12-step Groups Research Articles

An Overview of the Efficacy of the 12-Step Group Therapy for Substance Abuse Treatment

This study was designed to determine if 12-Steps groups efficacy for substance abuse treatment significantly improve abstinence rates of heroin addicts in the short run and long run (1-year and 5-year period); and if abstinence rates are found to be lower for heroin addicts that have attended 12-Step groups at the 1-year mark, and if similar results would be expected at the 5-year mark. Secondary data from the Inter-University Consortium of Political and Social Research (ICPSR) was extracted and analyzed for the aforementioned hypothesis. Using SSPS to test the research hypothesis for the 1 -Year Follow Up, the chi-square test shows a p-value below of .10, and the analysis determined that there was significant evidence to support the hypothesis that cases in a 12-Steps or self-help program have a higher success than cases not in a program for the 1 -year follow up. For 5-Year Follow Up, the cases that attended a 12-Step program or a self-help program and about 27% went on to use heroin during the last 12 months compared to 34% cases that did not go to a program.

‘A New Way to Live My Life’: How Al-Anon Influences Resilience: A Qualitative Account

ABSTRACTAlcoholism can have deep and enduring negative outcomes for the close relatives of problem drinkers. This qualitative study explored Al-Anon's (a 12-step mutual-help group for relatives) role in enhancing resilience among its members. Data from 2 focus groups (n = 5 and n = 3, respectively) and 2 individual interviews were analyzed using interpretative phenomenological analysis. Participants described increased positive adaptation in terms of personal growth and enhanced functioning. The findings indicated that Al-Anon plays a role in fostering resilience among members by providing protective factors. The implications were discussed in the context of bolstering clinical interventions.

Text message content preferences to improve buprenorphine maintenance treatment in primary care

ABSTRACTFew studies have evaluated text message content preferences to support evidence-based treatment approaches for opioid use disorders, and none in primary care office-based buprenorphine treatment settings. This study assessed the acceptability and preferences for a tailored text message intervention in support of core office-based buprenorphine treatment medical management components (e.g., treatment adherence, encouraging abstinence, 12-step group participation, motivational interviewing, and patient-provider communication as needed). There were 97 patients enrolled in a safety net office-based buprenorphine treatment program who completed a 24-item survey instrument that consisted of multiple-choice responses, 7-point Likert-type scales, binomial “Yes/No” questions, and open-ended responses. The sample was predominately male (81%), had an average age of 46 years, and was diverse (64% ethnic/racial minorities); 56% lacked stable employment. Respondents were interested in receiving text message appointment reminders (90%), information pertaining to their buprenorphine treatment (76%), supportive content (70%), and messages to reduce the risk of relapse (88%). Participants preferred to receive relapse prevention text messages during all phases of treatment: immediately after induction into buprenorphine treatment (81%), a “few months” into treatment (57%), and after discontinuing buprenorphine treatment (72%). Respondents also expressed interest in text message content enhancing self-efficacy, social support, and frequent provider communication to facilitate unobserved “home” induction with buprenorphine. Older participants were significantly less receptive to receiving text message appointment reminders; however, they were as interested in receiving supportive, informational, and relapse prevention components compared to younger respondents. Implications for integrating a text message support system in office-based buprenorphine treatment are discussed.

Social processes explaining the benefits of Al-Anon participation.

