Journal of Substance Abuse Treatment

Editorial Board

2010-09-01

Priorities for policy research on treatments for alcohol and drug use disorders

Dennis McCarty, K. John McConnell, Laura A. Schmidt — 2010-07-05

Abstract: The Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP) supported 368 awards for nearly $60 million to complete policy research related to alcohol, tobacco, and illicit drug use and abuse. As part of its closure in 2009, SAPRP commissioned four papers that articulated policy research priorities for tobacco cessation and control, alcohol prevention, drug prevention, and addiction treatment. The papers were released at a Congressional Briefing on October 2, 2009 and are available on the SAPRP Web site (http://www.saprp.org/Research_Agenda.cfm). An abridged version of the treatment policy paper summarizes what we know, what we need to know, and research recommendations. The paper examines five categories of policy concerns that are likely to affect addiction treatment services over the next 5 years: (a) organization and delivery of care, (b) quality of care, (c) evidence-based practices, (d) access to care, and (e) financing, costs, and value of care.

Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians

2010-07-05

Abstract: Office-based treatment of opioid dependence with buprenorphine has the potential to expand treatment capacity in the United States. However, nationally, little is known about the number, characteristics, and experiences of physicians certified to prescribe buprenorphine. Moreover, little is known about the impact of easing federal regulations on the number of patients a physician is allowed to treat concurrently. To address these questions, surveys of national samples of physicians certified to prescribe buprenorphine (2004–2008) were analyzed (N = 6,892). There has been a continual increase in the number of physicians certified to prescribe buprenorphine, increase in the mean number of patients treated by physicians, and decrease in patients turned away, coinciding temporally with easing of federal regulations. In addition, most physicians prescribed buprenorphine outside of traditional treatment settings. The U.S. experiment in expanding Schedule III-V medications for opioid dependence to physicians outside of formal substance abuse treatment facilities appears to have resulted in expanded capacity.

Validation of the Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD) in civilian substance use disorder patients

Debora van Dam, Thomas Ehring, Ellen Vedel, Paul M.G. Emmelkamp — 2010-07-05

Abstract: This study aimed to cross-validate and extend earlier findings regarding the diagnostic efficiency of the four-item Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) as a screening questionnaire for posttraumatic stress disorder (PTSD) among civilian patients with substance use disorder (SUD). The PC-PTSD was originally developed in a Veteran Affairs primary care setting (Prins, Ouimette, Kimerling, Cameron, Hugelshofer, Shaw-Hegwer, et al., 2004) and has been widely used in the U.S. army. The diagnostic efficiency of the screener was compared to those of an extended eight-item version of the PC-PTSD and the Posttraumatic Diagnostic Scale (PDS). The sample consisted of 142 participants with SUD and most of the participants (89%) were still using substances in the month preceding the assessment. Results showed a high sensitivity (.86) and moderate specificity (.57) for the PC-PTSD when using a cutoff score of 2. The diagnostic efficiency of the PC-PTSD was equivalent to the extended eight-item version and the 17-item PDS. Results suggest that the original PC-PTSD is a useful screening instrument for PTSD within a civilian SUD population. These findings have important clinical implications because screening for PTSD among patients with SUD is crucial to ascertain appropriate treatment allocation.

Comparison of opiate-primary treatment seekers with and without alcohol use disorder

Bryan Hartzler, Dennis M. Donovan, Zhen Huang — 2010-07-05

Abstract: Many persons seeking opiate treatment present with complex clinical challenges, which may be exacerbated by alcohol misuse. This report details secondary data analyses aggregating treatment-seeking samples across 10 National Institute on Drug Abuse (NIDA) Clinical Trials Network treatment trials to examine alcohol-related characteristics of opiate-primary (OP) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder (AUD). Analysis of this aggregate OP client sample (n = 1,396) indicated that 38% had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common. Further, comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning. Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical, psychological, case management, and other support services.

Service utilization during and after outpatient treatment for comorbid substance use disorder and depression

Matthew J. Worley, Ryan S. Trim, Susan R. Tate, Jessica E. Hall, Sandra A. Brown — 2010-07-05

Abstract: Patients with comorbid substance use disorder (SUD) and depression incur greater treatment costs than those with either disorder alone. Integrated treatment targeting both issues concurrently has been shown to reduce substance use and depression in this population, but little is known about the effects of such treatment on the utilization of costly health services. This study compared 18-month patterns of service utilization for 236 veterans with comorbid SUD depression randomly assigned to 6 months of either Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy. Treatment group differences were found for the utilization of psychotropic medication services and inpatient hospitalization. Higher rates of therapy attendance, lower baseline depression, and receiving ICBT all predicted shorter admissions for those hospitalized during treatment. Ethnicity and gender predicted medication service use both during and following treatment. The findings provide evidence supporting the long-term cost-effectiveness of integrated treatment for this high-risk population.

