1
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Grau LE, Larkin K, Lalloo C, Stinson JN, Zempsky WT, Ball SA, Buono FD. Perspectives on adapting a mobile application for pain self-management in neurofibromatosis type 1: results of online focus group discussions with individuals living with neurofibromatosis type 1 and pain management experts. BMJ Open 2022; 12:e056692. [PMID: 35840301 PMCID: PMC9295671 DOI: 10.1136/bmjopen-2021-056692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Neurofibromatosis type 1 (NF1) is a genetic disorder in which chronic pain commonly occurs. The study sought to understand the needs of individuals with NF1 and pain management experts when adapting a pain self-management mobile health application (app) for individuals with NF1. DESIGN We conducted a series of online, audio-recorded focus groups that were then thematically analysed. SETTING Online focus groups with adults currently residing in the USA. PARTICIPANTS Two types of participants were included: individuals with NF1 (n=32 across six focus groups) and pain management experts (n=10 across three focus groups). RESULTS Six themes across two levels were identified. The individual level included lifestyle, reasons for using the mobile app and concerns regarding its use. The app level included desired content, desired features and format considerations. Findings included recommendations to grant free access to the app and include a community support feature for individuals to relate and validate one another's experience with pain from NF1. In addition, participants noted the importance of providing clear instructions on navigating the app, the use of an upbeat, hopeful tone and appropriate visuals. CONCLUSIONS Both participant groups endorsed the use of iCanCope (iCC) as an NF1 pain self-management mobile app. Differences between groups were noted, however. The NF1 group appeared interested in detailed and nuanced pain tracking capabilities; the expert group prioritised tracking information such as mood, nutrition and activity to identify potential associations with pain. In tailoring the existing iCC app for individuals with NF1, attention should be paid to creating a community support group feature and to tailoring content, features and format to potential users' specific needs.
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale University Yale School of Public Health, New Haven, Connecticut, USA
| | - Kaitlyn Larkin
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer N Stinson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Toronto SickKids, Toronto, Ontario, Canada
| | - William T Zempsky
- Department of Pediatrics and Nursing, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Division of Pain and Palliative Care, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Samuel A Ball
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Silva MA, Añez LM, Carroll KM, Jaramillo Y, Kiluk BD, Frankforter T, Ball SA, Gordon MA, Paris M. Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction. J Ethn Subst Abuse 2022:1-21. [PMID: 35714996 PMCID: PMC10350903 DOI: 10.1080/15332640.2022.2086194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.
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Affiliation(s)
- Michelle A Silva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis M Añez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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3
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Krystal JH, Alvarado J, Ball SA, Fortunati FG, Hu M, Ivy ME, Kapo J, Olson KD, Rohrbaugh RM, Sinha R, Tebes JK, Vender RJ, Yonkers KA, Mayes LC. Mobilizing an institutional supportive response for healthcare workers and other staff in the context of COVID-19: The Yale experience. Gen Hosp Psychiatry 2021; 68:12-18. [PMID: 33254081 PMCID: PMC7680059 DOI: 10.1016/j.genhosppsych.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic.
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Affiliation(s)
- John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States of America,Department of Psychology, Yale University, New Haven, CT, United States of America,Department of Psychiatry and Behavioral Health, Yale-New Haven Hospital, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Corresponding author at: Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States of America
| | - Javier Alvarado
- Department of Social Work, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Samuel A. Ball
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Silver Hill Hospital, New Canaan, CT, United States of America
| | - Frank G. Fortunati
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Psychiatry and Behavioral Health, Yale-New Haven Hospital, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America
| | - Mary Hu
- Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael E. Ivy
- Office of the Chief Medical Officer, Yale New Haven Health, New Haven, CT, United States of America
| | - Jennifer Kapo
- Yale Medicine, New Haven, CT, United States of America,Palliative Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Kristine D. Olson
- Office of the Chief Wellness Officer, Yale-New Haven Hospital, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America
| | - Robert M. Rohrbaugh
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Child Study Center, Yale School of Medicine, New Haven, CT, United States of America
| | - Jacob K. Tebes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America,Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT, United States of America
| | - Ronald J. Vender
- Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America
| | - Kimberly A. Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT, United States of America,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Linda C. Mayes
- Department of Psychology, Yale University, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Child Study Center, Yale School of Medicine, New Haven, CT, United States of America,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
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4
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Tracy K, Wachtel L, Goldmann E, Nissenfeld J, Burton M, Galanter M, Ball SA. Mentorship for Addiction Problems (MAP): A New Behavioral Intervention to Assist in the Treatment of Substance Use Disorders. J Stud Alcohol Drugs 2020. [DOI: 10.15288/jsad.2020.81.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kathlene Tracy
- Psychosocial Division, Addiction Institute Mount Sinai (AIMS), Laboratory of Psychosocial Processes in Addiction, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, New York
| | - Leah Wachtel
- Psychosocial Division, Addiction Institute Mount Sinai (AIMS), Laboratory of Psychosocial Processes in Addiction, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, New York
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, New York
| | - Joseph Nissenfeld
- Division of Alcoholism and Drug Abuse, New York University School of Medicine, Department of Psychiatry, New York, New York
| | - Mark Burton
- Division of Alcoholism and Drug Abuse, New York University School of Medicine, Department of Psychiatry, New York, New York
| | - Marc Galanter
- Division of Alcoholism and Drug Abuse, New York University School of Medicine, Department of Psychiatry, New York, New York
| | - Samuel A. Ball
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut
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5
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El Shahawy O, Park SH, Rogers ES, Shearston JA, Thompson AB, Cooper SC, Freudenberg N, Ball SA, Abrams D, Shelley D, Sherman SE. Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students. Subst Abuse Treat Prev Policy 2020; 15:65. [PMID: 32859230 PMCID: PMC7453717 DOI: 10.1186/s13011-020-00283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Background Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. Methods A cross-sectional survey of 2460 students (aged 18–25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. Results Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. Conclusions The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.
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Affiliation(s)
- Omar El Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY, USA. .,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates. .,School of Global Public Health, New York University, New York, USA.
| | - Su Hyun Park
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Erin S Rogers
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,VA New York Harbor Healthcare System, New York, USA
| | - Jenni A Shearston
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.,School of Global Public Health, New York University, New York, USA.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Azure B Thompson
- Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Spring C Cooper
- City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Nicholas Freudenberg
- City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Samuel A Ball
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - David Abrams
- School of Global Public Health, New York University, New York, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,School of Global Public Health, New York University, New York, USA
| | - Scott E Sherman
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.,School of Global Public Health, New York University, New York, USA.,VA New York Harbor Healthcare System, New York, USA
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6
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Paris M, Silva M, Añez-Nava L, Jaramillo Y, Kiluk BD, Gordon MA, Nich C, Frankforter T, Devore K, Ball SA, Carroll KM. Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial. Am J Public Health 2018; 108:1535-1542. [PMID: 30252519 PMCID: PMC6187780 DOI: 10.2105/ajph.2018.304571] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate whether adding Web-based cognitive behavioral treatment (CBT) to standard outpatient psychiatric or addiction treatment improved substance use outcomes. METHODS We conducted a randomized clinical trial in New Haven, Connecticut, between 2014 and 2017 comparing 8 weeks of standard outpatient treatment to the same treatment with access to a culturally adapted version of Web-based CBT with a 6-month follow-up. Participants were 92 treatment-seeking individuals with Spanish as their primary language and current substance use disorder, with few other restrictions. RESULTS Treatment completion and data availability were high (98% of the randomized sample). For the primary outcome (change in frequency of primary substance used), there was a significant effect of treatment condition by time (t 1, 718 = -2.64; 95% confidence interval = -0.61, 0.09; P = .01), indicating significantly greater reductions for those assigned to Web CBT, which were durable through the 6-month follow-up. The knowledge test indicated significantly greater increases for those assigned to Web CBT. CONCLUSIONS Adding a culturally adapted version of Web-based CBT to standard treatment improved substance use outcomes. Public Health Implications. This approach has high potential to address health disparities by providing an easily accessible, inexpensive form of evidence-based treatment to a range of Latinos with substance use disorders.
