Gender differences in the impact of comprehensive services in substance abuse treatment

Female Patients Show a Larger Reduction in Suicidal Ideation in Inpatient Addiction Treatment Than Male Patients: Results of a Single-Center Observational Study

Background

Substance use disorders (SUD) are prevalent disorders worldwide. Among other associated health problems, patients with SUD are at an increased risk of dying of suicide, with females displaying an even higher risk than males. Therefore, the aim of this study was to conduct a gender-sensitive evaluation of changes in suicidal ideation during multimodal inpatient treatment at a hospital facility specialized in treating addiction.

Methods

A total of 694 patients (68.2% male) completed routine assessment including suicidal ideation, abstinence confidence, impulsivity, emotion regulation, self-efficacy and autonomy and joy both before (T1) and at the end (T2) of treatment. Mean changes were evaluated with repeated measures MANOVAs.

Results

Before treatment, a total of n=127 (18.3%) of the respondents reported suicidal ideation, which was reduced to n=72 (10.4%) by the end of treatment. Among female patients, the change in reported suicidal ideation compared from T1 to T2 (21.7% vs 7.7%) was significantly higher than among male patients (T1: 16.7%%, T2: 11.6%; p=0.040). Generally, females reported worse symptoms scores and slightly higher numbers of suicidal thoughts at baseline (effect sizes ranging from η²=.008 - 0.044). While both genders significantly profited from the treatment, female patients generally showed larger improvements than male.

Discussion

Our study underscores the beneficial effect of addiction-specialized inpatient treatment on suicidal ideation. Additionally, we found a substantial gender effect: while female patients generally were more distressed before treatment, they also reported higher symptom reduction during the treatment. This result highlights the need to perform more gender-sensitive research and develop more gender-sensitive treatment programs.

Exploring Gender and Ethnoracial Differences and Trends in Methamphetamine Treatment

Introduction

Given the significant rise in methamphetamine use and related mortality in the United States, it is critical to explore differences in treatment trends with particular attention to women and ethnoracial groups in hard-hit areas like Los Angeles County.

Methods

We analyzed a large sample across 4 waves: 2011 (105 programs, 10 895 clients), 2013 (104 programs, 17 865 clients), 2015 (96 programs, 16 584 clients), and 2017 (82 programs, 15 388 clients). We completed a comparative analysis to identify differences across subgroups and a trend analysis of treatment episodes by gender and ethnoracial group to differentiate users of methamphetamine and users of other drugs.

Results

Treatment clients using methamphetamine increased over time for each gender and race. There were also significant differences across age groups. Women comprised a greater proportion of treatment episodes involving methamphetamine use (43.3%) compared to all other drugs combined (33.6%). Latinas represented 45.5% of methadone-related admissions. Compared with other drug users, methamphetamine users had a lower successful treatment completion rate and were served by programs with less financial and culturally responsive capacity.

Conclusions

Findings highlight a sharp increase in treatment admissions for methamphetamine users of all gender and ethnocultural groups. Women, especially Latinas, saw the most significant increases, with a widening gender gap over time. All subgroups of methamphetamine users had a lower treatment completion rate compared with users of other drugs, and critical differences existed in the programs where they received services.

Identifying gender differences in risk profiles and in opioid treatment outcomes in Los Angeles County

Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients' risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1035 clients), 2013 (77 programs, 3671 clients), 2015 (75 programs, 4625 clients), and 2017 (69 programs, 4106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.

Methadone Maintenance Treatment Discontinuation Among Young People who use Opioids in Vancouver, Canada

OBJECTIVE

Retaining adolescents and young adults (AYA) in medications for opioid use disorder (MOUD), like methadone maintenance treatment (MMT), is critical to reducing toxic drug fatalities. This analysis sought to identify factors associated with MMT discontinuation among AYA.

METHOD

Data were derived from the At-Risk Youth Study, a prospective cohort study of street-involved AYA in Vancouver, Canada, between December 2005 and June 2018. Multivariable extended Cox regression identified factors associated with time to MMT discontinuation among AYA who recently initiated MMT. In subanalysis, multivariable extended Cox regression analysis identified factors associated with time to "actionable" MMT discontinuation, which could be addressed through policy changes.

RESULTS

A total of 308 participants reported recent MMT during the study period. Participants were excluded if they reported MMT in the past 6 months at baseline and were retained in MMT (n = 94, 30.5%); were missing MMT status data (n = 43, 14.0%); or completed an MMT taper (n = 11, 3.6%). Of the remaining 160 participants who initiated MMT over the study period, 102 (63.8%) discontinued MMT accounting for 119 unique discontinuation events. In multivariable extended Cox regression, MMT discontinuation was positively associated with recent weekly crystal methamphetamine use (adjusted hazard ratio [AHR] = 1.67, 95% confidence interval [CI]: 1.19 to 2.35), but negatively associated with age of first "hard" drug use (per year older) (AHR = 0.95, 95% CI: 0.90 to 1.00) and female sex (AHR = 0.66, 95% CI: 0.44 to 0.99). In subanalysis, recent weekly crystal methamphetamine use (AHR = 4.61, 95% CI: 1.78 to 11.9) and weekly heroin or fentanyl use (AHR = 3.37, 95% CI: 1.21 to 9.38) were positively associated with "actionable" MMT discontinuation, while older age (AHR = 0.87, 95% CI: 0.76 to 0.99) was negatively associated.