This study examined social processes of support, goal direction, provision of role models, and involvement in rewarding activities to explain benefits of participating in Al-Anon, a 12-step mutual-help program for people concerned about another person's substance use. Newcomers to Al-Anon were studied at baseline and 6 months later, at which time they were identified as having either sustained attendance or dropped out. Among both newcomers and established Al-Anon members ("old-timers"), we also used number of Al-Anon meetings attended during follow-up to indicate extent of participation. Social processes significantly mediated newcomers' sustained attendance status versus dropped out and outcomes of Al-Anon in the areas of life context (e.g., better quality of life, better able to handle problems due to the drinker), improved positive symptoms (e.g., higher self-esteem, more hopeful), and decreased negative symptoms (e.g., less abuse, less depressed). Social processes also significantly mediated newcomers' number of meetings attended and outcomes. However, among old-timers, Al-Anon attendance was not associated with outcomes, so the potential mediating role of social processes could not be examined, but social processes were associated with outcomes. Findings add to the growing body of work identifying mechanisms by which 12-step groups are effective, by showing that bonding, goal direction, and access to peers in recovery and rewarding pursuits help to explain associations between sustained Al-Anon participation among newcomers and improvements on key concerns of Al-Anon attendees. Al-Anon is free of charge and widely available, making it a potentially cost-effective public health resource for help alleviating negative consequences of concern about another's addiction.

How Do Females With PTSD and Substance Abuse View 12-Step Groups? An Empirical Study of Attitudes and Attendance Patterns

Background. Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. Objectives. We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind. Methods. Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity. Results. Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se.

Physical and self-reported response and the pharmacokinetics of e-cigarettes compared to cigarettes in substance-abusing participants

control training including relevant 12-Step content (AC). Posttraining and 6-mo follow-up observations of 12-Step groups were audiotaped and coded for adherence to 12-Step content and skillfulness. 12-Step engagement and self-reported substance use was assessed among clients (N=307) for six months following toolkit exposure. Results: TK counselors demonstrated very large Preto PostTraining adherence improvements in core curriculum techniques (F=55.49, p< .0001; d=2.07) and moderate improvements in 12Step content (F=4.66, p= .011; d= .55) relative to counselors in the AC condition. These effects were consistent and durable at 6months. Therewerenomaineffects of TKexposureon self-reported 12-stepattendanceandsubstanceuse.Amongclients activelyusing at baseline (35%), TK clients reported significantly fewer drinking days (p= .024; d= .52) and a trend towards fewer drug use days (p= .076; d= .49) relative to AC clients at 3 months. These differences were attenuated and no longer significant at 6 months. Conclusions: Multimedia toolkits are an easily disseminated approach to durably improve group counseling outcomes in community treatment for key client subgroups with minimal training and supervision. Financial support: NIAAA R01 AA017867.

Predicting patient post-detoxification engagement in 12-step groups with an extended version of the theory of planned behavior.

IntroductionIndividuals with substance use disorders can receive important abstinence-specific support in 12-step groups (TSGs). However, our understanding of key factors that influence TSG participation remains limited. This study used an extended version of the theory of planned behavior (TPB) to enhance the understanding of TSG affiliation.MethodsData were retrieved from a controlled trial of a 12-step facilitation intervention conducted on an inpatient detoxification ward in Norway (N = 140). Surveys at baseline included a TPB questionnaire. The behavioral target was to attend at least two TSG meetings per month in the 6-month follow-up period. Structural equation modeling was used to analyze the predictors of behavior at follow-up.ResultsWe found that attitudes, the moral norm, and perceived behavior control accounted for 81 % of the variance in the intention to participate regularly in TSGs after treatment. Subjective norms did not significantly influence the intention to participate. Moreover, the intention to participate significantly predicted behavior (β = 0.42, p < 0.001). In contrast to theory, there was a substantial, model-independent pathway from past to later behavior (β = 0.22, p = 0.047). The model explained 46 % (p < 0.001) of the variance in behavior. Attending ≥ 12 TSG meetings in the follow-up period was associated with a high percentage of abstinent days at follow-up (β = 0.38, p = 0.023).ConclusionsThe present TPB questionnaire worked well for assessing patient intentions to attend a TSG. Treatment providers should encourage patient intentions to participate in TSGs post-detoxification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13722-015-0036-3) contains supplementary material, which is available to authorized users.

Rehab, respite and recovery: the experiences of methadone users in a modified therapeutic community (MTC) in Scotland

Purpose – There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms. Design/methodology/approach – A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software. Findings – Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”? Research limitations/implications – A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative. Practical implications – Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers. Social implications – This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success. Originality/value – There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.

Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes

This analysis examines patient experiences and outcomes with 12-step recovery group attendance during buprenorphine maintenance treatment (BMT), two approaches with traditionally divergent philosophies regarding opioid medications for treatment of opioid use disorder. Using quantitative (n=300) and qualitative (n=20) data collected during a randomized trial of counseling services in buprenorphine treatment, this mixed-methods analysis of African Americans in BMT finds the number of NA meetings attended in the prior 6months was associated with a higher rate of retention in BMT (p<.001) and heroin/cocaine abstinence at 6month follow-up (p=.005). However, patients whose counselors required them to attend 12-step meetings did not have better outcomes than patients not required to attend such meetings. Qualitative narratives highlighted patients' strategies for managing dissonant viewpoints on BMT and disclosing BMT status in community 12-step meetings. Twelve-step meeting attendance is associated with better outcomes for BMT patients over the first 6months of treatment. However, there is no benefit to requiring meeting attendance as a condition of treatment, and clinicians should be aware of potential philosophical conflicts between 12-step and BMT approaches.

Mobile phone use patterns and preferences in safety net office-based buprenorphine patients.

Integrating mobile phone technologies in addiction treatment is of increasing importance and may optimize patient engagement with their care and enhance the delivery of existing treatment strategies. Few studies have evaluated mobile phone and text message (TM) use patterns in persons enrolled in addiction treatment, and none have assessed the use in safety net, office-based buprenorphine practices. A 28-item, quantitative and qualitative semistructured survey was administered to opiate-dependent adults in an urban, publicly funded, office-based buprenorphine program. Survey domains included demographic characteristics, mobile phone and TM use patterns, and preferences pertaining to their recovery. Surveyors approached 73 of the 155 eligible subjects (47%); 71 respondents completed the survey. Nearly all participants reported mobile phone ownership (93%) and TM use (93%), and most reported "very much" or "somewhat" comfort sending TM (79%). Text message contact with 12-step group sponsors, friends, family members, and counselors was also described (32%). Nearly all preferred having their providers' mobile phone number (94%), and alerting the clinic via TM in the event of a potential relapse to receive both supportive TM and a phone call from their buprenorphine provider was also well received (62%). Mobile phone and TM use patterns and preferences among this sample of office-based buprenorphine participants highlight the potential of adopting patient-centered mobile phone-based interventions in this treatment setting.

First-Person Perspectives on Dual Diagnosis Anonymous (DDA): A Qualitative Study

Objective: People with dually diagnosed substance abuse and mental illnesses often feel alienated at traditional 12-step meetings, yet they need the peer support provided by such groups. Dual Diagnosis Anonymous (DDA) is a peer-support program specifically for people with co-occurring disorders, which addresses many of the factors that members find alienating about traditional 12-step groups. This study aimed to elicit first-person perspectives on DDA. Methods: Occupational therapy students conducted 13 focus groups with 106 DDA members in three settings: the community (6 groups, n = 36), correctional facilities (5 groups, n = 53), and the state psychiatric hospital (2 groups, n = 17). Researchers inductively analyzed focus group transcripts to identify prominent themes. Results: The vast majority of participants were between the ages of 18 and 49 (n = 87, 82.1%) and were non-Hispanic/White (n = 82, 77.4%). Most participants had been using substances for more than 10 years and had a diagnosed mental illness for more than 10 years. The most common substance of choice among those in the community and corrections setting was multiple substances, while those in the state hospital identified alcohol most often. Bipolar disorder was the most common mental illness diagnosis among participants in the state hospital, but depression and anxiety were the two most common diagnoses in the community and corrections participants. Four primary themes emerged from the qualitative analysis: (1) feeling accepted by others in the group, (2) understanding the interactive nature of dual disorders, (3) the open discussions in DDA meetings, and (4) a focus on hope and recovery from both illnesses. Conclusions: DDA provides a helpful alternative for individuals who do not feel comfortable at traditional 12-step groups due to their mental illness. Members value the acceptance, understanding, discussion, and hope in DDA meetings.