The 10-year course of remission, abstinence, and recovery in dual diagnosis

Haiyi Xie, Robert E. Drake, Gregory J. McHugo, Lynn Xie, Anita Mohandas — 2010-07-05

Abstract: This study examined the frequency, stability, predictors, and long-term outcomes of 6-month remissions of alcohol use disorders among 116 adults with co-occurring severe mental illnesses followed up prospectively for 10 years. Remission was defined as 6 months without meeting syndromal criteria for alcohol abuse or dependence. Most participants (86%) experienced at least one 6-month remission, and these remissions were relatively durable. One third did not relapse during follow-up, and two thirds relapsed on average 3 years after remission. Six-month remissions were preceded by increased participation in substance abuse treatments, reductions in alcohol and drug use, decreases in psychiatric symptoms, increases in competitive employment, and increases in life satisfaction. Following remissions, participants improved in multiple domains of adjustment: reductions of psychiatric symptoms, decreases in alcohol and drug use, increases in work and social contacts with nonabusers, decreases in hospitalizations and incarcerations, increases in independent living, and increases in life satisfaction. Participants with alcohol dependence rather than alcohol abuse were less likely to attain 6-month remissions and more likely to relapse after attaining remissions.

The cost of concordance with opiate substitution treatment guidelines

Paul G. Barnett, Jodie A. Trafton, Keith Humphreys — 2010-07-05

Abstract: The Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

Perceived drug assignment and treatment outcome in smokers given nicotine patch therapy

2010-07-05

Abstract: This study assessed the relationship between treatment outcome and perceived drug assignment in smokers (nicotine patch [NP] or placebo) using abstinence and relapse status. Smokers (N = 424) were randomly assigned to receive either NP or placebo as part of a study that examined the effects of combining NP with self-help programs. Beliefs about drug assignment, assessed at the 12-month follow-up, were obtained from 384 participants. Beliefs were related to abstinence at the 2-month, p < .05, and 6-month follow-ups, p < .05, for the NP group, but not the placebo. Beliefs were not related to abstinence at 12 months for either group. Survival analysis assessing relapse revealed that beliefs were related to relapse status, regardless of actual group assignment. Our results suggest that there is a relationship between perceived drug assignment and treatment outcome. Future studies using multiple treatment outcome measures and assessments of beliefs over time are warranted.

Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons

2010-07-05

Abstract: Our goal was to determine whether treatment of depressive symptoms with escitalopram during buprenorphine treatment for opioid dependence would improve treatment retention compared to placebo in a 12-week, randomized, double-blind trial. Treatment dropout was defined as missing seven consecutive buprenorphine dosing days. Participants were 76% male, 80% non-Hispanic Caucasian, and 64% heroin users. At baseline, the mean Beck Depression Inventory II (BDI-II) score was 28.4 (±9.7). Sixty-one percent of participants completed the 12-week buprenorphine protocol. Dropout rates were 33.3% and 44.0% among those randomized to escitalopram or placebo, respectively (p = .19). Relative to baseline, mean BDI-II scores were significantly lower at all follow-up assessments, but the Treatment × Time interaction effect was not statistically significant (p = .18). Participants randomized to escitalopram also did not have a significantly lower likelihood of testing positive for either opiates or other drugs during follow-up. Depressive symptoms often resolved with buprenorphine treatment, and the immediate initiation of escitalopram does not improve treatment retention, depression outcomes, or illicit drug use. Clinicians should determine the need for antidepressant treatment later in buprenorphine care.

