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Duncan DF, Ellis-Griffith G, Nicholson T, Nimkar S. Health care administration and drug policy. Int J Health Plann Manage 2023; 38:735-746. [PMID: 36808644 DOI: 10.1002/hpm.3621] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/11/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
The American healthcare system faces a potential reorganization of the way in which services are provided and financed. We argue that healthcare administrators need to be increasingly aware of the ways in which our nation's illicit drug policy, commonly referred to as the 'War on Drugs', affects the provision of health services. A large and growing portion of the US population uses one or more of the currently illegal drugs and some of these persons suffer from an addiction or other substance use disorder. This is clearly demonstrated by the current opioid epidemic which is not yet being adequately controlled. Providing specialty treatment for drug abuse disorders will be increasingly important for healthcare administrators thanks to recent mental health parity legislation. At the same time, drug users and abusers will be increasingly encountered while providing care not specifically tied to drug use or abuse. The character of our current national drug policy has an important impact on how drug abuse disorders are treated and how the health delivery system responds to drug users who are increasingly often encountered in primary care, emergency care, specialty care, and long-term care settings.
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Affiliation(s)
| | | | - Thomas Nicholson
- Department of Public Health, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Swateja Nimkar
- University of Southern Indiana, Evansville, Indiana, USA
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2
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Affiliation(s)
- Udi E Ghitza
- National Institute on Drug Abuse Center for Clinical Trials Network , Bethesda, MD , USA
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Stuart EA, Barry CL, Donohue JM, Greenfield SF, Duckworth K, Song Z, Kouri EM, Ebnesajjad C, Mechanic R, Chernew ME, Huskamp HA. Effects of accountable care and payment reform on substance use disorder treatment: evidence from the initial 3 years of the alternative quality contract. Addiction 2017; 112:124-133. [PMID: 27517740 PMCID: PMC5148657 DOI: 10.1111/add.13555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 02/10/2016] [Revised: 06/01/2016] [Accepted: 08/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Global payment and accountable care reform efforts in the United States may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an Alternative Quality Contract (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. DESIGN Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC. SETTING Massachusetts, USA. PARTICIPANTS BCBSMA enrollees aged 13-64 years from 2006 to 2011 (3 years prior to and after implementation) representing 1 333 534 enrollees and 42 801 SUD service users. MEASUREMENTS Outcomes were SUD service use and spending and SUD performance metrics. Primary exposures were enrollment into an AQC provider organization and whether the AQC organization did or did not face risk for behavioral health costs. FINDINGS Enrollees in AQC organizations facing behavioral health risk experienced no change in the probability of using SUD services (1.64 versus 1.66%; P = 0.63), SUD spending ($2807 versus $2700; P = 0.34) or total spending ($12 631 versus $12 849; P = 0.53), or SUD performance metrics (identification: 1.73 versus 1.76%, P = 0.57; initiation: 27.86 versus 27.02%, P = 0.50; engagement: 11.19 versus 10.97%, P = 0.79). Enrollees in AQC organizations not at risk for behavioral health spending experienced a small increase in the probability of using SUD services (1.83 versus 1.66%; P = 0.003) and the identification performance metric (1.92 versus 1.76%; P = 0.007) and a reduction in SUD medication use (11.84 versus 14.03%; P = 0.03) and the initiation performance metric (23.76 versus 27.02%; P = 0.005). CONCLUSIONS A global payment and accountable care model introduced in Massachusetts, USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients' care during a specified time-period, incentivizing providers to keep their patients healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first 3 years following its implementation.
