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Journal of Substance Abuse Treatment — Mon, 08 Mar 2010 18:53:20 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Mon, 08 Mar 2010 18:53:19 +0100

(Source: Journal of Substance Abuse Treatment)

The route to change: Within-session predictors of change plan completion in a motivational interview

Journal of Substance Abuse Treatment — Thu, 11 Feb 2010 00:00:00 +0100

This study is the first to examine within-session therapist and client language/process predictors of a client's decision to complete a written Change Plan in an alcohol-focused motivational interview (MI). Data were from an ongoing hospital-based clinical trial (N = 291). Trained raters coded audiorecorded MI sessions using the Motivational Interviewing Skill Code. Logistic regression analyses found that therapist MI-consistent behaviors (b = .023, p < .001) and client change talk (b = .063, p < .001) were positive predictors, and client counter change talk (b = −.093, p < .001) was a negative predictor of the decision to complete a Change Plan regarding alcohol use. Mean comparisons showed that compared to noncompletion, Change Plan completion did not result in significantly greater ch...

Nonmedical use of prescription stimulants and depressed mood among college students: Frequency and routes of administration

Journal of Substance Abuse Treatment — Thu, 04 Feb 2010 00:00:00 +0100

Abstract: Studies demonstrate associations between nonmedical use of prescription stimulants (NMUPS) and depressed mood; however, relevance of NMUPS route of administration and frequency of use have not been examined. We hypothesized frequent NMUPS and nonoral routes would be significantly associated with depressed mood. A Web survey was self-administered by a probability sample of 3,639 undergraduate students at a large U.S. university. The survey contained substance use (e.g., frequency, route of administration) and depressed mood measurement. Past-year prevalence of NMUPS was 6.0% (n = 212). Approximately 50% of frequent or nonoral NMUPS reported depressed mood. Adjusted odds of depressed mood were over two times greater among frequent monthly NMUPS (adjusted odds ratio [AOR] = 2.3, 95%...

Effect of co-occurring disorders and intimate partner violence on substance abuse treatment outcomes

Journal of Substance Abuse Treatment — Thu, 04 Feb 2010 00:00:00 +0100

Abstract: This retrospective cohort study examined risk factors for co-occurring substance use and mental disorders (COD) and the effect of COD and intimate partner violence (IPV) victimization among women and IPV-related arrest among men on 1-year substance abuse treatment outcomes. The study sample included clients admitted to Washington State publicly funded substance abuse treatment facilities in 2004–2007. COD was associated with a high substance use and IPV risk profile at admission. Having a COD decreased the odds of completing treatment by 30% among men and women and increased the risk of treatment reentry by 9% and 12% among men and women, respectively. IPV also decreased the odds of completing treatment among women and increased the risk of treatment reentry among men. Men with...

Hostility in mandated students: Exploratory analysis and implications for treatment

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

We examined the relationship between hostility and a variety of drinking-related variables in mandated students (N = 466). Results indicated that individuals reporting higher levels of hostility reported riskier drinking and alcohol-related problems, yet exhibited ambivalence regarding their alcohol use. Findings are discussed in the context of treating mandated students exhibiting high hostility and risky drinking, a particularly challenging population. (Source: Journal of Substance Abuse Treatment)

The adoption of alcohol pharmacotherapies in the Clinical Trials Network: The influence of research network participation

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Organizational participation in clinical research may lead to adoption of the intervention by treatment agencies, but it is not known whether research involvement enhances innovativeness beyond the specific interventions that are tested. The National Institute on Drug Abuse's Clinical Trials Network (CTN) is a platform for considering this research question. To date, the CTN has not conducted research on medications for alcohol use disorders (AUDs), so greater adoption of innovative AUD pharmacotherapies by CTN-affiliated programs would suggest an added value of research network participation. Using longitudinal data from a pooled sample of CTN and non-CTN publicly funded treatment programs, we investigate adoption of tablet naltrexone and acamprosate over a 2-year period. CTN-af...

A randomized pilot study of the Engaging Moms Program for family drug court

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: In response to the need for effective drug court interventions, the effectiveness of the Engaging Moms Program (EMP) versus Intensive Case Management Services (ICMS) on multiple outcomes for mothers enrolled in family drug court was investigated. In this intent-to-treat study, mothers (N = 62) were randomly assigned to either usual drug court care or the Engaging Moms drug court program. Mothers were assessed at intake and 3, 6, 12, and 18 months following intake. Results indicated that at 18 months post drug court enrollment, 77% of mothers assigned to EMP versus 55% of mothers assigned to ICMS had positive child welfare dispositions. There were statistically significant time effects for both intervention groups on multiple outcomes including substance use, mental health, parent...

A randomized controlled study of a web-based performance improvement system for substance abuse treatment providers

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

We report here the results of a randomized, controlled trial evaluating the efficacy of a semiautomated performance improvement system (“patient feedback”) that enables real-time monitoring of patient outcomes in outpatient substance abuse treatment clinics. The study involved 118 clinicians working at 20 community-based outpatient substance abuse treatment clinics in the northeast United States. Ten clinics received 12 weeks of the patient feedback performance improvement intervention, and 10 clinics received no intervention during the 12 weeks. More than 1,500 patients provided anonymous ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use. There was no evidence of an intervention effect on the primary drug and alcohol use scales. There was also no evidence o...

It's the thought that counts: Craving metacognitions and their role in abstinence from methamphetamine use

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Craving is frequently reported as a trigger for relapse by those trying to remain abstinent from psychoactive substances. Metacognitive beliefs about managing craving may play an important role in determining further cognition and behavior. They are, therefore, important to measure in treatment and may serve as target cognitions to be modified in support of behavioral change. As part of the assessment battery of a randomized controlled trial among 214 methamphetamine users, we included the Craving Beliefs Questionnaire (CBQ), a measure designed to assess an individual's perception of the potential negative impact of craving, at baseline. Changes in abstinence rates were significantly related to CBQ score, suggesting that craving beliefs are associated with changes in methamphetam...

Relationship between anxiety disorders and opiate dependence— A systematic review of the literature: Implications for diagnosis and treatment

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Our objective was to evaluate the prevalence and temporal sequence of co-occurrence of anxiety disorders with opiate dependence in order to better define the relationship between these two disorders and to improve diagnosis and treatment. The search used Medline and Toxibase up to January 1, 2009, and was based on a systematic review method. Eighteen studies were found. Prevalence of anxiety disorders assessed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria was high in opiate-dependent treated persons (lifetime prevalence ranged from 26% to 35%). Among anxiety disorders, phobic disorders have been shown to often precede the onset of opiate dependence. The identification of substance-induced versus independent anxiety disorder has importa...

The implementation of tobacco-related brief interventions in substance abuse treatment: A national study of counselors

Journal of Substance Abuse Treatment — Mon, 01 Feb 2010 00:00:00 +0100

In this study, we examined counselors' implementation of brief interventions that are consistent with the U.S. Public Health Service's (PHS) clinical practice guideline, Treating Tobacco Use and Dependence, when counselors are engaging new clients in treatment. We hypothesized that counselors' implementation of tobacco-related brief interventions is associated with organizational and counselor-level factors. Data were collected from 2,067 counselors via mailed surveys. Implementation of recommended brief interventions during intake was significantly lower among counselors reporting greater barriers to smoking cessation services within their organizational context. Perceived managerial support for smoking cessation services was positively associated with implementation. Counselors with grea...

Journal of Substance Abuse Treatment — Fri, 22 Jan 2010 16:56:22 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Fri, 22 Jan 2010 16:56:22 +0100

(Source: Journal of Substance Abuse Treatment)

Predictors of employment in substance-using male and female welfare recipients

Journal of Substance Abuse Treatment — Fri, 18 Dec 2009 00:00:00 +0100

This study examined predictors of employment among substance-using men and women enrolled in welfare-to-work programs. Participants were 394 welfare applicants assigned to either coordinated care management or usual care for treatment services and job training and followed up for 1 year to track employment outcomes. Common barriers to work were assessed at baseline in four key domains: disabilities, situational barriers, labor capital, and motivation. Results indicated substantial gender differences in the number and profile of work barriers. Among men, work experience and job motivation were the only significant predictors of employment; among women, multiple factors from each barrier domain predicted job acquisition even when controlling for all other significant predictors. Findings sug...

A review of computer-based alcohol problem services designedfor the general public

Journal of Substance Abuse Treatment — Wed, 16 Dec 2009 00:00:00 +0100

Abstract: This review summarizes the literature on computer-based drinking assessment and intervention programs evaluated using members of the general public. The primary aim was to summarize the demand, usage, and effectiveness of these services. A systematic search of the literature identified seven online drinking assessments and eight computerized interventions that were evaluated using members of the general public. Internet assessment users tend to be in their early 30s, are more often male, tend to be at risk for or are experiencing alcohol-related problems, more fully explore assessment sites, and are more likely to enroll in interventions linked to these sites when their drinking problem is more severe. Although dropout from computer-based interventions is often very high and tre...

Smoking cessation interventions among individuals in methadone maintenance: A brief review

Journal of Substance Abuse Treatment — Wed, 16 Dec 2009 00:00:00 +0100

Conclusions: To date, interventions among individuals in methadone treatment have been largely unsuccessful in achieving sustained smoking abstinence. However, smoking cessation treatment does not worsen substance use. Future studies are necessary to determine intervention designs and components that can enhance smoking cessation among individuals in methadone maintenance. (Source: Journal of Substance Abuse Treatment)

Structural-level factors affecting implementation of the methadone maintenance therapy program in China

Journal of Substance Abuse Treatment — Wed, 16 Dec 2009 00:00:00 +0100

This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for c...

A randomized experimental study of gender-responsive substance abuse treatment for women in prison

Journal of Substance Abuse Treatment — Wed, 16 Dec 2009 00:00:00 +0100

Abstract: This experimental pilot study compared postrelease outcomes for 115 women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment (GRT) program using manualized curricula (Helping Women Recover and Beyond Trauma) or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Bivariate and multivariate analyses were conducted. Results indicate that both groups improved in psychological well-being; however, GRT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer (2.6 vs. 1.8 months, p < .05), and were less likely to have been reincarcerated within 12 months after parole (31% vs. 45%...

