Addiction Treatment Facilities Research Articles

Substance Use Disorder Treatment: Opportunities for Interdisciplinary Collaboration in Neurology and Beyond.

Driving the overdose epidemic, a significant proportion of adult and adolescent patients seen in neurology practice and hospital settings has substance use disorder. Fortunately, there are effective treatments available, in particular for opioid addiction. Some elements of treatment can be delivered directly in medical office-based settings, while others are best provided from within specialized addiction treatment facilities. In this article, we review the nature of substance use disorders, and the various treatment approaches that can be utilized to stabilize patients and facilitate their building a strong recovery foundation. Some interventions discussed may be directly provided by a physician identifying the disorder, while others involve collaboration with specialized addiction treatment centers and recovery support entities.

Using implementation methods to study a combined dance/movement therapy (DMT) and cognitive behavioral therapy (CBT) protocol at an inpatient substance use setting

There is evidence that dance/movement therapy (DMT) has positive outcomes for patients with various conditions when used either as a standalone therapy or when coupled with a gold standard modality such as cognitive behavioral therapy (CBT). This combined DMT/CBT has yet to be studied for patients struggling with alcohol and substance use disorders from a structured, manualized, implementation perspective. The current study outlines patient engagement and satisfaction with a 4-session DMT/CBT program at an inpatient addiction treatment facility. The 4-session manualized DMT/CBT protocol comprised “impulse inventory,” “studying impulses,” “subconscious movement,” and “body language.” Participants reported the most engagement in “studying impulses” and attended an average of 2.38 sessions during their time in treatment. Most patients reported receiving some (55%) or substantial (23%) benefit from the protocol. These findings lay the foundation to better optimize a DMT/CBT protocol for patients struggling with alcohol and substance use disorders. However, about a quarter of patients received no benefit from the group (23%), highlighting known barriers to DMT in general. Findings can help small inpatient facilities utilize information toward next steps of optimizing a DMT/CBT protocol.

Effectiveness of Clinical Practicum Experience in Drug Addiction Treatment Facilities in Nursing Students' Attitudes Toward Alcohol, Alcohol Use Disorders, and Alcoholics: Systematic Review and Meta-Analysis.

The aim of this study was to identify, analyze, and synthesize the best evidence on the effectiveness of clinical practicum experience in drug addiction treatment facilities on nursing students' attitudes toward alcohol, alcohol use disorder (AUD), and persons with AUD. This systematic review followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and used the System for the Unified Management of the Assessment and Review of Information to assess methodological quality and extract data for meta-analysis. A comprehensive literature search of the EBSCO databases, Embase, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, PsycINFO, Scopus, Web of Science, Mednar, Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior, and ProQuest Dissertations & Theses catalog was conducted. The System for the Unified Management of the Assessment and Review of Information tool was used for the extraction and critical evaluation of the selected articles followed by a meta-analysis. After removing duplicates, 2,831 publications were identified, and eight met the inclusion criteria. More positive attitudes were observed after performing practicum experience in specialized services (-1.27, 95% confidence interval [-2.85, -0.30]), and an increase in the motivation and satisfaction among the students to care for patients with AUD was also noted. In conclusion, the review suggests that clinical practicum experience in a drug addiction treatment facility has the potential to change the attitudes of nursing students toward AUD and persons with AUD.

Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder

Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale—the Pain-Motivated Drinking Scale (PMDS)—was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol “to get relief from physical pain” at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PerspectiveNociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.

Equity of overdose education and naloxone distribution provided in the Kentucky HEALing Communities Study

BackgroundOpioid overdoses differentially affect demographic groups. Strategies to reduce overdose deaths, specifically overdose education and naloxone distribution (OEND), are not consistently delivered equitably. MethodsThe HEALing Communities StudySM (HCS) is a cluster-randomized trial designed to implement evidence-based practices, including OEND, to reduce overdose deaths across communities. Individuals receiving OEND in eight Kentucky counties between January 2020 and June 2022 provided demographics and overdose history. Recipient characteristics were compared to opioid overdose decedent characteristics to evaluate whether OEND was equitably delivered to the target population. Recipient characteristics were also analyzed based on whether OEND was delivered in criminal justice, behavioral health, or health care facilities. ResultsA total of 26,273 demographic records were analyzed from 137 partner agencies. Most agencies were in behavioral health (85.6 %) or criminal justice sectors (10.4 %). About half of OEND recipients were male (50.6 %), which was significantly lower than the 70.3 % of overdose decedents who were male, (p<0.001). OEND recipients tended to be younger than overdose decedents, but there were not significant differences in race/ethnicity between OEND recipients and overdose decedents. Over 40 % of OEND recipients had overdosed, and 68.9 % had witnessed a prior overdose. There were notable differences across facility types, as males and Black individuals accounted for fewer OEND recipients in addiction treatment facilities compared to jails. ConclusionAlthough OEND recipients’ demographics resembled those of decedents, specific attention should be paid to ensuring equitable OEND access. Variation in OEND uptake by facility type may reflect biases and barriers to care.

Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs.

Drug overdose deaths among adolescents are increasing in the United States. Residential treatment facilities are one treatment option for adolescents with substance use disorders, yet little is known about their accessibility or cost. Using the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data, we identified 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. We called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose, to inquire about policies and costs. Eighty-seven facilities (54.4percent) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. We were unable to identify any facilities for adolescents in ten states or Washington, D.C. Access to adolescent residential addiction treatment centers in the United States is limited and costly.

An Implementation Approach to Translating Assessment Data into Treatment for Disorders of Addiction.

Effective translation of data to inform real-time patient care is lacking in addiction inpatient settings. The current study presents the optimization of an assessment report that is used by clinicians to individualize treatment. A multi-aim, iterative approach was taken, utilizing an implementation science perspective to arrive at a final version of the assessment report. This occurred at a small inpatient addiction treatment facility. Participants were all available clinical staff (N = 7; female = 71%). A quantitative survey was used for aims 1 and 2 to, respectively, assess motives and context around the report as well as evaluate its design. Aim 3 focused on optimization via semi-structured interviews. Descriptive and modified content analyses were utilized appropriately across aims. This resulted in five versions of the assessment report being created between February 2021 and August 2022, the most recent of which was adapted into patients' electronic medical records. We discuss each version of the report in depth, including clinicians' iterative feedback and researchers' perceived barriers to this translational process. The response rate was 64.3%. The current study highlights a replicable approach for optimizing the translation of assessment data into treatment for patients with disorders of addiction as well as an assessment report that could be utilized by similar facilities with a naturally low sample size.

알코올중독 치료기관 간호사의 근무 경험

Objectives: To analyze work experiences of nurses working in alcohol addiction treatment facilities, data were collected through focus group interviews. The objective of this study was to identify role conflicts and enhance their adaptive abilities. Methods: This study was conducted from July 1st, 2022 to September 30th, 2022. Twelve nurses working in two alcohol addiction treatment facilities (selected using intentional sampling methods) participated in this study after obtaining their consent for participation and recording. Data collected through focus group interviews were transcribed and analyzed according to qualitative research methods. Results: Three main themes and 17 subthemes categorized into seven categories were found. The three themes were 'doubts about the work itself,' 'confusing role conflicts,' and 'adaptation and competency enhancement.' The seven categories were: 'initial shock of work,' 'work burden due to exhaustion,' 'doubts about the nursing profession,' 'Conflict of roles where one cannot complain', 'adaptation through personal coping methods,' 'regaining confidence in the role of a nurse' and 'support for competency enhancement.' Conclusions: Nurses in alcohol addiction treatment facilities had different experiences of exhaustion and support depending on the hospital culture they worked in. Nurses recognized that having a clear understanding of their roles was more important than anything else.

In Case You Haven't Heard…

Two giants in addiction treatment, in a field known for competition, have united. And in the process, taken both organizations to, or back to, nonprofit status. Last week the Hanley Foundation announced its acquisition of Origins Behavioral HealthCare. The Hanley Center in West Palm Beach, Florida, is now part of the same system as all Origins facilities across Texas and Florida. “In this era of commercialization of medicine, it is rare, perhaps unheard of, for an addiction treatment facility to go from nonprofit to for‐profit and back to nonprofit again,” said Chip James, board chairman of Hanley Foundation. “Our board of directors, management team, and medical and operational staff are deeply committed to the success of this big step toward eliminating addiction.” Mary Jane Hanley, co‐founder of both Hanley Center and Hanley Foundation said, “At its 40‐year milestone, nothing could make me happier than witnessing the reunification of Hanley Foundation and Hanley Center. You find great reward in helping others, especially if you walk down their path. It brings me comfort knowing that the original mission [that] Jack Hanley and I, in partnership with the community, envisioned for the organization will be fulfilled for many years to come.”

