Drug-free Programs Research Articles

Factors affecting the quality of life of drug dependent people under methadone maintenance treatment

Introduction: Treatment approaches for drug addiction are classified into several general types: psychosocial interventions as a part of drug-free programs, opioid maintenance treatment programs and detoxification programs. Μethadone maintenance treatment (MMT) is one of the most common therapeutic approaches. Aim: To investigate the factors that affect drug dependent people’s subjective Quality of Life (QOL) under MMT. Methods: A cross sectional study was conducted in a convenience sample of 209 drug dependent people under MMT provided by a substitution treatment unit (OKANA). They completed a questionnaire that included: a) demographic/occupational characteristics, b) the Short Form 12-Item Health Survey questionnaire (SF-12) and c) the Symptom Checklist-90-R (SCL-90-R). Data analysis was carried out using the statistical package SPSS 24.0. Results: Mean scores for the physical (PCS) and the mental (MCS) subscale of SF-12 were 47.4(±8.8) and 38.6(±9.2) respectively, displaying lower level of drug dependent people’ QOL. High mean scores of the nine symptomatic dimensions and the three global indices of the SCL-90-R demonstrate existence between addiction and psychiatric disorder. Prolonged time period over two years under MMT was associated with deterioration in their QOL. Drug dependent people with the longest stay under MMT had higher scores in the subscales of somatization (p =0.051), the obsessive-compulsive disorder (p =0.013), the Global Severity Index (p=0.041) and the Positive Symptoms Total (p=0.033). Findings indicate that female sex, the age of initiation of drugs (younger age) and previous Conclusions: In line with drug dependent people’s subjective QOL, prolonged time under MMT was associated with poor QOL. Therefore, changing MMT program’s philosophy is essential to cover drug dependent people’s further psychosocial needs.

Немедикаментозные программы реабилитации пациентов с абактериальными простатитами

Немедикаментозные программы реабилитации пациентов с абактериальными простатитами

1469 – Integrative narcology: new strategy for the improvement of therapeutic programs

Recently, due to social, ecological and endoecological factors, pathomorphism in narcological pathological conditions has determined formation of a new scientific and applied concept - integrative narcology. Item phasized new strategies in improvement of addictology medical programs based on international experience extrapolation. Principal tasks of integrative narcology centres include reduction of negative consequences resulted from psychoactive substances long-term intake, lowering the risk of chronic comorbidity, decreasing the harm caused by narcotization and polypragmasy at uncoordinated isolated services. Integrative narcology aims at a complex expert approach to treatment of combined postintoxication somatoneurological disorders in one drug- and alcohol-addict. Integrative medicine main concept is bound together by the evidence-based medicine methods, emergency urgent and intensive therapy aids with drug-free, medication and rehabilitation-restorative programs. Statement of the mentioned problems is extremely important for the health of a patient and society in general. The first pilot trial in Ukraine of the patterns for integrated complex therapeutic aid were based on the cohorts of the HIV- infected opioid addicts, patients with comorbidity (tuberculosis, chroniosepsis, hepatites, cardiomyopathy, epilepsy, depression). Activity of the centres includes methods with detoxication, anticraving, immunomodulation therapeutic effects connecting with different medical subjects: nanotechnological modifications of membrane plasmapheresis, laser therapy, hyperbaric oxygenation, ozone therapeutics, acupuncture, psychotherapy, transcranial electrostimulation methods, sorption detoxication, craniocerebralhypothermy, extremal cryopuncture, general ultralow dosage hypothermy, etc. Conclusion Joined efforts of experts within integrative narcology built on new concepts ensure more effective humanization of therapeutic approaches,“doctor - patient” positive compliance and improve life quality of the respondents.

Organizational correlates of service availability in outpatient substance abuse treatment programs.

