1
|
Ahmad NJ, Shapiro H, Griffin ML, Weiss RD, Macias-Konstantopoulos WL. Racial and ethnic differences in self-reported barriers to substance use treatment among emergency department patients. Am J Addict 2024. [PMID: 39104150 DOI: 10.1111/ajad.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/11/2024] [Accepted: 06/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As overdose rates rise among non-White Americans, understanding barriers to substance use disorder (SUD) treatment access by race and ethnicity is important. This study explores self-reported barriers to SUD treatment by race and ethnicity in emergency department (ED) populations. METHODS We conducted a secondary, exploratory analysis of a randomized trial of patients not seeking SUD treatment who endorsed active drug use at six academic EDs. Responses to the Barriers to Treatment Inventory were compared by race, ethnicity, and drug severity, using χ2 tests (N = 858), followed by adjusted logistic regression models. RESULTS Absence of a perceived drug problem (39% non-Hispanic Black, 38% Hispanic, 50% non-Hispanic White; p ≤ .001) was the most prevalent barrier to SUD treatment. Non-Hispanic Black participants were less likely to state that they could handle their drug use on their own (OR = 0.69, CI = 0.50-0.95), and were more likely to report disliking personal questions than non-Hispanic White participants (OR = 1.49, CI = 1.07-2.09). Non-Hispanic Black participants were less likely than Hispanic participants to agree that treatment availability (OR = 0.46, CI = 0.28-0.76) and family disapproval (OR = 0.38, CI = 0.16-0.91) were treatment barriers. DISCUSSION AND CONCLUSIONS Screening and counseling may help address the barrier, common to all groups, that drug use was not seen as problematic. Expanding access to diverse treatment options may also address the range of barriers reported by our study population. SCIENTIFIC SIGNIFICANCE Our study is one of the first in the U.S. to examine both individual and structural barriers to accessing treatment and to examine the association with drug use severity by race/ethnicity.
Collapse
Affiliation(s)
- Neha Jia Ahmad
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Margaret L Griffin
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Wendy L Macias-Konstantopoulos
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Oesterle TS, Bormann NL, Ochal DA, Arndt S, Breitinger SA. Transitioning Virtual-Only Group Therapy for Substance Use Disorder Patients to a Hybrid Model. Subst Abuse Rehabil 2024; 15:73-78. [PMID: 38681859 PMCID: PMC11055515 DOI: 10.2147/sar.s460024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed. Patients and Methods Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181-255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure. Results A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demographics; however, the overall IOP sample for 2020-2022, from which the sample was derived, was 29.8% female, and 64.1% were 18-40 years of age. For completed treatment, hybrid group exposure relative to virtual-only had a univariate odds ratio of 1.88 (95% CI: 1.50-2.41, p < 0.001). No significant difference was seen across IOP sites. Conclusion These results describe a novel hybrid group approach to virtual care for SUDs with outcome data not previously documented in the literature. While virtual treatment delivery can increase access, these results suggest a benefit is derived from including an in-person option. Further research is needed to identify how an in-person component may change dynamics and if it can be replicated in virtual-only models.
Collapse
Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Hohmann L, Harris K, Zhao Y, Marlowe K, Phillippe H, Correia C, Fox B. Organizational Readiness to Implement Community Pharmacy-Based Opioid Counseling and Naloxone Services: A Scoping Review of Current Practice Models and Opportunities. PHARMACY 2023; 11:99. [PMID: 37368424 DOI: 10.3390/pharmacy11030099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language articles published in peer-reviewed journals from January 2012-July 2022 were sought via PubMed, CINAHL, IPA, and Google Scholar using permutations of terms such as "pharmacist/pharmacy", "opioid/opiate", "naloxone", "counseling", and "implement/implementation". Original articles reporting the resources/inputs (personnel; pharmacist full-time equivalents; facilities and expenses; in-house versus outsourced personnel), implementation processes (legal source of pharmacist authority; patient identification strategies; intervention procedures; workflow strategies; business operations), and programmatic outcomes (uptake and delivery; interventions made; economic impact; patient or provider satisfaction) of pharmacist-delivered OCN services in community (retail) settings were retained. Twelve articles describing ten unique studies were included. The studies primarily used quasi-experimental designs and were published from 2017 to 2021. The articles described seven broad program elements/themes: interprofessional collaboration (n = 2); patient education format including one-on-one patient education (n = 12) and group education sessions (n = 1); non-pharmacist provider education (n = 2); pharmacy staff education (n = 8); opioid misuse screening tools (n = 7); naloxone recommendation/dispensing (n = 12); and opioid therapy and pain management (n = 1). Pharmacists screened/counseled 11-2716 patients and provided 11-430 doses of naloxone. Limited implementation costs, patient/provider satisfaction, or economic impact measures were reported. This review may serve as a guide for community pharmacists in implementing OCN services in their own practices. Future studies should clarify OCN program implementation costs, patient/provider satisfaction, and the economic impact.
Collapse
Affiliation(s)
- Lindsey Hohmann
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, 1330 Walker Building, Auburn, AL 36849, USA
| | - Klaudia Harris
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, 1330 Walker Building, Auburn, AL 36849, USA
| | - Yi Zhao
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL 36849, USA
| | - Karen Marlowe
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, 1330 Walker Building, Auburn, AL 36849, USA
| | - Haley Phillippe
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, 1330 Walker Building, Auburn, AL 36849, USA
| | - Chris Correia
- Department of Psychological Sciences, College of Liberal Arts, Auburn University, 221 Cary Hall, Auburn, AL 36849, USA
| | - Brent Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL 36849, USA
| |
Collapse
|
4
|
Parker DG, Zentner D, Burack JA, Wendt DC. The impact of the COVID-19 pandemic on medications for opioid use disorder services in the U.S. and Canada: a scoping review. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2181147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel G. Parker
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Daysi Zentner
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Jacob A. Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dennis C. Wendt
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
5
|
The influence of members’ attachment style on group cohesion in substance use therapy groups. DISCOVER PSYCHOLOGY 2022. [PMCID: PMC8785002 DOI: 10.1007/s44202-022-00022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Group cohesion is an important factor in group therapy as it influences treatment outcomes and group processes. One’s attachment style has been found to impact experiences of group cohesion, however research into this relationship in substance use disorder (SUD) group treatment is lacking. This is of particular concern as insecure attachment presentations are more prevalent in this clinical population and group therapy is often treatment of choice. The current study sought to determine whether attachment style significantly predicted group cohesion. It also provided a qualitative exploration of factors that promote group cohesion in SUD group treatment. Participants (N = 38) attending a SUD therapy program completed self-report measures. Attachment avoidance was a significant negative predictor of positive bonding and positive working, and a significant positive predictor of negative relationships. Attachment anxiety was a significant negative predictor of negative relationships, however, unexpectedly did not significantly predict positive bonding or positive working. The current findings highlight the importance of group therapists tailoring group treatment to meet the attachment needs of individuals to promote a group therapy environment conducive to recovery.
