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Gallant K, Hayashi K, Choi J, Milloy MJ, Kerr T. Involuntary discharge from drug or alcohol treatment programs in Vancouver, Canada. Harm Reduct J 2024; 21:121. [PMID: 38907209 PMCID: PMC11191289 DOI: 10.1186/s12954-024-01036-4] [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: 09/07/2023] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Retention in substance use treatment is essential to treatment success. While programmatic factors are known to influence retention, less is known about the role of involuntary discharges from drug or alcohol treatment programs. Therefore, we sought to identify the prevalence of and factors associated with involuntary discharge due to ongoing substance use. METHODS Data were derived from two community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada. Generalized estimating equation (GEE) analyses were used to identify variables associated with involuntary discharge from treatment programs due to ongoing substance use. RESULTS Between June 2017 and March 2020, 1487 participants who accessed substance use treatment and completed at least one study interview were included in this study. Involuntary discharge from a treatment program due to ongoing substance use was reported by 41 (2.8%) participants throughout the study, with 23 instances reported at baseline and another 18 reported during study follow-up. In a multivariable GEE analysis, involuntary discharge was positively associated with homelessness (Adjusted Odds Ratio [AOR] = 3.22, 95% Confidence Interval [95% CI]: 1.59-6.52), daily injection drug use (AOR = 1.87, 95% CI 1.06-3.32) and recent overdose (AOR = 2.50, 95% CI 1.38-4.53), and negatively associated with age (AOR = 0.93, 95% CI 0.90-0.96). In sub-analyses, participants have most commonly been discharged from in-patient treatment centres (52.2%), recovery houses (28.3%) and detox programs (10.9%), and for using heroin (45.5%) and/or crystal methamphetamine (36.4%). CONCLUSIONS While involuntary discharge was a relatively rare occurrence, those who were discharged due to active substance use possessed several markers of risk, including high-intensity injection drug use, homelessness, and recent non-fatal overdose. Our findings highlight the need for increased flexibility within treatment programs to account for those who re-initiate or continue to use substances during treatment.
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Affiliation(s)
- Kat Gallant
- British Columbia Centre on Substance Use, British Columbia, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, British, Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, British Columbia, Canada
- Department of Medicine, University of British Columbia, British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, British Columbia, Canada.
- Department of Medicine, University of British Columbia, British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
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Lowenstein M, Abrams MP, Crowe M, Shimamoto K, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Chertok J, Garcia KP, Truchil R, Holliday-Davis M, Aronowitz S. "Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder. Drug Alcohol Depend 2023; 248:109915. [PMID: 37207615 PMCID: PMC10330675 DOI: 10.1016/j.drugalcdep.2023.109915] [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: 02/01/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view. METHODS We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021. We analyzed interview data using thematic content analysis and identified key themes. RESULTS The 36 participants were 58% male, 64% Black, 28% White, and 31% Latinx. 89% were enrolled in Medicaid, and 47% were unstably housed. Our analysis revealed three main facilitators of treatment in the low-barrier model. These included 1) program structure that met participant needs, such as flexibility, rapid medication access and robust case management services; 2) harm reduction approach that included acceptance of patient goals other than abstinence and provision of harm reduction services on-site; and 3) strong interpersonal connections with team members, including those with lived experience. Participants contrasted these experiences with other care they had received in the past. Barriers related to lack of structure, limitations of street-based care, and limited support for co-occurring needs, particularly mental health. CONCLUSIONS This study provides key patient perspectives on low-barrier approaches for OUD treatment. Our findings can inform future program design to increase treatment access and engagement for individuals poorly served by traditional delivery models.
