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Hoang BL, Sledge D. The association between medication for opioid use disorder and employment outcomes in the U.S.: The relevance of race and ethnicity. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100081. [PMID: 36846575 PMCID: PMC9948818 DOI: 10.1016/j.dadr.2022.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
•White admissions given MOUD were less likely to become unemployed at discharge.•Blacks and Hispanics given MOUD were more likely to remain unemployed at discharge.•Racial disparities associated with MOUD have notable implications for policy.
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Nyamathi AM, Zhang S, Salem BE, Farabee D, Hall B, Marlow E, Faucette M, Bond D, Yadav K. A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2016; 12:49-74. [PMID: 27217822 PMCID: PMC4874341 DOI: 10.1007/s11292-015-9236-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. METHODS The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. RESULTS When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. CONCLUSIONS In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.
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Affiliation(s)
- Adeline M. Nyamathi
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
| | | | - Benissa E. Salem
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
| | - David Farabee
- University of California Los Angeles, Integrated Substance Abuse Programs, San Diego, CA, USA
| | - Betsy Hall
- University of California Los Angeles, Integrated Substance Abuse Programs, San Diego, CA, USA
| | - Elizabeth Marlow
- University of California, San Francisco, School of Nursing, San Diego, CA, USA
| | | | - Doug Bond
- Amity Foundation, Los Angeles, CA, USA
| | - Kartik Yadav
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
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Dunn K, DeFulio A, Everly JJ, Donlin WD, Aklin WM, Nuzzo PA, Leoutsakos JMS, Umbricht A, Fingerhood M, Bigelow GE, Silverman K. Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 29:270-6. [PMID: 25134047 DOI: 10.1037/adb0000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral naltrexone could be a promising relapse-prevention pharmacotherapy for recently detoxified opioid-dependent patients; however, interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a contingency (n = 35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace or a prescription (n = 32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, contingency participants provided significantly more naltrexone-positive urine samples than prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-groups differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence, longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued. (PsycINFO Database Record
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Affiliation(s)
- Kelly Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Anthony DeFulio
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Jeffrey J Everly
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Wendy D Donlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Will M Aklin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Paul A Nuzzo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Annie Umbricht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Fingerhood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - George E Bigelow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Dunn KE, Defulio A, Everly JJ, Donlin WD, Aklin WM, Nuzzo PA, Leoutsakos JMS, Umbricht A, Fingerhood M, Bigelow GE, Silverman K. Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users. Exp Clin Psychopharmacol 2013. [PMID: 23205722 PMCID: PMC3641088 DOI: 10.1037/a0030743] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence yet suffers from notoriously poor adherence. This study evaluated whether entry to a therapeutic workplace could reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a contingency (n = 35) or prescription (n = 32) group for a 26-week period. Contingency participants were required to ingest naltrexone under staff observation to gain access to the therapeutic workplace. Prescription participants received a take-home supply of naltrexone and could access the workplace independent of naltrexone ingestion. Primary outcome measures were percent of urine samples positive for naltrexone at 30-day assessments and negative for opiates and cocaine at 30-day assessments. Contingency participants provided significantly more urine samples that were positive for naltrexone compared with prescription participants (72% vs. 21%, p < .01); however, no effect of experimental group was observed on percent opiate-negative (71% vs. 60%, p = .19.) or cocaine-negative (56% vs. 53%, p = .82) samples in the contingency and prescription groups, respectively. Opiate-positive samples were significantly more likely to occur in conjunction with cocaine (p < .001) and when not protected by naltrexone (p < .02), independent of experimental group. Overall, these results show that contingent access to a therapeutic workplace significantly promoted adherence to oral naltrexone, and that the majority of opiate use occurred in conjunction with cocaine use, suggesting that untreated cocaine use may limit the effectiveness of oral naltrexone in promoting opiate abstinence.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, W142, Baltimore, MD 21224, USA
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Sigmon SC, Patrick ME. The use of financial incentives in promoting smoking cessation. Prev Med 2012; 55 Suppl:S24-32. [PMID: 22525802 PMCID: PMC3411852 DOI: 10.1016/j.ypmed.2012.04.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cigarette smoking is the leading cause of preventable death in the United States and world. Despite the availability of numerous therapies for smoking cessation, additional efficacious interventions are greatly needed. We provide a narrative review of published studies evaluating financial incentives for smoking cessation and discuss the parameters important for ensuring the efficacy of incentive interventions for smoking cessation. METHODS Published studies that evaluated the impact of incentives to promote smoking cessation and included an appropriate control or comparison condition were identified and reviewed. RESULTS Incentives are efficacious for promoting smoking abstinence across the general population of smokers as well as substance abusers, adolescents, patients with pulmonary disease, patients with serious mental illness and other challenging subgroups. To develop and implement an effective incentive treatment for smoking, special attention should be paid to biochemical verification of smoking status, incentive magnitude and the schedule of incentive delivery. CONCLUSION Consistent with the extensive literature showing that incentives are effective in reducing illicit drug use, a large body of evidence supports their effectiveness in reducing smoking. Continued efforts are warranted to further develop and disseminate incentive-based treatments for smoking cessation across clinical settings and populations.