What is recovery? Revisiting the Betty Ford Institute Consensus Panel Definition: The Betty Ford Consensus Panel and Consultants

Journal of Substance Abuse Treatment — Mon, 14 Dec 2009 00:00:00 +0100

There are an unknown but very large number of individuals who have experienced and successfully resolved dependence on alcohol or other drugs, referring to their new sober, productive lifestyle as being “in recovery.” Although widely used, the lack of a standard definition for the term recovery has hindered public understanding of and research involvement in the topic. Better public understanding might foster greater interest in and greater availability of recovery-oriented interventions. Increased research involvement might lead to more effective forms of those interventions. With these goals in mind, a group of researchers, treatment providers, recovery advocates, and policy makers was convened by the Betty Ford Institute (BFI) in September 2006 to develop an initial definition of re...

Of scientific quality and relevance

Journal of Substance Abuse Treatment — Sat, 05 Dec 2009 16:19:51 +0100

Most 10-year-olds are familiar with the standard “knock-knock” jokes. Recently I heard a series of similar one-liners from a group of health care professionals. The joke starts with the phrase, “How do you hide a dollar…?” Here are some examples. “How do you hide a dollar from a radiologist?” “Attach it to a patient.” “How do you hide a dollar from a clinician?” “Put it in a scientific journal.” “How do you hide a dollar from a researcher?” Again, “attach it to a patient.” And lastly, “how do you hide a dollar from a plastic surgeon?” “You can't hide a dollar from a plastic surgeon.” (Yesterday, I was sharing these witticisms with a physician in recovery, and he responded, “How do you hide a dollar from an alcoholic? Put it in the Big Book of Alc...

Journal of Substance Abuse Treatment — Sat, 05 Dec 2009 16:19:51 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Sat, 05 Dec 2009 16:19:51 +0100

(Source: Journal of Substance Abuse Treatment)

Journal of Substance Abuse Treatment — Mon, 26 Oct 2009 17:02:36 +0100

(Source: Journal of Substance Abuse Treatment)

The torch is passed again

Journal of Substance Abuse Treatment — Mon, 26 Oct 2009 17:02:35 +0100

In June of this year I was honored to become the Editor-in-Chief for the Journal of Substance Abuse Treatment (JSAT). I had worked at the Treatment Research Institute (TRI) with the former editor, Dr. A. Thomas McLellan, and in the spring of this year, my TRI colleagues and I were delighted to learn that Tom was nominated as Deputy Director of the White House Office of National Drug Control Policy, even though we knew we would miss his leadership and personal presence. Taking the position also meant that he had to resign from other positions of leadership, including the editorship of this journal. Knowing that he quickly needed to delegate many responsibilities, I asked how I could help. The next thing I knew, I was agreeing to serve as JSAT Editor until the end of 2009. (Source: Journal o...

Editorial Board

Journal of Substance Abuse Treatment — Mon, 26 Oct 2009 17:02:35 +0100

(Source: Journal of Substance Abuse Treatment)

A cluster-randomized effectiveness trial of smoking cessation modified for at-risk smoker subgroups

Journal of Substance Abuse Treatment — Mon, 12 Oct 2009 00:00:00 +0100

This study aimed to replicate the smoker subgroups and test the comparative effectiveness of standard pharmacobehavioral smoking cessation versus modified smoking cessation matched to at-risk smokers' needs. On the basis of their self-report responses, adult regular smokers (N = 268) were classified into smoker subgroups. At-risk smokers were randomly assigned to receive the standard or modified treatments; lower risk smokers received standard treatment. Modified treatment produced higher abstinence rates than the standard treatment for depressive smokers but not for other at-risk smokers. Overall, abstinence rates among at-risk smokers receiving modified treatment were not significantly different from those of lower risk smokers; however, abstinence among higher dependence smokers receivi...

Home- versus office-based buprenorphine inductions for opioid-dependent patients

Journal of Substance Abuse Treatment — Mon, 05 Oct 2009 00:00:00 +0100

We examined whether patients who had home-based inductions achieved greater 30-day retention than patients who had traditional office-based inductions in a study of 115 opioid-dependent patients treated in an inner-city health center. Retention was similar in both groups: 50 (78.1%) in office-based group versus 40 (78.4%) in home-based group, p = .97. Several patient characteristics were associated with choosing office- versus home-based inductions, which likely influenced these results. We conclude that opioid dependence can be successfully managed in the primary care setting. Approaches that encourage patient involvement in treatment for opioid dependence can be beneficial. (Source: Journal of Substance Abuse Treatment)

Male methamphetamine-user inmates in prison treatment: During-treatment outcomes

Journal of Substance Abuse Treatment — Mon, 05 Oct 2009 00:00:00 +0100

Abstract: Psychosocial functioning and criminal thinking of methamphetamine-using inmates were examined before and after their completion of primary treatment in three in-prison drug treatment programs (one “outpatient” and two different modified therapeutic communities [TCs]). The sample consisted of 2,026 adult male inmates in 30 programs in Indiana. Data included background, psychosocial functioning, criminal thinking, and therapeutic engagement indicators. Multilevel repeated measures analysis was used to evaluate changes during treatment, and multilevel covariate analysis adjusted for sample differences in tests of between-treatment differences. Significant improvements were found for all three treatments, but the two modified TCs showed significantly better progress than did outp...

Preference for buprenorphine/naloxone and buprenorphine among patients receiving buprenorphine maintenance therapy in France: A prospective, multicenter study

Journal of Substance Abuse Treatment — Mon, 05 Oct 2009 00:00:00 +0100

This study did not identify any impediments to a direct buprenorphine-to-buprenorphine/naloxone switch and revealed some characteristics that may facilitate treatment with buprenorphine/naloxone. (Source: Journal of Substance Abuse Treatment)

Journal of Substance Abuse Treatment — Fri, 04 Sep 2009 18:19:41 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Fri, 04 Sep 2009 18:19:41 +0100

(Source: Journal of Substance Abuse Treatment)

A randomized controlled trial of telephone continuing care

Journal of Substance Abuse Treatment — Thu, 03 Sep 2009 00:00:00 +0100

Abstract: Telephone continuing care (TCC) was compared to usual continuing care (UCC) on substance use and related problems among adults discharged from residential treatment. Participants were randomly assigned to receive either UCC or TCC. A tapered TCC protocol, initiated by paraprofessional staff and volunteers, was provided during the first 3 months following discharge. The TCC condition participants reported high satisfaction ratings with the procedure and were more than twice as likely to enter continuing care than UCC participants. At the 3-month point, TCC patients reported significantly fewer past-month substance problems than UCC patients. Among the subgroup of lower severity (LS) participants, the TCC-LS sample had both significantly more days abstinent and fewer past-month sub...

Genetic, personality, and environmental predictors of drug use in adolescents

Journal of Substance Abuse Treatment — Tue, 01 Sep 2009 00:00:00 +0100

Abstract: During adolescence there is a significant increase in risk-taking behavior, including experimenting with alcohol and drugs, which can lead to drug dependence. A new hypothesis regarding the genetic mechanisms that lead to drug use is tested using adolescent Caucasian children of alcoholics (57 males, 54 females; mean age = 14.5 years) data. Variables included in the study were dopaminergic genes (ANKK1 TaqI A, DRD2 C957T, DRD4 7R, COMT Val/Met substitution, and SLC6A3 9R) and a GABAergic gene (GABRB3), all combinations of genes, a count of the number of hypodopaminergic genotypes, personality traits, neurocognitive factors, depressive symptoms, and environmental factors. Separate predictive models were found for males and females. Hypodopaminergic functioning predicted drug use i...

Using enhanced and integrated services to improve response to standard methadone treatment: Changing the clinical infrastructure of treatment networks

Journal of Substance Abuse Treatment — Tue, 01 Sep 2009 00:00:00 +0100

Abstract: Outcomes are presented from opioid-dependent outpatients (N = 81) participating in a new community-based initiative designed to improve access to enhanced substance abuse and psychiatric services in a publicly supported methadone maintenance treatment network in Baltimore, MD. The initiative, entitled Community Access to Specialized Treatment (CAST), is located at the Addiction Treatment Services, a program within this network. Network programs referred patients engaged in unremitting drug use who are at risk for discharge to CAST, where they received methadone substitution, individual and group counseling within an adaptive platform, behavioral contingencies to reinforce adherence, and on-site psychiatric evaluation and care. Patients returned to their referring program after pr...

Increasing program capability to provide treatment for co-occurring substance use and mental disorders: Organizational characteristics

Journal of Substance Abuse Treatment — Tue, 01 Sep 2009 00:00:00 +0100

Abstract: The Dual Diagnosis Capability in Addiction Treatment and the Dual Diagnosis Capability in Mental Health Treatment indexes were used to document change in the capability of 14 substance abuse and mental health agencies to provide services to clients with co-occurring substance use and mental disorders (COD). COD capability significantly increased over 2 years, with the largest improvements seen in client assessment and staff training for COD. The role of agency structural characteristics and organizational readiness for change was also investigated. The study found modest evidence that some structural characteristics (e.g., agency size) and organizational readiness for change were related to increased COD capability. Further study is needed of how these factors affect implementati...

Anticonvulsant drugs in cocaine dependence: A systematic review and meta-analysis

Journal of Substance Abuse Treatment — Tue, 01 Sep 2009 00:00:00 +0100

Abstract: A systematic review and meta-analysis according to the methodology developed by the Cochrane Collaboration and the Quality of Reporting of Meta-Analyses statement based on randomized controlled trials to evaluate the efficacy of anticonvulsants in subjects with cocaine dependence were performed. Fifteen randomized, double-blind, placebo-controlled clinical trials involving 1,236 patients were included. Two outcome measures were evaluated: retention in the anticonvulsant treatment (compared to the placebo treatment) and the subsequent cocaine use, measured by urinalysis results. The efficacy of the seven anticonvulsant drugs analyzed was not homogenous. On average, 50% of the enrolled participants were lost to follow-up. Treatments did not show an improvement in subject retention ...