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Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Matthew P Abrams
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Molly Crowe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Denise Botcheos
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | | | - Shawn Westfahl
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kristine Pamela Garcia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - M Holliday-Davis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Shoshana Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania School of Nursing, Philadelphia, PA, United States
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Gentil L, Grenier G, Vasiliadis HM, Fleury MJ. Predictors of Length of Hospitalization and Impact on Early Readmission for Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15127. [PMID: 36429846 PMCID: PMC9689971 DOI: 10.3390/ijerph192215127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Length of hospitalization, if inappropriate to patient needs, may be associated with early readmission, reflecting sub-optimal hospital treatment, and translating difficulties to access outpatient care after discharge. This study identified predictors of brief-stay (1-6 days), mid-stay (7-30 days) or long-stay (≥31 days) hospitalization, and evaluated how lengths of hospital stay impacted on early readmission (within 30 days) among 3729 patients with mental disorders (MD) or substance-related disorders (SRD). This five-year cohort study used medical administrative databases and multinomial logistic regression. Compared to patients with brief-stay or mid-stay hospitalization, more long-stay patients were 65+ years old, had serious MD, and had a usual psychiatrist rather than a general practitioner (GP). Predictors of early readmission were brief-stay hospitalization, residence in more materially deprived areas, more diagnoses of MD/SRD or chronic physical illnesses, and having a usual psychiatrist with or without a GP. Patients with long-stay hospitalization (≥31 days) and early readmission had more complex conditions, especially more co-occurring chronic physical illnesses, and more serious MD, while they tended to have a usual psychiatrist with or without a GP. For patients with more complex conditions, programs such as assertive community treatment, intensive case management or home treatment would be advisable, particularly for those living in materially deprived areas.
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Affiliation(s)
- Lia Gentil
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada
| | - Helen-Maria Vasiliadis
- Département Des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada
- Centre de Recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les Innovations en Santé (CR-CSIS), Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Lemoyne, Longueuil, QC J4K 0A8, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada
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Leyrer-Jackson JM, Acuña AM, Olive MF. Current and emerging pharmacotherapies for opioid dependence treatments in adults: a comprehensive update. Expert Opin Pharmacother 2022; 23:1819-1830. [PMID: 36278879 PMCID: PMC9764962 DOI: 10.1080/14656566.2022.2140039] [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: 06/02/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is characterized by compulsive opioid seeking and taking, intense drug craving, and intake of opioids despite negative consequences. The prevalence of OUDs has now reached an all-time high, in parallel with peak rates of fatal opioid-related overdoses, where 15 million individuals worldwide meet the criteria for OUD. Further, in 2020, 120,000 opioid-related deaths were reported worldwide with over 75,000 of those deaths occurring within the United States. AREAS COVERED In this review, we highlight pharmacotherapies utilized in patients with OUDs, including opioid replacement therapies, and opioid antagonists utilized for opioid overdoses and deterrent of opioid use. We also highlight newer treatments, such as those targeting the neuroimmune system, which are potential new directions for research given the recently established role of opioids in activating neuroinflammatory pathways, as well as over the counter remedies, including kratom, that may mitigate withdrawal. EXPERT OPINION To effectively treat OUDs, a deeper understanding of the current therapeutics being utilized, their additive effects, and the added involvement of the neuroimmune system are essential. Additionally, a complete understanding of opioid-induced neuronal alterations and therapeutics that target these abnormalities - including the neuroimmune system - is required to develop effective treatments for OUDs.
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Affiliation(s)
- Jonna M. Leyrer-Jackson
- Department of Medical Education, School of Medicine, Creighton University, Phoenix, AZ, 85012, USA
| | - Amanda M. Acuña
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ, 85257, USA
- Interdepartmental Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, 85257, USA
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Salani D, Goldin D, Valdes B, McKay M. The Impaired Nurse. Am J Nurs 2022; 122:32-40. [PMID: 36083031 DOI: 10.1097/01.naj.0000884568.95085.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Substance use disorders (SUDs) do not discriminate. Anyone can be affected regardless of age, sex, ethnicity, socioeconomic status, or profession. Nurses with SUDs present serious risks to both their patients and the nursing profession. Frontline nurses' responsibility to provide patients with safe, high-quality care may be too great a challenge for those with SUDs, resulting in adverse consequences. Early recognition and treatment of nurses with SUDs promotes patient safety and retention in the profession. For this reason, all nurses and other health care professionals should be able to recognize behaviors associated with SUDs and should be familiar with the available treatment modalities.
