Alcohol And Other Drug Treatment Research Articles

Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase.

The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.

Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis.

Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non-government sector. Using the socio-ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non-government AOD services. Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health-care providers that were not identified by staff. Findings highlight the importance of developing resources to enhance the health literacy and capacity of non-government AOD services to address the physical health of clients. Given some clients reported negative experiences with health-care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non-government organisation AOD services needs more formal evaluation.

Contracting treatment services in Australia: Do measures adhere to best practice?

BackgroundContracting non-government services to provide alcohol and other drug (AOD) treatment requires the specification of performance measures to ensure accountability for public funds. There is currently no standardised approach by funders to the measurement of performance of AOD treatment in Australia. Funding to non-government organisations (NGOs) is complex, with NGOs managing funding agreements from a range of sources that contain a large number of differing performance measures. This study aimed to assess performance measures used in contracts for NGO AOD treatment providers and how they align with best practice. MethodsPerformance measures contained in funding agreements for treatment providers were collected from a diverse sample of both funders (n=8) and treatment providers (n=20) resulting in more than 1,100 measures. The list of measures was synthesized to a finite, non-duplicative list (n=537). Measures were assessed by three raters against 11 criteria (for example, measurable and timely) documented as best practice elements of performance measures (Council of Australian Governments, 2011a). Measures were also coded into different measurement types (such as outcome and process). ResultsNone of the 537 unique performance measures used in funding agreements for treatment providers fully met the criteria for best practice in performance measurement. Whilst the literature and government policy is being directed towards outcomes-based funding and reporting, only 7.6% of measures were classified as outcome measures. The majority of measures were classified at output (41.3%) and process (23.6%) measures. ConclusionCurrent measures in contracts applied by funders to treatment services do not adhere to best practice. The development and implementation of new performance measures is required to inform AOD policy and accountability of public funds. Further, identifying more robust performance measures has the potential to lead to reduced reporting burden on service providers and better monitoring of service quality and outcomes.

Improved rates of treatment success following alcohol and other drug treatment among clients who quit or reduce their tobacco smoking.

Alcohol and other drug (AOD) treatment seekers who smoke tobacco are more likely to die of tobacco-related causes than those attributable to their primary drug of concern (PDOC), yet smoking cessation is frequently overlooked in the context of AOD treatment settings. We explored rates of AOD treatment success among participants who quit or continued smoking 12 months after initiating AOD treatment. Secondary analysis of data from a prospective multisite naturalistic outcome study of 559 smokers recruited from 21 publicly funded specialist AOD services as part of the Patient Pathways National Project. Only 7.1% of participants successfully quit smoking at 12-month follow-up; however, doing so was associated with a 30% increase in treatment success (i.e. reliable reductions in use of their PDOC) (χ2 = 8.74, P = 0.003) and a 21% reduction in the severity of PDOC dependence (χ2 = 4.559, P = 0.033). Furthermore, those who did not nominate tobacco as a drug of concern reported demographic characteristics indicative of greater social disadvantage. Despite low overall rates of smoking cessation, our findings suggest clients who do successfully quit have a greater likelihood of achieving reductions in PDOC use and dependence severity. These results reinforce efforts to promote more comprehensive, routine provision of smoking cessation care (i.e. counselling and nicotine replacement therapy). AOD treatment presents a crucial opportunity to deliver smoking cessation care to all clients who smoke, particularly those who are unconcerned about their use, as this group may stand to benefit most.

Impact of a new specialist alcohol and drug brief intervention service model integrated into the emergency department: An interrupted time series analysis.

