Journal of Substance Abuse Treatment - Articles in Press

Drug-abusing offenders with comorbid mental disorders: Problem severity, treatment participation, and recidivism - Corrected Proof

Adi Jaffe, Jiang Du, David Huang, Yih-Ing Hser — 2012-02-03

Abstract: This study examined problem severity, treatment participation, and recidivism among 1,016 offenders with co-occurring mental disorders who participated in California's Proposition 36. Participants were assessed using the Addiction Severity Index (ASI) at baseline, and their records on mental health diagnoses, drug treatment participation, and arrests were also obtained. Participants' co-occurring disorder (COD) severity was classified as mild or severe based on specific mental health diagnoses. Predictors of recidivism were examined among mild-COD and severe-COD participants separately using ordinal logistic regression. Results indicate that although previous arrests, education, and treatment retention length are predictors of recidivism generally, gender, age, primary drug, ASI drug severity score, and treatment modality are differentially important depending on COD status. These results underscore the need for COD-focused intervention strategies among offenders, taking into consideration the severity of their COD status.

Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors - Corrected Proof

Carla Smith Stover, Chelsea Hall, Thomas J. McMahon, Caroline J. Easton — 2012-02-03

Abstract: Objective: The relationship between fatherhood and both psychiatric distress and severity of substance abuse (SA) among men entering SA treatment has not been well explored. This study was designed to (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers.Methods: PTSD symptoms, severity of SA, and parenting data reported on structured questionnaires were collected from 126 men presenting for an SA evaluation at a forensic drug diversion clinic.Results: There were no differences in severity of alcohol or drug use between fathers and nonfathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting.Conclusions: Further exploration of the impact of trauma-related symptoms on the parenting behaviors of substance-abusing men is warranted.

Problem recognition, intention to stop use, and treatment use among regular heroin injectors - Corrected Proof

2012-02-02

Abstract: This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social–behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.

Physicians in the substance abuse treatment workforce: Understanding their employment within publicly funded treatment organizations - Corrected Proof

Hannah K. Knudsen, Carrie B. Oser, Amanda J. Abraham, Paul M. Roman — 2012-02-02

Abstract: The employment of physicians by substance abuse treatment organizations is understudied, despite physicians' importance in implementing pharmacotherapy and integrating treatment into the broader system of medical care. Drawing on data collected from 249 publicly funded treatment organizations, this study examined organizational and environmental factors associated with the employment of physicians in these settings. A negative binomial regression model indicated that greater numbers of physicians were employed when organizations offered detoxification services, were embedded in health care settings, and were larger in size. Funding barriers, including the costs of physicians and inadequate reimbursement by funders, were negatively associated with physician employment. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field. Increasing physician employment may be challenging in the current economic climate.

Treating depression and substance use: A randomized controlled trial - Corrected Proof

2012-02-02

Abstract: Few integrated substance use and depression treatments have been developed for delivery in outpatient substance abuse treatment settings. To meet the call for more “transportable” interventions, we conducted a pilot study to test a group cognitive–behavioral therapy (CBT) for depression and substance use that was designed for delivery by outpatient substance abuse treatment counselors. Seventy-three outpatient clients were randomized to usual care enhanced with group CBT or usual care alone and assessed at three time points (baseline and 3 and 6 months postbaseline). Our results demonstrated that the treatment was acceptable and feasible for delivery by substance abuse treatment staff despite challenges with recruiting clients. Both depressive symptoms and substance use were reduced by the intervention but were not significantly different from the control group. These results suggest that further research is warranted to enhance the effectiveness of treatment for co-occurring disorders in these settings.

Two approaches to tailoring treatment for cultural minority adolescents - Corrected Proof

Sarah W. Feldstein Ewing, Alisha M. Wray, Hilary K. Mead, Sue K. Adams — 2012-02-02

Abstract: At this time, compared with mainstream (Caucasian) youth, cultural minority adolescents experience more severe substance-related consequences and are less likely to receive treatment. Although several empirically supported interventions (ESIs), such as motivational interviewing (MI), have been evaluated with mainstream adolescents, fewer published studies have investigated the fit and efficacy of these interventions with cultural minority adolescents. In addition, many empirical evaluations of ESIs have not explicitly attended to issues of culture, race, and socioeconomic background in their analyses. As a result, there is some question about the external validity of ESIs, particularly in disadvantaged cultural minority populations. This review seeks to take a step toward filling this gap, by addressing how to improve the fit and efficacy of ESIs like MI with cultural minority youth. Specifically, this review presents the existing literature on MI with cultural minority groups (adult and adolescent), proposes two approaches for evaluating and adapting this (or other) behavioral interventions, and elucidates the rationale, strengths, and potential liabilities of each tailoring approach.

Developing an evidence-based, multimedia group counseling curriculum toolkit - Corrected Proof

2012-02-02

Abstract: Training community-based addiction counselors in empirically supported treatments (ESTs) far exceeds the ever-decreasing resources of publicly funded treatment agencies. This feasibility study describes the development and pilot testing of a group counseling toolkit (an approach adapted from the education field) focused on relapse prevention (RP). When counselors (N = 17) used the RP toolkit after 3 hours of training, their content adherence scores on “coping with craving” and “drug refusal skills” showed significant improvement, as indicated by moderate to large effect sizes (Cohen's d = 0.75 and 0.60, respectively). Counselor skillfulness, in the “adequate-to-average” range at baseline, did not change. Although this feasibility study indicates some benefit to counselor EST acquisition, it is important to note that the impact of the curriculum on client outcomes is unknown. Because a majority of addiction treatment is delivered in group format, a multimedia curriculum approach may assist counselors in applying ESTs in the context of actual service delivery.

