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Drazdowski TK, Castedo de Martell S, Sheidow AJ, Chapman JE, McCart MR. Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch. JMIR Res Protoc 2024; 13:e60671. [PMID: 39037768 DOI: 10.2196/60671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. OBJECTIVE This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. METHODS Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. RESULTS Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. CONCLUSIONS While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study's strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. TRIAL REGISTRATION ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/60671.
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Affiliation(s)
- Tess K Drazdowski
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
| | | | - Ashli J Sheidow
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
| | - Jason E Chapman
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
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Drazdowski TK, Kelton K, Hibbard PF, McCart MR, Chapman JE, Castedo de Martell S, Sheidow AJ. Implementation outcomes from a pilot study of training probation officers to deliver contingency management for emerging adults with substance use disorders. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209450. [PMID: 38960144 DOI: 10.1016/j.josat.2024.209450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/29/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Emerging adults (EAs) in the criminal legal system are at high risk for substance use and related negative outcomes. EAs also have low levels of engagement in treatment services, a pattern exacerbated for those living in rural communities. This pilot study investigated implementation outcomes of task-shifting an evidence-based substance use intervention, via a developmentally targeted program, provided by probation officers (POs) to selected EA clients. METHODS Ten POs recruited from two counties in Oregon who provide services to rural clients were trained and supported in delivering contingency management for EAs (CM-EA) to 17 EAs on their current caseloads. The pilot took place entirely during the COVID-19 pandemic. POs submitted session audiotapes and checklists from meetings with participating EA clients and participated in focus groups. EA clients completed baseline interviews and agreed to have their adult criminal records collected. Ten semi-structured interviews were completed with probation/parole administration and staff from four rural counties across three states highly impacted by the opioid epidemic about the barriers and facilitators for delivering a program like CM-EA in their offices. RESULTS Based on self-reports and observational coding, POs demonstrated fidelity and adoption as they delivered all CM-EA components and engaged in CM-EA quality assurance protocols. Penetration was demonstrated by the selection of EAs reflecting the demographics of their local offices (i.e., White, non-Hispanic, balanced across sex), struggling with polysubstance use, and primarily holding felony convictions. Emerging themes from focus groups and interviews revealed feasibility, acceptability, and appropriateness of CM-EA, including use with clients not currently in the research program and reported intentions to continue CM-EA use. Barriers for future use include those found for the delivery of other programs in rural areas such as resource limitations. CONCLUSIONS There is initial support for the implementation outcomes related to task-shifting a program like CM-EA to POs, particularly those serving rural clients, to increase access to evidence-based substance use services for EAs. Future research with larger samples and multiple follow-ups will allow for effectiveness testing and further program refinement for this high-priority population.
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Affiliation(s)
- Tess K Drazdowski
- Oregon Social Learning Center, United States of America; Chestnut Health Systems, Lighthouse Institute, United States of America.
| | | | - Patrick F Hibbard
- Oregon Social Learning Center, United States of America; Chestnut Health Systems, Lighthouse Institute, United States of America
| | | | - Jason E Chapman
- Oregon Social Learning Center, United States of America; Chestnut Health Systems, Lighthouse Institute, United States of America
| | | | - Ashli J Sheidow
- Oregon Social Learning Center, United States of America; Chestnut Health Systems, Lighthouse Institute, United States of America
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Kane L, Baucom DH, Daughters SB. Dual-substance use disorder couples: An integrative review and proposed theoretical model. Clin Psychol Rev 2024; 111:102447. [PMID: 38781717 DOI: 10.1016/j.cpr.2024.102447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/17/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.
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Affiliation(s)
- Louisa Kane
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA.
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
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Gorman JA, Lindvig-Springborn A, Lee J, Khazanov GK, DePhilippis D. Adherence to buprenorphine-XR through hybrid telehealth contingency management procedures: a case series. JOURNAL OF SUBSTANCE USE 2024; 2024:1-6. [PMID: 39055109 PMCID: PMC11271741 DOI: 10.1080/14659891.2024.2351019] [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: 08/08/2023] [Accepted: 04/24/2024] [Indexed: 07/27/2024]
Abstract
Background and objectives Contingency management (CM) for substance use disorders (SUD) is effective in strengthening recovery behaviors, however can be quite burdensome. When health facilities experience staff shortages, adapting current CM protocols to be less staff and time intensive may be one way to address this challenge. Methods Case series (N = 3). Results Three veterans with opioid use disorder (OUD) received CM for treatment adherence through a Veteran Health Administration Outpatient Substance Disorder program. Due to the COVID-19 pandemic, traditional CM procedures resulted in limited accessibility and staff, delayed appointments, and decreased patient satisfaction. In response, the hybrid telehealth contingency management (HTCM) procedure was developed and implemented. Flexibility offered by HTCM allowed for consecutive completion of appointments and maintained adherence to BUP-XR treatment. Conclusions This is a novel method of CM implementation. HTCM streamlined the process and was successful in increasing accessibility, reducing time-burden on patients and staff, while preserving fidelity to key components of the model. Considerations for future implementation and implications of HTCM are discussed.