Collapse
|
6
|
Sugarman DE, Meyer LE, Reilly ME, Greenfield SF. Women's and men's experiences in group therapy for substance use disorders: A qualitative analysis. Am J Addict 2022; 31:9-21. [PMID: 34730866 PMCID: PMC8799487 DOI: 10.1111/ajad.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This thematic analysis of qualitative interviews from participants in Stage II randomized controlled trial examined women's and men's experiences in group therapy for substance use disorders (SUDs). METHODS Interviews were conducted with 77 women and 38 men after completion of either the gender-specific Women's Recovery Group (WRG) or mixed-gender Group Drug Counseling (GDC). Interviews were coded for themes using a deductive approach with a coding scheme modified from the Stage I trial. Satisfaction was measured quantitatively posttreatment. RESULTS Participants had high satisfaction scores with no significant differences between groups. Women in GDC rated group gender composition as less helpful than those in WRG. In the GDC group, women more frequently discussed the theme of self-perception (e.g., feelings of comfort, safety, shame) compared with men. Men overwhelmingly expressed the benefits of having women in the group, whereas women expressed advantages and disadvantages of mixed-gender groups and preference for single-gender groups. Guilt and shame were discussed by women and men; however, only women discussed stigma and its important role in their addiction and recovery. DISCUSSION AND CONCLUSION Men more frequently endorsed the helpfulness of mixed-gender groups than did women while women appreciated the enhanced support in single-gender SUD groups. Issues of stigma are especially salient for women. SCIENTIFIC SIGNIFICANCE Men and women express differences in their experiences of SUD group therapy. Only women endorse stigma as an obstacle to their treatment and recovery. Tailoring treatment to meet women's and men's needs may enhance engagement, retention, and clinical outcomes.
Collapse
Affiliation(s)
- Dawn E. Sugarman
- McLean Hospital, Division of Alcohol, Drugs, and Addiction, Belmont, MA 02478, United States,McLean Hospital, Division of Women’s Mental Health, Belmont, MA 02478, United States,Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Laurel E. Meyer
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD 21250, United States
| | - Meghan E. Reilly
- McLean Hospital, Division of Alcohol, Drugs, and Addiction, Belmont, MA 02478, United States,McLean Hospital, Division of Women’s Mental Health, Belmont, MA 02478, United States
| | - Shelly F. Greenfield
- McLean Hospital, Division of Alcohol, Drugs, and Addiction, Belmont, MA 02478, United States,McLean Hospital, Division of Women’s Mental Health, Belmont, MA 02478, United States,Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| |
Collapse
|
7
|
Warner N, Murphy M. Dialectical behaviour therapy skills training for individuals with substance use disorder: A systematic review. Drug Alcohol Rev 2021; 41:501-516. [PMID: 34337811 DOI: 10.1111/dar.13362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
ISSUES Dialectical behaviour therapy skills training (DBT-ST) is currently being implemented as a standalone intervention for substance use disorders (SUD), despite limited empirical evidence to support its efficacy in this context. This review aimed to investigate the feasibility, acceptability and efficacy of DBT-ST for SUD. APPROACH English language journal articles which focused on quantitative evaluations of DBT-ST for SUD were identified by systematically searching five databases; Medline, Psychinfo, Pubmed, The Applied Social Sciences Index and Abstracts and Cumulative Index of Nursing and Allied Health Literature. Relevant grey literature was also identified using Google Scholar. The titles, abstracts and full-text of retrieved articles were independently screened by both authors. The nine retained articles were read in-depth and quality assessed by both authors. Data were synthesised narratively. KEY FINDINGS Interventions described as DBT-ST for SUD were implemented and adapted differently across studies. Despite these inconsistencies, DBT-ST was generally found to be acceptable and feasible for people with SUD. Findings offered preliminary support for DBT-ST for substance use reduction and emotion regulation enhancement for this cohort. Findings must be considered in light of the quality of studies which ranged from weak to strong. IMPLICATIONS Positive outcomes indicate that more rigorous studies, including large randomised controlled trials comparing DBT-ST to other evidence-based interventions for SUDs, are warranted. CONCLUSIONS Despite offering preliminary support for DBT-ST for SUD, the lack of controls, small samples and inconsistent adaptations of DBT-ST across studies, limits capacity to draw causal conclusions or make specific recommendations.
Collapse
Affiliation(s)
- Niamh Warner
- Department of Applied Psychology, University College Cork, Cork, Ireland
| | - Mike Murphy
- Department of Applied Psychology, University College Cork, Cork, Ireland
| |
Collapse
|
8
|
Ripley D, Welfare LE. Reflections on Person-Centered Group Therapy from Clients in Opioid Treatment. JOURNAL FOR SPECIALISTS IN GROUP WORK 2021. [DOI: 10.1080/01933922.2021.1950879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
López G, Orchowski LM, Reddy MK, Nargiso J, Johnson JE. A review of research-supported group treatments for drug use disorders. Subst Abuse Treat Prev Policy 2021; 16:51. [PMID: 34154619 PMCID: PMC8215831 DOI: 10.1186/s13011-021-00371-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women's recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.
Collapse
Affiliation(s)
- Gabriela López
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA
| | - Lindsay M Orchowski
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, 02904, USA.
| | - Madhavi K Reddy
- Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Jessica Nargiso
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jennifer E Johnson
- Division of Public Health, Michigan State University, Flint, MI, 48502, USA
| |
Collapse
|
10
|
Howard KA, Rennert L, Pericot-Valverde I, Heo M, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C. J Subst Abuse Treat 2021; 126:108459. [PMID: 34116813 DOI: 10.1016/j.jsat.2021.108459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/15/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.
Collapse
Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Linda Agyemang
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA; University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
| |
Collapse
|
11
|
Karsberg SH, Pedersen MU, Hesse M, Thylstrup B, Pedersen MM. Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial. BMC Public Health 2021; 21:413. [PMID: 33637061 PMCID: PMC7913269 DOI: 10.1186/s12889-021-10271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark. METHODS A two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients' use of drugs and alcohol, and patients' wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment. DISCUSSION The present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020). TRIAL REGISTRATION ISRCTN88025085 , registration date 30/06/2020.
Collapse
Affiliation(s)
| | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | | |
Collapse
|
12
|
Eaton E, Capone C, Shea MT, Cameron A. Evaluation of Self-Compassion Focused Group Treatment for Co-Occurring PTSD and Substance Use in Veterans with Posttraumatic Guilt: A Case Study. Int J Group Psychother 2020; 70:481-508. [PMID: 38449164 DOI: 10.1080/00207284.2020.1805617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) following combat exposure affects a significant proportion of military veterans. Guilt and shame are common to PTSD-SUD, suggesting a possible role as a mechanism underlying both disorders. Cultivating self-compassion (SC) among veterans is a logical approach to treating guilt and shame. The purpose of this article is threefold: (a) present scientific theories of SC in the veteran population with emphasis on PTSD, substance use, and guilt and shame; (b) present a case study that highlights how self-compassion-focused treatment (SCFT) can be utilized in a group format with veterans with PTSD-SUD and posttraumatic guilt; and (c) discuss implications of our findings for refining SCFT within a group intervention setting among this population and for future research.