CONCLUSIONS

Efforts to revise MMT programming; provide access to a range of MOUD, harm reduction, and treatments; and explore coprescribing stimulants to AYA with concurrent stimulant use may improve treatment retention and reduce toxic drug fatalities.

Identifying relative strength of methadone versus health and social services in comprehensive substance use disorder treatment using a variance decomposition approach

BACKGROUND

The purpose of this study is to identify the relative strengths of association of medication and health and social services in comprehensive substance use disorder (SUD) treatment.

OBJECTIVES

The study uses a novel variance decomposition method to assess the relative strength of association of six active ingredients of comprehensive SUD treatment: methadone medication, access services, SUD counseling, matched service ratio, client-provider relationship, and treatment duration.

METHODS

The study uses data from the National Treatment Improvement Evaluation Study (1992-1997), a dataset with an unusual number of services and service strategies measured. The data include 3012 clients from 45 SUD treatment programs. Linear mixed models are used to assess the relation of service variables to the outcome of posttreatment substance use. Variance decomposition methods are used to assess the relative importance of the ingredients in the treatment model.

RESULTS

Along with a random intercept and background variables, receipt of methadone accounted for the greatest relative strength of association at 35.4%, compared with 23.8% for treatment duration, 15.4% for client-provider relationship, and 11.2% for matched service ratio. Access and SUD counseling accounted for modest strengths of association at 1% and 3% each.

CONCLUSION

Findings indicate somewhat greater strength of association of methadone compared with other services and service strategies and overall, reinforce the importance of both medication and services and service strategies in the design and development of effective models of service delivery.

SIGNIFICANCE

This study, among the first to evaluate the relative importance of specific services and service strategies of comprehensive SUD treatment, provides insights relevant to the development of effective models of service delivery.

Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research

In May 2021, a reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) was introduced in the U.S. Senate. This reauthorization substantially amends provisions concerning infants affected by prenatal substance exposure and decidedly shifts the policy from a child safety- to a public health-focused approach to achieve the larger goals of healthy and safe child development and caregiver recovery from substance use disorder. Despite its honorable aspirations, no research has tested whether CAPTA "works". To advance scholarship on this policy, we summarize the service needs for this population and clarify how the CAPTA reauthorization aims to address these needs. We then apply a health utilization theory to understanding the mechanisms of effect on maternal-child outcomes. Based on this theoretical analysis, we discuss directions for future research.

Disparities in opioid treatment access and retention among women based on pregnancy status from 2006 to 2017

Background:

The purpose of this study is to assess differences in wait time and retention in opioid use disorder (OUD) treatment among a sample of pregnant and non-pregnant women from low-income urban communities in Los Angeles, California.

Methods:

Data were collected in 9 waves consisting of consecutive years from 2006 to 2011, and then including 2013, 2015, and 2017. The sample consisted of 12,558 women, with 285 being pregnant and 12,273 being non-pregnant. We compared pregnant women with non-pregnant women at admission on key characteristics and relied on two multilevel negative binomial regressions analyses to examine factors related to access (days on the waiting list) and retention (days in treatment).

Results:

We detected disparities existed in access and retention. Pregnant women spent less time waiting to initate treatment than non-pregnant women and, once in treatment, had longer treatment episodes. Among pregnant women, clients identifying as Latina or Other waited longer to enter treatment compared to clients identifying as non-Latina White or Black. Women entering residential waited longer than those entering methadone or counseling services. Pregnant women were more likely to be in treatment longer if they had mental health issues, greater parenting responsibilities (number of children less than 18), and greater SUD severity (number of prior treatment episodes).

Conclusions:

Findings suggest pregnant women’s access and retention can be improved through Medicaid coverage and through the implementation of a standard of care that includes MOUD (methadone) along with ancillary health and social services.

Interpersonal Trauma Among Women and Men Receiving Buprenorphine in Outpatient Treatment for Opioid Use Disorder

People with opioid use disorder (OUD) are vulnerable to negative health outcomes related to substance use and psychosocial issues, such as interpersonal trauma (IPT). Participants receiving buprenorphine completed a cross-sectional survey (July-September 2019). OUD outcomes were prospectively abstracted over a 28-week timeframe. More than a third reported recent IPT (40% women, 36% men). Sexual violence was more common among women than men (p = .02). For women only, IPT was associated with substance use during follow-up (β = 20.72, 95% CI: 4.24, 37.21). It is important for public health strategies in the opioid crisis to address IPT using sex- and gender-informed approaches.

Gender disparities in opioid treatment progress in methadone versus counseling

BACKGROUND

In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States.

METHODS

Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs.

RESULTS

We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients.

CONCLUSIONS

Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.

