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Bórquez I, Cerdá M, González-Santa Cruz A, Krawczyk N, Castillo-Carniglia Á. Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile. Addiction 2024; 119:753-765. [PMID: 38192124 DOI: 10.1111/add.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. DESIGN National-level registry-based retrospective cohort. SETTING AND PARTICIPANTS Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). MEASUREMENTS Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. FINDINGS A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups. CONCLUSIONS In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.
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Affiliation(s)
- Ignacio Bórquez
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Andrés González-Santa Cruz
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- School of Public Health, Universidad de Chile, Santiago, Chile
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Álvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
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Faltushanskiy Z, Herrold AA, Werby J, Betteridge EM, Angres D. Personality predicting relapse: A facet analysis of the NEO PI-R. Am J Addict 2024; 33:58-64. [PMID: 37667561 DOI: 10.1111/ajad.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Revised NEO Personality Inventory (NEO PI-R) domains are associated with substance use disorders (SUD), including potential for relapse. However, individual facets of the NEO PI-R domains have not been rigorously analyzed. This paper assesses NEO PI-R individual facets among participants with SUD and their value in predicting relapse. METHODS Between 2015 and 2018, all patients admitted to a single private rehabilitation center (n = 642) were offered participation in this study. Participants who completed NEO PI-R questionnaires at the start of treatment and with known relapse outcomes up to 1-year posttreatment were included (n = 441). Statistical analysis included a series of unadjusted univariate logistic regressions and additional adjusted multivariate regression controlling for employment status in healthcare. RESULTS Neuroticism, Agreeableness, and Conscientiousness domains had significant impacts on relapse. Three individual facets of Neuroticism were significant predictors of relapse, and seven individual facets within the Conscientiousness and Agreeableness domains were inversely related to relapse. When controlling for employment, Conscientiousness and three of its individual facets (Dutifulness, Competence, and Self-Discipline) continued to be significant in predicting relapse. The individual facets Impulsiveness and Straightforwardness also continued to be significant in predicting relapse. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Several personality domains and facets were significantly related to relapse, confirming and expanding on prior literature. This study focuses on the risk of relapse as it relates to NEO PI-R individual facets, which have not been previously explored with a sample size of this magnitude. These findings can guide clinical care of patients with SUD, allowing for more targeted treatment.
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Affiliation(s)
- Zalman Faltushanskiy
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy A Herrold
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Positive Sobriety Institute, Chicago, Illinois, USA
| | - Jasper Werby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eliza M Betteridge
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Angres
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Positive Sobriety Institute, Chicago, Illinois, USA
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Beaulieu M, Tremblay J, Bertrand K. Adjustments to Service Organization in Specialized Addiction Services and Clinical Strategies for Better Meeting the Needs of People with a Persistent Substance Use Disorder. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Gonzales-Castaneda R, McKay JR, Steinberg J, Winters KC, Yu CH(A, Valdovinos IC, Casillas JM, McCarthy KC. Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project. Subst Abus 2022; 43:1-12. [PMID: 31638878 PMCID: PMC7174140 DOI: 10.1080/08897077.2019.1671941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR-Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion. Method: Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recovery and prevent primary substance use relapse. The data come from a two-group randomized controlled pilot study testing the initial efficacy of a mobile health texting aftercare intervention among 80 youth (Mage= 20.7, SD = 3.5, range: 14-26 years) who volunteered to participate after completing SUD treatment between 2012 and 2013. Results: Among the two recovery processes examined in the mediational modeling, only involvement in extracurricular activities mediated the effects of the texting aftercare intervention on reductions in primary substance use relapse; not self-help participation. Conclusion: Findings from this pilot study offer greater understanding about potential recovery-related mechanisms of action of mobile aftercare interventions. Mobile texting was found to promote increased engagement in recovery-related behaviors such as participation in extracurricular activities, which mediated the effects of the mobile aftercare intervention on decreasing primary substance use relapse. Findings suggest mobile approaches may be effective for increasing adherence to a wide-array of recovery behavioral regiments among youth populations challenged by complex behavioral issues.
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Affiliation(s)
- Rachel Gonzales-Castaneda
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA,Azusa Pacific University, Psychology Department, Azusa, CA
| | - James R. McKay
- University of Pennsylvania, Center on the Continuum of Care in the Addictions, Philadelphia, PA
| | - Jane Steinberg
- Azusa Pacific University, Psychology Department, Azusa, CA,Keck School of Medicine, University of Southern California, Los Angeles, CA
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Stanojlović M, Davidson L. Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:1178221820976988. [PMID: 34211275 PMCID: PMC8216338 DOI: 10.1177/1178221820976988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022]
Abstract
Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Cheung CK, Ngai SSY. Encouraging the Disuse of Illicit Drugs Among At-Risk Youth. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2016; 60:640-656. [PMID: 25472992 DOI: 10.1177/0306624x14561432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Youth at risk of illicit drug abuse and other delinquent acts are the target of social work services. Preventing or discouraging the use of illicit drugs among at-risk youth is a long-standing practical and research concern. For this reason, the preventive function of courage is a research gap the present study seeks to fill. The study collected data from 169 at-risk youths and their social workers with two-wave panel surveys. Results show that courage in Wave 1 presented a strong negative effect on illicit drug use in Wave 2 in the youth, controlling for illicit drug use in Wave 1 and background characteristics. Moreover, the negative effect was stronger when Wave 1 drug use was more likely. These results imply the helpfulness of encouraging at-risk youth to gather courage to resist the temptation to use illicit drugs.
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Elison S, Weston S, Dugdale S, Ward J, Davies G. A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616630013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.
