Journal of Substance Abuse Treatment - Articles in Press

Feasibility and effectiveness of computer-based therapy in community treatment - Corrected Proof

Adam C. Brooks, Deanna Ryder, Deni Carise, Kimberly C. Kirby — 2010-07-30

Abstract: Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.90, p = .007, d = 1.05, and were significantly more likely to select CRA style coping responses, F (1, 20) = 11.95, p = .002, d = 1.16, relative to the treatment-as-usual group (n = 14). We also detected small, nonsignificant, between-group effects indicating TES decreased cocaine use during treatment. In Phase 2, counselors referred only around 10% of their caseload to the TES, and the modal number of completed modules in the absence of tangible reinforcement was three. Computer-based therapy approaches are viable in community-based treatment but must be integrated with incentive systems to ensure engagement.

Motivations for non-medical prescription drug use: a mixed methods analysis - Corrected Proof

Khary K. Rigg, Gladys E. Ibañez — 2010-07-30

Abstract: Despite a dramatic increase in the nonmedical use of prescription drugs among illicit drug users, their motives for abusing prescription drugs are still largely unknown. The objective of this study was to (a) determine the motivations for engaging in the nonmedical use of prescription opioids and sedatives among street-based illicit drug users, methadone maintenance patients, and residential drug treatment clients; (b) examine associations between prescription drug abuse motivations and gender, age, race/ethnicity, and user group; and (c) examine associations between specific motivations and prescription drug abuse patterns. Quantitative surveys (n = 684) and in-depth interviews (n = 45) were conducted with a diverse sample of prescription drug abusers in South Florida between March 2008 and November 2009. The three most common motivations reported were “to get high,” “to sleep,” and “for anxiety/stress.” There were age, race/ethnicity, and gender differences by motives. Prescription drug abuse patterns were also found to be associated with specific motivations. Although additional research is needed, these findings serve to inform appropriate prevention and treatment initiatives for prescription drug abusers.

Examination of posttraining supervision of peer counselors in a motivational enhancement intervention to reduce drinking in a sample of heavy-drinking college students - Corrected Proof

Nadine R. Mastroleo, Rob Turrisi, JoLynn V. Carney, Anne E. Ray, Mary E. Larimer — 2010-07-30

Abstract: Importance of peer counselor posttraining supervision on motivational interviewing (MI) microskills and postintervention drinking outcomes were evaluated in a sample of heavy-drinking undergraduate students completing Brief Alcohol Screening and Intervention for College Students (BASICS; L.A. Dimeff, J.S. Baer, D.R. Kivlahan, & G.A. Marlatt, 1999). Two peer counselor groups were trained using identical protocols. Posttraining, one group was randomized to receive supervision, whereas the other received no supervision. Groups were subsequently compared on MI microskills. College students (n = 122) were randomly assigned to either assessment-only control, supervision, or no supervision groups and completed a BASICS intervention. Postintervention drinking outcomes were examined. Results suggested supervision aided peer counselors in reducing use of closed-ended questions. Both treatment groups reduced total drinks per week and heavy-drinking behaviors compared to control. No differences on peak blood alcohol concentration (BAC) or alcohol-related consequences were observed. Differences in supervision did not influence drinking outcomes; however, posttraining supervision for peer counselors deficient in MI microskills may be needed to improve BASICS fidelity.

Contingency management among homeless, out-of-treatment men who have sex with men - Corrected Proof

2010-07-30

Abstract: Homeless men who have sex with men are a particularly vulnerable population with high rates of substance dependence, psychiatric disorders, and HIV prevalence. Most need strong incentives to engage with community-based prevention and treatment programs. Contingency management (CM) was implemented in a community HIV prevention setting and targeted reduced substance use and increased health-promoting behaviors over a 24-week intervention period. Participants in the CM condition achieved greater reductions in stimulant and alcohol use (χ2 = 27.36, p < .01) and, in particular, methamphetamine use (χ2 = 21.78, p < .01) and greater increases in health-promoting behaviors (χ2 = 37.83, p < .01) during the intervention period than those in the control group. Reductions in substance use were maintained to 9- and 12-month follow-up evaluations. Findings indicate the utility of CM for this high-risk population and the feasibility of implementing the intervention in a community-based HIV prevention program.

Cigarette smoking knowledge, attitudes, and practices of patients and staff at a perinatal substance abuse treatment center - Corrected Proof

2010-07-30

Abstract: This study compares cigarette smoking knowledge, attitudes, and practices (S-KAP) of opioid- and other substance-dependent patients and their multidisciplinary staff at an outpatient perinatal substance abuse treatment center. Consenting patients (n = 95) and staff (n = 41) concurrently completed a modified form of the S-KAP survey instrument. Ninety-five percent of patients reported currently smoking, and half endorsed wanting “to quit smoking now.” This patient desire to quit smoking was significantly underrated by staff compared to the patients themselves (p = .028). Both patients and staff demonstrated suboptimal knowledge of smoking health risks, but 73% of patients reported trying to quit with past pregnancies to avoid harm to the fetus/baby. Although results show that patients could benefit from smoking cessation strategies centered on smoking's fetal/neonatal health risks, organizational interventions that focus on changing staff attitudes about patient desire to quit smoking may first need to be implemented.