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Affiliation(s)
- Manuel Paris
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Michelle Silva
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis Añez-Nava
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Charla Nich
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen Devore
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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7
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Madden LM, Farnum SO, Eggert KF, Quanbeck AR, Freeman RM, Ball SA, Schottenfeld RS, Shi JM, Savage ME, Barry DT. An investigation of an open-access model for scaling up methadone maintenance treatment. Addiction 2018; 113:1450-1458. [PMID: 29453891 DOI: 10.1111/add.14198] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/03/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023]
Abstract
AIMS To examine retrospectively patient and programmatic outcomes following the development and implementation of an 'open-access' model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. DESIGN Medical and administrative records were abstracted to compare data for 1 year before and 9 years after initiating the implementation of an open-access treatment model in May 2007. SETTING Methadone maintenance treatment center in Connecticut, USA. PARTICIPANTS Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n = 2594) of the sample were men and 80% (n = 3133) reported that they were white. INTERVENTION The Network for the Improvement of Addiction Treatment-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity. MEASUREMENTS Census, waiting time, retention, non-medical opioid use, patient mortality and financial sustainability (net income and state-block grants as proportions of revenue). FINDINGS In the 9 years following the initial implementation of the open-access model, patient census increased by 183% from 1431 to 4051, and average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state-block grant revenues declined 14% and the proportion of total revenue from state-block grant revenue decreased from 49 to 24%. CONCLUSIONS An open-access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes.
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Affiliation(s)
- Lynn M Madden
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | | | | | | | | | - Samuel A Ball
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Richard S Schottenfeld
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Julia M Shi
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Mary Ellen Savage
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Declan T Barry
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
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8
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Richter L, Pugh BS, Smith PH, Ball SA. The co-occurrence of nicotine and other substance use and addiction among youth and adults in the United States: implications for research, practice, and policy. The American Journal of Drug and Alcohol Abuse 2016; 43:132-145. [DOI: 10.1080/00952990.2016.1193511] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Linda Richter
- The National Center on Addiction and Substance Abuse, New York, NY, USA
| | - Brandie S. Pugh
- The National Center on Addiction and Substance Abuse, New York, NY, USA
| | - Philip H. Smith
- Department of Community Health and Social Medicine, Sophie Davis Biomedical Education/CUNY School of Medicine, The City College of New York, New York, NY, USA
| | - Samuel A. Ball
- The National Center on Addiction and Substance Abuse, New York, NY, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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9
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Richter L, Pugh BS, Ball SA. Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana. Am J Drug Alcohol Abuse 2016; 43:247-260. [PMID: 27292878 DOI: 10.3109/00952990.2016.1164711] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The changing political and social climate surrounding marijuana use, coupled with the fact that available estimates of marijuana use disorder prevalence are outdated and do not adequately represent adolescents, underscore the need for up-to-date and comprehensive prevalence estimates of marijuana use disorder. OBJECTIVES To provide recent national estimates of marijuana use disorder as a function of usage patterns, age, and other sociodemographic, substance use, and mental health variables. METHODS Analyses of data from the 2014 National Survey on Drug Use and Health examined the prevalence of marijuana use disorder among respondents (N = 55,271) with various sociodemographic, substance use, and mental health characteristics. Logistic and multinomial regression analyses examined the correlates of marijuana use disorder as a function of these variables, with a special focus on age. RESULTS In 2014, 3.49% of lifetime, 11.62% of past-year, and 15.32% of past-30-day marijuana users met DSM-IV criteria for a marijuana use disorder; rates among youth generally were at least double those of adults across reported time frame and intensity of use. Regression analyses indicated that young age, black race/ethnicity, greater intensity of use, current tobacco/nicotine use, and alcohol and other drug use disorders were associated with increased odds of a marijuana use disorder. CONCLUSIONS A significant proportion of marijuana users, especially youth, are at risk for having a marijuana use disorder, even at relatively low levels of use.
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Affiliation(s)
- Linda Richter
- a The National Center on Addiction and Substance Abuse , New York , NY , USA
| | - Brandie S Pugh
- a The National Center on Addiction and Substance Abuse , New York , NY , USA
| | - Samuel A Ball
- a The National Center on Addiction and Substance Abuse , New York , NY , USA.,b Department of Psychiatry , Yale School of Medicine , New Haven , CT , USA
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10
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Abstract
Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut 06511;
| | - Stephanie Yarnell
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut 06511;
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut 06511; .,VA Connecticut Healthcare System, West Haven, Connecticut 06516.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Connecticut 06511
| | - Samuel A Ball
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut 06511; .,VA Connecticut Healthcare System, West Haven, Connecticut 06516.,The National Center on Addiction and Substance Abuse at Columbia University, New York, NY 10027
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut 06511; .,VA Connecticut Healthcare System, West Haven, Connecticut 06516.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Connecticut 06511
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11
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DeVito EE, Babuscio TA, Nich C, Ball SA, Carroll KM. Gender differences in clinical outcomes for cocaine dependence: randomized clinical trials of behavioral therapy and disulfiram. Drug Alcohol Depend 2014; 145:156-67. [PMID: 25457739 PMCID: PMC4268325 DOI: 10.1016/j.drugalcdep.2014.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/11/2014] [Accepted: 10/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite extensive research on gender differences in addiction, there are relatively few published reports comparing treatment outcomes for women versus men based on evidence-based treatments evaluated in randomized clinical trials. METHODS An aggregate sample comprised of data from five randomized clinical trials of treatment for cocaine dependence (N = 434) was evaluated for gender differences in clinical outcomes. Secondary analyses compared gender differences in outcome by medication condition (disulfiram versus no medication) and across multiple behavioral treatment conditions. RESULTS Women, compared with men, had poorer treatment outcomes on multiple measures of cocaine use during treatment and at post-treatment follow-up. These results appear to be primarily accounted for by disulfiram being less effective in women compared with men. There was no evidence of meaningful gender differences in outcome as a function of the behavioral therapies evaluated. CONCLUSIONS These findings suggest that women and men may benefit to similar degrees from some empirically validated behavioral treatments for addiction. Conversely, some addiction pharmacotherapies, such as disulfiram, may be associated with poorer outcomes among women relative to men and point to the need for careful assessment of pharmacological treatments in both sexes prior to widespread clinical implementation.
