A review of factors affecting treatment outcomes: Expected Treatment Outcome Scale

Impact of Pharmacophobia and Pharmacophilia on Perception of Medication Use and Self-Medication Behaviors in Saudi Arabia

Objectives

Pharmacophilia and pharmacophobia have positive and negative effects on treatment outcomes. There exist lacune of information on these phenomena in middle east countries. Therefore the current study aimed to determine the pattern and predictors of Pharmacophilia and pharmacophobia in Saudi Arabia. The study further explored the impact of these phenomena on the perception of medication use and self-medication behaviours.

Experimental design

An online questionnaire-based cross-sectional study was conducted during March-May 2021. Saudi residents aged 15 years or older were eligible for this study. Individuals' attitude towards medication was assessed using the Drug attitude inventory classification questionnaire, and the general belief of medication was assessed using the Beliefs about Medicine Questionnaire.

Observation

One-fifth (n = 101; 20%) and two-third (n = 338; 65%) participants were categorized as pharmacophobic and pharmacophilic, respectively. The mean BMQ score was not statistically significant between the pharmacophobic and pharmacophilic groups (mean difference = 0.314; p-value = 0.176). Males were more likely pharmacophilic than females [AOR: 0.34 (95% CI 0.17-0.69)]. Both groups showed nearly a similar pattern of self-medication behaviours.

Conclusion

There exist a good number of pharmacophobic and pharmacophilic among the Saudi population. A detailed understanding of the attitudes towards treatment among these groups is essential for enhancing treatment outcomes.

HIV risk and the association with accessibility coverage to medical facilities and socioeconomic status among heroin users in Kaohsiung, Taiwan (2011-2015): A GIS approach

Illegal drug use has caused considerable health and social costs. Access to medical treatment has been one of the most cost-effective interventions to reduce problematic drug use. Accessibility to treatment, which can be analyzed by the spatial approach such as geographic information system (GIS), has thus been utilized as a measure of the proportion of population that reaches appropriate health services. In this study, the association of accessibility coverage to medical facilities and socioeconomic status with human immunodeficiency virus (HIV) risk for heroin users was evaluated by GIS analysis in Kaohsiung, Taiwan. Data of 7890 heroin users were collected from 2011 to 2015 and categorized into five risk groups according to their income and distance to treatment settings. The results of this GIS-based analysis show that the areas with over 50% accessibility coverage rate had less amounts of HIV cases with statistical significance. Inconvenient access to medical facilities could result in poor treatment outcomes such as higher HIV incidences. Therefore, in order to effectively reduce HIV incidences among the heroin users, the accessibility coverage and locations of medical treatment facilities should meet the needs of drug users. It is also advised that the formulation of policies associated with illegal drug use problems should be evidence-based and geographical indicators could serve for this purpose from either prevention or intervention perspective.

Differences in Drug Treatment Services Based on Profit Status

The goal of this article is to examine whether profit status affects the provision of seven "core" drug treatment services and nine "auxiliary" treatment services. Data on the type of services provided by 8,606 treatment providers obtained from the National Survey of Substance Abuse Treatment Services (N-SSATS) collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2000 were used for this study. The types of services offered by the providers were modeled to be a function of the drug treatment providers' (DTP) profit status, DTP organizational and financial characteristics, staff's characteristics, clients' characteristics, and regional variables. A total of 16 logistic regressions were estimated. For-profit DTPs were found to be more likely to offer only two core services and were less likely to offer eight auxiliary services. However, after correcting for sample selection bias many differences in the supply of services between for-profit and nonprofit providers disappeared.

Case Management and Client Access to Health and Social Services in Outpatient Substance Abuse Treatment

A primary goal of case management is to coordinate services across treatment settings and to integrate substance abuse services with other types of services offered in the community, including housing, mental health, medical, and social services. However, case management is a global construct that consists of several key dimensions, which include extent of case management coverage, the degree of management of the referral process, and the location of case management activity (on-site, off-site, or both). This study examines the relationship between specific dimensions of case management and the utilization of health and ancillary social services in outpatient substance abuse treatment. In general, results suggest that more active case management during the referral process and providing case management both on-site and off-site are most consistent with our predictions of greater use of health and ancillary social services by substance abuse clients. However, these effects are specific to general health care and mental health services. Case management appears to have little effect on use of social services or aftercare plans.

