Addiction Treatment Outcomes Research Articles

EVALUATING THE EFFICACY OF COGNITIVE BEHAVIORAL THERAPY FOR AMPHETAMINE USE DISORDER: IMPACT OF SOCIO-DEMOGRAPHIC AND BEHAVIORAL FACTORS IN PAKISTAN

Background: Amphetamine use disorder (AUD) is a significant public health concern globally, with rising incidence in Pakistan. Cognitive Behavioral Therapy (CBT) is a well-established intervention for substance use disorders, yet its effectiveness may vary based on socio-demographic and behavioral factors. This study aims to assess the efficacy of CBT for AUD in Pakistan and explore how factors such as education, profession, duration of addiction, residence, age, family support, smoking, and alcohol intake impact treatment outcomes. Methods: A quasi-experimental design was utilized with 100 participants recruited from outpatient treatment facilities and rehabilitation centers across Pakistan. Fifty participants received a culturally adapted CBT program, while 50 participants in the control group received standard treatment as usual (TAU). Pre-test and post-test assessments measured changes in AUD symptoms, psychological well-being, quality of life, and relapse rates. Data were analyzed using descriptive statistics, paired t-tests, ANOVA, multiple regression, and survival analysis. Results: Participants in the CBT group showed a significant reduction in the frequency of amphetamine use from 5.8 to 2.3 days per week (p < 0.001), and a substantial decrease in Addiction Severity Index (ASI) scores from 30.2 to 18.7 (p < 0.001). Improvements were also observed in psychological measures, with Beck Depression Inventory (BDI) scores decreasing from 22.4 to 14.1 (p < 0.001) and General Anxiety Disorder-7 (GAD-7) scores decreasing from 18.5 to 11.3 (p < 0.001). Quality of Life (WHOQOL-BREF) scores improved significantly from 45.3 to 62.0 (p < 0.001). The TAU group showed improvements, but these were less pronounced compared to the CBT group. Socio-demographic factors such as higher education, stable employment, and strong family support were positively associated with better outcomes, while unemployment, longer duration of addiction, and regular alcohol intake were negatively associated. Conclusions: CBT is effective in reducing amphetamine use, improving psychological well-being, and enhancing quality of life among individuals with AUD in Pakistan. The study highlights the importance of tailoring CBT interventions to consider socio-demographic and behavioral factors to optimize treatment outcomes.

Integrating Neuro-informed Counseling Techniques in Addiction Treatment Outcomes Among Drug Addicts in Rehabilitation Centers in Kenyan (Systematic Review Analysis)

Background: The rising prevalence of substance use disorders in Kenya necessitates the exploration of innovative treatment approaches. Neuro-informed counseling techniques, which integrate insights from neuroscience into therapeutic practices, have shown promise in enhancing treatment outcomes for individuals struggling with addiction. This systematic review aims to evaluate the effectiveness of neuro-informed counseling techniques in improving addiction treatment outcomes among drug addicts in rehabilitation centers in Kenya. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, PsycINFO, and Google Scholar, to identify studies published between 2010 and 2023 that focused on neuro-informed counseling techniques in addiction treatment within Kenyan rehabilitation settings. Inclusion criteria encompassed randomized controlled trials, cohort studies, and qualitative research that reported on treatment outcomes such as relapse rates, psychological well-being, and overall recovery. Results: A total of 15 studies met the inclusion criteria, revealing a significant positive impact of neuro-informed counseling techniques on treatment outcomes. Key findings indicated that these techniques, which include mindfulness-based interventions, cognitive-behavioral strategies, and neuro-feedback, were associated with reduced relapse rates, improved emotional regulation, and enhanced coping skills among participants. Additionally, qualitative data highlighted increased engagement and motivation in treatment, suggesting that neuro-informed approaches foster a more supportive therapeutic environment. Conclusion: The integration of neuro-informed counseling techniques in addiction treatment within Kenyan rehabilitation centers demonstrates promising potential for improving outcomes among drug addicts. This systematic review underscores the need for further research to establish standardized protocols and training for practitioners, as well as to explore the long-term effects of these interventions. By adopting a neuro-informed approach, rehabilitation centers can enhance the efficacy of their treatment programs, ultimately contributing to better recovery rates and improved quality of life for individuals affected by addiction.

