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McBrayer C, Turner A, Whitener M, Adams ZW, Hulvershorn L, Zapolski TCB, Aalsma MC. "Just as expensive as sending him to college:" barriers and perceptions of treatment in justice-involved youth. HEALTH & JUSTICE 2024; 12:33. [PMID: 39042254 PMCID: PMC11265333 DOI: 10.1186/s40352-024-00289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Justice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population. RESULTS Justice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14-17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939). Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability. CONCLUSIONS The barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.
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Affiliation(s)
- Corey McBrayer
- Adolescent Medicine, PennState Health, 905 Governor Rd Ste 200, Hershey, PA, 17033, USA.
| | - Annie Turner
- Marion University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA
| | - Mackenzie Whitener
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, Indianapolis, IN, 46202, USA
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 W 10th St, Indianapolis, IN, 46202, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 410 W 10th St, Indianapolis, IN, 46202, USA
| | - Tamika C B Zapolski
- Department of Psychiatry, Indiana University School of Medicine, 410 W 10th St, Indianapolis, IN, 46202, USA
| | - Matthew C Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, Indianapolis, IN, 46202, USA
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Allami N, O'Connor K, Bagley SM. A case of severe opioid and methamphetamine use disorder in a 14 year old. Addict Sci Clin Pract 2024; 19:54. [PMID: 39030629 PMCID: PMC11264861 DOI: 10.1186/s13722-024-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024] Open
Abstract
We present the case of a 14-year-old who established care at our primary care clinic after hospitalization for unintentional fentanyl overdose. They were diagnosed with severe opioid use disorder (OUD) and stimulant use disorder (StUD) and initiated buprenorphine while inpatient. They were then transitioned to the only known outpatient primary care clinic in her county who was actively providing medications for opioid use disorder (MOUD) in adolescents.At the first visit, they reported a history of 20 overdoses, struggling with adherence to buprenorphine and continued opioid cravings. An overdose safety plan was reviewed with them and their parent including providing them naloxone kits, fentanyl test strips, and education handout sheets. Due to their significant overdose history and adherence challenges with sublingual buprenorphine, they were started on long-acting injectable buprenorphine (LAIB) with weekly provider visits and urine toxicology screening. In collaboration with the treatment team, they initiated behavioral treatment with contingency management (CM), with incentives for appointment completion, expected urine results, and successful medication administration. Over the next 19 months, and to date, they have increasingly engaged with care and have remained abstinent. LAIB may be an appealing alternative for adolescents with OUD to improve adherence and reduce risk of recurrent use and overdose. Adjunctive treatment with CM may improve retention in MOUD and have the benefit of treating StUD. There is a need for further research to explore innovative, community-based treatment for youth with OUD.
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Affiliation(s)
- Nadia Allami
- Santa Cruz Community Health, 1510 Capitola Road, Santa Cruz, CA, 95062, USA.
| | - Kristen O'Connor
- Santa Cruz Community Health, 1510 Capitola Road, Santa Cruz, CA, 95062, USA
| | - Sarah M Bagley
- Chobanian & Avedisian School of Medicine and Boston Medical Center, 801 Mass Ave, Boston, MA, 02118, USA
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Pfund RA, Ginley MK, Boness CL, Rash CJ, Zajac K, Witkiewitz K. Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:136-150. [PMID: 38863566 PMCID: PMC11164545 DOI: 10.1037/cps0000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.
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Affiliation(s)
- Rory A. Pfund
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | | | | | - Carla J. Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00140-0. [PMID: 38537736 DOI: 10.1016/j.jaac.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE In 2014, the U.S. National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018) updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices. METHOD The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research. RESULTS Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research. CONCLUSION These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.
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Crum KI, Aloi J, Blair KS, Bashford-Largo J, Bajaj S, Zhang R, Hwang S, Schwartz A, Elowsky J, Filbey FM, Dobbertin M, Blair RJ. Latent profiles of substance use, early life stress, and attention/externalizing problems and their association with neural correlates of reinforcement learning in adolescents. Psychol Med 2023; 53:7358-7367. [PMID: 37144406 PMCID: PMC10625649 DOI: 10.1017/s0033291723000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adolescent substance use, externalizing and attention problems, and early life stress (ELS) commonly co-occur. These psychopathologies show overlapping neural dysfunction in the form of reduced recruitment of reward processing neuro-circuitries. However, it is unclear to what extent these psychopathologies show common v. different neural dysfunctions as a function of symptom profiles, as no studies have directly compared neural dysfunctions associated with each of these psychopathologies to each other. METHODS In study 1, a latent profile analysis (LPA) was conducted in a sample of 266 adolescents (aged 13-18, 41.7% female, 58.3% male) from a residential youth care facility and the surrounding community to investigate substance use, externalizing and attention problems, and ELS psychopathologies and their co-presentation. In study 2, we examined a subsample of 174 participants who completed the Passive Avoidance learning task during functional magnetic resonance imaging to examine differential and/or common reward processing neuro-circuitry dysfunctions associated with symptom profiles based on these co-presentations. RESULTS In study 1, LPA identified profiles of substance use plus rule-breaking behaviors, attention-deficit hyperactivity disorder, and ELS. In study 2, the substance use/rule-breaking profile was associated with reduced recruitment of reward processing and attentional neuro-circuitries during the Passive Avoidance task (p < 0.05, corrected for multiple comparisons). CONCLUSIONS Findings indicate that there is reduced responsivity of striato-cortical regions when receiving outcomes on an instrumental learning task within a profile of adolescents with substance use and rule-breaking behaviors. Mitigating reward processing dysfunction specifically may represent a potential intervention target for substance-use psychopathologies accompanied by rule-breaking behaviors.