An Exploratory Study of Sex and Gender Differences in Demographic, Psychosocial, Clinical, and Substance Use Treatment Characteristics of Patients in Outpatient Opioid Use Disorder Treatment with Buprenorphine

As treatment expansion in the opioid epidemic continues, it is important to examine how the makeup of individuals with opioid use disorder (OUD) is evolving. Treatment programs are increasingly utilizing buprenorphine, an effective OUD medication. This exploratory study examines sex and gender differences in psychosocial, clinical and substance use treatment characteristics of a clinical population in outpatient medication treatment for OUD with buprenorphine. This is a secondary data analysis from a cross-sectional survey study with retrospective medical record review conducted with patients recruited from an office-based opioid treatment clinic between July-September 2019. Participants on buprenorphine for at least 28 days at time of survey completion were included (n=133). Differences between men and women were explored with Pearson χ2 and Fisher's Exact Tests for categorical variables and T-Tests for continuous variables. The sample was 55.6% women and nearly three-fourths Black (70.7%). Mean days in current treatment episode was 431.6 (SD=244.82). Women were younger and more likely to be unemployed, identify as a sexual minority, and live alone with children than men. More women than men had a psychiatric comorbidity. Women reported more prescription opioid misuse while men had more heroin only opioid use. More men reported comorbid alcohol use and a history of drug overdose. One-third of participants reported recent discrimination in a healthcare setting due to substance use. As buprenorphine-based outpatient treatment programs continue to expand, present study findings support evaluation of the unique needs of men and women in order to better tailor OUD-related services and improve treatment outcomes.

Gender disparities in access and retention in outpatient methadone treatment for opioid use disorder in low-income urban communities

The purpose of this study was to detect and understand gender disparities in access and retention among outpatient methadone treatment programs located in low-income urban communities in Los Angeles, California. The study collected client- and program-level data in 4 waves in 2011, 2013, 2015, and 2017 from 34 publicly funded methadone treatment programs serving 11,169 clients with opioid use disorder (OUD). The sample included 29.8% female and 70.2% male clients, where 10.6% identified as Black or African American, 41.5% as Latino, 44.2% as non-Latino white, and 3.8% as Other. We conducted two multilevel negative binomial regression models to examine direct and moderated relationships related to both access (days on the waitlist) and retention (days in treatment) while accounting for clients clustered within programs. Gender disparities existed in both access and retention where women spent more time than men waiting to enter treatment but then remained in treatment longer. Further, female clients identifying as African American, Latino, and Other were at greater risk for shorter treatment duration than those who identified as non-Latino white and men. Overall, OUD clients receiving methadone treatment in low-income neighborhoods experienced barriers to access and retention in treatment associated with mental illness, family responsibilities, and use severity. OUD clients with MediCal insurance eligibility were consistently more likely to gain access to and remain in methadone treatment. Overall, findings call for improving treatment access and retention for women with OUD who receive methadone in outpatient methadone treatment programs through comprehensive, gender-specific, and evidence-based programming.

Racial Disparities in Substance Use Treatment Completion Among Older Adults

Background and Objectives

Racial disparities in substance use among young adults have been well documented in the substance use literature, but little attention has been paid to older adults. While being an older adult is positively associated with substance use treatment completion, racial disparities in treatment completion have yet to be examined. The purpose of this study was to determine to what extent racial disparities exist in substance use treatment completion among older adults (65 and older).

Research Design and Methods

This cross-sectional study utilized data from the most recent Treatment Episode Data from the Substance Abuse and Mental Health Services Administration, which documents discharges from a publicly funded substance use treatment program in the United States. A total of 17,942 older adults reported to a substance use treatment program in 2017 and 6,653 met the criteria for the study. Chi-squared tests were used to analyze group differences and a binary logistic regression was used to predict substance use treatment completion.

Results

Results show that Black older adults were 37% less likely to complete a substance use treatment program than Whites (OR = 0.630) while Hispanic older adults were 26% more likely to complete a substance use treatment program than Whites (OR = 1.26).

Discussion and Implications

These results support the findings from similar studies with younger adults and support the theory that racial disparities are prevalent across the life span. Although Hispanics had a higher treatment completion rate than Whites, this is likely a reflection of familismo, where decisions about health treatments is a group process and a steady network of family members are available to provide advice and encouragement. The significant disparity observed between Black and White older adults suggest a need to consider cultural, historical, and systemic factors that affect voluntary termination of substance use treatment among Black older adults.

Determinants and Prevention Strategies of Substance Abuse in Pacific Countries: A Systematic Review

Objectives

People abuse substances like drugs, alcohol, and tobacco for different reasons, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control. In this review, we sought to identify the determinants and prevention strategies that have been undertaken to minimize the issue of substance abuse.

Methods

The systematic review was conducted following the Cochrane Library Guidelines and PRISMA checklist. We searched six online databases to identify studies from January 2000 to July 2017.

Results

Only peer-reviewed studies published in the English language that had full text accessible were included. We reviewed 19 studies; only one was quasi-experimental and the majority were descriptive studies. The determinants of substance abuse identified include personal, faciliatory/promotor, environmental, and social factors. The prevention strategies identified use culturally appropriate and gender-sensitive treatments, and identify sources of strength in families, community, individual, and even spiritual.

Conclusions

Substance abuse poses significant public health risks and therefore requires adequate interventions such as educating and informing individuals of the health risks associated with substance abuse and must be considered locally to promote the well-being of people.