Measurement of self-reported HIV risk behaviors in injection drug users: Comparison of standard versus timeline follow-back administration procedures

Journal of Substance Abuse Treatment — Tue, 01 Sep 2009 00:00:00 +0100

This study compares the frequencies of retrospective self-reported HIV high-risk drug use and sexual behaviors in 127 out-of-treatment injection drug users using the HIV Risk Questionnaire (HRQ) across two administration methods: (a) a brief standard quantity–frequency approach covering the past 30 days and (b) a lengthier timeline follow-back (TLFB) procedure for improving recall. The two procedures produced similar frequencies of risk behavior across most items (80%) and good intra- and interclass correlation coefficients. The TLFB, however, resulted in higher frequencies for two risk behavior questions—sharing of any drug injection equipment and having any type of unprotected sex. The TLFB is a well-established procedure for retrospective assessment of HIV risk behavior and a good c...

Journal of Substance Abuse Treatment — Tue, 28 Jul 2009 12:44:43 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Tue, 28 Jul 2009 12:44:42 +0100

(Source: Journal of Substance Abuse Treatment)

Early recovery from alcohol dependence: Factors that promote or impede abstinence

Journal of Substance Abuse Treatment — Mon, 27 Jul 2009 00:00:00 +0100

The objectives of this prospective follow-up study were to identify factors that promote or impede the early recovery process and to examine whether drinking status at 4 weeks predicts later abstinence. Patients with alcohol use disorders were assessed by clinical and semistructured interviews upon entering addiction treatment (N = 175) and were followed up biweekly to monitor their alcohol use. During the first 4 weeks of treatment, 57% (n = 100) of patients slipped or relapsed on alcohol, whereas 43% (n = 75) were fully abstinent. Patients who slipped or relapsed were more likely to report nondependent use of a secondary substance, meet criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II Cluster B personality disorder, have a higher level of impul...

What are your priorities right now? Identifying service needs across recovery stages to inform service development

Journal of Substance Abuse Treatment — Fri, 24 Jul 2009 00:00:00 +0100

Abstract: Substance use disorders (SUD) are, for many, chronic conditions that are typically associated with severe impairments in multiple areas of functioning. “Recovery” from SUD is, for most, a lengthy process; improvements in other areas of functioning do not necessarily follow the attainment of abstinence. The current SUD service model providing intense, short-term, symptom-focused services is ill-suited to address these issues. A recovery-oriented model of care is emerging, which provides coordinated recovery-support services using a chronic-care model of sustained recovery management. Information is needed about substance users' priorities, particularly persons in recovery who are not currently enrolled in treatment, to guide the development of recovery-oriented systems. As a f...

Economic evaluation of a prerelease substance abuse treatment program for repeat criminal offenders

Journal of Substance Abuse Treatment — Fri, 24 Jul 2009 00:00:00 +0100

This article conducted one of the few comprehensive economic evaluations of prerelease substance abuse treatment to determine whether Community Education Centers' programs in New Jersey generated desirable outcomes, significant economic benefits, and positive net benefits. Relative to a matched comparison group of offenders who did not receive treatment, the intervention group returned an average economic benefit of $4,307 to $6,209 over the 1-year postrelease period. These economic benefits are underscored by the fact that the treatment program is housed in a separate facility, with a lower average per diem from that of the general inmate population. These results provide quantitative economic evidence that prerelease substance abuse treatment programs have the potential to reduce recidiv...

Incentives for retention of pregnant substance users: A secondary analysis

Journal of Substance Abuse Treatment — Mon, 06 Jul 2009 00:00:00 +0100

Abstract: Retention of pregnant substance users in treatment is challenging. In a multisite clinical trial, 200 pregnant substance users entering outpatient treatment at one of four programs were randomized to either three individual sessions of Motivational Enhancement Therapy for Pregnant Substance users or three individual sessions normally provided. Retail scrip from $25 to $30 was provided for attendance of research visits but not treatment visits. A post hoc analysis of the non-methadone-maintained participants (n = 175) evaluated the hypotheses that monetary reinforcement for attendance would result in more consecutive, and overall, weeks of attendance of research versus nonincentivized treatment visits. Findings indicate participants were nearly three times as likely to attend 4 co...

Buprenorphine adoption in the National Drug Abuse Treatment Clinical Trials Network

Journal of Substance Abuse Treatment — Sun, 05 Jul 2009 23:00:00 +0100

Abstract: The National Drug Abuse Treatment Clinical Trials Network (CTN), a collaborative federal research initiative that brings together universities and community-based treatment programs (CTPs), has conducted multiple clinical trials of buprenorphine for opioid dependence. Part of the CTN's mission is to promote the adoption of evidence-based treatment technologies. Drawing on a data collected during face-to-face interviews with administrators from a panel of 206 CTPs, this research examines the adoption of buprenorphine over a 2-year period. These data indicated that the adoption of buprenorphine doubled between the baseline and 24-month follow-up interviews. Involvement in a buprenorphine protocol continued to be a strong predictor of adoption at the 2-year follow-up, although adopt...

A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification

Journal of Substance Abuse Treatment — Thu, 02 Jul 2009 00:00:00 +0100

Abstract: This pilot study tested the effectiveness of transcutaneous electric acupoint stimulation (TEAS) as an adjunctive treatment for inpatients receiving opioid detoxification with buprenorphine–naloxone at a private psychiatric hospital. Participants (N = 48) were randomly assigned to active or sham TEAS and received three 30-minute treatments daily for 3 to 4 days. In active TEAS, current was set to maximal tolerable intensity (8–15 mA); in sham TEAS, it was set to 1 mA. By 2 weeks postdischarge, participants in active TEAS were less likely to have used any drugs (35% vs. 77%, p < .05). They also reported greater improvements in pain interference (F = 4.52, p < .05) and physical health (F = 4.84, p < .01) over time. TEAS is an acceptable, inexpensive adjunctive treatment that is...

The Washington Circle continuity of care performance measure: Predictive validity with adolescents discharged from residential treatment

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

This study examined the predictive validity of the Washington Circle (WC) continuity of care after long-term residential treatment performance measure, as well as the impact of assertive continuing care interventions on achieving continuity of care. This measure is a process measure that focuses on timely delivery of a minimal floor of services that are necessary to provide sufficient quality of treatment but should not be construed to be the optimal continuity of care after residential treatment for any specific adolescent. Participants included 342 adolescents who were admitted to long-term residential treatment and randomly assigned to either standard continuing care or an assertive continuing care condition. Overall, results provide initial support for the WC continuity of care after r...

Impact of Access to Recovery services on alcohol/drug treatment outcomes

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

Abstract: The purpose of this study was to assess the impact of providing recovery support services to clients receiving publicly funded chemical dependency (CD) treatment through the Access to Recovery (ATR) Program in Washington State. Services included case management, transportation, housing, and medical. A comparison group composed of clients who received CD treatment only was constructed using a multistep procedure based on propensity scores and exact matching on specific variables. Outcomes were obtained from administrative data sources. Results indicated that ATR services were associated with a number of positive outcomes including increased length of stay in treatment, increased likelihood of completing treatment, and increased likelihood of becoming employed. The beneficial effec...

Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

Abstract: The purposes of this study were to assess outcomes of patients prescribed buprenorphine at a primary care practice and to identify factors associated with favorable outcomes. All 255 patients given at least one prescription for buprenorphine between August 2003 and September 1, 2007, at a primary care practice in Baltimore were included. Data regarding demographics and comorbidities were collected retrospectively. Patients were classified as “opioid-positive” or “opioid-negative” each month based on patient report, urine toxicology, and provider assessment. After 12 months, 145 (56.9%) patients remained in treatment, and 64.7% of their months were opioid-negative. Patients using heroin were less likely to be opioid-negative, whereas those using prescription opioids were m...

Interest in marijuana treatment programs among teenage smokers and nonsmokers

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

Abstract: Little is known about adolescents' interest in marijuana treatment programs. This question was evaluated by telephone interview in a convenience sample of 575 adolescents responding to advertisements for tobacco research studies. Eighty-one percent of respondents endorsed the need for marijuana treatment programs for adolescents. These adolescents were younger and less likely to smoke tobacco, smoke marijuana, or use alcohol than those not endorsing such a need. Among the 192 marijuana smokers, the 58.8% who endorsed the need for marijuana treatment programs took their first puff of marijuana at a younger age than those who did not endorse the need. Those who were willing to participate in a marijuana treatment program were more likely African American and took their first mariju...

Reducing cultural barriers to substance abuse treatment among Asian Americans: A case study in New York City

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

This study tested strategies to enhance the continuum of care in the Asian community by adapting a well-documented generic early intervention model in a culture-specific setting. The results of this study indicate that these models may be successfully adapted to culturally specific settings such as Asian American communities. When culturally competent services combined with case management and motivational interviewing are provided, there tends to be an increase in Asian clients' chance of accomplishing treatment goals. (Source: Journal of Substance Abuse Treatment)

Choosing a control group in effectiveness trials of behavioral drug abuse treatments

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

Abstract: Effectiveness trials are an important step in the scientific process of developing and evaluating behavioral treatments. The focus on effectiveness research presents a different set of requirements on the research design when compared with efficacy studies. The choice of a control condition has many implications for a clinical trial's internal and external validity. The purpose of this article was to provide a discussion of the issues involved in choosing a control group for effectiveness trials of behavioral interventions in substance abuse treatment. The authors provide a description of four trial designs and a discussion of the advantages and disadvantages of each. (Source: Journal of Substance Abuse Treatment)

Behavioral couple therapy for gay and lesbian couples with alcohol use disorders

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

This study reports two separate trials, one with gay male participants and one with lesbian female participants. For both gay and lesbian patients with AUD, those who received BCT had a significantly lower percentage of days of heavy drinking during the year after treatment than patients who received IBT only. In addition, both gay and lesbian couples who received BCT reported higher levels of relationship adjustment at the end of treatment and in the year after treatment than those who received IBT only. Thus, the response of gay and lesbian couples with an alcoholic member to BCT was consistent with what has been observed with heterosexual couples. (Source: Journal of Substance Abuse Treatment)

College students rarely seek help despite serious substance use problems

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

Abstract: The prevalence of substance use disorders (SUD) and aspects of the help-seeking process among a high-risk sample of 946 students at one large public university were assessed in personal interviews during the first 3 years of college. After statistically adjusting for purposive sampling, an estimated 46.8%wt of all third-year students met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUD involving alcohol and/or marijuana at least once. Of 548 SUD cases, 3.6% perceived a need for help with substance use problems; 16.4% were encouraged by someone else to seek help. Help-seeking was rare among SUD cases (8.8%) but significantly elevated among individuals who perceived a need (90.0%) or experienced social pressures from parents (32.5%), friends (3...