Collapse
|
13
|
Görgülü T. How Effective are Psychosocial Group Workings in Improving Treatment Compliance and Self-Efficacy? An Experimental Study with Substance Users. Noro Psikiyatr Ars 2020; 57:241-247. [PMID: 32952428 PMCID: PMC7481974 DOI: 10.29399/npa.24810] [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: 07/26/2019] [Accepted: 01/02/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Group work is one of the most effective treatment methods in rehabilitation of substance use behavior. In addition, the individual's motivation to quit substance and self-efficacy perceptions of quitting are important factors for the course of the treatment. Therefore, the aim of this study was to investigate the effect of group work process on motivational processes (intrinsic and extrinsic motivation, interpersonal help seeking and confidence-in-treatment subscales) and self-efficacy perception of substance users. METHOD This is an experimental study with 43 substance users. The Treatment Motivation Questionnaire subscales were used to measure the effect of the group work on the dimensions of treatment motivation (intrinsic motivation, extrinsic motivation, confidence-in-treatment, interpersonal help seeking), and the General Self-Efficacy Scale was used to measure the effect of group work on the self-efficacy perceptions. RESULTS The group work resulted in a significant increase in participants' intrinsic motivation and confidence-in-treatment. However, group work did not result in any significant change in extrinsic motivation, interpersonal help seeking and the perception of self-efficacy. In the follow-up process, a significant decrease was observed in the participants' self-efficacy perceptions. CONCLUSIONS Group work with substance users increases the intrinsic motivation and confidence-in-treatment. Therefore, group work practices will increase the effectiveness of substance use treatment.
Collapse
Affiliation(s)
- Tuğba Görgülü
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- İstinye Üniversitesi, Sağlık Bilimleri Fakültesi, Sosyal Hizmet Bölümü, İstanbul, Türkiye
| |
Collapse
|
14
|
McCormick R, Rosenblad SR, Newmeyer M. Untapped Therapeutic Potential: Using Sandtray in Substance Abuse Treatment Groups. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2020.1789016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael McCormick
- Serenity House Substance Abuse Treatment Facility, Abilene, Texas, USA
| | | | | |
Collapse
|
15
|
Sugarman DE, Meyer LE, Reilly ME, Greenfield SF. Feasibility and Acceptability of a Web-Based, Gender-Specific Intervention for Women with Substance Use Disorders. J Womens Health (Larchmt) 2020; 29:636-646. [DOI: 10.1089/jwh.2018.7519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dawn E. Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
- Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laurel E. Meyer
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
- Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts
| | - Meghan E. Reilly
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
- Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts
| | - Shelly F. Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
- Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Ariss T, Fairbairn CE. The effect of significant other involvement in treatment for substance use disorders: A meta-analysis. J Consult Clin Psychol 2020; 88:526-540. [PMID: 32162930 DOI: 10.1037/ccp0000495] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Substantial research has accrued in support of a key role for social processes in substance use disorders (SUD). Researchers have developed a range of interventions that capitalize on these social processes to bolster treatment outcomes by involving significant others (e.g., romantic partners, family, friends) in SUD treatment. Yet dissemination of these treatments to many contexts has been slow, and information on their broad efficacy is lacking. This meta-analysis aims to quantify the effect of significant other involvement in SUD treatments above and beyond individually-based therapies. METHOD A total of 4,901 records were screened for randomized controlled trials examining the effect of Significant Other Involved SUD Treatments (SOIT) versus individually-based active comparator treatments. Our search yielded 77 effect sizes based on data from 2,115 individuals enrolled in 16 independent trials. RESULTS Findings indicated a significant effect of SOIT above and beyond individually-based active comparator treatments for reducing substance use and substance-related problems, d = 0.242, 95% CI [0.148, 0.336], I² = 10.596, Q(15) = 16.778. This effect was consistent across SOIT treatment types and endured 12-18 months after the end of treatment. Analyses of raw mean differences indicated that this effect translates to a 5.7% reduction in substance use frequency-the equivalent of approximately 3 fewer weeks a year of drinking/drug use. CONCLUSION Findings indicate a significant advantage for SOIT in SUD treatment, and hold interesting conceptual implications for theories of SUD maintenance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
18
|
Lander LR, Zheng W, Hustead JD, Mahoney JJ, Berry JH, Marshalek P, Winstanley EL. Long-term treatment retention in West Virginia's comprehensive opioid addiction treatment (COAT) program. J Neurol Sci 2020; 411:116712. [PMID: 32058182 PMCID: PMC7409552 DOI: 10.1016/j.jns.2020.116712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The United States continues to experience an opioid epidemic of unprecedented proportions despite FDA approval of life saving medications, such as buprenorphine. This paper describes a novel group-based buprenorphine treatment model and summarizes patient characteristics and treatment retention. This model, known as the Comprehensive Opioid Addiction Treatment (COAT) program, was developed in West Virginia, the epicenter of the opioid epidemic. METHODS Data on 454 patients actively enrolled in the COAT program were extracted from an administrative clinical data set and electronic medical records and analyzed using descriptive and quantitative analysis to determine long-term retention in treatment using frequencies and means. RESULTS The characteristics of the 454 patients are as follows: average age of 39, 53% female, predominantly white (94%) and Medicaid was the primary insurance provider (68%). Analysis of retention showed 37.8% of patents were retained less than one year and 14.7% were retained 10 or more years. Initiating treatment at a younger age was associated with long-term retention. CONCLUSION Opioid use disorder is a chronic relapsing disease and treatment models that retain patients long-term have the greatest benefit. The COAT model has been successful in retaining patients long-term in a rural setting where barriers to treatment are many.
Collapse
Affiliation(s)
- Laura R Lander
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - Wanhong Zheng
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Jeremy D Hustead
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James J Mahoney
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Erin L Winstanley
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| |
Collapse
|
19
|
Cavicchioli M, Ramella P, Vassena G, Simone G, Prudenziati F, Sirtori F, Movalli M, Maffei C. Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:368-384. [PMID: 31990583 DOI: 10.1080/00952990.2020.1712411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUNDS Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors. OBJECTIVE s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors. METHODS The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively. RESULTS Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors. CONCLUSION The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.