Addiction treatment-related employment barriers: The impact of methadone maintenance - Corrected Proof

Lindsey Richardson, Evan Wood, Julio Montaner, Thomas Kerr — 2012-02-02

Abstract: Employment is commonly upheld as an important outcome of addiction treatment. To explore this attribution, we assessed whether treatment enrollment predicts employment initiation among participants enrolled in a community-recruited Canadian cohort of people who inject drugs (IDU; N = 1,579). Survival analysis initially found no association between addiction treatment enrollment and employment initiation. However, when methadone maintenance therapy (MMT) was separated from other treatment modalities, non-MMT treatment positively predicted employment transitions, whereas MMT was negatively associated with employment initiation. Subanalyses examining transitions into temporary, informal, and under-the-table income generation echo these results. Findings suggest that individual factors impacting employment transitions may systematically apply to MMT clients and that, in this setting, the impact of treatment on employment outcomes is contingent on treatment type and design. Treatment-specific differences underscore the need to expand low-threshold MMT, explore MMT alternatives, and evaluate the impact of treatment design on the social and economic activity of IDU.

Comparing buprenorphine induction experience with heroin and prescription opioid users - Corrected Proof

2012-02-02

Abstract: Prescription opioid (PO)-dependent treatment presentations are becoming increasingly common; however, most research on the treatment of opioid-dependent populations has been conducted in heroin users. The aim of this secondary data analysis was to compare the buprenorphine induction experience of 167 heroin and 61 PO users. Results demonstrate that although the groups differed on some baseline characteristics, many of the key induction experience variables were comparable between the groups. Heroin users were found to have significantly higher preinduction Clinical Opiate Withdrawal Scale (COWS) scores (p = .014) and postinduction COWS score (p = .008) compared with the PO users. No differences between groups were found for self-reported craving and withdrawal scores, mean buprenorphine dose on Day 1, or retention at the end of the first week. The findings of this study suggest that existing buprenorphine induction practices developed for heroin users appear to be equally effective with PO users.

Superior methadone treatment outcome in Hmong compared with non-Hmong patients - Corrected Proof

Gavin Bart, Qi Wang, James S. Hodges, Chris Nolan, Gregory Carlson — 2012-01-30

Abstract: The Hmong are a distinct ethnic group from Laos. Little is known about how opiate-addicted Hmong respond to methadone maintenance treatment. Therefore, opium-addicted Hmong (exclusive route of administration: smoking) attending an urban methadone maintenance program in Minneapolis, MN, were matched by gender and date of admission with predominately heroin-addicted non-Hmong (predominant route of administration: injection) attending the same program, and both groups were evaluated for 1-year treatment retention, stabilization dose of methadone, and urine drug screen results. Hmong had greater 1-year treatment retention (79.8%) than non-Hmong (63.5%; p < .01). In both groups, methadone dose was significantly associated with retention (p = .005). However, Hmong required lower doses of methadone for stabilization (M = 49.0 vs. 77.1 mg; p < .0001). For both groups, positive urine drug screens were associated with stopping treatment. Further research to determine levels of tolerance and psychosocial and pharmacogenetic factors contributing to differences in methadone treatment outcome and dosing in Hmong may provide further insight into opiate addiction and its treatment.

Safety and effectiveness of a fixed-dose phenobarbital protocol for inpatient benzodiazepine detoxification - Corrected Proof

Sarah Sharfstein Kawasaki, Janet S. Jacapraro, Darius A. Rastegar — 2012-01-30

Abstract: Benzodiazepine dependence is a common problem. However, there is limited data on safe and effective detoxification protocols for benzodiazepine-dependent patients. We reviewed the medical records of 310 patients treated with a 3-day fixed-dose phenobarbital taper for benzodiazepine dependence over a 5-year period between 2004 and 2009. We recorded the incidence of seizures, falls, delirium, and emergency department (ED) visits or readmission to our institution within 30 days as markers for safety; we also recorded how many patients had doses held because of sedation. The taper was well tolerated, although one quarter of the patients had at least one dose held because of sedation. There were no seizures, falls, or injuries reported. Six percent had a readmission, and 7% had an ED visit at our institution within 30 days of discharge, but only 3 patients required readmission for withdrawal symptoms. Overall, this protocol appears to be safe and effective.

The role of therapeutic alliance in substance use disorder treatment for young adults - Corrected Proof

Karen A. Urbanoski, John F. Kelly, Bettina B. Hoeppner, Valerie Slaymaker — 2012-01-30

Abstract: The therapeutic alliance is deemed to be integral to psychotherapeutic interventions, yet little is known about the nature of its role in treatment for substance use disorders (SUD), especially among young people. We investigated baseline predictors of the therapeutic alliance measured midtreatment and tested whether the alliance influenced during-treatment changes in key process variables (psychological distress, motivation, self-efficacy, coping skills, and commitment to Alcoholics Anonymous/Narcotics Anonymous [AA/NA]) independent of these baseline influences. Young adults in residential treatment (N = 303; age 18–24 years) were assessed at intake, midtreatment, and discharge. Older age and higher baseline levels of motivation, self-efficacy, coping skills, and commitment to AA/NA predicted a stronger alliance. Independent of these influences, participants who developed a stronger alliance achieved greater reductions in distress during treatment. Findings clarify a role for alliance in promoting during-treatment changes through reducing distress.