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McCollister K, Yang X, McKay JR. Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults. Drug Alcohol Depend 2016; 158:38-44. [PMID: 26621551 PMCID: PMC4698077 DOI: 10.1016/j.drugalcdep.2015.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period. METHODS Intervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. RESULTS From the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. CONCLUSIONS Telephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. CLINICAL TRIAL REGISTRATION Clinical Trials.gov Number: NCT00685659.
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Affiliation(s)
- Kathryn McCollister
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Xuan Yang
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James R. McKay
- University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
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Hilton TF, Pilkonis PA. The Key to Individualized Addiction Treatment is Comprehensive Assessment and Monitoring of Symptoms and Behavioral Change. Behav Sci (Basel) 2015; 5:477-95. [PMID: 26529025 PMCID: PMC4695774 DOI: 10.3390/bs5040477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022] Open
Abstract
Modern health services now strive for individualized treatment. This approach has been enabled by the increase in knowledge derived from neuroscience and genomics. Substance use disorders are no exception to individualized treatment even though there are no gene-specific medications yet available. What is available is the ability to quickly and precisely assess and monitor biopsychosocial variables known to vary during addiction recovery and which place addicts at increased risk of relapse. Monitoring a broad spectrum of biopsychosocial health enables providers to address diverse genome-specific changes that might trigger withdrawal from treatment or recovery relapse in time to prevent that from occurring. This paper describes modern measurement tools contained in the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) and the NIH Toolbox and suggests how they might be applied to support recovery from alcohol and other substance use disorders in both pharmacological and abstinence-oriented modalities of care.
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Affiliation(s)
| | - Paul A Pilkonis
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street Pittsburgh, PA 15213, USA.
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Elison S, Weston S, Davies G, Dugdale S, Ward J. Findings from mixed-methods feasibility and effectiveness evaluations of the “Breaking Free Online” treatment and recovery programme for substance misuse in prisons. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1090397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah Elison
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | - Samantha Weston
- School of Sociology and Criminology, University of Keele, Keele, Staffs, Staffs, UK
| | - Glyn Davies
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | | | - Jonathan Ward
- Breaking Free Group, 274 Deansgate, Manchester, UK and
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Gonzales R, Ang A, Murphy DA, Glik DC, Anglin MD. Substance use recovery outcomes among a cohort of youth participating in a mobile-based texting aftercare pilot program. J Subst Abuse Treat 2014; 47:20-6. [PMID: 24629885 DOI: 10.1016/j.jsat.2014.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/20/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Abstract
Project ESQYIR (Educating & Supporting Inquisitive Youth in Recovery) is a pilot study examining the feasibility of a 12-week mobile-based aftercare intervention for youth (ages 12 to 24) transitioning out of community-based substance abuse treatment programs. From January 2012 through July 2013, a total of 80 youth were recruited from outpatient and residential treatment programs, geographically dispersed throughout Los Angeles County, California. Results revealed that youth who participated in the texting mobile pilot intervention were significantly less likely to relapse to their primary compared to the aftercare as usual control condition (OR=0.52, p=0.002) over time (from baseline throughout the 12-week aftercare pilot program to a 90-day follow-up). Participants in the texting aftercare pilot program also reported significantly less substance use problem severity (β=-0.46, p=0.03) and were more likely to participate in extracurricular recovery behaviors (β=1.63, p=0.03) compared to participants in the standard aftercare group. Collectively, findings from this pilot aftercare study suggest that mobile texting could provide a feasible way to engage youth in recovery after substance abuse treatment to aid with reducing relapse and promoting lifestyle behavior change.
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Affiliation(s)
- Rachel Gonzales
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA; Azusa Pacific University, Psychology Department, Azusa, CA.
| | - Alfonso Ang
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA
| | - Debra A Murphy
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA
| | - Deborah C Glik
- University of California at Los Angeles, School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - M Douglas Anglin
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA
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Fisher EA. Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment? PJE. PEABODY JOURNAL OF EDUCATION 2014; 89:258-270. [PMID: 24999290 PMCID: PMC4078875 DOI: 10.1080/0161956x.2014.897104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article seeks to address how our understanding of the recovery process and resulting supports can be made more comprehensive: how can links from treatment to home to school to communities be made so that there are fewer and fewer recovery gaps for adolescents? Using the ecology of recovery model developed by White (2009) as the impetus for such a review, the article discusses the challenges inherent within adolescent substance abuse recovery, factors impacting successful recovery, and programs addressing this issue that have been empirically studied. Studied programs can be categorized as (1) formalized aftercare recovery and (2) recovery communities, and both examples will be described using existing literature. From the review of existing recovery support research and resources, the discussion highlights gaps and future research areas in order to address the complexity of recovery among young people.
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Laudet A, Harris K, Kimball T, Winters KC, Moberg DP. Collegiate Recovery Communities Programs: What do we know and what do we need to know? JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2014; 14:84-100. [PMID: 24634609 PMCID: PMC3952555 DOI: 10.1080/1533256x.2014.872015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As the broad construct of recovery increasingly guides addiction services and policy, federal agencies have called for the expansion of peer-driven recovery support services. The high prevalence of substance use and abuse in colleges and universities in the U.S. constitute a significant obstacle to pursuing an education for the unknown number of youths who have attained remission from substance use dependence. Collegiate Recovery Programs (CRPs) are an innovative and growing model of peer-driven recovery support delivered on college campuses. Although no systematic research has examined CRPs, available site-level records suggest encouraging outcomes: low relapse rates and above average academic achievement. The number of CRPs nationwide is growing, but there is a noticeable lack of data on the model, its students and their outcomes. We review the literature supporting the need for the expansion of CRPs, present information on the diversity of CRP services and outline key areas where research is needed.