To describe and examine the impact of a new specialist drug and alcohol brief intervention team (DABIT) model integrated into the ED on the identification of individuals at risk of future alcohol and other drug (AOD)-related harm. A cost-outcome analysis was conducted to assess the impact on costs per referral. An interrupted time series analysis examined the changes in number of referrals following the implementation of the DABIT model over 2 years (January 2015-December 2016) within a large 436-bed public hospital. The primary outcome of interest was the number of AOD-related referrals per month identified following ED presentations. The independent variables were: time (measured in months), implementation periods (pre-implementation; a transition period of adjustment during which the new DABIT model of care was developed; post-implementation period with a fully operational DABIT model); and the number of full-time equivalent staff per month to account for the increase in labour productivity. In a second time series analysis, the outcome was cost per referral per month. After controlling for changes in labour productivity, the number of referrals was significantly higher following the implementation of the DABIT model when compared to those during the pre-implementation and transition periods. Costs were significantly lower following DABIT implementation resulting in $1096 net cost savings per referral. Integration of a specialist brief intervention AOD model to support ED care may increase uptake of specialist AOD treatment and could be beneficial from an economic efficiency viewpoint.

On providing smoking cessation services in alcohol and other drug treatment settings: Results from a U.S. national survey of attitudes among recovering persons

BackgroundNicotine addiction through cigarette use is highly prevalent among individuals suffering from alcohol and other drug (AOD) problems and remains a prominent risk factor for morbidity, mortality, and healthcare utilization. Whereas most people agree that providing smoking cessation services (SCS) to this vulnerable population is vitally important, the timing of such service provision has been hotly debated, including whether such services should be excluded, available (but not offered), offered, or fully integrated into AOD treatment settings. Important stakeholders in this debate are those in recovery from AOD problems who, in addition to having often been AOD treatment patients themselves, frequently hold influential clinical, research or policy positions and thus can influence the likelihood of SCS provision. This study sought to understand the attitudes of this important stakeholder group in providing SCS in AOD treatment settings. MethodWe assessed a national cross-sectional sample of individuals in recovery from an AOD problem (n = 1973) on whether SCS should be: a. excluded; b. available; c. offered; or d. integrated into AOD services. We estimated associations between participants' demographic, clinical, and recovery support service use history, and SCS attitude variables, using multinomial logistic regression. ResultsRoughly equal proportions endorsed each attitudinal position (23.5% excluded, 25% available, 24.6% offered; 26.9% integrated). Correlates of holding more positive SCS implementation attitudes were Black race; primary substance other than alcohol, greater intensity of former or recent smoking, and less mutual-help organization participation; older individuals achieving recovery between 30 and 40 years ago also had more positive attitudes toward integrating SCS. ConclusionsAbout half of those sampled were either against SCS inclusion in AOD settings or were in favor of making it “available” only, but not in offering it or integrating it. This oppositional pattern was accentuated particularly among those with primary alcohol problem histories and those participating in mutual-help organizations. Given the universally well-known negative health effects of smoking, understanding more about the exact reasons why certain groups of recovering persons may endorse such positions is an area worthy of further investigation, as it may uncover potential barriers to SCS implementation in AOD treatment settings.

Assessing the validity of the Australian Treatment Outcomes Profile for telephone administration in drug health treatment populations.

The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool measuring recent substance use, health and wellbeing among clients attending alcohol and other drug (AOD) treatment services. It has previously been assessed for concurrent validity and inter-rater reliability. In this study we examine whether it is suitable for administration over the telephone. We recruited a sample of 107 AOD clients across public sector specialist AOD treatment services in New South Wales, Australia between 2016 and 2018. Participants had a mean age of 47 years and 46% were female. Participants completed a face-to-face ATOP and a phone ATOP with a researcher within 5 days. Comparisons between the two administration modes were undertaken using Spearman's rank correlation coefficient for continuous or ordinal variables, and Cohen's Kappa for nominal variables. Among 107 participants, 59% were attending for alcohol treatment and 41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 (excellent) agreement between face-to-face and telephone use. Our findings suggest that the ATOP is a suitable instrument for telephone monitoring of recent substance use, health and social functioning among AOD clients. Its validation for remote use over the telephone will support staff to monitor clients' risks and outcomes-of particular relevance in response to the COVID-19 pandemic in which services are increasingly relying on telework approaches to client monitoring.

Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment.

Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms. Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes. Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources. In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach.

Same same but different: A comparison of LGB and non-LGB client preferences and reported receipt of smoking care in alcohol and other drug treatment services

Introduction and aimsLesbian, gay, and bisexual (LGB) people are more likely to use tobacco and other substances than non-LGB people. A limited body of research has examined LGB people in the alcohol and other drug (AOD) treatment setting. This study aims to examine the tobacco smoking behaviours of LGB people receiving AOD treatment, their receipt and preferences for quit support compared to non-LGB, as well as the factors associated with receipt of quit smoking support strategies for LGB people. Design and methodsWe examined baseline survey responses (February to August 2014) from a longitudinal RCT, with clients who were current smokers from 32 AOD treatment services in four states and territories of Australia. ResultsAmong 896 respondents, 100 respondents identified as LGB. Nearly all LGB (94%) respondents identifies as daily tobacco smokers. On average, LGB respondents had made more quit attempts in the last 12 months (3 vs 2, p = 0.012). Both LGB and non-LGB respondents reported receiving similar rates of quit smoking support however more LGB respondents reported receiving a prescription of varenicline (31.5% vs 36.4%, p = 0.04). Higher motivation to quit (OR 1.39 95% CI 1.07, 1.78) and older age of LGB respondents were associated with greater receipt of quit smoking support. Both LGB and non-LGB respondents reported similar preferences for quit support. Discussion and conclusionsLGB smokers in AOD treatment are attempting to quit smoking yet both LGB and non-LGB smokers are not receiving adequate treatment despite openness to receive multiple types of quit support.

Drug and Alcohol Policies at Tribal Colleges: A Descriptive Study Assessing Variations in Alcohol and Drug Policy by Setting.

This paper explores drug and alcohol policies at Tribal Colleges and Universities (TCUs). A research team conducted a needs assessment of Alcohol and Other Drug (AOD) use and policies in 27 TCUs, surveying key informants on perceived AOD prevalence. Student body size did not affect levels of AOD training or treatment. Larger TCU size increased the likelihood of on-campus housing, which increased the prevalence of zerotolerance policies and greater access to AOD services. Reservation policies, local resources, and cultural practices did not appear to affect TCU AOD policies. Designed properly, these policies can support desirable academic outcomes for TCU students.

Assessing the impacts of daily Cannabis versus alcohol and methamphetamines on young Australians in youth AOD treatment

BackgroundCannabis is the most widely used illicit substance by Australian young people, including those engaged with youth alcohol and other drug (AOD) systems. While recreational cannabis use in young people may be a developmental activity for some, for others, this usage becomes regular and be associated with poorer long term outcomes. This study reports on the rates of cannabis use and co-existing psychosocial complexity factors in the Youth Needs Census (2013 and 2016) where workers report on all clients in the youth AOD system, a cohort considered highly vulnerable.MethodsData was examined for two rounds of data collection for the Youth Needs Census, including 823 youth AOD service engaged young people in 2016 and 1000 AOD service engaged young people in 2013, to identify usage rates, psychosocial outcomes, and changes over time.ResultsDaily use of cannabis alone significantly exceeded daily usage rates for methamphetamines, alcohol, and cannabis used alongside other substances. Daily cannabis use was significantly associated with mental health problems, employment problems, education problems, family problems, and housing problems. Daily cannabis use was associated with most psychosocial complexity factors to the same extent as daily methamphetamine use and daily alcohol use, with daily cannabis users only showing lower incidence of the drug-related harm measure. Notably, daily cannabis use also increased from 2013 (47.5%) to 2016 (54.2%).ConclusionsIt is imperative that the number of individuals using cannabis is considered alongside the severity of harm when assessing the social impact of this substance. Within cannabis users engaged with the youth AOD system, who often have high levels of psychosocial complexity, cannabis is used daily by a large proportion of these youths and may play a role in negatively impacting their lives.