In pursuit of quality care for drug abuse treatment programs, researchers continue to monitor program characteristics related to service provision. The current study examines 115 outpatient drug-free programs in four U.S. regions and documents typical methods of offering an array of services and the relationship between program characteristics and services offered onsite and by referral. Core services (e.g., comprehensive assessments) are offered primarily onsite, whereas delivery methods of wraparound services are mixed with transitional services offered generally onsite and medical services traditionally offered offsite. Accredited programs offered more core services onsite, while those providing case management offered more core and wraparound services onsite. Programs with a higher proportion of dually diagnosed clients offered more core services onsite and fewer wraparound services by referral. Programs with a higher concentration of criminal justice-referred clients offered fewer core services onsite. These findings suggest ways of improving access to services.

HEPATITIS C KNOWLEDGE AMONG STAFF IN U.S. DRUG TREATMENT PROGRAMS

Staff in drug treatment programs are in an optimal position to support the hepatitis C related needs of their patients. To do so effectively, however, staff need to have accurate information about the hepatitis C virus (HCV). This article examines the HCV knowledge of staff (N= 104) in two drug-free and two methadone maintenance treatment programs (MMTPs) in the New York metropolitan area. Five of 20 items on an HCV Knowledge Assessment were not answered correctly by the majority of the participating staff, and total scores on the Assessment averaged 70%, 71%, and 45% among the medically credentialed staff, non-medically credentialed staff in the MMTPs, and non-medically credentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in a training specifically devoted to HCV. Results suggest the need for effective HCV-related training for all staff in drug treatment programs.

Drug treatment programs' HCV service delivery to their HCV positive clients

Hepatitis C virus (HCV) infection is the most common blood-borne infectious disease among drug users in the US. Drug treatment programs are ideally situated to assist their clients to obtain HCV medical and support services. Using data collected from 233 drug free and methadone maintenance treatment programs (MMTPs) throughout the US, this article examines the range of HCV services that treatment programs provide to their HCV positive clients. Findings indicate that MMTPs offer more comprehensive HCV services to more of their HCV positive clients than drug free programs, although drug free programs provide more individualized services. While 84% of the programs provided some HCV services, there are still serious gaps in the provision of these services (e.g., dealing with medical providers to obtain HCV medication and facilitating access to liver transplant lists). Drug treatment programs need increased funding and staff training to be able to provide comprehensive HCV services to their HCV positive clients.

Advancing Safety Through Drug-Free Workplace Programs: A Role for the Industrial Hygienist

Advancing Safety Through Drug-Free Workplace Programs: A Role for the Industrial Hygienist

Medical Examinations at Entry to Treatment for Drug Abuse as an Opportunity to Initiate Care for Hepatitis C Virus Infection

Over the course of addiction, a substantial proportion of drug users enter drug abuse treatment programs. Data from a cross-sectional survey of drug abuse treatment programs in the United States were analyzed to describe the scope of the medical examination performed at admission to such programs. All of the methadone programs (n=95) and 50% of drug-free programs (80 of 161) required a medical examination at entry. Most examinations included screening for signs and symptoms of liver disease and liver function testing. Nearly all methadone programs (97%) provided referral to medical care or support for patients with test results positive for antibody to hepatitis C virus (HCV), compared with 75% of drug-free programs (P<.01). Drug-free programs requiring medical examinations provided education about HCV and testing for HCV to a larger proportion of their patients (P<.05). With high dropout rates in the early stages of treatment for drug addiction, these medical visits may be an important opportunity for further monitoring and care for HCV infection and other conditions.

A randomized trial of one-day vs. three-day buprénorphine inpatient detoxification protocols for heroin dependence