Collapse
Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Federica Sirtori
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| |
Collapse
|
20
|
Mentalisierungsbasierte Gruppentherapie (MBT-G) – eine Pilotstudie über Patientinnen mit Persönlichkeitsstörungen und Substanzmissbrauch. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2019. [DOI: 10.13109/grup.2019.55.3.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Osilla KC, Paddock SM, McCullough CM, Jonsson L, Watkins KE. Randomized Clinical Trial Examining Cognitive Behavioral Therapy for Individuals With a First-Time DUI Offense. Alcohol Clin Exp Res 2019; 43:2222-2231. [PMID: 31472028 DOI: 10.1111/acer.14161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Driving under the influence (DUI) programs are a unique setting to reduce disparities in treatment access to those who may not otherwise access treatment. Providing evidence-based therapy in these programs may help prevent DUI recidivism. METHODS We conducted a randomized clinical trial of 312 participants enrolled in 1 of 3 DUI programs in California. Participants were 21 and older with a first-time DUI offense who screened positive for at-risk drinking in the past year. Participants were randomly assigned to a 12-session manualized cognitive behavioral therapy (CBT) or usual care (UC) group and then surveyed 4 and 10 months later. We conducted intent-to-treat analyses to test the hypothesis that participants receiving CBT would report reduced impaired driving, alcohol consumption (drinks per week, abstinence, and binge drinking), and alcohol-related negative consequences. We also explored whether race/ethnicity and gender moderated CBT findings. RESULTS Participants were 72.3% male and 51.7% Hispanic, with an average age of 33.2 (SD = 12.4). Relative to UC, participants receiving CBT had lower odds of driving after drinking at the 4- and 10-month follow-ups compared to participants receiving UC (odds ratio [OR] = 0.37, p = 0.032, and OR = 0.29, p = 0.065, respectively). This intervention effect was more pronounced for females at 10-month follow-up. The remaining 4 outcomes did not significantly differ between UC versus CBT at 4- and 10-month follow-ups. Participants in both UC and CBT reported significant within-group reductions in 2 of 5 outcomes, binge drinking and alcohol-related consequences, at 10-month follow-up (p < 0.001). CONCLUSIONS In the short-term, individuals receiving CBT reported significantly lower rates of repeated DUI than individuals receiving UC, which may suggest that learning cognitive behavioral strategies to prevent impaired driving may be useful in achieving short-term reductions in impaired driving.
Collapse
|
22
|
Roos C, Stein E, Bowen S, Witkiewitz K. Individual gender and group gender composition as predictors of differential benefit from mindfulness-based relapse prevention for substance use disorders. Mindfulness (N Y) 2019; 10:1560-1567. [PMID: 31741686 PMCID: PMC6860023 DOI: 10.1007/s12671-019-01112-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Mindfulness-based relapse prevention (MBRP) is an effective group-based aftercare treatment for substance use disorders (SUDs), yet few studies have examined moderators of MBRP efficacy. This secondary data analysis evaluated individual gender and group gender composition (e.g., proportion of women relative to men in each therapy group) as treatment moderators of MBRP. METHODS The analysis sample included 186 individuals with SUDs randomized to MBRP or relapse prevention (RP) as an aftercare treatment. Outcomes included number of heavy drinking days and drug use days at the 12-month follow-up. RESULTS There were no treatment moderation effects for models with heavy drinking days as the outcome (all ps > .05). Group gender composition, but not individual gender, moderated the effect of treatment condition on drug use days (p < .01). Individuals who received MBRP had significantly fewer drug use days at 12-months than those who received RP, but only among individuals in therapy groups comprising one-third or more women (p <0 .0001). Specifically, all women and men who received MBRP in groups with one-third or more women were abstinent from drugs at month 12, whereas those in RP groups with one-third or more women had an average of about eight drug use days at month 12 (corresponding to a large between-treatment condition effect size). CONCLUSIONS Group-based MBRP may be more efficacious than group-based RP, particularly when women compose at least one-third of the therapy group. Further research is warranted on gender and group gender composition as moderators of MBRP.
Collapse
Affiliation(s)
- Corey Roos
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque NM, 87131
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque NM, 87106
| | - Elena Stein
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque NM, 87131
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque NM, 87106
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, 190 SE 8th Avenue, Hillsboro OR 97123
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque NM, 87131
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque NM, 87106
| |
Collapse
|
23
|
McDuff D, Stull T, Castaldelli-Maia JM, Hitchcock ME, Hainline B, Reardon CL. Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review. Br J Sports Med 2019; 53:754-760. [PMID: 31097457 DOI: 10.1136/bjsports-2019-100669] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Substances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders. OBJECTIVE To review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender. METHODS A comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class. RESULTS Alcohol, cannabis, tobacco (nicotine) and prescribed opioids and stimulants are the most commonly used substances in elite athletes, but generally used at lower rates than in non-athletes. In contrast, use/misuse rates for binge alcohol, oral tobacco, non-prescription opioids and anabolic-androgenic steroids are higher among athletes than non-athletes, especially in power and collision sports. Cannabis/cannabinoids seem to have replaced nicotine as the second most commonly used substance. CONCLUSIONS Substance use in elite athletes varies by country, ethnicity, gender, sport and competitive level. There are no studies on substance use disorder prevalence in elite male and female athletes and few studies with direct comparison groups.
Collapse
Affiliation(s)
- David McDuff
- Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA .,MD Sports Performance, Ellicott, Maryland, USA
| | - Todd Stull
- Athletics, University of Nebraska-Lincoln University Health Center, Lincoln, Nebraska, USA
| | - João Mauricio Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil
| | - Mary E Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
24
|
Cruz M, Osilla KC, Paddock SM. Group Cohesion and Climate in Cognitive Behavioral Therapy for Individuals with a First-Time DUI. ALCOHOLISM TREATMENT QUARTERLY 2019; 38:68-86. [PMID: 32952283 PMCID: PMC7500184 DOI: 10.1080/07347324.2019.1613941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Few studies have examined group cohesion and climate in the substance use disorder treatment literature. We examined whether group cohesion and climate are associated with increased self-efficacy outcomes and reduced drinks per week, binge drinking and DUI behaviors, in a sample of individuals with a first-time DUI receiving either cognitive behavioral therapy (CBT) or usual care. Additionally, we examined whether CBT moderates these relationships. Group measures and drinking outcomes were not significantly associated. This study is the first to provide an in-depth analysis on group processes in DUI settings, and as such, provides important insights into how group processes may differ in a mandated DUI context.
Collapse
Affiliation(s)
- Maricela Cruz
- Department of Statistics, University of California, Irvine
| | | | | |
Collapse
|
25
|
Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53:667-699. [DOI: 10.1136/bjsports-2019-100715] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/03/2022]
Abstract
Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
Collapse
|
26
|
Cost-effectiveness of individual versus group female-specific cognitive behavioral therapy for alcohol use disorder. J Subst Abuse Treat 2019; 100:1-7. [PMID: 30898323 DOI: 10.1016/j.jsat.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/07/2019] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT). METHODS This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods. All cost data (including resource utilizations) were collected prospectively alongside the trial. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to determine the cost-effectiveness of I-FS-CBT relative to G-FS-CBT. Results are presented from the provider perspective. RESULTS During the 12-week treatment period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $141 (or $258), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $141 (or $258). During the 1-year follow-up period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $54 (or $169), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $54 (or $169). The results are robust to sensitivity analyses on several key cost parameters. CONCLUSIONS Compared to I-FS-CBT, G-FS-CBT holds promise as a cost-effective approach, in both the short run and the long run, for improving drinking outcomes of women with alcohol use disorder.
Collapse
|
27
|
Lo Coco G, Melchiori F, Oieni V, Infurna MR, Strauss B, Schwartze D, Rosendahl J, Gullo S. Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. J Subst Abuse Treat 2019; 99:104-116. [PMID: 30797382 DOI: 10.1016/j.jsat.2019.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS From residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods. METHODS We included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS Thirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias. CONCLUSIONS The current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.
