Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder

PURPOSE

Addiction-focused eye movement desensitization reprocessing (AF-EMDR) is a viable add-on therapy to treat memories that drive addiction cravings. However, little research has explored AF-EMDR and its effects in people with substance abuse disorder (SUD). The purposes of this study were to determine the feasibility of conducting AF-EMDR and to test the preliminary efficacy of AF-EMDR on overall cravings experienced by persons with SUD, craving, perseverations associated with addiction, and irrational cognitions related to addiction.

METHODS

This pilot study used a two-arm randomized controlled trial (RCT) design with an experimental group (AF-EMDR + cognitive behavioral therapy [CBT]) and a control group (CBT Only). Thirty participants were recruited from a residential program or a partial hospitalization program in a recovery center in Florida, from October 2021 through January 2022 and randomly assigned to the experimental group (n = 15) or the control group (n = 15).

RESULTS

All participants adhered to the four-session 60-min AF-EMDR intervention and post-intervention data collection; 98.33% completed all four sessions. Results indicated significant reductions in cravings, perseverative thoughts about substance of choice, and irrational cognitions among participants in both the experimental (AF-EMDR + CBT) and control (CBT Only) groups during the intervention; however, there was no significant difference between groups.

CONCLUSIONS

The results showed positive trends in decreasing craving. However, more clinical trials with a larger sample are necessary to assess the efficacy and sustainability of such effects in persons with SUD.

Trends in HIV-Related Services Offered by Substance Abuse Treatment Facilities

Introduction In the United States, persons who inject drugs (PWID) represent an increasingly vulnerable population, with a high risk of HIV transmission related to needle sharing. This paper aims to investigate the availability of HIV-related services within substance abuse treatment facilities while emphasizing the need for implementing comprehensive harm-reduction strategies in such facilities. Methods This study explores the prevalence and trends regarding HIV-related services within substance abuse treatment facilities in the United States including testing, counseling, early intervention, and medication provision. Data from the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed in order to assess trends in HIV-related services from 2013 to 2020. Results Facility response rates revealed an increase in the availability of HIV testing and specialized programs for individuals with HIV. However, there was a contrasting trend with the decline in early intervention and counseling services, only with a slight increase in 2020. Additionally, government-owned facilities demonstrated superior performance in delivering HIV services compared to private facilities. Conclusion This study highlights the dire need for implementing routine opt-out HIV testing within substance abuse treatment facilities in order to identify new cases. Additionally emphasized is the importance of early intervention for this at-risk population. To effectively address these challenges, we suggest considering the adoption of the "Seek, Test, Treat, Retain" model as a potential solution. Increasing access to HIV-related services within substance abuse facilities requires enhanced resource allocation as well as integrated programs. Identifying deficiencies in HIV service integration is crucial to enhancing care and reducing HIV transmission among PWID.

Outpatient substance abuse treatment completion rates for racial-ethnic minorities during the Great Recession

There has been minimal research linking the effects on racial-ethnic minorities' health outcomes, particularly research focused on racial-ethnic minorities seeking outpatient substance abuse treatment in the United States. The Great Recession from December 2007 to June 2009 in the United States provides the backdrop against the completion of substance abuse treatments among racial-ethnic minorities that may be associated with the impacts on users' social realities. We utilized data from the 2006-2011 Treatment Episode Datasets-Discharge (TEDS-D) dataset which collects data on outpatient substance abuse treatment institutions throughout the United States. The substance abuse treatment completion rates were higher prior to the Great Recession and lower following the Great Recession. Hispanics were more likely than non-Hispanic whites to complete substance abuse treatment, while other minority groups such as Non-Hispanic Blacks, were less likely to do so. Clients in the Northeast and West regions were more likely to successfully complete substance abuse treatment than those in the South. These findings have implications for impacting outpatient substance abuse treatment completion rates following the Great Recession to reduce racial-ethnic disparities which were impacted by region. Even amid an economic recession, treatment for substance abuse should continue to be a top concern.

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

Background

Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods.

Methods

Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed.

Results

PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities.

Conclusions

Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data

INTRODUCTION

Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success.

METHODS

Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use.

RESULTS

Moderate effect size relations were found between the different type of clinical discharge and months in retention (η²  = 0.12) and proportion of attendance (η²  = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge.

DISCUSSIONS/CONCLUSION

Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.

Reducing Problematic Substance Use under Exceptional Circumstances-Effects of the COVID-19 Restrictions on Inpatient Substance Use Disorder Treatment in Finland

The COVID-19 pandemic has affected people's daily lives on multiple levels. At highest risk are the most vulnerable members of the society, whose lives were already affected by various risks even before the pandemic. This study investigates how clients in inpatient substance use disorder treatment experienced the COVID-19 restrictions and their influence on recovery. The research data consists of six focus group interviews conducted remotely using a semi-structured thematic interview method. The focus group clients (N = 19) were currently in inpatient substance abuse treatment during the pandemic and the ensuring restrictions. The data were analyzed using qualitative content analysis. The results show that the COVID-19 restrictions have influenced the clients' desistance processes throughout the pandemic. The restrictions seemed to exacerbate substance abuse problems before treatment initiation and highlight the importance of peer support during treatment. Moreover, the restrictions seemed to change the function and hamper the management of social capital, raise concerns about returning home, as well as intensifying the inter-municipal segregation of services. To conclude, attention should be paid to facilitating and ensuring informal support and managing social capital. In light of this study, it seems necessary to explore the social conditions among clients in inpatient substance abuse treatment during the pandemic.

Community-based models of alcohol and other drug support for First Nations peoples in Australia: A systematic review

Issues

The transgenerational impacts of colonisation—inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation—places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community‐based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community‐based models of AOD support for First Nations adults in Australia.

Approach

A systematic search of the empirical literature from the past 20 years was conducted.

