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Oluwoye O, Hirchak K, Leickly E, Skalisky J, McPherson S, Srebnik D, Roll JM, Ries RK, McDonell MG. Interaction between pre-treatment drug use and heterogeneity of psychiatric diagnosis predicts outcomes in outpatients with co-occurring disorders. Psychiatry Res 2018; 260:233-235. [PMID: 29220679 PMCID: PMC5975078 DOI: 10.1016/j.psychres.2017.11.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/06/2017] [Accepted: 11/25/2017] [Indexed: 11/30/2022]
Abstract
We examined whether the interaction of baseline stimulant use, assessed by urine drug tests, and type of serious mental illness (SMI) diagnosis predicted stimulant use in a trial of contingency management (CM). The interaction between baseline stimulant use and SMI diagnoses was significant in the overall sample (p=0.002) when controlling for the main effects of treatment condition, baseline stimulant use, and SMI diagnosis. Similar results were also found within the CM sample. Individuals with bipolar disorder were more or less likely, depending on their baseline stimulant-drug test results, to use stimulants during treatment compared to those with other SMI diagnoses.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
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A Comparison of Five Reinforcement Schedules for use in Contingency Management-Based Treatment of Methamphetamine Abuse. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Davidson A, Jensen M, Burgess E, Stevens A, Hayes L, Sieweke S, Stough K, Wright A, McCarty R, Eddleman L, Kim YI, Milby JB, Schumacher JE. Effects of therapeutic goal management (TGM) on treatment attendance and drug abstinence among men with co-occurring substance use and axis I mental disorders who are homeless: results of the Birmingham EARTH program. Addict Sci Clin Pract 2013; 8:17. [PMID: 24499617 PMCID: PMC3829098 DOI: 10.1186/1940-0640-8-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/21/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose This study describes the implementation and impact of Therapeutic Goal Management (TGM) in a Substance Abuse and Mental Health Services Administration (SAMHSA)-sponsored demonstration project entitled Enhanced Addiction Recovery through Housing (EARTH). Participants The sample included 28 male participants followed at six months who completed some treatment. Forty-three percent were Caucasian, and 57% were African American. The average age of participants was 42 years. Design The relationships between TGM goal achievement, treatment attendance, and drug abstinence outcomes were studied among EARTH program participants who were homeless and met criteria for co-occurring substance use and severe DSM-IV Axis I mental disorders. Results The results revealed an overall drug abstinence rate of 72.4% over six months and significant positive relationships between TGM goal achievement and drug abstinence (r = 0.693) and TGM goal achievement and treatment attendance (r = 0.843). Conclusions This research demonstrated the relationship and potential positive impact of systematically setting, monitoring, and reinforcing personalized goals in multiple life areas on drug abstinence and treatment attendance outcomes among persons who are homeless with co-occurring substance use and other Axis I disorders in a integrated community service delivery program.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joseph E Schumacher
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT 616, Birmingham, AL 35205, USA.
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Roll JM, Chudzynski J, Cameron JM, Howell DN, McPherson S. Duration effects in contingency management treatment of methamphetamine disorders. Addict Behav 2013; 38:2455-62. [PMID: 23708468 DOI: 10.1016/j.addbeh.2013.03.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/23/2013] [Accepted: 03/27/2013] [Indexed: 11/26/2022]
Abstract
The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of the four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of the three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p<0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p<0.05) and time (p<0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence.
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Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness. Prev Med 2012; 55 Suppl:S54-60. [PMID: 22197799 PMCID: PMC3336027 DOI: 10.1016/j.ypmed.2011.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/23/2011] [Accepted: 11/30/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed. METHODS Published reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed. RESULTS Results of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted. CONCLUSION Given the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.