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Affiliation(s)
- Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, 1
Church Street, Suite 701, New Haven, CT 06510, United States,Corresponding author. Tel.: +1 203 737 4882;
fax: +1 203 737 3591
| | - Theresa A. Babuscio
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States,The APT Foundation, New Haven, CT 1 Long Wharf, New Haven, CT 06511,
United States
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950
Campbell Avenue, 151D, West Haven, CT 06516, United States
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12
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Carr WA, Ball SA. Predictors and treatment outcomes of perceived ward atmosphere among therapeutic community residents. J Subst Abuse Treat 2014; 46:567-73. [DOI: 10.1016/j.jsat.2014.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 12/15/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
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Carroll KM, Kiluk BD, Nich C, DeVito EE, Decker S, LaPaglia D, Duffey D, Babuscio TA, Ball SA. Toward empirical identification of a clinically meaningful indicator of treatment outcome: features of candidate indicators and evaluation of sensitivity to treatment effects and relationship to one year follow up cocaine use outcomes. Drug Alcohol Depend 2014; 137:3-19. [PMID: 24556275 PMCID: PMC4042667 DOI: 10.1016/j.drugalcdep.2014.01.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Selection of an appropriate indictor of treatment response in clinical trials is complex, particularly for the various illicit drugs of abuse. Most widely used indicators have been selected based on expert group recommendation or convention rather than systematic empirical evaluation. Absence of an evidence-based, clinically meaningful index of treatment outcome hinders cross-study evaluations necessary for progress in addiction treatment science. METHOD Fifteen candidate indicators used in multiple clinical trials as well as some proposed recently are identified and discussed in terms of relative strengths and weaknesses (practicality, cost, verifiability, sensitivity to missing data). Using pooled data from five randomized controlled trials of cocaine dependence (N=434), the indicators were compared in terms of sensitivity to the effects of treatment and relationship to cocaine use and general functioning during follow-up. RESULTS Commonly used outcome measures (percent negative urine screens; percent days of abstinence) performed relatively well in that they were sensitive to the effects of the therapies evaluated. Others, including complete abstinence and reduction in frequency of use, were less sensitive to effects of specific therapies and were very weakly related to cocaine use or functioning during follow-up. Indicators more strongly related to cocaine use during follow-up were those that reflected achievement of sustained periods of abstinence, particularly at the end of treatment. CONCLUSIONS These analyses did not demonstrate overwhelming superiority of any single indicator, but did identify several that performed particularly poorly. Candidates for elimination included retention, complete abstinence, and indicators of reduced frequency of cocaine use.
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Affiliation(s)
- Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Brian D. Kiluk
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Suzanne Decker
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,New England Mental Illness, Research Education and Clinical Center, VA Connecticut Healthcare System
| | - Donna LaPaglia
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Dianne Duffey
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Theresa A. Babuscio
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
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Carroll KM, Kiluk BD, Nich C, Gordon MA, Portnoy GA, Marino DR, Ball SA. Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. Am J Psychiatry 2014; 171:436-44. [PMID: 24577287 PMCID: PMC4042674 DOI: 10.1176/appi.ajp.2013.13070987] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A previous pilot trial evaluating computer-based training for cognitive-behavioral therapy (CBT4CBT) in 77 heterogeneous substance users (alcohol, marijuana, cocaine, and opioids) demonstrated preliminary support for its efficacy in the context of a community-based outpatient clinic. The authors conducted a more definitive trial in a larger, more homogeneous sample. METHOD In this randomized clinical trial, 101 cocaine-dependent individuals maintained on methadone were randomly assigned to standard methadone maintenance or methadone maintenance with weekly access to CBT4CBT, with seven modules delivered within an 8-week trial. RESULTS Treatment retention and data availability were high and comparable across the treatment conditions. Participants assigned to the CBT4CBT condition were significantly more likely to attain 3 or more consecutive weeks of abstinence from cocaine (36% compared with 17%; p<0.05, odds ratio=0.36). The group assigned to CBT4CBT also had better outcomes on most dimensions, including urine specimens negative for all drugs, but these reached statistical significance only for individuals completing the 8-week trial (N=69). Follow-up data collected 6 months after treatment termination were available for 93% of the randomized sample; these data indicate continued improvement for those assigned to the CBT4CBT group, replicating previous findings regarding its durability. CONCLUSIONS This trial replicates earlier findings indicating that CBT4CBT is an effective adjunct to addiction treatment with durable effects. CBT4CBT is an easily disseminable strategy for broadening the availability of CBT, even in challenging populations such as cocaine-dependent individuals enrolled in methadone maintenance programs.
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Decker SE, Frankforter T, Babuscio T, Nich C, Ball SA, Carroll KM. Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials. Am J Addict 2014; 23:466-74. [PMID: 24628970 DOI: 10.1111/j.1521-0391.2014.12132.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/08/2013] [Accepted: 11/17/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cocaine use during randomized clinical trials (RCTs) is typically assessed by participant self-report or biological assay (eg, urinalysis). There have been few direct comparisons of these assessment methods to investigate their concordance and their predictive validity for cocaine use and psychosocial outcomes following treatment completion. METHOD In a combined sample of 380 participants from 5 cocaine RCTs, the concordance between cocaine use assessment methods was examined. Sequential multiple linear and logistic regression models evaluated the predictive validity of two assessment methods for cocaine use and psychosocial outcomes assessed at 1, 3, 6, and 12 months after treatment. RESULTS Concordance for self-report and urinalysis indicators of cocaine use was high within-treatment (k = 0.72) and moderate during follow-up (k = 0.51). Rates of concordance were higher in studies using test cups with immediate urinalysis results. Regression analyses indicated that self-report data within-treatment predicted self-reported cocaine use at all post-treatment points (β 0.22-0.30, p < .01), while urinalysis results within-treatment predicted urinalysis results at 1, 3, and 6 months post-treatment (OR 3.92-20.99, p < .05). Cocaine-positive urinalyses within-treatment were negatively associated with a composite "good outcome" indicator at 1 and 3 months post-treatment (OR 0.17-0.32, p < .05). DISCUSSION AND CONCLUSIONS These results suggest a significant role of method variance in predicting post-treatment outcomes from within-treatment cocaine use indices. SCIENTIFIC SIGNIFICANCE Results support recommendations that cocaine treatment trials should include both biological assay and self-report assessment. Test cups may facilitate increased self-report accuracy.
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Affiliation(s)
- Suzanne E Decker
- New England Mental Illness Research Education and Clinical Center, VA Connecticut Health Care System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
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Samuel DB, Carroll KM, Rounsaville BJ, Ball SA. Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample. J Pers Disord 2013; 27:625-35. [PMID: 24044664 PMCID: PMC4125199 DOI: 10.1521/pedi.2013.27.5.625] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.
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Moore BA, Fazzino T, Barry DT, Fiellin DA, Cutter CJ, Schottenfeld RS, Ball SA. The Recovery Line: A pilot trial of automated, telephone-based treatment for continued drug use in methadone maintenance. J Subst Abuse Treat 2013; 45:63-9. [PMID: 23375114 DOI: 10.1016/j.jsat.2012.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/07/2012] [Accepted: 12/19/2012] [Indexed: 11/27/2022]
Abstract
The current pilot study evaluated feasibility, acceptability, and initial efficacy of a therapeutic Interactive Voice Response (IVR) system ("the Recovery Line") for patients receiving methadone maintenance who continue to use illicit drugs. Patients were randomized (N=36) to 4weeks of treatment-as-usual (TAU) or Recovery Line plus TAU. Ratings of the Recovery Line were high and remained stable throughout the study. However, despite instructions and reminders, patients used substantially less than the recommended daily use (<10days of 28). Patients were more likely to report abstinence from opioids and cocaine on days they used the Recovery Line (p=.01) than those they did not. Conditions did not differ significantly on patient satisfaction, urine screen outcomes, or coping efficacy. As with other computer-based treatments, findings suggest the Recovery Line is acceptable and feasible. However, additional methods to increase patient utilization of automated systems and larger clinical trials are needed.
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Affiliation(s)
- Brent A Moore
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; APT Foundation, New Haven, CT 06519, USA.