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Affiliation(s)
- Deborah Salani
- Deborah Salani is an associate professor of clinical in the University of Miami School of Nursing and Health Studies, Coral Gables, FL, where Beatriz Valdes is an associate professor of clinical and Mary McKay is a professor of clinical. Deana Goldin is a clinical associate professor at the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Contact author: Deborah Salani, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Drug court utilization of medications for opioid use disorder in high opioid mortality communities. J Subst Abuse Treat 2022; 141:108850. [DOI: 10.1016/j.jsat.2022.108850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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Stahler GJ, Mennis J, Stein LAR, Belenko S, Rohsenow DJ, Grunwald HE, Brinkley-Rubinstein L, Martin RA. Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015-2018. Drug Alcohol Depend 2022; 236:109498. [PMID: 35605535 DOI: 10.1016/j.drugalcdep.2022.109498] [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] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine the use and association of medications for opioid use disorder (MOUD) with treatment completion and retention for criminal justice referred (CJR) admissions to residential treatment. METHODS A retrospective analysis of the Treatment Episode Dataset-Discharge (TEDS-D; 2015-2018) for adults (N = 205,348) admitted to short-term (ST) (< 30 days) or long-term (LT) (>30 days) residential treatment for OUD. Outcomes were MOUD in treatment plans, and treatment completion and retention (ST >10 days; LT > 90 days). Logistic regression analyses were conducted separately for ST and LT settings. RESULTS CJR admissions were less likely to have MOUD than non-CJR admissions (ST, 11% vs. 21%; LT, 10% vs. 24%, respectively) and were more likely to complete and be retained in treatment. In ST settings, MOUD was associated with higher likelihood of treatment completion and retention. In LT settings, MOUD was associated with higher likelihood of treatment retention and lower likelihood of treatment completion. These associations tended to be slightly weaker for CJR admissions, with the exception of treatment completion in LT settings, but the moderating effect size of CJR status in all models was very small. Small differences in the moderating effect of CJR status by race and ethnicity were observed in LT settings. CONCLUSIONS MOUD is greatly under-utilized for CJR patients, and given that MOUD was associated with positive outcomes, there is a critical need to find ways to increase access to MOUD for CJR patients in residential treatment. Race and ethnicity appear to have relatively little impact on outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, United States
| | - L A R Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States; Department of Psychology, The University of Rhode Island, United States
| | - Steven Belenko
- Department of Criminal Justice, Temple University, United States
| | - Damaris J Rohsenow
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
| | | | | | - Rosemarie A Martin
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
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Mutschler C, Haines H, Gryspeerdt C, Bushe J, McShane K, Lochran M, Bhoi L. Integration of Twelve Step with Evidence-Based Practices in a Residential Treatment Center. Subst Use Misuse 2022; 57:2110-2116. [PMID: 36331245 DOI: 10.1080/10826084.2022.2136496] [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: 11/06/2022]
Abstract
Background: Residential treatment for substance use disorders (SUDs) typically involves both medical and psychological treatments to best meet the needs of service users. Common treatments include Twelve Step Facilitation (TSF) as well as evidence-based practices (EBPs) such as cognitive behavioral therapies and medications. Researchers have discussed the difficulties with implementation and sustainability of EBPs within treatment centers that predominantly use TSF. Objectives: Understanding the process of implementation is an important area of study to inform future implementation efforts. The present study involved a qualitative investigation of a residential treatment center that integrated EBPs alongside TSF. Treatment stakeholders (N=22) were interviewed about their experience with integration. Results: The results indicated that the organization's evolution to integrate evidence-based practices (e.g., medication, evidenced-based psychotherapy) occurred through a process of themes including staff members' personal allegiance to Twelve Step; tension among staff members; staff collaboration; and integration of theoretical orientations. The results parallel those found in the Normalization Process Theory of implementation. Conclusions: The present study provides an understanding as to how Twelve Step and EBPs can be integrated into a residential treatment center, allowing for service users to have choice in their care. The program's ability to navigate the treatment evolution can be used as an example for integrating evidence-based practice with Twelve Step to meet the many needs of individuals seeking substance use treatment.