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Affiliation(s)
- Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
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Ghitza UE, Gore-Langton RE, Lindblad R, Tai B. NIDA Clinical Trials Network Common Data Elements Initiative: Advancing Big-Data Addictive-Disorders Research. Front Psychiatry 2015; 6:33. [PMID: 25784882 PMCID: PMC4347299 DOI: 10.3389/fpsyt.2015.00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/17/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Udi E Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
| | | | | | - Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
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6
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Ghitza UE. Needed Relapse-Prevention Research on Novel Framework (ASPIRE Model) for Substance Use Disorders Treatment. Front Psychiatry 2015; 6:37. [PMID: 25798112 PMCID: PMC4351566 DOI: 10.3389/fpsyt.2015.00037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/21/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Udi E Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
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7
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Ghitza UE. ASPIRE Model for Treating Cannabis and Other Substance Use Disorders: A Novel Personalized-Medicine Framework. Front Psychiatry 2014; 5:180. [PMID: 25538635 PMCID: PMC4258994 DOI: 10.3389/fpsyt.2014.00180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/25/2014] [Indexed: 01/23/2023] Open
Affiliation(s)
- Udi E Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
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Kinlock TW, Gordon MS, Schwartz RP, O'Grady KE. Individual Patient and Program Factors Related to Prison and Community Treatment Completion in Prison-Initiated Methadone Maintenance Treatment. J Offender Rehabil 2013; 52:509-528. [PMID: 25580067 PMCID: PMC4287211 DOI: 10.1080/10509674.2013.782936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While prison-initiated methadone maintenance treatment is effective, it is largely unknown as to what patient and program factors are related to outcomes. These issues were studied in a secondary analysis of data from 67 male prerelease prison inmates with preincarceration heroin addiction. Three outcomes are examined: completed prison treatment; completed 1 year of community treatment; and number of days in community treatment. Being employed (p = .045) during the three years prior to index incarceration was significantly and positively related to community treatment completion. Increased frequency of urine tests taken was significantly associated with a greater number of days in community treatment (p < .001). Limitations, policy implications, and directions for future research are discussed.
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Affiliation(s)
- Timothy W Kinlock
- Friends Research Institute, Baltimore, Maryland, USA and School of Criminal Justice, College of Public Affairs, University of Baltimore, Baltimore, Maryland, USA
| | - Michael S Gordon
- Friends Research Institute, Baltimore, Maryland, USA and Department of Criminal Justice, Stevenson University, Stevenson, Maryland, USA
| | - Robert P Schwartz
- Friends Research Institute, Baltimore, Maryland, USA and School of Medicine, Department of Psychiatry, University of Maryland, College Park, Maryland, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A. Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. Curr Opin HIV AIDS 2012; 7:320-5. [PMID: 22498479 PMCID: PMC3646543 DOI: 10.1097/coh.0b013e32835369ad] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent breakthroughs in HIV-prevention science led us to evaluate the current state of combination HIV prevention for injection drug users (IDUs). We review the recent literature focusing on possible reasons why coverage of prevention interventions for HIV, hepatitis C virus (HCV) and tuberculosis among IDUs remains dismal. We make recommendations for future HIV research and policy. RECENT FINDINGS IDUs disproportionately under-utilize voluntary HIV counseling and testing (VCT), primary care and antiretroviral therapy (ART), especially in countries that have the largest burden of HIV among IDUs. IDUs present later in the course of HIV infection and experience greater morbidity and mortality. Why are IDUs under-represented in HIV-prevention research, access to treatment for both HIV and addiction, and access to HIV combination prevention? Possible explanations include addictophobia, apathy, and inattention, which we describe in the context of recent literature and events. SUMMARY This commentary discusses the current state of HIV-prevention interventions for IDUs including VCT, needle and syringe program (NSP), opioid substitution therapy (OST), ART and pre-exposure chemoprophylaxis (PrEP), and discusses ways to work towards true combination HIV prevention for IDU populations. Communities need to overcome tacit assumptions that IDUs can navigate through systems that are maintained as separate silos, and begin to take a rights-based approach to HIV prevention to ensure that IDUs have equitable access to life-saving prevention and treatments.
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Affiliation(s)
- Steffanie A Strathdee
- Division of Global Public Health, University of California, San Diego School of Medicine, USA.
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Abadi MH, Shamblen SR, Johnson K, Thompson K, Young L, Courser M, Vanderhoff J, Browne T. Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan. Int J Womens Health 2012; 4:155-65. [PMID: 22532779 PMCID: PMC3333825 DOI: 10.2147/ijwh.s28737] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT) centers assesses (a) the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b) whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91%) reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50%) experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one’s own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.
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Affiliation(s)
- Melissa Harris Abadi
- Pacific Institute for Research and Evaluation - Louisville Center, Louisville, KY, USA
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Guydish J, Ziedonis D, Tajima B, Seward G, Passalacqua E, Chan M, Delucchi K, Zammarelli L, Levy M, Kolodziej M, Brigham G. Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings. Drug Alcohol Depend 2012; 121:30-7. [PMID: 21906892 PMCID: PMC3335347 DOI: 10.1016/j.drugalcdep.2011.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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: 05/03/2011] [Revised: 08/03/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence. METHODS The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked. RESULTS From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up. CONCLUSIONS The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.