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Carroll KM, Nich C, Shi JM, Eagan D, Ball SA. Efficacy of disulfiram and Twelve Step Facilitation in cocaine-dependent individuals maintained on methadone: a randomized placebo-controlled trial. Drug Alcohol Depend 2012; 126:224-31. [PMID: 22695473 PMCID: PMC3461119 DOI: 10.1016/j.drugalcdep.2012.05.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cocaine use remains a major problem within methadone maintenance programs. Disulfiram's efficacy in reducing cocaine use has been demonstrated in several trials, but its relative efficacy among individuals who use versus abstain from alcohol remains unclear. Treatment approaches which seek to enhance substance users' involvement in self-help activities (Twelve Step Facilitation, TSF) have been associated with better outcomes among alcohol and cocaine users, but have rarely been evaluated among methadone-maintained cocaine-opioid users. METHODS We conducted a randomized, placebo-controlled, double blind (for medication condition), factorial (2×2) trial with 4 treatment conditions: Disulfiram plus TSF, disulfiram plus standard counseling only, placebo plus TSF, and placebo plus standard counseling in the context of a community-based methadone maintenance program. Participants (N=112) received either disulfiram (250 mg/d) or placebo in conjunction with daily methadone maintenance. RESULTS Assignment to TSF was associated with less cocaine use throughout treatment and a higher number of cocaine-negative urines. While there were no significant main effects of disulfiram versus placebo, individuals without an alcohol use disorder demonstrated greater reductions in cocaine use over time when assigned to disulfiram. CONCLUSIONS TSF appears feasible in this methadone maintenance program and was associated with modest reductions in cocaine use, an often intractable problem in this setting. Support for the efficacy of disulfiram was weaker, as it appeared effective only for those without a current alcohol use disorder for this sample.
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Affiliation(s)
- Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Julia M. Shi
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
| | - Dorothy Eagan
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
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Samuel DB, Miller JD, Widiger TA, Lynam DR, Pilkonis PA, Ball SA. Conceptual changes to the definition of borderline personality disorder proposed for DSM-5. J Abnorm Psychol 2012; 121:467-76. [PMID: 21875165 PMCID: PMC3706458 DOI: 10.1037/a0025285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Personality and Personality Disorders Work Group proposed the elimination of diagnostic criterion sets in favor of a prototype matching system that defines personality disorders using narrative descriptions. Although some research supports this general approach, no empirical studies have yet examined the specific definitions proposed for DSM-5. Given the wide interest in borderline personality disorder (BPD), it is crucial to determine how this methodological shift might affect the content and conceptualization of the diagnosis. Eighty-two experts on BPD provided ratings of the DSM-IV-TR or DSM-5 version of BPD in terms of 37 traits proposed for DSM-5. Analyses revealed significant and meaningful differences among the two constructs, with the DSM-5 version evincing increased interpersonal dependency but a decreased emphasis on antagonism and disinhibition. A second study within a clinical sample demonstrated that both antagonism and disinhibition mediated the relationships between DSM-IV BPD and impairment, suggesting that the proposed changes might have important consequences for BPD's coverage, prevalence, and nomological network. More globally, our results illustrate that unanticipated shifts in diagnostic constructs can stem from seemingly minor revisions and suggest that research is needed to understand how these, or other changes, might affect our conceptualization, diagnosis, and treatment of BPD.
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Affiliation(s)
- Douglas B Samuel
- Department of Psychiatry, Yale University School of Medicine, USA.
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Samuel DB, Connolly AJ, Ball SA. The convergent and concurrent validity of trait-based prototype assessment of personality disorder categories in homeless persons. Assessment 2012; 19:287-98. [PMID: 22523133 DOI: 10.1177/1073191112444461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The DSM-5 proposal indicates that personality disorders (PDs) be defined as collections of maladaptive traits but does not provide a specific diagnostic method. However, researchers have previously suggested that PD constructs can be assessed by comparing individuals' trait profiles with those prototypic of PDs and evidence from the five-factor model (FFM) suggests that these prototype matching scores converge moderately with traditional PD instruments. The current study investigates the convergence of FFM PD prototypes with interview-assigned PD diagnoses in a sample of 99 homeless individuals. This sample had very high rates of PDs, which extends previous research on samples with more modest prevalence rates. Results indicated that diagnostic agreement between these methods was generally low but consistent with the agreement previously observed between explicit PD measures. Furthermore, trait-based and diagnostic interview scores evinced similar relationships with clinically important indicators such as abuse history and past suicide attempts. These findings demonstrate the validity of prototype methods and suggest their consideration for assessing trait-defined PD types within DSM-5.
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Affiliation(s)
- Douglas B Samuel
- Purdue University, Department of Psychological Science, West Lafayette, IN 47907, USA.
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Schlauch RC, O'Malley SS, Rounsaville BJ, Ball SA. Internalizing and externalizing dimensions and alcohol use in first time DWI offenders: Indirect effects through coping self-efficacy. Psychology of Addictive Behaviors 2012; 26:133-9. [DOI: 10.1037/a0025808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Palmer RS, McMahon TJ, Moreggi DI, Rounsaville BJ, Ball SA. College Student Drug Use: Patterns, Concerns, Consequences, and Interest in Intervention. J Coll Stud Dev 2012; 53:10.1353/csd.2012.0014. [PMID: 24339478 PMCID: PMC3856915 DOI: 10.1353/csd.2012.0014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although previous surveys have indicated high rates of illicit and prescription drug misuse among college students, few have assessed negative consequences, personal concerns, or interest in interventions for drug use. In a survey of 262 college students who self-reported lifetime use of an illicit drug, 69% reported at least one negative consequence over the course of their lifetime and 63% in the past year. Many also reported being moderately concerned (28%) about their drug or medication misuse and moderately interested in some form of intervention (76%). The frequency of marijuana use and medication misuse in the past month was related to increased negative consequences and personal concerns even when controlling for the frequency of past month alcohol use. There were relatively few differences as a function of gender or year in college.
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Affiliation(s)
- Rebekka S Palmer
- Yale School of Medicine Department of Psychiatry 915 Old Oak Rd. Livermore, CA 94550
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Samuel DB, Lynam DR, Widiger TA, Ball SA. An expert consensus approach to relating the proposed DSM-5 types and traits. ACTA ACUST UNITED AC 2012; 3:1-16. [DOI: 10.1037/a0023787] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. This study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 days) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition, but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment.
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Affiliation(s)
- Douglas B Samuel
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
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Carroll KM, Ball SA, Jackson R, Martino S, Petry NM, Stitzer ML, Wells EA, Weiss RD. Ten take home lessons from the first 10 years of the CTN and 10 recommendations for the future. Am J Drug Alcohol Abuse 2011; 37:275-82. [PMID: 21854269 PMCID: PMC3232679 DOI: 10.3109/00952990.2011.596978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The first 10 years of the National Institute on Drug Abuse's Clinical Trials Network (CTN) yielded a wealth of data on the effectiveness of a number of behavioral, pharmacological, and combined approaches in community-based settings. METHODS We summarize some of the methodological contributions and lessons learned from the behavioral trials conducted during its first ten years, including the capacity and enormous potential of this national research infrastructure. RESULTS The CTN made contributions to the methodology of effectiveness research; new insights from secondary analyses; the extent to which approaches with strong evidence bases, such as contingency management, extend their effectiveness to real world clinical settings; new data on 'standard treatment' as actually practiced in community programs, the extent to which retention remains a major issue in the field; important data on the safety of specific behavioral therapies for addiction; and heightened the importance of continued sustained attention to bridging the gap between treatment and research. CONCLUSIONS Areas of focus for the CTN's future include defining common outcome measures to be used in treatment outcome studies for illicit drugs; incorporating performance indicators and measures of clinical significance; conducting comparative outcome studies; contributing to the understanding of effective treatments of comorbidity; reaching underserved populations; building implementation science; understanding long-term outcomes of current treatments and sustaining treatment effects; and conducting future trials more efficiently.