The effectiveness of community-based delivery of an evidence-based treatment for adolescent substance use - Corrected Proof

2011-12-30

Abstract: This study evaluates the effectiveness of motivational enhancement therapy/cognitive behavioral therapy–5 (MET/CBT-5) when delivered in community practice settings relative to standard community-based adolescent treatment. A quasi-experimental strategy was used to adjust for pretreatment differences between the MET/CBT-5 sample (n = 2,293) and those who received standard care (n = 458). Results suggest that youth who received MET/CBT-5 fared better than comparable youth in the control group on five of six 12-month outcomes. A low follow-up rate (54%) in the MET/CBT-5 sample raised concerns about nonresponse bias in the treatment effect estimates. Sensitivity analyses suggest that although modest differences in outcomes between the MET/CBT-5 nonrespondents and respondents would yield no significant differences between the two groups on two of the six outcomes, very large differences in outcomes between responders and nonresponders would be required for youth receiving MET/CBT-5 to have fared better had they received standard outpatient care.

Adaptability of contingency management in justice settings: Survey findings on attitudes toward using rewards - Corrected Proof

Amy Murphy, Anne Giuranna Rhodes, Faye S. Taxman — 2011-12-30

Abstract: Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards.

Do 12-step meeting attendance trajectories over 9 years predict abstinence? - Corrected Proof

2011-12-29

Abstract: This study grouped treatment-seeking individuals (n = 1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed Year 9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The “high” class reported the highest attendance and abstention. The “descending” class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence, but by Year 5, their attendance and abstinence dropped. The “early-drop” class, which started with high attendance and abstinence but with low problem severity, reported no attendance after Year 1. The “rising” class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the “low” and “no” classes, which reported low problem severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles.

Randomized trial comparing computer-delivered and face-to-face personalized feedback interventions for high-risk drinking among college students - Corrected Proof

2011-12-26

Abstract: This study evaluated the efficacy of two brief personalized feedback interventions (PFIs) using identical feedback and motivational interviewing strategies aimed at reducing alcohol consumption and alcohol-related problems to two control conditions among a sample of high-risk drinking college students. Students (N = 152) were randomly assigned to a computer-delivered PFI with a video interviewer, a face-to-face PFI with a live interviewer, a comprehensive assessment condition, or a minimal assessment-only condition. At 10 weeks posttreatment, the face-to-face PFI significantly reduced weekly drinking quantity and peak and typical blood alcohol concentration compared with the comprehensive assessment and minimal assessment-only conditions (d values ranged from 0.32 to 0.61). No significant between-group differences were evidenced for the computer-delivered PFI condition, although effect sizes were comparable to other college drinking studies using computer-delivered interventions (d values ranged from 0.20 to 0.27). Results provide further support for the use of a face-to-face PFI to help reduce college students' alcohol consumption and suggest that a video interviewer in the context of a computer-delivered PFI is likely a helpful but not necessarily a complete substitute for a live interviewer.

Prevalence, predictors, and service utilization of patients with recurrent use of Veterans Affairs substance use disorder specialty care - Corrected Proof

Eric J. Hawkins, Carol A. Malte, John S. Baer, Daniel R. Kivlahan — 2011-12-26

Abstract: Although substance use disorders (SUDs) are chronic conditions for many patients, the prevalence, predictors, and health care utilization patterns of those who reenter SUD specialty care are understudied. We identified 1,640 patients who initiated SUD specialty care at 1 Veterans Affairs (VA) medical center and categorized them, using their subsequent 24 and prior 60 months receipt of VA SUD care, as index episode only (35.7%, 33.5–38.1), index and prior episode(s) (24.6%, 22.5–22.7), and index and postindex episodes (39.6%, 37.3–42.0). Compared with the index episode-only group, the postindex episode(s) group had modestly higher percentages of men, divorced/separated, and alcohol use, cocaine use, bipolar disorder, and psychotic disorders. Patients with postindex episodes averaged 2 times more postindex emergency visits and mental health hospitalizations than patients with an index only episode. Results document the prevalence, overall health care utilization, and limited predictability of SUD treatment reentry and support development of new models of care for these complex patients.

Temporal relationship between substance use and delinquent behavior among young psychiatrically hospitalized adolescents - Corrected Proof

2011-12-26

Abstract: There is considerable evidence linking substance use and delinquent behavior among adolescents. However, the nature and temporal ordering of this relationship remain uncertain, particularly among early adolescents and those with significant psychopathology. This study examined the temporal ordering of substance use and delinquent behavior in a sample of psychiatrically hospitalized early adolescents. Youth (N = 108) between the ages of 12 and 15 years completed three assessments over 18 months following hospitalization. Separate cross-lagged panel models examined the reciprocal relationship between delinquent behavior and two types of substance use (e.g., alcohol and marijuana). Results provided evidence of cross-lagged effects for marijuana: Delinquent behavior at 9 months predicted marijuana use at 18 months. No predictive effects were found between alcohol use and delinquent behavior over time. Findings demonstrate the stability of delinquent behavior and substance use among young adolescents with psychiatric concerns. Furthermore, results highlight the value of examining alcohol and marijuana use outcomes separately to better understand the complex pathways between substance use and delinquent behavior among early adolescents.