Adapting, Implementing, and Maintaining a Group Cognitive Behavioral Therapy Program at an Inpatient Addiction Treatment Facility.

Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources. The current paper focuses on evaluating the state of our facility's group CBT manual and clinical training on the manual in a "realistic" (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting. Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability). Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place. The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to study their EBP, namely CBT. Such an approach will ensure that the highest quality care is being delivered to patients and actively addresses known training barriers that prevent proper EBP delivery.

A descriptive study of hepatitis C in people who inject drugs.

The seroprevalence of the hepatitis C virus (HCV) in general population is higher than that of human immunodeficiency virus (HIV) in India. People who inject drugs (PWIDs) constitute a high-risk group for all blood-borne infections. Multiple behavioural surveillance surveys have provided a rich typology of HIV-infected PWIDs, but this information is missing for HCV infection. We describe awareness, transmission risk factors and the treatment continuum for HCV infection among PWID. We also report spatial clustering of HCV infection in PWIDs residing in Bengaluru. Information from clinical records was collected and telephonic interviews of retrospectively identified PWIDs who received treatment at a tertiary-level addiction treatment facility between 2016 and 2021 were conducted. We identified 391 PWIDs; 220 (56.26%) received an anti-HCV antibody test (4 th Generation HCV-Tridot). Individuals reporting unsafe injection practices were more often tested than those who did not ( χ2 =44.9, df=1, P <0.01). Almost half of the tested and more than a quarter of the whole sample (109/220, 49.9%; 109/391, 27.9%) were seropositive for HCV infection. The projected seropositivity in this group was between 27.9 per cent (best case scenario, all untested assumed negative) and 71.6 per cent (worst case scenario, all untested assumed positive). Only a minority of participants interviewed were aware of HCV (27/183, 14.7%). HCV infection and its associated risk behaviour (PWID) were clustered in certain localities (Diggle and Chetwynd Test; P =0.001) in Bengaluru in the southern district of Karnataka. Undetected HCV infection is common in PWIDs; awareness and treatment uptake is poor in this group. Spatial clustering of infections in a district shows transmission in close networks and provides opportunities for targeted interventions.

Self-Reported Substance Use With Clinician Interviewers Versus Self-Administered Surveys.

Underreporting of substance use is a frequent concern about studies based on self-report, but few robust studies have examined the agreement between different methods for capturing self-reported substance use. The current study therefore used repeated measures to compare self-reported substance use using (a) clinician interviewers and (b) self-administered computerized surveys in a sample that included both inpatients and community residents. Adults age 18 years and older with problematic substance use were recruited from the community or an inpatient addiction treatment facility. At baseline (N = 588), 3-month (n = 469), and 6-month (n = 476) interviews, participants were asked whether they used alcohol, cannabis, cocaine, heroin, and prescription painkillers by two methods: semi-structured, clinician-administered interview, and computerized self-administered questionnaire. Agreement between these two methods was investigated using Cohen's kappa coefficient. Multivariable logistic regression assessed differences in the odds of discordance between the two measures by recruitment source, gender, age, race/ethnicity, employment status, marital status, and level of education. There was moderate-to-strong agreement between clinician-administered and self-administered surveys for alcohol (kappa = .70-.88), cannabis (kappa = .87-.92), cocaine (kappa = .81-.89), and heroin (kappa = .90-.92). However, there was only weak-to-moderate agreement for nonmedical use of prescription painkillers (kappa = .55-.71), with the self-administered questionnaire capturing a higher prevalence of use (percent difference = 2.4%). Clinician interviewers and self-administered surveys were shown to capture similar rates of self-reported use of alcohol, cannabis, cocaine, and heroin. Surveys assessing nonmedical prescription opioid use may benefit from using self-administered questionnaires.

Is the Clinical Practicum in Addiction Treatment Facilities an Effective Educational Intervention to Improve Nursing Students' Attitudes Toward Alcohol Use Disorders?