Key Findings

Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap‐around psychosocial support, increased local community participation and engagement, funding and breaking down silos.

Implications

Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community‐based AOD services for First Nations peoples.

Conclusion

There is a limited evidence‐base for community‐based AOD programs for First Nations peoples. First Nations‐led research that is controlled by and co‐produced with First Nations peoples is necessary to extend our understanding of community‐based programs within First Nations communities.

Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program

Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.

MIRRORS program: Helping pregnant and postpartum women and families with substance use problems

Background: Pregnant and postpartum women with substance use disorders are a highly vulnerable population, especially when this is compounded by homelessness or unstable housing, justice involvement, and/or co-occurring mental health challenges. The MIRRORS (Maternal Initiative for Reflective Recovery-Oriented Residential Services) program provided expanded and enhanced residential substance use disorder treatment, prevention and recovery support for women and children through integrated, trauma-informed care and services strengthened by a comprehensive and coordinated family systems approach. This paper describes the program and provides evaluation of the outcomes. Methods: Pregnant and postpartum women (n = 215) were assessed at 3 time points: intake, discharge and 6-months post-intake using standardized measures of family functioning, parenting, recovery capital, and other outcomes. Multilevel modeling was employed to examine individual differences in trends over time. Results: Over 80% of participants reported that the MIRRORS program enhanced their recovery treatment experience. Women reported significant improvements in general family functioning, problem solving, behavioral control, affective responsiveness, and communication. Participants also reported increased recovery capital and improved parental monitoring over time. Conclusions: Outcomes indicate that the MIRRORS program was effective in improving family functioning and reducing substance use, thus enhancing women's functioning and recovery.

Treatments, Perceived Stigma, and Employment Outcomes among Substance Abusers in China

Employment is a vital component of a substance abuser's recovery, but little is known about how stigma affects employment for substance abusers receiving treatment. The current study investigates the effects of stigma and treatment on employment in the Chinese context. Using a sample of substance abusers (N = 3.978), multiple logistics regressions with moderation effects were employed. The findings show that treatments positively reduce confirmative experiences of anticipated stigma, and promote employment only when respondents do not perceive stigma. The findings highlight the impact of perceived stigma on limiting substance abusers' chances of being employed, implying that eliminating stigma is the foundation for recovery. Possible strategies that can be explored for reducing stigma are discussed.

Association between negative life events and morbidity in homeless seeking treatment for substance abuse in Greenland

INTRODUCTION

The aim of the investigation was to describe the association between negative life events on morbidity in homeless seeking treatment for substance abuse in Greenland.

METHODS

Cross sectional study on register data comparing homeless and individuals in secure housing initiating alcohol or substance abuse treatment in Greenland between 1 January 2017 and 14 December 2019, (N = 950). Results: Homeless were socio-economically disadvantaged compared to treatment seekers in secure housing. They had a heavier burden of psychiatric morbidity and suffered more negative life experiences. Controlled for having experienced abuse, most morbidity measures' predictive value was slightly less pronounced with psychiatric morbidity as an exception.

CONCLUSION

The results indicate that both the morbidity and most analyzed negative life events are associated with being homeless and are mutually linked.

Rural Re-entry and Opioid Use: Identifying Health-Related Predictors of Relapse Among Formerly Incarcerated Women in Appalachia

INTRODUCTION

Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.

PURPOSE

With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.

METHODS

As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6- and 12-months post-release from jail.

RESULTS

Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse.

IMPLICATIONS

Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.

Nonmedical Use of Xtampza® ER and Other Oxycodone Medications in Adults Evaluated for Substance Abuse Treatment: Real-World Data from the Addiction Severity Index-Multimedia Version (ASI-MV®)

Purpose

The purpose of this study was to evaluate real-world data related to past 30-day nonmedical use (NMU) and routes of administration of Xtampza^® ER and comparator oxycodone medications in the US as captured within the Addiction Severity Index-Multimedia Version^® (ASI-MV^®).

Methods

Data were collected from July 2016 through December 2019 from 647 centers located in 44 states using the ASI-MV, a clinical instrument used to evaluate substance use and treatment planning. Demographic characteristics were assessed using Pearson's chi-square test for categorical data and quarterly NMU rates were calculated. Distribution of route of administration was studied using a proportional reporting ratio (PRR) analysis.

Results

Of 192,810 assessments, 42,279 (21.9%) indicated past 30-day NMU of at least one prescription opioid, including Xtampza ER (N=73, 0.2%), other oxycodone ER (n=3802, 9.0%) and oxycodone IR (n=14,579, 34.5%). All quarterly Xtampza ER NMU rates per 100 ASI-MV assessments were significantly lower than those for other oxycodone ER and oxycodone IR. Overall, quarterly Xtampza ER NMU drug utilization adjusted rates were significantly lower than quarterly rates observed for other oxycodone ER NMU but not consistently significantly lower than oxycodone IR NMU. Although not all statistically significant, all ratios from the PRR analysis were less than 1.0, indicating that rates of use of any alternate route, any non-oral route, snorting, and injecting were higher for other oxycodone ER and oxycodone IR than for Xtampza ER.

Conclusion

Xtampza ER had significantly lower rates of NMU than other oxycodone ER products and oxycodone IR products, as well as significantly lower rates of non-oral NMU than oxycodone IR products, in a population of individuals seeking substance abuse treatment. Understanding risks associated with different opioid medications is important for prescribers as they manage risks of opioid misuse and abuse with effective pain therapy.