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Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA.
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Abstract
We conducted a randomized comparison of dual-focus schema therapy with individual drug counseling as enhancements to the residential treatment of 105 substance-dependent patients with specific personality disorders versus those without. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using the Cox proportional hazards model, we found no psychotherapy differences in retention (days in treatment). Hierarchical linear modeling indicated that participants with personality disorders started with higher psychiatric, interpersonal, and dysphoria symptoms and that both therapies reduced symptoms in 6 months. Contrary to predictions, individual drug counseling resulted in more sustained reductions than did dual-focus schema therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms.
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Affiliation(s)
- Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
AIMS The effectiveness of expert-led (EX) and train-the-trainer (TT) strategies was compared to a self-study approach (SS) for teaching clinicians motivational interviewing (MI). DESIGN Twelve community treatment programs were assigned randomly to the three conditions. EX and TT conditions used skill-building workshops and three monthly supervision sessions guided by treatment integrity ratings, performance feedback and coaching techniques. Trainers in TT were first trained and certified in MI and then prepared carefully to deliver the workshops and supervise MI at their programs. Clinicians in SS only received the training materials. SETTING Licensed out-patient and residential addiction and mental health treatment programs in the US state of Connecticut were involved in the study. PARTICIPANTS Ninety-two clinicians who provided addiction treatment within these programs and had limited experience with MI participated in the study. MEASUREMENTS Primary outcomes were the clinicians' MI adherence and competence and the percentage of clinicians meeting clinical trial standards of MI performance. Assessments occurred at baseline, post-workshop, post-supervision and at 12-week follow-up. FINDINGS The study found EX and TT, in comparison to SS, improved clinicians' adherence and competence significantly, with higher percentages of clinicians reaching clinical trial standards of MI performance and few differences between EX and TT. CONCLUSIONS This study supports the combined use of workshops and supervision to teach community program clinicians MI and suggests the train-the-trainer approach may be a feasible and effective strategy for disseminating empirically supported treatments.
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Affiliation(s)
- Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Carroll KM, Kiluk BD, Nich C, Babuscio TA, Brewer JA, Potenza MN, Ball SA, Martino S, Rounsaville BJ, Lejuez CW. Cognitive function and treatment response in a randomized clinical trial of computer-based training in cognitive-behavioral therapy. Subst Use Misuse 2011; 46:23-34. [PMID: 21190403 PMCID: PMC3083447 DOI: 10.3109/10826084.2011.521069] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cognitive-behavioral therapy (CBT), because of its comparatively high level of cognitive demand, is likely to be challenging for substance users with limitations in cognitive function. However, it is not known whether computer-assisted versions of CBT will be particularly helpful (e.g., allowing individualized pace and repetition) or difficult (e.g., via complexity of computerized delivery) for such patients. In this secondary analysis of data collected from a randomized clinical trial evaluating computer-assisted CBT, four aspects of cognitive functioning were evaluated among 77 participants. Those with higher levels of risk taking completed fewer sessions and homework assignments and had poorer substance use outcomes.
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Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Gibbons CJ, Carroll KM, Ball SA, Nich C, Frankforter TL, Martino S. Community program therapist adherence and competence in a motivational interviewing assessment intake session. Am J Drug Alcohol Abuse 2010; 36:342-9. [PMID: 20942726 DOI: 10.3109/00952990.2010.500437] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Teaching community program therapists to use motivational interviewing (MI) strategies for addictions treatment with sufficient frequency (i.e., adherence) and skill (i.e., competence) is a priority and challenge for the field. The development of psychometrically valid MI integrity measures that can be used for supervision and evaluation and be both sensitive and robust across clinical situations is needed. OBJECTIVE This article examines the performance of the Independent Tape Rating Scale (ITRS) when used to evaluate the delivery of MI within a one-session assessment intake. METHODS Audiotapes of 315 sessions of therapists in MI and counseling-as-usual conditions were rated according to the ITRS by raters blind to treatment condition. RESULTS Results indicate that community therapists were successfully trained and supervised to use MI within an assessment intake session, with MI adherence and competence that was discriminable from counseling-as-usual practices. Increased therapist MI adherence and competence was associated with increases in an index of client motivation for change, though unrelated to treatment outcome. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The ITRS appears to be a valid instrument for measuring therapist MI adherence and competence within an assessment intake.
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Affiliation(s)
- Carly J Gibbons
- Yale University School of Medicine, West Haven, Connecticut, USA
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Palmer RS, McMahon TJ, Rounsaville BJ, Ball SA. Coercive sexual experiences, protective behavioral strategies, alcohol expectancies and consumption among male and female college students. J Interpers Violence 2010; 25:1563-78. [PMID: 20040711 PMCID: PMC3679644 DOI: 10.1177/0886260509354581] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Alcohol use and sexual assault on college campuses are highly prevalent and the focus of numerous prevention and intervention efforts. Our goals were to gain a greater understanding of the relationship between coercive sexual experiences, utilization of protective behavioral strategies and alcohol expectancies and consumption among male and female college students. We surveyed 370 college students regarding their past year experiences and found that 34% of women and 31% of men reported unwanted sexual contact, 6% of women and 13% of men reported engaging in sexually coercive behavior, and 4% of women and 9% of men reported experiencing both unwanted contact and engaging in sexually coercive behavior. Findings indicated students who experienced unwanted sexual contact reported significant differences in alcohol expectancies. More specifically, those who engaged in sexually coercive behaviors had significantly higher sex-related alcohol expectancies. In addition, recipients of unwanted contact reported higher alcohol consumption, used fewer protective strategies when drinking, and experienced more negative consequences due to their alcohol use. Results suggest that campus alcohol and sexual assault prevention efforts should include information on alcohol expectancies and use of protective strategies.
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Affiliation(s)
- Rebekka S Palmer
- Yale School of Medicine, Department of Psychiatry, 915 Old Oak Rd., Livermore, CA 94550, USA.