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Affiliation(s)
- Jay A. Gorman
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Jonathan Lee
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Gabriela K. Khazanov
- Center of Excellence for Substance Addiction Treatment & Education, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominick DePhilippis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- U.S. Department of Veteran Affairs, Office of Mental Health and Suicide Prevention, Washington, District of Columbia, USA
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Earnshaw VA, Sepucha KR, Laurenceau JP, Subramanian SV, Hill EC, Wallace J, Brousseau NM, Henderson C, Brohan E, Morrison LM, Kelly JF. Disclosing Recovery: A pilot randomized controlled trial of a patient decision aid to improve disclosure processes for people in treatment for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209291. [PMID: 38272118 PMCID: PMC11060902 DOI: 10.1016/j.josat.2024.209291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION People engaged in treatment for opioid use disorder (OUD) report struggling with whether and how to disclose, or share information about their OUD history and/or treatment with others. Yet, disclosure can act as a gateway to re-establishing social connection and support during recovery. The current study describes a pilot randomized controlled trial of Disclosing Recovery: A Decision Aid and Toolkit, a patient decision aid designed to facilitate disclosure decisions and build disclosure skills. METHODS Participants (n = 50) were recruited from a community-based behavioral health organization in 2021-2022 and randomized to receive the Disclosing Recovery intervention versus an attention-control comparator. They responded to surveys immediately after receiving the intervention as well as one month following the intervention at a follow-up appointment. Primary outcome analyses examined indicators of implementation of the intervention to inform a future efficacy trial. Secondary outcome analyses explored impacts of the intervention on the decision-making process, disclosure rates, and relationships. RESULTS Participants were successfully recruited, randomized, and retained, increasing confidence in the feasibility of future efficacy trials to test the Disclosing Recovery intervention. Moreover, participants in the Disclosing Recovery intervention agreed that the intervention is acceptable, feasible, and appropriate. They additionally reported a higher quality of their decision-making process and decisions than participants in the comparator condition. At their follow-up appointment, participants with illicit opioid use who received the Disclosing Recovery intervention were less likely to disclose than those who received the comparator condition. Moreover, significant interactions between illicit opioid use and the intervention condition indicated that participants without illicit opioid use who received the Disclosing Recovery intervention reported greater closeness to and social support from their planned disclosure recipient than those who received the comparator condition. CONCLUSIONS The Disclosing Recovery intervention appears to be an acceptable, feasible, and appropriate patient decision aid for addressing disclosure processes among people in treatment for OUD. Moreover, preliminary results suggest that it shows promise in improving relationship closeness and social support in patients without illicit opioid use. More testing is merited to determine the intervention's efficacy and effectiveness in improving relationship and treatment outcomes for people in treatment for OUD.
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Affiliation(s)
- Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE 19716, USA.
| | - Karen R Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, 100 Cambridge St, Suite 1600, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Jean-Philippe Laurenceau
- Department of Psychological and Brain Sciences, University of Delaware, 231 Wolf Hall, Newark, DE 19716, USA.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - E Carly Hill
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE 19716, USA; Center for Research on Education and Social Policy, University of Delaware, 125 Academy Street, Newark, DE 19716, USA.
| | - James Wallace
- Center for Research on Education and Social Policy, University of Delaware, 125 Academy Street, Newark, DE 19716, USA; Department of Epidemiology, University of Delaware, 100 Discovery Blvd, Newark, DE 19716, USA.
| | - Natalie M Brousseau
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Rd, Piscataway, NJ 08854-8020, USA.
| | - Claire Henderson
- Health Services and Population Research Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom of Great Britain and Northern Ireland.
| | - Elaine Brohan
- Health Services and Population Research Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom of Great Britain and Northern Ireland.
| | - Lynn M Morrison
- Brandywine Counseling and Community Services, 2713 Lancaster Avenue, Wilmington, DE 19805, USA.
| | - John F Kelly
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac St, 6th Floor, Boston, MA 02114, USA.
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Goker Z. Religion would be a missing link in the case formulation of adolescents with conduct problems: an eclectic approach. Front Psychiatry 2024; 15:1348799. [PMID: 38711870 PMCID: PMC11070571 DOI: 10.3389/fpsyt.2024.1348799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Psychiatry is concerned with mental health. Cognition is one of the key mental functions and manifests itself primarily as behavior. A behavior exhibited in response to a stimulus is influenced by biological (inherited), psychological (individual), and social (environmental) factors. During consolidation of an exhibited behavior, the factors affecting the individual's cognitive structure and personality play crucial roles. Underlying factors for a problematic behavior, and their weakness/strength levels are determined via the Biopsychosocial model. Empirically effective current practices to intervene the problematic behaviors do not always result in success. One of the reasons may be other elements that were omitted during the case formulation process. This article aims to stress the idea that whatever the underlying factor of a problematic behavior is, the most crucial determinant and/or pre-emptive factor in developing or maintaining that behavior might actually be the religion as a governing and directive philosophy on how to conduct oneself. In this instance, the key is in the hands of the parents or caregivers.
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Liddle HA, Dakof G, Rowe C, Mohamed AB, Henderson C, Foulkrod T, Lucas M, DiFrancesco M. Multidimensional Family Therapy for Justice-Involved Young Adults with Substance Use Disorders. J Behav Health Serv Res 2024; 51:250-263. [PMID: 37532966 PMCID: PMC10940488 DOI: 10.1007/s11414-023-09852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
The present study explored the acceptability, feasibility, fidelity, and outcomes of a young adult adaptation of multidimensional family therapy (MDFT), an evidence-based family treatment originally developed for adolescents. Participants included 22 individuals between the ages of 19 to 25 who were enrolled in a criminal drug court program. MDFT was found to be feasible and was delivered with strong fidelity to young adults and their families. Participants reported high satisfaction with MDFT, and 95% completed treatment. Analyses revealed statistically significant decreases in substance use on all indicators from baseline to the 6-month follow-up. Significant improvements were also noted in vocational functioning, including a 73% increase in full-time employment from baseline to 6-month follow-up. Criminal justice outcomes included a significant decrease in legal risk, and 86% of study participants had no rearrests from baseline through the 18-month follow-up period. The article concludes with recommendations for implementing family-based interventions with young adults, as well as future research directions in this important area.