Difference in Response to Feedback and Gender in Three Therapeutic Community Units

Therapeutic communities (TCs) for substance abuse incorporate a system of peer feedback through written affirmations and corrections. Previous research has found that TC residents show a response to affirmations that is detectable for roughly 8 weeks, with response to corrections being of shorter duration and weaker overall. It is not clear whether and to what extent response to feedback in TCs varies between men and women. Previous research in other settings suggests that women should be more responsive to feedback than men. In order to test this hypothesis we draw on a large dataset of affirmations and corrections sent and received in three 80 bed TC units, two of which house men and one of which houses women. The analysis uses a multilevel negative binomial model, treating affirmations and corrections that TC residents receive as predictors of affirmations that they send over a 9 week period (week 0, the week during which affirmations and corrections are actually sent, and eight subsequent weeks). The model controls for gender, age, race, unit and scores on the Level of Service Inventory-Revised (LSI-R). The relationship between affirmations received and those sent is stronger for women during the initial week and on lags 1-2 and 5-8. The relationship between corrections received and affirmations sent is stronger for women on lags 2 and 8. Graphs suggest that response to affirmations falls off in an exponential curve, while that to corrections appears to include a periodic element. These results indicate that both men and women respond to feedback, but that the strength of the women's response is somewhat greater. These results suggest that any difference in suitability by gender to the feedback approach that characterizes TCs may favor women.

Improving Medication Access within Integrated Treatment for Individuals with Co-Occurring Disorders in Substance Use Treatment Agencies

BACKGROUND

The best approach to provide comprehensive care for individuals with co-occurring disorders (CODs) related to substance use and mental health is to address both disorders through an integrated treatment approach. However, only 25% of behavioral health agencies offer integrated care and less than 7% of individuals who need integrated treatment receive it. A project used a cluster-randomized waitlist control group design to evaluate the effectiveness of Network for the Improvement of Addiction Treatment (NIATx) implementation strategies to improve access to addiction and psychotropic medications.

METHODS

This study represents a secondary analysis of data from the NIATx project. Forty-nine agencies were randomized to Cohort1 (active implementation group, receiving the NIATx strategy [n=25]) or Cohort2 (waitlist control group [n=24]). Data were collected at three time points (Baseline, Year1 and Year2). A two-level (patient within agency) multinomial logistic regression model investigated the effects of implementation strategy condition on one of four medication outcomes: both medication types, only psychotropic medication, only addiction medication, or neither medication type. A per-protocol analysis included time, NIATx fidelity, and agency focus as predictors.

RESULTS

The intent-to-treat analysis found a statistically significant change in access to addiction versus neither medication, but Cohort1 compared to Cohort2 at Year1 showed no differences. Changes were associated with the experimental intervention and occurred in the transition from Year 1 to Year 2, where greater increases were seen for agencies in Cohort2 versus Cohort1. The per-protocol analysis showed increased access to both medications and addiction medications from pre- to post-intervention for agencies in both cohorts; however, differences in change between high- and low-implementation agencies were not significant.

CONCLUSIONS

Access to integrated services for people with CODs is a long-standing problem. NIATx implementation strategies had limited effectiveness in improving medication access for individuals with CODs. Implementation strategy adherence is associated with increased medication access.

Secondary traumatic stress in Norwegian SUD-therapists: Symptoms and related factors

This study examined the prevalence of secondary traumatic stress (STS) among substance-abuse therapists in relation to burnout, work-related stressors, as well as peer and leader support.

The Moderating Effect of Substance Abuse Treatment Engagement on the Connection Between Support From Program Participants and Substance-Related Recidivism for Justice-Involved Women

This study examines the prediction of substance-related technical violations and arrests from (a) a three-dimensional measure of substance abuse treatment engagement-treatment satisfaction, treatment participation, and counselor rapport-and (b) support from peers in the treatment program. The study focuses on 204 women on probation or parole who attended a substance abuse treatment program in the first 9 months of supervision. Data were collected in face-to-face interviews and from official records of violations and arrests. Generalized linear mixed-effects modeling was used to assess the main effects and the interaction effect of within-program peer support and other indicators of engagement as predictors of substance-related technical violations and arrests. Peer support was positively related to violations/arrests when treatment engagement was low. Findings suggest that for women who do not score high in treatment engagement, support from peers is related to increased recidivism, and group treatment may be contraindicated.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Responding to substance-use-related probation and parole violations: are enhanced treatment sanctions preferable to jail sanctions?

An increase in correctional treatment programming options coupled with prison population reduction legislation has driven a widespread transfer of supervision from prisons to community corrections. As a result, medium-to-high risk offenders with substance use needs are increasingly managed through community-based supervision programs such as intensive supervision probation (ISP). ISP programs frequently rely on different types of graduated sanctions to encourage program completion. To further develop research on how graduated sanctions should be applied in response to substance-use-related violations, this study examines whether enhanced treatment sanctions (a rehabilitative approach) and jail sanctions (a punitive approach) may differentially impact successful ISP completion. Using a sample of persons who committed a substance use violation while on ISP, results from multilevel models demonstrate that enhanced treatment sanctions are significantly associated with increased odds of successful ISP completion. On the other hand, jail is not significant, and enhanced treatment and jail do not interact to influence ISP program success. Due to the deleterious nature of the jail environment, findings call into question the utility of jail sanctions on ISP outcomes. Overall, enhanced treatment may be a preferable means through which to sanction probationers and parolees who commit substance-use-related violations while under community supervision.

A randomized trial of culturally accommodated versus standard group treatment for Latina/o adolescents with substance use disorders: Posttreatment through 12-month outcomes

OBJECTIVES

Latina/o adolescents are at particular risk for substance use disorders (SUDs) and effective treatments are needed. Some critics indicate that standard evidence-based treatments may not meet the needs of Latina/o adolescents and culturally accommodated treatments are needed; however, few comparative studies have been conducted to test this assumption. This randomized trial was designed to test a standard group-based version of a cognitive-behavioral treatment (S-CBT) against its culturally accommodated equivalent (A-CBT) for a sample of Latina/o adolescents with SUDs.