Integrating information on substance use disorders into electronic health record systems - Corrected Proof

Betty Tai, A. Thomas McLellan — 2011-12-09

Abstract: For reasons of safety and effectiveness, many forces in health care, especially the Affordable Care Act of 2010, are pressing for improved identification and management of substance use disorders within mainstream health care. Thus, standard information about patient substance use will have to be collected and used by providers within electronic health record systems (EHRS). Although there are many important technical, legal, and patient confidentiality issues that must be dealt with to achieve integration, this article focuses upon efforts by the National Institute on Drug Abuse and other federal agencies to develop a common set of core questions to screen, diagnose, and initiate treatment for substance use disorders as part of national EHRS. This article discusses the background and rationale for these efforts and presents the work to date to identify the questions and to promote information sharing among health care providers.

Community Reinforcement and Family Training: A pilot comparison of group and self-directed delivery - Corrected Proof

2011-12-07

Abstract: In a randomized clinical pilot study, 40 concerned significant others (CSOs) of treatment-refusing alcohol- and drug-using individuals were randomized to either Community Reinforcement and Family Training (CRAFT) conducted in a group format (Group CRAFT) or a Self-Directed CRAFT condition. Although results indicated no significant between-group difference in engaging treatment-refusing substance-using individuals (referred to as identified patients or IPs) into treatment, the engagement rate in Group CRAFT was similar to rates previously reported with individual CRAFT. For the intent-to-treat analysis, 60% of Group CRAFT CSOs engaged their loved one into treatment, as compared with 40% in Self-Directed CRAFT. Of CSOs in the Group condition who received at least one session of group therapy, 71% engaged their IP into treatment. CSOs in both conditions reported improvements in family cohesion and conflict at the 3- and 6-month follow-up, replicating prior CRAFT findings.

Does the Alcohol Use Disorders Identification Test–Consumption identify the same patient population as the full 10-item Alcohol Use Disorders Identification Test? - Corrected Proof

2011-12-07

Abstract: The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used (AUDIT: 5–8 points, AUDIT-C: 4–6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.

Factors associated with methadone treatment among injection drug users in Bangkok, Thailand - Corrected Proof

2011-12-07

Abstract: Little is known about the characteristics of injection drug users (IDU) who take methadone treatment in Thailand. We examined prevalence and correlates of methadone treatment among a community-recruited sample of IDU in Bangkok, Thailand. Among 273 participants, 143 (52.4%) reported accessing methadone treatment within the previous 6 months. Older age (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI] = 1.10–3.30) and more than weekly midazolam injection (AOR = 1.85, 95% CI = 1.04–3.29) were positively associated, whereas alcohol use (AOR = 0.34, 95% CI = 0.18–0.63) and noninjection methamphetamine use (AOR = 0.49, 95% CI = 0.29–0.85) were negatively associated with methadone treatment. In subanalyses, 98.6% of IDU on methadone continued to inject drugs, and the most common reason for stopping methadone was becoming incarcerated (49%). Evidence-based addiction treatment in the form of methadone maintenance therapy, with attention paid to concomitant midazolam injection in this setting, should be implemented.

Examination of the latent factor structure of the Alcohol Use Disorders Identification Test in two independent trauma patient groups using confirmatory factor analysis - Corrected Proof

Darryl Wade, Tracey Varker, Meaghan O'Donnell, David Forbes — 2011-12-07

Abstract: Recent research on the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) provides support for two underlying factors: consumption and consequences. The current study sought to extend these findings to two independent and diverse trauma populations: traumatic injury patients and military veterans treated for posttraumatic stress disorder. The 2- and 3-factor solutions provided the best fit to the data, but there was a very high correlation between the second and third factors of the 3-factor solution. Parsimony suggests that the 2-factor solution is the preferred model. The 2-factor model has implications for alcohol screening using the AUDIT and supports the goal of screening to identify those with hazardous drinking and alcohol use disorders. An algorithm is proposed to inform alcohol screening protocols in a range of health settings for trauma-exposed patient groups.

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment - Corrected Proof

Jennifer Cole, Erin Stevenson, Robert Walker, T.K. Logan — 2011-12-07

Abstract: Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040–0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105–0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.

Community-based group intervention for tobacco cessation in rural Tamil Nadu, India: A cluster randomized trial - Corrected Proof

Muthusamy Santhosh Kumar, P. Sankara Sarma, Kavumpurathu Raman Thankappan — 2011-12-07

Abstract: The objective of this study was to determine the efficacy of community-based group intervention for tobacco cessation. We recruited 400 men (20–40 years) currently using any form of tobacco from 20 villages of the Indian State of Tamil Nadu and randomized them equally into intervention and control groups. A physician offered two sessions of health education 5 weeks apart along with self-help material on tobacco cessation to the intervention group. The control group received only self-help material. The contents of the sessions included tobacco-related health problems, benefits of quitting, and coping strategies for withdrawal symptoms. Follow-up data were available for 92%. Self-reported point prevalence abstinence of 12.5% in the intervention group was significantly higher than the 6.0% in the control group at 2 months. Community-based group intervention has the potential to increase the coverage of tobacco cessation services for men in rural Tamil Nadu.