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Affiliation(s)
- Joseph Guydish
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94118, United States.
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Ruger JP, Lazar CM. Economic evaluation of drug abuse treatment and HIV prevention programs in pregnant women: a systematic review. Addict Behav 2012; 37:1-10. [PMID: 21962429 PMCID: PMC3216632 DOI: 10.1016/j.addbeh.2011.07.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Received: 10/29/2010] [Revised: 05/21/2011] [Accepted: 07/29/2011] [Indexed: 11/20/2022]
Abstract
Drug abuse and transmission of HIV during pregnancy are public health problems that adversely affect pregnant women, their children and surrounding communities. Programs that address this vulnerable population have the ability to be cost-effective due to resulting cost savings for mother, child and society. Economic evaluations of programs that address these issues are an important tool to better understand the costs of services and create sustainable healthcare systems. This study critically examined economic evaluations of drug abuse treatment and HIV prevention programs in pregnant women. A systematic review was conducted using the criteria recommended by the Panel on Cost-Effectiveness in Health and Medicine and the British Medical Journal (BMJ) checklist for economic evaluations. The search identified 6 economic studies assessing drug abuse treatment for pregnant women, and 12 economic studies assessing programs that focus on prevention of mother-to-child transmission (PMTCT) of HIV. Results show that many programs for drug abuse treatment and PMTCT among pregnant women are cost-effective or even cost-saving. This study identified several shortcomings in methodology and lack of standardization of current economic evaluations. Efforts to address methodological challenges will help make future studies more comparable and have more influence on policy makers, clinicians and the public.
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Affiliation(s)
- Jennifer Prah Ruger
- Yale School of Public Health and Yale School of Medicine, New Haven, CT 06520, USA.
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Abstract
A small randomized trial investigated a new family-based intervention for Hispanic adolescents who met DSM-IV criteria for substance abuse disorder. The Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components. The study used an "add on" design to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components. Twenty-eight Hispanic adolescents and their families were randomized either to the experimental treatment or to traditional family therapy (TFT) and were assessed at baseline and 8-month follow-up. Despite the small sample, results revealed statistically significant time × treatment effects on both self-reported drug use (marijuana + cocaine), F(1, 22) = 10.59, p < .01, η² = .33 and adolescent reports of parenting practices, F(1, 22) = 9.01, p < .01, η² = .29. Both sets of analyses favored CIFFTA participants. There was a significant time × treatment effect, F(1, 22) = 6.72, p = .02, η² = .23, favoring CIFFTA on parent report of parenting practices using a composite that matched the variables used for adolescents, but only a nonsignificant trend, F(1, 22) = 2.43, p = .13, η² = .10, with a composite that used all parenting subscales. Parent reports of adolescent behavior problems did not show a significant time or time × treatment effect. These results show the promise of this adaptive treatment for substance abuse in Hispanic adolescents and suggest the need for a larger randomized trial to fully investigate this treatment.
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Affiliation(s)
- Daniel A Santisteban
- El Centro, School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33124, USA.