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Affiliation(s)
| | - Gayle Dakof
- University of Miami Miller School of Medicine, Miami, USA.
| | - Cynthia Rowe
- University of Miami Miller School of Medicine, Miami, USA
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Norona JC, Borsari B, Yalch MM, Baxley C, Gnys M, DeMarce JM. The Impact of Cognitive Behavioral Therapy for Substance Use Disorders on Veterans' Interpersonal Difficulties. Subst Use Misuse 2024; 59:510-519. [PMID: 38037842 DOI: 10.1080/10826084.2023.2287192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background: Substance use disorders (SUDs) negatively impact veterans and their relationships with others. Although there are several evidence-based treatments for SUD symptoms, there is less research on whether reduction in SUD symptoms coincides with reduction in interpersonal difficulties. Methods: In this study we examined the relationship between SUD and relationships in a national sample of 458 veterans who received approximately 12 sessions of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) through the Veterans Health Administration (VHA). Results: Parallel latent growth curve modeling (LGCM) indicated that self-reported alcohol use, drug use, and interpersonal difficulties decreased over the course of treatment. Alcohol and drug use were positively associated with each other and with interpersonal difficulties at each time point, and baseline alcohol and drug use were negatively associated with the reduction of use over time. However, there was little evidence that reductions in substance use led to a reduction in interpersonal difficulties (or vice-versa). Conclusions: Findings highlight promising strategies to further understand how CBT-SUD may enhance reductions in substance use as well as improve relationships with family and friends.
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Affiliation(s)
- Jerika C Norona
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Brian Borsari
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Catherine Baxley
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Maryann Gnys
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia, USA
- VISN 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Mental Health Center, Durham, North Carolina, USA
| | - Josephine M DeMarce
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia, USA
- VISN 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Mental Health Center, Durham, North Carolina, USA
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Buchholz C, Bell LA, Adatia S, Bagley SM, Wilens TE, Nurani A, Hadland SE. Medications for Opioid Use Disorder for Youth: Patient, Caregiver, and Clinician Perspectives. J Adolesc Health 2024; 74:320-326. [PMID: 37815763 PMCID: PMC10842045 DOI: 10.1016/j.jadohealth.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Clinical trial data support use of medications for opioid use disorder (MOUD) in adolescents and young adults ("youth"), but qualitative data are lacking on the acceptability and importance of MOUD to youth, caregivers, and clinicians. We assessed how these stakeholders viewed the role of MOUD in treatment and recovery. METHODS We recruited youth aged from 15 to 25 years with opioid use disorder who had received buprenorphine, naltrexone, or methadone and caregivers from a primary care-based youth addiction treatment program. We also recruited clinicians with addiction expertise from social work, nursing, pediatrics, internal medicine, and psychiatry. We conducted semistructured interviews assessing special considerations for MOUD use in youth. Three coders performed inductive and deductive thematic analysis of transcripts. RESULTS Among 37 participants, including 15 youth (age range, 17-25 years), nine caregivers, and 13 clinicians, we identified three themes. (1) Medications support recovery in the short term: Youth described MOUD as beneficial in managing withdrawal symptoms. Notably, some youth and caregivers preferred to limit MOUD duration. (2) Medication adherence is affected by type of medication, dosing regimen, and route of administration. Participants endorsed long-acting, injectable MOUD for ease of use and youth's ability to continue engagement in "normal activities" without daily medication. (3) Caregiver involvement can support medication decisions and adherence. Youth and some clinicians described the need to assess caregiver involvement before incorporating them into treatment; caregivers and other clinicians described caregivers as critical in supporting accountability. DISCUSSION MOUD is evidence-based, and its provision should be developmentally responsive and youth- and family-centered, incorporating caregivers when appropriate.
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Affiliation(s)
- Connor Buchholz
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lauren A Bell
- Department of Pediatrics-Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Safina Adatia
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah M Bagley
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Timothy E Wilens
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alykhan Nurani
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Allan J, Snowdon N, Thapa S, Ahmed KY. Study protocol for the family empowerment program: a randomized waitlist-controlled trial to evaluate the effectiveness of online Community Reinforcement and Family Training (CRAFT) on the wellbeing of family members with a relative experiencing substance dependence and mental illness. BMC Psychiatry 2024; 24:43. [PMID: 38200508 PMCID: PMC10782775 DOI: 10.1186/s12888-023-05487-0] [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] [Received: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Systematic reviews consistently show that family-focused interventions are effective at improving substance treatment engagement and outcomes across the lifespan. Yet, Australian substance use treatment services rarely incorporate family members and concerned significant others. Testing of family focussed interventions in the Australian context is required. METHODS The trial is a randomized wait-list control trial assessing the effectiveness, feasibility and acceptability of online CRAFT with a parallel group. Participants will be randomised to receive either online CRAFT or to a wait-list control group who are provided with CRAFT related reading material during the waiting period. Outcomes will be assessed at baseline and then at 6- and 15-weeks post baseline. The primary outcome will be improved wellbeing of participating family members. The trial reporting will comply with SPIRIT guidelines. DISCUSSION This study will focus on people living in rural areas. Substance treatment programs are limited in rural Australia. The provision of the Family Empowerment Program (CRAFT) online should make family focused substance treatment support accessible and attainable for the first time in rural areas. The outcomes of this trial could have meaningful implications for the future funding and support of family focused substance treatment services that are inclusive of people with mental health conditions. TRIAL REGISTRATION ANZCTR, ACTRN12623000796684p, Registered 26 July 2023. Prospectively registered with protocol version 3.
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Affiliation(s)
- Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia.
