.1016/j.jsat.2007.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 03/22/2007] [Accepted: 03/30/2007] [Indexed: 11/19/2022]
Abstract
This special issue consolidates some recent research findings and scientific thought on co-occurring disorders from both the substance abuse and mental health fields. This summary article recaps and synthesizes the main findings and themes, then considers additional issues in the field today to arrive at an agenda for future co-occurring disorders research. Plans must: (1) encourage and assist further development of treatment programs that respond to an array of types and severities of co-occurring disorders while taking into account the limited resources typically available; (2) continue the development and testing of continuing care models by exploring strategies that will sustain the recovery of treated individuals who remain vulnerable to relapse; and (3) contribute to our understanding of the mechanisms and processes that enable new interventions and practices to be adopted, implemented, and sustained. "Co-occurring disorders" is a relatively new area of research; this special issue illustrates the productivity of work to date and indicates the potential for advances to come.
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Affiliation(s)
- STANLEY SACKS
- Director, Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010, tel 212.845.4400, fax 212.845.4650,
| | - REDONNA CHANDLER
- Branch Chief, Services Research Branch, National Institute on Drug Abuse, 6001 Executive Blvd. Room 5185, Bethesda, MD 20892, tel 301.443.6504, fax 301.443.6815,
| | - JUNIUS GONZALES
- Principal Associate, Healthcare Policy and Clinical Research Division, Abt Associates, Inc., 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD, 20814, tel 301.634-1700, fax 301.634.1801,
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Katz EC, Brown BS, Schwartz RP, King SD, Weintraub E, Barksdale W. Impact of Role Induction on Long-Term Drug Treatment Outcomes. J Addict Dis 2007; 26:81-90. [PMID: 17595001 DOI: 10.1300/j069v26n02_10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In prior research, Katz et al. found that role induction (RI) improved engagement for substance dependent clients relative to standard outpatient treatment orientation. The current study replicates and extends these findings to an examination of long-term outcomes. Substance dependent clients entering outpatient drug-free treatment (N = 353) were randomly assigned to RI or to Standard (ST) orientation followed by routine clinic treatment. Measures of employment, crime, and substance use were collected at intake and at six- and 12-months post-intake. Controlling for baseline differences in substance use, results partially replicated our earlier findings of better engagement for RI, as compared to ST participants; more RI than ST participants attended at least one post-orientation counselling session. RI improved 12-month substance use outcome relative to ST. The potential gain in retention and in reduced substance use at follow-up associated with a single RI session, recommend this strategy for further development and study.
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Affiliation(s)
- Elizabeth C Katz
- Friends Research Institute, Inc., Social Research Center, Baltimore, MD 21201, USA.
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Kovas AE, McFarland BH, McCarty DJ, Boverman JF, Thayer JA. Buprenorphine for acute heroin detoxification: diffusion of research into practice. J Subst Abuse Treat 2006; 32:199-206. [PMID: 17306728 DOI: 10.1016/j.jsat.2006.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 08/24/2006] [Indexed: 10/23/2022]
Abstract
Buprenorphine has been approved for heroin detoxification, but little is known about its impact on everyday practice. Concerns about buprenorphine include expense, limited knowledge about its use, patient limits, and social and clinical attitudes regarding opioid treatment for heroin dependence. On the other hand, randomized clinical trials suggest that buprenorphine is superior to clonidine with regard to withdrawal symptom relief. In June 2004, a community-based residential medical detoxification center switched from clonidine to buprenorphine treatment for all new and returning heroin clients. This study is a retrospective chart review of subject outcomes with clonidine (n = 100) versus buprenorphine (n = 100). Bivariate analysis suggested few cohort differences in pretreatment demographics and client characteristics. In contrast, buprenorphine was significantly associated with increased length of stay and treatment completion. The positive associations between buprenorphine and both treatment completion and length of stay persisted and were slightly enhanced after regression analysis adjusted for potential confounders. Additionally, clinical staff reported better subject engagement in treatment and psychosocial group sessions. This single-site study is an example of successful integration of an evidence-based treatment into community-based practice.
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Affiliation(s)
- Anne E Kovas
- Department of Psychiatry, Oregon Health and Science University, Portland, OR 97239, USA.
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