Collapse
Affiliation(s)
- Gianluca Lo Coco
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy.
| | | | | | | | - Bernhard Strauss
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Dominique Schwartze
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Jenny Rosendahl
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Salvatore Gullo
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy
| |
Collapse
|
28
|
Maffei C, Cavicchioli M, Movalli M, Cavallaro R, Fossati A. Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial. Subst Use Misuse 2018; 53:2368-2385. [PMID: 29958050 DOI: 10.1080/10826084.2018.1480035] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it. OBJECTIVES The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation. METHODS We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program. RESULTS Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation. CONCLUSIONS This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.
Collapse
Affiliation(s)
- Cesare Maffei
- a Department of Psychology , University Vita-Salute San Raffaele , Milano , Italy.,b Unit of Clinical Psychology and Psychotherapy , San Raffaele-Turro Hospital , Milano , Italy
| | - Marco Cavicchioli
- a Department of Psychology , University Vita-Salute San Raffaele , Milano , Italy.,b Unit of Clinical Psychology and Psychotherapy , San Raffaele-Turro Hospital , Milano , Italy
| | - Mariagrazia Movalli
- a Department of Psychology , University Vita-Salute San Raffaele , Milano , Italy.,b Unit of Clinical Psychology and Psychotherapy , San Raffaele-Turro Hospital , Milano , Italy
| | | | - Andrea Fossati
- a Department of Psychology , University Vita-Salute San Raffaele , Milano , Italy.,b Unit of Clinical Psychology and Psychotherapy , San Raffaele-Turro Hospital , Milano , Italy
| |
Collapse
|
29
|
Valeri L, Sugarman DE, Reilly ME, McHugh RK, Fitzmaurice GM, Greenfield SF. Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes. J Subst Abuse Treat 2018; 94:60-68. [PMID: 30243419 PMCID: PMC9976621 DOI: 10.1016/j.jsat.2018.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022]
Abstract
In-session affiliation among members is a hypothesized mechanism of action of group therapy for women with substance use disorders (SUDs). We evaluated group affiliation as an independent predictor of SUD treatment outcome in women (n = 100), 18 years or older diagnosed with substance dependence, who were randomized to the single-gender Women's Recovery Group (WRG) or mixed-gender group therapy (Group Drug Counseling; GDC). Affiliative statements made by members in both groups were measured for 39 women in each treatment arm. We studied the relationship between frequency of affiliative statements categorized in quintiles and the trajectory of days of any drug use during 3 months treatment and 6 months post-treatment using a Poisson regression model with estimation via generalized estimating equations. Furthermore, we investigated whether the effect of affiliation on substance use was moderated by group therapy type. The relationship between amount of affiliation and substance use reduction was non-linear. At the end of the treatment phase (3 months), women who experienced the highest level of affiliation (>65 affiliative statements on average) were found to reduce substance use by about 1.75 days more (p-value = 0.02) than women who experienced the lowest level of affiliation (<26). The effects of affiliation persisted 6 months post-treatment and were moderated by therapy group, whereby women enrolled in the single-gender WRG appeared to benefit more from affiliation post-treatment. Training therapists to facilitate verbal affiliation may provide added therapeutic benefit to group therapy for women with SUDs.
Collapse
Affiliation(s)
- Linda Valeri
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Dawn E Sugarman
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Meghan E Reilly
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - R Kathryn McHugh
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States
| | - Garrett M Fitzmaurice
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Shelly F Greenfield
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States.
| |
Collapse
|
30
|
Epstein EE, McCrady BS, Hallgren KA, Gaba A, Cook S, Jensen N, Hildebrandt T, Holzhauer CG, Litt MD. Individual versus group female-specific cognitive behavior therapy for alcohol use disorder. J Subst Abuse Treat 2018; 88:27-43. [PMID: 29606224 PMCID: PMC6424104 DOI: 10.1016/j.jsat.2018.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/28/2017] [Accepted: 02/13/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes. METHODS Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session. RESULTS Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline. CONCLUSIONS Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care.
Collapse
Affiliation(s)
- Elizabeth E Epstein
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States.
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States.
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA 98195, United States
| | - Ayorkor Gaba
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States.
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States.
| | - Noelle Jensen
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States.
| | - Thomas Hildebrandt
- Department of Psychiatry, Mt. Sinai School of Medicine, 1425 Madison Ave, Floor 6, Room 30, New York, NY 10029, United States.
| | - Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States; Veterans Affairs VISN 1 Central Western Massachusetts, 421 North Main St Leeds MA 01053, United States.
| | - Mark D Litt
- University of Connecticut Health Center, Division of Behavioral Sciences and Community Health, 263 Farmington Avenue, MC 3910, Farmington, CT 06030-3910, United States.
| |
Collapse
|
31
|
Wendt DC, Gone JP. Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients. Int J Group Psychother 2018; 68:608-628. [PMID: 31527925 DOI: 10.1080/00207284.2018.1442225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.
Collapse
|
32
|
Wendt DC, Gone JP. Complexities with group therapy facilitation in substance use disorder specialty treatment settings. J Subst Abuse Treat 2018; 88:9-17. [PMID: 29606227 DOI: 10.1016/j.jsat.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 11/17/2022]
Abstract
In spite of increased attention to research-based interventions for substance use disorders (SUDs), a formidable research-practice gap impedes the implementation of evidence-based treatments (EBTs). An underappreciated dimension of this gap is a mismatch in treatment modality: Whereas clinical trial and implementation research has focused primarily on individual therapy, the majority of SUD specialty treatment is in group format, with open-enrolling groups being most common. This study aims to narrow this research-practice gap by exploring clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. Semi-structured interviews were conducted with 13 group clinicians from among three outpatient SUD specialty clinics-diverse in their operational structures, treatment philosophies, clientele, and services-located in the same Midwestern U.S. metropolitan area. Interview questions addressed organizational characteristics, services provided, group therapy curricula, and use of EBTs or other structured treatments. Clinicians emphasized the importance of having flexibility in facilitating groups, through built-in group processes and clinicians' own adaptions and accommodations; this flexibility was especially emphasized for the use of EBTs or manualized interventions. Clinicians also had difficulties with group facilitation generally, as evidenced by their reported difficulty in managing complex group dynamics, their limited group therapy experience and training, and their reliance on educational groups. We discuss specific strategies for improved innovation and implementation of EBTs for SUD group therapy.
Collapse
Affiliation(s)
- Dennis C Wendt
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109, USA.
| | - Joseph P Gone
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109, USA.
| |
Collapse
|
33
|
Wendt DC, Gone JP. Group Therapy for Substance Use Disorders: A Survey of Clinician Practices. JOURNAL OF GROUPS IN ADDICTION & RECOVERY 2017; 12:243-259. [PMID: 30546274 PMCID: PMC6289265 DOI: 10.1080/1556035x.2017.1348280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Substance use disorder (SUD) treatment is typically delivered in group format, but clinical research focuses on individual therapy. This exploratory study narrows this gap through a survey of 566 SUD group clinicians in the United States, concerning most commonly used group practices, attitudes about evidence-based treatments (EBTs), and beliefs about addiction. Clinicians reported high use of open groups, moderately high utilization of EBT practices, and moderate use of questionable practices. Clinicians' attitudes about EBTs and beliefs about addiction were correlated with the use of certain EBTs and questionable practices. Strategies for implementation of EBTs in group settings are discussed.