Detoxification from opioids remains an important first step in the treatment of many patients with opioid dependence. Several pharmacologic regimens have been used for opioid detoxification. In the United States, the partial mu-opioid agonist, buprenorphine (BUP) is the most recently approved pharmacotherapy for opioid detoxification and replacement. The literature in recent years has described detoxification protocols using a single high dose of BUP and a three-day BUP regimen. In many settings, such as drug-free programs, a single-dose detoxification protocol would be of significant benefit. There have been no prior studies comparing one-day and three-day BUP-assisted opioid withdrawal. In this pilot study, we conducted an open-label, randomized trial of one-day vs. three-day BUP/naloxone sublingual tablet-assisted opioid withdrawal. Twenty patients from a therapeutic community treatment program were randomly assigned to receive either 32 mg sublingual BUP over one hour (one-day group), or 32 mg sublingual BUP over three days (three-day group). Nine of 10 subjects (90 percent) in each group completed seven days in the detoxification protocol. There was no statistically significant difference between the two groups in all other outcome variables, including retention in the treatment program, intensity of withdrawal signs and symptoms, amounts of adjunct medications used, and ability to produce opiate-free urine. This study further validates the feasibility of the single high dose of BUP as a rapid detoxification method.

Potential Sources of Reinforcement and Punishment in a Drug-Free Treatment Clinic: Client and Staff Perceptions

Contingency management interventions are quite successful at initiating abstinence from drugs of abuse. However, these approaches to drug abuse treatment are often criticized because of their perceived cost. One way to reduce the cost of contingency management interventions would be to use nonmonetary sources of reinforcement or punishment. A number of reports have discussed the availability of potential sources of reinforcement in opiate replacement clinics. This report describes the availability of potential sources of reinforcement and punishment available in drug-free treatment programs. Both clients and clinic staff rated a number of items in terms of their potential reinforcing and punishing efficacy. Results suggest that there are several sources of reinforcement and punishment available in drug-free clinics, which could be used in contingency management programs. The results also suggest that the clinic staff perceives potential sources of punishment as more aversive than do the clients.

Relationship between drug treatment services, retention, and outcomes.

This longitudinal study conducted path analyses to examine the relationships between treatment processes and outcomes among patients in community-based drug treatment programs. A total of 1,939 patients from 36 outpatient drug-free and residential treatment programs in 13 California counties were assessed at intake, discharge, three months after admission, and nine months after admission. Path analyses were conducted to relate the quantity and quality of services that were received in the first three months of treatment to treatment retention and outcomes at the nine-month follow-up. Patients were determined to have a favorable outcome if for at least 30 days before the follow-up assessment they did not use drugs, were not involved in criminal activity, and lived in the community. The path analyses controlled for patients' baseline characteristics. Greater service intensity and satisfaction were positively related to either treatment completion or longer treatment retention, which in turn was related to favorable treatment outcomes. Patients with greater problem severity received more services and were more likely to be satisfied with treatment. These patterns were similar for patients regardless of whether they were treated in outpatient drug-free programs or residential programs. The positive association between process measures-that is, greater levels of service intensity, satisfaction, and either treatment completion or retention-and treatment outcome strongly suggests that improvements in these key elements of the treatment process will improve treatment outcomes.

A comparison of HCV antibody testing in drug-free and methadone maintenance treatment programs in the United States

Drug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients’ use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs ( N=256) in the US, and reports programs’ recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted.

Patient and program factors in obtaining supportive services in DATOS

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients ( N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.

Gaps in the drug-free and methadone treatment program response to Hepatitis C

Drug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample ( N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.

The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment

Length of stay in treatment has been found to be a significant predictor of positive post-treatment outcomes, such as decreases in unemployment and crime. However, length of stay may be an incomplete predictor of successful treatment. Surprisingly, few studies have examined whether completing treatment in addition to length of stay is an important factor in explaining positive treatment outcomes. The objective of our study is to examine the effect that treatment completion and length of stay have on post-treatment employment and crime for patients in outpatient drug-free treatment, the largest treatment modality in the United States. We use conditional logit and multiple regression models with program-level indicator variables (fixed effects) to estimate the effect of treatment completion and length of stay on employment and crime controlling for drug use severity, previous treatment history, and other patient demographics. Data are from the National Treatment Improvement Evaluation Study and include 986 adults enrolled in outpatient drug-free programs across the United States. We find that treatment completion and length of stay are significantly related to post-treatment employment. Holding length of stay constant, the occurrence of employment at follow-up among patients who complete their planned treatment is almost 2 times that of patients who do not complete treatment. However, treatment completion did not have a statistically significant effect on the probability of post-treatment crime. Although our results are mixed, these findings suggest that greater attention should be placed on evaluating the importance of both length of stay and treatment completion in treatment outcome studies.