| | - Nicole Snowdon
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
| | - Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
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McCrady BS, Tonigan JS, Fink BC, Chávez R, Martinez AD, Borders A, Fokas K, Epstein EE. A randomized pilot trial of brief family-involved treatment for alcohol use disorder: Treatment engagement and outcomes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:853-862. [PMID: 36931829 PMCID: PMC10504405 DOI: 10.1037/adb0000912] [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: 03/18/2023]
Abstract
OBJECTIVE Involving family members in a patient's treatment for alcohol use disorder (AUD) leads to more positive outcomes, but evidence-based family-involved treatments have not been adopted widely in AUD treatment programs. Study aims the following: (a) modify an empirically supported 12-session AUD treatment, alcohol behavioral couple therapy (ABCT) to make it shorter and appropriate for any concerned family member and (b) conduct a small clinical trial to obtain feasibility data and effect size estimates of treatment efficacy. METHOD ABCT content was adapted to three-sessions following input from clinicians, patients, and family members. Patient and family member dyads were recruited from an inpatient treatment program and randomized to the new treatment, brief family-involved treatment (B-FIT), or treatment-as-usual (TAU). Drinking was assessed using the Form-90; family support and family functioning were assessed using the Family Environment Scale Conflict and Cohesion subscales and the Family Adaptability and Cohesion Evaluation Scale-IV, Communication scale. Dyads (n = 35) were assessed at baseline and 4-month follow-up. RESULTS On average, dyads received one of three B-FIT sessions with 6 dyads receiving no sessions due to scheduling conflicts or patient discharge. At follow-up, there was a large-to-medium effect size estimate favoring B-FIT for proportion drinking days (patient report, n = 22; Hedges' g = 1.01; patient or family report, n = 28; Hedges' g = .48). Results for family support or family functioning measures favored TAU. CONCLUSIONS Implementation of brief family-involved treatment in inpatient AUD treatment was challenging, but preliminary data suggest the potential value of B-FIT in impacting drinking outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Brandi C. Fink
- University of New Mexico
- University of Oklahoma Health Sciences Center, Department of Psychiatry and Behavioral Sciences, 920 Stanton L. Young Boulevard, G. Rainey Williams Pavilion, Third Floor, Oklahoma City, OK 73104
| | | | | | | | - Kathryn Fokas
- University of New Mexico
- Independent practice, Los Angeles
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Eriksen JW, Fiskaali A, Zachariae R, Wellnitz KB, Oernboel E, Stenbro AW, Marcussen T, Petersen MW. Psychological intervention for gambling disorder: A systematic review and meta-analysis. J Behav Addict 2023; 12:613-630. [PMID: 37450372 PMCID: PMC10562823 DOI: 10.1556/2006.2023.00034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background and aims Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to best treat gambling disorder (GD) remains important. Our aim was to review systematically and quantitatively synthesize the available evidence on psychological intervention for GD. Methods Records were identified through searches for randomized controlled trials (RCTs) evaluating psychological intervention for GD via six academic databases without date restrictions until February 3, 2023. Study quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Primary outcomes were GD symptom severity and remission of GD, summarized as Hedges' g and odds ratios, respectively. The study was preregistered in PROSPERO (#CRD42021284550). Results Of 5,541 records, 29 RCTs (3,083 participants analyzed) were included for meta-analysis of the primary outcomes. The efficacy of psychological intervention across modality, format and mode of delivery corresponded to a medium effect on gambling severity (g = -0.71) and a small effect on remission (OR = 0.47). Generally, risk of bias was high, particularly amongst early face-to-face interventions studies. Discussion and conclusions The results indicate that psychological intervention is efficacious in treating GD, with face-to-face delivered intervention producing the largest effects and with strongest evidence for cognitive behavioral therapy. Much remains to be known about the long-term effects, and investigating a broader range of treatment modalities and digital interventions is a priority if we are to improve clinical practice for this heterogeneous patient group.
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Affiliation(s)
- Jakob W. Eriksen
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Anne Fiskaali
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Science, Aarhus University, Denmark
- Department of Oncology, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Denmark
| | - Kaare B. Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Eva Oernboel
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Anna W. Stenbro
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Thomas Marcussen
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Marie W. Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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Hogue A, Bobek M, MacLean A, Schumm JA, Wenzel K, Fishman M. Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders. HSOA JOURNAL OF ADDICTION & ADDICTIVE DISORDERS 2023; 10:144. [PMID: 38707487 PMCID: PMC11068080 DOI: 10.24966/aad-7276/100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.
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Affiliation(s)
| | | | | | - Jeremiah A Schumm
- OneFifteen, Inc./Samaritan Behavioral Health, Inc., Wright
State University, Dayton, USA
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Timko C, Cucciare MA, Lor MC, Stein M, Vest N. Patient-Concerned Other Dyads' 12-Step Involvement and Patients' Substance Use: A Latent Class Growth Model Analysis. J Stud Alcohol Drugs 2023; 84:762-771. [PMID: 37219032 PMCID: PMC10600972 DOI: 10.15288/jsad.22-00378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE This study aimed to inform clinical practice by identifying subgroups of patient-concerned other (CO) dyads. Patients with alcohol use disorders (AUDs) were characterized on Alcoholics Anonymous (AA) involvement and substance use together with COs' Al-Anon involvement. Predictors and recovery maintenance outcomes of subgroup membership were examined. METHOD Participants were 279 patient-CO dyads. Patients were in residential treatment for AUD. Parallel latent class growth model analysis characterized 12-step involvement and substance use at treatment entry and 3-, 6-, and 12-month follow-ups. RESULTS Three classes were as follows: 38% Low AA/Low Al-Anon (patients' low AA and COs' low Al-Anon involvement, and patients' high-to-moderate substance use), 10% High AA/High Al-Anon (patients' high AA and COs' high Al-Anon involvement, and patients' moderate-to-low substance use), and 52% High AA/Low Al-Anon (patients' high AA and COs' low Al-Anon involvement, and patients' moderate-to-low substance use). At follow-up, the Low AA/Low Al-Anon classes' patients were less likely to have spirituality as recovery support, confidence about staying abstinent, and satisfaction with recovery progress. The High AA classes' COs had less concern about patients' drinking and scored higher on positive aspects of relationships with patients. CONCLUSIONS Clinicians should encourage patients' and COs' 12-step group involvement (12-step practices' engagement). Among patients treated for AUD, AA involvement was related to better outcomes, and to COs' lessened concern about the patients' drinking. COs' Al-Anon involvement was associated with having a more positive view of their relationship with the patient. That more than one third of dyads had low 12-step group involvement suggests that treatment programs may need to facilitate involvement in non-12-step mutual-help groups.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Michael A. Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, California
| | - Michael Stein
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
| | - Noel Vest
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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15
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Ingesson Hammarberg S, Sundbye J, Tingvall R, Hammarberg A, Nehlin C. A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting. Addict Sci Clin Pract 2023; 18:44. [PMID: 37475039 PMCID: PMC10357895 DOI: 10.1186/s13722-023-00398-7] [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] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD. METHODS Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis. RESULTS Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session. CONCLUSIONS Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions. TRIAL REGISTRATION The current trial was retrospectively registered at isrtcn.com (14539251).