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Affiliation(s)
| | - Heather Haines
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Julianne Bushe
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Kelly McShane
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,HR Management and Organizational Behaviour, Ryerson University, Toronto, ON, Canada
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [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: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Your diagnosis will not protect you (and neither will academia): Reckoning with education and Dis-Ease. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103450. [PMID: 34531035 DOI: 10.1016/j.drugpo.2021.103450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
Abstract
This article is an autoethnographic exploration of institutionalized responses to uncontrolled substance use informed by medical paradigms. Theoretically, it is situated within a lineage of work in critical drug and Mad studies that challenge assumptions about choice, including - and especially - by interrogating the extent to which choice is an apt conceptual tool for making sense of "addiction." Throughout, I focus on two discrete but analogous events, both of which entailed binging on substances, entering altered states, and being rejected from academic spaces through a lens of biomedicine. My objective in doing so is two-fold: First, I hope to incite what I feel is a long overdue conversation between Mad and critical drug studies in service of theoretical cross-pollination. Second, I wish to outline how codifying people as Mad and addicted can amount to a "cutting out" (Smith, 1978) of relevant extraneous factors that motivate one's deviant actions, including within education institutions whose members research these same identities. I conclude by discussing the implications of this "cutting out" for my and possibly others' academic trajectories.
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Yang J, Kim S. Effects of a nonviolent communication-based training program for inpatient alcoholics in South Korea. Perspect Psychiatr Care 2021; 57:1187-1194. [PMID: 33135195 DOI: 10.1111/ppc.12673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to evaluate a communication skills program based on nonviolent communication targeted on inpatient alcoholics at the alcoholics specialized ward. DESIGN AND METHODS The sample for this mixed methods quasi-experimental study comprised 47 patients who were hospitalized in the alcoholic wards of two psychiatric hospitals in South Korea. FINDINGS The program effectively improved participants' empathy, anger expression, communication competence, and alcohol abstinence self-efficacy (p < .001). PRACTICE IMPLICATIONS This program could be implemented in community-based alcoholic care with the aim of preventing relapse and serve as the basis for developing similar programs for family members.
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Affiliation(s)
- Jeongwoon Yang
- Department of Nursing, Kyungbok University, Namyangju, Geyonggi, South Korea
| | - Sungjae Kim
- Department of Alcoholism Specialized Ward, College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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Jason LA, Majer JM, Bobak T, O'Brien J. Medication assisted therapy and recovery homes. J Prev Interv Community 2021; 50:178-190. [PMID: 34116624 DOI: 10.1080/10852352.2021.1934940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a need to better understand improved recovery supportive services for those on Medication Assisted Treatment (MAT) for opioid use disorder (OUD) and, at the same time, enhance the available treatment interventions and positive long-term outcomes for this vulnerable population. A growing empirical literature supports the assertion that improved access to housing and recovery support is a low-cost, high-potential opportunity that could help former substance users who are utilizing MAT to sustain their recovery. Recovery home support could serve the populations that need them most, namely servicing a significant number of the enrolled in MAT programs. The two largest networks of recovery homes are staff run Traditional Recovery Homes (TRH) and self-run Oxford House Recovery Homes (OH). There is a need to better understand how substance users on MAT respond to recovery homes, as well as how those in recovery homes feel toward those on MAT and how any barriers to those utilizing MAT may be reduced. Recovery may be an outcome of the transactional process between the recovering individual and his/her social environment. In particular, how recovery houses can help people on MAT attain long-term recovery.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - John M Majer
- Department of Social and Behavioral Sciences, Harry S. Truman College, Chicago, Illinois, USA