Prize-based contingency management is efficacious in cocaine-abusing patients with and without recent gambling participation - Corrected Proof

Nancy M. Petry, Sheila M. Alessi — 2010-07-30

Abstract: Prize-based contingency management (CM) is efficacious in treating cocaine abuse, and the chance-based procedures of prize CM may be appealing to those who gamble. Using data from three randomized trials, we evaluated whether cocaine-abusing patients who had wagered in the month before treatment (n = 62) responded more favorably to prize CM than those who had not (n = 278). Participants were randomized to standard care (SC) or SC plus prize CM. Although prize CM was related to better outcomes overall, recent gambling was not associated with outcomes across or within treatment conditions. Gambling participation before treatment entry was associated with reductions in gambling over time, and this effect was more pronounced among those assigned to CM. These data suggest that prize CM is equally efficacious for substance-abusing patients who do and do not gamble, and they extend prior studies indicating that prize CM does not increase gambling.

Effect of early and late compliance on the effectiveness of acamprosate in the treatment of alcohol dependence - Corrected Proof

Maarten W.J. Koeter, Wim van den Brink, Philippe Lehert — 2010-07-14

Abstract: Background: The aim of this study is to assess the influence of early and late compliance of acamprosate on attendance and abstinence duration in the treatment of alcohol dependence.Methods: Individual patient data of 2,305 patients from 11 randomized controlled trials comparing acamprosate (n = 1,128) with placebo (n = 1,177) were used to predict early and late compliance and to study the effect of early and late compliance on attendance and abstinence duration using regression analysis and structural equation modeling.Results: Early compliance was predicted by baseline motivation to become fully abstinent and baseline abstinence (R2 = .26); late compliance was predicted by early compliance (R2 = .13); treatment discontinuation was predicted by young age, marital status, compliance, and treatment condition (R2 = .26); and abstinence duration was predicted by motivation to become fully abstinent early compliance and the interaction of early compliance and treatment condition (R2 = .27). Structural equation modeling showed that abstinence duration was significantly associated with motivation at baseline, late compliance, and treatment condition (Goodness of Fit Index [GFI] χ2/df = 1.56; Parsimonious Goodness of Fit Index [PGFI] = 0.69).Conclusions: Motivation to become fully abstinent and abstinence at the start of treatment are important for early compliance. Early compliance in turn predicts late compliance. Late compliance, in combination with motivation to become fully abstinent, and treatment condition (acamprosate vs. placebo) predict duration of abstinence. This suggests that motivational interventions directed toward full abstinence motivation and abstinence at the start of treatment are crucial for both compliance with acamprosate and successful treatment outcome.

Analysis of the impact of treatment setting on outcomes from methadone treatment - Corrected Proof

Catherine M. Comiskey, Gemma Cox — 2010-07-12

Abstract: How methadone setting, duration of drug career, and dose impact on treatment are assessed. Two hundred fifteen participants were recruited. Analysis revealed significant reductions in drug use at 1 year within all settings, but the pattern varied. Proportions using heroin reduced in all settings, unprescribed benzodiazepines reduced in community, and general practitioner settings and cocaine use reduced in community and Government health board settings. A logistic model controlling for intake methadone dose, setting, previous treatments, and intake heroin use revealed that setting was a significant factor in predicting heroin use at 1 year but was not significant in predicting changes in health. Findings illustrate that drug outcomes improved across all settings, and health did not improve in any setting. For optimum outcomes to be achieved, opiate users must be directed to settings that best match their needs and that the “one-stop-shop for methadone” is not the most effective solution.

Obstacles to 12-step group participation as seen by addiction professionals: Comparing Norway to the United States - Corrected Proof

John-Kåre Vederhus, Alexandre Laudet, Øistein Kristensen, Thomas Clausen — 2010-07-12

Abstract: Twelve-step groups (TSGs) are a valuable recovery resource for substance-dependent individuals. However, some aspects of these fellowships are controversial and may limit clinician referrals. This study describes attitude- and knowledge-based barriers to TSG participation as seen by addiction professionals in Norway, a treatment culture in which less than 5% of programs use the 12-step philosophy, and compares the findings with those of a similar study in the United States. Data were collected in Norway in mid-2008 using a self-administered questionnaire, and the U.S. sample was obtained from historical data. The Norwegian professionals (n = 291) considered the religious aspects of TSGs a considerable obstacle to participation, whereas the U.S. providers (n = 100) did not. Treatment providers unfamiliar with the 12-step philosophy need to be better informed of TSGs' “higher power” concept to educate patients and maximize the utilization of TSGs.

Disseminating contingency management to increase attendance in two community substance abuse treatment centers: Lessons learned - Corrected Proof

2010-07-05

Abstract: Although contingency management (CM) has been shown to be effective in substance use treatments, community adoption has been slow. To increase dissemination of CM into community practice, two community treatment programs collaborated with university faculty investigators to design, implement, and evaluate low-cost, prize-based CM interventions delivered by treatment staff using Petry's (2000) fishbowl technique. A pre–post study design was used to evaluate the impact of CM on outpatient group attendance. All clients attending the targeted outpatient groups at both treatment programs were eligible to participate. Group attendance was significantly positively impacted after intervention implementation. This is one of the first studies demonstrating successful implementation of CM by community treatment program counselors within their existing treatment groups. The discussion focuses on practical lessons learned during the planning and implementation of the interventions.