METHOD

Seventy Latina/o adolescents were randomly assigned to 1 of 2 treatment conditions and followed over 4 posttreatment time points with the last at 12-months. Generalized longitudinal mixed models for count data were conducted to evaluate treatment differences across time for adolescent substance use. The cultural variables ethnic identity, acculturation, and familism were included in the analysis as potential moderators of treatment outcome.

RESULTS

A significant difference was found at the 12-month follow-up in favor of the culturally accommodated treatment (d = .92, 95% confidence interval, CI [.43, 1.42]) and parental familism moderated treatment outcome (d = .60, 95% CI [.12, 1.08]).

CONCLUSION

This is one of the first studies to demonstrate that a culturally accommodated treatment differentially improved outcomes compared with that of its standard equivalent for a sample of Latina/o adolescents with SUDs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Effect of Treatment Completion on Recidivism Among TASC Program Clients

Despite the enormous resources spent by states in the United States on bridging the gap between criminal justice and behavioral health services, there have been relatively few statewide evaluations of drug treatment client recidivism. We present the results of an evaluation of recidivism outcomes for a sample of individuals ( n = 1,274) referred to the Treatment Accountability for Safer Communities (TASC) program in North Carolina from 2007 to 2008. The methodology accounted for both client and offense characteristics drawn from TASC, court, and corrections records. Multivariate analyses indicated that program completion is the most important predictor of re-arrest in the 3-year follow-up period, followed by a number of protective and risk factors. More specifically, being female, older at the time of program entry, as well as higher levels of educational attainment decreased the odds of re-arrest, whereas using crack/cocaine increased the odds of re-arrest. Suggestions for future research and policy implications are provided.

Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention

OBJECTIVES

To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined.

DESIGN

A pre-post trial conducted from May 2012 to May 2014.

SETTING

Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia.

PARTICIPANTS

Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up.

INTERVENTIONS

A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity.

PRIMARY AND SECONDARY OUTCOME MEASURES

Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up.

RESULTS

Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care.

CONCLUSION

This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed.

TRIALREGISTRATION NUMBER

ACTRN12614000469617.

A population-based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees

BACKGROUND

Medication treatment (MT) with methadone and buprenorphine are effective treatments for opioid use disorders, but little information is available regarding the extent to which buprenorphine's approval resulted in more individuals receiving MT nor to what extent receipt of such treatment was equitable across communities.

METHODS

To examine changes in MT utilization and the association between MT utilization and county-level indicators of poverty, race/ethnicity, and urbanicity, we used Medicaid claims of non-dually eligible Medicaid enrollees aged 18-64 from 14 states for 2002-2009. We generated county-level aggregate counts of MT (methadone, buprenorphine, and any MT) by year (N = 7760 county-years). We estimated count data models to identify associations between MT and county characteristics, including levels of poverty and racial/ethnic concentration.

RESULTS

The number of Medicaid enrollees receiving MT increased 62% from 2002 to 2009. The number of enrollees receiving methadone increased 20%, with the remaining increase resulting from buprenorphine. Urban county residents were significantly more likely to receive MT in both 2002 and 2009 than rural county residents. However, buprenorphine substantially increased MT in rural counties from 2002 to 2009. Receipt of MT increased at a much higher rate for residents of counties with lower poverty rates and lower concentrations of black and Hispanic individuals than for residents of counties without those characteristics.

CONCLUSIONS

The increase in Medicaid enrollees receiving MT in the years following buprenorphine's approval is encouraging. However, it is concerning that MT trends varied so dramatically by characteristics of the county population and that increases in utilization were substantially lower in counties with populations that historically have been disadvantaged with respect to health care access and quality. Concerted efforts are needed to ensure that MT benefits are equitably distributed across society and reach disadvantaged individuals who may be at higher risk of experiencing opioid use disorders.

Time-Series Analysis of the Impact of Prescription Drug Monitoring Programs on Heroin Treatment Admissions

BACKGROUND

Prescription drug abuse has become a major issue in the United States in recent years. Prescription drug monitoring programs (PDMPs) are designed to help health care providers to prevent such abuses. There may be unintended effects of these programs. Specifically, PDMPs may move prescription opioid users to begin use of heroin.

OBJECTIVES

This article aims to evaluate the impact of PDMPs on heroin abuse across several different states through use of treatment admissions records obtained from the Treatment Episode Data Set.

METHODS

Operational dates and other characteristics of state PDMPs were obtained from the Prescription Drug Monitoring Program Training and Technical Assistance Center. Data for the dependent variable were collected from the Treatment Episodes Data Set from 1992 to 2012. Interrupted time-series analyses using autoregressive integrated moving average modeling were used to estimate the effect of presence of an operational PDMP on the number of admissions reporting heroin as their primary drug being used.

RESULTS

The relationship between heroin admissions and prescription opioid admissions was significant for the average data (β = 0.41, p = 0.0017) and the 5-year data (β = 0.5, p = 0.036), both showing positive associations between heroin and prescription drug admissions in states in the post PDMP implementation period. Conclusions/Importance: The study found a positive relationship that between heroin and prescription opioid admissions post PDMP implementation. Future research should attempt to identify what this relationship means and how this information can be used to improve opioid policy.

Comparisons of Alcohol and Drug Dependence in Terms of Attachments and Clinical Issues

BACKGROUND

Alcohol and drug dependencies are associated with different social stigmas, and some studies suggest they might exhibit different clinical presentations. Further, the treatments for each vary considerably. Alcohol versus drug use problems were compared in terms of attachment patterns and related clinical treatment issues in two interlocking studies using converging logic and designs.

METHODS

In Study 1, alcohol versus drug dependence was defined in terms of a known groups design. Patients from an inpatient alcohol treatment center, patients receiving treatment for opiate dependence in a methadone maintenance clinic, and controls were compared on the 29 scales of the Attachment and Clinical Issues Questionnaire (ACIQ). Study 2 sampled a substantially different population (491 university students) and used different operational definitions of substance use problems, relying on screening instruments.