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Guydish J, Tajima B, Chan M, Delucchi KL, Ziedonis D. Measuring smoking knowledge, attitudes and services (S-KAS) among clients in addiction treatment. Drug Alcohol Depend 2011; 114:237-41. [PMID: 21055884 PMCID: PMC3062722 DOI: 10.1016/j.drugalcdep.2010.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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: 05/21/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Addiction treatment programs are increasingly working to address prevalent and comorbid tobacco dependence in their service populations. However at present there are few published measurement tools, with known psychometric properties, that can be used to assess client-level constructs related to tobacco dependence in addiction treatment settings. Following on previous work that developed a staff-level survey instrument, this report describes the development and measurement characteristics of the smoking knowledge, attitudes and services (S-KAS) for use with clients in addiction treatment settings. METHOD 250 clients enrolled in residential drug abuse treatment programs were surveyed. Summary statistics were used to characterize both the participants and their responses, and exploratory factor analysis (EFA) was used to examine the underlying factor structure. RESULTS Examination of the rotated factor pattern indicated that the latent structure was formed by one knowledge factor, one attitude factor, and two "service" factors reflecting program services and clinician services related to tobacco dependence. Standardized Cronbach's alpha coefficients for the four scales were, respectively, .57, .75, .82 and .82. CONCLUSIONS The proposed scales have reasonably good psychometric characteristics, although the knowledge scale leaves room for improvement, and will allow researchers to quantify client knowledge, attitudes and services regarding tobacco dependence treatment. Researchers, program administrators, and clinicians may find the S-KAS useful in changing organizational culture and clinical practices related to tobacco addiction, help in program evaluation studies, and in tracking and improving client motivation.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco USA
| | - Mable Chan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco USA
| | - Kevin L. Delucchi
- Department of Psychiatry, University of California, San Francisco USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School & UMass Memorial Medical Center, 55 Lake Avenue North, Worchester, Massachusettes 01655 USA
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Abstract
The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is designed to test drug abuse treatment interventions in multisite clinical trials and to support the translation of effective interventions into practice. In this study, qualitative methods were applied to examine adoption of motivational interviewing and motivational enhancement therapy (MI/MET) in five clinics where these interventions were tested. Participants were clinic staff (n=17) who were interviewed about the MI/MET study, and about whether MI/MET was adopted after the study ended. Although clinics' participation in a clinical trial includes many elements thought to be necessary for later adoption of the intervention, we found that there was "adoption" in one clinic, "partial adoption" in one clinic, "counselor adoption" in one clinic, and "no adoption" in two clinics. These findings highlight a distinction between adoption at the organizational and counselor levels, and suggest that a range of adoption outcomes may be observed in the field. Findings are relevant to clinical staff, program directors, administrators and policy makers concerned with improvement of drug abuse treatment systems through adoption of evidence-based practices.
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Affiliation(s)
- Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, CA 94118, USA.
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Carlson RG, Sexton R, Wang J, Falck R, Leukefeld CG, Booth BM. Predictors of substance abuse treatment entry among rural illicit stimulant users in Ohio, Arkansas, and Kentucky. Subst Abus 2010; 31:1-7. [PMID: 20391264 PMCID: PMC2856131 DOI: 10.1080/08897070903442459] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 10/19/2022]
Abstract
Illicit drug use in the rural United States is increasingly common, yet little is known about drug users' treatment-seeking behaviors. This study identifies predictors of substance abuse treatment entry over 24 months among 710 illicit stimulant users in rural areas of Ohio, Arkansas, and Kentucky. Active users of powdered cocaine, crack cocaine, and/or methamphetamine (MA) were recruited using respondent-driven sampling. Participants completed structured interviews at baseline and follow-up questionnaires every 6 months for 24 months. Data were analyzed using the Cox proportional hazards model. The paper is informed by the Anderson-Newman Model. Overall, 18.7% of the sample entered treatment. Ohio or Kentucky residence, perceived need for substance abuse treatment, higher Addiction Severity Index (ASI) legal problem composite scores, prior substance abuse treatment, and tranquilizer use were positively associated with treatment entry. Nondaily crack cocaine users and marijuana users were less likely to enter treatment. The findings can help inform rural substance abuse treatment program development and outreach.
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Affiliation(s)
- Robert G Carlson
- Boonshoft School of Medicine, Center for Interventions, Treatment, and Addiction Research, Wright State University, Dayton, Ohio 45435, USA.
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Brady JE, Friedman SR, Cooper HLF, Flom PL, Tempalski B, Gostnell K. Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002. J Urban Health 2008; 85:323-51. [PMID: 18344002 PMCID: PMC2329751 DOI: 10.1007/s11524-007-9248-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [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: 07/06/2007] [Accepted: 11/29/2007] [Indexed: 11/30/2022]
Abstract
This paper estimates the prevalence of current injection drug users (IDUs) in 96 large U.S. metropolitan statistical areas (MSAs) annually from 1992 to 2002. Multiplier/allocation methods were used to estimate the prevalence of injectors because confidentiality restrictions precluded the use of other commonly used estimation methods, such as capture-recapture. We first estimated the number of IDUs in the U.S. each year from 1992 to 2002 and then apportioned these estimates to MSAs using multiplier methods. Four different types of data indicating drug injection were used to allocate national annual totals to MSAs, creating four distinct series of estimates of the number of injectors in each MSA. Each series was smoothed over time; and the mean value of the four component estimates was taken as the best estimate of IDUs for that MSA and year (with the range of component estimates indicating the degree of uncertainty in the estimates). Annual cross-sectional correlations of the MSA-level IDU estimates with measures of unemployment, hepatitis C mortality prevalence, and poisoning mortality prevalence were used to validate our estimates. MSA-level IDU estimates correlated moderately well with validators, demonstrating adequate convergence validity. Overall, the number of IDUs per 10,000 persons aged 15-64 years varied from 30 to 348 across MSAs (mean 126.9, standard deviation 65.3, median 106.6, interquartile range 78-162) in 1992 and from 37 to 336 across MSAs (mean 110.6, standard deviation 57.7, median 96.1, interquartile range 67-134) in 2002. A multilevel model showed that overall, across the 96 MSAs, the number of injectors declined each year until 2000, after which the IDU prevalence began to increase. Despite the variation in component estimates and methodological and component data set limitations, these local IDU prevalence estimates may be used to assess: (1) predictors of change in IDU prevalence; (2) differing IDU trends between localities; (3) the adequacy of service delivery to IDUs; and (4) infectious disease dynamics among IDUs across time.