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden.
| | - Jennie Sundbye
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden
| | - Rebecca Tingvall
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden
| | - Christina Nehlin
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Urmanche AA, Harocopos A. Experiences Administering Naloxone Among People in Different Social Roles: People Who Use Opioids and Family Members and Friends. JOURNAL OF DRUG ISSUES 2023; 53:475-489. [PMID: 37829614 PMCID: PMC10569559 DOI: 10.1177/00220426221133024] [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] [Indexed: 10/14/2023]
Abstract
Unintentional drug overdose deaths continue to be a critical public health issue. Naloxone, a nonscheduled, safe, and effective drug that reverses opioid-involved overdoses is available to non-medically trained individuals ("lay people"), but there is scant information about how people in different social roles experience naloxone administration. We conducted 24 in-depth interviews with people who use opioids (PWUO; n = 15) and family members and friends of people who use opioids (FF; n = 9) who had administered naloxone in response to an opioid overdose. Compared with PWUO, members of the FF group were less reticent to administer naloxone in response to an overdose. PWUO and FF had different perspectives of law enforcement and demonstrated varied knowledge of the Good Samaritan Law. While PWUO found that having and administering naloxone was empowering, FF took a more pragmatic approach, reporting the need for naloxone as an unfortunate reality of their loved one's drug use.
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Affiliation(s)
- Adelya A Urmanche
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NY, USA
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Dellazizzo L, Potvin S, Giguère S, Landry C, Léveillé N, Dumais A. Meta-review on the efficacy of psychological therapies for the treatment of substance use disorders. Psychiatry Res 2023; 326:115318. [PMID: 37356250 DOI: 10.1016/j.psychres.2023.115318] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
This meta-review aimed to summarize the current state of knowledge provided by meta-analyzes on the efficacy of psychotherapies for substance use disorders. A systematic search was performed in PubMed, PsycINFO, Web of Science and Google Scholar. Meta-analyzes were included if they quantitatively examined the efficacy of a psychotherapy on substance use. Among the 6866 potential articles that were screened for eligibility, 23 meta-analyzes were eligible (78 effect sizes). Each meta-analysis included 2-156 studies, with samples ranging between approximately 130 to over 33,000 individuals. The quality of evidence was evaluated as being globally of low to moderate quality. Substances were categorized as: alcohol (k = 12), cannabis (k = 7), stimulants (k = 4), opioids (k = 3) and benzodiazepines (k = 1). Interventions comprised brief intervention, cognitive-behavioral therapy, contingency management, voucher-based reinforcement therapy, motivational interview, motivational enhancement therapy, significant other people involved in the treatment, and cue-expose therapy. Concerning solely significant results, small benefits were observed for significant other people involved in treatment, motivational interviewing, and the combination of cognitive-behavioral therapy with motivational interviewing for alcohol use disorder. Likewise, small-to-moderate effects were found for motivational approaches, and cognitive-behavioral therapy as well as the combination of cognitive-behavioral therapy and motivational enhancement therapy in the case of cannabis use disorder. Small effects were observed for contingency management as well as cognitive behavioral-therapy for amphetamine-type use disorder. Small effects were similarly found for contingency management for cocaine use disorder. Concerning opioid use disorder, moderate effects were observed for contingency management and voucher-based reinforcement intervention. For benzodiazepine use disorder, small effects were noted for cognitive-behavioral therapy with taper. Results often displayed small to moderate heterogeneity when reported and were generally compared to inactive controls, such as treatment-as-usual. In all, the psychosocial treatments for substance use disorders included in this meta-review have shown to be at best moderately effective over inactive controls in the short term. Nevertheless, further trials are needed as well as meta-analyzes on interventions not included in this meta-review.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Clara Landry
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nayla Léveillé
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada.
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18
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Porter NP, Hogue A, Bobek M, Henderson CE. Caregiver Engagement in Outpatient Treatment for Adolescents in Community Settings: Construct and Predictive Validity of Family Therapy Techniques. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01272-z. [PMID: 37178423 DOI: 10.1007/s10488-023-01272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Caregiver engagement and participation in community-based outpatient treatment services for adolescents is generally poor, which is problematic given the integral role of caregivers prescribed by evidence-based treatments across orientations. The current study explores the psychometric and predictive properties of a set of caregiver engagement techniques distilled from family therapy, used by community clinicians in routine care. It highlights relational engagement interventions and adds to growing work distilling core elements of family therapy. The study examined caregiver engagement techniques observed in 320 recorded sessions and outcome data from 152 cases treated by 45 therapists participating in one of three randomized trials investigating delivery of family therapy for adolescent behavior problems in community settings. Construct and predictive validity of caregiver engagement coding items were analyzed to understand the degree to which they cohered as a single factor and predicted outcomes in predictable ways. Results demonstrated item reliability and construct validity of a Caregiver Engagement Techniques factor. Greater use of these techniques was associated with decreased adolescent substance use. Unexpected results suggested greater use of techniques was associated with worsening internalizing symptoms and family cohesion per youth-report only. Post-hoc analyses revealed additional complexities in the association between engagement techniques and outcomes. Caregiver engagement practices tested in the current study represent a unified treatment factor that may contribute to positive therapeutic outcomes for adolescents in some clinical domains. Further research is needed to understand predictive effects.
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Affiliation(s)
- Nicole P Porter
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA.
- McLean Hospital and Department of Psychiatry, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
| | - Aaron Hogue
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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19
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Esteban J, Suárez-Relinque C, Jiménez TI. Effects of family therapy for substance abuse: A systematic review of recent research. FAMILY PROCESS 2023; 62:49-73. [PMID: 36564902 DOI: 10.1111/famp.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.