Prospective validation of substance abuse severity measures from administrative data

BACKGROUND

Severity measures for clients in substance abuse treatment programs are becoming increasingly important as funders adopt payment systems linked to agency performance. Recently, two severity measures based on administrative data have been developed. This study validated these measures using prospective data.

METHODS

Subjects were participants in the Drug Abuse Treatment Outcomes Study (adult or adolescent components) or the Substance Abuse and Mental Health Services Administration Medicaid Managed Behavioral Healthcare and Vulnerable Populations project (adult or adolescent chemical dependency components). Severity measures were calculated based on data obtained at entry into substance abuse treatment. The baseline severity measures were included along with age, gender, and race/ethnicity in logistic regression models predicting abstinence at follow-up for alcohol use, marijuana use, cocaine use, or heroin use.

RESULTS

For adults, the severity measures were highly statistically significant (p<0.001) for all models in both data sets, indicating that adults with higher severity were more likely (and much more likely in many cases) to use alcohol, marijuana, cocaine, or heroin at the follow-up interview than were those with lower severity. For adolescents, the severity measure was highly statistically significant (p<0.001) for marijuana in both data sets and for alcohol in the Medicaid data set.

CONCLUSIONS

Baseline severity measures were powerful predictors of abstinence at follow-up. These measures, derived from routinely available electronic records, appear to have noteworthy predictive validity. The severity indicators can be used for administrative purposes such as risk-adjustment when examining treatment agency performance.

Protective resources and long-term recovery from alcohol use disorders

AIMS

This study examined indices of personal and social resources drawn from social learning, behavioral economics, and social control theories as predictors of medium- and long-term alcohol use disorder outcomes.

DESIGN AND MEASURES

Individuals (N = 461) who initiated help-seeking for alcohol-related problems were surveyed at baseline and 1, 3, 8, and 16 years later. At baseline and each follow-up, participants provided information about their personal and social resources and alcohol-related and psychosocial functioning.

FINDINGS

In general, protective resources associated with social learning (self-efficacy and approach coping), behavioral economics (health and financial resources and resources associated with Alcoholics Anonymous), and social control theory (bonding with family members, friends, and coworkers) predicted better alcohol-related and psychosocial outcomes. A summary index of protective resources associated with all three theories significantly predicted remission. Protective resources strengthened the positive influence of treatment on short-term remission and partially mediated the association between treatment and remission.

CONCLUSIONS

Application of social learning, behavior economic, and social control theories may help to identify predictors of remission and thus to allocate treatment more efficiently.

The effect of persistence of cocaine use on 12-month outcomes for the treatment of heroin dependence

AIMS

To determine the effects of cocaine use across the study period on outcomes of treatment for heroin dependence 12 months post-treatment entry.

DESIGN

Longitudinal cohort (12 months). Interviews were conducted at baseline, 3 and 12 months.

SETTING

Sydney, Australia.

PARTICIPANTS

Four hundred ninety-five heroin users recruited for the Australian Treatment Outcome Study and re-interviewed at 12-month follow-up.

FINDINGS

Cocaine was widely used among treatment entrants in NSW, with almost all having a lifetime history of cocaine use and almost half having used in the month preceding baseline. While there was an overall decline in cocaine use across the study period, individual use patterns varied widely. Approximately half of the cohort did not report cocaine use at any data point, with the remainder reporting having used at one (29%), two (12%), or at all three (5%) points. Cocaine use across the study period was an independent predictor of most major treatment outcomes, with more cocaine use points predicting poorer outcome. Persistent cocaine use predicted a higher prevalence of homelessness, heroin use, daily injecting, needle sharing and injection-related health problems at 12 months as well as more extensive recent polydrug use.

CONCLUSIONS

Cocaine use was common among individuals seeking treatment for primary heroin dependence in NSW. Any cocaine use over the study period was associated with poorer outcomes in virtually all areas. Persistent cocaine use over the study period, however, appeared particularly detrimental. Cocaine use among clients should evidently be a cause for concern amongst treatment providers and may warrant being specifically targeted during treatment.

Predictive validity of the Brazilian version of the Expected Treatment Outcome Scale in cocaine-dependent outpatients at a drug treatment referral center

BACKGROUND

High dropout rates among patients under treatment for cocaine dependence have stimulated research into predictors of treatment outcome.

OBJECTIVE

To assess the predictive value of the Brazilian version of the Expected Treatment Outcome Scale.

METHODS

The original English version of the scale was translated and back-translated. A total of 210 subjects participating in a 10-week randomized double-blind clinical trial (nefazodone versus placebo) completed the questionnaire at their first appointment. Mean Expected Treatment Outcome Scale scores were compared with treatment outcomes.