Health-related quality of life trajectories of methamphetamine-dependent individuals as a function of treatment completion and continued care over a 1-year period

Journal of Substance Abuse Treatment — Thu, 25 Jun 2009 00:00:00 +0100

This study applies a chronic illness framework to evaluate treatment outcomes among individuals dependent on methamphetamine (MA). Using growth curve modeling, health-related quality of life (HRQOL) trajectories of MA-dependent individuals (N = 723) were examined over a 1-year period. Results show greater improvements in mental HRQOL trajectories as a function of treatment completion and continued care, although fairly static trajectories in physical health status. Other factors affecting HRQOL trajectories included gender, psychosocial functioning, drug use severity, and health impairment. Results extend research on treatment evaluations for MA dependence, highlighting the importance of continued service utilization for improved quality of life outcomes. (Source: Journal of Substance Abus...

Substance use treatment barriers for patients with frequent hospital admissions

Journal of Substance Abuse Treatment — Mon, 22 Jun 2009 00:00:00 +0100

Abstract: Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a...

Effects of research setting on observed depressive symptoms in marijuana users

Journal of Substance Abuse Treatment — Mon, 22 Jun 2009 00:00:00 +0100

Abstract: A post hoc analysis examined depressive symptoms in regular marijuana smokers interested in nontreatment, laboratory studies, and marijuana-dependent treatment-seekers considering clinical trial participation. Among marijuana-dependent treatment-seeking patients screened for a clinical trial, the mean Beck Depression Inventory Score (BDI) was significantly higher than for marijuana-using volunteers screened for nontreatment laboratory studies. Mean self-reported baseline marijuana use was not significantly different between groups, and BDI score was not correlated with use. Although the methods by which the two groups were selected influenced their characteristics (i.e., treatment-seekers are more likely to be experiencing some degree of clinical distress), it is notable that tre...

Developing an integrated treatment for substance use and depression using cognitive–behavioral therapy

Journal of Substance Abuse Treatment — Mon, 22 Jun 2009 00:00:00 +0100

Abstract: Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple a...

Scaling-up interim methadone maintenance: Treatment for 1,000 heroin-addicted individuals

Journal of Substance Abuse Treatment — Mon, 22 Jun 2009 00:00:00 +0100

The objectives of this study were to determine the following: (a) the feasibility of expanding interim methadone treatment (IM), (b) the impact of IM on heroin and cocaine use, and (c) the effect of charging a modest fee for IM. Six clinics provided daily methadone plus emergency counseling only (IM) to heroin-addicted individuals on a waiting list for treatment. IM was provided for up to 120 days before transfer to regular methadone treatment. Drug testing was conducted at admission to IM and at transfer to methadone treatment program (MTP). Half the patients were charged $10/week for IM. Logistic regression analysis was used to determine the effect of fee status and other variables on transfer. Of 1,000 patients enrolled in IM, 762 patients (76.2%) were admitted to a regular MTP. For tho...

Dually diagnosed patients' responses to substance use disorder treatment

Journal of Substance Abuse Treatment — Mon, 22 Jun 2009 00:00:00 +0100

Abstract: Few studies have investigated whether dually diagnosed patients with co-occurring substance use and psychiatric disorders (DD) respond as well to substance use disorder (SUD) treatments as patients with SUD do. Here we assessed whether male veteran DD and SUD patients with alcohol dependence diagnoses differed in the process and outcomes of residential SUD treatment. The main findings showed that (a) DD patients did not perceive SUD programs as positively as patients with SUD did and had worse proximal outcomes at discharge from treatment; (b) DD patients did as well as SUD patients on 1- and 5-year substance use outcomes but had worse psychiatric outcomes; and (c) patients who perceived treatment more positively and had better outcomes at discharge had better longer term outcome...

How are addicted physicians treated? A national survey of physician health programs

Journal of Substance Abuse Treatment — Sat, 06 Jun 2009 07:28:15 +0100

Conclusion: Addicted physicians receive an intensity, duration, and quality of care that is rarely available in most standard addiction treatments: (a) intensive and prolonged residential and outpatient treatment, (b) 5 years of extended support and monitoring with significant consequences, and (c) involvement of family, colleagues, and employers in support and monitoring. Although not available to the general public now, several aspects of this continuing care model could be adapted and used for the general population. (Source: Journal of Substance Abuse Treatment)

Journal of Substance Abuse Treatment — Sat, 06 Jun 2009 07:28:14 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Sat, 06 Jun 2009 07:28:08 +0100

(Source: Journal of Substance Abuse Treatment)

Adherence to methadone treatment: Not just a patient problem

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:52 +0100

reported recently on “adherence to oral methadone.” Perhaps the most surprising finding is that almost 60% of the patients “were fully compliant” with a regimen that was demanding, to say the least, with 82% being required to attend a pharmacy 5 or more days per week. Of those who failed to adhere strictly to the criteria assessed, “remarkably few patients (5%) admitted to selling their dose in the past month,” and none injected the medication. (Source: Journal of Substance Abuse Treatment)

Outcomes from primary care management of alcohol dependence in France

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:50 +0100

Abstract: A prospective study assessed the outcome in a sample of 122 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol-dependent patients in primary care. Standardized questionnaires collected clinical, social, and management data during 875 visits over an 18-month follow-up. A time–event analysis identified outcome predictors. Forty-three percent of patients attempted at least one detoxification during follow-up, one out of three in a hospital. Despite a very high relapse rate (83%), only 14% of the patients attempted a repeated abstinence. Longest and cumulative durations of abstinence appeared to be very close, corresponding to 29% of the follow-up time. The frequency of visits (risk ratio [RR] = 1.08) and visits addressing alcohol consumption (RR = 1.73) ...

Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:48 +0100

This study, using three waves of U.S. National Alcohol Surveys (1995–2005), examines lifetime alcohol treatment utilization and perceived treatment barriers among Latinos. The sample included 4,204 Latinos (2,178 women and 2,024 men); data were weighted. Analyses were linear and logistic regressions. Controlling for survey year, severity, and other covariates, male gender and English language interview predicted higher utilization generally and Alcoholics Anonymous use specifically; English interview was also associated with institutional treatment. (Effects for gender on general utilization were marginal.) Other predictors of utilization included older age, lower education, greater social pressures, greater legal consequences, greater dependence symptoms, and public insurance. Whereas m...

Organizational contexts of primary care approaches for managing problem drinking

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:42 +0100

Abstract: Little is known about the organizational contexts associated with different primary care (PC) approaches to managing PC patients with drinking problems. Relying upon the Chronic Care Model and a theoretically based taxonomy of health care systems, we identified organizational factors distinguishing PC practices using PC-based approaches (managed by PC providers, mental health specialists, or jointly with specialty services) versus referral-based management in the Veterans Affairs health care system. Data were obtained from a national survey of 218 PC practices characterizing usual management approaches as well as practices' leadership, delivery system design, information system, and decision support characteristics and from a national survey of substance use disorder specialty pr...

Impact of symptoms experienced by varenicline users on tobacco treatment in a real world setting

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:40 +0100

This article examines reported symptoms, nonsmoking rates, and medication use among 1,018 smokers using varenicline in a randomized trial comparing three forms of behavioral support for smoking cessation (phone, Web, or phone + Web). One month after beginning varenicline, 168 people (17%) had discontinued the medication. Most (53%) quit due to side effects and other symptoms. The most common side effect among all users was nausea (reported by 57% of users). At 1 month post medication initiation, those not taking varenicline were more likely to report smoking than those who continued the medication (57% vs. 16%, p < .001). Women reported more symptoms but did not discontinue medication at higher rates. Participants who received any telephone counseling (n = 681) were less likely to disconti...

Departments of corrections as purchasers of community-based treatment: A national study

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:38 +0100

This report represents the first step in describing the availability, mechanisms, and regulations of these two publicly funded community-based treatment systems. (Source: Journal of Substance Abuse Treatment)

Utilization of substance abuse treatment services under Medicare, 2001–2002

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:33 +0100

Abstract: In 2006, the Medicare program covered 37 million elderly persons and 7 million persons younger than 65 years, but little is known about substance abuse (SA) service utilization. Using the 5% Sample of Medicare claims data, the study examines individuals who used SA detoxification (“detox”) and/or rehabilitation (“rehab”) services under Medicare in 2001 and 2002. SA claimants less than 65 years of age (disabled) were compared to claimants more than 65 years of age (elderly). The disabled were more likely to have a co-occurring mental disorder than elderly claimants (50% vs. 14%) and more likely to have serious mental illness (21% vs. 2.3%). Disabled claimants were more than three times as likely to receive any detox service as elderly claimants (17% vs. 6%). The rate of cl...

Stress-related factors in cannabis use and misuse: Implications for prevention and treatment

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:28 +0100

We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsychINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption. Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. Although many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stress-related motivation to use/abuse ca...