A pilot randomized controlled trial of medication adherence therapy: Psychosocial leverage using a significant other (MAT-PLUS) for individuals on extended-release naltrexone

BackgroundExtended-release naltrexone (XR-NTX) is an important treatment option for individuals with opioid use disorder (OUD) and/or alcohol use disorder (AUD). However, problems with retention are a major barrier to its overall effectiveness, and interventions to improve adherence are underdeveloped. The purpose of this study was to pilot test the MAT-PLUS intervention, which combines assertive outreach and involvement of a treatment significant other (TSO) to improve adherence to XR-NTX. MethodsAdults (N = 41) seeking treatment for OUD and/or AUD with XR-NTX were recruited from an inpatient addiction treatment center and randomized to the MAT-PLUS intervention or treatment as usual (TAU) for 16-weeks. TSOs (N = 19) of individuals in the MAT-PLUS condition were also enrolled. The primary outcome was the number of XR-NTX doses received and relapse to regular heavy use (opioid or alcohol) was a secondary outcome. ResultsParticipants in the MAT-PLUS group received 3.4 doses compared to 2.5 in TAU, which was significant after controlling for SUD diagnosis (p < 0.05). Rates of receipts of all prescribed doses were 61.1 % in MAT-PLUS compared to 30.4 % in TAU, giving an NNT of 3.3. Relapse rates and days of heavy use did not vary by treatment group. ConclusionsThis study demonstrates preliminary efficacy of the MAT-PLUS intervention for XR-NTX adherence. This study was limited by its small sample size and future research should broaden the intervention to apply across medications for SUD in larger samples. Family support with an emphasis on medication adherence has strong potential for improving addiction treatment outcomes.

Opioid Use Disorder Treatment Prescribers’ Views of Implementing an Electronic System to Collect Patient-Reported Outcomes Measures

Use of patient-reported outcomes measures (PROMs) may improve addiction treatment outcomes. This qualitative study investigated barriers and facilitators for PROMs implementation among prescribers of medications for opioid use disorder (MOUD) participating in AMNet, an addiction medicine practice-based research network. Semi-structured interviews were conducted with seven qualitative research participants of 57 AMNet providers. Interview data were analyzed thematically and coded using ATLAS.ti. Barriers included lack of electronic health record (EHR) integration; user interface issues; insufficient administrative support; challenges with patient engagement; and lack of fit with clinical practice. Facilitators included perceptions that PROMs use would improve outcomes and increase accountability while advancing addiction medicine. Patient-reported outcomes measures implementation is feasible in small outpatient MOUD practices, although resource constraints and technological barriers may reduce potential reach.

Addiction Treatment Outcomes: Examining the Impact of an Inpatient Program for Substance Use Disorders and Concurrent Mental Distress

ABSTRACT Substance use disorders (SUDs) affect over 35 million individuals worldwide and are associated with significant harms. Residential treatment is an essential component of Canada’s approach to combating SUDs, offering highly intensive and specialized acute services. Historically, residential treatment facilities have quantified the success of their program(s) solely based on program completion. However, there has been a recent movement toward empirically evaluating programs using standardized measures of distress. The purpose of this study was to evaluate whether the inpatient residential program for SUDs at Edgewood Treatment Centre is effective in providing substantive improvement of a range of addiction and mental health symptoms. The current study assessed both addiction related and psychological outcomes. Specifically, we examined whether patients improved on various measures of functional impairment, addiction-related symptoms, traumatic stress, and psychological distress, following completion of the 7-week inpatient addiction program. Findings suggested that there were significant improvements in emotion regulation, and decreases in substance dependence, substance cravings, anxiety, depressive symptoms, and traumatic stress between admission and discharge.