A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom program - Corrected Proof

Anne R. Lindsay, Cortney S. Warren, Sara C. Velasquez, Minggen Lu — 2011-12-07

Abstract: Given that women increasingly report using drugs to lose weight, substance abuse treatment programs must include body image, weight, eating pathology, and health knowledge as core intervention targets. This study tested the efficacy of a supplemental health and body image curriculum designed for women in substance abuse treatment who report weight concerns called Healthy Steps to Freedom (HSF). Data from 124 adult women recruited from substance abuse treatment facilities in southern Nevada completed measures of drug use, body dissatisfaction, eating pathology, thin-ideal internalization, and health knowledge/behaviors before and after participation in the 12-week HSF program. Results revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased. These results suggest that the inclusion of the HSF program in substance abuse treatment improves weight-related issues in substance-abusing women.

System-level effects of integrating a promising treatment into juvenile drug courts - Corrected Proof

Michael R. McCart, Scott W. Henggeler, Jason E. Chapman, Phillippe B. Cunningham — 2011-12-07

Abstract: This study examined the system-level effects of implementing a promising treatment for adolescent substance abuse in juvenile drug courts (JDCs). Six JDCs were randomized to receive training in the experimental intervention (contingency management–family engagement [CM-FAM]) or to continue their usual services (US). Participants were 104 families served by the courts, 51 therapists, and 74 JDC stakeholders (e.g., judges, prosecutors, defense attorneys). Assessments included repeated measurements of CM-FAM implementation by therapists and therapist and stakeholder perceptions of incentive-based interventions and organizational characteristics. Results revealed greater use of CM and family engagement techniques among CM-FAM relative to US therapists. In addition, therapists and stakeholders in the CM-FAM condition reported more favorable attitudes toward the use of incentives and greater improvement on several domains of organizational functioning relative to US counterparts. Taken together, these findings suggest that JDC professionals are amenable to the adoption and implementation of a treatment model that holds promise for improving youth outcomes.

Assessing self-determined motivation for addiction treatment: Validity of the Treatment Entry Questionnaire - Corrected Proof

Karen A. Urbanoski, T. Cameron Wild — 2011-12-05

Abstract: Although legal, formal, and informal social controls are frequently used to pressure individuals to enter treatment, motivational consequences of using these tactics have been neglected. Self-determination theory (SDT) provides a useful perspective for understanding client experiences of social controls and highlights the importance of self-determined motivation for long-term behavior change. This study assessed the construct validity of the Treatment Entry Questionnaire (TEQ), a brief scale derived from SDT to measure identified, introjected, and external treatment motivation. Two independent samples of clients entering Canadian residential and outpatient treatment completed TEQ items (ns = 529 and 623). Exploratory and confirmatory factor analyses supported a 9-item version of the scale, with 3 factors aligning with SDT motivational subtypes. Subscales showed high internal consistency and correlated as expected with social controls and perceived coercion at treatment entry. The TEQ-9 is a valid option for assessing self-determined motivation in clinical practice and evaluating coerced addiction treatment.

An intervention to increase alcohol treatment engagement: A pilot trial - Corrected Proof

Tracy Stecker, Mark P. McGovern, Beverly Herr — 2011-12-05

Abstract: Objectives: Previous research has documented the difficulty individuals with alcohol use disorders have initiating alcohol treatment. This study assessed the feasibility of a brief, cognitive–behavioral intervention designed to increase treatment initiation among individuals with alcohol use disorders.Methods: This randomized controlled trial included 196 participants who screened positive for a possible alcohol use disorder on the Alcohol Use Disorders Identification Test. Randomly assigned intervention participants were administered a brief cognitive–behaviorally-based intervention by telephone designed to modify beliefs that may interfere with treatment-seeking behavior. Beliefs about treatment and treatment-seeking behavior were assessed postintervention.Results: Participants receiving the intervention had significantly improved their attitudes toward addiction treatment (p < .002) and increased their reported intention-to-seek treatment (p < .000) postintervention. Further, intervention participants were almost three times more likely to attend treatment within a 3-month period (odds ratio = 2.60, p < .025) than participants in the control group.Conclusions: A brief, cognitive–behavioral intervention delivered by telephone and focused on modifying treatment-interfering beliefs holds promise for increasing alcohol treatment seeking among individuals in need.

Type of health insurance and the substance abuse treatment gap - Corrected Proof

2011-11-28

Abstract: Objective: Most individuals reporting symptoms consistent with substance use disorders do not receive care. This study examines the correlation between type of insurance coverage and receipt of substance abuse treatment, controlling for other observable factors that may influence treatment receipt.Method: Descriptive and multivariate analyses are conducted using pooled observations from the 2002–2007 editions of the National Survey on Drug Use and Health. The likelihood of treatment entry is estimated by type of insurance coverage controlling for personal characteristics and characteristics of the individual's substance use disorder.Results: Multivariate analyses that control for type of substance and severity of disorder (dependence vs. abuse) find that those with Civilian Health and Medical Program of the Uniformed Services/Veterans Affairs, Medicaid only, Medicare only, and Medicare and Medicaid (dual eligibles) have 50% to almost 90% greater odds of receiving treatment relative to those with private insurance.Conclusions: The privately insured population has substantially lower treatment entry rates than those with publicly provided insurance. Additional research is warranted to understand the source of the differences across insurance types so that improvements can be achieved.