Psychiatric comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and other drug treatment initiation and engagement across 7 health care systems

Background: Psychiatric comorbidity is common among patients with alcohol and other drug (AOD) use disorders. To better understand how psychiatric comorbidity influences AOD treatment access in health care systems, the present study examined treatment initiation and engagement among a large, diverse sample of patients with comorbid psychiatric and AOD use disorders. Methods: This study utilized data from a multisite observational study examining Healthcare Effectiveness Data and Information Set (HEDIS) measures of initiation and engagement in treatment (IET) among patients with AOD use disorders from 7 health care systems. Participants were aged 18 or older with at least 1 AOD index diagnosis between October 1, 2014, and August 15, 2015. Data elements extracted from electronic health records and insurance claims data included patient demographic characteristics, ICD-9 (International Classification of Diseases, Ninth Revision) diagnostic codes, and procedure codes. Descriptive analyses and multivariate logistic regression models were used to examine the relationship between patient-level factors and IET measures. Results: Across health care systems, out of a total of 86,565 patients who had at least 1 AOD index diagnosis during the study period, 66.2% (n = 57,335) patients also had a comorbid psychiatric disorder. Among patients with a comorbid psychiatric disorder, 34.9% (n = 19,998) initiated AOD treatment, and of those, 10.3% (n = 2,060) engaged in treatment. After adjusting for age, sex, and race/ethnicity, patients with comorbid psychiatric disorders were more likely to initiate (odds ratio [OR] = 3.20, 95% confidence interval [CI] = 3.08, 3.32) but no more likely to engage (OR = 0.56, 95% CI = 0.51, 0.61) in AOD treatment, compared with those without a comorbid psychiatric disorder. Conclusions: Findings suggest that identification of comorbid psychiatric disorders may increase initiation in AOD treatment. However, innovative efforts are needed to enhance treatment engagement both generally and especially for individuals without diagnosed psychiatric conditions.

The association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement for alcohol and other drug use disorders

Background: Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.Methods: We used electronic health record and insurance claims data from 7 US health care systems to identify patients with AOD use disorders between October 1, 2014, and August 15, 2015 (N = 86,565). Among patients identified with AOD use disorders in outpatient and emergency department (ED) settings, we examined how Charlson/Deyo comorbidity index scores and medical complications of AOD use were associated with treatment initiation. Among those who initiated treatment in inpatient and outpatient/ED settings, we also examined how comorbidity and AOD use–related medical complications were associated with treatment engagement. Analyses were conducted using generalized estimating equation logistic regression modeling.Results: Among patients identified as having an AOD diagnosis in outpatient and ED settings (n = 69,965), Charlson/Deyo comorbidity index scores of 2 or more were independently associated with reduced likelihood of initiation (risk ratio [RR] = 0.80, 95% confidence interval [CI] = 0.74, 0.86; reference score = 0), whereas prior-year diagnoses of cirrhosis (RR = 1.25, 95% CI = 1.12, 1.35) and pancreatic disease (RR = 1.34, 95% CI = 1.15, 1.56) were associated with greater likelihood of initiation. Among those who were identified in outpatient/ED settings and initiated, higher comorbidity scores were associated with lower likelihood of engagement (score 1: RR = 0.85, 95% CI = 0.76, 0.94; score 2+: RR = 0.61, 95% CI = 0.53, 0.71).Conclusion: Medical comorbidity was associated with lower likelihood of initiating or engaging in AOD treatment, but cirrhosis and pancreatic disease were associated with greater likelihood of initiation. Interventions to improve AOD treatment initiation and engagement for patients with comorbidities are needed, such as integrating medical and AOD treatment.

