Pretreatment social network characteristics relate to increased risk of dropout and unfavorable outcomes among women in a residential treatment setting for substance use

Social support networks of incarcerated women with opioid use disorder: Differences associated with jail-based substance use treatment

INTRODUCTION

Social support is a critical factor for women's engagement with substance use treatment and recovery, particularly for women with criminal-legal system involvement. However, less is known about the social support networks of incarcerated women, particularly as a function of service engagement. Thus, this paper aims to describe the structure, composition, and function of social support networks of women with opioid use disorder (OUD) incarcerated in jails; and compare network differences between women receiving jail-based substance use treatment and non-treatment participants.

METHODS

As part of a larger clinical trial under the NIDA-funded Justice Community Opioid Innovation Network (JCOIN), staff conducted an egocentric social network inventory with women who were randomly selected from eight jails in Kentucky, screened for OUD, and consented (N = 445). Women were asked to name people (alters) who provided them with support in the past 90 days and respond to questions about alters who were named. Bivariate comparisons examined differences in social networks among women who were currently receiving jail-based treatment (29.9 %, n = 133) and those who were incarcerated, but not receiving treatment (70.1 %, n = 312).

RESULTS

On average, women's social support networks consisted of 2.4 alters (range 1-9). Compared to women with OUD who were not receiving treatment, those in treatment were significantly more likely to name at least one alter who was in recovery (57.9 % vs. 43.9 %, p = .007) and less likely to name a partner (21.8 % vs. 37.8 %, p = .001) or someone who had recently used opioids (9.8 % vs. 24.7 %, p < .001). On average, women in treatment also felt significantly closer to their alters (4.70 vs. 4.55 out of 5, p = .021) and rated alters as fulfilling more types of social support functions (5.54 vs. 5.18 out of 6, p < .001) and recovery support functions (2.83 vs. 2.70 out of 3, p = .016).

CONCLUSION

Results suggest that women participating in jail-based substance use treatment reported more positive social support network attributes, including network function and composition. Future research should assess longitudinal changes in networks and associated differences in recovery outcomes as women are released to the community.

Risk and protective factors for early dropout from telephone monitoring for individuals with drug convictions in community mental health centers in Japan

INTRODUCTION

Individuals involved with the criminal justice system face challenges in receiving and maintaining substance use disorder (SUD) treatment and support. Although telephone monitoring (TM) could reduce these barriers, data on TM for community-dwelling individuals involved with the criminal justice system and research on individuals who drop out of TM are scarce. We examined the factors associated with dropping out early from the Voice Bridges Project, which provides TM for individuals on probation for drug-related convictions through community mental health centers in Japan.

METHODS

Participants (n = 546) were individuals aged ≥20 years with methamphetamine-related convictions who were on probation. Univariate analyses examine the associations between one-year follow-up status and baseline variables, and multivariate Cox proportional hazards regression analyses identify the risk and protective factors associated with dropping out. Stratified analyses report results based on sex and halfway-house residency.

RESULTS

The one-year dropout rate was 43.6 % (n = 238). Multivariate analysis identified two risk factors for dropping out-halfway-house residency and suicide attempts in the past year, and two protective factors-higher education and the current use of SUD services. Sex-stratified analyses showed that halfway-house residency was a risk factor for both men and women. Attempted suicide was a risk factor for women. Conversely, higher education and current use of SUD services were protective factors for men.

CONCLUSIONS

Our results identify unique risk factors for women, such as a recent history of suicide attempts, and distinctive protective factors for men, including higher education and current use of SUD services, emphasizing the importance of sex-specific approaches. Furthermore, the study reveals that irrespective of sex, vulnerable individuals, such as halfway-house residents, are at a higher risk of dropping out from TM.

The role of social connection in opioid use disorder treatment engagement

OBJECTIVE

Medications for opioid use disorder (OUD or MOUD) treatment combining pharmacotherapy with psychosocial support are effective for managing OUD. However, treatment engagement remains a challenge, with retention rates ∼30%-50%. Although social connection has been identified as important to recovery, it remains unclear whether and how social factors can bolster participation in treatment.