Therapist competence and treatment adherence for a brief intervention addressing alcohol and violence among adolescents - Corrected Proof

2011-11-28

Abstract: This study examines therapist competency and treatment adherence for a brief intervention addressing alcohol misuse and violent behaviors among adolescents aged 14–18 years. Three observational measures of fidelity were used by independent raters to evaluate 60 therapist-delivered sessions (M = 32.5 minutes). Individual items from the Content Adherence scale, the Global Rating of Competence (Global Rating of Motivational Interviewing Therapist [GROMIT]), and the Self Exploration and Change Talk (SECT) demonstrated fair to excellent interrater reliability (intraclass correlations ranged from .40 to 1.0). Principal components analysis was used to identify the underlying factor structure of the Content Adherence and the GROMIT. Parallel analysis suggested the extraction of three components for the Content Adherence reflecting the three distinct goals for each segment of the intervention. Two components were identified for the GROMIT representing the general spirit of motivational interviewing and empowerment. Findings provide support for the fidelity instruments adapted for this study and offer direction for future training and clinical supervision.

Predicting drug court outcome among amphetamine-using participants - Corrected Proof

Lora J. Wu, Sandra J. Altshuler, Robert A. Short, John M. Roll — 2011-11-28

Abstract: Amphetamine use and abuse carry with it substantial social costs. Although there is a perception that amphetamine users are more difficult to treat than other substance users, drug courts have been used to effectively address drug-related crimes and hold the potential to lessen the impact of amphetamine abuse through efficacious treatment and rehabilitation. The objective of this study was to identify predictors of drug court outcome among amphetamine-using participants. A drug court database was obtained (N = 540) and amphetamine-using participants (n = 341) identified. Multivariate binary regression models run for the amphetamine-using participants identified being employed and being a parent as predictive of successful completion of the program, whereas being sanctioned to jail during the program was inversely related to program completion.

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers - Corrected Proof

2011-11-28

Abstract: Objectives: This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics.Methods: A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information–advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change.Results: Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type.Conclusions: The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.

The effect of social desirability on reported motivation, substance use severity, and treatment attendance - Corrected Proof

Sarah E. Zemore — 2011-11-28

Abstract: Research has not consistently supported an association between stage of change and substance abuse treatment retention. This study examined whether social desirability response bias could help explain why. Participants (N = 200) recruited from an outpatient program completed the University of Rhode Island Change Assessment Scale (URICA), Treatment Readiness Tool (TREAT), Marlowe–Crowne Social Desirability Scale, and other measures. Number of treatment groups attended was collected from program records. In bivariate analyses, neither the URICA nor the TREAT was related to attendance. However, higher social desirability was strongly associated with lower URICA (but not TREAT) total scores, and in a multivariate path model, a moderately strong association emerged between higher URICA scores and greater treatment attendance when accounting for social desirability. Higher social desirability was also an independent predictor of greater treatment attendance and was strongly associated with lower Addiction Severity Index alcohol, drug, and psychiatric severity. Results underline a critical problem in measuring motivation and problem severity that has been largely neglected.

Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: A pilot feasibility study - Corrected Proof

Cynthia J. Price, Elizabeth A. Wells, Dennis M. Donovan, Tessa Rue — 2011-11-28

Abstract: This study examined mindful awareness in body-oriented therapy (MABT) feasibility as a novel adjunct to women's substance use disorder (SUD) treatment. As an individual therapy, MABT combines manual and mind–body approaches to develop interoception and self-care tools for emotion regulation. A 2-group randomized controlled trial repeated-measures design was used, comparing MABT to treatment as usual (TAU) on relapse to substance use and related health outcomes. Sixty-one women were screened for eligibility, and 46 enrolled. Participants randomized to MABT received 8 weekly MABT sessions. Results showed moderate to large effects, including significantly fewer days on substance use, the primary outcome, for MABT compared with TAU at posttest. Secondary outcomes showed improved eating disorder symptoms, depression, anxiety, dissociation, perceived stress, physical symptom frequency, and bodily dissociation for MABT compared with TAU at the 9-month follow-up. In conclusion, it is feasible to implement MABT in women's SUD treatment, and results suggest that MABT is worthy of further efficacy testing.

Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment - Corrected Proof

2011-11-28

Abstract: Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.

Is exposure to an effective contingency management intervention associated with more positive provider beliefs? - Corrected Proof

2011-11-24

Abstract: This study empirically examined opinions of treatment providers regarding contingency management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched nonparticipating sites (n = 69) within the same nodes of the National Institute of Drug Abuse Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program versus matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions than those from matched sites. Some differences were found in opinions regarding costs of incentives, and these generally indicated that participants from CM sites were more likely to see the costs as worthwhile. The results from the study suggest that exposing community treatment providers to incentive programs may itself be an effective strategy in prompting the dissemination of CM interventions.