RESULTS

There were ten subjects (5%) who failed to complete at least six items, and 37 (17.5%) failed to complete 1 to 3 items. The most frequently unanswered questions involved time estimates (treatment time and abstinence) and third-party judgments. The mean score was 34.4 (9.3) (median, 33.9). There were no differences in mean scores between subjects evaluated in the first to the fifth appointment 35.2 (9.3) or in the sixth to the eleventh appointment 35.2 (9.3) (p = 0.13); completing the treatment 33.8 (10.3) or not 34.6 (9.1) (p = 0.64); remaining abstinent for three weeks 34 (9.3) or not 34.8 (9.4) (p = 0.58), and medication compliance 33.9 (8.8) or noncompliance 35.3 (10.3) (p = 0.34). The ROC curve of Expected Treatment Outcome Scale scores, when dropout was defined as not appearing for all 11 appointments, was linear, with an area under the curve of .54 (range, .44-.64), suggesting that the scale is ineffective in discriminating between cases and noncases.

CONCLUSION

In this study, the Brazilian version of the Expected Treatment Outcome Scale was found to have no predictive value for treatment adherence and abstinence in cocaine-dependent subjects subjected to a standardized treatment protocol.

Facilitating Self-Management of Substance Use Disorders with Online Counseling: The Intervention and Study Design

This paper describes a pilot study using online counseling for court-involved parents who have been charged with child abuse and neglect related to substance use. All families resided in the medically underserved area of Newark, New Jersey and were recruited from halfway houses and the Family Court. The sample consisted of 30 participants randomly assigned to control (n=15) and experimental (n=15) groups. Of the participants, 83% were Black, 13% were White, and 3% were Hispanic. The control group had access to usual face-to-face treatment at a local treatment center where typical court-ordered offenders were referred. Usual face-to-face treatment often involved being wait-listed for periods of months even for a detox bed. The experimental group had immediate access to the online counseling intervention. The online counseling software and the live counseling components of the intervention were developed with a stages of change theoretical framework. Preliminary findings show promise for the feasibility of online interventions for underserved populations.

Managed care and access to substance abuse treatment services

Using nationally representative data from 1995 and 2000, this study examined how managed care penetration and other organizational characteristics were related to accessibility to outpatient substance abuse treatment. At an organizational level, access was measured as the percentage of clients unable to pay for services; the percentage of clients receiving a reduced fee; and the percentage of clients with shortened treatment because of their inability to pay. Treatment units with both relatively low and relatively high managed care penetration were more likely to support access to care; these units provided care to higher percentages of clients unable to pay and were less likely to shorten treatment because of client inability to pay. Treatment units with midrange managed care penetration were least likely to support access to care. The complexity of managing in an environment of conflicting incentives may reduce the organization's ability to serve those with limited financial means.

A staging system to predict prognosis among methadone maintenance patients, based on admission characteristics

As U.S. general internists play an increasing role in providing opioid maintenance therapy in practice offices, they are having to face the challenge of identifying patients who need specialized services especially at the outset of treatment. In methadone maintenance treatment, prognostic studies have failed to find robust predictors on the basis of single predictive variables. We hypothesize that a multivariable staging system will predict treatment outcome more accurately than single variables. We reviewed baseline and treatment data regarding 226 consecutive patients admitted to a methadone maintenance program in New Haven, Connecticut, from January 1, 1993 to March 28, 1994, and followed until December 1, 1996. The staging system was developed from the data on the first 112 patients, confirmed in the remaining 114 patients, and then applied to the entire cohort of 226 patients. Retention was the main outcome measure used in developing the staging system. The staging system was also validated as a predictor of illicit drug use during treatment and adverse discharge. In the staging system one point is scored for each of the following: use of more than two bags of heroin daily, previous prison term, previous period in reform school, and a history of diseases related to substance use, e.g., endocarditis, hepatitis, abscesses, and overdose. The total score classifies patients as Stage I (0 and 1 points), Stage II (2 points), or Stage III (3 and 4 points). This staging system was significantly associated with retention in a proportional-hazards model, and no other variable added any additional predictive influence. The specific stage was also found to be a significant predictor of adverse discharge. Although additional validation is necessary in other populations, we found the staging system to be a useful and simple way of identifying patients at risk for early attrition and adverse discharge.