Potential predictors of smoking relapse in treatment-seeking smokers

Impulsive behavior problems are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes. This study aims to evaluate the capacity of impulsive behavior to predict the risk of relapse and the number of relapses for smokers. The sample comprised 141 participants (Mage= 47.3, SD= 8.31; 59% females) in psychopharmacology treatment for dependence to nicotine. Participants provided breath carbon monoxide samples for determining smoking throughout the study. The different impulsiveness dimensions were evaluated with a Go/NoGo task, the visual search and attention test and a delayed discount task, while self-informed impulsivity was assessed with Barratt’s Impulsiveness Scale. Unplanned impulsivity, attention failures and performance in the Go/NoGo task are postulated among the individual factors related to the number of relapses. Our results contribute to the understanding of relapse components and enable the inference of assiduity by quantifying relapse.

The INFINITE Study: Pilot Research Exploring Plant-Based Nutrition in Treatment for Substance Use Disorders

Standard treatment for substance use disorders (SUDs) rarely incorporates a dietary intervention. The purpose of this research is to explore how nutrition might influence early recovery outcomes. Participants (N = 33) self-selected into the 10-week treatment (whole food, plant-based diet) or control group (standard treatment center diet). Both received weekly nutrition education lessons to complement the diet. At baseline, week 3, and week 10, participants completed assessments to track mental health markers. Mean values were calculated for Healthy Eating Index-2015 (HEI-2015) and Plant-based Diet Indices (PDI). Semi-structured interviews were gathered and analyzed using grounded theory. The intervention group had significantly higher scores for HEI-2015 and PDI scores (all P’s &lt; .001). For all psychosocial outcomes, there was a statistically significant effect of time ( P’s &lt; .001-.02), but not by condition. A significant condition by time interaction was seen with the Rosenberg Self-Esteem outcome ( P = .043). Resilience at 10-weeks was significantly higher in the high PDI group ( P = .031). Qualitative data showed that all participants found meaning and value in the experience. Early addiction treatment outcomes show modest but important effects of whole food plant-based nutrition and suggest value in further exploration of its use in SUD treatment.

Can psychedelic-assisted psychotherapy play a role in enhancing motivation to change in addiction treatment settings?

Abstract Despite growing availability of several evidence-based approaches in the treatment of substance use disorders, existing pharmacotherapy and psychosocial interventions continue to have significant limitations, such as low treatment retention rates and high rates of relapse. There is a need to develop new strategies and models to address these limitations and target underlying psychosocial drivers of addiction, such as motivation to change – a crucial factor in achieving positive addiction treatment outcomes. Re-emerging clinical evidence and literature signal the promise of psychedelic-assisted psychotherapies as being novel, adjunctive treatments for a range of mental health and substance use disorders, encouraging further research. However, there remains a lack of formally validated metrics to evaluate recovery capital and motivation, limiting interpretation of the growing psychedelic literature. This commentary describes the current state of this line of investigation and potential impact of psychedelic-assisted psychotherapy on enhancing motivation to change in addiction treatment, and the need for validated metrics to evaluate recovery motivation and capital to assess the potential for psychedelic-assisted psychotherapies to elicit positive, lasting changes in substance use behaviors among those seeking treatment.

Link Between Perception of Treatment Need and Craving Reports in Addiction.