METHOD

Individuals receiving MOUD at three outpatient treatment programs (N = 82) and healthy community controls (N = 62) completed validated measures assessing social connection including (a) size, diversity, and embeddedness of social networks; (b) perceived social support and criticism within familial relationships; and (c) subjective social status. For those receiving MOUD, we also examined how aspects of social connection related to opioid (re)use and treatment engagement (medication adherence, group, and individual meeting attendance) assessed over ∼8 weeks/person.

RESULTS

Compared to controls, individuals receiving MOUD had smaller and less diverse and embedded social networks (Cohen's d > 0.4), and despite similar levels of perceived social support (d = 0.02), reported higher levels of social criticism (d = 0.6) and lower subjective social status (d = 0.5). Within the MOUD group, higher social network indices correlated specifically with higher therapeutic group attendance (Rs > 0.30), but not medication adherence, while higher levels of perceived criticism correlated with more frequent opioid use (R = 0.23). Results were mostly robust to control for sociodemographic variables, psychological distress/COVID-19, and treatment duration, but differed by MOUD type/program.

CONCLUSIONS

These findings highlight the potential importance of assessing an individual's social capital, promoting positive social connection, and continuing to assess the implementation and value of psychosocial support in MOUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of dropout from treatment among patients using specialized addiction treatment centers

OBJECTIVES

This study investigated the use of outpatient care, and sociodemographic and clinical characteristics of patients with substance-related disorders (SRD) to predict treatment dropout from specialized addiction treatment centers. The study also explored risks of adverse outcomes, frequent emergency department (ED) use (3+ visits/year), and death, associated with treatment dropout within the subsequent 12 months.

METHODS

The study examined a cohort of 16,179 patients who completed their last treatment episode for SRD between 2012 and 13 and 2014-15 (financial years: April 1 to March 31) in 14 specialized addiction treatment centers using Quebec (Canada) health administrative databases. We used multivariable logistic regressions to measure risk of treatment dropout (1996-96 to 2014-15), while we used survival analysis controlling for sex and age to assess the odds of frequent ED use and death in 2015-16.

RESULTS

Of the 55 % of patients reporting dropout from SRD treatment over the 3-year period, 17 % were frequent ED users, and 1 % died in the subsequent 12 months. Patients residing in the most socially deprived areas, having polysubstance-related disorders or personality disorders, and having previously dropped out from specialized addiction treatment centers had increased odds of current treatment dropout. Older patients, those with a history of homelessness, past SRD treatment, or more concurrent outpatient care outside specialized addiction treatment centers had decreased odds of treatment dropout. Patients who dropped out were subsequently at higher risk of frequent ED use and death.

CONCLUSIONS

This study highlighted that patients with more severe problems and previous dropout may need more sustained and adequate help to prevent subsequent treatment dropout. Specialized addiction treatment centers may consider enhancing their follow-up care of patients over a longer duration and better integrating their treatment with other outpatient care resources to meet the multiple needs of the more vulnerable patients using their services.

What relates to length of stay in a sober living home among women with histories of victimization and addiction? A longitudinal analysis

Despite preliminary research suggesting that length of stay in sober living homes (SLHs) is related to sustained sobriety, little research has examined factors that relate to length of stay in SLHs. The purpose of the proposed exploratory study was to prospectively examine baseline characteristics of women with histories of addiction and victimization as correlates of length of stay in a trauma-informed, gender-responsive SLH. Participants (N = 45) were surveyed three times over a 1-year period. Women were invited to participate within a week of their arrival to the SLH. Nearly two-thirds (62.2%, n = 28) of women stayed under 3 months, and 37.8% (n = 17) of women stayed over 3 months. Whereas older age and greater financial worries were associated with staying over 3 months at the SLH, other variables (e.g., demographics, mental health, recent victimization, recent substance use) were unrelated. Findings indicate that efforts may be needed to ensure that younger women as well as women with less financial worries, who may be less likely to stay for longer periods of times at SLHs, have adequate support for sobriety.

The impact of social network dynamics on engagement in drug use reduction programs among men and women who use drugs

BACKGROUND

Cross-sectional studies have shown strong relationships between social network characteristics and substance use disorder (SUD) treatment engagement. The current study examined associations between longitudinal changes in egocentric social networks of male and female people who use drugs (PWUD) and engagement in drug use reduction programs, broadly defined as either formal SUD treatment or self-help groups.