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Petry NM, Ford JD, Barry D. Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:293-300. [PMID: 21443305 DOI: 10.1037/a0022632] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exposure to sexual victimization is prevalent among persons with substance use disorders (SUDs). Contingency management (CM) treatments utilize concrete and relatively immediate positive reinforcers to retain patients in treatment and reduce substance use, and CM may have particular benefits for patients with histories of sexual victimization. Using data from three randomized trials of CM (N = 393), this study evaluated main and interactive effects of sexual abuse history and treatment condition (standard care versus CM) with respect to during treatment outcomes (retention, proportion of negative urine samples submitted, and longest duration of abstinence) and abstinence at a nine-month follow-up. Compared to patients without sexual abuse histories (N = 316), those with sexual abuse histories (N = 77) submitted a significantly higher proportion of negative samples in treatment. In CM, but not in standard care, patients with sexual abuse histories achieved significantly longer durations of abstinence during treatment than those without sexual abuse histories. Although sexual abuse history was not associated with abstinence at nine-month follow-up evaluations, longest duration of abstinence during treatment was significantly associated with this long-term outcome. Results suggest that SUD patients with sexual abuse histories may accrue particular benefits during CM treatment that are associated with long-term abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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Affiliation(s)
- Nancy M Petry
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
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Austin J, McKellar JD, Moos R. The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders. Addict Behav 2011; 36:941-4. [PMID: 21620571 DOI: 10.1016/j.addbeh.2011.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 04/11/2011] [Accepted: 05/03/2011] [Indexed: 11/30/2022]
Abstract
The current study examined the relationship between co-occurring substance use and Axis I psychiatric disorders and treatment utilization and outcome among homeless individuals (N=365) who participated in an episode of intensive outpatient substance use treatment. Compared to patients without a co-occurring diagnosis, homeless patients with a diagnosis of major depressive disorder or PTSD participated in more substance use treatment. Diagnostic status did not predict 12-month alcohol or drug treatment outcome. Substance use treatment programs appear to successfully engage homeless individuals with major depressive disorder and PTSD in treatment. Such individuals appear to achieve similar benefits from standard substance use treatment as do homeless individuals without such disorders.
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McGovern MP, Lambert-Harris C, Alterman AI, Xie H, Meier A. A Randomized Controlled Trial Comparing Integrated Cognitive Behavioral Therapy Versus Individual Addiction Counseling for Co-occurring Substance Use and Posttraumatic Stress Disorders. J Dual Diagn 2011; 7:207-227. [PMID: 22383864 PMCID: PMC3289146 DOI: 10.1080/15504263.2011.620425] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE: Co-occurring posttraumatic stress (PTSD) and substance use disorders provide clinical challenges to addiction treatment providers. Interventions are needed that are effective, well-tolerated by patients, and capable of being delivered by typical clinicians in community settings. This is a randomized controlled trial of integrated cognitive behavioral therapy for co-occurring PTSD and substance use disorders. METHODS: Fifty-three participants sampled from seven community addiction treatment programs were randomized to integrated cognitive behavioral therapy plus standard care or individual addiction counseling plus standard care. Fourteen community therapists employed by these programs delivered both manual-guided therapies. Primary outcomes were PTSD symptoms, substance use symptoms and therapy retention. Participants were assessed at baseline, 3- and 6-month follow-up. RESULTS: Integrated cognitive behavioral therapy was more effective than individual addiction counseling in reducing PTSD re-experiencing symptoms and PTSD diagnosis. Individual addiction counseling was comparably effective to integrated cognitive behavioral therapy in substance use outcomes and on other measures of psychiatric symptom severity. Participants assigned to individual addiction counseling with severe PTSD were less likely to initiate and engage in the therapy than those assigned to integrated cognitive behavioral therapy. In general, participants with severe PTSD were more likely to benefit from integrated cognitive behavioral therapy. CONCLUSIONS: The findings support the promise of efficacy of integrated cognitive behavioral therapy in improving outcomes for persons in addiction treatment with PTSD. Community counselors delivered both interventions with satisfactory adherence and competence. Despite several limitations to this research, a larger randomized controlled trial of integrated cognitive behavioral therapy appears warranted.
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Affiliation(s)
- Mark P McGovern
- Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USA
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Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, Hillhouse M, Ang A, Rawson R. Anxiety disorders among methamphetamine dependent adults: association with post-treatment functioning. Am J Addict 2010; 19:385-90. [PMID: 20716300 DOI: 10.1111/j.1521-0391.2010.00061.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although anxiety is one of the most prominent psychiatric complaints of methamphetamine (MA) users, little is known about the association between anxiety disorders and treatment outcomes in this population. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant anxiety disorders 3 years after treatment. Anxiety disorders were associated with poorer alcohol and drug use outcomes, increased health service utilization, and higher levels of psychiatric symptomatology, including suicidality. Addressing anxiety symptoms and syndromes in MA users may be helpful as a means of optimizing treatment outcomes.