Moderators of fluoxetine treatment response for children and adolescents with comorbid depression and substance use disorders - Corrected Proof

2011-11-24

Abstract: Our recent 8-week, randomized, placebo-controlled trial of fluoxetine in adolescents (ages 12-17 years) with comorbid depression and substance use disorder (SUD) did not detect a significant antidepressant treatment effect. The purpose of this secondary analysis was to explore moderators of the effect of fluoxetine in this sample. Static moderators measured at baseline were depression chronicity and hopelessness severity; time-varying moderators measured at baseline and weekly during the 8-week trial period were alcohol and marijuana use severity. Treatment effects on depression outcomes were examined among moderating subgroups in random effects regression models. Subjects assigned to fluoxetine treatment with chronic depression at baseline (p = .04) or no more than moderate alcohol use during the trial (p = .04) showed significantly greater decline in depression symptoms in comparison to placebo-assigned subgroups. The current analysis suggests that youth with chronic depression and no more than moderate alcohol consumption are likely to respond better to treatment with fluoxetine compared with placebo than youth with transient depression and heavy alcohol use.

On-site provision of substance abuse treatment services at community health centers - Corrected Proof

Deborah Gurewich, Jenna T. Sirkin, Donald S. Shepard — 2011-11-24

Abstract: We examined on-site and off-site referral-based provision of substance abuse (SA) treatment services among a sample of community health centers (CHCs). Analyses used survey data collected from CHCs in three states merged with administrative claims to both characterize CHC care delivery models and examine the association between models and care quality. Care quality was based on the Washington Circle measures of initiation and engagement. Approximately half the sample provided at least some SA treatment services on site. The provision of intensive outpatient treatment services on site was associated with significantly higher engagement rates. It was also associated with higher (but not significantly) initiation rates. At the same time, on-site provision of screening and counseling services was negatively associated with both initiation and engagement rates. Given limited resources, investing in more intensive services on site may yield better outcomes for CHC patients than lower level services, but further study is recommended.

Multiple routes of drug administration and HIV risk among injecting drug users - Corrected Proof

2011-11-24

Abstract: This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25–0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01–3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02–5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.

Neuroscience exposure and perceptions of client responsibility among addictions counselors - Corrected Proof

Timothy A. Steenbergh, Jason D. Runyan, Douglas A. Daugherty, Joseph G. Winger — 2011-11-24

Abstract: Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., the amount to which members considered themselves familiar with current neuroscience research). We used the two-dimensional model of responsibility (Responsible/not responsible for development × Responsible/not responsible for recovery) proposed by P. Brickman et al. (1982) to guide our assessment of responsibility, thus inquiring about counselors' views of clients' responsibility for both the development of a substance-related addiction and its resolution. Findings suggest that counselors rate biological factors as most influential in the development of an addiction and assign clients less personal responsibility for the development of an addiction than for recovery from an addiction. Counselors' level of neuroscience exposure was negatively correlated with their ratings of client responsibility for the development of an addiction but positively correlated to ratings of client responsibility for recovery. This suggests that counselors are integrating neuroscientific findings with what is learned from other modes of enquiry in a way that diminishes the view that clients are responsible for addiction development but accentuates the view that clients are responsible for recovery. We explore reasons for why this is and why this approach may be beneficial.

Development and preliminary results of the Financial Incentive Coercion Assessment questionnaire - Corrected Proof

2011-11-24

Abstract: Financial incentives are often used in research, yet no measure exists to determine whether they lead to perceptions of coercion in subjects. We present a preliminary evaluation of a recently developed Financial Incentive Coercion Assessment (FICA) questionnaire. FICA measures perceived coercion specifically related to payment for participation in a research study. Two hundred sixty-six subjects were recruited from a large randomized controlled trial; 152 returned for a 6-month follow-up and completed the FICA. Approximately 30% of participants reported the major reason for participating was “for the money,” but less than 5% felt that the financial incentives were coercive. FICA results are consistent with levels of perceived coercion using an alternative measure. Initial assessment of responses on the FICA suggests that it may provide a novel approach to measuring perceived coercion from financial incentives in research. Future work will refine the FICA and analyze its psychometric properties.

Parental substance use impairment, parenting and substance use disorder risk - Corrected Proof

Amelia M. Arria, Amy A. Mericle, Kathleen Meyers, Ken C. Winters — 2011-11-23

Abstract: Using data from a nationally representative sample, this study investigated substance use disorder (SUD) among respondents with ages 15–54 years as a function of their parents' substance-related impairment and parents' treatment history. In addition, associations among maternal and paternal substance-related impairment, specific parenting behaviors, and risk for SUD in the proband were examined. As expected, parental substance-related impairment was associated with SUD. Paternal treatment history was associated with a decreased risk for SUD in the proband but did not appear to be associated with positive parenting practices. Results of post hoc analyses suggested that parenting behaviors might operate differently to influence SUD risk in children where parents are affected by substance use problems compared with nonaffected families. Future research is warranted to better understand the complex relationships among parental substance use, treatment, parenting behaviors, and SUD risk in offspring. Opportunities might exist within treatment settings to improve parenting skills.

Variation in substance use relapse episodes among adolescents: A longitudinal investigation - Corrected Proof

Danielle E. Ramo, Mark A. Prince, Scott C. Roesch, Sandra A. Brown — 2011-11-23

Abstract: Substance use disorders are chronically relapsing conditions, and there is a need to evaluate whether relapse precursors are consistent across multiple relapses. We identified latent groups of relapse characteristics over time in adolescents with alcohol and substance use disorders following an inpatient treatment episode. Youth (N = 124, mean age = 16 years, 56% male, 60% Caucasian) were interviewed while in treatment and biannually during the first year after treatment to gather contextual information about first and second relapse episodes. We identified two latent classes of relapse precursors labeled aversive–social (41% at initial relapse, 57% at subsequent relapse) and positive–social (59% at initial relapse, 43% at subsequent relapse). Classes were stable in structure over time; however, only 61% of those assigned to aversive–social and 39% assigned to positive–social classes at initial relapse remained there for the subsequent relapse. Findings highlight the dynamic nature of relapse for youth and have important clinical implications.