Consistency between beliefs and behavior regarding use of substances in recovery.

This paper addresses the assumption that pathways to recovery from substance abuse and dependence, and the language used to define one's relationship to substances, translate to actual beliefs and behaviors in terms of substance use. We draw on social representation theory, and use data from a large web-based study (n=9,341) whose goal was to understand how individuals in recovery define what recovery means to them. We often hear people say that they are "in recovery," and present findings now provide empirical evidence of the prevalent meanings of this ubiquitous expression. The belief that recovery is abstinence was broadly held in our sample, especially among those exposed to treatment and 12-step self-help groups and who define themselves as in recovery-and most (but not all) of such individuals are complete abstainers (no alcohol or drugs). In contrast, among the "self-changers" who did not attend treatment or self-help groups, the most common self-definition was used to have an alcohol or drug problem but don't any more, half of whom believe that recovery is abstinence while half do not, and only one-third are abstainers. Findings are of public health relevance, as it is estimated that among American adults alone, 10% report having had alcohol or drug problems but no longer do (The New York State Office of Alcoholism and Substance Abuse Services (OASAS), 2012). In line with the central concepts of social representation theory, people's pathways to recovery have a strong effect on how they define themselves and their behaviors and beliefs, but it is not universal.

Criminal Typology of Veterans Entering Substance Abuse Treatment

Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N=332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6months and 1year post-intake. Cluster analysis yielded three types of criminal histories mild—(78.9%), moderate (13.6%), and severe (7.5%)—distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.

Reported use of non-prescribed marijuana for biomedical and psychiatric conditions among regular marijuana users

Aims: Substance use disorders (SUD) often start in adolescence, making this transitional period critical. Treatment is effective for youths but relapse is common. For youths in SUD remission wishing to attend college, the high rates of substance use on campus are a serious threat to continued sobriety. Collegiate Recovery Programs (CRPs) are an innovative model of campus-based recovery support that is growing exponentially but remains unexplored. Demographic andclinical information is lackingonstudents inCRPs and on their experiences with CRPs. Such knowledge can inform model development and evaluation. Methods: Data from an online survey of CRP students describes their background and clinical history, reasons for CRP participation, overall experiences with and use of CRP services. Results: Students (preliminary N=480, target M=550) from 25 universities in17 states were 56% male, Caucasians (91%) with an average age of 26; 12% were veterans. Drugs had been the primary problem for 58% (42% alcohol). Over half (59%) had been charged with a crime and 33% had had a period of homelessness; 82% had been in addiction treatment, 93% had attended 12-steps. Although substance-free, a minority engage in other addictive behaviors at a problematic level (e.g., 12% each compulsive eating and sex/love addiction past 90 days); 41% smoke and 66% are being treated for a mental healthproblem. CRPenrollmentduration ranged from1 to8 semesters; top referral sources areword ofmouth (29%), treatment (22%) and 12-step groups (12%). One third of students said they would not be in college right now were it not for the CRP and 60% find the CRP quite a bit or extremely helpful to their recovery. Conclusions: CRP students experienced severe consequences of their SUD; CRPs may promote college attendance in recovery. Further information is needed on compulsive behavior patterns in recovery to promote healthy functioning. Financial Support: Financial support NIDA Grant R21DA033448.

Maximizing Social Model Principles in Residential Recovery Settings

Peer support is integral to a variety of approaches to alcohol and drug problems. However, there is limited information about the best ways to facilitate it. The “social model” approach developed in California offers useful suggestions for facilitating peer support in residential recovery settings. Key principles include using 12-step or other mutual-help group strategies to create and facilitate a recovery environment, involving program participants in decision making and facility governance, using personal recovery experience as a way to help others, and emphasizing recovery as an interaction between the individual and their environment. Although limited in number, studies have shown favorable outcomes for social model programs. Knowledge about social model recovery and how to use it to facilitate peer support in residential recovery homes varies among providers. This article presents specific, practical suggestions for enhancing social model principles in ways that facilitate peer support in a range of recovery residences.