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Laudet AB, Humphreys K. Promoting recovery in an evolving policy context: what do we know and what do we need to know about recovery support services? J Subst Abuse Treat 2013; 45:126-33. [PMID: 23506781 PMCID: PMC3642237 DOI: 10.1016/j.jsat.2013.01.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/23/2012] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
Abstract
As both a concept and a movement, "recovery" is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery at National Development and Research Institutes, Inc., (NDRI), 71 West 23rd Street, 8th floor, NYC, NY 10010, USA.
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Manning V, Best D, Faulkner N, Titherington E, Morinan A, Keaney F, Gossop M, Strang J. Does active referral by a doctor or 12-Step peer improve 12-Step meeting attendance? Results from a pilot randomised control trial. Drug Alcohol Depend 2012; 126:131-7. [PMID: 22677458 DOI: 10.1016/j.drugalcdep.2012.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Active engagement in 12-Step self-help groups (SHG) is associated with improvements in substance use outcomes during and after treatment, yet levels of participation in SHG meetings in the U.K. remain low. METHOD An RCT investigating the impact of active referral to SHG, delivered by doctors or 12-Step peers during inpatient treatment on both inpatient and post-treatment meeting attendance was conducted. 151 inpatients with alcohol, opiate, crack-cocaine or benzodiazepine dependence undergoing detoxification, received one of two active referral interventions: 12-Step peer intervention (PI), doctor intervention (DI), or no intervention (NI). 83% of the sample was followed up, 2-3 months following discharge. RESULTS Active referral interventions significantly increased attendance at 12-Step meetings during inpatient treatment (88% versus 73%, p<.05). Rates of post-discharge meeting attendance were PI=64%, DI=48%, NI=33%, with those in the PI group significantly (OR=3.6; CI=1.3, 9.8) more likely to have attended. Inpatient meeting attenders were three times as likely to have attended meetings post-discharge (59% versus 20%, p<.01), and post-discharge meeting attenders reported significantly higher abstinence rates (60.8% versus 39.2%, p<.05) at follow-up. However, abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]). CONCLUSION Attendance at 12-Step SHGs is associated with greater rates of abstinence and active referral, especially by 12-Step peers, increases 12-Step SHG attendance rates. However, improved clinical outcomes among attendees might not occur until stronger recovery peer support networks are established. These results show promise for the benefit of incorporating Twelve Step Facilitation into U.K. treatment settings.
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Affiliation(s)
- Victoria Manning
- Kings College London, National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8BB, UK.
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Farabee D, Cousins SJ, Brecht ML, Antonini VP, Lee AB, Brummer J, Hemberg J, Karno M, Rawson RA. A comparison of four telephone-based counseling styles for recovering stimulant users. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 27:223-9. [PMID: 22867295 DOI: 10.1037/a0029572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The continuing development and refinement of empirically supported interventions to increase participation in posttreatment care and promote sustained abstinence from illicit drug use is a priority for the addictions field. The purpose of this study was to assess the combined and relative effectiveness of four types of counseling styles, delivered by telephone, relative to a no call control condition. Stimulant users (N = 302) were randomized to one of four low-cost, telephone support protocols (unstructured/nondirective, unstructured/directive, structured/nondirective, structured/directive) or a standard referral to aftercare without telephone counseling (control). All of the study participants were nearing the completion of (or had completed) an intensive phase of structured, outpatient stimulant abuse treatment. Drug use and aftercare participation were assessed at 3 and 12 months following randomization. Intent-to-treat analyses showed no significant time-by-group interactions for these primary outcomes. Subsequent analyses, however, revealed a significant difference between the aggregated call groups and the control group at the time of the 3-month follow-up. The mean ASI drug use severity composite score for subjects in the call conditions declining from .058 at baseline to .048 at 3 months, whereas the no call/control group average score increased from .053 to .062 (χ (1) = 4.95, p = .026). A similar-and slightly stronger-effect was found when the study sample was restricted to those reporting any use during the month prior to the baseline interview (n = 152). This study provides modest support for the telephone-based counseling approaches strategies examined in this project. Subsequent research will assess interactions between patient characteristics and counseling styles, and improved identification of which treatment graduates might be more likely to benefit from this type of continuing support. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Affiliation(s)
- David Farabee
- Integrated Substance Abuse Programs and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90025, USA.
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Achara-Abrahams I, Evans AC, Ortiz J, Lopez Villegas D, O'Dell J, Ali O, Hawkins D. Recovery Management and African Americans: A Report from the Field. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.691049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Sun AP. Helping homeless individuals with co-occurring disorders: the four components. SOCIAL WORK 2012; 57:23-37. [PMID: 22768626 DOI: 10.1093/sw/swr008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless individuals with co-occurring disorders (CODs) of severe mental illness and substance use disorder are one of the most vulnerable populations. This article provides practitioners with a framework and strategies for helping this client population. Four components emerged from a literature review: (1) ensuring an effective transition for individuals with CODs from an institution (such as a hospital, foster care, prison, or residential program) into the community, a particularly important component for clients who were previously homeless, impoverished, or at risk of homelessness; (2) increasing the resources of homeless individuals with CODs by helping them apply for government entitlements or supported employment (3) linking homeless individuals to supportive housing, including housing first options as opposed to only treatment first options, and being flexible in meeting their housing needs; and (4) engaging homeless individuals in COD treatment, incorporating modified assertive community treatment, motivational interviewing, cognitive-behavioral therapy, contingency management, and COD specialized self-help groups.
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Affiliation(s)
- An-Pyng Sun
- School of Social Work, University of Neveda, Las Vegas, Nevada 89154-5032, USA.
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19
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Kelly JF, Hoeppner BB, Urbanoski KA, Slaymaker V. Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale. Addict Behav 2011; 36:987-93. [PMID: 21700396 DOI: 10.1016/j.addbeh.2011.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 03/25/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults. METHOD Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. RESULTS Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. CONCLUSIONS The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts.