Research on the diffusion of evidence-based treatments within substance abuse treatment: A systematic review

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:27 +0100

This article provides a comprehensive review of research studies that have examined the diffusion of evidence-based treatments (EBTs) within the field of substance abuse treatment. Sixty-five research studies were identified and were grouped into one of three major classifications: attitudes toward EBTs, adoption of EBTs, and implementation of EBTs. This review suggests significant progress has been made with regard to the advancement of the fields' knowledge about attitudes toward and the extent to which specific EBTs have been adopted in practice, as well as with regard to the identification of organizational factors related to EBT adoption. In an effort to advance the substance abuse treatment field toward evidence-based diffusion practices, recommendations are made for greater use of m...

Informal discussions in substance abuse treatment sessions

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:25 +0100

This study evaluated the extent to which counselors initiated informal discussions (i.e., general discussions and self-disclosures about matters unrelated to treatment) with their clients during treatment sessions within two National Institute on Drug Abuse Clinical Trial Network protocols involving adaptations of motivational interviewing (MI). Sixty counselors across the two protocols had 736 sessions independently rated for counselor treatment fidelity and the occurrence of informal discussions. The results showed that 88% of the counselors initiated informal discussions in their sessions and that most of these discussions involved counselors sharing personal information or experiences they had in common with their clients. The major finding was that counselor training in MI was associa...

Influence of ownership on access in outpatient substance abuse treatment

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:19 +0100

Abstract: Marked changes in ownership and control in substance abuse treatment delivery have garnered the attention of providers and policymakers alike. The proliferation of private for-profit providers and the shift to a delivery system that may be more explicitly influenced by financial incentives are of particular concern for this vulnerable population. This work empirically addresses how treatment unit ownership affected access and retention between 1995 and 2005 in the United States. Regressions show statistically significant associations between unit ownership and both restricted treatment access and shortening of treatment duration for financial reasons. In comparison to private nonprofit and public units, private for-profit units were less likely to provide initial treatment access...

Revisiting the past for a look toward future research: A final editorial

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:14 +0100

Effective June 1, 2009 I will no longer be Editor in Chief of the Journal of Substance Abuse Treatment (JSAT). After 9 years as Editor, 18 years at the Treatment Research Institute (TRI), and 30 years at the University of Pennsylvania, I have accepted a position in Washington that requires me to resign from all other activities. (Source: Journal of Substance Abuse Treatment)

Robert Hirsch, MD: 1926–2009

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:04 +0100

The field of addiction and behavioral health services has lost one of its most ardent supporters and practitioners with the passing of Dr. Robert Hirsch. Co-founder and Editor in Chief (1984–2000) of the Journal of Substance Abuse Treatment, Bob served for more than 30 years as Director of Treatment Services for North Shore University Hospital's Drug Treatment and Education Center. He was Clinical Assistant Professor of Psychiatry at New York University School of Medicine, a pioneer in the application of family therapy to addictive disorders, and, in conjunction with NYU School of Medicine, developed one of the first PGY-V Addiction Psychiatry Residency Program in the country. (Source: Journal of Substance Abuse Treatment)

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:03 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Tue, 05 May 2009 00:55:00 +0100

(Source: Journal of Substance Abuse Treatment)

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders

Journal of Substance Abuse Treatment — Mon, 27 Apr 2009 00:00:00 +0100

Abstract: Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related ...

Measures of cognitive functioning as predictors of treatment outcome for cocaine dependence

Journal of Substance Abuse Treatment — Mon, 27 Apr 2009 00:00:00 +0100

Abstract: Amlodipine is a calcium-channel antagonist with neuropharmacological properties believed to be protective against cerebral hypoperfusion, microinfarcts, and excitoxic cell death. Based on its pharmacological properties, we hypothesized that amlodipine would be associated with improved attention, processing speed, memory, and executive functioning at treatment follow-up in 84 cocaine-dependent individuals enrolled in a 12-week, placebo-controlled, double-blind clinical trial of amlodipine. We also hypothesized that better cognitive functioning at baseline would be associated with reduced cocaine use (negative urine drug screens) and longer treatment retention (last session attended). Results indicated that amlodipine produced no measurable benefit in cognitive functioning. Percent...

Comparative treatment and mortality correlates and adverse event profile of implant naltrexone and sublingual buprenorphine

Journal of Substance Abuse Treatment — Sun, 26 Apr 2009 23:00:00 +0100

Abstract: There is increasing interest in the use of implantable naltrexone as a new treatment for opiate dependence. This center has been one of the leaders in this form of treatment in Australia and has recently completed a registry-controlled review of our mortality data. As part of the study of the safety profile of this therapy, we were interested to review both the treatment correlates of previously presented mortality data and of adverse events. A total of 255 naltrexone implant therapy (NIT) and 2,518 buprenorphine (BUP) patients were followed for 1,322.22 and 8,030.02 patient-years, respectively. NIT patients had significantly longer days in treatment per episode (mean ± standard deviation, 238.32 ± 110.11 vs. 46.96 ± 109.79), total treatment duration (371.21 ± 284.64 vs. 162....

A comparison of two depressive symptomatology measures in residential substance abuse treatment clients

Journal of Substance Abuse Treatment — Wed, 08 Apr 2009 23:00:00 +0100

Abstract: Comorbid depression is common among substance abusers, making routine assessment of depression critical for high-quality care. We evaluated two of the most commonly used depressive symptomatology measures in a sample of clients (N = 240) in residential substance abuse treatment settings. The Beck Depression Inventory (BDI-II) has previously been used in clients receiving substance abuse treatment. The Patient Health Questionnaire (PHQ-9), originally developed for primary care settings, has not been used as frequently in substance abuse treatment settings, and it is unknown how it performs in this population. The measures were highly correlated with each other (r = .76) and demonstrated good internal consistency reliability (BDI-II = 0.91, PHQ-9 = 0.87); however, the PHQ-9 classif...

HIV screening among substance-abusing veterans in care

Journal of Substance Abuse Treatment — Sun, 05 Apr 2009 23:00:00 +0100

Abstract: Calls for screening for HIV infection among individuals with substance use disorders, including alcohol use, are increasing. We investigated HIV screening and its predictors in the Veterans Health Administration (VA) system among such individuals in care. Our primary outcome was retrospective evidence of screening for HIV infection, adjusting for patient demographics and important comorbid disease. Of the 371,749 sample patients with histories of substance use disorders using VA services, 20% had evidence of HIV screening. Screening was lowest among those with alcohol use disorders alone (11%) and highest among those treated in substance use programs (28%) or receiving inpatient care (28%). The findings suggest a low recognition of substance use disorders (especially alcohol use)...

Parental consent in adolescent substance abuse treatment outcome studies

Journal of Substance Abuse Treatment — Thu, 02 Apr 2009 23:00:00 +0100

Abstract: No systematic review has focused on parental consenting procedures used in adolescent substance abuse treatment outcomes research. To address this gap, we examined parental consenting procedures in adolescent outcome studies (n = 34) published between 1980 and 2007. Although parental consent was required in 89% of adolescent treatment outcome studies we reviewed, consenting procedures were not routinely reported. We argue that parental consenting procedures should be routinely reported as a methodological feature of adolescent treatment outcome studies and, given concerns about sample bias in adolescent risk behavior research when parental consent is required, encourage outcomes researchers in this area to prospectively study the impact of consenting procedures on both the study ...

Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 23:00:00 +0100

Abstract: Most treatment programs recommend clients attend 12-step groups, but many drop out posttreatment. The effectiveness of Making Alcoholics Anonymous [AA] Easier (MAAEZ ), a manual-guided intervention designed to help clients connect with individuals encountered in AA, was tested using an “OFF/ON” design (n = 508). MAAEZ effectiveness was determined by comparing abstinence rates of participants recruited during ON and OFF conditions and by studying the effect of the number of MAAEZ sessions attended. At 12 months, more clients in the ON condition (vs. OFF) reported past 30-day abstinence from alcohol (p = .012), drugs (p = .009), and both alcohol and drugs (p = .045). In multivariate analyses, ON condition participants had significantly increased odds of abstinence from alcoho...

Auricular acupuncture as an adjunct to opiate detoxification treatment: Effects on withdrawal symptoms

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: It was hypothesized that auricular acupuncture would lead to reduced severity of opiate withdrawal symptoms and craving when provided as an adjunct to methadone detoxification. The study used a randomized, placebo-controlled study design. The sample consisted of 83 drug misusers who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for opiate dependence. Daily measures of withdrawal severity and craving were taken using the Short Opiate Withdrawal Scale and an eight-item craving questionnaire. Urine screening was used as an objective assessment of treatment adherence. The study hypothesis was not confirmed. Auricular acupuncture had no effect upon withdrawal severity or craving when provided as an adjunct to a standard methadone detoxification tre...

Are cannabis users who participate in a randomized clinical trial different from other treatment seekers?

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

This study compares profiles taken from a centralized intake process for those presenting with cannabis as their main drug, which were then separated into three categories, (a) those who were offered a specialist assessment for cannabis dependence over the phone but did not attend their appointment, (b) those who presented for their initial appointment, and c) those attending and subsequently recruited into an RCT. To explore whether issues such as severity of cannabis use and co-occurring disorders acted as a barrier to attending treatment or to inclusion in an RCT, we examined basic triage information. Results indicated that there were no statistically significant differences on selected characteristics between groups, suggesting that RCT participants were representative of treatment see...

Assessing the effectiveness of an Internet-based videoconferencing platform for delivering intensified substance abuse counseling

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

This study assesses treatment satisfaction and response to Internet-based (CRC Health Group's e-Getgoing) group counseling for partial responders to methadone maintenance treatment. Patients testing positive for an illicit substance (n = 37) were randomly assigned to e-Getgoing or onsite group counseling and followed for 6 weeks. Patients in both conditions responded favorably to intensified treatment by achieving at least 2 consecutive weeks of abstinence and 100% attendance to return to less-intensive care (e-Getgoing: 70% vs. routine: 71%, ns). Treatment satisfaction was good and comparable across conditions. E-Getgoing patients expressed a preference for the Internet-based service, reporting convenience and increased confidentiality as major reasons. Integrating Internet-based group c...