A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups. Preliminary results and methodological issues

This article is an initial report from a review of alcohol and drug treatment studies with follow-ups of 2 years or more. The goals of the review are to examine the stability of substance use outcomes and the factors that moderate or mediate these outcomes. Results from 12 studies that generated multiple research reports are presented, and methodological problems encountered in the review are discussed. Substance use outcomes at the group level were generally stable, although moderate within-subject variation in substance use status over time was observed. Of factors assessed at baseline, psychiatric severity was a significant predictor of outcome in the highest percentage of reports, although the nature of the relationship varied. Stronger motivation and coping at baseline also consistently predicted better drinking outcomes. Better progress while in treatment, and the performance of pro-recovery behaviors and low problem severity in associated areas following treatment, consistently predicted better substance use outcomes.

Managed care and outpatient substance abuse treatment intensity

This study examines the extent to which managed care behavioral controls are associated with treatment intensity in outpatient substance abuse treatment facilities. Data are from the 1995 National Drug Abuse Treatment System Survey, a nationally representative survey that includes over 600 provider organizations with a response rate of 86%. Treatment intensity is measured in three ways: (1) the number of months clients spend in outpatient drug treatment, (2) the number of individual treatment sessions clients receive over the course of treatment, and (3) the number of group treatment sessions clients receive over the course of treatment. After accounting for selection bias and controlling for market, organization, and client characteristics, there is no significant relationship between the scope of managed care oversight and treatment intensity. However, the stringency of managed care oversight activities is negatively associated with the number of individual and group treatment sessions received over the course of treatment.

Drug treatment outcomes: investigating the long-term effects of sexual and physical abuse histories

Individuals in drug treatment, particularly women, generally report high levels of past sexual and physical abuse. Although histories of sexual and physical abuse are associated with greater prevalence and severity of depression, anxiety, phobias, and interpersonal difficulties for individuals seeking substance-related treatment, several recent studies failed to show that prior sexual or physical abuse compromised short-term drug treatment outcomes. This study examined the possible effects of sexual and physical abuse on a wide array of behavioral domains over a two-year posttreatment period. The findings indicate few differences between those with and without past histories of such abuse in terms of drug use, drug treatment and 12-Step program participation, criminality, income sources, intimate relationships, family functioning, and psychiatric symptoms. There are specific exceptions, but they apply only to men. Overall, the findings indicate that the impact of sexual and physical abuse histories on relatively long-term treatment outcomes is minimal. Addressing the sexual and physical abuse histories of those seeking treatment for drug abuse may be justified on humanistic grounds, but it will not significantly improve the long-term effectiveness of drug treatment, nor will it substantially enhance the lives of those with histories of abuse.

Managed care and technical efficiency in outpatient substance abuse treatment units

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.

Directors' perceptions of the effects of managed care in outpatient substance abuse treatment

This study examines the perceptions of unit directors' regarding the effects of managed care on outpatient treatment and operations. Specifically, we propose that perceptions vary as a function of managed care penetration, managed care complexity, and the stringency of managed care oversight procedures. Data are from a nationally representative sample survey of 236 outpatient substance abuse treatment organizations conducted in 1995. Study findings support the thesis that directors' perceptions vary systematically with specific attributes of managed care. Specifically, directors' perceptions of positive managed care effects are associated with two managed care oversight procedures: (a) managed care limits on the number of sessions provided; and (b) managed care requirements for follow-up after treatment. Directors perceptions of negative effects of managed care are significantly related to (a) managed care penetration, (b) managed care complexity; and (c) four different managed care oversight procedures. These results have implications for treatment given the rapid growth in managed behavioral care.

Sexual and physical abuse: do they compromise drug treatment outcomes?

Histories of sexual and physical abuse are frequently reported by individuals participating in substance abuse treatment, these experiences may be associated with psychopathology and poor drug treatment outcomes. This paper presents the findings from a longitudinal study of 330 subjects participating in 26 outpatient treatment programs. Sexual abuse among women was associated with higher levels of depression, anxiety, suicidal ideation, suicide attempts, and PTSD, while physical abuse was associated with fewer psychological disturbances. For men, sexual abuse was associated only with anxiety. Physical abuse was associated with depression, anxiety, suicidal ideation, and PTSD. However, no significant association was found between sexual and physical abuse, and lower levels of treatment participation or drug use at follow-up. These findings indicate that there is a complex connection between abuse, psychopathology, treatment participation, and relapse. Clinical and research implications of these findings are discussed.