The paucity of education and training on alcohol use disorders (AUDs) in nursing curricula is the main predictor of negative attitudes and results in limited knowledge access and delivery of health care for persons experiencing these problems. Although experts advocate increasing the time devoted to alcohol-related content in a crowded curriculum, didactic strategies for teaching about addiction in prequalifying nursing education have been discussed. This study aimed to verify the effectiveness of an educational experience that integrated clinical practicum experience in addiction treatment facilities for nursing students' attitudes. A quasi-experimental one-group study with pre-and-post 3-month follow-ups was carried out with 108 nursing students who answered the Attitudes Scale toward Alcohol, Alcohol Use Disorder, and Patients with Alcohol Use Disorders. The effect of the clinical practicum was apparent, with statistically significant changes to more positive global attitude scores in all measures. Previous educational intervention for AUDs during nursing education was a predictor of positive attitudes (OR = 7.21, p < .04). Students' self-perceived skills and professional preparation to deliver and direct care for patients with AUDs improved after the intervention, suggesting that clinical practice influenced students' skills for AUD identification across nursing practice. Previous contact with this population with lack of training in substance use disorder seems to favor negative attitude development. Clinical practicum experience in addiction treatment facilities improved nursing students' attitudes toward AUDs and patients with AUDs, and its effects were sustained 3 months later.

MANEMOS. The Trigger Situations Inventory. Validation of a Measure Helping Relapse Prevention in the Treatment of Alcohol Use Disorders

Background: Relapse Prevention (RP) is a cognitive-behavioral approach that aims to identify situations at high risk of relapse and to support patients with alcohol use disorders (AUDs) in developing coping strategies for the maintenance of desired behavioral changes. Based on this framework, the present study aims to assess and validate the psychometric properties of the MANEMOS, a 24-item inventory of alcohol relapse triggering situations. Methods: The internal consistency and factor structure of the MANEMOS were analyzed in a sample of 313 (27.7% women) in-patients and out-patients, attending alcohol treatment programs in Italian addiction treatment facilities. Results: The results support the internal reliability and validity of the measure. A confirmative factor analysis has revealed the existence of eight distinct dimensions measuring relapse risk situations: namely, Pleasant emotions, Unpleasant emotions, Craving, Conflicts with others, Occasions, Social Pressure, Personal Control, and Physical Discomfort. The patients’ assessment of the riskiness of the situation showed some significant differences depending on gender and on type of treatment received. Conclusions: The findings indicate that MANEMOS is a valid measure for identifying and reflecting on patients’ high relapse-risk situations. This easy and flexible assessment measure may have important implications for prevention and clinical intervention.

Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022

This study surveyed US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder.

Conceptions of Recovery and Relapse of Severe Mental Illness from the Perspective of Mental Health Personnel in Mexico City

AbstractThis study explores recovery from severe mental disorders from the perspective of 89 mental health care professionals working in Mexico City, using a mixed method approach. The participants were recruited and interviewed from mental health and addiction treatment facilities in Mexico City using convenience sampling techniques. Transcribed interviews were coded and analyzed for thematic content regarding recovery and relapse of mental illness. On the quantitative level, we used a sample of 11 items from the Mexican adaptation of the Opinions about Mental Illness questionnaire to compare the attitudes of health personnel and consider differences by gender. Of the respondents, 18% did not believe that recovery was possible for individuals with severe mental disorders, but most believed in recovery in at least some cases. The results also indicated a strong orientation toward recovery in the clinical sense, focused on patients’ symptomatology. There were significant differences in attitudes toward mental illness items by gender. Men showed more favorable attitudes than women (F = 6.60, p = .05). However, the small size of our sample limits the generalizability of the findings. Educational strategies based on social contact with persons with mental health problems could be useful in modifying negative attitudes toward mental illness.

SOCIO-DEMOGRAPHIC CORRELATES IN PATIENTS COMING TO AN ADDICTION TREATMENT FACILITY AT A TERTIARY CARE HOSPITAL.

Substance use is a multifactorial challenge involving the individual, the substance and the community. Substance users are generally the active workforce of the nation who contribute to the progress,but owing to the substance use, the nation misses out on them. By our study we compiled the sociodemographic data of people coming to an addiction treatment facility in a tertiary care hospital. A cross sectional study was done from April 2021 to December 2022 and 921 patients were assessed. Majority of the patients (71.45%) were from the age group of 21-50 years, and 94.94% of the study sample were males.79.59% were working as a semiskilled / skilled worker. 52.33% were educated up to high school.90.01% of patients were from the upper lower socioeconomic class as per Kuppuswamy's Socioeconomic Scale. A majority of the sample (45.1%) were seen using tobacco and 40.1% of the study sample was using alcohol. Our Results were consistent with many other studies, and were in contrast with some as they had different location where the study was done. It was seen that substance use is more common in working age group with more population belonging to the upper lower socioeconomic class as per kuppuswamy's socioeconomic scale. To tackle this challenge of substance use, awareness about hazards of substance use and better accessibility to addiction treatment facilities is of paramount importance.