METHOD

Using data from an HIV prevention and care study in Baltimore, MD, this study categorized PWUD into those who engaged and did not engage in any drug use reduction programs over two follow-ups during a one-year observation window. The study used multivariate logistic generalized estimating equations (GEE) to examine associations between network composition and stability measures and drug use reduction program engagement, stratified by gender.

RESULTS

Of the 176 subjects participating in drug use reduction programs at baseline, 56.3% remained engaged at one year. Among both male and female respondents, higher turnover into non-kin networks was associated with increased odds of engagement in drug use reduction programs (AOR 1.4; 95% CI: 1.1-1.9, AOR 1.3; 95% CI: 1.0-1.8, respectively). For males, retention of intimate partner networks was associated with increased odds of program engagement (AOR 2.9; 95% CI: 1.1-7.6); for females, higher turnover into kin networks was associated with decreased odds of engagement (AOR 0.8; 95% CI: 0.5-1.0).

CONCLUSION

Evaluation of associations between social network characteristics and drug use reduction program engagement appears to benefit from longitudinal analyses that are stratified by gender. Efforts to improve retention in formal SUD treatment or self-help groups might consider intervening through social networks, perhaps by increasing overall levels of social support.

Examining the role of social support in treatment for co-occurring substance use disorder and posttraumatic stress disorder

Objective

Social support may be a critical mechanism in the treatment of co-occurring substance use disorder (SUD) and posttraumatic stress disorder (PTSD). However, no studies have examined how social support changes as a function of treatment or predicts treatment outcome in a Veteran population with co-occurring SUD and PTSD.

Method

The current study is a secondary analysis that examined social support over the course of treatment for co-occurring SUD and PTSD (N = 81). Analyses were conducted to examine if a) social support predicts change in substance use and PTSD symptoms, respectively, over the course of treatment and during follow-up, and b) substance use and PTSD symptoms, respectively, predicts change in social support over treatment and during follow-up.

Results

The findings revealed that between-person social support moderated decreases in substance use (B = -0.17, SE = 0.07, p = 0.017) and PTSD symptom severity (B = -0.12, SE = 0.05, p = 0.009) during treatment but not during follow-up. Within-person substance use and PTSD symptom severity predicted social support but substance use and PTSD symptoms did not moderate changes in social support during treatment or follow-up.

Conclusions

The findings highlight the critical role of social support during treatment in enhancing outcomes for individuals with co-occurring SUD and PTSD.

Irregular hospital discharge from acute inpatient and residential mental health treatment settings in a large integrated healthcare system

OBJECTIVE

Irregular discharge is a concern among mental health populations and associated with poor outcomes. Little is known about the relationship between irregular discharge and treatment setting. Because care processes differ between acute inpatient and residential settings, it is important to evaluate irregular discharge in these settings.

METHOD

A retrospective study was conducted in patients with mental health conditions admitted to acute inpatient or residential mental health settings in the Department of Veterans Affairs, 2003-2019. Logistic regression and multivariate Cox proportional hazards were used to evaluate factors associated with irregular discharge risk in the first 90- days of admission.

RESULTS

Among 1.8 million discharges, 7.4% had an irregular discharge within 90- days of admission. Younger age was a central predictor of risk. Irregular discharge rates were four-fold higher in residential versus acute settings. When accounting for length of stay (LOS) across settings, there was a modest higher risk of irregular discharge from acute versus residential settings (HR = 1.06, 95% Confidence Interval 1.04-1.07).

CONCLUSIONS

Patients are at high risk for irregular discharge from acute and residential settings when they are young. LOS is an important determinant of irregular discharge risk.. Interventions are needed to address drivers of irregular discharge.

Examination of referral source and discharge outcomes among women in residential substance use disorder treatment

BACKGROUND

Court-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear.

PURPOSE

This study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women.

METHODS

Study staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group's clinically defined treatment discharge outcomes while controlling for covariates.

RESULTS

Multinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress.

CONCLUSIONS

This study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.