Collapse
|
34
|
Sugarman DE, Reilly ME, Greenfield SF. Treatment Outcomes for Women with Substance Use Disorders: a Critical Review of the Literature (2010–2016). CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Osilla KC, Kulesza M, Miranda J. Bringing alcohol treatment to driving under the influence programs: Perceptions from first-time offenders. ALCOHOLISM TREATMENT QUARTERLY 2017; 35:113-129. [PMID: 28943712 DOI: 10.1080/07347324.2017.1288484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcohol use disorders (AUDs) are common among first-time driving under the influence (DUI) offenders. Individuals with a DUI arrest may attend a DUI alcohol education program for license reinstatement. We evaluated the acceptability of cognitive behavioral treatment (CBT) for AUDs adapted for DUI programs. Participants (N=35) were enrolled in one of two DUI programs in Los Angeles and were an average of 34.5 (SD=11.9) years old; 66% male; 37.1% African American, 34.2% Hispanic/Latino(a), and 20% non-Hispanic White. We analyzed data from ten focus groups and 35 self-report surveys that evaluated the nine-session CBT group protocol. Overall, participants stated that the CBT philosophy was acceptable and helpful in thinking about how to prevent future DUIs. They also found the coping skills in the sessions relevant to other life events and decisions. Participants valued the personal disclosure and interactive role-play and group exercises embedded within each session stating that these exercises helped with group cohesion and self-disclosure. Data from satisfaction surveys showed that participants reported high satisfaction ratings on the overall session, session content, and session facilitator. Future studies are needed to evaluate whether evidence-based treatment within DUI programs may increase access to evidence-base care among at-risk individuals who may not otherwise seek treatment for their AUDs.
Collapse
Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Magdalena Kulesza
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Jeanne Miranda
- Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, 10920 Wilshire Blvd. Suite 300, Los Angeles, CA 90024, USA
| |
Collapse
|
36
|
Abstract
The focus of this paper is to provide an update on the use of psychotherapy as a treatment in sport psychiatry, and the use of this approach to address common psychiatric issues encountered with this population. Specifically, family therapy, individual therapy, and group psychotherapy prescribed alone, or in combination with medication, will be examined as methods to manage issues/disorders often associated with athletes. These include obsessive-compulsive rituals and perfectionism, and aggressive and risky behaviours, such as gambling, infidelity, substance use, and suicidal ideation, narcissism, and aggression in the context of individual and team competitive sports.
Collapse
Affiliation(s)
- Mark A Stillman
- a Department of Clinical Medical Pschology , Mercer University, Health Sciences Center , Atlanta , GA , USA
| | - Tyler Brown
- b Mercer University, Health Sciences Center , Atlanta GA , USA
| | | | - Ira D Glick
- d Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
| |
Collapse
|
37
|
Pavia L, Di Blasi M, Cinquegrana A, Scioti E, Bussola T, Pasinelli A, Cavani P. The Influence of Retention, Turnover, and Alliance on Process and Outcomes in Rolling Group Psychotherapy for Cocaine Disorder. Int J Group Psychother 2016; 66:526-550. [PMID: 38475620 DOI: 10.1080/00207284.2016.1176491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A longitudinal repeated measures design was used to investigate the influence of treatment retention, and membership turnover on individual outcomes, and the relationship between individual-level and group-level therapeutic alliance in rolling group psychotherapy for individuals with cocaine abuse disorder. Eighteen patients were studied; data were collected prior to therapy and then monthly for 24 months. Patient outcomes and process were assessed. Improvements in symptoms and psychological functioning were associated with retention in psychotherapy. Membership turnover had a negative influence on symptoms. Development of an individual alliance was affected by the development of group-level therapeutic alliance, but not by time spent in therapy.
Collapse
|
38
|
Sugarman DE, Wigderson SB, Iles BR, Kaufman JS, Fitzmaurice GM, Hilario EY, Robbins MS, Greenfield SF. Measuring affiliation in group therapy for substance use disorders in the Women's Recovery Group study: Does it matter whether the group is all-women or mixed-gender? Am J Addict 2016; 25:573-80. [PMID: 27647710 DOI: 10.1111/ajad.12443] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A Stage II, two-site randomized clinical trial compared the manualized, single-gender Women's Recovery Group (WRG) to mixed-gender group therapy (Group Drug Counseling; GDC) and demonstrated efficacy. Enhanced affiliation and support in the WRG is a hypothesized mechanism of efficacy. This study sought to extend results of the previous small Stage I trial that showed the rate of supportive affiliative statements occurred more frequently in WRG than GDC. METHODS Participants (N = 158; 100 women, 58 men) were 18 years or older, substance dependent, and had used substances within the past 60 days. Women were randomized to WRG (n = 52) or GDC (n = 48). Group therapy videos were coded by two independent raters; Rater 1 coded 20% of videos (n = 74); Rater 2 coded 25% of videos coded by Rater 1 (n = 19). RESULTS The number of affiliative statements made in WRG was 66% higher than in GDC. Three of eight affiliative statement categories occurred more frequently in WRG than GDC: supportive, shared experience, and strategy statements. DISCUSSION AND CONCLUSIONS This larger Stage II trial provided a greater number of group therapy tapes available for analysis. Results extended our previous findings, demonstrating both greater frequency of all affiliative statements, as well as specific categories of statements, made in single-gender WRG than mixed-gender GDC. SCIENTIFIC SIGNIFICANCE Greater frequency of affiliative statements among group members may be one mechanism of enhanced support and efficacy in women-only WRG compared with standard mixed-gender group therapy for substance use disorders. (Am J Addict 2016;25:573-580).
Collapse
Affiliation(s)
- Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sara B Wigderson
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Brittany R Iles
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | | | - Garrett M Fitzmaurice
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - E Yvette Hilario
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | | | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts. .,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
39
|
Shorey RC, Elmquist J, Wolford-Clevenger C, Gawrysiak MJ, Anderson S, Stuart GL. The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Res 2016; 238:122-128. [PMID: 27086221 PMCID: PMC4834542 DOI: 10.1016/j.psychres.2016.02.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/28/2015] [Accepted: 02/16/2016] [Indexed: 11/27/2022]
Abstract
Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.