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20
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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.
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Affiliation(s)
- Jee Wook Kim
- Department of Neuropsychiatry, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
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21
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Karno MP, Longabaugh R, Herbeck D. What explains the relationship between the therapist structure × patient reactance interaction and drinking outcome? An examination of potential mediators. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 24:600-7. [PMID: 21038931 DOI: 10.1037/a0020526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent research found that among patients in aftercare treatment for alcoholism the level of therapist structure interacted with the level of patients' interpersonal reactance to predict alcohol use outcomes. The present study examined two sets of potential mediators of this interaction effect among a sample from two aftercare sites of Project MATCH (n = 127). The mediator constructs were types of pro-recovery change talk and resistance to therapeutic work. Dependent variables were percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD) across the year after treatment. Multiple-mediator models using bootstrapped estimates of indirect effects were used to test for mediation. Results indicated that the 'taking steps' aspect of change talk partially mediated the Structure × Reactance interaction effect on both PDA and PHDD post treatment. Resistance was not found to mediate the interaction effect though resistance did predict worse drinking outcomes. Depending on patients' openness to being influenced by others, therapist structure early in treatment may promote or inhibit pro-recovery steps taken by aftercare patients between treatment sessions. Those steps in turn play an important role in predicting future alcohol use.
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Affiliation(s)
- Mitchell P Karno
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA 90025, USA.
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22
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Dennis ML, French MT, McCollister KE, Scott CK. The economic costs of quarterly monitoring and recovery management checkups for adults with chronic substance use disorders. J Subst Abuse Treat 2011; 41:201-7. [PMID: 21466944 DOI: 10.1016/j.jsat.2011.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/25/2011] [Accepted: 02/11/2011] [Indexed: 11/15/2022]
Abstract
Recovery management checkups (RMCs) for clients with substance use disorders reduce the time from relapse to treatment reentry, increase treatment retention, and improve long-term outcomes. The objectives of this article are to calculate and compare the economic costs of providing outcome monitoring (OM) only with those of providing OM + RMC to help understand the feasibility of disseminating this model more widely. We estimate the total and incremental costs of OM and OM + RMC using data from a recently completed randomized controlled trial with adult chronic substance users (N = 446). Adding RMC to OM increased total intervention costs by about 50% per person per year ($707 to $1,283) and quarter ($177 to $321). It cost an average of $834 to identify a person in relapse and $2,699 to identify, link, and retain them in treatment. The increased costs of RMC are modest relative to the substantial societal costs of chronic substance users returning to regular use, crime, and other risk behaviors.
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23
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Daley M, Shepard DS, Tompkins C, Dunigan R, Reif S, Perloff J, Siembab L, Horgan C. Randomized trial of enhanced profiling in substance abuse treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:96-104. [PMID: 20680676 PMCID: PMC3040276 DOI: 10.1007/s10488-010-0306-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A randomized trial of substance abuse treatment programs tested whether "enhanced profiles," consisting of feedback and coaching about performance indicators, improved the performance of residential, methadone, and detoxification programs. These enhanced profiles were reviewed during quarterly on-site visits between October 2005 and July 2007. The performance indicators were the percentage of clients completing referrals to a lower level of care, and the percentage of clients admitted to a higher level of care within 30 days of discharge. Control programs received only "basic profiles," consisting of emailed quarterly printouts of these performance indicators. Effectiveness was evaluated using hierarchical linear models with client-level information nested within agencies and regions of the state. Treatment programs receiving enhanced profiles (n = 74) did not perform significantly differently from those receiving only basic profiles (n = 29) on either performance measure. To improve performance, interventions with greater scope and incentives may be needed.
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Affiliation(s)
- Marilyn Daley
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Donald S. Shepard
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Christopher Tompkins
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Robert Dunigan
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Sharon Reif
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Jennifer Perloff
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
| | - Lauren Siembab
- Connecticut Department of Mental Health and Addiction Services, 410 Capitol Avenue, Hartford, CT 06134, USA
| | - Constance Horgan
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, MS035, Brandeis University, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, USA
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24
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Arbour S, Hambley J, Ho V. Predictors and outcome of aftercare participation of alcohol and drug users completing residential treatment. Subst Use Misuse 2011; 46:1275-87. [PMID: 21615214 DOI: 10.3109/10826084.2011.572941] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between 2004 and 2007 at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.
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25
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Daley M, Shepard DS, Reif S, Dunigan R, Tompkins CP, Perloff J, Siembab L, Horgan CM. Evaluation of Provider Profiling in Public Sector Substance Abuse Treatment. ALCOHOLISM TREATMENT QUARTERLY 2010. [DOI: 10.1080/07347324.2010.512221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Vanderplasschen W, Bloor M, McKeganey N. Long-Term Outcomes of Aftercare Participation following Various Forms of Drug Abuse Treatment in Scotland. JOURNAL OF DRUG ISSUES 2010. [DOI: 10.1177/002204261004000308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to high relapse rates after leaving treatment, drug users are often recommended to participate in some form of lower intensity continuing care. The importance of aftercare is widely accepted, but little empirical data are available about the effectiveness of continuing services over longer periods of time and following various treatment modalities. In this study, we assessed the influence of various forms of aftercare on treatment outcomes and service utilization over a 33-month period among a naturalistic cohort of 653 drug users treated in prison or community settings, as part of the Drug Outcome Research in Scotland (DORIS study). Although participation in aftercare after initial treatment is rather unusual, the odds of having experienced a drug-free period (after 8 months) (OR = 1.91, 95% CI 1.10–3.33) and of being abstinent from heroin (after 33 months) (OR= 0.56, 95% CI 0.34–0.94) almost doubled. Program aftercare was of little additional value after intensive residential treatment, but particularly important after prison-based and community treatment and if combined with self-help participation. Consequently, attractive and fitted aftercare services should be offered as an integrated part of various treatment modalities.