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Affiliation(s)
- Kathleen I Crum
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Neuroimaging, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amanda Schwartz
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Jaimie Elowsky
- Department of Psychology, University of Nebraska - Lincoln, Lincoln, NE, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - R James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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Buono FD, Larkin K, Pham Q, De Sousa D, Zempsky WT, Lalloo C, Stinson JN. Maintaining Engagement in Adults with Neurofibromatosis Type 1 to Use the iCanCope Mobile Application (iCanCope-NF). Cancers (Basel) 2023; 15:3213. [PMID: 37370823 PMCID: PMC10296339 DOI: 10.3390/cancers15123213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Neurofibromatosis Type 1 (NF1) is an autosomal dominant genetic condition in which chronic pain is a predominant issue. Given the rarity of the disease, there are limited psychosocial treatments for individuals with NF1 suffering with chronic pain. Using mobile applications can facilitate psychosocial treatments; however, there are consistent issues with engagement. Utilizing a mixed methodology, the current study evaluated the customized iCanCope mobile application for NF1 on increasing engagement through the usage of contingency management. METHODS A mixed methods study from a subset of data coming from a randomized clinical trial that occurred from January 2021 to August 2022 was undertaken. Two groups (iCC and iCC + CM) were exposed to the customized iCanCope mobile application in which engagement data were captured in real-time with daily check-ins for interference, sleep, mood, physical activity, energy levels, goal setting, and accessing article content (coping strategies). Additionally, semi-structured interviews were conducted to gain insight into the participants' experience at the end of the trial. RESULTS Adults (N = 72) were recruited via NF patient advocacy groups. Significant differences were noted between the groups in total articles read (p = 0.002), goals achieved (p = 0.017), and goals created (p = 008). Additionally, there were significant differences observed between user-generated goals and those that were app recommended (p < 0.001). Both groups qualitatively reported positive feedback on the customized mobile application, indicating that continued usage and engagement of the mobile application were acceptable. CONCLUSIONS Employing customized mobile applications for adults with NF1 along with contingency management can leverage self-managed pain treatments while providing auxiliary resources to this population.
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Affiliation(s)
- Frank D. Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Kaitlyn Larkin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Quynh Pham
- Centre for Digital Therapeutics, University Health Network, Toronto, ON M5G 2C4, Canada; (Q.P.); (D.D.S.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
| | - Diane De Sousa
- Centre for Digital Therapeutics, University Health Network, Toronto, ON M5G 2C4, Canada; (Q.P.); (D.D.S.)
| | - William T. Zempsky
- Department of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT 06106, USA;
- Department of Pediatrics and Nursing, University of Connecticut School of Medicine, Stores, CT 06032, USA
| | - Chitra Lalloo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- The Research Institute, The Hospital of Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Jennifer N. Stinson
- The Research Institute, The Hospital of Sick Children, Toronto, ON M5G 1X8, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Hesse M, Thylstrup B, Karsberg S, Mulbjerg Pedersen M, Pedersen MU. Voucher Reinforcement Decreases Psychiatric Symptoms in Young People in Treatment for Drug Use Disorders - A Post Hoc Secondary Analysis of a Randomized Controlled Trial. J Dual Diagn 2021; 17:257-266. [PMID: 34289330 DOI: 10.1080/15504263.2021.1942379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This multicenter, parallel randomized, open study examined the effect of using vouchers and session reminders as an added element to outpatient treatment for drug use disorders in youth. It was hypothesized that being randomly assigned to a contingency management condition would lead to a reduction of psychiatric symptoms, and that this reduction would be mediated through abstinence and treatment completion. METHODS A total of 460 participants aged 15 to 25 years from nine outpatient sites were randomized to one of four treatment conditions (standard treatment alone [STD], i.e., 12 sessions using motivational interviewing and cognitive behavioral therapy, STD plus vouchers for attendance [VOU], STD plus text reminders [REM], or STD plus vouchers and text reminders [REM + VOU]). Participants' symptoms of psychological distress were assessed using the YouthMap 12 instrument at intake, and at 3, 6, and 9 months post-treatment initiation. Interviewers were blinded to interventions. RESULTS 114 participants were randomized to STD, 112 to REM, 113 to VOU, and 121 to VOU + REM. 69 clients were never interviewed for follow-up, leaving 391 for analysis (n = 90, n = 94, n = 99, n = 108). The mean age was 20.5 years (SD = 2.6), 23% were female, and 34% reported having a psychiatric diagnosis. Random effects regression showed that participants randomized to one of the two voucher-based conditions experienced significantly steeper declines in symptoms compared with STD (p < .01). Structural equation modeling results indicated that the effects of contingency management on symptoms were mediated through abstinence, but not sessions attended. CONCLUSIONS Adding contingency management to interventions for drug use disorders can reduce symptoms of psychological and emotional distress among populations of treatment-seeking youth, in part due to indirect effects through abstinence at follow-up. The data is collected from a clinical trial registered as ISRCTN27473213, at https://www.isrctn.com/.