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Affiliation(s)
- Jessica Esteban
- Facultad de Ciencias Sociales y Humanas, Campus de Teruel, Universidad de Zaragoza, Teruel, Spain
| | | | - Teresa I Jiménez
- Facultad de Ciencias Sociales y Humanas, Campus de Teruel, Universidad de Zaragoza, Teruel, Spain
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20
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Lee BK, Ofori Dei SM, Brown MMR, Awosoga OA, Shi Y, Greenshaw AJ. Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial. FAMILY PROCESS 2023; 62:124-159. [PMID: 36217243 DOI: 10.1111/famp.12813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Abstract
A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes-alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes-emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74-1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27-1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14-0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14-0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16-0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.
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Affiliation(s)
- Bonnie K Lee
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Samuel M Ofori Dei
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Matthew M R Brown
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Olu A Awosoga
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Yanjun Shi
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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21
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Clifford B, Van Gordon K, Magee F, Malone V, Siefried KJ, Graham D, Ezard N. "There's a big tag on my head": exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Serv Res 2023; 23:162. [PMID: 36793060 PMCID: PMC9933255 DOI: 10.1186/s12913-023-09125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment. METHODS We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software. RESULTS Three themes were developed from participants' responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. CONCLUSION Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.
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Affiliation(s)
- Brendan Clifford
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia. .,National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia. .,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia.
| | - Kate Van Gordon
- Victor Medical Centre, Victor Harbor, South Australia Australia
| | - Fiona Magee
- grid.477714.60000 0004 0587 919XSouth Eastern Sydney Local Health District, Sydney, New South Wales Australia
| | - Victoria Malone
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia
| | - Krista J. Siefried
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Duncan Graham
- grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia
| | - Nadine Ezard
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
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Hogue A, Bobek M, Porter N, MacLean A, Wenzel K, Fishman M, Coatsworth JD, Langer DA. Launching Relationship-Oriented Behavioral Services for Youth Opioid Use Disorder: Innovations in Medication Decision-Making and Adherence Planning. CHILD & FAMILY BEHAVIOR THERAPY 2023; 45:199-225. [PMID: 37767113 PMCID: PMC10531035 DOI: 10.1080/07317107.2023.2172704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 09/29/2023]
Abstract
This article presents behavioral interventions designed to enhance uptake and retention on medication for opioid use disorder (MOUD) among transition-age youth (16-25 years) enrolled in treatment services. The article describes three relationship-oriented interventions designed to address barriers to MOUD uptake, enhance MOUD adherence planning, and strengthen OUD recovery among youth: Relational Orientation; Medication Education and Decision-making Support, and Family Leadership and Ownership of Adherence to Treatment. These interventions are inter-connected can be delivered flexibly. The article concludes with three case examples that illustrate how these modular interventions can be tailored to meet the needs of diverse client profiles.
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Affiliation(s)
- Aaron Hogue
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Molly Bobek
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Nicole Porter
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Alexandra MacLean
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Kevin Wenzel
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - Marc Fishman
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - J. Douglas Coatsworth
- Knoxville Boyd Center for Business and Economic Research, Social Work, University of Tennessee, Knoxville, Tennessee, USA
| | - David. A. Langer
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
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Bel-Bahar TS, Khan AA, Shaik RB, Parvaz MA. A scoping review of electroencephalographic (EEG) markers for tracking neurophysiological changes and predicting outcomes in substance use disorder treatment. Front Hum Neurosci 2022; 16:995534. [PMID: 36325430 PMCID: PMC9619053 DOI: 10.3389/fnhum.2022.995534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD.
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Affiliation(s)
- Tarik S. Bel-Bahar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anam A. Khan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Riaz B. Shaik
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Muhammad A. Parvaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Olashore AA, Paruk S, Maphorisa T, Mosupiemang B. Pattern of substance use and substance use disorder in adolescent learners at public secondary schools in Gaborone, Botswana. PLoS One 2022; 17:e0268961. [PMID: 36084095 PMCID: PMC9462716 DOI: 10.1371/journal.pone.0268961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Substance use amongst adolescents remains a global public health challenge. The potential negative health outcomes of substance use suggest the need to understand the pattern of use and the associated factors among adolescents. This study aimed to describe the prevalence of substance use, SUDs, and PD and the associated factors in adolescent learners at public schools in Gaborone, Botswana.
Methods
A cross-sectional study was conducted at 13 public secondary schools in Gaborone among 742 students. Assessment tools included the World Health Organization drug questionnaire, DSM-5 interview for SUD, and the General Health Questionnaire-12.
Results
The mean age (SD) of the participants was 15.26 (1.57) years, and there were more females (55.5%). Over two-fifths (44.6%) of learners reported psychoactive substance use in the past 12 months, and 31.5% meeting DSM 5 criteria for a SUD. Alcohol was the most used psychoactive substance (25.1%). Male gender (AOR = 1.94; 95% CI: 1.26–2.995), having a friend (AOR = 4.27; 95% CI: 2.68–6.78), or father (AOR = 1.87; 95% CI: 1.14–3.04), who uses substance, and higher levels of PD (AOR = 1.09; 95% CI: 1.03–1.17) remained significantly associated with SUD. Regular participation in religious activities negatively correlated with SUD (AOR = 0.61; 95% CI: 0.38–0.96).
Conclusion
The high prevalence of substance use and SUDs among in-school adolescents is concerning. Substance use programs need to include family-focused and religious-based therapy and youth empowerment in developing positive peer relationships. Also, they should be integrated with mental health screening to assess comorbid PD.
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Affiliation(s)
- Anthony A. Olashore
- Faculty of Medicine, Department of Psychiatry, University of Botswana, Gaborone, Botswana
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Saeeda Paruk
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Taboka Maphorisa
- Faculty of Medicine, Department of Psychiatry, University of Botswana, Gaborone, Botswana
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Schumm JA, Renno S. Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice. FAMILY PROCESS 2022; 61:25-42. [PMID: 33904595 DOI: 10.1111/famp.12659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.