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27
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Grella CE, Stein JA, Weisner C, Chi F, Moos R. Predictors of longitudinal substance use and mental health outcomes for patients in two integrated service delivery systems. Drug Alcohol Depend 2010; 110:92-100. [PMID: 20338696 PMCID: PMC2885543 DOI: 10.1016/j.drugalcdep.2010.02.013] [Citation(s) in RCA: 28] [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: 10/19/2009] [Revised: 02/05/2010] [Accepted: 02/10/2010] [Indexed: 11/18/2022]
Abstract
AIM Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a health maintenance organization (HMO). METHODS Sub-samples from each system were selected using multiple criteria indicating severity of mental health problems at admission to substance use disorder treatment (VA=401; HMO=331). Separate and multiple group structural equation model analyses used baseline characteristics, service use, and 12-step participation as predictors of substance use and mental health outcomes at 1 and 5 years following admission. RESULTS Substance use and related problems showed stability across time, however, these relationships were stronger among VA patients. More continuing care substance use outpatient visits were associated with reductions in mental health symptoms in both groups, whereas receipt of outpatient mental health services was associated with more severe psychological symptoms. Participation in 12-step groups had a stronger effect on reducing cocaine use among VA patients, whereas it had a stronger effect on reducing alcohol use among HMO patients. More outpatient psychological services had a stronger effect on reducing alcohol use among HMO patients. CONCLUSION Common findings across these two systems demonstrate the persistence of substance use and related psychological problems, but also show that continuing care services and participation in 12-step groups are associated with better outcomes in both systems.
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Affiliation(s)
- Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, United States.
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28
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Vanderplasschen WOI, Colpaert KAG, Broekaert EKM. Determinants of relapse and re-admission among alcohol abusers after intensive residential treatment. Arch Public Health 2010. [PMCID: PMC3436679 DOI: 10.1186/0778-7367-67-4-194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Garner BR, Godley MD, Funk RR, Lee MT, Garnick DW. The Washington Circle continuity of care performance measure: predictive validity with adolescents discharged from residential treatment. J Subst Abuse Treat 2009; 38:3-11. [PMID: 19553067 DOI: 10.1016/j.jsat.2009.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/12/2009] [Accepted: 05/21/2009] [Indexed: 11/18/2022]
Abstract
This study examined the predictive validity of the Washington Circle (WC) continuity of care after long-term residential treatment performance measure, as well as the impact of assertive continuing care interventions on achieving continuity of care. This measure is a process measure that focuses on timely delivery of a minimal floor of services that are necessary to provide sufficient quality of treatment but should not be construed to be the optimal continuity of care after residential treatment for any specific adolescent. Participants included 342 adolescents who were admitted to long-term residential treatment and randomly assigned to either standard continuing care or an assertive continuing care condition. Overall, results provide initial support for the WC continuity of care after residential treatment performance measure as a useful predictor of 3-month recovery status. In addition, assignment to an assertive continuing care condition was found to significantly increase the likelihood of achieving continuity of care.
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Harvey E, Shakeshaft A, Hetherington K, Sannibale C, Mattick RP. The efficacy of diversion and aftercare strategies for adult drug-involved offenders: a summary and methodological review of the outcome literature. Drug Alcohol Rev 2009; 26:379-87. [PMID: 17564873 DOI: 10.1080/09595230701373917] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Diversion strategies aim to redirect drug-involved offenders away from the criminal justice system and into treatment. Despite the interest in diversionary practices, the emergence of an empirical evaluation literature has been slow. A methodological review of published outcome studies was conducted to investigate the current strength of evidence for the efficacy of diversion and aftercare practices for criminal offenders. Twenty outcome studies were identified for review: 19 on diversion and one on aftercare. The vast majority of studies were non-randomised evaluations, reflecting the paucity of rigorous evaluation work in this area. Although most studies were prospective, very few reported on long-term outcomes following treatment. Detail was lacking with regard to basic study characteristics, such as eligibility criteria and outcomes. Despite these methodological shortcomings, results provide some tentative evidence that diversion and aftercare programmes could be effective. Best practice elements of diversion and aftercare programmes are identified and feasible strategies to improve the methodological quality of future evaluations are considered.
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Affiliation(s)
- Evelyn Harvey
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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31
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Pulford J, Black S, Wheeler A, Sheridan J, Adams P. Providing Post-Treatment Support in an Outpatient Alcohol and Other Drug Treatment Context: A Qualitative Study of Staff Opinion. Int J Ment Health Addict 2009. [DOI: 10.1007/s11469-009-9218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Wickizer TM, Mancuso D, Campbell K, Lucenko B. Evaluation of the Washington State Access to Recovery project: effects on Medicaid costs for working age disabled clients. J Subst Abuse Treat 2009; 37:240-6. [PMID: 19339138 DOI: 10.1016/j.jsat.2009.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 01/22/2009] [Indexed: 10/20/2022]
Abstract
In 2004, the federal government made a major commitment to support expanded substance abuse (SA) recovery services by initiating the Access to Recovery (ATR) program. The initial ATR I program awarded grants to 14 states, including Washington State. We evaluated Washington's ATR I program to determine its effect on Medicaid costs for working age disabled clients. We compared per member per month (PMPM) Medicaid costs during 1 year follow-up for clients who received ATR services (N = 1,347) with costs for a matched comparison group of 1,243 clients and used multiple regression techniques to estimate changes in Medicaid costs associated with ATR. ATR was found to be associated with reductions in PMPM Medicaid costs of $66 (p = .11) to $136 (p = .05) depending upon months of Medicaid eligibility. Recovery services aimed at facilitating engagement in SA treatment and aftercare appear to foster modest savings in Medicaid costs for working age disabled clients.