Parallel modeling of pain and depression in prediction of relapse during buprenorphine and naloxone treatment: A finite mixture model

BACKGROUND

Relapse is common in treatment for opioid use disorders (OUDs). Pain and depression often co-occur during OUD treatment, yet little is known about how they influence relapse among patients with a primary diagnosis of prescription opioid use disorder (POUD). Advanced statistical analyses that can simultaneously model these two conditions may lead to targeted clinical interventions.

METHOD

The objective of this study was to utilize a discrete survival analysis with a growth mixture model to test time to prescription opioid relapse, predicted by parallel growth trajectories of depression and pain, in a clinical sample of patients in buprenorphine/naloxone treatment. The latent class analysis characterized heterogeneity with data collected from the National Institute of Drug Abuse Clinical Trials Network project (CTN-0030).

RESULTS

Results suggested that a 4-class solution was the most parsimonious based on global fit indices and clinical relevance. The 4 classes identified were: 1) low relapse, 2) high depression and moderate pain, 3) high pain, and 4) high relapse. Odds ratios for time-to-first use indicated no statistically significant difference in time to relapse between the high pain and the high depression classes, but all other classes differed significantly.

CONCLUSION

This is the first longitudinal study to characterize the influence of pain, depression, and relapse in patients receiving buprenorphine and naloxone treatment. These results emphasize the need to monitor the influence of pain and depression during stabilization on buprenorphine and naloxone. Future work may identify appropriate interventions that can be introduced to extend time-to-first prescription opioid use among patients.

Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex

INTRODUCTION

Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.

METHOD

Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.

RESULTS

BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.

CONCLUSIONS

This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

The Pregnancy Recovery Center: A women-centered treatment program for pregnant and postpartum women with opioid use disorder

OBJECTIVE

To evaluate the impact of women-centered substance abuse treatment programming on outcomes among pregnant women with opioid use disorder (OUD).

METHODS

We compared two retrospective cohorts of pregnant women with OUD on buprenorphine maintenance therapy who delivered an infant at the University of Pittsburgh from 2014 to 2016. Cohort 1 was composed of pregnant women who received women-centered OUD treatment services through the Pregnancy Recovery Program (PRC) and Cohort 2 was composed of pregnant women who received buprenorphine at OUD programs without women-centered services (non-PRC). Women-centered outcomes were defined as a) pregnancy-specific buprenorphine dosing, b) prenatal and postpartum care attendance, c) breastfeeding and d) highly effective contraception utilization. Chi-square and t-tests were used to compare outcomes between PRC and non-PRC patients.

RESULTS

Among 248 pregnant women with OUD, 71 (28.6%) were PRC and 177 (71.4%) were non-PRC patients. PRC patients were significantly more likely to initiate buprenorphine during vs. prior to their pregnancy (81.4% vs. 44.2%; p < .01) and have a higher buprenorphine dose at the time of delivery (16.0 mg vs. 14.1 mg; p = .02) compared to non-PRC patients. Likewise, PRC patients were significantly more likely to attend their postpartum visit (67.9% vs. 52.6%; p = .05) and receive a long-acting reversible contraceptive (LARC) method (23.9% vs. 13.0%, p = .03) after delivery compared to non-PRC patients. Finally, PRC patients had a smaller percent decrease in the rate of breastfeeding during their delivery hospitalization (-14.7% vs. -37.1%).

CONCLUSIONS

Incorporating women-centered services into OUD treatment programming may improve gender-specific outcomes among women with OUD.

The Relationship Between Residential Mobility and Behavioral Health Service Use in a National Sample of Adults With Mental Health and/or Substance Abuse Problems

OBJECTIVE

Individuals with mental health and/or substance abuse problems experience disparities in health care utilization. While previous studies have focused on individual and social determinants of health care use in these populations, few have investigated the role of residential stability, especially in relation to different types of service use (i.e., inpatient vs. outpatient treatment). The present study examined the relationship between residential mobility, defined as the number of residential relocations in the past year, and past-year use of four types of behavioral services (i.e., inpatient and outpatient mental health services, inpatient and outpatient substance abuse services) among a national sample of adults with mental health and/or substance abuse problems.

METHODS

Data were drawn from the 2011-2014 National Survey of Drug Use and Health (unweighted N = 43,411). Based on prior literature and theory, we hypothesized that individuals who frequently relocate are more likely to use inpatient services and are less likely to use outpatient services. Logistic regression analyses were conducted and all models controlled for predisposing, need, and enabling factors.

RESULTS

Compared to individuals who did not move in the past year, those who moved three or more times were more likely to report using inpatient mental health and substance abuse services. The relationship between residential mobility and outpatient mental health and substance use service use is not significant.

CONCLUSIONS

The findings highlight the importance of understanding housing stability as a predictor factor of service use and access. Future research is needed to shed light on the pathway through which residential mobility affects behavioral health service utilization.

Gender Differences in Perceived Unmet Treatment Needs Among Persons With and Without Co-occurring Disorders

This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008-2013 National Survey on Drug Use and Health (unweighted N = 37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.

Developing a scale of domains of negative consequences of chronic heroin use

BACKGROUND

Chronic use of heroin typically leads to numerous negative life consequences and serious clinical impairment. Increased negative consequences can result in poor treatment outcomes as well as adverse health effects and impaired social functioning. Certain risk factors, including early substance use initiation, concurrent use of other illicit substances, and injection drug use are associated with an increase in negative consequences. This study examined whether there are unique domains of heroin consequences and, if so, whether these domains are related to specific substance use characteristics.