The Important People Drug and Alcohol interview: Psychometric properties, predictive validity, and implications for treatment

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: Research with the Important People instrument has shown that social support for abstinence is related to alcohol treatment outcomes, but less work has been done on the role of network support in drug treatment outcomes. A drug and alcohol version of the Important People instrument (IPDA) was developed and administered to 141 patients in residential treatment for cocaine dependence. Three components were found, all with acceptable internal consistency: (a) substance involvement of the network, (b) general/treatment support, and (c) support for abstinence. These components and three fundamental network characteristics (size of daily network, size of network, and importance of the most important people) were investigated as correlates of pretreatment and posttreatment alcohol and dr...

Relating counselor attributes to client engagement in England

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere. By linking records from English clients with their counselors in each program, findings also indicate these relationships are rooted in the pers...

Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Conclusions: Multilevel interventions that address individual, social, and environmental factors are necessary to improve substance abuse treatment retention and treatment outcomes among IDUs referred from NEP. (Source: Journal of Substance Abuse Treatment)

Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

This study examined the patient- and facility-level associations between the continuity of care performance measure adopted by the Department of Veterans Affairs (VA) and improvements in self-administered Addiction Severity Index (ASI) composites and other indicators of problematic substance use. Up to 50 patients from each of a nationally representative sample of 109 VA substance use disorder (SUD) treatment programs at 73 VA facilities were assessed at intake and posttreatment. The continuity of care performance measure specifies that patients should receive at least two SUD outpatient visits in each of the three consecutive 30-day periods after they qualify as new SUD patients. In analyses adjusting for baseline characteristics, meeting the continuity of care performance measure was not...

Do drug treatment services predict reunification outcomes of mothers and their children in child welfare?

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1,115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a “high” level of family-related or education/employment services were approxim...

Adapting Washington Circle performance measures for public sector substance abuse treatment systems

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: The Washington Circle, a group focused on developing and disseminating performance measures for substance abuse services, developed three such measures for private health plans. In this article, we explore whether these measures are appropriate for meeting measurement goals in the public sector and feasible to calculate in the public sector using data collected for administrative purposes by state and local substance abuse and/or mental health agencies. Working collaboratively, 12 states specified revised measures and 6 states pilot tested them. Two measures were retained from the original specifications: initiation of treatment and treatment engagement. Additional measures were focused on continuity of care after assessment, detoxification, residential or inpatient care. These d...

Exposure to Adolescent Community Reinforcement Approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: Data from 399 adolescents, who participated in one of four randomly controlled trials of the Adolescent Community Reinforcement Approach (A-CRA) intervention, were used to examine the extent to which exposure to A-CRA procedures mediated the relationship between treatment retention and outcomes. Although zero-order correlations indicated that retention in treatment was a significant predictor of alcohol and other drug (AOD) use (r = −0.18, p < .001), this relationship was reduced to nonsignificance (p = .39) when exposure to A-CRA procedures was included in the model. Overall, the final model evidenced a very good fit (root mean square error of approximation = .00; comparative fit index = 1.00) and explained 29% and 43% of the variance in adolescents' posttreatment AOD use and ...

Factors affecting willingness to provide buprenorphine treatment

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimburseme...

The relevance and treatment of cue-induced cravings in tobacco dependence

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: Craving to smoke is often conceptualized and measured as a tonic, slowly changing state induced by abstinence. In this article, we review the literature on the existence, causes, and treatment of cue-induced cravings: intense, episodic cravings typically provoked by situational cues associated with drug use. In laboratory research, smokers exposed to smoking-related cues demonstrate increased craving as well as distinct patterns of brain activation. Observational field studies indicate that such cue-induced cravings are substantially responsible for relapse to smoking but that smoking can often be averted by coping responses. The effects of pharmacological interventions are mixed. Steady-state medications (bupropion, varenicline, nicotine patch) do not appear to protect smokers f...

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

(Source: Journal of Substance Abuse Treatment)

Editorial Board

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 04:00:00 +0100

(Source: Journal of Substance Abuse Treatment)

Self-perceived motivation for benzodiazepine use and behavior related to benzodiazepine use among opiate-dependent patients

Journal of Substance Abuse Treatment — Wed, 01 Apr 2009 00:00:00 +0100

Abstract: Clinical observations have shown a high prevalence of benzodiazepine use among opiate-dependent patients. Our objective was to identify if distinct patterns of behavior could be associated with three different self-perceived motivations for benzodiazepine use: (a) exclusive self-therapeutic motivation, (b) exclusive hedonic motivation, and (c) combined self-therapeutic and hedonic motivation. Data were collected through a self-administered questionnaire in 92 opiate users in treatment in France (Aquitaine). The behaviors associated with exclusive self-therapeutic motivation included the search for an anxiolytic effect, oral administration, use within the context of a medical prescription, and use without other substances. The behaviors associated with exclusive hedonic motivation...

Early abstinence in cocaine pharmacotherapy trials predicts successful treatment outcomes

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: There is a robust relationship between early and later abstinence in smoking cessation, but that relationship has not been explored among other substances of abuse. To assess whether early abstinence during treatment, as opposed to baseline abstinence, predicted later abstinence among cocaine-dependent patients, data from two randomized double-blind controlled clinical pharmacotherapy trials were analyzed. Similar to the findings in the smoking cessation literature, results indicate that abstinence in the first 2 weeks of pharmacotherapy predicted later in-trial abstinence. This finding has implications both for treatment research and for clinical practice, suggesting that patients who do not respond early in treatment may need a more intensive intervention. (Source: Journal of S...

Drug abstinence and cognitive control in methamphetamine-dependent individuals

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: Chronic methamphetamine (MA) abuse is associated with disruption of frontostriatal function as well as deficits in cognitive control. To examine the relationship between drug use patterns and cognitive deficits, we pooled previously published behavioral data with new data collected using the Stroop Attention Test. Subject groups are composed of 38 MA-abusing individuals who recently initiated abstinence (36.1 ± 8.8 years of age), 27 MA-abusing individuals who had initiated abstinence more than 1 year prior to study (38.7 ± 7.7 years of age), and 33 non-substance-abusing controls (33.9 ± 8.5 years of age). The recently abstinent MA-abusing individuals exhibited greater Stroop reaction time (RT) interference compared with both the control group (p = .001) and the long-term abst...

A randomized clinical trial of methadone maintenance for prisoners: Results at 12 months postrelease

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

This study examined the impact of prison-initiated methadone maintenance at 12 months postrelease. Males with preincarceration heroin dependence (N = 204) were randomly assigned to (a) Counseling Only: counseling in prison, with passive referral to treatment upon release; (b) Counseling + Transfer: counseling in prison with transfer to methadone maintenance treatment upon release; and (c) Counseling + Methadone: counseling and methadone maintenance in prison, continued in the community upon release. The mean number of days in community-based drug abuse treatment were, respectively, Counseling Only, 23.1; Counseling + Transfer, 91.3; and Counseling + Methadone, 166.0 (p < .01); all pairwise comparisons were statistically significant (all ps < .01). Counseling + Methadone participants were a...

A web application for moderation training: Initial results of a randomized clinical trial

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: Eighty-four heavy drinkers who responded to a newspaper recruitment advertisement were randomly assigned to receive either (a) training in a Moderate Drinking protocol via an Internet-based program (www.moderatedrinking.com) and use of the online resources of Moderation Management (MM; www.moderation.org) or (b) use of the online resources of MM alone. Follow-ups are being conducted at 3, 6, and 12 months. Results of the recently completed 3-month follow-up (86% follow-up) indicated both groups significantly reduced their drinking based on these variables: standard drinks per week, percent days abstinent, and mean estimated blood alcohol concentration (BAC) per drinking day. Both groups also significantly reduced their alcohol-related problems. Relative to the control group, the ...

Comparing smoking treatment programs for lighter smokers with and without a history of heavier smoking

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: The study examined the impact of counseling intensity (high vs. low) combined with either bupropion or the nicotine patch. Two hundred sixty participants smoking 6 to 15 cigarettes per day (cpd) were enrolled in a yearlong study to examine the effects of treatment. Four groups of smokers under medication-blinded conditions were compared for treatment completion and abstinence at three follow-up points from the initiation of treatment (Weeks 12, 26, and 52). Both counseling groups had similar treatment completion rates (i.e., defined by a combination of counseling attendance and medication adherence levels). There was a main treatment effect for abstinence favoring the high counseling condition in early follow-up (Week 12) and for continuous abstinence. Participants with a history...

Evaluation of the Washington State Access to Recovery project: Effects on Medicaid costs for working age disabled clients

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: In 2004, the federal government made a major commitment to support expanded substance abuse (SA) recovery services by initiating the Access to Recovery (ATR) program. The initial ATR I program awarded grants to 14 states, including Washington State. We evaluated Washington's ATR I program to determine its effect on Medicaid costs for working age disabled clients. We compared per member per month (PMPM) Medicaid costs during 1 year follow-up for clients who received ATR services (N = 1,347) with costs for a matched comparison group of 1,243 clients and used multiple regression techniques to estimate changes in Medicaid costs associated with ATR. ATR was found to be associated with reductions in PMPM Medicaid costs of $66 (p = .11) to $136 (p = .05) depending upon months of Medicai...

A randomized trial comparing two models of web-based training in cognitive–behavioral therapy for substance abuse counselors

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

This study compared training outcomes obtained by 147 substance abuse counselors who completed eight self-paced online modules on cognitive–behavioral therapy (CBT) and attended a series of four weekly group supervision sessions using Web conferencing software. Participants were randomly assigned to two conditions that systematically varied the degree to which they explicitly promoted adherence to the CBT protocol and the degree of control that they afforded participants over the sequence and relative emphasis of the training curriculum. Outcomes were assessed at baseline and immediately following training. Counselors in both conditions demonstrated similar improvements in CBT knowledge and self-efficacy. Counselors in the low-fidelity condition demonstrated greater improvement on one of...