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Crits-Christoph P, Gallop R, Temes CM, Woody G, Ball SA, Martino S, Carroll KM. The alliance in motivational enhancement therapy and counseling as usual for substance use problems. J Consult Clin Psychol 2010; 77:1125-35. [PMID: 19968388 DOI: 10.1037/a0017045] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data from a community-based multicenter study of motivational enhancement therapy (MET) and counseling as usual (CAU) for outpatient substance users were used to examine questions about the role of the alliance in MET and CAU. Most (94%) of the sample met diagnostic criteria for abuse or dependence (primarily alcohol and/or cocaine). Sixteen therapists for CAU and 14 for MET participated. No reliable differences in patient ratings (n = 319) on the Helping Alliance Questionnaire-II (HAq-II) were evident for MET compared to CAU, but significant differences between therapists were found within each condition in mean patient-rated HAq-II scores. Overall, average levels of alliance were high. The between-therapists component of the alliance, but not the within-therapist component, was significantly associated with self-reported days of primary substance use during the follow-up period from Week 4 to Week 16 (Cohen's d = 0 .39; n = 257). Therapists with either low or very high alliances had relatively poorer average outcomes (quadratic effect, d = 0.44). For therapists in both MET and CAU, increased use of MET fundamental techniques and MET advanced techniques during treatment sessions was associated with higher levels of alliance. Implications of the findings for conceptualization of the alliance and for training of therapists are discussed.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Schwarz RK, Bruce RD, Ball SA, Herme M, Altice FL. Comparison of tuberculin skin testing reactivity in opioid-dependent patients seeking treatment with methadone versus buprenorphine: policy implications for tuberculosis screening. Am J Drug Alcohol Abuse 2010; 35:439-44. [PMID: 20014914 DOI: 10.3109/00952990903447741] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Buprenorphine's availability in primary care settings offers increased access to treatment and linkage to primary care for opioid-dependent patients. Currently, tuberculin skin testing (TST) is recommended for patients enrolling in methadone maintenance treatment (MMT), but not for those enrolling in buprenorphine maintenance treatment (BMT). OBJECTIVES To compare TST screening results in enrollees in BMT and MMT programs and assess the correlates of TST positivity among these subjects. METHODS A cross-sectional analysis of a retrospective cohort study was conducted to compare concurrent TST results among contemporaneously matched groups of MMT and BMT patients in the same community. RESULTS TST positivity was approximately 9% in both MMT and BMT settings (p = .27). Increased TST positivity was associated with being Black (AOR = 3.53, CI = 1.28-9.77), Hispanic (AOR = 3.11, CI = 1.12-8.60), and having higher education (AOR = 3.01, CI = 1.20-7.53). CONCLUSIONS These results confirm a similar high prevalence of TST positivity in opioid-dependent patients enrolling in MMT and BMT programs. Racial and ethnic health disparities remain associated with TST positivity, yet a relationship between higher education and tuberculosis requires further investigation. SCIENTIFIC SIGNIFICANCE These data suggest the importance of incorporating TST screening in emerging BMT programs as a mechanism to provide increased detection and treatment of tuberculosis infection in opioid-dependent patient populations.
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Affiliation(s)
- Ryan K Schwarz
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA
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Carroll KM, Martino S, Ball SA, Nich C, Frankforter T, Anez LM, Paris M, Suarez-Morales L, Szapocznik J, Miller WR, Rosa C, Matthews J, Farentinos C. A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users. J Consult Clin Psychol 2009; 77:993-9. [PMID: 19803579 DOI: 10.1037/a0016489] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition x Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.
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Affiliation(s)
- Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06519, USA.
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Holt LJ, O'Malley SS, Rounsaville BJ, Ball SA. Depressive symptoms, drinking consequences, and motivation to change in first time DWI offenders. Am J Drug Alcohol Abuse 2009; 35:117-22. [PMID: 19462293 DOI: 10.1080/00952990802585398] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychological disorders are common among driving-while-intoxicated (DWI) offenders; thus, a DWI arrest may serve as an important opportunity for further screening and subsequent treatment. OBJECTIVES The current study examined the extent to which mild to moderate pretreatment depressive symptoms, as measured by the Beck Depression Inventory (BDI), could predict intervention outcomes in 284 first-time DWI offenders. METHODS Participants were given drinking-related and psychosocial assessments at the beginning and end of a 10-week intervention and at 6- and 12-month follow-ups. RESULTS After the intervention and at both follow-ups, all participants reported declines in depressive symptoms, alcohol consumption, and negative drinking consequences and higher self-efficacy to avoid high-risk drinking. It was notable, however, that offenders with depressive symptoms reported more drinking-related consequences and lower self-efficacy at all time points, but greater motivation to change their drinking behavior. CONCLUSIONS The findings suggest that offenders with depressive symptoms have more severe symptomatology than nondepressed offenders but may be more amenable to changing their drinking. SCIENTIFIC SIGNIFICANCE The BDI may be a useful screening tool for determining which offenders are in need of an intervention following a DWI arrest.
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Affiliation(s)
- Laura J Holt
- Department of Psychology, Trinity College, Hartford, Connecticut 06106, USA.
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Yonkers KA, Howell HB, Allen AE, Ball SA, Pantalon MV, Rounsaville BJ. A treatment for substance abusing pregnant women. Arch Womens Ment Health 2009; 12:221-7. [PMID: 19350369 PMCID: PMC3103065 DOI: 10.1007/s00737-009-0069-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
We describe the adaptation of a manualized behavioral treatment for substance using pregnant women that includes components of motivational interviewing and cognitive therapy. In a pilot study conducted in 2006-2007, five non-behavioral health clinicians were trained to provide the treatment to 14 women. Therapy was administered concurrent with routine prenatal care at inner-city maternal health clinics in New Haven and Bridgeport, Connecticut, small urban cities in the USA. Substance use was monitored by self report, and urine and breath tests. Treatment fidelity was assessed using the Yale Adherence and Competence System. Behavioral treatment delivery in this setting is feasible and is being evaluated in a randomized, controlled, clinical trial.
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Affiliation(s)
- Kimberly Ann Yonkers
- Perinatal Research Program, Department of Psychiatry, Yale University School of Medicine, 142 Temple Street, New Haven, CT 06510, USA.
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Ball SA, Martino S, Nich C, Frankforter TL, Van Horn D, Crits-Christoph P, Woody GE, Obert JL, Farentinos C, Carroll KM. “Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics”: Correction. J Consult Clin Psychol 2009. [DOI: 10.1037/a0015304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Field CA, Adinoff B, Harris TR, Ball SA, Carroll KM. Construct, concurrent and predictive validity of the URICA: data from two multi-site clinical trials. Drug Alcohol Depend 2009; 101:115-23. [PMID: 19157723 PMCID: PMC3097110 DOI: 10.1016/j.drugalcdep.2008.12.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND A better understanding of how to measure motivation to change and how it relates to behavior change in patients with drug and alcohol dependence would broaden our understanding of the role of motivation in addiction treatment. METHODS Two multi-site, randomized clinical trials comparing brief motivational interventions with standard care were conducted in the National Institute on Drug Abuse Clinical Trials Network. Patients with primary drug dependence and alcohol dependence entering outpatient treatment participated in a study of either Motivational Enhancement Therapy (n=431) or Motivational Interviewing (n=423). The construct, concurrent, and predictive validity of two composite measures of motivation to change derived from the University of Rhode Island Change Assessment (URICA): Readiness to Change (RTC) and Committed Action (CA) were evaluated. RESULTS Confirmatory factor analysis confirmed the a priori factor structure of the URICA. RTC was significantly associated with measures of addiction severity at baseline (r=.12-.52, p<.05). Although statistically significant (p<.01), the correlations between treatment outcomes and RTC were low (r=-.15 and -18). Additional analyses did not support a moderating or mediating effect of motivation on treatment retention or substance use. CONCLUSIONS The construct validity of the URICA was confirmed separately in a large sample of drug- and alcohol-dependent patients. However, evidence for the predictive validity of composite scores was very limited and there were no moderating or mediating effects of either measure on treatment outcome. Thus, increased motivation to change, as measured by the composite scores of motivation derived from the URICA, does not appear to influence treatment outcome.
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Affiliation(s)
- Craig A Field
- School of Social Work, Center for Social Work Research, University of Texas at Austin, Health Behavior Research and Training Institute, 1717 West 6th Street Ste 295, Austin, TX 78703, USA.