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Jack O'Brien
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Stewart RE, Wolk CB, Neimark G, Vyas R, Young J, Tjoa C, Kampman K, Jones DT, Mandell DS. It's not just the money: The role of treatment ideology in publicly funded substance use disorder treatment. J Subst Abuse Treat 2020; 120:108176. [PMID: 33298303 DOI: 10.1016/j.jsat.2020.108176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that investigated attitudes and barriers toward MOUD. Most treatment organizations that we interviewed are adopting at least one MOUD, suggesting that Philadelphia exceeds the national average of organizations with MOUD capacity. Leaders indicated that both practical resources and ideological barriers thwart adoption and implementation of MOUD in publicly funded substance use disorder treatment agencies. Organizations that had recently adopted MOUDs revealed facilitators to MOUD adoption, such as strong leadership that champions the implementation to staff and redefining recovery from substance use disorders throughout the organization. This study's findings highlight that clients, clinicians, and leadership need to address both practical and ideological barriers to expanding MOUD use.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Ridhi Vyas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordyn Young
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Tjoa
- Community Behavioral Health, Philadelphia, PA, USA
| | - Kyle Kampman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David T Jones
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Majer JM, Jason LA, Norris J, Hickey P, Jeong H, Bobak TJ. Medications for Opioid Use Disorder Utilization Among Oxford House Residents. Community Ment Health J 2020; 56:925-932. [PMID: 31993842 DOI: 10.1007/s10597-020-00558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
Medications for opioid use disorder (MOUD) and recovery homes that have traditionally served those not taking medications for their recovery are important resources for treating opioid use disorder. However, little is known whether such recovery homes are a good fit for persons utilizing MOUD, and whether residents' characteristics such as drug histories and the composition of recovery homes in terms MOUD and non-MOUD residents are related to attitudes toward MOUD. The present investigation examined characteristics of persons utilizing MOUD, and attitudes regarding MOUD utilization among residents living in recovery homes (Oxford Houses, OH) in the U.S. consisting of MOUD and non-MOUD residents. Residents living with others who were utilizing MOUD reported more favorable attitudes than residents who were not living with such residents, but this was observed only among residents whose primary drug of choice involved heroin or opioids. There were no significant differences observed in terms of abstinence rates, involvement in 12-step groups, or previous MOUD treatments between residents utilizing or not utilizing MOUD. Findings suggest that persons utilizing MOUD benefit by recovery homes such as OHs whose residents have favorable attitudes toward MOUD, especially when living with fellow residents who utilize MOUD.
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Affiliation(s)
- John M Majer
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA.
| | - Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
| | - Joshua Norris
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
| | - Patrick Hickey
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA
| | - Hayoung Jeong
- Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA
| | - Ted J Bobak
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, 60614, USA
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Stahler GJ, Mennis J. The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US. Drug Alcohol Depend 2020; 212:108067. [PMID: 32445926 DOI: 10.1016/j.drugalcdep.2020.108067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. METHODS Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. RESULTS Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. CONCLUSIONS Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
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Rieb LM, Samaan Z, Furlan AD, Rabheru K, Feldman S, Hung L, Budd G, Coleman D. Canadian Guidelines on Opioid Use Disorder Among Older Adults. Can Geriatr J 2020; 23:123-134. [PMID: 32226571 PMCID: PMC7067148 DOI: 10.5770/cgj.23.420] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background In Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults. Methods A systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method. Results Thirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care. Conclusion These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.