METHODS

Data regarding substance use characteristics were collected from 370 non-treatment seeking, heroin-using, 18 to 55year-old participants from the Detroit metropolitan area. Principal component analysis (PCA) was used to analyze the factor structure of 21 negative heroin consequence items.

RESULTS

PCA demonstrated that heroin consequences could be divided into 5 unique domains. These unique domains were related to specific substance use characteristics and heroin consequence domains. Injection heroin use was significantly associated with increased Factor 1 consequences (primarily acute medical problems) but not with consequences in other domains. Certain substance use characteristics, such as injection status and earlier onset of marijuana use, were associated with increased consequences in specific domains.

CONCLUSIONS

These findings support the existence of unique domains of negative consequences, and indicate that some risk factors (e.g. injection use) may be specific to these domains. Potential tailored-treatment strategies aimed at improving treatment engagement and reducing harm for heroin use based on person-specific risks and negative consequences are discussed.

Recovery capital pathways: Modelling the components of recovery wellbeing

BACKGROUND

In recent years, there has been recognition that recovery is a journey that involves the growth of recovery capital. Thus, recovery capital has become a commonly used term in addiction treatment and research yet its operationalization and measurement has been limited. Due to these limitations, there is little understanding of long-term recovery pathways and their clinical application.

METHODS

We used the data of 546 participants from eight different recovery residences spread across Florida, USA. We calculated internal consistency for recovery capital and wellbeing, then assessed their factor structure via confirmatory factor analysis. The relationships between time, recovery barriers and strengths, wellbeing and recovery capital, as well as the moderating effect of gender, were estimated using structural equations modelling.

RESULTS

The proposed model obtained an acceptable fit (χ² (141, N=546)=533.642, p<0.001; CMIN/DF=3.785; CFI=0.915; TLI=0.896; RMSEA=0.071). Findings indicate a pathway to recovery capital that involves greater time in residence ('retention'), linked to an increase in meaningful activities and a reduction in barriers to recovery and unmet needs that, in turn, promote recovery capital and positive wellbeing. Gender differences were observed.

CONCLUSIONS

We tested the pathways to recovery for residents in the recovery housing population. Our results have implications not only for retention as a predictor of sustained recovery and wellbeing but also for the importance of meaningful activities in promoting recovery capital and wellbeing.

History of medication-assisted treatment and its association with initiating others into injection drug use in San Diego, CA

BACKGROUND

Medication-assisted treatment (MAT) remains the gold standard for the treatment of opioid use disorder. MAT also reduces the frequency of injecting among people who inject drugs (PWID). Relatedly, data suggest that PWID play a key role in the initiation of others into drug injecting by exposing injecting practices to injection-naïve drug users. Our primary objective was to test whether a history of MAT enrollment is associated with a reduced odds of PWID providing injection initiation assistance.

METHODS

Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01), is a multi-site cohort study assessing the impact of socio-structural factors on the risk that PWID provide injection initiation assistance. Data were drawn from a participating cohort of PWID in San Diego, CA. The primary outcome was reporting ever providing injection initiation assistance; the primary predictor was reporting ever being enrolled in MAT. Logistic regression was used to model associations between MAT enrollment and ever initiating others into injecting while adjusting for potential confounders.

RESULTS

Participants (n = 354) were predominantly male (n = 249, 70%). Thirty-eight percent (n = 135) of participants reported ever initiating others into injection drug use. In multivariate analysis, participants who reported a history of MAT enrollment had significantly decreased odds of ever providing injection initiation assistance (Adjusted Odds Ratio [AOR]: 0.62, 95% Confidence Interval [CI]: 0.39-0.99).

CONCLUSIONS

These preliminary findings suggest an association between MAT enrollment and a lower odds that male PWID report providing injection initiation assistance to injection-naïve drug users. Further research is needed to identify the pathways by which MAT enrollment may impact the risk that PWID initiate others into drug injecting.

Disparities by Sex Tracked in the 2015 National Healthcare Quality and Disparities Report: Trends across National Quality Strategy Priorities, Health Conditions, and Access Measures

INTRODUCTION

Established by the Affordable Care Act, the National Quality Strategy (NQS) is the national policy goals aimed at improving the quality of health care for all Americans. The NQS established six priorities to provide better, more affordable care for individuals and communities. This is the first analysis of data on the NQS and access measures that focus on sex differences, health conditions, trends, and disparities.

METHODS

Measures from the 2015 National Healthcare Quality and Disparities Report (QDR) for the four National Quality Strategy priorities (Patient Safety, Person Centered Care, Effective Treatment, and Healthy Living), access to care, and health conditions for women were compared to measures for men. Trends were analyzed for women by health condition and the four NQS priorities and access to care. Baseline year (2000-2002) and most current year (2012-2013) were compared to assess disparity trends. All non-institutionalized women and men in the U.S. over the age of 18 were included in the sample.

RESULTS

Disparities between males and females for the four NQS priority and access measures did not change for 83 percent of measures (n=81); disparities remained constant. The greatest improvement over time for females from the baseline year was in the patient safety measures (3.66 percent increase per year). Access of care measures showed the least amount of improvement with a median change of -1.20 percent per year. The greatest improvement in quality of care by health condition was amongst chronic kidney disease (11.95 median percent change) and HIV/AIDS (6.63 median percent change) measures. Behavioral health measures showed the least amount of improvement with a median change of -0.33 percent per year.