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Affiliation(s)
- Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, OH, USA
- Samaritan Behavioral Health, Inc., Dayton, OH, USA
- OneFifteen, Inc., Dayton, OH, USA
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Mutschler C, Malivoire BL, Schumm JA, Monson CM. Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature. Behav Cogn Psychother 2022; 50:1-22. [PMID: 35190008 DOI: 10.1017/s1352465822000042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT. AIMS The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment. METHOD A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators. RESULTS The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender. CONCLUSIONS The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.
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Affiliation(s)
| | | | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, OH, USA
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Schumm JA, O’Farrell TJ. A comparison of psychosocial adjustment among children of women who received behavioral couples therapy versus individually based therapy for substance use disorder. J Subst Abuse Treat 2022; 133:108560. [PMID: 34246515 PMCID: PMC8733047 DOI: 10.1016/j.jsat.2021.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Children of women with substance use disorder (SUD) exhibit elevated risk for psychosocial adjustment problems. However, little research has examined whether women's SUD treatment is beneficial for their children. In comparison to individually based therapy (IBT), behavioral couples therapy (BCT) is superior for reducing women's SUD problems and improving their intimate partner relationships. The current study sought to examine whether BCT is more efficacious than 12-step-oriented IBT for reducing psychosocial adjustment problems among the children of women with SUD. METHODS The study obtained the data from two larger randomized clinical trials, both of which compared BCT plus IBT versus IBT alone for women with SUD. Participants were women (N = 75) and their male partners who had an identified target child between the ages of 6 and 16 years old (M = 10.63). Most (62%) were the biological child of both partners, and 92% lived with the couple. Both partners completed the Child Behavior Checklist (CBCL) in relation to the target child at baseline, post-treatment, and 6-month follow-up. RESULTS Comparisons of CBCL scores from baseline to following treatment mostly showed significant improvement in BCT + IBT but not IBT. Generalized estimating equations, which controlled for baseline CBCL, showed better retainment of treatment gains for mother-reported internalizing CBCL scores in BCT + IBT, but the study found no other between treatment differences. CONCLUSION These findings suggest that BCT + IBT produces more consistent improvements for children of women with SUD versus IBT.
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Affiliation(s)
- Jeremiah A. Schumm
- School of Professional Psychology, Wright State University,Samaritan Behavioral Health, Inc.,OneFifteen, Inc
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Sang J, Patton RA, Park I. Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery. Subst Use Misuse 2022; 57:983-994. [PMID: 35373710 DOI: 10.1080/10826084.2022.2058706] [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: 10/18/2022]
Abstract
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 .
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Affiliation(s)
- Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Rikki A Patton
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Insun Park
- Department of Criminal Justice, The University of Akron, Akron, OH, USA
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Hogue A, Schumm JA, MacLean A, Bobek M. Couple and family therapy for substance use disorders: Evidence-based update 2010-2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:178-203. [PMID: 34435387 DOI: 10.1111/jmft.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/24/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13 studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, Suite, New York, USA
| | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University and OneFifteen, Inc./Samaritan Behavioral Health, Inc., Dayton, Ohio, USA
| | | | - Molly Bobek
- Partnership to End Addiction, Suite, New York, USA
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Timko C, Rossi FS, Grant KM, Lor MC, Cucciare MA. Concerned others' help utilization and patients' alcohol treatment outcomes. Drug Alcohol Depend 2021; 228:108983. [PMID: 34507007 PMCID: PMC8595707 DOI: 10.1016/j.drugalcdep.2021.108983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study of dyads composed of patients in treatment for alcohol use disorders (AUDs) and their Concerned Others (COs) examined (1) COs' attendance at three types of help (educational sessions, treatment sessions with the patient, and treatment sessions without the patient) during a 3-month period after patients' admission, and (2) whether COs' use of help was associated with better treatment outcomes reported by COs about patients, and patients about themselves. METHODS Dyads (n = 277) were assessed when patients entered AUD treatment and 3 months later (80 %). COs rated their patient's AUD, and patients rated their own AUD, on the Brief Addiction Monitor. At 3-month follow-up, COs answered three items about help (education, treatment with patient, treatment without patient) from their patient's treatment program. Main analyses were analyses of covariance to examine associations between COs' help use and patients' outcomes. RESULTS At 3-month follow-up, COs who had obtained one type of help were significantly more likely to have also obtained the other two types of help. However, relatively few COs (39 %) obtained any type of help. COs who obtained help rated their patient as having more protection against future substance use. And, when COs had obtained help, patients rated themselves as having less risk of future substance use, and had attended a greater number of AA meetings, than when COs had not obtained help. CONCLUSIONS Findings suggest that COs' use of help can benefit patients in AUD treatment. Clinicians and researchers should increase the availability and use of help among COs.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Fernanda S Rossi
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Kathleen M Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, 68105, USA; Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Streets, Omaha, NE, 68198, USA.
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Dopp AR, Manuel JK, Breslau J, Lodge B, Hurley B, Kase C, Osilla KC. Value of family involvement in substance use disorder treatment: Aligning clinical and financing priorities. J Subst Abuse Treat 2021; 132:108652. [PMID: 34742609 DOI: 10.1016/j.jsat.2021.108652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Family members' support (e.g., informational, tangible, emotional) has important and lasting impacts on individuals' recovery from substance use disorders (SUDs). Unfortunately, SUD services in the United States do not consistently incorporate patients' family members effectively. One barrier to family involvement in SUD services is the mechanisms through which SUD services in the United States are commonly financed. METHOD Using our recent experiences with developing a group intervention for support persons of patients with opioid use disorder, we illustrate how gaps in feasible financing models limit SUD service systems from effectively implementing and sustaining family services for individuals receiving SUD treatment. DISCUSSION Long-term availability of family-inclusive interventions will require collaboration with payors and health systems. We offer two sets of recommendations for funding family involvement in SUD services; one set of immediately implementable recommendations and other longer-term goals requiring structural changes in SUD service delivery and financing.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, United States of America.
| | - Jennifer K Manuel
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, United States of America; San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA 94121, United States of America.