BackgroundPerception of treatment need (PTN), a component of clinical insight, is associated to negative addiction treatment outcomes when low. Our hypothesis was that lower PTN was associated with less craving when reported retrospectively, the most common measure of craving in clinical settings.ObjectiveTo explore the association between PTN and craving among a dataset of subjects with severe substance use disorders.MethodsParticipants were recruited from outpatient addiction clinic admissions or harm reduction program services. Good and low PTN were based on consistency between severe addiction (at least six DSM-5 criteria) and self-report need for addiction treatment from the Addiction Severity Index. Craving was retrospectively characterized over the past 30 days. Multiple regression analyses were conducted.ResultsParticipants with low PTN (n = 97) retrospectively reported less frequent and intense episodes of craving, compared with participants with good PTN (n = 566) after controlling for sociodemographic factors, addiction type, and severity (p < 0.0001).ConclusionLow perception of treatment need among subjects with severe addictions is associated to less retrospective report of craving, which may contribute to reduced efficiency of treatment. Further studies are needed to explore the mechanisms of the association.

Time for a paradigm shift: The adolescent brain in addiction treatment

ObjectiveOne route to improve adolescent addiction treatment outcomes is to use translational approaches to help identify developmental neuroscience mechanisms that undergird active treatment ingredients and advance adolescent behavior change. MethodsThis sample included 163 adolescents (ages 15–19) randomized to motivational interviewing (MI) vs. brief adolescent mindfulness (BAM). Youth completed an fMRI paradigm assessing adolescent brain response to therapist language (complex reflection vs. mindful; complex reflection vs. confront; mindful vs. confront) at pre- (prior to the completion of the full intervention) and post-treatment (at 3-month follow-up) and behavioral measures at 3, 6 and 12 months. ResultsYouth in both treatment groups showed significant problem drinking reductions at 3 and 6 months, but MI youth demonstrated significantly better treatment outcomes than BAM youth at 12 months. We observed several significant treatment group differences (MI > BAM) in neural response to therapist language, including at pre-treatment when examining complex reflection vs. mindful, and complex reflection vs. confront (e.g., superior temporal gyrus, lingual gyrus); and at post-treatment when examining mindful vs. confront (e.g., supplementary motor area; middle frontal gyrus). When collapsed across treatment groups (MI + BAM), we observed significant differences by time, with youth showing a pattern of brain change in response to complex reflection vs. mindful, and complex reflection vs. confront (e.g., precuneus; postcentral gyrus). There was no evidence of a significant group × time interaction. However, brain change in response to therapist language (complex reflection vs. confront) in regions such as middle frontal gyrus, was associated with reductions in problem drinking at 12 months. Yet, few treatment group differences were observed. ConclusionsThese data underscore the need to better understand therapist language and it's impact on the developing brain, in order to inform and aggregate the most impactful elements of addiction treatment for future treatment development for adolescents.

NAATP launches nonprofit to study treatment effectiveness

Last month, the National Association of Addiction Treatment Providers (NAATP) announced the creation of a new nonprofit to measure the effectiveness of treatment for substance use disorder (SUD). Long committed to studying treatment outcomes, NAATP is now using a centralized clinical data repository to conduct its Addiction Treatment Outcomes Program, through the NAATP Foundation for Recovery Science and Education (FoRSE).

Psychosocial difficulties and treatment retention in inpatient detoxification programmes.

Aims:Treatment retention is associated with addiction treatment outcomes. Research regarding predictors of retention at inpatient detoxification treatment is limited. The aim of this study was to investigate whether psychosocial difficulties (PSDs) are associated with treatment retention among Finnish inpatients undergoing detoxification treatment.Design:This register-based study included real-life data on detoxification treatment episodes (n = 2,752) between February of 2016 and May of 2019 from several inpatient treatment units in Finland. The PARADISE24fin instrument was used to assess PSDs. Socio-demographic and substance use related variables, as well as PSDs, were analysed with regard to treatment retention. Multiple logistic regression models were used to identify predictors of treatment incompletion.Results:Of the 2,752 detoxification treatment episodes, 80.3% (n = 2,209) were completed. Men and women differed with regard to the variables associated with treatment retention. After adjusting for confounders, younger age (≤ 35 years), being less educated (≤ 9 years), being unemployed, using opioids, polysubstance use and more severe dependence were associated with treatment incompletion. Overall severity of PSDs (PARADISE24fin mean score) became non-significant after adjusting for confounders. However, having more severe cognitive difficulties was significantly associated with treatment incompletion, while more severe difficulties in daily activities was associated with treatment completion.Conclusions:Special attention should be paid to younger individuals with opioid and/or polysubstance use, as well as those with cognitive difficulties, in order to retain people in treatment.

Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine

Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine. To compare patient satisfaction between depot buprenorphine and sublingual buprenorphine in adult outpatients with opioid dependence. This open-label, randomized clinical trial was conducted among adult patients with opioid dependence at 6 outpatient clinical sites in Australia from October 2018 to September 2019. Data analysis was conducted from October 2019 to May 2020. Participants were randomized to receive treatment with weekly or monthly depot buprenorphine or daily sublingual buprenorphine over 24 weeks. The primary end point was the difference in global treatment satisfaction, assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 (range, 0-100; higher score indicates greater satisfaction) at week 24. Secondary end points included other patient-reported outcomes, including quality of life, treatment burden, and health-related outcomes, as well as measures of opioid use, retention in treatment, and safety. A total of 119 participants (70 [58.8%] men; mean [SD] age, 44.4 [10.5] years) were enrolled, randomized to, and received either depot buprenorphine (60 participants [50.4%]) or sublingual buprenorphine (59 participants [49.6%]). From the initial sample of 120, a participant (0.8%) in the sublingual buprenorphine group withdrew consent and did not receive study treatment. All participants were receiving sublingual buprenorphine when enrolled. The mean TSQM global satisfaction score was significantly higher for the depot group compared with the sublingual group at week 24 (mean [SE] score, 82.5 [2.3] vs 74.3 [2.3]; difference, 8.2; 95% CI, 1.7 to 14.6; P = .01). Improved outcomes were also observed for several secondary end points after treatment with depot buprenorphine (eg, mean [SE] treatment burden assessed by the Treatment Burden Questionnaire global score, on which lower scores indicate lower burden: 13.2 [2.6] vs 28.6 [2.5]; difference, -15.4; 95% CI, -22.6 to -8.2; P < .001). Thirty-nine participants (65.0%) in the depot buprenorphine group experienced 117 adverse drug reactions, mainly injection site reactions of mild intensity following subcutaneous administration, and 12 participants (20.3%) in the sublingual buprenorphine group experienced 21 adverse drug reactions. No participants withdrew from the trial medication or the trial due to adverse events. In this study, participants receiving depot buprenorphine reported improved treatment satisfaction compared with those receiving sublingual buprenorphine. The results highlight the application of patient-reported outcomes as alternative end points to traditional markers of substance use in addiction treatment outcome studies. anzctr.org.au Identifier: ANZCTR12618001759280.

Predicting alcohol use disorder remission: a longitudinal multimodal multi-featured machine learning approach

Predictive models for recovering from alcohol use disorder (AUD) and identifying related predisposition biomarkers can have a tremendous impact on addiction treatment outcomes and cost reduction. Our sample (N = 1376) included individuals of European (EA) and African (AA) ancestry from the Collaborative Study on the Genetics of Alcoholism (COGA) who were initially assessed as having AUD (DSM-5) and reassessed years later as either having AUD or in remission. To predict this difference in AUD recovery status, we analyzed the initial data using multimodal, multi-features machine learning applications including EEG source-level functional brain connectivity, Polygenic Risk Scores (PRS), medications, and demographic information. Sex and ancestry age-matched stratified analyses were performed with supervised linear Support Vector Machine application and were calculated twice, once when the ancestry was defined by self-report and once defined by genetic data. Multifeatured prediction models achieved higher accuracy scores than models based on a single domain and higher scores in male models when the ancestry was based on genetic data. The AA male group model with PRS, EEG functional connectivity, marital and employment status features achieved the highest accuracy of 86.04%. Several discriminative features were identified, including collections of PRS related to neuroticism, depression, aggression, years of education, and alcohol consumption phenotypes. Other discriminated features included being married, employed, medication, lower default mode network and fusiform connectivity, and higher insula connectivity. Results highlight the importance of increasing genetic homogeneity of analyzed groups, identifying sex, and ancestry-specific features to increase prediction scores revealing biomarkers related to AUD remission.

Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain

Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment. ClinicalTrials.gov Identifier: NCT01372267.

A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome

We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths’ and a therapists’ perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth’ (b = 1.29) and therapist’ (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths’ and therapists’ perspective on alliance is considered.

Gender Differences on Methadone Maintenance Treatment Outcome among Patients with Opioid use Disorder: A Systematic Review.

ABSTRACTObjectives:The objective of this study was to review the significant differences of MMT outcomes related to drug use behavior, health status, and social behavioral functioning between genders.Materials and Methods:A search of publication was conducted in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Scopus database. Two reviewers independently screened the titles, abstracts, and keyword use for the search. Inclusion of studies was based on randomized controlled trials (RCTs) or observational studies that report the difference of opioid addiction treatment outcomes between genders. Any conflict between the two reviewers was resolved through discussion and consensus. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO with a registration number CRD42019116261.Results:A total of 25 studies were evaluated as part of qualitative synthesis. The review resulted in three main themes, which are (1) improving well-being and methadone-related outcome (five subthemes), (2) impact on social and behavioral (four subthemes), and (3) illicit drug use pattern–related behavior (four subthemes).Conclusion:This review will highlight how men and women differ in methadone treatment outcomes for further application and improvement in the clinical setting.

Convergent Validity of Self-Administered Addiction Severity Index in a Sample of Nigerian Patients in a Residential Treatment Facility.

Background:Substance use disorders present with multiple drug-related problems that need to be evaluated with a view to planning and administering holistic interventions that could potentially improve addiction treatment outcomes. Many valid instruments are available for assessing the problems that occur in addiction but most of them require some training and they take a lot of time to administer. This study validates a shorter self-administered version of the Addiction severity Index (ASI) against the Clinician-administered ASI with a view to cutting the time needed to administer the instrument.Methods:The study recruited 142 patients in a residential treatment center. Correlation coefficient and t-test were used to assess for the convergence of the two version.Results:The correlation coefficients ranged from 0.52 to 0.97 for the different domain of the ASI with higher endorsement of problems in the self-administered than clinician administered version in most domains.Conclusion:The self-administered ASI is a valid alternative to the clinician-administered ASI and it saves valuable time especially in resource-constrained settings.

Exposure to Violence and Posttreatment Substance Use Among Patients With Opioid Use Disorder.

Exposure to violence can lead to a dramatic increase in the likelihood of the development of a substance use disorder (SUD). Given the overlap between the two, substance use for survivors of violence, then, can be a coping mechanism to manage the traumatic effects of abuse and persistent use can evolve into a diagnosable SUD. This study was designed to examine the posttreatment substance use among adults who have a history of exposure to violence and sought treatment for opioid use disorder. Data for this study were drawn from the Comprehensive Addiction Treatment Outcome Research system. Among the 13,105 patients included in the study, 444 (3.4%) received a formal diagnosis for opioid use disorder. Female victims of violence are at a greater risk of suffering injuries related to violence, resulting in increased levels of medical care utilization, which may prompt the initiation and prolonged use of prescription pain relief medication. Related to this important finding is another indicating that exposure to violence at multiple points in the past was associated with more severe indicators of substance use. These data show that there is a relationship between exposure to violence, SUDs, and relapse among patients seeking treatment. Not only must patients and treatment providers address these past violent experiences as important psychological factors in recovery, but in the context of opioid use disorder, physical injuries contributing to chronic pain may also trigger persistent substance use.

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors. MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers. ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=−1.79; 95% CI: −3.13, −0.45; p-value = 0.009). ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.