CONCLUSIONS

This analysis highlights cardiovascular disease, behavioral health, and access to care as problem areas for women that require immediate attention. It is of concern that 83% of the measures showed a persistent disparity over time between men and women. These results indicate that there is room for improving the quality of healthcare received by women and reducing sex-based disparities experienced by women in the healthcare delivery system.

Drug use among Asian Americans: Differentiating use by acculturation status and gender

This study examined past-year drug use among Asian Americans with respect to ethnic subgroup, acculturation, and gender differences. Survey data were collected during the National Latino and Asian American Survey, a national epidemiological household survey of behavioral health prevalence and service utilization rates. The analytical sample consisted of 505 Filipino, 598 Chinese, 518 Vietnamese, and 466 other Asian respondents. Results indicated that among ethnic subgroups, Filipinos had the highest rates of drug use. Among all Asian Americans, those who were born in the United States, those with higher levels of English proficiency, males, those who were younger, those with lifetime prevalence of a major depressive episode, and those who were frequent drinkers were all more likely to have reported past-year drug use. Findings suggest the need to better understand the heterogeneous character of Asian American drug use when considering the provision of culturally competent and linguistically appropriate prevention and treatment services.

Gender differences in discharge dispositions of emergency department visits involving drug misuse and abuse-2004-2011

Background

Drug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services. Yet, little is known about where patients go post discharge. We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences.

Methods

We extracted data from the 2004–2011 Drug Abuse Warning Network, a national probability sample of drug-related visits to hospital EDs in the U.S. We computed weighted multinomial logistic regression models to estimate discharge dispositions over time and to examine associations between gender and the relative risk of discharge dispositions, controlling for patient characteristics.

Results

The final pooled sample included approximately 1.2 million ED visits between 2004 and 2011. Men accounted for more than half (57.6%) of all ED visits involving drug misuse and abuse. Compared with women, men had a greater relative risk of being released to the police/jail, being referred to outpatient detox or other treatment, and leaving against medical advice than being discharged home. The relative risk of being referred to outpatient detox/drug treatment than discharged home increased over time for men versus women.

Conclusions

Greater understanding of gender-based factors involved in substance-related ED visits and treatment needs may inform discharge planning and preventive interventions.

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial/ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy/binge alcohol use (n=52,496) and those with alcohol use disorder (n=22,966). Difference-in-differences models estimated service-related disparities before (2008-2009) and after (2011-2014) health care reform. A sub-analysis was conducted before (2011-2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy/binge drinking were excluded from SUD treatment and unmet need outcome models due to insufficient cell size. Among heavy/binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. MH treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. While there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.

Trajectories of Substance Use Disorder in Youth After Detention: A 12-Year Longitudinal Study

OBJECTIVE

To identify trajectories of substance use disorders (SUDs) in youth during the 12 years after detention and how gender, race/ethnicity, and age at baseline predict trajectories.

METHOD

As part of the Northwestern Juvenile Project, a longitudinal study of 1,829 youth randomly sampled from detention in Chicago, Illinois from 1995 through 1998, participants were reinterviewed in the community or correctional facilities up to 9 times over 12 years. Independent interviewers assessed SUDs using the Diagnostic Interview Schedule for Children 2.3 (baseline) and the Diagnostic Interview Schedule IV (follow-ups). Primary outcome was a mutually exclusive 5-category typology of disorder: no SUD, alcohol alone, marijuana alone, comorbid alcohol and marijuana, or "other" illicit ("hard") drug. Trajectories were estimated using growth mixture models with a 3-category ordinal variable derived from the typology.

RESULTS

During the 12-year follow-up, 19.6% of youth did not have an SUD. The remaining 81.4% were in 3 trajectory classes. Class 1 (24.5%), a bell-shaped trajectory, peaked 5 years after baseline when 42.7% had an SUD and 12.5% had comorbid or "other" illicit drug disorders. Class 2 (41.3%) had a higher prevalence of SUD at baseline, 73.8%. Although prevalence decreased over time, 23.5% had an SUD 12 years later. Class 3 (14.6%), the most serious and persistent trajectory, had the highest prevalence of comorbid or "other" illicit drug disorders-52.1% at baseline and 17.4% 12 years later. Males, Hispanics, non-Hispanic whites, and youth who were older at baseline (detention) had the worst outcomes.

CONCLUSION

Gender, race/ethnicity, and age at detention predict trajectories of SUDs in delinquent youth. Findings provide an empirical basis for child psychiatry to address health disparities and improve prevention.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

The Relationship Between Client Characteristics and Wraparound Services in Substance Use Disorder Treatment Centers

OBJECTIVE

The National Institute on Drug Abuse (NIDA) recommends a comprehensive treatment program for individuals with substance use disorder (SUD) in order to treat needs they often have in addition to their SUD. Specifically, NIDA suggests providing services related to the following issues: medical care, mental health care, HIV/AIDS, child care, educational, vocational, family counseling, housing, transportation, financial, and legal. By providing a comprehensive model that combines core and wraparound services, treatment centers can deliver a higher quality of treatment. In this article, we assessed the relationship between client characteristics and the availability of wraparound services in SUD treatment centers.

