Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment

Factors associated with an increase in tobacco use and alcohol drinking during the COVID-19 pandemic: A cross-sectional study of data from 105 countries

INTRODUCTION

The COVID-19 pandemic has inevitably led to monumental challenges, and alcohol drinking and tobacco use have unlikely been spared. This cross-sectional survey reports on factors associated with an increase in alcohol drinking and tobacco use during the COVID-19 pandemic.

METHODS

An online survey conducted in 2020, generated data from 14899 adults residing in 105 countries. Dependent variables were changes in alcohol drinking and tobacco use. Independent variables were age, sex, education level, job loss, lost or reduced wages, investment/retirement benefits, interrupted substance addiction care, and income level of the countries. Multilevel logistic regression analysis was computed to explore the associations between dependent and independent variables in adjusted models using the backward stepwise method. The probability of including or excluding a covariate was set at p(in)<0.05 and p(out)>0.1, respectively.

RESULTS

Of the regular alcohol consumers (N=4401), 22.9% reported an increase in their alcohol drinking. Of the regular tobacco users (N=2718), 31% reported an increase in their tobacco use. Job loss (Alcohol: AOR=1.26; Tobacco: AOR=1.32) and lost/reduced wages (Alcohol: AOR=1.52; Tobacco: AOR=1.52) were associated with higher odds of increased alcohol drinking and tobacco use. Many interruptions to addiction care (AOR=1.75) were associated with higher odds of increased alcohol drinking. Whereas no interruption to addiction care was associated with lower odds of increased alcohol drinking (AOR=0.77). Also, none (AOR=0.66) or some (AOR=0.70) interruptions to addiction care were associated with lower odds of increased tobacco use.

CONCLUSIONS

This global survey alludes to the unintended consequences of the current COVID-19 pandemic on alcohol drinking and tobacco use. It is critical that the strategies for emergency responses should include support to ameliorate the impact of financial distress and disruption in substance dependence treatment services.

Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial

BACKGROUND

 Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population.

OBJECTIVE

 This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT.

METHODS

 Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment.

RESULTS

 Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods.

CONCLUSIONS

 This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44694.

Understanding the therapeutic factors of the initial treatment phase in a residential treatment setting: a qualitative approach

Purpose

The purpose of this study is to understand deeply the important elements of the initial phase of treatment. This is important mainly because the retention of patients at the beginning of treatment is associated with better therapeutic results.

Design/methodology/approach

The participants were 14 people suffering from addiction to drugs who attended a residential treatment program that follows the principles of therapeutic communities. The data obtained by semi-structured interview were qualitatively analyzed by interpretive phenomenological analysis.

Findings

The results showed the importance and value of the group as a therapeutic tool, highlighted the consequences of long-term substance use, optimism as the main emotion and confirmed the controversial role of social support.

Originality/value

The value of the study lies in highlighting the important therapeutic elements of the initial treatment phase through the way the patients themselves experience them. The results are discussed on the basis of the enhancement of the therapeutic interventions that are followed at this initial treatment stage.

Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery

Background: The purpose of this qualitative study was to compare and contrast the differing perspectives of service users and professionals regarding the current substance use disorders (SUD) services provided in Summit County, Ohio. Seven focus groups were conducted with 44 participants (52.3% male, mean age 46 years), including 15 individuals in recovery, 16 direct service providers, and 13 executive directors. The participants were asked about three areas: (1) effective treatment for SUD, (2) challenges for persons with SUD, and (3) suggestions for improving SUD treatment outcomes. The data were analyzed and coded according to major themes. Results: While there were numerous emergent themes that were concordant between service use and professionals, several differing themes between the groups were also identified. First, participants disagreed on the effectiveness of medication-assisted treatment/Medications for Opioid Use Disorder. Second, professionals identified trauma, stigma, "one-size-fits-all" approach to treatment, and limitations set by managed care act as barriers to treatment, whereas individuals in recovery reported difficulty dealing with feelings, feeling of being rushed into recovery, and the lack of long-term recovery plans as the most significant barriers. Lastly, in order to improve treatment outcomes, professionals emphasized the importance of education unlike individuals in recovery who identified sober supports as the most important factor. Conclusion: This study identified challenges in SUD recovery and highlights essential areas for consideration when developing and implementing SUD treatment. The findings can be used as guidelines to provide better services to individuals with SUDs.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2058706 .

The Role of Social Skills in the Prevention of Drug Addiction in Adolescents

Background:

Substance abuse has turned into a great problem in the worldwide. Considering the increased prevalence of addiction in this study, we tried to assess the role of social skills aspects in tendency to addiction among the adolescents.

Materials and Methods:

This cross-sectional study was conducted on 600 high school students studying in the Isfahan City, Iran, from 2016 to 2018. The studied population was assessed using addiction tendency questionnaire and Matson's social skills questionnaire. Data were analyzed by Statistical Package for the Social Sciences software and independent t-test, Pearson and Spearman correlation, and linear regression test.