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Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Rounsaville BJ. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Drug Alcohol Depend 2009; 100:178-81. [PMID: 19041197 PMCID: PMC2742309 DOI: 10.1016/j.drugalcdep.2008.09.015] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the durability of effects of a computer-assisted version of cognitive behavioral therapy (CBT) as treatment for substance dependence through a 6-month follow-up. METHODS Following a randomized clinical trial in which 73 individuals seeking outpatient treatment for substance dependence in an outpatient community setting were randomized to either standard treatment-as-usual (TAU) or TAU with 8 weeks of biweekly access to computer-based training for CBT (CBT4CBT), participants were interviewed 1, 3, and 6 months after the termination of study treatments. RESULTS Sixty of the 73 participants were reached for follow-up (82%); follow-up rates and availability of data were comparable across treatment conditions. Random regression analyses of use across time indicated significant differences between groups, such that those assigned to TAU increased their drug use across time while those assigned to CBT4CBT tended to improve slightly. The durability of the CBT4CBT effect remained even after controlling for treatment retention, treatment substance use outcomes, and exposure to other treatment during the follow-up period. CONCLUSIONS Computerized CBT4CBT appears to have both short-term and enduring effects on drug use.
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Affiliation(s)
- Kathleen M Carroll
- Yale University School of Medicine, Division of Substance Abuse, 950 Campbell Avenue, 151D West Haven, CT 06516, USA.
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39
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Abstract
Reasons for premature termination of outpatient substance user treatment were evaluated from client and clinician perspectives using qualitative (focus groups) and quantitative (survey) methods in a pilot study (N = 44). The sample consisted of clients (n = 22), the majority of whom were male (73%) and African American (50%) or Caucasian (41%). The sample of clinicians (n = 22) were predominantly female (64%), and Caucasian (52%) or African American (24%). The most frequently endorsed reasons for leaving treatment were related to individual rather than program characteristics with heavy drug or alcohol use, transportation or financial problems, and ambivalence about abstinence being highly rated by both clinicians and clients. Survey results indicated that clinicians more frequently attributed treatment dropout to individual- or client-level factors than did clients. Focus group ratings indicated that clinicians felt client motivation and staff connection issues were primary reasons for dropout, whereas clients indicated social support and staff connection issues. The findings suggest that the development of early therapeutic alliance and active problem solving of potential barriers to treatment attendance may influence treatment retention.
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Affiliation(s)
- Rebekka S Palmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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40
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Abstract
Sixty homeless clients at two drop-in centers in different boroughs in New York City were assessed using the Structured Clinical Interview for DSM-IV Axis I and II disorders and the Positive and Negative Syndrome Scale. Very high rates of all personality disorders were found for Cluster A (73% paranoid, 65% schizoid, 43% schizotypal), B (57% antisocial, 62% borderline, 20% histrionic, 57% narcissistic) and C (50% avoidant, 25% dependent, 57% obsessive compulsive). Axis I mood, anxiety, and substance use disorders were each diagnosed in over half the sample. At least one Cluster A disorder was diagnosed in 92% of the sample, and these disorders were distinguished from Axis I psychotic disorders (20%) with regard to prevalence, patterns of association, and constellation of symptoms. Cluster A disorders were not associated with any Axis I disorder, suggesting diagnostic independence in this sample.
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Petry NM, Roll JM, Rounsaville BJ, Ball SA, Stitzer M, Peirce JM, Blaine J, Kirby KC, McCarty D, Carroll KM. Serious adverse events in randomized psychosocial treatment studies: safety or arbitrary edicts? J Consult Clin Psychol 2008; 76:1076-82. [PMID: 19045975 PMCID: PMC2756150 DOI: 10.1037/a0013679] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human subjects protection policies developed for pharmaceutical trials are now being widely applied to psychosocial intervention studies. This study examined occurrences of serious adverse events (SAEs) reported in multicenter psychosocial trials of the National Institute on Drug Abuse Clinical Trials Network. Substance-abusing participants (N = 1,687) were randomized to standard care or standard care plus either contingency management or motivational enhancement. Twelve percent of participants experienced 1 or more SAEs during the 27,198 person-weeks of follow-up. Of the 260 SAEs recorded, none were judged by the data safety monitoring board to be study related, and there were no significant differences between experimental and control conditions in SAE incidence rates. These data underscore the need to reconsider the rationale behind, and appropriate methods for, monitoring safety during psychosocial therapy trials.
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Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, Department of Medicine, University of Connecticut Health Center, USA.
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Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM. Informal discussions in substance abuse treatment sessions. J Subst Abuse Treat 2008; 36:366-75. [PMID: 18835679 DOI: 10.1016/j.jsat.2008.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/25/2008] [Accepted: 08/23/2008] [Indexed: 11/29/2022]
Abstract
This study evaluated the extent to which counselors initiated informal discussions (i.e., general discussions and self-disclosures about matters unrelated to treatment) with their clients during treatment sessions within two National Institute on Drug Abuse Clinical Trial Network protocols involving adaptations of motivational interviewing (MI). Sixty counselors across the two protocols had 736 sessions independently rated for counselor treatment fidelity and the occurrence of informal discussions. The results showed that 88% of the counselors initiated informal discussions in their sessions and that most of these discussions involved counselors sharing personal information or experiences they had in common with their clients. The major finding was that counselor training in MI was associated with significantly less informal discussion across sessions. A higher frequency of informal discussion was related to less counselor MI proficiency and less in-session change in client motivation, although unrelated to client program retention and substance use outcomes. The findings suggest that although some informal discussions may help build an alliance between counselors and clients, too much of it may hinder counselors' proficient implementation of MI treatment strategies and the clients' motivational enhancement process.
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Affiliation(s)
- Steve Martino
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06516, USA.
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Abstract
This study assesses the psychometric properties of the Condom Barriers Scale (CBS), an instrument originally designed to measure women's perceptions and attitudes regarding male condom use, with a sample of men at high risk for human immunodeficiency virus (HIV). Participants include 590 male patients in drug abuse treatment involved in a gender-specific HIV prevention intervention for teaching safer sex skills. Second-order confirmatory factor analysis generally supported the underlying four-factor subscale structure of the CBS. However, exploratory factor analysis revealed a few specific discrepancies in the factor structure between men and women. Internal consistency and test-retest reliability estimates were moderate to high in value. CBS scores correlated with use of condoms for men with high-risk sexual partners, supporting criterion-related validity. Overall, the analysis indicates that the CBS is a potentially valid and reliable instrument and has utility for assessing barriers to condom use with men, but may need some item content modifications to allow appropriate assessment of gender differences and comparisons across studies.
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Affiliation(s)
- Suzanne R Doyle
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105-4631, USA.
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Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Nuro KF, Gordon MA, Portnoy GA, Rounsaville BJ. Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT. Am J Psychiatry 2008; 165:881-8. [PMID: 18450927 PMCID: PMC2562873 DOI: 10.1176/appi.ajp.2008.07111835] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study evaluated the efficacy of a computer-based version of cognitive-behavioral therapy (CBT) for substance dependence. METHOD This was a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to standard treatment or standard treatment with biweekly access to computer-based training in CBT (CBT4CBT) skills. RESULTS Treatment retention and data availability were comparable across the treatment conditions. Participants assigned to the CBT4CBT condition submitted significantly more urine specimens that were negative for any type of drugs and tended to have longer continuous periods of abstinence during treatment. The CBT4CBT program was positively evaluated by participants. In the CBT4CBT condition, outcome was more strongly associated with treatment engagement than in treatment as usual; furthermore, completion of homework assignments in CBT4CBT was significantly correlated with outcome and a significant predictor of treatment involvement. CONCLUSIONS These data suggest that CBT4CBT is an effective adjunct to standard outpatient treatment for substance dependence and may provide an important means of making CBT, an empirically validated treatment, more broadly available.
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Ball SA, Martino S, Nich C, Frankforter TL, Van Horn D, Crits-Christoph P, Woody GE, Obert JL, Farentinos C, Carroll KM. Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. J Consult Clin Psychol 2007; 75:556-67. [PMID: 17663610 PMCID: PMC2148493 DOI: 10.1037/0022-006x.75.4.556] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.