RESULTS

Study 1 found that, although the drug and alcohol dependent patients differed substantially from the controls, they did not differ from one another on any of the 29 ACIQ scales measuring attachments and clinical issues. Study 2 converged on the known groups design of Study 1, showing convergent and concurrent rather than discriminate evidence for the alcohol and drug dependence screening instruments.

CONCLUSION

Alcohol and drug dependencies were not found to differ significantly in terms of attachments or clinical issues. These studies aimed to provide clearer and more empirically grounded guidance to the clinician and researcher.

Structural factors affecting Asians and Pacific Islanders in community-based substance use treatment: Treatment provider perspectives

Asians and Pacific Islanders (API) have large disparities in utilization of substance use treatment compared to other racial groups. In this study, we analyzed factors that shape API experiences accessing and engaging in community-based treatment from the perspective of treatment providers. We conducted semi-structured interviews with 40 treatment providers who work with API clients in treatment programs in San Francisco and Los Angeles. We analyzed the transcribed interview data in ATLAS.ti using a content analysis approach. There were three main findings. First, treatment providers found the API category itself is too broad and heterogeneous to meaningfully explain substance use patterns. Second, beyond race/ethnicity, structural factors such as poverty, neighborhood, housing, and age had an impact on API substance use. Third, factors such as family, immigration status, religion, language, stigma played complex roles in API treatment experiences, contingent on how client, programs, and providers attended to differences in these categories.

Saving My Life: Dynamics of Peer and Staff Corrections Among Therapeutic Community Residents

BACKGROUND

Therapeutic communities (TCs) maintain order and encourage behavior change through a system of peer corrections. This study is the first quantitative analysis of the dynamics of the exchange of peer corrections at TCs.

OBJECTIVES

We applied longitudinal social network analysis to compare the reactions of TC residents to peer versus staff intervention, while analyzing dynamics of correction exchange among residents.

METHOD

The data consisted of a large database of staff and peer affirmations and corrections at four therapeutic community units that occurred between the years 2006 and 2008. We modeled the data as a directed temporal social event network, using a generalized linear mixed effects model to analyze predictors of corrections among residents.

RESULTS

Residents were more likely to send a correction following peer affirmations and corrections than following staff affirmations and corrections. Residents reciprocated corrections to individual peers. Autocorrelation was evident in both sending and receiving corrections and residents were more likely to send a correction after having sent an affirmation. Residents who arrived at roughly the same time were more likely to exchange corrections. Residents tended to send and receive more corrections in the middle 3 months of their treatment. European American residents and those with higher scores on the LSI-R were more likely to receive corrections than others.

CONCLUSIONS

TC residents respond more strongly and more positively to peer than to staff intervention. The pattern of exchange of peer corrections in TCs is complex. This suggests possible paths to improved outcomes.

Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders

In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW ( n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs.

Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network

BACKGROUND

Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior.

OBJECTIVES

The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials.

METHODS

Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder.

RESULTS

When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.

The daily progress system: A proof of concept pilot study of a recovery support technology tool for outpatient substance abuse treatment

BACKGROUND

Illicit substance use remains highly prevalent in the US, and epidemiological surveillance surveys estimate that in 2015, over 27 million individuals (10.1% of the US population) 12 years of age or older used illicit drugs in the past 30 days.¹ Outpatient treatment delivered in community-based settings is the dominant modality for addiction treatment, typically involving weekly psychosocial counseling sessions in an individual and/or group format.^2,3 Unfortunately, relapse and premature treatment discontinuation are quite common in outpatient treatment.^3-5 Objectives: This is a pilot proof of concept feasibility study involving clients presenting for outpatient SUD treatment. This study sought to examine the feasibility and acceptability of the Daily Progress System (DPS), a telephone-based software program, using interactive voice response (IVR), designed to enhance quality care and improve client outcomes.

METHODS

Individuals who presented at the participating treatment clinic, who met study eligibility criteria, and who provided written informed consent to participate were included in the study (N = 15; 53.3% females). Incentives were paid to participants for calls completed.

RESULTS

Participants completed 65% of scheduled daily call-ins, representing 273 person-days of data on client cravings, mood, substance use, and involvement in recovery support activities. The average call duration was approximately 2 minutes and 42 seconds. There was a high degree of client and counselor acceptance and satisfaction using the system. Conclusions and Clinical Significance: Findings suggest that the DPS appears to be a feasible means of potentially addressing relapse and treatment engagement issues based on client and counselor engagement and satisfaction with the system.

Patient Retention in Therapeutic Communities for Substance Abuse Treatment: An Organizational-Environmental-Professional Perspective

This study examined various organizational, environmental, and professional components of therapeutic communities in Israel and their relationship with patient retention rates. Key elements included the juxtaposition between objective and subjective components of social environments, as reflected in the perceptions of staff (mostly social workers) and patients. The current study's findings suggest that retention rates are predicted to be higher when staff receive more hours of supervision and identify less with their peers, and when their assessments of the organizational climate within facilities is closer to their patients' assessments of this aspect of organizational milieu. These findings are discussed using various organizational and professional perspectives, guided by a field theory framework.

Differences by Gender in Predictors of Motivation Among Substance Abuse Treatment Participants

BACKGROUND

Substance-involved females tend to have different clinical profiles than men (Adams, Leukefeld, & Peden, 2008 ); yet they do not appear to have worse treatment outcomes (Green, 2006 ; Hser, Huang, Teruya, & Anglin, 2003 ). As motivation for treatment is considered essential in the substance abuse treatment context (Cahill, Adinoff, Hosig, Muller, & Pulliam, 2003 ; Longshore & Teruya, 2006 ), it is possible that higher motivation among females could potentially counteract the negative effect of more risk factors.