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Burns MN, Lehman KA, Milby JB, Wallace D, Schumacher JE. Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence? Behav Res Ther 2010; 48:588-98. [PMID: 20363465 PMCID: PMC2878926 DOI: 10.1016/j.brat.2010.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 02/27/2010] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
Abstract
Homeless individuals (n=187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.
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Affiliation(s)
- Michelle Nicole Burns
- University of Alabama at Birmingham Campbell Hall / Suite 415 1300 University Blvd Birmingham, AL 35294-1170 USA , ,
| | - Kenneth A. Lehman
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine 680 N Lake Shore Dr., Suite 1220 Chicago, IL 60611
| | - Jesse B. Milby
- University of Alabama at Birmingham Campbell Hall / Suite 415 1300 University Blvd Birmingham, AL 35294-1170 USA , ,
| | - Dennis Wallace
- RTI International 3040 East Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 USA
| | - Joseph E. Schumacher
- University of Alabama at Birmingham Campbell Hall / Suite 415 1300 University Blvd Birmingham, AL 35294-1170 USA , ,
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Milby JB, Schumacher JE, Wallace D, Vuchinich R, Mennemeyer ST, Kertesz SG. Effects of sustained abstinence among treated substance-abusing homeless persons on housing and employment. Am J Public Health 2009; 100:913-8. [PMID: 19833998 DOI: 10.2105/ajph.2008.152975] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether cocaine-dependent homeless persons had stable housing and were employed 6, 12, and 18 months after they entered a randomized controlled trial comparing 2 treatments. METHODS One group (n = 103) received abstinence-contingent housing, vocational training, and work; another group (n = 103) received the same intervention plus cognitive behavioral day treatment. We examined baseline and early treatment variables for association with long-term housing and employment. RESULTS Although the enhanced-treatment group achieved better abstinence rates, the groups did not differ in long-term housing and employment stability. However, consecutive weeks of abstinence during treatment (and to a lesser extent, older age and male gender) predicted long-term housing and employment stability after adjustment for baseline differences in employment, housing, and treatment. CONCLUSIONS Our data showed a relationship of abstinence with housing stability. Contrasting these results with the increasingly popular Housing First interventions reveals important gaps in our knowledge to be addressed in future research.
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Affiliation(s)
- Jesse B Milby
- Department of Psychology, University of Alabama at Birmingham, CH 201, 1530 3rd Ave S, Birmingham, AL 35294-1170, USA.
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12
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Racial/Ethnic Differences in Dually Diagnosed Anglo and Ethnic Minority Women Receiving Chemical Dependency Treatment. J Ethn Subst Abuse 2008; 3:1-16. [PMID: 29019292 DOI: 10.1300/j233v03n03_01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article examines racial/ethnic differences in a sample of 51 dually diagnosed women who received chemical dependency treatment. Comparisons are made between Anglo and racial/ethnic minority women at admission to the inpatient treatment program and at follow-up where data are available. Findings from a repeated measures design showed significant decreases in several problem domains for the overall sample. Significant racial/ethnic differences were found only for the other drugs domain. Anglo women reported greater decreases than racial/ethnic minority women in the majority of the domains. Findings suggest continued investigations to inform culturally competent treatment for all dually diagnosed women.
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Milby JB, Schumacher JE, Vuchinich RE, Freedman MJ, Kertesz S, Wallace D. Toward cost-effective initial care for substance-abusing homeless. J Subst Abuse Treat 2008; 34:180-91. [PMID: 17512156 PMCID: PMC2764243 DOI: 10.1016/j.jsat.2007.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 02/28/2007] [Accepted: 03/04/2007] [Indexed: 11/17/2022]
Abstract
In a randomized controlled trial, behavioral day treatment, including contingency management (CM+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM+ also received cognitive-behavioral therapy, therapeutic goal management, and other intervention components. Results revealed that CM+ treatment attendance and abstinence were not significantly different from CM during 24 weeks of treatment. After treatment and contingencies ended, however, CM+ showed more abstinence than CM, indicating a delayed effect of treatment from 6 to 18 months. CM+ had more consecutive weeks abstinent across 52 weeks, but not during active treatment. We conclude that CM alone may be viable as initial care for cocaine-dependent homeless persons. That CM+ yields more durable abstinence indicates that it may be appropriate as stepped-up care for clients not responding to CM (Clinical Trials.gov, no. NCT00368524).