The prevalence of Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment among patients with cannabis use disorders in 7 US health systems

Background: Cannabis use disorders (CUDs) have increased with more individuals using cannabis, yet few receive treatment. Health systems have adopted the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of initiation and engagement in alcohol and other drug (AOD) dependence treatment, but little is known about the performance of these among patients with CUDs. Methods: This cohort study utilized electronic health records and claims data from 7 health care systems to identify patients with documentation of a new index CUD diagnosis (no AOD diagnosis ≤60 days prior) from International Classification of Diseases, Ninth revision, codes (October 1, 2014, to August 31, 2015). The adjusted prevalence of each outcome (initiation, engagement, and a composite of both) was estimated from generalized linear regression models, across index identification settings (inpatient, emergency department, primary care, addiction treatment, and mental health/psychiatry), AOD comorbidity (patients with CUD only and CUD plus other AOD diagnoses), and patient characteristics. Results: Among 15,202 patients with an index CUD diagnosis, 30.0% (95% confidence interval [CI]: 29.2–30.7%) initiated, 6.9% (95% CI: 6.2–7.7%) engaged among initiated, and 2.1% (95% CI: 1.9–2.3%) overall both initiated and engaged in treatment. The adjusted prevalence of outcomes varied across index identification settings and was highest among patients diagnosed in addiction treatment, with 25.0% (95% CI: 22.5–27.6%) initiated, 40.9% (95% CI: 34.8–47.0%) engaged, and 12.5% (95% CI: 10.0–15.1%) initiated and engaged. The adjusted prevalence of each outcome was generally highest among patients with CUD plus other AOD diagnosis at index diagnosis compared with those with CUD only, overall and across index identification settings, and was lowest among uninsured and older patients. Conclusion: Among patients with a new CUD diagnosis, the proportion meeting HEDIS criteria for initiation and/or engagement in AOD treatment was low and demonstrated variation across index diagnosis settings, AOD comorbidity, and patient characteristics, pointing to opportunities for improvement.

Patient characteristics associated with treatment initiation and engagement among individuals diagnosed with alcohol and other drug use disorders in emergency department and primary care settings

Background: Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however, it is unknown whether characteristics of patients who initiate and engage in treatment differ between these settings. Methods: Patients identified with an AOD disorder in ED or PC settings were drawn from a larger study that examined Healthcare Effectiveness Data and Information Set (HEDIS) AOD treatment initiation and engagement measures across 7 health systems using electronic health record data (n = 54,321). Multivariable generalized linear models, with a logit link, clustered on health system, were used to model patient factors associated with initiation and engagement in treatment, between and within each setting. Results: Patients identified in the ED had higher odds of initiating treatment than those identified in PC (adjusted odds ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.73–2.07), with no difference in engagement between the settings. Among those identified in the ED, compared with patients aged 18–29, older patients had higher odds of treatment initiation (age 30–49: aOR = 1.25, 95% CI = 1.12–1.40; age 50–64: aOR = 1.42, 95% CI = 1.26–1.60; age 65+: aOR = 1.27, 95% CI = 1.08–1.49). However, among those identified in PC, compared with patients aged 18–29, older patients were less likely to initiate (age 30–49: aOR = 0.81, 95% CI = 0.71–0.94; age 50–64: aOR = 0.68, 95% CI = 0.58–0.78; age 65+: aOR = 0.47, 95% CI = 0.40–0.56). Women identified in ED had lower odds of initiating treatment (aOR = 0.80, 95% CI = 0.72–0.88), whereas sex was not associated with treatment initiation in PC. In both settings, patients aged 65+ had lower odds of engaging compared with patients aged 18–29 (ED: aOR = 0.61, 95% CI = 0.38–0.98; PC: aOR = 0.42, 95% CI = 0.26–0.68). Conclusion: Initiation and engagement in treatment differed by sex and age depending on identification setting. This information could inform tailoring of future AOD interventions.

“Someone who is in this thing that I am suffering from”: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care

South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a “siloed treatment experience”), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.