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Affiliation(s)
- Launette M Rieb
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Zainab Samaan
- Department of Psychiatry, McMaster University, Hamilton, ON
| | | | - Kiran Rabheru
- Department of Psychiatry, University of Ottawa, Ottawa, ON
| | - Sid Feldman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Lillian Hung
- Canadian Gerontological Nurses Association, Toronto, ON
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Harvey LM, Fan W, Cano MÁ, Vaughan EL, Arbona C, Essa S, Sanchez H, de Dios MA. Psychosocial intervention utilization and substance abuse treatment outcomes in a multisite sample of individuals who use opioids. J Subst Abuse Treat 2020; 112:68-75. [PMID: 32199548 DOI: 10.1016/j.jsat.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/30/2019] [Accepted: 01/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are several relatively safe and effective FDA-approved medications for Opioid Use Disorder (OUD). Despite the existence of these medications, the rate of returning to opioid use after treatment is relatively high, underscoring the need for continued enhancement of treatments. Adjunctive psychosocial interventions paired with medication have been shown to improve OUD treatment outcomes. However, studies have yet to conclusively examine the distinct effects of the most widely utilized psychosocial treatment modalities. The current study will investigate the relationship between individual counseling, group therapy, and 12-Step participation and illicit opioid abstinence at the end of treatment, 1 and 3 months after treatment. METHOD A secondary analysis was conducted with data from a sample of 570 individuals diagnosed with OUD who were recruited from eight substance abuse treatment centers in the United States. Participants were enrolled in a two-group randomized, controlled trial testing buprenorphine-naloxone versus extended-release naltrexone for OUD. A two-level hierarchical linear growth model was used to examine the effects of individual counseling, group therapy, and 12-Step participation on illicit opioid abstinence (urinanalyses) 1- and 3-months post-treatment. RESULTS Hours of individual counseling and 12-Step participation significantly predicted abstinence at follow-up (p < .001, b = -0.59, 95% CI [0.42, 0.74]; p < .01, b = -0.05, 95% CI [0.92, 0.98]). There was a significant interaction between individual counseling and 12-Step participation (p < .01, b = -0.06, 95% CI [1.02, 1.10]). Additionally, participant age and employment status were significant predictors of illicit opioid abstinence (p < .01, b = -0.02, 95% CI [0.97, 0.99]; p < .01, b = -0.38, 95% CI [0.52, 0.90]). Hours of group therapy was not found to significantly predict illicit opioid abstinence. CONCLUSIONS Findings suggest that greater levels of individual therapy and 12-Step participation may be beneficial for individuals receiving medication treatment for OUD.
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Affiliation(s)
- Laura M Harvey
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States
| | - Weihua Fan
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, 11200 SW 8th St AHC5, Miami, FL 33199, United States
| | - Ellen L Vaughan
- Department of Counseling and Educational Psychology, Indiana University, 201 N Rose Ave, Bloomington, IN 47405, United States
| | - Consuelo Arbona
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States
| | - Saman Essa
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States
| | - Helen Sanchez
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States
| | - Marcel A de Dios
- Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States; HEALTH Research Institute, University of Houston, 4849 Calhoun Rd, Houston, TX 77204, United States.
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Majer JM, Bobak TJ, Jason LA. Homophily Effects Among Oxford House Residents Utilizing Medication Assisted Treatment. ALCOHOLISM TREATMENT QUARTERLY 2020. [DOI: 10.1080/07347324.2020.1738296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- John M. Majer
- Social and Behavioral Sciences Department, Harry S. Truman College, Chicago, Illinois, USA
| | - Ted J. Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Smith KE, Tillson MD, Staton M, Winston EM. Characterization of diverted buprenorphine use among adults entering corrections-based drug treatment in Kentucky. Drug Alcohol Depend 2020; 208:107837. [PMID: 31951906 PMCID: PMC7418075 DOI: 10.1016/j.drugalcdep.2020.107837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Illicit, medically unsupervised use of buprenorphine (i.e., "diverted use") among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored. METHODS Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007. RESULTS Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8 % reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0 %) and reported greater perceived need for treatment (79.4 %) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9 % increased likelihood of diverted buprenorphine use. CONCLUSIONS Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural Appalachia.