METHOD

We combined two nationally representative samples of treatment centers and used a negative binomial regression and a series of logistic regressions to analyze the relationship between client characteristics and wraparound services.

RESULTS

On average, centers offered fewer than half of the wraparound services endorsed by NIDA. Our results indicated that client characteristics were significantly related to the provision of wraparound services. Most notably, the proportion of adolescent clients was positively related to educational services, the proportion of female clients was positively related to child care, but the proportion of clients referred from the criminal justice system was negatively associated with the provision of multiple wraparound services.

CONCLUSIONS

Our findings have important implications for SUD clients and suggest that, although centers are somewhat responsive to their clients' ancillary needs, most centers do not offer the majority of wraparound services.

A Pilot Study of Reunification following Drug Abuse Treatment: Recovering the Mother Role

This qualitative study explored the experiences of women in recovery from drug abuse who had resumed parenting their children after child placement. Six mothers and 11 service providers from substance abuse treatment and child welfare agencies were interviewed about their perceptions of the experience of being reunified with one's children following substance abuse treatment. Findings revealed that mothers have intense emotional reactions to having children placed, which can motivate recovery but also be a source of stress. A variety of supports were identified as necessary to prepare mothers for resuming care of children beyond substance abuse treatment including counseling, child care, financial support, and parenting education. Reunification, however desirable, was described as overwhelming and fraught with parenting challenges, such as effective limit setting with children. Numerous challenges and barriers to successful reunification were identified, such as stigmatization in the child welfare system. Implications for service delivery and research are discussed.

Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

INTRODUCTION

Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide.

METHODS

We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient "seeking detox," or patient explicitly requesting for detox referral.

RESULTS

Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02-1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17-1.43]). This significant association prevailed after controlling for "seeking detox."

CONCLUSION

Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are "seeking detox." Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes.

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: a population-based approach

INTRODUCTION

Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services.

METHODS

We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes.

RESULTS

Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment.

CONCLUSIONS

Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.

Comparative analysis of recidivism outcomes following drug treatment court in Vancouver, Canada

Drug Treatment Courts (DTCs) integrate therapeutic interventions for substance using offenders with the administration of justice. Available evidence indicates that DTCs are effective at reducing recidivism, but it is not yet established whether they are equally effective for all subgroups of offenders. The current study investigates the comparative effectiveness of a Canadian DTC among subgroups defined by ethnicity, gender, prior offending, and the presence of a co-occurring mental disorder. Results indicate greater reductions in recidivism among female and Aboriginal participants, and no differences in recidivism associated with the presence or absence of co-occurring mental disorders or the number of prior convictions. Longer duration of involvement with the DTC program was positively associated with reduced recidivism. The effectiveness of DTCs with distinct subpopulations may be related to their composition and inclusion of expertise relevant to the needs of diverse participants.

Posttreatment drug use abstinence: does the majority program clientele matter?

The current study examines differences in organizational characteristics and client posttreatment drug use abstinence in residential substance abuse treatment programs serving clients with high or low levels of legal coercion to participate in treatment. The findings show that low legal coercion programs have higher counselor caseloads (Z = 59, p < .05) than high coercion programs. Although the results showed that programs with a large proportion of African American clients (β = 14.26, p < .0001) and high legal coercion programs (β = 19.99, p < .05) predicted longer abstinence posttreatment, the final models suggest organizational factors are the key predictors of client posttreatment abstinence.

RECIPROCAL RESPONSIBILITY AND SOCIAL SUPPORT AMONG WOMEN IN SUBSTANCE USE RECOVERY

This study sought to identify individual- and house-level predictors of women's employment, education, and retention in self-run recovery homes. Data from a national study of 292 women in Oxford House, an international organization of recovery homes grounded on self-help/mutual aid and 12-step principles were analyzed. Results indicated that the house's Reciprocal Responsibility predicted number of days of paid work. Individual and house variables did not predict participation in education. The presence of recovery home members in personal social networks was statistically significant in predicting retention in the recovery home. Lastly, results indicated that number of days of paid work were not predictive of likelihood of substance use in the next 12 months. The findings of this study indicate that the ability to develop social networks and Reciprocal Responsibility in recovery homes can contribute to positive outcomes for women.

Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups

This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment.

Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers' cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.

From the Individual to the Community: Perspectives about Substance Abuse Services

This paper argues that substance abuse interventions in distressed African-American communities must be culturally-tailored and incorporate a framework targeting changes in both individual behavior and the community. The current study employed Concept Mapping in conjunction with Community-Based Participatory Research (CBPR) principles to involve 100 community members, substance users, and service providers to examine the role of alcohol and other drugs in distressed African-American communities. Findings reveal the way participants understand the role of drugs and alcohol in their community and their perceptions of substance abuse services. The paper describes a collaborative approach to engage the community in addressing substance abuse.