Toward Enhancing 12-Step Facilitation Among Young People: A Systematic Qualitative Investigation of Young Adults’ 12-Step Experiences

ABSTRACT. Background: 12-Step Facilitation (TSF) interventions designed to enhance rates of engagement with 12-step mutual-help organizations (MHOs) have shown efficacy among adults, but research provides little guidance on how to adapt TSF strategies for young people. Methods: To inform TSF strategies for youth, this study used qualitative methods to investigate the self-reported experiences of 12-step participation, and reasons for nonattendance and discontinuation among young adults (18–24 years; N = 302). Responses to open-ended questions following residential treatment were coded into rationally derived domains. Results: Young adults reported that cohesiveness, belonging, and instillation of hope were the most helpful aspects of attending 12-step groups; meeting structure and having to motivate oneself to attend meetings were the most common aspects young adults liked least; logistical barriers and low recovery motivation and interest were the most common reasons for discontinued attendance; and perceptions that one did not have a problem or needed treatment were cited most often as reasons for never attending. Conclusions: Findings may inform and enhance strategies intended to engage young people with community-based recovery-focused 12-step MHOs and ultimately improve recovery outcomes.

Satisfaction with substance use treatment and 12-step groups predicts outcomes

IntroductionSatisfaction is a critical component of patient-centered care, yet little is known about the degree to which patient satisfaction is linked to subsequent outcomes, especially in substance use disorder (SUD) treatments and 12-step groups. The current study assessed the degree to which satisfaction with Department of Veterans Affairs (VA) outpatient SUD treatment and with 12-step groups, both measured at 6 months after treatment initiation, was associated with additional treatment utilization and better substance-related outcomes during the next 6 months, that is, up to 1 year after treatment initiation. MethodsParticipants were 345 patients entering the VA SUD treatment program. ResultsMore satisfaction with treatment and with 12-step groups at 6 months was associated with less alcohol use severity and more abstinence at 1 year. More treatment satisfaction was related to less subsequent medical severity, whereas more 12-step group satisfaction was related to less subsequent psychiatric severity. More 12-step group satisfaction was related to subsequent increases in 12-step group attendance and involvement. A single item assessing overall satisfaction appeared best related to subsequent outcomes. ConclusionsSatisfied SUD treatment patients and 12-step mutual help members appeared to have better subsequent service utilization patterns and treatment outcomes. SUD treatments can improve outcomes by monitoring and enhancing patient satisfaction.

When does self-help actually help?

The author discusses the self-help industry as of July 2014, focusing on the potential scientific evaluation of purported claims and programs that could be dangerous for participants. Topics include cognitive-behavior therapy, 12-step groups such as Alcoholics Anonymous, peer pressure, the sociologist Christine Whelan, and the deaths of people such as Kirby Brown at a retreat organized by the self-help guru James Arthur Ray.

Implementation of an electronic information system to enhance practice at an opioid treatment program