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Affiliation(s)
- Kirsten E Smith
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Kent School of Social Work, University of Louisville, Louisville, Kentucky, 40292, United States.
| | - Martha D Tillson
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Sociology, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, 40508, United States
| | - Erin M Winston
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, Kentucky 40508, United States
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McClintock CH, Worhunsky PD, Xu J, Balodis IM, Sinha R, Miller L, Potenza MN. Spiritual experiences are related to engagement of a ventral frontotemporal functional brain network: Implications for prevention and treatment of behavioral and substance addictions. J Behav Addict 2019; 8:678-691. [PMID: 31891313 PMCID: PMC7044576 DOI: 10.1556/2006.8.2019.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Spirituality is an important component of 12-step programs for behavioral and substance addictions and has been linked to recovery processes. Understanding the neural correlates of spiritual experiences may help to promote efforts to enhance recovery processes in behavioral addictions. We recently used general linear model (GLM) analyses of functional magnetic resonance imaging data to examine neural correlates of spiritual experiences, with findings implicating cortical and subcortical brain regions. Although informative, the GLM-based approach does not provide insight into brain circuits that may underlie spiritual experiences. METHODS Spatial independent component analysis (sICA) was used to identify functional brain networks specifically linked to spiritual (vs. stressful or neutral-relaxing) conditions using a previously validated guided imagery task in 27 young adults. RESULTS Using sICA, engagement of a ventral frontotemporal network was identified that was engaged at the onset and conclusion of the spiritual condition in a manner distinct from engagement during the stress or neutral-relaxing conditions. Degree of engagement correlated with subjective reports of spirituality in the scanner (r = .71, p < .001) and an out-of-the-magnet measure of spirituality (r = .48, p < .018). DISCUSSION AND CONCLUSION The current findings suggest a distributed functional neural network associated with spiritual experiences and provide a foundation for investigating brain mechanisms underlying the role of spirituality in recovery from behavioral addictions.
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Affiliation(s)
- Clayton H. McClintock
- Spirituality Mind Body Institute, Teachers College, Columbia University, New York, NY, USA
| | - Patrick D. Worhunsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jiansong Xu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Iris M. Balodis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioral Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Lisa Miller
- Spirituality Mind Body Institute, Teachers College, Columbia University, New York, NY, USA
| | - Marc N. Potenza
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Connecticut Mental Health Center, New Haven, CT, USA,Connecticut Council on Problem Gambling, Wethersfield, CT, USA,Corresponding author: Marc N. Potenza, MD, PhD; Department of Neuroscience, Yale University School of Medicine, 1 Church Street, 7th floor New Haven, CT 06510, USA; Phone: +1 203 737 3553; Fax: +1 203 737 3591; E-mail:
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Majer JM, Jason LA, Hickey P, Joshua N, Jeong H, Bobak TJ. Social Support among Oxford House Residents Utilizing Medication-Assisted Treatments. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2019.1678445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John M. Majer
- Social Science Department, Harry S. Truman College, Chicago, Illinois, USA
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Patrick Hickey
- Social Science Department, Harry S. Truman College, Chicago, Illinois, USA
| | - Norris Joshua
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Hayoung Jeong
- Social Science Department, Harry S. Truman College, Chicago, Illinois, USA
| | - Ted J. Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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22
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Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results. J Subst Abuse Treat 2019; 104:51-63. [DOI: 10.1016/j.jsat.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
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Panlilio LV, Stull SW, Kowalczyk WJ, Phillips KA, Schroeder JR, Bertz JW, Vahabzadeh M, Lin JL, Mezghanni M, Nunes EV, Epstein DH, Preston KL. Stress, craving and mood as predictors of early dropout from opioid agonist therapy. Drug Alcohol Depend 2019; 202:200-208. [PMID: 31357121 PMCID: PMC6707374 DOI: 10.1016/j.drugalcdep.2019.05.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 05/18/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Treatment with opioid agonists is effective for opioid use disorder, but early discontinuation of treatment is a major obstacle to success. Intensive longitudinal methods - which take many repeated measurements over time, usually in the field- have provided unique insight into the effects of stress, mood and craving on drug use while people are being treated; these methods might also be useful for studying the processes that lead people to drop out of treatment. METHODS Ecological momentary assessment (EMA) was conducted for up to 17 weeks by obtaining multiple electronic diary entries per day from 238 participants being treated with methadone or buprenorphine-naloxone. Survival analysis was used to study two outcomes: dropping out of treatment and noncompliance with EMA self-report requirements. Self-reports of stress, craving, and mood were used as time-varying predictors. Demographic and psychosocial variables measured with the Addiction Severity Index at the start of treatment were used as time-invariant predictors. RESULTS Dropping out of treatment was more likely in participants with more reported hassles (a measure of stress), higher levels of cocaine craving, lower levels of positive mood, a recent history of emotional abuse, a recent history of being bothered frequently by psychological problems, and with buprenorphine rather than methadone as their medication. In contrast, study noncompliance was not significantly associated with any of the variables analyzed. CONCLUSIONS Assessment of stress, craving and mood during treatment might identify people who are at greater risk of dropping out, and therapeutic interventions targeting these processes might increase retention.