Resets do not appear to increase the rate of adverse events or prolong relapse in voucher-based reinforcement therapy

2010-07-05

Abstract: Voucher-based reinforcement therapy (VBRT) is an efficacious contingency management intervention for substance use disorders that provides escalating voucher values to reinforce continuous abstinence and typically resets escalated values to the initial low level upon detection of drug use. The objective of this study involving 130 methadone-maintained outpatients receiving VBRT was to investigate whether resets (a) increase risk for adverse events (AEs) and (b) delay return to abstinence in relation to magnitude of voucher reset. Weeks following resets were examined for increased likelihood of AEs using a Poisson regression. A Cox proportional hazards model was used to determine if higher resets increased the number of days until a negative urine specimen. Results showed that resets did not increase the likelihood of AEs nor were higher resets related to an increased delay to abstinence. Research involving larger samples is needed to produce sufficient data directly addressing safety concerns of various treatment stakeholders.

Methadone use among HIV-positive injection drug users in a Canadian setting

2010-07-05

Abstract: We examined methadone maintenance therapy (MMT) use among HIV-positive injection drug users (IDU) in Vancouver. Among 353 participants, 199 (56.3%) were on MMT at baseline, and 48 initiated MMT during follow-up. Female gender (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI] = 1.14–2.62) and antiretroviral therapy use (AOR = 2.04, 95% CI = 1.46–2.86) were positively associated with MMT use, whereas frequent heroin injection (AOR = 0.34, 95% CI = 0.23–0.50), public injection (AOR = 0.76, 95% CI = 0.59–0.97), syringe borrowing (AOR = 0.54, 95% CI = 0.32–0.90), and nonfatal overdose (AOR = 0.58, 95% CI = 0.36–0.92) were negatively associated with MMT use. The rate of discontinuation of MMT was 12.46 (95% CI = 8.28–18.00) per 100 person years. Frequent heroin use (adjusted hazards ratio = 4.49, 95%CI = 1.81–11.13) was positively associated with subsequent discontinuation of MMT. These findings demonstrate the benefits of MMT among HIV-positive IDU and the need to improve access to and retention in MMT.

Structure, reliability, and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a residential substance abuse treatment facility

Sara E. Lowmaster, Leslie C. Morey, Kay L. Baker, Christopher J. Hopwood — 2010-07-05

Abstract: This study examined the structure and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a court mandated inpatient substance abuse treatment facility (N = 729). Client characteristics such as treatment motivation and psychological and social functioning were examined as predictors of prospective behavioral outcomes including compliance with treatment program rules and guidelines as well as completion of the treatment program. Results suggest that a broad indicator of individuals' pretreatment motivation predicted their ability to complete the program. Treatment noncompliance, as measured by the number of rule infractions committed during the inpatient treatment, was significantly predicted by individuals' propensity to externalize their symptoms. Implications for the effective use of the CR SRF-Intake as a screener for potential treatment problems are discussed as well as possible targets for interventions in substance abuse populations.

Substance abuse treatment providers' involvement in research is associated with willingness to use findings in practice

Rogério M. Pinto, Gary Yu, Anya Y. Spector, Prakash Gorroochurn, Dennis McCarty — 2010-09-01

Abstract: Using a national sample (n = 571) of substance abuse treatment providers affiliated with the Clinical Trials Network, we examined the contribution of several factors—demographic, attitudes, and involvement in research—toward providers' willingness to use research findings in practice. The sample included medical staff, social workers, psychologists, and counselors. Using a multiple linear regression model, we examined the impact of involvement in research and willingness to use research findings in practice. Providers involved in research were more willing to use findings in practice (p < .001). Latino/Latinas were less willing (p < .05). Providers with favorable attitudes toward evidence-based practices and whose agencies supported professional growth were more willing to use findings (p < .01). Involvement in research may enhance providers' willingness to use findings in practice and improve quality of services. Results underscore the need for providing opportunities for all providers to engage in substance abuse treatment research, particularly racial/ethnic minority providers.

Journal of Substance Abuse Treatment

Editorial Board

Contents

Priorities for policy research on treatments for alcohol and drug use disorders

Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians

Validation of the Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD) in civilian substance use disorder patients

Comparison of opiate-primary treatment seekers with and without alcohol use disorder

Service utilization during and after outpatient treatment for comorbid substance use disorder and depression

The 10-year course of remission, abstinence, and recovery in dual diagnosis

The cost of concordance with opiate substitution treatment guidelines

Perceived drug assignment and treatment outcome in smokers given nicotine patch therapy

Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons

Resets do not appear to increase the rate of adverse events or prolong relapse in voucher-based reinforcement therapy

Methadone use among HIV-positive injection drug users in a Canadian setting

Structure, reliability, and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a residential substance abuse treatment facility

Substance abuse treatment providers' involvement in research is associated with willingness to use findings in practice