OBJECTIVE

The purpose of the current study was to examine if females differ from males in their motivation for treatment using the Texas Christian University Motivation Form scales: desire for help, problem recognition, treatment readiness, pressure for treatment, and treatment needs; and whether factors predicting motivation for treatment differed between male and female participants of substance abuse treatment.

METHODS

The sample included 2,989 substance-involved males and 982 substance-involved females who were referred to substance abuse treatment through a case management program. Linear regression models predicting each motivation scale were analyzed, followed by gender-specific models.

RESULTS

Overall, the results did not demonstrate a significant gender difference in the motivation scales. However, among male participants, the findings did show that Hispanic significantly predicted desire for help and alcohol as a primary drug of choice predicted treatment readiness.

CONCLUSION

Findings suggest that motivation for treatment may be a gender-neutral construct, and that there is a need to better understand sociodemographic predictors of motivation.

Double whammy: Adverse childhood events and pain reflect symptomology and quality of life in women in substance abuse treatment

BACKGROUND

This study examined the profiles of symptoms and health-related quality of life (QOL) of women in substance abuse treatment, comparing those with higher versus lower histories of adverse childhood events (ACE), and those with versus without current pain.

METHODS

Adult women in outpatient substance abuse treatment (n = 30) completed questionnaires (cross-sectional study) on topics including drug use, adverse childhood events (ACE), QOL, functional ability, current pain, and depression.

RESULTS

Women with pain indicated significant differences in emotional (p < 0.05), and functional ability (p < 0.01); but no significant differences were found between women with high versus low levels of ACE. Yet, radar plots of women with both current pain and high levels of ACE, versus those without, portrayed a distinctive profile indicating high levels of anxiety and depression.

CONCLUSIONS

Rather than a checklist, visual composites of symptoms experienced by women in substance abuse treatment illustrates areas of concern in the overall status of women in substance abuse treatment.

Building Bridges in New Jersey

This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies 2 Improving Best Practices in Assessment and Case Planning for Offenders protocol in the state of New Jersey. The protocol was designed to test the effectiveness of an Organizational Process Improvement Intervention in improving four assessment and case planning domains for drug-involved offenders in correctional settings transferring to community treatment based agencies. This article describes the protocol and the change team model process through which correctional and community agency staff collaborated to improve assessment and case planning for offenders with substance abuse problems. The primary goal of these collaborative efforts was to link information across stages of the treatment continuum to improve service coordination. Data taken from qualitative interviews with agency participants are used to illustrate the common themes that emerged relating to the intervention process, barriers to implementing developed goals, and facilitative factors that contributed to successes. The findings from the current study provide indication that organizational process improvement strategies can be implemented within a correctional setting to reduce interorganizational barriers and to facilitate improvements in the continuum of care involved in the treatment of offenders with histories of substance abuse.

An Exploration of Smoking Among People Attending Residential Substance Abuse Treatment: Prevalence and Outcomes at Three Months Post-Discharge

OBJECTIVES

Smoking continues to be a major health concern for people with a history of alcohol or other substance use problems. The current research is aimed to (1) describe the prevalence of smoking in residential addictions treatment services and (2) compare characteristics of people who had or had not quit smoking.

METHODS

Participants were attending residential substance abuse treatment provided by the Australian Salvation Army. These programs are up to 10 months in length and offer a range of low-intensity smoking cessation supports. Measures of smoking, substance use, and clinical characteristics were collected from 2008 to 2015 at baseline and three months post-discharge from treatment (N = 702).

RESULTS

At baseline, 86% of people were smokers (n = 606). At follow-up, only 48 participants who were smokers at baseline (7%) had quit smoking. Participants who had quit smoking at follow-up also reported higher rates of abstinence from alcohol or other substances at follow-up (72%) than people who had not quit smoking (46%; OR = 2.95, 95% CI [1.52, 5.74]).

CONCLUSIONS

There is potential for smoking cessation to be better addressed as part of routine care in substance abuse treatment settings. Future research should evaluate the provision of more systematic smoking cessation interventions within these settings.

HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town

INTRODUCTION AND AIMS

Methamphetamine use is highly prevalent in parts of South Africa, and there is concern this will contribute to the country's substantial HIV epidemic. We examined the feasibility of implementing routine HIV testing at a community-based substance abuse treatment centre in Cape Town and determined the HIV sero-prevalence among methamphetamine users seeking treatment at this site.

DESIGN AND METHODS

In this cross-sectional study, 293 participants completed measures of demographics, substance use and HIV treatment. HIV sero-prevalence was determined by a rapid finger-prick HIV test, and prior HIV diagnosis was confirmed via clinic records.

RESULTS

The majority of participants were male and self-identified as 'Coloured', with a mean age of 28 years. The HIV sero-prevalence was 3.8%. Of the 11 participants who tested HIV positive, four were newly diagnosed. HIV-positive and HIV-negative participants were comparable on demographic and substance use factors. Uptake of HIV testing among all clients at the drug treatment centre increased from <5% prior to study initiation to 89% after study completion. Measures implemented to ensure high rates of HIV testing were regarded as sustainable.

DISCUSSION AND CONCLUSIONS

Our study suggests that integrating routine HIV testing into substance abuse treatment is feasible in a community-based health centre. The low HIV prevalence among this sample of treatment-seeking methamphetamine users highlights the potential benefits of supporting expanded efforts to optimise HIV prevention with this young adult population. [Gouse H, Joska JA, Lion RR, Watt MH, Burnhams W, Carrico AW, Meade CS. HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town. Drug Alcohol Rev 2016;35:580-583].

Brain potentials predict substance abuse treatment completion in a prison sample

INTRODUCTION

National estimates suggest that up to 80% of prison inmates meet diagnostic criteria for a substance use disorder. Because more substance abuse treatment while incarcerated is associated with better post-release outcomes, including a reduced risk of accidental overdose death, the stakes are high in developing novel predictors of substance abuse treatment completion in inmate populations.