Associations between Patient Experience and Addiction Treatment Facility Services: Results of the Addiction Treatment Locator, Assessment, and Standards Surveys.

Patient experience and presence of evidence-based facility services are 2 dimensions of assessing quality of addiction treatment facilities. However, the relationship between these two is not well described. The objective of this study was to explore associations between patient experience measures and service offerings at addiction treatment facilities. We used data from cross-sectional surveys of addiction treatment facilities and persons involved in treatment at corresponding facilities to identify facility services (eg, availability of medications for alcohol use disorder, assistance with obtaining social services, etc) and patient experience measures (overall facility rating, extent helped by treatment, ability to deal with daily problems after treatment), respectively. We used hierarchical multiple logistic regression to test for associations between top-box scores for each patient experience outcome and facility services. We analyzed 9191 patient experience surveys from 149 facilities. Assistance with obtaining social services (adjusted odds ratio [95% confidence interval], 0.43 [0.28-0.66]) was associated with lower overall treatment facility ratings. Childcare (2.00 [1.04-3.84]) was associated with top-box scores for extent helped. Availability of cognitive behavioral therapy (2.67 [1.25-5.73]) and childcare (1.77 [1.08-2.92]) were associated with top-box scores for ability to deal with daily problems after treatment. Assistance with obtaining social services (0.61 [0.41-0.90]) was associated with lower scores for ability to deal with problems after treatment. Few addiction treatment facility services were associated with patient experience measures. Future work should explore bridging the gap between evidence-based services and positive patient experiences.

Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in 6 US States.

We examined drive times to outpatient substance use disorder treatment providers that provide contingency management (CM) and those that integrate CM with medication for opioid use disorder (MOUD) services in 6 US states. We completed cross-sectional geospatial analysis among census tracts in Delaware, Louisiana, Massachusetts, North Carolina, New York, and West Virginia. We excluded census tracts with a population of zero. Using data from the 2020 Shatterproof substance use treatment facility survey, our outcome was the minimum drive time in minutes from the census tract mean center of population to the nearest outpatient CM provider, outpatient CM provider with MOUD services, and federally qualified health centers (FQHC). We stratified census tracts by 2010 Rural-Urban Commuting Area codes and by state. The population was greater than zero in 11,719 of 11,899 census tracts. The median drive time to the nearest CM provider was 12.2 [interquartile range (IQR), 7.0-23.5) minutes and the median drive time to the nearest CM provider increased from 9.7 (IQR, 6.0-15.0) minutes in urban census tracts to 38.8 (IQR, 25.4-53.0) minutes in rural ( H = 3683, P < 0.001). The median drive time increased to the nearest CM provider with MOUD services [14.2 (IQR, 7.9-29.5) minutes, W = 18,877, P < 0.001] and decreased to the nearest FQHC [7.9 (IQR, 4.3-13.6) minutes, W = 11,555,894, P < 0.001]. These results suggest limited availability of CM, particularly within rural communities and for patients needing concurrent CM and MOUD treatment. Our results suggest greater adoption of CM within FQHCs could reduce urban-rural disparities in CM availability.

357 Using Assessments to Create a Translational Pipeline at a Science-Based Inpatient Addiction Treatment Facility

OBJECTIVES/GOALS: Effective translation of data to inform real-time patient care is lacking in addiction inpatient settings. The current study presents the optimization of a Comprehensive Rehabilitation Assessment summary report that is used by clinicians to individualize treatment. METHODS/STUDY POPULATION: A multi-aim approach was taken that utilized aspects of various implementation science frameworks. Participants were clinical staff (N = 7; female = 71%). A quantitative survey was used for aims 1 and 2 to assess motives and context around the report as well as evaluate the design of it. Aim 3 focused on optimization via semi-structured interviews. Descriptive and modified content analyses were utilized appropriately for each aim. RESULTS/ANTICIPATED RESULTS: Five versions of the assessment report were created between February 2021 and August 2022, the most recent of was adapted into patients’electronic medical records based on study results. Each report version, participants’results/feedback, and researchers’perceived barriers to this translational process will be discussed. DISCUSSION/SIGNIFICANCE: The current study highlights a replicable approach for optimizing the translation of assessment data into treatment for patients with disorders of addiction.