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Affiliation(s)
- Thomas M Wickizer
- Department of Health Services, University of Washington, Seattle, WA 98195, USA.
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33
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Harris AH, Humphreys K, Bowe T, Kivlahan DR, Finney JW. Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure. J Subst Abuse Treat 2009; 36:294-305. [DOI: 10.1016/j.jsat.2008.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 04/09/2008] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
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34
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McKay JR. Continuing care research: what we have learned and where we are going. J Subst Abuse Treat 2009; 36:131-45. [PMID: 19161894 PMCID: PMC2670779 DOI: 10.1016/j.jsat.2008.10.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 09/08/2008] [Accepted: 10/06/2008] [Indexed: 11/23/2022]
Abstract
In the field of addiction treatment, the term continuing care has been used to indicate the stage of treatment that follows an initial episode of more intensive care. This article reviews controlled studies of continuing care conducted over the prior 20 years. The results indicate that continuing care interventions were more likely to produce positive treatment effects when they had a longer planned duration, made more active efforts to deliver treatment to patients, and were studied more recently. However, there was considerable variability in patient response and room for improvements in participation rates and effectiveness. It is possible that the effectiveness of continuing care interventions could be further improved by the use of adaptive algorithms, which adjust treatment over time based on changes in patients' symptoms and status. The use of alternative service delivery methods and care settings may also lead to greater engagement and retention in continuing care, particularly among the large numbers of individuals who do not want traditional, clinic-based specialty care.
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Affiliation(s)
- James R McKay
- University of Pennsylvania, Treatment Research Institute, Philadelphia VAMC, Philadelphia, PA 19104, USA.
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35
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Popovici I, French MT, McKay JR. Economic evaluation of continuing care interventions in the treatment of substance abuse: recommendations for future research. EVALUATION REVIEW 2008; 32:547-568. [PMID: 18334678 DOI: 10.1177/0193841x08316311] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The chronic and relapsing nature of substance abuse points to the need for continuing care after a primary phase of treatment. This article reviews the economic studies of continuing care, discusses research gaps, highlights some of the challenges of conducting rigorous economic evaluations of continuing care, and offers research guidelines and recommendations for future economic studies in this emerging field. Rigorous economic evaluations are needed by health care providers and policy makers to justify the allocation of scarce resources to continuing care interventions. The adoption of cost-effective continuing care services can reduce long-term consequences of addiction, thereby potentially increasing overall social welfare.
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36
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McKellar J, Ilgen M, Moos BS, Moos R. Predictors of changes in alcohol-related self-efficacy over 16 years. J Subst Abuse Treat 2008; 35:148-55. [DOI: 10.1016/j.jsat.2007.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/17/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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37
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Moberg DP, Finch AJ. Recovery High Schools: A Descriptive Study of School Programs and Students. ACTA ACUST UNITED AC 2008; 2:128-161. [PMID: 19165348 DOI: 10.1080/15560350802081314] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
High schools specifically designed for students recovering from a substance use disorder (substance abuse or dependence) have been emerging as a continuing care resource since 1987. This study of 17 schools provides the first systematic description of recovery school programs and their students. The most common school model is that of a program or affiliated school, embedded organizationally and physically with another school or set of alternative school programs. Although embedded, there are serious efforts to maintain physical separation of recovery school students from other students, using scheduling and physical barriers. Affiliation with public school systems is the case for most recovery schools, and seems to be a major factor in assuring fiscal and organizational feasibility.The students in the recovery high schools studied were predominantly white (78%), with about one-half from two parent homes. Overall parent educational levels suggest a higher mean SES than in the general population. Most students (78%) had prior formal treatment for substance use disorders, often concomitantly with treatment for mental health concerns, and were often referred by treatment providers. Students came with a broad and complex range of mental health issues, traumatic experiences, drug use patterns, criminal justice involvement, and educational backgrounds. The complexity of these problems clearly limits the enrollment capacity of the schools.Retrospective pretest to post-test analysis suggests significant reduction in substance use as well as in mental health symptoms among the students. Students were very positive in their assessment of the therapeutic value of the schools, but less enthusiastic regarding the educational programs. The school programs appear to successfully function as continuing care to reinforce and sustain the therapeutic benefits students gained from their treatment experiences.
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Affiliation(s)
- D Paul Moberg
- School of Medicine and Public Health, University of Wisconsin
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38
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Providing Post-treatment Support in an Outpatient Alcohol and other Drug Treatment Context: A Survey of Client Opinion. Int J Ment Health Addict 2008. [DOI: 10.1007/s11469-008-9159-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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39
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Rush BR, Dennis ML, Scott CK, Castel S, Funk RR. The interaction of co-occurring mental disorders and recovery management checkups on substance abuse treatment participation and recovery. EVALUATION REVIEW 2008; 32:7-38. [PMID: 18198169 PMCID: PMC5933848 DOI: 10.1177/0193841x07307532] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This article examines the effectiveness of quarterly Recovery Management Checkups (RMCs) for people with substance disorders by level of co-occurring mental disorders (34% none, 27% internalizing disorders, and 39% internalizing and externalizing) across two randomized experiments with 92% to 97% follow-up. The 865 participants are 82% African American, 53% female, and age 37 on average. RMC involves identification of those in need of treatment, motivational interviews, and treatment linkage assistance. It is effective in linking participants in need to treatment, with equal or better outcomes among those with more mental disorders. The data support the utility of monitoring and re-intervention for clients with co-occurring disorders.
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Affiliation(s)
- Brian R Rush
- Center for Addiction and Mental Health, Toronto, Canada.
