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Cioffi CC, Hibbard PF, Hagaman A, Tillson M, Vest N. Perspectives of researchers with lived experience in implementation science research: Opportunities to close the research-to-practice gap in substance use systems of care. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231180635. [PMID: 37790184 PMCID: PMC10326466 DOI: 10.1177/26334895231180635] [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] [Indexed: 10/05/2023] Open
Abstract
Background The field of implementation science acknowledges the importance of diversity within research teams including members from diverse disciplines and with lived expertise in practical implementation (e.g., administrators, front-line workers, patients/clients). Gaps remain in the successful implementation of proven substance use treatment interventions. Methods This paper will outline the rationale for the purposeful inclusion of researchers with lived experience (RLE) related to substance use disorder (SUD) within implementation science research studies focused on improving SUD services. Results We posit that researchers with such experience can help address research-to-practice gaps by (1) building strong community partnerships, (2) engaging in conversations around effective interventions through knowledge translation, (3) providing community-congruent approaches to evaluation, and (4) aiding in dissemination and sustainability efforts. Conclusions We end by offering recommendations for researchers without lived experience as they intentionally collaborate with RLE.
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Affiliation(s)
| | | | | | | | - Noel Vest
- Boston University School of Public Health, Boston,
MA, USA
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Fiddian-Green A, Gubrium A, Harrington C, Evans EA. Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9346. [PMID: 35954700 PMCID: PMC9368271 DOI: 10.3390/ijerph19159346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/07/2022]
Abstract
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling "safe" within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
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Affiliation(s)
- Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
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3
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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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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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5
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Majer JM, Bobak TJ, Jason LA. Psychiatric severity and stress among recovery home residents utilizing medication assisted treatment: a moderated mediation analysis of homophily. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-07-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to examine the relationship between psychiatric severity and stress among persons utilizing medication assisted treatment (MAT), and there is a need to identify resources that promote resilience against these risk factors. Although recovery homes might complement pharmacological interventions for persons using MAT, a lack of homophily (e.g. similar experiences) among residents could produce stress and increase psychiatric severity. The purpose of this paper is to examine stress and psychiatric severity in relation to recovery outcomes, and whether homophily moderated these relationships.
Design/methodology/approach
A cross-sectional analysis was conducted among recovery home residents who were recruited from the USA, including those using (n = 40) and not using (n = 132) MAT. Participants’ levels of psychiatric severity, stress, abstinence self-efficacy and quality of life were assessed in addition to whether residents using MAT were living with at least one other resident who used MAT. Moderated mediation analyses were conducted to examine whether homophily among residents using MAT would moderate the mediating effects of stress on the relationships between psychiatric severity and recovery outcomes (abstinence-self efficacy, quality of life).
Findings
Mediating effects were observed but they were significant only through homophily. Although stress increased the negative effects of psychiatric severity among residents using MAT, significantly lesser effects were observed among those living with residents using MAT.
Practical implications
Although psychiatric (problem) severity and stress threaten recovery for persons with substance use disorders, little is known how they impact recovery among those living in community-based settings such as recovery homes. In addition, there is a need to identify community resources that would complement MAT protocols, as patients who use MAT face unique stressors related to their sense of shared interests and experiences (i.e. homophily) when developing social bonds with others in recovery.
Social implications
This study suggests the social networks within recovery homes reduce the effects of psychiatric severity and stress, and that these effects are lessened for residents who use MAT when they live with others who also use MAT.
Originality/value
Little is known about recovery home residents who use MAT and have high psychiatric severity. Findings suggest homophily among persons using MAT living in recovery homes who have high psychiatric severity can promote resilience.
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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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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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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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Lin L(A, Lofwall MR, Walsh SL, Knudsen HK. Perceived need and availability of psychosocial interventions across buprenorphine prescriber specialties. Addict Behav 2019; 93:72-77. [PMID: 30690416 DOI: 10.1016/j.addbeh.2019.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Psychosocial interventions are often recommended as part of buprenorphine treatment for patients with opioid use disorder, but little is known about prescriber perspectives on their use and how this varies across buprenorphine prescriber specialties. METHODS A large US sample of physicians actively prescribing buprenorphine (n = 1174) was surveyed from July 2014 to January 2017. Analyses examined prescriber characteristics and their perceptions and use of psychosocial interventions across three groups of physicians: primary care providers (PCPs), addiction physicians/psychiatrists, and other physicians. RESULTS Across all prescribers, 93.3% (n = 1061) report most patients would benefit from formal counseling during buprenorphine treatment while only 36.4% (n = 414) believe there are adequate number of counselors in their communities. Among addiction physicians/psychiatrists, 75.9% (n = 416) report their treatment settings have the resources to provide psychiatric services to patients with complex psychiatric problems compared to 29.1% (n = 130) of PCPs and 29.6% (n = 39, p < .001) of other physicians. Addiction physicians/psychiatrists report a higher percentage of patients receive counseling from clinicians in their practice while PCPs report a higher percentage of patients receive counseling from external providers. CONCLUSIONS The majority of prescribers believe patients receiving buprenorphine would benefit from psychosocial interventions and there is variation in how these services are delivered. However, many prescribers, especially those without addiction or psychiatry backgrounds, report their settings do not have adequate psychosocial treatment resources for patients with complex psychosocial needs. Future work developing novel models of psychosocial interventions may be helpful to support prescribers to effectively treat complex patients with opioid use disorders.
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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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McGee MD. The Optimal Management of Opioid Use Disorder: Leveraging Advances in Addiction Psychopharmacology to Enhance Treatment Outcomes. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180417-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Eitan S, Emery MA, Bates M, Horrax C. Opioid addiction: Who are your real friends? Neurosci Biobehav Rev 2017; 83:697-712. [DOI: 10.1016/j.neubiorev.2017.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 01/29/2023]
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Gallagher JR, Bremer T. A Perspective from the Field: The Disconnect between Abstinence-Based Programs and the Use of Motivational Interviewing in Treating Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1355223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Traci Bremer
- School of Social Work, Indiana University South Bend, Indiana, USA
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Galanter M. Combining medically assisted treatment and Twelve-Step programming: a perspective and review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:151-159. [PMID: 28387530 DOI: 10.1080/00952990.2017.1306747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. OBJECTIVE To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. METHOD Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. RESULTS The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
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Affiliation(s)
- Marc Galanter
- a Department of Psychiatry , NYU School of Medicine , New York , NY , USA
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White W, Galanter M, Humphreys K, Kelly J. The Paucity of Attention to Narcotics Anonymous in Current Public, Professional, and Policy Responses to Rising Opioid Addiction. ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1217712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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