A systematic review of evaluations of prison‐based alcohol and other drug use behavioural treatment for men

ObjectiveA history of alcohol and other drug (AoD) use is common among men entering prison and often linked to the crime for which they are imprisoned. This is the first systematic review of prison‐based, behavioural AoD treatment programs for more than a decade and the first that reviews the methodological quality of evaluations. This review aims to create an understanding of the quality of research in this field and identify the most effective AoD use treatment for men in prison. MethodsA PRISMA‐compliant systematic review of international, peer‐reviewed research published between January 1995 and December 2015. The Dictionary for Effective Public Health Practice Project was used to assess the methodological quality of papers. ResultsA total of 25 relevant papers were identified, of which 12 were rated as methodologically sound. Four of these measured post‐release AoD use and three reported statistically significant reductions in AoD use. ConclusionsAlthough there is relatively little methodologically strong evidence of the impact of prison‐based AoD treatment, and no Australian papers studies, current best‐evidence practice is Cognitive behavioural therapy delivered in Therapeutic Community (TC) settings. Implications for public healthPrison‐based TC treatment should be available to people in prison who have a history of AoD use.

A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services

BackgroundExecutive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation.Methods/designThe study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals.DiscussionThis study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs.Trial registrationAustralian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291. Prospectively registered 17th July 2018.

Smoking cessation in the context of recovery from drug and alcohol problems: Prevalence, predictors, and cohort effects in a national U.S. sample

BackgroundTobacco and alcohol and other drug (AOD) use remain prominent risk factors for morbidity, mortality, and health care utilization. Moreover, these often cluster together within persons, exponentiating health risks. Little is known regarding if and when people resolving AOD problems stop smoking, who stops, and whether recent general population trends toward smoking cessation are evident also among persons more recently entering recovery. Design and participantsNational cross-sectional sample resolving AOD problems (final sample n = 2002). AnalysesWeighted smoking/cessation prevalence; logistic regressions; Hazard-models estimated time to smoking cessation overall, and for different cohorts entering recovery during one of three decades: a) 2006–2015; b) 1996–2005; c) 1986–1995. ResultsApproximately 30% of U.S. adults in AOD recovery with a smoking history stopped smoking before entering recovery, 7% quit smoking and AOD use concurrently, 26% stopped after entering recovery; 37% still smoked. Among those quitting after entering recovery, the prevalence of smoking cessation 5- and 10-years later was 27.2% and 55.1% respectively for the 2006–2015 cohort and 14.9% and 34.5% in the 1986–1995 cohort; time to smoking cessation also was 60% shorter (5yrs vs. 8yrs). Time to smoking cessation was associated with education and income, but not 12-step participation or AOD treatment. ConclusionsSmoking rates among those in AOD recovery are more than double that of the general population but those entering recovery in recent years are stopping and stopping sooner. It is plausible that public health-oriented tobacco policy measures and easier access to smoking cessation aids may be contributing to this salutary trend.

Multiple Pathways to Recovery, Multiple Roads to Well-Being: An Analysis of Recovery Pathways in the Australian Life in Recovery Survey

ABSTRACTIt is generally acknowledged that there are multiple pathways to recovery from alcohol and other drug (AOD) problems. These may include participation in AOD treatment, mutual aid, or other activities. It is unclear whether particular sociodemographic characteristics shape a person’s recovery journey or whether particular recovery pathways are associated with improved well-being. This article explores these questions using data from the Australian Life in Recovery study (N = 573). Compared to treatment and/or mutual aid pathway groups, the natural recovery group were less likely to have used mental health services and were more socially connected during periods of addiction. Since being in recovery, mutual aid pathway groups more strongly identified as being in recovery and having social networks consisting of a greater proportion of people in recovery compared to the natural recovery group. People in all pathway groups reported high well-being, and there were no significant differences in well-being measures between groups. Findings suggest that people in recovery may experience high well-being irrespective of the pathway they take, but social factors may be influential in which pathways people take. Treatment and recovery systems need to offer multiple recovery pathways so that people can take the pathway that suits them best.