s / Drug and Alcohol Dependence 140 (2014) e2–e85 e21 Evidence-based multimedia 12-step facilitation toolkit improves counselor adherence in group counseling with minimal training: Preliminary results Adam C. Brooks1, Alexandre B. Laudet2, T. Case1, C.M. Carpenedo1, D. Knoblach1, L. Benishek1, D. Carise3, K.C. Kirby1,3 1 Treatment Research Institute, Philadelphia, PA, United States 2 National Development and Research Institute, New York, NY, United States 3 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Numerous psychosocial interventions effectively improve client outcomes in clinical trials, but adapting evidencebased protocols into formats suitable for dissemination to community treatment programs is challenging. We translated 12-Step Facilitation (12SF) into a multimedia curriculum toolkit to help counselors deliver clinically useful group sessions that convey core elements of 12SF; we tested the toolkit’s conceptual fidelity and clinical utility. Methods: Toolkit material development was informed by consultation with content experts, counselors and clients, to develop simple, engaging presentations of core 12SF concepts. In a pre-post design, we coded 2 treatment groups on preselected 12-Step topics runby10 counselors. Counselorswere randomly assigned to attend a 3-h training to familiarize themwith the 12SF toolkit and accompanying self-teaching strategies (TK), or to an attention control training including relevant 12-Step content (AC). Post-training 12Step groups were audiotaped and coded for adherence to 12-Step content and skillfulness. 12-Step engagement and self-reported substanceusewas assessed among clients (N=44) for threemonths following toolkit exposure. Results: TK counselors demonstrated very large and statistically significant Preto Post-Training adherence improvements in 12SF techniques (mean d=1.74) and in 12-Step content (mean d=1.49) relative to counselors in the AC condition. TK counselors also demonstratedmoderate improvement in skill when delivering 12-Step content (mean d=0.58). TK exposed clients self-reported significantly fewer drinking days (d= .59) and fewer drug use days (d= .49) relative to AC clients. Conclusions: Preliminary results show thatmultimedia toolkits may be a costeffective, easily disseminated approach to improve group counseling in community treatment with minimal training. Financial support: NIAAA R01 AA017867. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.078 Implementation of an electronic information system to enhance practice at an opioid treatment program L.S. Brown, Steven A. Kritz, Melissa Lin Addiction Research and Treatment Corporation, Brooklyn, NY, United States Aims: The Addiction Research and Treatment Corporation is a medication-assisted opioid treatment program, also providing primary care (including HIV care) to approximately 2800 predominantly minority adults in New York City. We received National Institute on Drug Abuse R01 funding to study implementation of an electronic health information system. Methods: The domains of Quality, Risks, Productivity, Satisfaction, and Finances were evaluated utilizing a pre-post implementation study design. Subsequent to the research, we exploited systemcapabilities tomeasureOutcomes forHIVdisease, diabetesmellitus, and hypertension for 100% of patients under care for these conditions. Results: For the Quality domain, annual medical assessments and annual, 30-day, and 90-day multidiscipline assessments were timely for 83%, 70%, 72%, and 42% of cases, respectively, pre-implementation; and 97%, 96%, 87%, and 70% respectively, post-implementation. All results were highly significant. Hepatitis C viral load was appropriately performed in 85% of cases pre-implementation and 81% post-implementation; a nonsignificant difference. For Risks, the number of events was too low to detect a statistically meaningful change. For Satisfaction, there was no change for patients and a non-significant upward trend post-implementation for staff. Productivity declined postimplementation; reaching statistical significance for counselors. Finances did not change significantly. Outcomes for HIV disease (suppressed viral load), diabetes mellitus (HgbA1C<7), and hypertension (BP<140/90) showed improvement over the course of a 1-year timeframe. Conclusions: Despite onlymodest research results, we can now demonstrate system capabilities that improve patient outcomes, the key measure of patient status. Financial support: Researchsupportedby theNational Institute on Drug Abuse (R01 DA022030). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.079 Association of objective and perceived neighborhood characteristics with tobacco use among young adults Qiana L. Brown1, A.J. Milam1, M.J. Smart1, R.M. Johnson2, Sabriya L. Linton1, C.D. Furr-Holden1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Boston University School of Public Health, Boston,