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Mensinger JL, Lynch KG, TenHave TR, McKay JR. Mediators of telephone-based continuing care for alcohol and cocaine dependence. J Consult Clin Psychol 2007; 75:775-84. [PMID: 17907859 PMCID: PMC2677065 DOI: 10.1037/0022-006x.75.5.775] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested that self-help involvement during treatment and self-efficacy and commitment to abstinence 3 months after treatment mediated subsequent abstinence outcomes. These analyses controlled for substance use prior to the assessment of mediators. Conversely, there was no evidence that self-help beliefs or social support mediated the treatment effect. These results are consistent with a model in which treatment effects are first accounted for by changes in behavior, followed by changes in self-efficacy and in commitment to abstinence.
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Affiliation(s)
- Janell Lynn Mensinger
- Clinical Research Unit, Reading Hospital and Medical Center, Reading, PA 19612-6052, USA.
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41
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Laudet A, Stanick V, Sands B. An exploration of the effect of on-site 12-step meetings on post-treatment outcomes among polysubstance-dependent outpatient clients. EVALUATION REVIEW 2007; 31:613-46. [PMID: 17986710 PMCID: PMC2396509 DOI: 10.1177/0193841x07306745] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of on-site 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step on-site, were followed for one year post-treatment. On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance.
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Affiliation(s)
- Alexandre Laudet
- Alexandre Laudet, PhD, Center for the Study of Addictions and Recovery (C‐STAR) at the National Development and Research Institutes, Inc., (NDRI), 71 West 23 Street, 8 floor, NYC, NY, 10010, USA. , Virginia Stanick, Ph.D., C‐STAR,
| | - Virginia Stanick
- Alexandre Laudet, PhD, Center for the Study of Addictions and Recovery (C‐STAR) at the National Development and Research Institutes, Inc., (NDRI), 71 West 23 Street, 8 floor, NYC, NY, 10010, USA. , Virginia Stanick, Ph.D., C‐STAR,
| | - Brian Sands
- Brian Sands, MD, Psychiatry, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA,
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Hser YI, Longshore D, Anglin MD. The life course perspective on drug use: a conceptual framework for understanding drug use trajectories. EVALUATION REVIEW 2007; 31:515-547. [PMID: 17986706 DOI: 10.1177/0193841x07307316] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This article discusses the life course perspective on drug use, including conceptual and analytic issues involved in developing the life course framework to explain how drug use trajectories develop during an individual's lifetime and how this knowledge can guide new research and approaches to management of drug dependence. Central concepts include trajectories marked by transitions and social capital and turning points influencing changes. The life course perspective offers an organizing framework for classifying varying drug use trajectories, identifying critical events and factors contributing to the persistence or change in drug use, analytically ordering events that occur during the life span, and determining contributory relationships.
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43
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Pelissier B, Jones N, Cadigan T. Drug treatment aftercare in the criminal justice system: A systematic review. J Subst Abuse Treat 2007; 32:311-20. [PMID: 17383555 DOI: 10.1016/j.jsat.2006.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 08/24/2006] [Accepted: 09/23/2006] [Indexed: 11/22/2022]
Abstract
Drug treatment aftercare is frequently cited as necessary for individuals served within the criminal justice system. The purposes of this article are to review how much is actually known about aftercare and to highlight issues in studying the role of aftercare. We begin with a review of the literature, looking at how aftercare is defined within the criminal justice system outcome literature and the findings on aftercare for offenders who received initial treatment from in-prison substance use treatment programs. We continue with a discussion of how substance use treatment provided within the federal system, drug use patterns, and responses to drug use create methodological difficulties in adequately assessing the effectiveness of aftercare services. Taking into account both the previous research on aftercare and the issues encountered in attempting to evaluate the federal aftercare services, we concluded that the claim of certainty about aftercare effectiveness is not well substantiated and that the precise nature of aftercare services needed is not well understood. We conclude with a discussion of the methodological and substantive issues that need to be addressed in future research. Issues identified include the need to address self-selection bias and to disentangle offender behavior from the effects of criminal justice system policies. Research is also needed to identify the most effective type and intensity of aftercare.
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44
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Abstract
BACKGROUND Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples. METHODS Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes. RESULTS Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence. Satisfaction with treatment and affiliation with Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence. CONCLUSION Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.
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Affiliation(s)
- Maria C Bodin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Claus RE, Orwin RG, Kissin W, Krupski A, Campbell K, Stark K. Does gender-specific substance abuse treatment for women promote continuity of care? J Subst Abuse Treat 2006; 32:27-39. [PMID: 17175396 DOI: 10.1016/j.jsat.2006.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/06/2006] [Accepted: 06/15/2006] [Indexed: 11/20/2022]
Abstract
Research has stressed the value of providing specialized services to women and suggests the importance of treatment duration. This quasi-experimental retrospective study reports on the continuity of care for women with children who were admitted to long-term residential substance abuse treatment. Women were admitted to 7 agencies offering specialized, women's only treatment (SP, n = 747) or to 9 agencies that provided standard mixed-gender treatment (ST, n = 823). Client and treatment data were gathered from administrative sources. We hypothesized that women in specialized treatment would demonstrate higher continuing care rates after controlling for treatment completion and length of stay. Women in SP programs (37%) were more likely than those in ST programs (14%) to continue care. Multivariate analyses revealed that SP clients who completed treatment with longer stays were most likely to continue care. The findings show that specialized treatment for women promotes continuing care and demonstrate the importance of treatment completion.
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Affiliation(s)
- Ronald E Claus
- Missouri Institute of Mental Health, University of Missouri School of Medicine, St. Louis, MO 63139, USA.