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Affiliation(s)
- Leigh V. Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Samuel W. Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - William J. Kowalczyk
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA,Present address: Hartwick College, Department of Psychology, Oneonta, NY, 13820, USA
| | - Karran A. Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | | | - Jeremiah W. Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Massoud Vahabzadeh
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Jia-Ling Lin
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Mustapha Mezghanni
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Edward V. Nunes
- Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, 10032, USA
| | - David H. Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Kenzie L. Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA,Corresponding author: Kenzie L. Preston, Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, USA,
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Weiss RD, Griffin ML, Marcovitz DE, Hilton BT, Fitzmaurice GM, McHugh RK, Carroll KM. Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence. J Clin Psychiatry 2019; 80:18m12292. [PMID: 30920187 PMCID: PMC6842303 DOI: 10.4088/jcp.18m12292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/12/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The natural course of prescription opioid use disorder has not been examined in longitudinal studies. The current study examined correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence. METHODS The multisite Prescription Opioid Addiction Treatment Study examined different durations of buprenorphine-naloxone treatment and different intensities of counseling to treat prescription opioid dependence, as assessed by DSM-IV; following the clinical trial, a longitudinal study was conducted from March 2009-January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N = 375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help) and opioid abstinence rates at the follow-up assessments. RESULTS At the 3 follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47%-50%). The most common treatments were buprenorphine maintenance (27%-35%) and mutual-help group attendance (27%-30%), followed by outpatient counseling (18%-23%) and methadone maintenance (4%). In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (odds ratios [ORs] = 5.4, 4.6, and 2.8 at the 3 assessments), followed by current mutual-help attendance (ORs = 2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models. CONCLUSIONS While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00316277.
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Affiliation(s)
- Roger D Weiss
- McLean Hospital, 115 Mill St, Belmont, MA 02478.
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - David E Marcovitz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Blake T Hilton
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
| | - Garrett M Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Rodríguez-Martín BC, Gallego-Arjiz B. Overeaters Anonymous: A Mutual-Help Fellowship for Food Addiction Recovery. Front Psychol 2018; 9:1491. [PMID: 30177901 PMCID: PMC6109797 DOI: 10.3389/fpsyg.2018.01491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/30/2018] [Indexed: 01/11/2023] Open
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Kelly JF, Bergman BG, Fallah-Sohy N. MECHANISMS OF BEHAVIOR CHANGE IN 12-STEP APPROACHES TO RECOVERY IN YOUNG ADULTS. CURRENT ADDICTION REPORTS 2018; 5:134-145. [PMID: 30416931 PMCID: PMC6224158 DOI: 10.1007/s40429-018-0203-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs. RECENT FINDINGS Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time. SUMMARY Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Nilofar Fallah-Sohy
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
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Robinson SM, Adinoff B. The mixed message behind “Medication-Assisted Treatment” for substance use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:147-150. [DOI: 10.1080/00952990.2017.1362419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sean M. Robinson
- American Lake Veteran’s Affairs, VA Puget Sound Health Care System, Psychology, Tacoma, WA, USA
| | - Bryon Adinoff
- UT Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
- VA North Texas Health Care System, Dallas TX, USA
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