Collapse
Affiliation(s)
- Ryan C Shorey
- Ohio University, Department of Psychology, Athens, OH, USA.
| | - JoAnna Elmquist
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN, USA
| | | | | | | | - Gregory L Stuart
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN, USA
| |
Collapse
|
40
|
Burlingame GM, Gleave R, Erekson D, Nelson PL, Olsen J, Thayer S, Beecher M. Differential effectiveness of group, individual, and conjoint treatments: An archival analysis of OQ-45 change trajectories. Psychother Res 2015; 26:556-72. [DOI: 10.1080/10503307.2015.1044583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
41
|
Beadnell B, Crisafulli MA, Stafford PA, Rosengren DB, DiClemente CC. Operating under the influence: Three year recidivism rates for motivation-enhancing versus standard care programs. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:48-56. [PMID: 25879708 DOI: 10.1016/j.aap.2015.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/17/2014] [Accepted: 03/21/2015] [Indexed: 06/04/2023]
Abstract
Operating a motor vehicle under the influence of alcohol (OUI) is an international problem. In the United States, one intervention strategy is to require offenders to attend group-delivered interventions. We compared three year rearrest rates among 12,267 individuals in Maine receiving either a motivation-enhancing (ME) program, Prime For Life(®), or historical standard care (SC) programs. We created two cohorts, one when Maine used SC (9/1/1999-8/31/2000) and one after the ME program was implemented (9/1/2002-8/31/2003). Adjusted for control variables, rearrest rates among people not completing an assigned program did not differ for the ME versus SC cohorts (12.1% and 11.6%, respectively; OR=1.05, ns). In contrast, ME compared to SC program completers had lower rearrest rates (7.4% versus 9.9%, OR=0.73, p<.05). The same pattern occurred for people required to take these programs plus substance use treatment (12.1% versus 14.7%, OR=0.82, p<.01). For those rearrested, time to rearrest did not differ between ME and SC cohorts. Among those required to have substance abuse treatment, ME and SC arrest rates did not differ for younger individuals; otherwise, the ME cohort's lower rearrest rates occurred across gender, age, having a previous OUI, and having completed a previous intervention program.
Collapse
Affiliation(s)
- Blair Beadnell
- Prevention Research Institute, 841 Corporate Drive, Suite 300, Lexington, KY 40503, USA.
| | - Michele A Crisafulli
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| | - Pamela A Stafford
- Prevention Research Institute, 841 Corporate Drive, Suite 300, Lexington, KY 40503, USA.
| | - David B Rosengren
- Prevention Research Institute, 841 Corporate Drive, Suite 300, Lexington, KY 40503, USA.
| | - Carlo C DiClemente
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| |
Collapse
|
42
|
Greenfield SF, Crisafulli MA, Kaufman JS, Freid CM, Bailey GL, Connery HS, Rapoza M, Rodolico J. Implementing substance abuse group therapy clinical trials in real-world settings: challenges and strategies for participant recruitment and therapist training in the Women's Recovery Group Study. Am J Addict 2014; 23:197-204. [PMID: 24724875 DOI: 10.1111/j.1521-0391.2014.12099.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/29/2013] [Accepted: 04/28/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Open-enrollment group therapy research is challenged by the participant recruitment necessary to ensure continuous group enrollment. We present successful strategies to overcome the following barriers during the Women's Recovery Group (WRG) two-site clinical trial (N = 158): maintenance of sample size and balanced gender randomization during continuous enrollment, maintenance of group attendance, and training and retention of therapists over the 24-month continuous group enrollment. METHODS To increase recruitment, we targeted referral sources yielding the highest enrollment conversion at each site. Group sessions were consistently held regardless of group size. Therapists were trained in two teams allowing for coverage and uninterrupted treatment over 24 months. RESULTS At both sites recruitment and enrollment increased with each successive quarter. Sample size and end date targets were met without disruptions in treatment. Group therapists reported high satisfaction with their training and treatment experiences. DISCUSSION AND CONCLUSIONS These strategies supported targeted enrollment and study duration, stability of open-enrollment group therapy frame, and therapist retention and satisfaction. SCIENTIFIC SIGNIFICANCE Applying these strategies can aid in providing evidence-based group therapy in both clinical and research settings.
Collapse
Affiliation(s)
- Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Greenfield SF, Sugarman DE, Freid CM, Bailey GL, Crisafulli MA, Kaufman JS, Wigderson S, Connery HS, Rodolico J, Morgan-Lopez AA, Fitzmaurice GM. Group therapy for women with substance use disorders: results from the Women's Recovery Group Study. Drug Alcohol Depend 2014; 142:245-53. [PMID: 25042759 PMCID: PMC4150678 DOI: 10.1016/j.drugalcdep.2014.06.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/18/2014] [Accepted: 06/21/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND This Stage II trial builds on a Stage I trial comparing the single-gender Women's Recovery Group (WRG) to mixed-gender Group Drug Counseling (GDC) that demonstrated preliminary support for the WRG in treating women with substance use disorders. The Stage II trial aims were to (1) investigate effectiveness of the WRG relative to GDC in a sample of women heterogeneous with respect to substance of abuse and co-occurring psychiatric disorders, and (2) demonstrate the feasibility of implementing WRG in an open-enrollment group format at two sites. METHOD In this randomized clinical trial, participants were included if they were substance dependent and had used substances within the past 60 days (n=158). Women were randomized to WRG (n=52) or GDC (n=48); men were assigned to GDC (n=58). Substance use outcomes were assessed at months 1-6 and 9. RESULTS Women in both the WRG and GDC had reductions in mean number of substance use days during treatment (12.7 vs 13.7 day reductions for WRG and GDC, respectively) and 6 months post-treatment (10.3 vs 12.7 day reductions); however, there were no significant differences between groups. CONCLUSIONS The WRG demonstrated comparable effectiveness to standard mixed-gender treatment (i.e., GDC) and is feasibly delivered in an open-group format typical of community treatment. It provides a manual-based group therapy with women-focused content that can be implemented in a variety of clinical settings for women who are heterogeneous with respect to their substance of abuse, other co-occurring psychiatric disorders, and life-stage.
Collapse
Affiliation(s)
- Shelly F Greenfield
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States.
| | - Dawn E Sugarman
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Cathryn M Freid
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States
| | - Genie L Bailey
- Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02912, United States; Stanley Street Treatment and Resources, Fall River, MA 02720, United States
| | - Michele A Crisafulli
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD 21250, United States
| | - Julia S Kaufman
- Miami University, Department of Psychology, Oxford, OH 45056, United States
| | - Sara Wigderson
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Hilary S Connery
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - John Rodolico
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Antonio A Morgan-Lopez
- RTI International, Risk Behavior and Family Research Program, Research Triangle Park, NC 27709, United States
| | - Garrett M Fitzmaurice
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| |
Collapse
|
44
|
Brooks AC, Carpenedo CM, Fairfax-Columbo J, Clements NT, Benishek LA, Knoblach D, Carise D, Kirby KC. The RoadMAP Relapse Prevention Group Counseling Toolkit™: counselor adherence and competence outcomes. J Subst Abuse Treat 2013; 45:356-62. [PMID: 23810230 DOI: 10.1016/j.jsat.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 04/30/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
Training counselors in empirically supported treatments (ESTs) far exceeds the ever decreasing resources of community-based treatment agencies. The purpose of this study was to examine outpatient substance abuse group counselors' (n=19) adherence and competence in communicating and utilizing concepts associated with empirically-supported relapse prevention treatment following a brief multimedia toolkit (RoadMAP Toolkit™) training. Moderate or large baseline to post-training effect sizes for counselor adherence to toolkit content were identified for 13 of 21 targeted behaviors (overall d range=.06-2.85) with the largest gains on items measuring active skill practice. Post-training adherence gains were largely maintained at the 6-month follow-up, although no statistically significant improvements were identified over time for counselor competence. This study provides important preliminary support for using a multi-media curriculum approach to increase empirically-supported relapse prevention skills among group counselors. Future research should focus on finding ways to improve counselor skill level and to determine the impact of the Toolkit on client outcomes.