Results:

Social behavior (P = 0.002, r = −0.124), high self-esteem (P < 0.001, r = −0.381), and peer-communication (P < 0.001, r = −0.361) were inversely associated with a tendency to addiction and were independent predictors of it (P < 0.05). Aggression was associated with increased tendency to the addiction (P = 0.01, r = 0.103) but not a predictor.

Conclusion:

We found that appropriate social behaviors, inappropriate assertiveness, and functional communication were factors associated with less tendency to substance abuse in the adolescent.

Recovery Housing: Evolving Models to Address Resident Needs

Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment-a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford House^TM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.

Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study

Background

Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized.

Methods

Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011–2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis.

Results

We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration.

Conclusions

Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.

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MSM recognize that HIV diagnosis may trigger substance use and sexual risk behaviors.

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HIV-service providers inconsistently prepared to facilitate behavior change among MSM

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Need social network-based interventions to decrease MSM's risk behaviors

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Provider training on interventions & stages of change theory to address risk behaviors warranted

Building effective service delivery mechanisms for justice-involved individuals: an under-researched area

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.

Smokers versus snorters: do treatment outcomes differ according to route of cocaine administration?

Smoking cocaine achieves maximal concentration and effect far more rapidly than through the intranasal ("snorting") route, and it is associated with greater propensity for dependence and more severe consequences. However, very little is known about differences in treatment outcome according to route of administration. This study compared treatment outcomes, such as frequency of cocaine use and Addiction Severity Index (ASI) composite scores, by primary route of cocaine administration (smoking vs. intranasal) among a pooled sample of 412 cocaine-dependent individuals participating in 1 of 5 randomized clinical trials. The majority (80%) reported smoking as their primary route of cocaine administration. Overall, results indicated better cocaine use outcomes both during the treatment phase and through a 12-month follow-up period for intranasal users compared to smokers, although not all differences reached statistical significance. Intranasal users remained in treatment longer, F(1, 408) = 3.55, p < .05, and showed a trend toward achieving longer periods of sustained abstinence within treatment, F(1, 378) = 2.68, p = .08, as well as less use over time during the follow-up period than smokers (Time × Route: t = 1.87, p = .06). Also, intranasal users' ASI cocaine composite score decreased more than smokers, but there were overall decreases in the other ASI domains for all participants over the course of the study period. These results suggest that intranasal users may achieve better cocaine use outcomes than smokers, yet this doesn't appear to translate to differential changes in the severity of problems experienced in other life areas.

Treating substance use disorders in the criminal justice system

The large number of individuals with substance use disorders involved in the nation's criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders.

The Andrews' Principles of Risk, Need, and Responsivity as Applied in Drug Abuse Treatment Programs: Meta-Analysis of Crime and Drug Use Outcomes

OBJECTIVES

The purpose of the present meta-analysis was to answer the question: Can the Andrews principles of risk, needs, and responsivity, originally developed for programs that treat offenders, be extended to programs that treat drug abusers?

METHODS

Drawing from a dataset that included 243 independent comparisons, we conducted random-effects meta-regression and ANOVA-analog meta-analyses to test the Andrews principles by averaging crime and drug use outcomes over a diverse set of programs for drug abuse problems.

RESULTS

For crime outcomes, in the meta-regressions the point estimates for each of the principles were substantial, consistent with previous studies of the Andrews principles. There was also a substantial point estimate for programs exhibiting a greater number of the principles. However, almost all of the 95% confidence intervals included the zero point. For drug use outcomes, in the meta-regressions the point estimates for each of the principles was approximately zero; however, the point estimate for programs exhibiting a greater number of the principles was somewhat positive. All of the estimates for the drug use principles had confidence intervals that included the zero point.

CONCLUSIONS

This study supports previous findings from primary research studies targeting the Andrews principles that those principles are effective in reducing crime outcomes, here in meta-analytic research focused on drug treatment programs. By contrast, programs that follow the principles appear to have very little effect on drug use outcomes. Primary research studies that experimentally test the Andrews principles in drug treatment programs are recommended.

Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: outcomes from a 24-month pilot study of the MST-Building Stronger Families program

This manuscript presents outcomes from a pilot study of Multisystemic Therapy-Building Stronger Families (MST-BSF), an integrated treatment model for the co-occurring problem of parental substance abuse and child maltreatment among families involved in the child welfare system. Participants were 25 mother-youth dyads who participated in MST-BSF and an additional 18 families with similar demographic and case characteristics who received Comprehensive Community Treatment (CCT). At post-treatment, mothers who received MST-BSF showed significant reductions in alcohol use, drug use, and depressive symptoms; they also significantly reduced their use of psychological aggression with the youth. Youth reported significantly fewer anxiety symptoms following MST-BSF treatment. Relative to families who received CCT, mothers who received MST-BSF were three times less likely to have another substantiated incident of maltreatment over a follow-up period of 24 months post-referral. The overall number of substantiated reabuse incidents in this time frame also was significantly lower among MST-BSF families, and youth who received MST-BSF spent significantly fewer days in out-of-home placements than did their CCT counterparts. These promising preliminary outcomes support the viability of a more rigorous (i.e., randomized) evaluation of the MST-BSF model.