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Affiliation(s)
- Joanne E Brady
- Institute for AIDS Research, National Development and Research Institutes, Inc. (NDRI), 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
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McCarty D, Fuller B, Kaskutas LA, Wendt WW, Nunes EV, Miller M, Forman R, Magruder KM, Arfken C, Copersino M, Floyd A, Sindelar J, Edmundson E. Treatment programs in the National Drug Abuse Treatment Clinical Trials Network. Drug Alcohol Depend 2008; 92:200-7. [PMID: 17875368 PMCID: PMC2223274 DOI: 10.1016/j.drugalcdep.2007.08.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [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: 03/27/2007] [Revised: 08/04/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.
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Affiliation(s)
- Dennis McCarty
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CB669, Portland, OR 97239, USA.
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Abstract
The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N=12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N=912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention.
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Affiliation(s)
- JongSerl Chun
- Institute for Health Policy Studies, University of California, San Francisco 94118, USA.
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Kinlock TW, Gordon MS, Schwartz RP, O'Grady K, Fitzgerald TT, Wilson M. A randomized clinical trial of methadone maintenance for prisoners: results at 1-month post-release. Drug Alcohol Depend 2007; 91:220-7. [PMID: 17628351 PMCID: PMC2423344 DOI: 10.1016/j.drugalcdep.2007.05.022] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [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: 03/28/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite its effectiveness, methadone maintenance is rarely provided in American correctional facilities. This study is the first randomized clinical trial in the US to examine the effectiveness of methadone maintenance treatment provided to prisoners with pre-incarceration heroin addiction. METHODS A three-group randomized controlled trial was conducted between September 2003 and June 2005. Two hundred eleven Baltimore pre-release inmates who were heroin dependent during the year prior to incarceration were enrolled in this study. Participants were randomly assigned to the following: counseling only: counseling in prison, with passive referral to treatment upon release (n=70); counseling+transfer: counseling in prison with transfer to methadone maintenance treatment upon release (n=70); and counseling+methadone: methadone maintenance and counseling in prison, continued in a community-based methadone maintenance program upon release (n=71). RESULTS Two hundred participants were located for follow-up interviews and included in the current analysis. The percentages of participants in each condition that entered community-based treatment were, respectively, counseling only 7.8%, counseling+transfer 50.0%, and counseling+methadone 68.6%, p<.05. All pairwise comparisons were statistically significant (all ps<.05). The percentage of participants in each condition that tested positive for opioids at 1-month post-release were, respectively, counseling only 62.9%, counseling+transfer 41.0%, and counseling+methadone 27.6%, p<.05, with the counseling only group significantly more likely to test positive than the counseling+methadone group. CONCLUSIONS Methadone maintenance initiated prior to or immediately after release from prison appears to have beneficial short-term impact on community treatment entry and heroin use. This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories.
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Affiliation(s)
- Timothy W Kinlock
- Social Research Center, Friends Research Institute, Baltimore, MD 21201, USA.