Collapse
Affiliation(s)
- Adam C Brooks
- Treatment Research Institute, 150 S. Independence Mall West, Philadelphia, PA 19106, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Thompson-Brenner H, Franko DL, Thompson DR, Grilo CM, Boisseau CL, Roehrig JP, Richards LK, Bryson SW, Bulik CM, Crow SJ, Devlin MJ, Gorin AA, Kristeller JL, Masheb R, Mitchell JE, Peterson CB, Safer DL, Striegel RH, Wilfley DE, Wilson GT. Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder. J Consult Clin Psychol 2013; 81:710-21. [PMID: 23647283 DOI: 10.1037/a0032946] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and posttreatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome. METHOD Data were aggregated from 11 randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multilevel regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission. RESULTS Moderator analyses of race/ethnicity and education were nonsignificant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater posttreatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome. CONCLUSIONS Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups.
Collapse
|
46
|
Harpaz-Rotem I, Libby D, Rosenheck RA. Psychotherapy use in a privately insured population of patients diagnosed with a mental disorder. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1837-44. [PMID: 22349151 DOI: 10.1007/s00127-012-0486-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Although there is growing evidence demonstrating the effectiveness of psychotherapy in the treatment of mental disorders, the use of psychotherapy in privately insured populations has not been examined. This study examines utilization rates and correlates of the receipt of psychotherapy. METHODS A large claims database of US private sector claims was used to examine utilization rates and correlates of receipt of psychotherapy. Altogether, 860,090 adults who received mental health services in 2005 were identified from the database. Multivariate binary regression and general linear models were used to assess the association of patient characteristics with use of psychotherapy, use of group or family therapy and the number of psychotherapy visits based on current procedural terminology (CPT) codes. RESULTS Only 32.4% of patients diagnosed with a mental illness received CPT codes indicating receipt of psychotherapy, and of these 96.5% received individual psychotherapy. Almost 75% of individuals diagnosed with posttraumatic stress disorder, 62% with major depressive disorder, and 54% with bipolar disorder received psychotherapy. Larger numbers of psychotherapy visits were associated with posttraumatic stress disorder (PTSD), alcohol use and mild depression. Larger numbers of psychotherapy visits were associated with PTSD, alcohol use and mild depression. Drug use, schizophrenia, bipolar disorder and major depressive disorder (MDD) were associated with fewer psychotherapy visits. CONCLUSIONS Substantial differences in use of psychotherapy were observed across diagnoses, perhaps reflecting the availability of alternative drug therapies. Greater use of psychotherapy in patients with PTSD may reflect weaker evidence of the effectiveness of pharmacological treatment, while less use in MDD may reflect greater evidence of drug benefits.
Collapse
|
47
|
Brooks AC, Diguiseppi G, Laudet A, Rosenwasser B, Knoblach D, Carpenedo CM, Carise D, Kirby KC. Developing an evidence-based, multimedia group counseling curriculum toolkit. J Subst Abuse Treat 2012; 43:178-89. [PMID: 22301082 DOI: 10.1016/j.jsat.2011.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 12/09/2011] [Accepted: 12/13/2011] [Indexed: 11/16/2022]
Abstract
Training community-based addiction counselors in empirically supported treatments (ESTs) far exceeds the ever-decreasing resources of publicly funded treatment agencies. This feasibility study describes the development and pilot testing of a group counseling toolkit (an approach adapted from the education field) focused on relapse prevention (RP). When counselors (N = 17) used the RP toolkit after 3 hours of training, their content adherence scores on "coping with craving" and "drug refusal skills" showed significant improvement, as indicated by very large effect sizes (Cohen's d = 1.49 and 1.34, respectively). Counselor skillfulness, in the "adequate-to-average" range at baseline, did not change. Although this feasibility study indicates some benefit to counselor EST acquisition, it is important to note that the impact of the curriculum on client outcomes is unknown. Because a majority of addiction treatment is delivered in group format, a multimedia curriculum approach may assist counselors in applying ESTs in the context of actual service delivery.
Collapse
Affiliation(s)
- Adam C Brooks
- Treatment Research Institute, Philadelphia, PA 19106, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Hien DA, Morgan-Lopez AA, Campbell ANC, Saavedra LM, Wu E, Cohen L, Ruglass L, Nunes EV. Attendance and substance use outcomes for the Seeking Safety program: sometimes less is more. J Consult Clin Psychol 2012; 80:29-42. [PMID: 22182262 PMCID: PMC3682930 DOI: 10.1037/a0026361] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups. METHOD Women receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover. RESULTS Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels. CONCLUSIONS The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population.
Collapse
Affiliation(s)
- Denise A Hien
- Department of Clinical Psychology, Graduate Center, City College of the City University of New York, 160 Convent Avenue, New York, NY 10030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed.
Collapse
Affiliation(s)
- Ken C Winters
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA.
| | | | | |
Collapse
|
50
|
Kim JW, Choi YS, Shin KC, Kim OH, Lee DY, Jung MH, Lee BC, Kang TC, Choi IG. The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcohol Clin Exp Res 2011; 36:686-92. [PMID: 21950637 DOI: 10.1111/j.1530-0277.2011.01643.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Group psychotherapy (PT) is one of the most common interventions used to treat alcohol dependence (AD), and it is assumed to be effective. Despite its common clinical use, long-term trials that have been conducted to examine the efficacy of group PT in the treatment of outpatients with AD are limited and often lack appropriate comparisons. On that basis, a long-term comparative trial was performed with the main objective of evaluating the effectiveness of continuing group PT for outpatients with AD. METHODS Quasi-experimental trial was conducted from January 2004 to May 2010 in 177 AD subjects who had completed an inpatient 10-week alcohol treatment program. Abstinence rates of the combined group (experimental group: outpatient individual PT plus group PT, N = 94) and the standard outpatient individual PT-only group (comparison group, N = 83) were statistically compared using Kaplan-Meier survival analysis. Predictive factors of abstinence rate for alcohol were assessed using Cox regression analysis. RESULTS Abstinence rates of the combined PT group were significantly high relative to those of the outpatient individual PT-only group. Significant predictive factors for the alcohol abstinence rate were outpatient group PT and age. Even after controlling for confounding factors, outpatient group PT was a significant predictive factor for the alcohol abstinence rate. CONCLUSIONS Our findings indicate that for AD patients who had completed an inpatient 10-week alcohol treatment, outpatient group PT appears to be an effective form of continuing care or aftercare within the context of an outpatient service delivery system.
Collapse
Affiliation(s)
- Jee Wook Kim
- Department of Neuropsychiatry, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|