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Affiliation(s)
- Stacey C Sigmon
- Department of Psychiatry, University of Vermont, University Health Center Campus, 1 S. Prospect St, Burlington, VT 05401, USA.
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Matthews LR, Harris LM, Jaworski A, Alam A, Bozdag G. Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services. Disabil Rehabil 2012; 35:460-7. [PMID: 22889352 DOI: 10.3109/09638288.2012.699583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lynda R Matthews
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Dallery J, Raiff B. Monetary-based consequences for drug abstinence: methods of implementation and some considerations about the allocation of finances in substance abusers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:20-9. [PMID: 22149758 PMCID: PMC3311913 DOI: 10.3109/00952990.2011.598592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED Conceptualizing drug abuse within the framework of behavioral theories of choice highlights the relevance of environmental variables in shifting behavior away from drug-related purchases. Choosing to use drugs results in immediate and certain consequences (e.g., drug high and relief from withdrawal), whereas choosing abstinence typically results in delayed, and often uncertain, consequences (e.g., improved health, interpersonal relationships, money). METHODS This is a selective review of the literature on Contingency management (CM). RESULTS We highlight a variety of methods to deliver CM in practical, effective, and sustainable ways. We consider a number of parameters that are critical to the success of monetary-based CM, and the role of the context in influencing CM's effects. To illustrate the broad range of applications of CM, we also review different methods for arranging contingencies to promote abstinence and other relevant behavior. Finally, we discuss some considerations about how drug-dependent individuals allocate their finances in the context of CM interventions. CONCLUSIONS Contingency management (CM) increases choice for drug abstinence via the availability of immediate, financial-based gains, contingent on objective evidence of abstinence.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, 32611, USA.
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Everly JJ, DeFulio A, Koffarnus MN, Leoutsakos JMS, Donlin WD, Aklin WM, Umbricht A, Fingerhood M, Bigelow GE, Silverman K. Employment-based reinforcement of adherence to depot naltrexone in unemployed opioid-dependent adults: a randomized controlled trial. Addiction 2011; 106:1309-18. [PMID: 21320227 PMCID: PMC3107896 DOI: 10.1111/j.1360-0443.2011.03400.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Naltrexone can be used to treat opioid dependence, but patients refuse to take it. Extended-release depot formulations may improve adherence, but long-term adherence rates to depot naltrexone are not known. This study determined long-term rates of adherence to depot naltrexone and whether employment-based reinforcement can improve adherence. DESIGN Participants who were inducted onto oral naltrexone were assigned randomly to contingency (n = 18) or prescription (n = 17) groups. Participants were offered six depot naltrexone injections and invited to work at the therapeutic workplace on week days for 26 weeks, where they earned stipends for participating in job skills training. Contingency participants were required to accept naltrexone injections to maintain workplace access and to maintain maximum pay. Prescription participants could work independently of whether they accepted injections. SETTING The therapeutic workplace, a model employment-based intervention for drug addiction and unemployment. PARTICIPANTS Opioid-dependent unemployed adults. MEASUREMENTS Depot naltrexone injections accepted and opiate-negative urine samples. FINDINGS Contingency participants accepted significantly more naltrexone injections than prescription participants (81% versus 42%), and were more likely to accept all injections (66% versus 35%). At monthly assessments (with missing urine samples imputed as positive), the groups provided similar percentages of samples negative for opiates (74% versus 62%) and for cocaine (56% versus 54%). Opiate-positive samples were more likely when samples were also positive for cocaine. CONCLUSIONS Employment-based reinforcement can maintain adherence to depot naltrexone. Future research should determine whether persistent cocaine use compromises naltrexone's effect on opiate use. Workplaces may be useful for promoting sustained adherence to depot naltrexone.
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Affiliation(s)
- Jeffrey J Everly
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Affiliation(s)
- Hendrik G Roozen
- Erasmus University Medical Centre, Department of Forensic Psychiatry, P.O. box 2040, 3000 CA Rotterdam, The Netherlands.
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French MT, Popovici I, Tapsell L. The economic costs of substance abuse treatment: updated estimates and cost bands for program assessment and reimbursement. J Subst Abuse Treat 2008; 35:462-9. [PMID: 18294803 DOI: 10.1016/j.jsat.2007.12.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 11/21/2007] [Accepted: 12/25/2007] [Indexed: 11/19/2022]
Abstract
Federal, state, and local government agencies require current and accurate cost information for publicly funded substance abuse treatment programs to guide program assessments and reimbursement decisions. The Center for Substance Abuse Treatment published a list of modality-specific cost bands for this purpose in 2002. However, the upper and lower values in these ranges are so wide that they offer little practical guidance for funding agencies. Thus, the dual purpose of this investigation was to assemble the most current and comprehensive set of economic cost estimates from the readily available literature and then use these estimates to develop updated modality-specific cost bands for more reasonable reimbursement policies. Although cost estimates were scant for some modalities, the recommended cost bands are based on the best available economic research, and we believe that these new ranges will be more useful to and pertinent for all stakeholders of publicly funded substance abuse treatment.
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Affiliation(s)
- Michael T French
- Department of Sociology, University of Miami, Coral Gables, FL 33124-2030, USA.
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