METHODS

Using electroencephalography (EEG), this study investigated stimulus-locked ERP components elicited by distractor stimuli in three tasks (VO-Distinct, VO-Repeated, Go/NoGo) as a predictor of treatment discontinuation in a sample of male and female prison inmates. We predicted that those who discontinued treatment early would exhibit a less positive P3a amplitude elicited by distractor stimuli.

RESULTS

Our predictions regarding ERP components were partially supported. Those who discontinued treatment early exhibited a less positive P3a amplitude and a less positive PC4 in the VO-D task. In the VO-R task, however, those who discontinued treatment early exhibited a more negative N200 amplitude rather than the hypothesized less positive P3a amplitude. The discontinuation group also displayed less positive PC4 amplitude. Surprisingly, there were no time-domain or principle component differences among the groups in the Go/NoGo task. Support Vector Machine (SVM) models of the three tasks accurately classified individuals who discontinued treatment with the best model accurately classifying 75% of inmates. PCA techniques were more sensitive in differentiating groups than the classic time-domain windowed approach.

CONCLUSIONS

Our pattern of findings are consistent with the context-updating theory of P300 and may help identify subtypes of ultrahigh-risk substance abusers who need specialized treatment programs.

The Role of Familismo and Acculturation as Moderators of the Association Between Family Conflict and Substance Abuse on Latino Adult Males

The significant research gap on Latino adults who completed substance abuse treatment (SAT) impacts the provision of substance use prevention and treatment for this population. Given the need for culturally-appropriate SAT for Latinos, research that examines the role of cultural constructs and acculturation in relation to substance use behavior is warranted. The purpose of the present study is to test, based on the social control theory, a multiple moderation model using the PROCESS macro¹ to examine the moderating effect of Familismo on the association between history of family conflict and years of substance abuse on Latino males who completed SAT at different levels of acculturation (i.e., cultural orientation). Generational status (i.e., immigrant, U. S. born) and age are used as covariates. A total of 117 Latino male participants (M_age= 37, 54% non-U.S. born with a mean length of stay of 19 years in the U.S.) who completed SAT from facilities located in the metropolitan area of Chicago completed self-report measures. Results from the multiple moderation analysis showa significant three-way interaction (family conflict × Familismo × acculturation), indicating that participants with Latino and bicultural orientation who endorse average to high levels of Familismo have fewer years of substance abuse compared to those with U.S. mainstream culture orientation and low Familismo. Findings illustrate the need for SAT that assesses for family conflict and integrates cultural aspects to reduce substance use behavior on Latino males.

Pretreatment drug use characteristics and experiences among patients in a voluntary substance abuse treatment center in Malaysia: A mixed-methods approach

BACKGROUND

Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) centers. To best serve the needs of regional C&C centers, data on drug use are essential among patients accessing treatment. Using a mixed-methods approach, the authors examined pretreatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan-a religiously conservative state in northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns.

METHODS

A mixed-methods study utilizing surveys (n = 96) and semistructured interviews (n = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan.

RESULTS

Survey results showed that 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use, followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C center on drug rehabilitation.

CONCLUSIONS

The drug use profile of the Kelantan C&C center enrollees shows extensive pretreatment amphetamine use, polysubstance use, and injection drug use, including high-risk behaviors such as sharing needles, syringes, and containers. Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

Recent Developments in Alcohol Services Research on Access to Care

In the United States, only about 10 percent of people with an alcohol or drug use disorder receive care for the condition, pointing to a large treatment gap. Several personal characteristics influence whether a person will receive treatment; additionally, many people with an alcohol use disorder do not perceive the need for treatment. The extent of the treatment gap differs somewhat across different population subgroups, such as those based on gender, age, or race and ethnicity. Recent health care reforms, such as implementation of the Patient Protection and Affordable Care Act of 2010, likely will improve access to substance abuse treatment. In addition, new treatment approaches, service delivery systems, and payment innovations may facilitate access to substance abuse services. Nevertheless, efforts to bridge the treatment gap will continue to be needed to ensure that all people who need alcohol and drug abuse treatment can actually receive it.

Cannabis Withdrawal, Posttreatment Abstinence, and Days to First Cannabis Use Among Emerging Adults in Substance Use Treatment: A Prospective Study

Very little prospective research investigates how cannabis withdrawal is associated with treatment outcomes, and this work has not used the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) thresholds for cannabis withdrawal. The sample included 110 emerging adults entering outpatient substance use treatment who were heavy cannabis users with no other drug use and limited alcohol use. We used survival analyses to predict days to first use of cannabis and logistic regression to predict whether participants were abstinent and living in the community at 3 months. Those meeting criteria for cannabis withdrawal were more likely to return to use sooner than those not meeting criteria for cannabis withdrawal. However, the presence of cannabis withdrawal was not a significant predictor of 3-month abstinence. Emerging adults with DSM-5 cannabis withdrawal may have difficulty initiating abstinence in the days following their intake assessment, implying the need for strategies to mitigate their more rapid return to cannabis use.

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties

POLICY POINTS

Buprenorphine is an effective opioid dependence treatment that has expanded access to care since its 2002 approval, but it can only be prescribed by physicians waivered to treat a limited number of individuals. We examined the impact of 2006 legislation that increased waivered physician patient limits from 30 to 100 on buprenorphine use, and found that 100-patient-waivered physicians were significantly associated with growth in buprenorphine use, with no such relationship for 30-patient-waivered physicians. Policies relaxing patient limits may be more effective in increasing buprenorphine use than alternatives such as opening new substance abuse treatment facilities or increasing the overall number of waivered physicians.

CONTEXT

Opioid use disorders are a significant public health problem. In 2002, the FDA approved buprenorphine as an opioid use disorder treatment when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients. Although federal legislators are considering increasing these limits further and expanding prescribing privileges to nonphysicians, little information is available regarding the impact of such changes on buprenorphine use. We therefore examined the impact of the 2006 legislation-as well as the association between urban and rural waivered physicians, opioid treatment programs, and substance abuse treatment facilities-on buprenorphine distributed per capita over the past decade.