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46
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Cost-Effectiveness of Public Sector Substance Abuse Treatment. J Behav Health Serv Res 2005. [DOI: 10.1097/00075484-200510000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Beattie MC, Hu TW, Li R, Bond JC. Cost-effectiveness of public sector substance abuse treatment. J Behav Health Serv Res 2005; 32:409-29. [PMID: 16215450 DOI: 10.1007/bf02384201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Costs and cost-effectiveness of public sector substance abuse treatment in 2 California counties with similar substance abuse treatment system histories are compared; one county (MidState) has adopted managed care principles. As hypothesized, MidState's costs for the index treatment episode were significantly lower than SouthState's, although unexpectedly because of lower outpatient utilization. Treatment benefits in the 7 Addiction Severity Index functional areas were examined through cost-effectiveness analyses. MidState can claim greater cost-effectiveness for its treatment dollars for significant improvement in alcohol and medical functioning (compared to unsuccessful clients and those reporting no problems). When comparing both improved clients and those maintaining no problems to unsuccessful clients, MidState is more cost-effective for improving alcohol, medical, legal, and family/social functioning; and 3 outcomes important to community stakeholders and taxpayers (legal, medical, and psychiatric functioning) are more cost-effective than alcohol, drug, and employment improvement.
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Affiliation(s)
- Martha C Beattie
- School of Public Health, University of California, Berkeley, 94709, USA.
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48
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Johnson JE, Finney JW, Moos RH. Predictors of 5-year mortality following inpatient/residential group treatment for substance use disorders. Addict Behav 2005; 30:1300-16. [PMID: 16022928 DOI: 10.1016/j.addbeh.2005.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 01/05/2005] [Accepted: 01/21/2005] [Indexed: 11/22/2022]
Abstract
This study examined the prevalence and predictors of 5-year mortality following treatment for substance use disorders. The predictors were assessed at baseline, at discharge, and at a 1-year follow-up for 3698 male veterans, and included demographic, substance use, medical, and psychological functioning, social support, and continuing care. The annual mortality rate was 2.38%, with an observed/expected ratio of 3.05. After accounting for significant demographic, substance use, psychological, and medical conditions, not having a spouse or partner at intake independently predicted 5-year mortality. After accounting for intake variables, more depression at discharge and more medical conditions, a diagnosis of HIV or AIDS, more ounces of ethanol on a maximum drinking day, and lack of a spouse or partner at the 1-year follow-up independently predicted 5-year mortality. Unexpectedly, good quality relationships were related to a higher mortality risk. Results can be used to increase at-risk patients' motivation for recovery.
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Affiliation(s)
- Jennifer E Johnson
- Center for Health Care Evaluation, Department of Veterans Affairs, 795 Willow Road, Menlo Park, California 94025, United States.
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49
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Sridharan S, Kawata JH, Campbell B, Tseng CWM. Contemporaneous relationship between substance abuse treatment and poly-substance use: Evidence from the Persistent Effect of Treatment Studies. J Subst Abuse Treat 2005; 28 Suppl 1:S83-90. [PMID: 15797642 DOI: 10.1016/j.jsat.2004.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 09/01/2004] [Accepted: 09/24/2004] [Indexed: 10/25/2022]
Abstract
Data from the Persistent Effect of Treatment Studies (PETS) are used to explore the relationship between duration of substance use treatment and simultaneous poly-substance using behaviors. Studying such contemporaneous relationships is especially important given the chronic nature of the substance-using population (McLellan, 2002) in the PETS study. Data were collected at intake to treatment programs and follow-up interviews were performed periodically at treatment program sites. One of the features of the analysis was the development of a poly-substance scale to measure multiple substance use. Multilevel models were implemented to examine the relationship between three levels of care (i.e., intensive outpatient, outpatient, and residential) and simultaneous poly-substance use. Contemporaneous effects of treatment were obtained such that higher duration of treatment was associated with drops in substance-using behaviors. This result supports the need for sustaining treatment for a population of chronic substance abusers.
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Dennis ML, Scott CK, Funk R, Foss MA. The duration and correlates of addiction and treatment careers. J Subst Abuse Treat 2005; 28 Suppl 1:S51-62. [PMID: 15797639 DOI: 10.1016/j.jsat.2004.10.013] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 09/18/2004] [Accepted: 10/28/2004] [Indexed: 11/17/2022]
Abstract
While addiction is increasingly recognized as a chronic condition, little information is available on the actual duration of addiction and treatment careers. The purpose of this study was to estimate the duration and correlates of years between (a) first use and at least a year of abstinence and (b) first treatment admission and at least one year of abstinence. Data are from 1,271 of 1,326 (96%) people recruited from a stratified sequential sample of admissions to publicly funded treatment programs in a large metropolitan area. Participants were interviewed at 6, 18, 24, 36, 48, and 60 months post-intake. With an average age at the referent intake of 35 (SD = 8) years, the sample is 59% female, 87% African American, 7% Hispanic, and 5% white. The most common dependence diagnoses were for cocaine (64%), alcohol (44%), opioids (41%), and/or marijuana (14%). Using lifetime substance use and treatment histories collected at intake and subsequent treatment utilization recorded during follow-up interviews, we conducted survival analysis to estimate the time from first use and first treatment until people reported 12 months of abstinence or died (with people still using, in treatment, or dead at the last follow-up treated as right censored). During the three years after intake, 47% reached at least 12 months of abstinence. The median time from first to last use was 27 years. The median time from first treatment episode to last use was 9 years. Years to recovery were significantly longer for males, people starting use under the age of 21 (particularly those starting under the age of 15), people who had participated in treatment 3 or more times, and for people high in mental distress. The exploratory results suggest that multiple episodes of care over several years are the norm and that rather than thinking of multiple episodes in terms of "cumulative dosage," it might be better thought of as further evidence of chronicity and that we need to develop and evaluate models of longer term recovery management.
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