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Affiliation(s)
- Jesse B Milby
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294-1170, USA.
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Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, Hillhouse M, Ang A, Rawson R. Clinical course and outcomes of methamphetamine-dependent adults with psychosis. J Subst Abuse Treat 2008; 35:445-50. [PMID: 18294802 DOI: 10.1016/j.jsat.2007.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 12/06/2007] [Accepted: 12/25/2007] [Indexed: 10/22/2022]
Abstract
Little is known about the association between psychosis and treatment outcomes in methamphetamine (MA) users. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant psychotic illness 3 years after treatment. The presence of a psychotic disorder was associated with increased health service utilization and higher levels of psychiatric symptomatology across multiple domains over time. MA users with co-occurring psychotic illness may therefore benefit from early psychosocial and/or pharmacologic interventions to address psychiatric symptoms.
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Affiliation(s)
- Suzette Glasner-Edwards
- Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA.
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Lester KM, Milby JB, Schumacher JE, Vuchinich R, Person S, Clay OJ. Impact of behavioral contingency management intervention on coping behaviors and PTSD symptom reduction in cocaine-addicted homeless. J Trauma Stress 2007; 20:565-75. [PMID: 17721968 DOI: 10.1002/jts.20239] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to examine changes in posttrauma symptoms among 118 homeless cocaine-dependent adults participating in a randomly controlled trial studying effective treatments for dually diagnosed homeless individuals. Among those with trauma exposure and PTSD symptoms, the group receiving more behaviorally intensive, contingency management treatment had significantly greater reductions in PTSD symptomatology than did the group receiving less-intensive treatment. Regression analyses revealed that greater positive distraction coping and lower negative avoidance coping at baseline, in addition to changes in avoidance coping over the 6-month study period, were significantly related to greater symptom and severity reductions. The study provides some initial evidence of important treatment outcomes other than abstinence in addiction-related interventions.
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Affiliation(s)
- Kristin M Lester
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Kertesz SG, Mullins AN, Schumacher JE, Wallace D, Kirk K, Milby JB. Long-term housing and work outcomes among treated cocaine-dependent homeless persons. J Behav Health Serv Res 2006; 34:17-33. [PMID: 17171458 PMCID: PMC1885681 DOI: 10.1007/s11414-006-9041-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 10/11/2006] [Indexed: 11/30/2022]
Abstract
Communities across the United States have initiated plans to end chronic homelessness. In many of these communities, addiction treatment programs remain the default point of entry to housing and services. This study examined the percentage of cocaine-using homeless persons (all with psychiatric distress) attaining stable housing and employment 12 months after entering a randomized trial of intensive behavioral day treatment, plus one of the following for 6 months: no housing; housing contingent on drug abstinence; housing not contingent on abstinence. Of 138 participants, the percentages with stable housing and employment at 12 months were 34.1 and 33.3%, respectively. Analyses suggested superior outcomes in trial arms that offered housing as part of the behavioral treatment. The majority of participants, however, did not achieve housing or employment, in part because of the limited capacity of the local housing programs to accommodate persons who had not achieved perfect abstinence. The findings demonstrate a helpful role for addiction treatment and suggest the need for services to support housing of persons who reduce but do not eliminate all substance use.
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Affiliation(s)
- Stefan G Kertesz
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham and Deep South Center on Effectiveness at Birmingham Veterans' Affairs Medical Center, 1530 3rd Ave South MT608, Birmingham, AL 35294-4410, USA.
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17
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Kertesz SG, Madan A, Wallace D, Schumacher JE, Milby JB. Substance abuse treatment and psychiatric comorbidity: do benefits spill over? Analysis of data from a prospective trial among cocaine-dependent homeless persons. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2006; 1:27. [PMID: 16965639 PMCID: PMC1584225 DOI: 10.1186/1747-597x-1-27] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 09/11/2006] [Indexed: 11/10/2022]
Abstract
Background Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied. Results Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996–1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12). Conclusion Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population.