Agency context and tailored training in technology transfer: A pilot evaluation of motivational interviewing training for community counselors

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

This study reports the results of a randomized pilot evaluation of CTT for motivational interviewing (MI). Investigators randomly assigned community substance abuse treatment agencies to receive either CTT or a standard 2-day MI workshop. The study also evaluated the effects of counselor-level and organizational-level variables on the learning of MI. No between-condition differences were observed on the acquisition and maintenance of MI skills despite reported higher satisfaction with the more costly context-tailored model. Analyses revealed that those counselors with more formal education and less endorsement of a disease model of addiction made the greatest gains in MI skills, irrespective of training condition. Similarly, agencies whose individual counselors viewed their organization as...

What could the program have done differently? A qualitative examination of reasons for leaving outpatient treatment

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: Attrition from treatment for substance abuse disorders is a persistent challenge that severely limits the effectiveness of services. Although a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients' stated reasons for leaving outpatient treatment (n = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors. Program-level barriers include dissatisfaction with the program, especially counselors; unmet social services needs; and lack of flexibility in scheduling. Individual-level barriers to retention were low problem reco...

“What I got from treatment”: Predictors of treatment content received and association of treatment content with 6-month outcomes in adolescents

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

We examined the extent to which amount of treatment content received was associated with certain patient characteristics (e.g., readiness to change) and severity of substance involvement at 6-month follow-up. Adolescents (N = 107) recruited from outpatient addiction treatment reported at follow-up on the extent to which treatment addressed addictive behaviors (e.g., getting motivated to change) and other concerns (e.g., depression). Contrary to prediction, readiness to change did not predict amount of treatment content received, but greater number of inpatient days during follow-up predicted greater endorsement of addictive behaviors content. At 6 months, more addictive behaviors content received was associated with fewer alcohol symptoms. For both alcohol and marijuana, greater endorsemen...

Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

This study explores counselor views and the impact of organizational context using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. Results show counselors hold generally positive opinions of program director leadership and job satisfaction and have low levels of burnout, but they also have important variations in their ratings. Higher counselor caseloads were related to poorer ratings, and leadership behaviors predicted both satisfaction and burnout. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts. (Source: Journal of Substance Abuse Treatment)

Counselor skill influences outcomes of brief motivational interventions

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

Abstract: The aim of this study was to estimate the influence of counselor skills during brief motivational interventions (BMIs) on patient alcohol use 12 months later. Ninety-five BMIs delivered by five counselors of similar background and training were recorded and coded using the Motivational Interviewing Skills Code (MISC). Baseline alcohol measures and sociodemographics of patients did not differ across counselors, whereas MISC scores and outcome at 12 months did. Multilevel models showed that counselors with better motivational interviewing (MI) skills achieved better outcomes overall and maintained efficacy across all levels of an important predictor (patient ability to change), whereas counselors with poorer MI skills were effective mostly at high levels of ability to change. Findi...

Beck Depression Inventory for depression screening in substance-abusing adolescents

Journal of Substance Abuse Treatment — Tue, 31 Mar 2009 23:00:00 +0100

In this study, we evaluated the diagnostic efficiency of the Beck Depression Inventory (BDI) in detecting MDD, as assessed by psychiatrists administering the Diagnostic Interview for Children and Adolescents, and its factor structure, internal consistency, and discriminant validity in a clinical sample of adolescents with SUD (n = 145). Results indicate that BDI scores of 12 and higher had the most optimal sensitivity (73%), whereas BDI scores of 17 and higher, the most optimal specificity (75%). Five factors accounted for approximately 56% of the variance. Overall, internal consistency was high, and the BDI adequately discriminated MDD from non-MDD cases. Results support the use of BDI as a screen for MDD with moderate to high psychometric properties in an adolescent SUD sample. (Source: ...

Treatment seeking for smoking cessation among young adults

Journal of Substance Abuse Treatment — Thu, 05 Feb 2009 00:00:00 +0100

Abstract: Young adult smokers (18–24 year olds) do not seek treatment for smoking cessation as often as older smokers. Two commonly hypothesized reasons for this are that younger smokers are not aware of treatments or cannot afford them. The State of Vermont provides free smoking cessation treatment, and most young smokers are aware of this; thus, we tested whether young adult smokers from Vermont would still underutilize treatment via a secondary analysis of the population-based 2005 VT Adult Tobacco Survey. Young adult smokers from Vermont were less likely to have used medication (24% vs. 58%; relative risk = 0.42) or psychosocial (28% vs. 53%; relative risk = 0.54) treatment than middle-aged smokers (25–44 year olds). We conclude that reasons other than awareness and cost cause youn...

Racial/ethnic disparities in the patterns of co-occurring mental health problems in adolescents in substance abuse treatment

Journal of Substance Abuse Treatment — Thu, 05 Feb 2009 00:00:00 +0100

This study examines disparities in co-occurring mental health and substance use problems by race/ethnicity to inform the development of culturally appropriate treatment approaches. Using pooled clinical data collected with the Global Assessment of Individual Needs, we identified racial/ethnic and other factors associated with co-occurring internalizing problems, externalizing problems, and the combination thereof in adolescents in federally funded treatment facilities. Results show that after controlling for demographic and socioenvironmental factors, African Americans, Hispanics, and mixed-race adolescents were more likely than Whites to have co-occurring internalizing problems. African Americans and Native Americans were less likely than Whites to have externalizing problems and to have ...

Management practices in substance abuse treatment programs

Journal of Substance Abuse Treatment — Thu, 05 Feb 2009 00:00:00 +0100

This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of “good” management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area. (Source: Journal of Substance Abuse Treatment)

Dental care and oral disease in alcohol-dependent persons

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

Abstract: Dental/Oral health of alcohol-dependent persons and substance abusers is often neglected. It is not clear that alcohol dependence has effects on oral health beyond those expected in nonalcoholic persons of similar socioeconomic status (SES). Study objectives were to examine the personal dental care habits, ability to access professional dental care, and the types of services received and to examine their effect on the oral health of alcohol-dependent persons and substance abusers. Forty Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised-diagnosed alcohol-dependent persons and a comparison group of 25 non-alcohol-dependent subjects matched for race, age, gender, and SES were recruited. Subjects were medically healthy. Each subject received a comprehensive...

Motivational and skills training HIV/sexually transmitted infection sexual risk reduction groups for men

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

Abstract: The effectiveness of a motivational and skills training HIV/AIDS group intervention designed for men in substance abuse treatment was evaluated. Men in methadone maintenance (n = 288) or outpatient psychosocial treatment (n = 302) completed assessments at baseline, 2 weeks, 3 months, and 6 months postintervention. Participants were randomly assigned to attend either Real Men Are Safe (REMAS; five sessions containing information, motivational exercises, and skills training) or HIV education (HIV-Ed; one session containing HIV prevention information). REMAS participants engaged in significantly fewer unprotected vaginal and anal sexual intercourse occasions (USO) during the 90 days prior to the 3- and 6-month follow-ups than HIV-Ed participants. Completing REMAS resulted in an even...

Meta-analysis of depression and substance use among individuals with alcohol use disorders

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

Abstract: The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset o...

The effect of methadone maintenance on positive outcomes for opiate injection drug users

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6-month follow-up. Outcome variables of interest included drug use, productivity, and HIV risk behaviors. Participants were recruited through street outreach in Denver, CO, from 2000 through 2004 using targeted sampling. The sample was primarily men, White (48%), averaged 39 years of age, and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance to maximize their tre...

The Intensive Treatment Unit: A brief inpatient detoxification facility demonstrating good postdetoxification treatment entry

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

This report presents outcomes from the Intensive Treatment Unit (ITU), a brief inpatient detoxification unit in Baltimore, MD, found to have good postdischarge treatment entry outcomes. The patients followed were predominantly male African Americans in early middle age who were sequentially admitted to the unit (N = 134) and demonstrated severe social disruption and psychiatric comorbidity. More than 80% of the patients discharged from the ITU were admitted to treatment postdetoxification, with most going to long-term residential settings or recovery houses. Success was associated with seeking residential treatment, and failure was concentrated among the minority discharged with no plan for aftercare and those seeking outpatient treatments. The report explores patient and process factors a...

Results of a statewide evaluation of “paperwork burden” in addiction treatment

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

This article chronicles three steps taken by research, clinical, and state staff toward assessing, evaluating, and streamlining clinical and administrative paperwork at all public outpatient addiction treatment programs in one state. The first step was an accounting of all paperwork requirements at each program. The second step included the development of time estimates for the paperwork requirements; synthesis of information across sites; providing written evaluation of the need, utility, and redundancy of all forms (paperwork) collected; and suggestions for eliminating unused or unnecessary data collection and streamlining the remaining data collection. Thirdly, the state agency hosted a meeting with the state staff, researchers, and staff from all programs and agencies with state-funded...

Randomized trial of training and supervision in motivational interviewing with adolescent drug treatment practitioners

Journal of Substance Abuse Treatment — Fri, 16 Jan 2009 00:00:00 +0100

Abstract: Motivational interviewing is an empirically supported treatment for drug and alcohol problems. Training in this approach is very popular, although previous studies have identified that the acquisition of key skills is challenging and that postworkshop supervision inputs are helpful. This pilot trial investigated the training of adolescent drug treatment practitioners, comparing a group who received immediate training against a delayed training study condition. Training and supervision were found to have no impact upon skill levels as measured by the Motivational Interviewing Treatment Integrity Version 2, with the exception of a very specific effect on motivational interviewing spirit. Motivational interviewing was not easy to learn for these practitioners. Progress made indicate...

Successful treatment of chronic hepatitis C with pegylated interferon in combination with ribavirin in a methadone maintenance treatment program

Journal of Substance Abuse Treatment — Fri, 28 Nov 2008 00:00:00 +0100

Abstract: Injection drug users constitute 60% of the more than 4 million people in the United States with hepatitis C virus (HCV), including many methadone maintenance patients. Few data exist describing clinical outcomes for patients receiving HCV treatment on-site in methadone maintenance settings. In this retrospective study, we describe clinical outcomes for 73 patients receiving HCV treatment on-site in a methadone maintenance treatment program. Fifty-five percent of patients achieved end-of-treatment response, and 45% achieved sustained viral response. These treatment response rates are nearly equivalent to previously published HCV treatment response rates, despite high prevalences of ongoing drug use (49%), psychiatric comorbidity (67%), and HIV coinfection (32%). These data show th...