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Affiliation(s)
- Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, APT Foundation, New Haven, CT 06511, USA.
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Suarez-Morales L, Matthews J, Martino S, Ball SA, Rosa C, Farentinos C, Szapocznik J, Carroll KM. Issues in designing and implementing a Spanish-language multi-site clinical trial. Am J Addict 2007; 16:206-15. [PMID: 17612825 PMCID: PMC3628724 DOI: 10.1080/10550490701375707] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To address at least in part health disparities in Hispanic populations, the NIDA Clinical Trials Network implemented the first multi-site randomized clinical trial of substance abuse treatment conducted entirely in Spanish. This trial was intended to evaluate the effectiveness of Motivational Enhancement Therapy in a diverse population of Hispanics. In the conduct of this trial, several barriers to the successful implementation of a Spanish-language multi-site trial had to be addressed, including the appropriate translation of assessment instruments, shortage of appropriately trained Spanish-speaking clinical staff, and barriers to recruitment and retention of this population. To encourage similar research, strategies are described that were developed by the study team to meet these challenges.
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Affiliation(s)
- Lourdes Suarez-Morales
- Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Ball SA, Todd M, Tennen H, Armeli S, Mohr C, Affleck G, Kranzler HR. Brief motivational enhancement and coping skills interventions for heavy drinking. Addict Behav 2007; 32:1105-18. [PMID: 16945487 DOI: 10.1016/j.addbeh.2006.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 06/23/2006] [Accepted: 07/13/2006] [Indexed: 11/16/2022]
Abstract
Two brief (3-session) interventions were evaluated in a community sample of 98 non-dependent heavy drinking adults. Three weeks of intensive daily monitoring of drinking using a hand-held computer were completed before and after a 3-week intervention phase in which participants were randomly assigned to a brief coping skills, brief motivational enhancement, or waiting list condition. Waiting list participants drank more before, during, and after the brief intervention than brief intervention subjects, but all participants demonstrated reductions in drinking amount and frequency. No differences in drinking were found between the two brief interventions. The potential value of intensive daily monitoring as a tool for non-alcohol dependent individuals interested in reducing their drinking was considered.
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Affiliation(s)
- Samuel A Ball
- Yale School of Medicine, VA CT Healthcare (151D), 950 Campbell Avenue-Bldg. 35, West Haven, CT 06516, USA.
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Abstract
Within a psychotherapy development research project, thirty male (50%) and female (50%) personality disordered outpatients receiving methadone maintenance were randomly assigned to receive one of two 6-month manual-guided individual psychotherapies, Dual Focus Schema Therapy (DFST) or 12 Step Facilitation Therapy (12FT). All participants met diagnostic criteria for at least one personality disorder with antisocial, borderline, avoidant, and dependent being the most common. There were no significant differences between the two therapies for retention, utilization, or reductions in psychiatric symptoms or psychosocial impairment. Both therapy conditions demonstrated significant reductions in various severity indicators. Participants demonstrated more rapid decreases in the frequency of their substance use over six months of DFST in comparison to 12FT. DFST also was associated with a stronger therapeutic alliance between therapists and participants. Contrary to predictions, 12FT demonstrated better reduction of dysphoric affect than did DFST. DFST shows initial promise as the first time-limited manual-guided psychotherapeutic approach for the full range of personality disorders encountered in substance abuse patients.
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Affiliation(s)
- Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Palmer RS, Ball SA, Rounsaville BJ, O'Malley SS. Concurrent and predictive validity of drug use and psychiatric diagnosis among first-time DWI offenders. Alcohol Clin Exp Res 2007; 31:619-24. [PMID: 17374041 DOI: 10.1111/j.1530-0277.2007.00346.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous studies have found that driving while intoxicated (DWI) offenders report high rates of substance dependence and other psychiatric disorders. METHOD The current study evaluated the prevalence, clinical correlates at program admission, and prognostic significance over a 1-year follow-up of 2 diagnostic subgroup variables (drug abuse or dependence; mood or anxiety disorder) among 290 first-time DWI offenders receiving group counseling interventions. RESULTS A lifetime diagnosis of drug abuse or dependence (42% of sample) was associated with higher levels of alcohol consumption, lower coping confidence, greater readiness to change, increased alcohol, drug, and legal problems, and more alcohol-related negative consequences at the initiation of DWI intervention. Significant decreases in drinking were noted at intervention termination for the drug diagnoses subgroup, but were not sustained at 1-year follow-up. The presence of a lifetime diagnosis of anxiety or mood disorder (30% of sample) was associated with lower coping confidence, greater readiness to change, and with greater and more enduring negative consequences of drinking during the DWI intervention and 1-year follow-up period. CONCLUSIONS Results suggest that a psychiatric diagnosis might guide the intervention and aftercare planning for DWI offenders to reduce recidivism and drinking.
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Affiliation(s)
- Rebekka S Palmer
- Department of Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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Baer JS, Ball SA, Campbell BK, Miele GM, Schoener EP, Tracy K. Training and fidelity monitoring of behavioral interventions in multi-site addictions research. Drug Alcohol Depend 2007; 87:107-18. [PMID: 17023123 PMCID: PMC1876726 DOI: 10.1016/j.drugalcdep.2006.08.028] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 08/25/2006] [Accepted: 08/28/2006] [Indexed: 11/20/2022]
Abstract
AIMS Methods for the training and fidelity monitoring of behavioral interventions in multi-site addictions research are reviewed, including five published studies and seven ongoing studies sponsored by the National Institute on Drug Abuse-funded Clinical Trials Network. METHODS Methods are categorized and reviewed consistent with a technology model of treatment delivery. Topics include: therapist selection, training, certification, and supervision; selection, training, and certification of supervisors; scales and processes used for monitoring of the quality of treatment; and processes followed to provide new training for replacement staff once trials have begun. RESULTS The review reveals both a wide array of procedures and emerging standards for multi-site trials. Methodological weakness was observed with respect to limited empirical support for many adherence scales, little or no evaluation of supervisory processes, and no evaluation of re-training practices. CONCLUSIONS Methods used in multi-site trials are important not only to ensure validity of those trials, but also to inform the wider dissemination of empirically based treatment into community agencies. Studies examining noted weaknesses are needed. Training and fidelity models that delegate responsibility to participating sites appear most relevant for establishing best practices for dissemination of behavioral interventions. The effectiveness of these distributed training and supervision models should be subjected to empirical study at a level of rigor comparable to the evaluation of their corresponding treatments.
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Affiliation(s)
- John S. Baer
- University of Washington Department of Psychology and the Alcohol and Drug Abuse Institute, and the VA Puget Sound Health Care System
| | - Samuel A. Ball
- Yale University School of Medicine, Department of Psychiatry, 1 Long Wharf - Suite 321, New Haven, CT 06510,
| | - Barbara K. Campbell
- Oregon Health & Science University, Department of Public Health & Preventive Medicine, 3181 SW Sam Jackson Park Road, CB-669, Portland, Oregon 97239, 503-227-3932,
| | - Gloria M. Miele
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 6182 Palomar Circle, Camarillo, CA 93012, 805-987-0340,
| | - Eugene P. Schoener
- Wayne State University, Departments of Psychiatry, Pharmacology and Community Medicine, 2761 East Jefferson Avenue, Detroit, MI 48207. 313-993-1364,
| | - Kathlene Tracy
- New York University School of Medicine, Department of Psychiatry,423 East 23rd Street, 12 North 122D, New York, NY 10010, 212/686-7500,x3167,
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