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Affiliation(s)
- Stefan G Kertesz
- Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine and the Deep South Center on Effectiveness at the Birmingham Veterans' Affairs Medical Center; 1530 3rd Ave South MT 608 Birmingham, Alabama 35294, USA
| | - Alok Madan
- Department of Psychiatry, University of North Carolina School of Medicine, Medical School Wing E, CB#7205 Chapel Hill, North Carolina 27599-7205, USA
| | - Dennis Wallace
- Rho Federal Systems, Inc., Chapel Hill, North Carolina 27517, USA
| | - Joseph E Schumacher
- Division of Preventive Medicine, The University of Alabama at Birmingham, School of Medicine. 1530 3rd Ave South MT 616 Birmingham, Alabama 35294, USA
| | - Jesse B Milby
- Department of Psychology, The University of Alabama at Birmingham, Division of Preventive Medicine, The University of Alabama at Birmingham, 1530 3rd Ave South CH 415 Birmingham, Alabama 35294, USA
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Roll JM, Prendergast ML, Sorensen K, Prakash S, Chudzynski JE. A comparison of voucher exchanges between criminal justice involved and noninvolved participants enrolled in voucher-based contingency management drug abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2005; 31:393-401. [PMID: 16161725 DOI: 10.1081/ada-200056774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This report compares requests for goods or services made by participants in two clinical trials of contingency management for the treatment of substance abuse. One trial was for participants involved with the criminal justice system and one was for participants who were not involved with the criminal justice system. In both trials, participants earned vouchers that could be exchanged for goods or services. Results indicated that the criminal justice group used the majority of their vouchers for paying fees or fines related to the criminal justice system while the other group used only a small portion of their vouchers for paying costs related to the criminal justice system. However, when the costs for the criminal justice system are removed, the proportion of vouchers exchanged for various goods and services are similar between the two groups. The results suggest that for those substance abusers involved in the criminal justice system, assistance in paying fines and fees related to their criminal justice system involvement may be a potentially powerful source of reinforcement that could be used in creative treatment strategies.
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Affiliation(s)
- John M Roll
- University of California Los Angeles, Integrated Substance Abuse Programs, Los Angeles, California, USA.
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Carroll KM. Behavioral therapies for co-occurring substance use and mood disorders. Biol Psychiatry 2004; 56:778-84. [PMID: 15556123 PMCID: PMC3693566 DOI: 10.1016/j.biopsych.2004.07.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 07/14/2004] [Accepted: 07/20/2004] [Indexed: 11/24/2022]
Abstract
There has been marked progress in recent years in the development of effective behavioral therapies for substance use disorders and in the largely independent development of behavioral therapies for mood disorders. Until recently, however, there were few well-specified behavioral approaches that incorporated an integrated approach for individuals in whom these disorders co-occur. The emerging literature on the efficacy of several types of behavioral therapy for engaging individuals with co-occurring mood and substance use disorders in treatment, reducing substance use and affective symptoms, enhancing adherence, and preventing disengagement and relapse is reviewed, followed by discussion of the challenges likely to be met in integrating these behavioral approaches into clinical practice.
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Affiliation(s)
- Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516, USA.
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Schumacher JE, Milby JB, Wallace D, Simpson C, Frison S, McNamara C, Usdan S. Diagnostic compared with abstinence outcomes of day treatment and contingency management among cocaine-dependent homeless persons. Exp Clin Psychopharmacol 2003; 11:146-57. [PMID: 12755459 DOI: 10.1037/1064-1297.11.2.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substance use disorder diagnoses were used as a treatment outcome measure in a randomized comparison of day treatment (DT) and day treatment plus contingency management (DT+) among homeless persons with primarily crack/cocaine disorders. Participants (N = 127, DT+ = 69, DT = 58, 73.2% male, 82.7% African American) were assessed at baseline and 6-month treatment completion. Binary positive and negative diagnostic outcomes for cocaine, marijuana, and alcohol were compared by treatment group. DT+ was 2.1 times more likely to have a positive treatment outcome than DT. Concordance between diagnostic change and point and continuous abstinence outcomes were found. The use of diagnostic change can be a practical addition to drug toxicology and self-report treatment outcome measures for research and practice.
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