The economic cost of outpatient marijuana treatment for adolescents: findings from a multi‐site field experiment

Despite recent advances in the economic evaluation of adult substance abuse treatment, information and basic research is lacking on the cost of adolescent substance abuse treatment. The present study conducted an economic cost analysis of several outpatient adolescent treatment approaches. The Cannabis Youth Treatment (CYT) study evaluated five structured treatments for cannabis-using adolescents. One of the approaches was implemented by all of the four geographically and institutionally diverse treatment facilities collaborating in CYT; each of the other four approaches was implemented in two of the sites. Using the Drug Abuse Treatment Cost Analysis Program (DATCAP), the economic cost of each site-specific treatment was determined. The average economic costs of the five types of outpatient treatments ranged from $837 to $3334 per episode, and varied by both direct factors (e.g. hours of treatment, treatment retention) and indirect factors (e.g. cost of living, staff level, case-load variation). These adolescent treatment cost estimates are examined in terms of their calculation, variability by condition, variability by site within condition and comparability with previous DATCAP results from outpatient drug-free programs for adults. Future research will integrate treatment outcomes and costs to complete cost-effectiveness and benefit-cost analyses of the five therapies.

Response: The New Environment of Accountability for OTPs

Response: The New Environment of Accountability for OTPs

Benefit-cost analysis of addiction treatment: methodological guidelines and empirical application using the DATCAP and ASI.

To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment. A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines. Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates. The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission. The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se. This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment.

Effects of program and patient characteristics on retention of drug treatment patients

Objective: To examine effects of program and patient characteristics on patient retention in residential drug treatment programs, outpatient drug-free programs (ODF), and methadone maintenance (MM) programs. Data sources/study setting: Patient data were based on admission and discharge records for individuals entering treatment programs in Los Angeles County during 1992 and 1993. Program data were collected from program directors via a mail survey. The study sample included 26,047 patients in 87 programs. The dependent variable was patient completion of a critical threshold of treatment (360 days for MM and 180 days for the other two modalities). We applied logistic regression hierarchical linear modeling analysis for each modality. Principal findings: Threshold retention rates were generally low in all three modalities (18.1% for residential programs, 22.9% for ODF, and 13.6% for MM). An articulated programmatic focus and low caseload increased patient retention in residential programs. A lower level of group therapy focus increased patient retention in ODF programs. A low programmatic focus and a low percentage of recovering staff were associated with high retention rates among MM patients. For ODF programs, none of the slopes showed random effects, while for residential and MM programs, some program factors contributed to the explanation of the random effects in several slopes (e.g., drug use severity). Conclusion: Program practice and service provision played important roles in determining patient retention in treatment. Service providers and planners should consider these key factors to improve retention of patients, which is likely to increase overall treatment effectiveness and efficiency.

Transportation and retention in outpatient drug abuse treatment programs.

To determine whether certain types of transportation assistance improve outpatient treatment retention beyond thresholds shown to have therapeutic benefits, we analyzed data from 1,144 clients in 22 outpatient methadone maintenance (OMM) programs and 2,031 clients in 22 outpatient drug-free (ODF) programs in the Drug Abuse Treatment Outcomes Study (DATOS), a national, 12-month, longitudinal study of drug abuse treatment programs. Directors' surveys provided information about provision of car, van, or contracted transportation services or individual vouchers/payment for public transportation. Chart-abstracted treatment retention was dichotomized at 365 days for OMM and 90 days for ODF. Separate multivariate hierarchical linear models revealed that provision of car, van, or contracted transportation services improved treatment retention beyond these thresholds for both OMM and ODF, but individual vouchers or payment for public transportation did not. Future research should validate whether car, van, or contracted transportation services improve retention and other treatment outcomes in outpatient drug abuse treatment.