Gender, race, and group behavior in group drug treatment

BACKGROUND

Group drug counseling is the primary treatment modality used to treat drug dependence in community settings in the United States. Findings from the social psychology literature suggest that gender may influence how individuals participate in groups, and that race may moderate the effects of gender on group behavior. This study examined gender, race, and their interaction as predictors of alliance, participation, self-disclosure, and receipt of advice and feedback in drug counseling groups, and explored how gender and racial differences in drug counseling group behavior related to outcome of cocaine dependence treatment.

METHOD

Ratings of group behavior were made from videotaped sessions of group drug counseling drawn from a randomized trial of treatment for cocaine-dependent individuals (n=438). Analyses examined the effects of race (African American or non-Hispanic White), gender, and the race by gender interaction on group behavior. Additional analyses examined race, gender, and group behavior, and interactions among these variables in predicting monthly cocaine use.

RESULTS

Race and the race by gender interaction, but not gender alone, predicted many group behaviors. Non-Hispanic White women had the highest rates of self-disclosure and receipt of advice and non-positive feedback, followed by men of both races, with African American women having the lowest levels. These differences were unrelated to cross-sectional cocaine outcome.

CONCLUSIONS

Women, but not men, of different races acted differently in mixed-race, mixed-gender cocaine treatment groups, with African American women exhibiting less of several behaviors. Additional research on causes and consequences of these differences could inform interventions for drug-dependent women.

Contingency management with community reinforcement approach or twelve-step facilitation drug counseling for cocaine dependent pregnant women or women with young children

BACKGROUND

Cocaine abuse among women of child-bearing years is a significant public health problem. This study evaluated the efficacy of contingency management (CM), the community reinforcement approach (CRA), and twelve-step facilitation (TSF) for cocaine-dependent pregnant women or women with young children.

METHODS

Using a 2×2 study design, 145 cocaine dependent women were randomized to 24 weeks of CRA or TSF and to monetary vouchers provided contingent on cocaine-negative urine tests (CM) or non-contingently but yoked in value (voucher control, VC). Primary outcome measures included the longest consecutive period of documented abstinence, proportion of cocaine-negative urine tests (obtained twice-weekly), and percent days using cocaine (PDC) during treatment. Documented cocaine abstinence at baseline and 3, 6, 9 and 12 months following randomization was a secondary outcome.

FINDINGS

CM was associated with significantly greater duration of cocaine abstinence (p<.01), higher proportion of cocaine-negative urine tests (p<0.01), and higher proportion of documented abstinence across the 3-, 6-, 9- and 12-month assessments (p<0.05), compared to VC. The differences between CRA and TSF were not significant for any of these measures (all p values ≥0.75). PDC decreased significantly from baseline during treatment in all four groups (p<0.001) but did not differ significantly between CM and VC (p=0.10) or between TSF and CRA (p=0.23).

INTERPRETATION

The study findings support the efficacy of CM for cocaine dependent pregnant women and women with young children but do not support greater efficacy of CRA compared to TSF or differential efficacy of CM when paired with either CRA or TSF.

Client-Provider relationship in comprehensive substance abuse treatment: differences in residential and nonresidential settings

As the substance abuse service system shifts from primarily residential to primarily nonresidential settings, it becomes important to understand how substance abuse treatment processes and outcomes may vary across service setting. Research increasingly indicates that, along with specific treatment and service strategies, client-provider relationship is an important ingredient in effective substance abuse treatment. This study uses a moderator-mediator analysis of a comprehensive service model to examine how the relation between client-provider relationship and substance abuse treatment outcomes may differ in residential and nonresidential settings. The study used data collected for the National Treatment Improvement Evaluation Study, a prospective, cohort-based study of U.S. substance abuse treatment programs and their clients, with an analytic sample of 59 publicly funded service delivery units and 3,027 clients. Structural equation modeling is used to assess the structural relations and causal connections between treatment process and treatment outcome variables. Results indicate that for nonresidential settings, a better client-provider relationship is directly related to improved outcomes of treatment duration and reduced posttreatment substance use and is indirectly related to both outcomes through provision of services matched to client needs. In residential settings, the quality of the client-provider relationship is unrelated to process or outcome variables. The findings point to the importance of the client-provider relationship in all settings but particularly in outpatient settings where there are limited physical constraints on the treatment process.

Improving health and social outcomes with targeted services in comprehensive substance abuse treatment

BACKGROUND

Improved life functioning along with substance use reduction is increasingly recognized as the definition of effective addiction treatment.

OBJECTIVES

To assess whether targeted health and social services contribute to improved physical/mental health and employment.

METHODS

This study used data from the National Treatment Improvement Evaluation Study (N = 3027) and modeled the improvement in physical/mental health and employment at discharge or 12 months after discharge compared with intake measures as a function of receipts of matched services.

RESULTS

Receiving matched medical service improves physical health only at treatment discharge; receiving matched mental health services improves mental health at discharge and 12 months after discharge; receiving matched vocational services improves employment only 12 months after discharge.

CONCLUSIONS

Need-service matching contributes to improved health and social outcomes when longitudinal assessments of treatment outcomes are used to evaluate treatment effectiveness.

SCIENTIFIC SIGNIFICANCE

Study findings document the value of targeted services for achieving success in health and social functioning in comprehensive substance abuse treatment.

The Impact of Comprehensive Services in Substance Abuse Treatment for Women With a History of Intimate Partner Violence

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete ( p = .016) and family services ( p = .023) in predicting substance use.