METHODS

Using 2004-2011 state-level data on buprenorphine dispensed and county-level data on the number of buprenorphine-waivered physicians and substance abuse treatment facilities using buprenorphine, we estimated a multivariate ordinary least squares regression model with state fixed effects of a state's annual total buprenorphine dispensed per capita as a function of the state's number of buprenorphine providers.

FINDINGS

The amount of buprenorphine dispensed has been increasing at a greater rate than the number of buprenorphine providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of buprenorphine dispensed per capita. There was no significant association in the growth of buprenorphine distributed and the number of physicians with 30-patient waivers.

CONCLUSIONS

The greater amounts of buprenorphine dispensed are consistent with the potentially greater use of opioid agonists for opioid use disorder treatment, though they also make their misuse more likely. The changes after the 2006 legislation suggest that policies focused on increasing the number of patients that a single waivered physician could safely and effectively treat could be more effective in increasing buprenorphine use than would alternatives such as opening new substance abuse treatment facilities or raising the overall number of waivered physicians.

Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa

BACKGROUND

A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA).

METHODS

First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency.

RESULTS

The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89.

CONCLUSION

A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients' perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.

Predictors of Physical Altercation among Adolescents in Residential Substance Abuse Treatment

This study tested the hypothesis that basic social information-processing components represented by family conflict, peer aggression, and pro-aggression cognitive scripts are related to aggression and social problems among adolescents in substance abuse treatment. The sample consisted of 547 adolescents in two community-based residential facilities. Correlation results indicated that more peer aggression is related to more pro-aggression scripts; scripts, peer aggression, and family conflict are associated with social problems; and in-treatment physical altercation involvement is predicted by higher peer aggression. Findings suggest that social information-processing components are valuable for treatment research.

Cultural accommodation of group substance abuse treatment for Latino adolescents: Results of an RCT

Comparative studies examining the difference between empirically supported substance abuse treatments versus their culturally accommodated counterparts with participants from a single ethnic minority group are frequently called for in the literature but infrequently conducted in practice. This randomized clinical trial was conducted to compare the efficacy of an empirically supported standard version of a group-based cognitive-behavioral treatment (S-CBT) to a culturally accommodated version (A-CBT) with a sample of Latino adolescents primarily recruited from the juvenile justice system. Development of the culturally accommodated treatment and testing was guided by the Cultural Accommodation Model for Substance Abuse Treatment (CAM-SAT). Seventy Latino adolescents (mean age = 15.2; 90% male) were randomly assigned to 1 of 2 group-based treatment conditions (S-CBT = 36; A-CBT = 34) with assessments conducted at pretreatment, posttreatment, and 3-month follow-up. Longitudinal Poisson mixed models for count data were used to conduct the major analyses. The primary outcome variable in the analytic models was the number of days any substance was used (including alcohol, except tobacco) in the past 90 days. In addition, the variables ethnic identity, familism, and acculturation were included as cultural moderators in the analysis. Although both conditions produced significant decreases in substance use, the results did not support a time by treatment condition interaction; however, outcomes were moderated by ethnic identity and familism. The findings are discussed with implications for research and practice within the context of providing culturally relevant treatment for Latino adolescents with substance use disorders.

Admissions to detoxification after treatment: Does engagement make a difference?

BACKGROUND

Treatment engagement is a well-established performance measure for the treatment of substance use disorders. This study examined whether outpatient treatment engagement is associated with a reduced likelihood of subsequent detoxification admissions.

METHODS

This study used administrative data on treatment services received by clients in specialty treatment facilities licensed in Massachusetts. The sample consisted of 11,591 adult clients who began an outpatient treatment episode in 2006. Treatment engagement was defined as receipt of at least 1 treatment service within 14 days of beginning a new outpatient treatment episode and receipt of at least 2 additional treatment services in the next 30 days. The outcome was a subsequent detoxification admission. Multilevel survival models examined the relationship between engagement and outcomes, with time to detoxification admission as the dependent variable censored at 365 days.

RESULTS

Only 35% of clients met the outpatient engagement criteria, and 15% of clients had a detoxification admission within a year after beginning their outpatient treatment episode. Controlling for client demographics, insurance type, and substance use severity, clients who met the engagement criteria had a lower hazard of having a detoxification admission during the year following the index outpatient visit than those who did not engage (hazard ratio = 0.87, P < .01).

CONCLUSIONS

Treatment engagement is a useful measure for monitoring quality of care. The findings from this study could help inform providers and policy makers on ways to target care and reduce the likelihood of more intensive services.

Substance abuse relapse in Oxford House recovery homes: A survival analysis evaluation

BACKGROUND

This study used survival analysis to examine risk factors for substance abuse relapse among residents in Oxford Houses (OH), a national network of self-run, self-financed aftercare homes for individuals recovering from substance use disorders.

METHODS

Participants who entered OH within 60 days of a 1-year longitudinal study (N = 268) were selected from of a nationally representative US sample. Discrete-time survival analysis compared baseline risk of relapse with 4 hypothesized survival models that included time-invariant and time-varying factors across 3 subsequent time periods.

RESULTS

The model predicting higher risk for more severe substance use disorders and psychiatric problems was supported. The hypothesized model that predicted time-varying increases in alcohol (but not drug) abstinence self-efficacy significantly affected risk of relapse. Hypothesized demographic and employment variables did not significantly predict relapse risk.

CONCLUSIONS

Results suggested that OH recovery homes may reduce relapse by providing closer monitoring and referring additional services to new residents with more severe prior addiction severity. Risk for relapse may also be reduced by enhancing abstinence self-efficacy for alcohol regardless of drug of choice.