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Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Denmark
| | | | - Sidsel Karsberg
- Centre for Alcohol and Drug Research, Aarhus University, Denmark
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Abstract
Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.
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Lay BPP, Khoo SYS. Associative processes in addiction relapse models: A review of their Pavlovian and instrumental mechanisms, history, and terminology. NEUROANATOMY AND BEHAVIOUR 2021. [DOI: 10.35430/nab.2021.e18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Animal models of relapse to drug-seeking have borrowed heavily from associative learning approaches. In studies of relapse-like behaviour, animals learn to self-administer drugs then receive a period of extinction during which they learn to inhibit the operant response. Several triggers can produce a recovery of responding which form the basis of a variety of models. These include the passage of time (spontaneous recovery), drug availability (rapid reacquisition), extinction of an alternative response (resurgence), context change (renewal), drug priming, stress, and cues (reinstatement). In most cases, the behavioural processes driving extinction and recovery in operant drug self-administration studies are similar to those in the Pavlovian and behavioural literature, such as context effects. However, reinstatement in addiction studies have several differences with Pavlovian reinstatement, which have emerged over several decades, in experimental procedures, associative mechanisms, and terminology. Interestingly, in cue-induced reinstatement, drug-paired cues that are present during acquisition are omitted during lever extinction. The unextinguished drug-paired cue may limit the model’s translational relevance to cue exposure therapy and renders its underlying associative mechanisms ambiguous. We review major behavioural theories that explain recovery phenomena, with a particular focus on cue-induced reinstatement because it is a widely used model in addiction. We argue that cue-induced reinstatement may be explained by a combination of behavioural processes, including reacquisition of conditioned reinforcement and Pavlovian to Instrumental Transfer. While there are important differences between addiction studies and the behavioural literature in terminology and procedures, it is clear that understanding associative learning processes is essential for studying relapse.
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Affiliation(s)
- Belinda Po Pyn Lay
- Center for Studies in Behavioral Neurobiology/Groupe de Recherche en Neurobiologie Comportementale, Department of Psychology, Concordia University, Montreal, Canada
| | - Shaun Yon-Seng Khoo
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Pedersen MU, Hesse M, Thylstrup B, Jones S, Pedersen MM, Frederiksen KS. Vouchers versus reminders to prevent dropout: Findings from the randomized youth drug abuse treatment project (youthDAT project). Drug Alcohol Depend 2021; 218:108363. [PMID: 33153829 DOI: 10.1016/j.drugalcdep.2020.108363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the last few decades, evidence-based treatments for emerging adults with drug use disorder (DUD) have been developed, but dropout and inconsistent session attendance persist. This study assessed the efficacy of voucher reinforcement and/or text reminders for treatment attendance and completion in emerging adults with DUD in Denmark. METHODS The study compared four levels of treatment intensity, with participants randomly assigned to standard outpatient counseling only (STD), outpatient counseling plus vouchers for attendance (VOU), outpatient counseling plus text reminders (REM), or outpatient counseling plus vouchers and text reminders (REM + VOU). A total of 460 individuals aged 15-25 years seeking treatment for DUD were randomly assigned to the four treatment conditions across nine sites. RESULTS STD counseling had the lowest completion rate (25%), followed by REM (39%), VOU (46%), and REM + VOU (49%). Additionally, post hoc comparisons indicated that clients randomized to the REM + VOU condition differed in terms of zero no-shows from clients who were randomized to the VOU condition (χ2(1) = 6.90, p = 0.009) and the REM condition (χ2(1) = 5.87, p = 0.015). CONCLUSIONS Vouchers and text reminders contribute to reduced dropout and increased treatment attendance in emerging adults with DUD. The combination of vouchers and reminders in particular has the potential to reduce the number of no-shows.
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Affiliation(s)
- Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Sheila Jones
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Michael Mulbjerg Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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