Predicting patient post-detoxification engagement in 12-step groups with an extended version of the theory of planned behavior

Attitudes and Intentions toward Use of HIV Pre-Exposure Prophylaxis (PrEP) among Adults Receiving Treatment for Opioid Use

Background: Although pre-exposure prophylaxis (PrEP) prevents HIV, little is known about PrEP awareness and factors associated with intention to take PrEP among people with opioid use disorder (OUD). Methods: HIV-negative adults recruited from an outpatient treatment program in Cincinnati, Ohio completed self-administered surveys. Items derived from literature and health behavioral theory included demographics, sexual and drug use behaviors, HIV prevention practices, PrEP knowledge, and attitudes toward PrEP. Primary outcomes were 1) intention to ask a clinician about PrEP and 2) intention to accept PrEP if recommended by a clinician. Outcomes were dichotomized into higher vs. lower intention for analyses in logistic regression models. Results: Among 198 participants, 60.3% reported past injection drug use. Among 58 participants (29.3%) meeting criteria for PrEP, 24% were aware of PrEP, 15.5% had discussed it with a clinician, and 5% had taken it. Factors associated with intention to ask a clinician about PrEP included being somewhat confident about consistent condom use (p < 0.01), motivation to comply with normative beliefs (p < 0.01), and reporting that PrEP fits very well (p < 0.01) and is easy to fit (p < 0.01) into current prevention practices. Factors associated with intention to accept PrEP if recommended by a clinician included motivation to comply with normative beliefs (p < 0.01) and PrEP being easy to fit into current prevention practices (p < 0.01). Conclusion: Among participants meeting indications for PrEP, only 24% were aware of it and few had taken it. Interventions that normalize PrEP and target incorporating PrEP into current prevention practices may improve uptake among individuals with OUD.

Perceived risk and condomless sex practice with commercial and non-commercial sexual partners of male migrant sex workers in London, UK

Background: Since the emergence of HIV and the AIDS pandemic, the majority of risk-reduction interventions have been centred on the use of condoms in sex workers.   Methods: This qualitative study recruited 25 male migrant sex workers in London to understand their risk perception and condomless sex experiences within the context of sex work and private life. The data was collected using face-to-face interviews, analysed using thematic analysis, and the findings interpreted through the theory of planned behaviour.   Results: The themes explain that condomless sex with clients occurred when participants consciously accepted to perform this service deploying a risk assessment of clients, faulty strategies, and sexual practices to reduce their risk; or when they lost control because of recreational drugs, feeling attraction to clients, were in precarious circumstances, or were victims of violence. Conversely, condomless sex with non-commercial partners occurred according to the type of relationship, with formal partners it was rationalised through emotional aspects attached to this kind of relationship, while with casual partners it was connected to sexual arousal and the use of alcohol and drugs.  Conclusions: Reinforce educational interventions to deliver STI-HIV information, enhance the use of condoms, and to address specific contextual factors that facilitate condomless practice with commercial and non-commercial sexual partners.

Applying the theory of planned behavior to predict online addiction treatment intention

METHODS

This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men.

RESULTS

Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment.

CONCLUSION

As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research

ISSUES

Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes.

APPROACH

We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised.

KEY FINDINGS

The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods.

IMPLICATIONS

The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success.

CONCLUSION

Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.

Development and validation of the help-seeking intention scale in university students with hazardous and harmful consumption of alcohol

Introduction

The Theory of Planned Behavior (TPB) has been proposed as suitable to study help-seeking intentions. This paper aims to develop the IH-RHAC scale (Help-seeking intention in young adults with hazardous and harmful alcohol consumption) with the TPB. The objectives of the study were: (a) to analyze the structure, reliability, and validity of the instrument, (b) to identify whether attitude, subjective norm, self-efficacy, and past help-seeking would predict help-seeking intention, and (c) to assess concurrent validity.

Methods

From a total of 2,011 students who responded to the surveys, the sample was made up of 263 university students aged 18 to 29 with hazardous and harmful alcohol consumption practices, who responded to an online questionnaire including the AUDIT, IH-RHAC, and a scale of barriers and resources for alcohol consumption. Partial least squares structural equations (PLS-SEM) were used to test the hypotheses about reliability, validity of the scales, and prediction of the constructs: attitude, subjective norms, self-efficacy, and help-seeking in the past about intention. Pearson's correlations were used to obtain evidence of concurrent validity.

Results

The results displayed favorable psychometric characteristics. The internal measurement model showed that attitude, self-efficacy, and prior help-seeking predicted a 27% help-seeking variance. Subjective norm did not predict intention.

Discussion

It has been concluded that this is an instrument with psychometric support that can contribute to designing and/or evaluating interventions that promote the students' search for help.

Barriers to retention in substance use treatment: Validation of a new, theory-based scale

PURPOSE

Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components.

METHODS

The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records.

RESULTS

Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses.

CONCLUSIONS

The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.

The effect of theory-based educational intervention on correct principles of manual material handling among men

BACKGROUND

Changing human behavior for the purposes of improving the way people work is an integral part of most educational interventions. This study aimed to evaluate the effect of a model based on the theory of planned behavior (TPB) on correct principles of manual material handling (MMH) among male soldiers.

SUBJECTS AND METHODS

This study was a quasi-experimental, pretest-posttest research with a control group. Furthermore, 140 soldiers, from an area located in the city of Bandar Abbas, Iran, were selected through a simple random sampling and they were divided into two groups: intervention and control (70 subjects in each group). The data were collected using a three-part questionnaire including demographic information, the theory constructs, and MMH behavior. The intervention group was given the relevant education, and after 2 months, the both groups were evaluated.

RESULTS

Based on regression analysis, attitude toward behavior and perceived behavioral control were predictors for correct principles of MMH. There were significant differences between the mean scores of the theory constructs before and after the education in intervention group (P < 0.001); however, no significant differences were observed in the theory constructs in the control group after the intervention. Before the education, the mean score of MMH of the intervention group was 38.30 ± 6.45; but after, the education, this changed into 44.20 ± 6.01, and significantly increased (P < 0.001).

CONCLUSIONS

Educational intervention based on the TPB was effective in improving behavior for correct MMH in soldiers. Thus, the use of such educational programs according to the constructs of the planned behavior theory is recommended.

Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study

Background

Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population.

Objective

This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period.

Methods

Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted.

Results

At Month 6, 6.9% (28/407) and 4.4% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU (β=.04; B=.002, 95% CI 0.001-0.01).

Conclusions

Social media and gay social networking apps may be a major source of influence on MSM’s perceptions and actual behaviors related to SDU.

Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes

Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.

Predictors of 12-Step Attendance and Participation for Individuals With Stimulant Use Disorders

OBJECTIVE

Few studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs).

METHOD

A clinical trial of 12-step facilitation (N=471) focusing on individuals with cocaine or methamphetamine use disorders allowed examination of four questions: Q1) To what extent do treatment-seeking stimulant users use 12-step programs and, which ones? Q2) Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users? Q3) What specific baseline "12-step readiness" factors predict subsequent 12-step participation and attendance? And Q4) Does stimulant drug of choice differentially predict 12-step participation and attendance?

RESULTS

The four outcomes variables, attendance, speaking, duties at 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity. Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3- and 6-month follow-ups than did methamphetamine users. Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment and 3-month follow-up. Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all time points by pre-randomization involvement in self-help activities.

CONCLUSIONS

The primary finding of this study is one of continuity: prior attendance and active involvement with 12-step programs were the main signs pointing to future involvement. Limitations and recommendations are discussed.