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Guydish J, Tajima B, Manser ST, Jessup M. Strategies to encourage adoption in multisite clinical trials. J Subst Abuse Treat 2007; 32:177-88. [PMID: 17306726 PMCID: PMC3349356 DOI: 10.1016/j.jsat.2006.08.001] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 08/02/2006] [Accepted: 08/24/2006] [Indexed: 11/29/2022]
Abstract
The goals of the National Institute on Drug Abuse Clinical Trials Network (CTN) are to test promising drug abuse treatment models in multisite clinical trials and to support the adoption of new interventions into clinical practice. Using qualitative research methods, we studied adoption in the context of two multisite trials, one outside the CTN and another within the CTN. Seventy-one participants representing eight organizational roles ranging from clinic staff to clinical trial leaders were interviewed about their role in the clinical trial, the trial's interactions with clinics, and intervention adoption. Drawing on the conceptual themes identified in these interviews, we report on strategies that could be applied in the planning, development, and implementation of multisite studies to better support the adoption of tested interventions in study clinics after trials had ended. Planning for adoption in the early stages of protocol development will enhance the integration of new interventions into practice.
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Affiliation(s)
- Joseph Guydish
- Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA 94118, USA.
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Strathdee SA, Ricketts EP, Huettner S, Cornelius L, Bishai D, Havens JR, Beilenson P, Rapp C, Lloyd JJ, Latkin CA. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug Alcohol Depend 2006; 83:225-32. [PMID: 16364566 PMCID: PMC2196224 DOI: 10.1016/j.drugalcdep.2005.11.015] [Citation(s) in RCA: 90] [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: 07/24/2005] [Revised: 11/12/2005] [Accepted: 11/15/2005] [Indexed: 12/12/2022]
Abstract
We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p=0.03). In a multivariate "intention to treat" model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional "as treated" analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.
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Affiliation(s)
- Steffanie A Strathdee
- Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA.
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23
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Guydish J, Manser ST, Jessup M, Tajima B, Sears C, Montini T. Multi-level assessment protocol (MAP) for adoption in multi-site clinical trials. J Drug Issues 2005; 35:529-546. [PMID: 20890376 PMCID: PMC2947142 DOI: 10.1177/002204260503500306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multi-site clinical trials, and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked: How might the technology of multi-site clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing 8 organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. In analysis of interview data we identified four conceptual themes which are likely to affect adoption and may be informative in future multi-site clinical trials. We offer the conclusion that planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice.
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Peck JA, Reback CJ, Yang X, Rotheram-Fuller E, Shoptaw S. Sustained reductions in drug use and depression symptoms from treatment for drug abuse in methamphetamine-dependent gay and bisexual men. J Urban Health 2005; 82:i100-8. [PMID: 15738315 PMCID: PMC3456165 DOI: 10.1093/jurban/jti029] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Methamphetamine abusers often complain of feelings of depression that can complicate accurately diagnosing these individuals during treatments for methamphetamine abuse. This article presents an examination of temporal associations between documented methamphetamine use and reported ratings of depression among 162 gay and bisexual male methamphetamine abusers who participated in a 16-week randomized clinical trial of four behavioral therapies for methamphetamine abuse. Methamphetamine use was measured using thrice-weekly urine samples analyzed for drug metabolite. Self-reported depressive symptoms were collected weekly using the Beck Depression Inventory (BDI). At treatment entry, 73.2% of participants rated their depressive symptoms as mild or higher in severity (BDI>or=10), with 28.5% reporting BDI scores in the moderate to severe range (BDI>or=19). All participants reported significant decreases in depressive symptoms from baseline through the end of treatment, regardless of treatment condition, HIV status, or mood disorder diagnosis. A mixed regression model showed methamphetamine use for up to 5 days prior to the BDI score strongly predicted depressive symptoms (F1, 968=18.6, P<.0001), while BDI scores had no significant association with subsequent methamphetamine use. Findings show that behavioral methamphetamine abuse treatment yields reductions in methamphetamine use and concomitant depressive symptom ratings that are sustained to 1 year after treatment entry.
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Affiliation(s)
- James A Peck
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, USA.
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25
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Friedman SR, Tempalski B, Cooper H, Perlis T, Keem M, Friedman R, Flom PL. Estimating numbers of injecting drug users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injecting drug users. J Urban Health 2004; 81:377-400. [PMID: 15273263 PMCID: PMC3455936 DOI: 10.1093/jurban/jth125] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [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] [Indexed: 11/14/2022]
Abstract
This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area. We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile range 42-87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services.
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Affiliation(s)
- Samuel R Friedman
- Institute for AIDS Research, National Development and Research Institutes, Inc., New York, NY 10010, USA.
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