Adolescent treatment initiation and engagement in an evidence-based practice initiative - Corrected Proof

2011-11-02

Abstract: This study examined client and program factors predicting initiation and engagement for 2,191 adolescents at 28 outpatient substance abuse treatment sites implementing evidence-based treatments. Using Washington Circle criteria for treatment initiation and engagement, 76% of the sample initiated, with 59% engaging in treatment. Analyses used a 2-stage Heckman probit regression, accounting for within-site clustering, to identify factors predictive of initiation and engagement. Adolescents treated in a pay-for-performance (P4P) group were more likely to initiate, whereas adolescents in the race/ethnicity category labeled other (Native American, Asian, Pacific Islander, Native Alaskan, Native Hawaiian, mixed race/ethnicity), or who reported high truancy, were less likely to initiate. Race/ethnicity groups other than Latinos were equally likely to engage. Among White adolescents, each additional day from first treatment to next treatment reduced likelihood of engagement. Although relatively high initiation and engagement rates were achieved, the results suggest that attention to program and client factors may further improve compliance with these performance indicators.

A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs - Corrected Proof

2011-10-31

Abstract: The purpose of this study was to examine the effects of feedback provided to counselors on the outcomes of patients treated at community-based substance abuse treatment programs. A version of the Outcome Questionnaire (OQ-45), adapted to include drug and alcohol use, was administered to patients (N = 304) in 3 substance abuse treatment clinics. Phase I of the study consisted only of administration of the assessment instruments. Phase II consisted of providing feedback reports to counselors based on the adapted OQ-45 at every treatment session up to Session 12. Patients who were found to not be progressing at an expectable rate (i.e., “offtrack”) were administered a questionnaire that was used as a second feedback report for counselors. For offtrack patients, feedback compared with no feedback led to significant linear reductions in alcohol use throughout treatment and also in OQ-45 total scores and drug use from the point of the second feedback instrument to Session 12. The effect for improving mental health functioning was evident at only 1 of the 3 clinics. These results suggest that a feedback system adapted to the treatment of substance use problems is a promising approach that should be tested in a larger randomized trial.

Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States - Corrected Proof

2011-10-31

Abstract: Although substance abuse treatment programs are important contact points for providing health services for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, availability of services in these programs has not been well characterized. This study evaluated the spectrum of HBV and HCV services offered by substance abuse treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Our survey of substance abuse treatment program administrators covered availability of testing for HBV and HCV; hepatitis A virus (HAV) and HBV immunization; and HCV medical and nonmedical services. There were also questions covering clarity of guidelines for HBV and HCV testing and HAV and HBV immunization. Differences between methadone and nonmethadone programs were examined. Despite the importance of substance abuse in sustaining the hepatitis epidemics, few programs offer comprehensive HBV and HCV testing or HCV health care services. Interventions to improve access to hepatitis services for substance-abusing patients are needed.

Predictive validity of the EuropASI: Clinical diagnosis or composite scoring? - Corrected Proof

José J. López-Goñi, Javier Fernández-Montalvo, Alfonso Arteaga — 2011-10-31

Abstract: This study assessed the correlation between the areas of the interviewer severity rating (ISR) and the areas of the composite scores (CSs) of the European version of the Addiction Severity Index (EuropASI). It evaluated the predictive validity of both types of scoring with regard to completion of treatment. For this purpose, 252 patients were interviewed using the EuropASI; 38.9% of patients discontinued treatment. Results indicated a high correlation between various areas of the ISR and the CS, except the legal and family–others scales. Regarding predictive results, patients with a score greater than 3 in the ISR family area were more likely to quit the program compared with patients with a score lower than 3. Patients with a CS score that was greater than 0.34 in the alcohol use area were more likely to drop out of treatment. When both ISR and CS scores were included in the prediction model, the ISR family area was a better predictor.

The early maladaptive schemas of an opioid-dependent sample of treatment seeking young adults: A descriptive investigation - Corrected Proof

Ryan C. Shorey, Gregory L. Stuart, Scott Anderson — 2011-10-20

Abstract: Opioid dependence is an increasingly prevalent problem throughout the world, particularly for young adults (e.g., ages 17–25 years). Opioid dependence is associated with a wealth of negative consequences and is often a chronic, relapsing condition. Research on factors that may contribute to the etiology of opioid dependence could result in improved treatment outcomes. Using preexisting patient records, the current study examined early maladaptive schemas among young adult opioid-dependent residential treatment patients (N = 169), as it is theorized that early maladaptive schemas may underlie or maintain substance use. Results showed that all 18 early maladaptive schemas were endorsed at various levels among male and female patients, with insufficient self-control being the most prevalent schema. In addition, females scored significantly higher than males on 11 of the 18 schemas. Findings from the current study are discussed in terms of future research and implications for the treatment of opioid dependence.

Barriers to implementation of evidence-based addiction treatment: A national study - Corrected Proof

2011-10-17

Abstract: Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff (n = 510) and director (n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change [TCU ORC]-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.