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, United States of America.
| | | | - Brian Hurley
- Los Angeles County Department of Health Services, 313 N. Figueroa St., Los Angeles, CA 90012, United States of America.
| | - Courtney Kase
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, United States of America.
| | - Karen Chan Osilla
- Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, United States of America.
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Hogue A, Becker SJ, Wenzel K, Henderson CE, Bobek M, Levy S, Fishman M. Family involvement in treatment and recovery for substance use disorders among transition-age youth: Research bedrocks and opportunities. J Subst Abuse Treat 2021; 129:108402. [PMID: 34080559 PMCID: PMC8380649 DOI: 10.1016/j.jsat.2021.108402] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022]
Abstract
This article presents a narrative review and conceptual framework for research on family involvement across the continuum of substance use disorder (SUD) services for transition-age youth (ages 15-26). Though families are powerful resources for enhancing treatment and recovery success among youth with SUDs, they are not routinely included in clinical practice. This article summarizes youth SUD prevalence and service utilization rates and presents developmental and empirical rationale for increasing family involvement in services. It then describes key research issues on family involvement across the SUD services continuum: Problem Identification, Treatment Engagement, Active Treatment, Recovery Support. Within each phase, it highlights bedrock research findings and suggests promising opportunities for advancing the scientific knowledge base on family involvement. The main goals are to endorse family-oriented practices for immediate adoption in routine care and identify areas of research innovation that could significantly enhance the quality of youth SUD services.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, United States of America.
| | - Sara J Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
| | - Kevin Wenzel
- Maryland Treatment Centers, United States of America
| | | | - Molly Bobek
- Partnership to End Addiction, United States of America
| | - Sharon Levy
- Boston Children's Hospital, Harvard Medical School, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
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Knapp KS, Cleveland HH, Apsley HB, Harris KS. Using daily diary methods to understand how college students in recovery use social support. J Subst Abuse Treat 2021; 130:108406. [PMID: 34118698 DOI: 10.1016/j.jsat.2021.108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Collegiate Recovery Communities (CRCs) are important sources of support for college students building and maintaining recovery from substance use disorders. The current study used daily diary data from members of a CRC to examine with which sources of social support students engaged daily, and whether students connected with these sources more on days when they indicated higher-than-usual recovery difficulty, negative affect, and/or school stress. Results indicate that on days when students reported having greater difficulty with recovery maintenance than usual, they had higher odds of being in contact with family members and were expected to talk or spend time with family for longer than usual. Students also had higher odds of having recovery-focused conversations with both 12-step sponsors and CRC peers on days of greater-than-usual recovery maintenance difficulty. Recovery maintenance difficulty was uniquely associated with longer duration of family contact, above and beyond negative affect and school stress. Thus, the occurrence, amount, and nature of CRC members' interactions with important social network members varied in relation to perceived recovery challenges that same day. Findings highlight the importance of providing college students with multiple sources of support that they can use to maintain their recoveries despite daily challenges.
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Affiliation(s)
- Kyler S Knapp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
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Hogue A, Bobek M, Levy S, Henderson CE, Fishman M, Becker SJ, Dauber S, Porter N, Wenzel K. Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:501-514. [PMID: 33760249 PMCID: PMC9830952 DOI: 10.1111/jmft.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
With opioid use at crisis levels, it is imperative to support youth ages with opioid use disorders (OUD) in taking medication and accessing behavioral services over long periods. This article presents a conceptual framework for telehealth strategies that can be adopted to increase family involvement across a four-stage continuum of youth OUD treatment and recovery: Treatment Preparation, Treatment Initiation, Treatment Stabilization, OUD Recovery. It first identifies provider-delivered tele-interventions that can enhance OUD services in each of the four stages, including family outreach, family engagement, family-focused intervention, and family-focused recovery maintenance. It then introduces several types of direct-to-family tele-supports that can be used to supplement provider-delivered interventions. These include both synchronous tele-supports (remote interactions that occur in real time) such as helplines, peer-to-peer coaching, and online support groups; and asynchronous tele-supports (communications that occur without participants being simultaneously present) such as automated text messaging, self-directed internet-based courses, and digital web support.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig E. Henderson
- Department of Psychology, Sam Houston, State University, Huntsville, TX, USA
| | | | - Sara J. Becker
- Center for Alcohol and Addictions, Studies, Brown University School of Public, Health, Providence, RI, USA
| | - Sarah Dauber
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
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Hogue A, Becker SJ, Fishman M, Henderson CE, Levy S. Youth OUD treatment during and after COVID: Increasing family involvement across the services continuum. J Subst Abuse Treat 2020; 120:108159. [PMID: 33298299 PMCID: PMC7538390 DOI: 10.1016/j.jsat.2020.108159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
Telehealth innovations in substance use treatment necessitated by the COVID-19 pandemic present a generational opportunity to increase family involvement in medication for opioid use disorders (MOUD) among youth. This commentary describes a conceptual framework for engaging and retaining youth and families across four stages of MOUD services: Preparation, Initiation, Stabilization, Remission & Recovery. Case vignettes illustrate provider-delivered and direct-to-family tele-interventions for augmenting family involvement in each MOUD stage: Family Outreach, Family Engagement, Family Training, Family Recovery Maintenance. COVID-19 has necessitated that substance use treatment services rely on tele-interventions. Youth and their families are difficult to engage and retain in medication for opioid use disorder (MOUD). Tele-interventions can increase family involvement across the youth MOUD services continuum. Case vignettes illustrate provider-delivered and direct-to-family tele-intervention strategies.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, United States of America.
| | - Sara J Becker
- Center for Alcohol and Addictions Studies at Brown University School of Public Health, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
| | | | - Sharon Levy
- Boston Children's Hospital, Harvard Medical School, United States of America
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