Evidence-based multimedia 12-step facilitation toolkit improves counselor adherence in group counseling with minimal training: Preliminary results

s / Drug and Alcohol Dependence 140 (2014) e2–e85 e21 Evidence-based multimedia 12-step facilitation toolkit improves counselor adherence in group counseling with minimal training: Preliminary results Adam C. Brooks1, Alexandre B. Laudet2, T. Case1, C.M. Carpenedo1, D. Knoblach1, L. Benishek1, D. Carise3, K.C. Kirby1,3 1 Treatment Research Institute, Philadelphia, PA, United States 2 National Development and Research Institute, New York, NY, United States 3 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Numerous psychosocial interventions effectively improve client outcomes in clinical trials, but adapting evidencebased protocols into formats suitable for dissemination to community treatment programs is challenging. We translated 12-Step Facilitation (12SF) into a multimedia curriculum toolkit to help counselors deliver clinically useful group sessions that convey core elements of 12SF; we tested the toolkit’s conceptual fidelity and clinical utility. Methods: Toolkit material development was informed by consultation with content experts, counselors and clients, to develop simple, engaging presentations of core 12SF concepts. In a pre-post design, we coded 2 treatment groups on preselected 12-Step topics runby10 counselors. Counselorswere randomly assigned to attend a 3-h training to familiarize themwith the 12SF toolkit and accompanying self-teaching strategies (TK), or to an attention control training including relevant 12-Step content (AC). Post-training 12Step groups were audiotaped and coded for adherence to 12-Step content and skillfulness. 12-Step engagement and self-reported substanceusewas assessed among clients (N=44) for threemonths following toolkit exposure. Results: TK counselors demonstrated very large and statistically significant Preto Post-Training adherence improvements in 12SF techniques (mean d=1.74) and in 12-Step content (mean d=1.49) relative to counselors in the AC condition. TK counselors also demonstratedmoderate improvement in skill when delivering 12-Step content (mean d=0.58). TK exposed clients self-reported significantly fewer drinking days (d= .59) and fewer drug use days (d= .49) relative to AC clients. Conclusions: Preliminary results show thatmultimedia toolkits may be a costeffective, easily disseminated approach to improve group counseling in community treatment with minimal training. Financial support: NIAAA R01 AA017867. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.078 Implementation of an electronic information system to enhance practice at an opioid treatment program L.S. Brown, Steven A. Kritz, Melissa Lin Addiction Research and Treatment Corporation, Brooklyn, NY, United States Aims: The Addiction Research and Treatment Corporation is a medication-assisted opioid treatment program, also providing primary care (including HIV care) to approximately 2800 predominantly minority adults in New York City. We received National Institute on Drug Abuse R01 funding to study implementation of an electronic health information system. Methods: The domains of Quality, Risks, Productivity, Satisfaction, and Finances were evaluated utilizing a pre-post implementation study design. Subsequent to the research, we exploited systemcapabilities tomeasureOutcomes forHIVdisease, diabetesmellitus, and hypertension for 100% of patients under care for these conditions. Results: For the Quality domain, annual medical assessments and annual, 30-day, and 90-day multidiscipline assessments were timely for 83%, 70%, 72%, and 42% of cases, respectively, pre-implementation; and 97%, 96%, 87%, and 70% respectively, post-implementation. All results were highly significant. Hepatitis C viral load was appropriately performed in 85% of cases pre-implementation and 81% post-implementation; a nonsignificant difference. For Risks, the number of events was too low to detect a statistically meaningful change. For Satisfaction, there was no change for patients and a non-significant upward trend post-implementation for staff. Productivity declined postimplementation; reaching statistical significance for counselors. Finances did not change significantly. Outcomes for HIV disease (suppressed viral load), diabetes mellitus (HgbA1C<7), and hypertension (BP<140/90) showed improvement over the course of a 1-year timeframe. Conclusions: Despite onlymodest research results, we can now demonstrate system capabilities that improve patient outcomes, the key measure of patient status. Financial support: Researchsupportedby theNational Institute on Drug Abuse (R01 DA022030). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.079 Association of objective and perceived neighborhood characteristics with tobacco use among young adults Qiana L. Brown1, A.J. Milam1, M.J. Smart1, R.M. Johnson2, Sabriya L. Linton1, C.D. Furr-Holden1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Boston University School of Public Health, Boston,