A pilot study of community-friendly manual-guided drug counseling

Journal of Substance Abuse Treatment — Fri, 28 Nov 2008 00:00:00 +0100

Abstract: Therapist training manuals that are more “community friendly” are needed to facilitate effectiveness testing and dissemination of treatments to community based setting. The aim of the current project was to create revised versions of individual drug counseling (IDC) and group drug counseling (GDC) treatment manuals for cocaine dependence and to conduct a preliminary study of their effectiveness. After changing the format and context of existing drug counseling manuals to have greater ease of use in the community, draft manuals were given to 23 community-based counselors for their feedback. Final versions were then used in a pilot randomized clinical trial involving 41 cocaine-dependent patients who received 3 months of either IDC + GDC or GDC-alone treatment. Counselors imple...

Organizational determinants of outpatient substance abuse treatment duration in women

Journal of Substance Abuse Treatment — Thu, 27 Nov 2008 00:00:00 +0100

This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey (n = 571 in 1999/2000, n = 566 in 2005). Analyses were conducted separately for methadone and nonmethadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the nonmethadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accredit...

The impact of loss to follow-up on hypothesis tests of the treatment effect for several statistical methods in substance abuse clinical trials

Journal of Substance Abuse Treatment — Fri, 14 Nov 2008 00:00:00 +0100

Abstract: “Loss to follow-up” can be substantial in substance abuse clinical trials. When extensive losses to follow-up occur, one must cautiously analyze and interpret the findings of a research study. Aims of this project were to introduce the types of missing data mechanisms and describe several methods for analyzing data with loss to follow-up. Furthermore, a simulation study compared Type I error and power of several methods when missing data amount and mechanism varies. Methods compared were the following: Last observation carried forward (LOCF), multiple imputation (MI), modified stratified summary statistics (SSS), and mixed effects models. Results demonstrated nominal Type I error for all methods; power was high for all methods except LOCF. Mixed effect model, modified SSS, an...

Alcohol Education Inventory—Revised: What every mental health professional should know about alcohol

Journal of Substance Abuse Treatment — Thu, 13 Nov 2008 00:00:00 +0100

Abstract: In 1995, Miller and C'de Baca created a 50-item measure, the Alcohol Education Inventory (AEI), to assess mental health professionals' basic knowledge of alcohol and alcohol problems. The purpose of this study was to update the AEI based on advances in the field since its publication. The AEI-Revised (AEI-R) consists of 13 of the original AEI items, 30 items that were revised and updated, and 7 new items. The AEI-R was administered to 90 mental health trainees with percentage correct ranging from 60% (psychology postdoctoral fellows) to 70% (psychiatry residents). The percent correct is very similar to that found on the original AEI (64%–70%). Survey results suggest that alcohol-related knowledge by mental health professionals in general training is less than adequate. The AEI-...

Adolescent tobacco use and substance abuse treatment outcomes

Journal of Substance Abuse Treatment — Thu, 13 Nov 2008 00:00:00 +0100

This study investigated the relationship between cigarette-smoking status and 12-month alcohol and marijuana treatment outcomes in a sample of 1,779 adolescents from the Drug Abuse Treatment Outcomes Study for Adolescents. Participants were classified into four groups based on change in cigarette-smoking status from intake to the 12-month follow-up: persistent smokers, nonsmokers, quitters, and smoking initiators. Logistic regression was used to predict likelihood of relapse to alcohol, marijuana, and other drugs after controlling for intake levels and demographic/treatment characteristics. Results found persistent smokers and smoking initiators to have significantly greater odds of alcohol and marijuana relapse compared with quitters. Furthermore, persistent smokers and smoking initiators...

Factors associated with the prescribing of buprenorphine or methadone for treatment of opiate dependence

Journal of Substance Abuse Treatment — Wed, 12 Nov 2008 00:00:00 +0100

Abstract: The study investigates patient preferences and beliefs and treatment program factors related to the decision to prescribe either buprenorphine or methadone to opiate-dependent patients. The sample (N = 192) was recruited from 10 addiction treatment services in London. Data were collected by means of a single structured interview conducted with patients commencing a treatment episode at the participating agencies. Data on patient demographics, beliefs, attitudes, and preferences were collected using a structured interview. Data regarding treatment goals and prescribed medication were collected from interviews with clinical staff. Oral methadone had a higher preference rating than buprenorphine. Clinical prescribing practices were influenced by patient preferences (both positive an...

Opioid treatment programs in the Clinical Trials Network: Representativeness and buprenorphine adoption

Journal of Substance Abuse Treatment — Wed, 12 Nov 2008 00:00:00 +0100

Abstract: As the Clinical Trials Network (CTN) begins to focus efforts on disseminating the results of its research studies to the addiction treatment field, it is important to begin to assess the capacity of programs outside the CTN to integrate with fidelity these endorsed treatment practices. To date, no data exist to assess the representativeness of opioid treatment programs (OTPs) participating in the CTN, nor potential barriers to the effective diffusion of practices aimed at the treatment of opioid-dependent patients, including buprenorphine. Using data obtained from OTPs within the CTN (n = 49) and a sample drawn from the population of U.S. OTPs (n = 50), this study compares the two groups on their organizational, clinical, and client characteristics, as well as their adoption of b...

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Contents

Editorial Board

The route to change: Within-session predictors of change plan completion in a motivational interview

Nonmedical use of prescription stimulants and depressed mood among college students: Frequency and routes of administration

Effect of co-occurring disorders and intimate partner violence on substance abuse treatment outcomes

Hostility in mandated students: Exploratory analysis and implications for treatment

The adoption of alcohol pharmacotherapies in the Clinical Trials Network: The influence of research network participation

A randomized pilot study of the Engaging Moms Program for family drug court

A randomized controlled study of a web-based performance improvement system for substance abuse treatment providers

It's the thought that counts: Craving metacognitions and their role in abstinence from methamphetamine use

Relationship between anxiety disorders and opiate dependence— A systematic review of the literature: Implications for diagnosis and treatment

The implementation of tobacco-related brief interventions in substance abuse treatment: A national study of counselors

Contents

Editorial Board

Predictors of employment in substance-using male and female welfare recipients

A review of computer-based alcohol problem services designedfor the general public

Smoking cessation interventions among individuals in methadone maintenance: A brief review

Structural-level factors affecting implementation of the methadone maintenance therapy program in China

A randomized experimental study of gender-responsive substance abuse treatment for women in prison

What is recovery? Revisiting the Betty Ford Institute Consensus Panel Definition: The Betty Ford Consensus Panel and Consultants

Of scientific quality and relevance

Contents

Editorial Board

Contents

The torch is passed again

Editorial Board

A cluster-randomized effectiveness trial of smoking cessation modified for at-risk smoker subgroups

Home- versus office-based buprenorphine inductions for opioid-dependent patients

Male methamphetamine-user inmates in prison treatment: During-treatment outcomes

Preference for buprenorphine/naloxone and buprenorphine among patients receiving buprenorphine maintenance therapy in France: A prospective, multicenter study

Contents

Editorial Board

A randomized controlled trial of telephone continuing care

Genetic, personality, and environmental predictors of drug use in adolescents

Using enhanced and integrated services to improve response to standard methadone treatment: Changing the clinical infrastructure of treatment networks

Increasing program capability to provide treatment for co-occurring substance use and mental disorders: Organizational characteristics

Anticonvulsant drugs in cocaine dependence: A systematic review and meta-analysis

Measurement of self-reported HIV risk behaviors in injection drug users: Comparison of standard versus timeline follow-back administration procedures

Contents

Editorial Board

Early recovery from alcohol dependence: Factors that promote or impede abstinence

What are your priorities right now? Identifying service needs across recovery stages to inform service development

Economic evaluation of a prerelease substance abuse treatment program for repeat criminal offenders

Incentives for retention of pregnant substance users: A secondary analysis

Buprenorphine adoption in the National Drug Abuse Treatment Clinical Trials Network

A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification

The Washington Circle continuity of care performance measure: Predictive validity with adolescents discharged from residential treatment

Impact of Access to Recovery services on alcohol/drug treatment outcomes

Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year

Interest in marijuana treatment programs among teenage smokers and nonsmokers

Reducing cultural barriers to substance abuse treatment among Asian Americans: A case study in New York City

Choosing a control group in effectiveness trials of behavioral drug abuse treatments

Behavioral couple therapy for gay and lesbian couples with alcohol use disorders

College students rarely seek help despite serious substance use problems

Health-related quality of life trajectories of methamphetamine-dependent individuals as a function of treatment completion and continued care over a 1-year period

Substance use treatment barriers for patients with frequent hospital admissions

Effects of research setting on observed depressive symptoms in marijuana users

Developing an integrated treatment for substance use and depression using cognitive–behavioral therapy

Scaling-up interim methadone maintenance: Treatment for 1,000 heroin-addicted individuals

Dually diagnosed patients' responses to substance use disorder treatment

How are addicted physicians treated? A national survey of physician health programs

Table of Contents

Editorial Board

Adherence to methadone treatment: Not just a patient problem

Outcomes from primary care management of alcohol dependence in France

Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys

Organizational contexts of primary care approaches for managing problem drinking

Impact of symptoms experienced by varenicline users on tobacco treatment in a real world setting

Departments of corrections as purchasers of community-based treatment: A national study

Utilization of substance abuse treatment services under Medicare, 2001–2002

Stress-related factors in cannabis use and misuse: Implications for prevention and treatment

Research on the diffusion of evidence-based treatments within substance abuse treatment: A systematic review

Informal discussions in substance abuse treatment sessions

Influence of ownership on access in outpatient substance abuse treatment

Revisiting the past for a look toward future research: A final editorial

Robert Hirsch, MD: 1926–2009

Contents

Editorial Board

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders