Effectiveness Of Substance Abuse Treatment Research Articles

A service evaluation of the Behavioural Treatment for Substance Abuse (BTSA) programme for forensic dual diagnosis populations

ABSTRACT Literature links mental health problems comorbid with substance abuse with increased recovery time. There is limited research evaluating the effectiveness of substance abuse treatments for dual-diagnosis patients. This project aimed to evaluate the effectiveness of the BTSA group with this population. Questionnaires measuring motivation, locus of control, confidence to abstain and self-efficacy were administered to six different cohorts of BTSA participants (N = 38) at baseline, post, and follow-up stages. In addition, participants from the most recent BTSA cohort (N = 4) attended a post-program focus group, to provide information about their experiences of the intervention. Statistical analyses revealed that participants’ confidence in their ability to manage substance abuse was significantly higher post group, but the hypotheses that there would also be significant improvements in participants’ self-efficacy, motivation, and locus of control following completion of the program were not supported. Thematic analysis identified three key themes relevant to participants, namely validation, psychoeducation and identifying progress. This project provided valuable insights into participants’ experiences of the group, highlighting what they had gained form the intervention, and the impact on them from having Recovery Champions working in conjunction with NHS staff to facilitate the intervention. Limitations are discussed, alongside recommendations for improving the program.

Substance abuse and weight control: Do they really have opposing effects?

Addiction to alcohol and cigarettes has been associated with being overweight and obese. Considering the compulsion for food and drugs may share the same neuronal pathway in the brain, this relationship is expected, but the empirical literature is mixed regarding directionality of the relationship between substance abuse and weight control, and it has never been studied directly. In order to address this gap, a systematic was conducted (quantitative) and resulted in a narrative report to summarize the effects of substance abuse treatment on body mass and the effect of weight control on substance abuse (due to the heterogenity of the studies designs, no meta-analysis was performed). Searches of PubMed, Web of Science, and CINHAL databases led to the inclusion of 9 studies out of 48 results. Three of these studies dealt with effects of substance abuse treatment on body weight, three dealt with effects of weight management treatment on substance use, and three studies dealt with both. Among the six studies testing drug interventions on smoking cessation only one increased body mass, while two of them reported a reduction in body weight and BMI of the abstinent subjects being treated, and three of them did not show any change at the intervention follow-up. The six studies testing interventions for weight reduction did not increase addiction to cigarettes or alcohol; and evidence from two of them these studies pointed to a higher number of smoke-abstinent individuals and reduced number of cigarettes per day with the intervention. The evidence collected from interventional studies showed that weight management and drug abuse treatment can be complementary to each other and may be a good combination to treat addiction in overweight and obese individuals. Considering none of the interventions designed for weight control led to increased addiction for substances, despite some risk of weight gain, the interventions did not lead to risk of increased substance abuse. • Most drug interventions for cigarette cessation did not increase body mass. • The RCTs showed reduction in body weight and BMI in abstinent subjects under drug treatment. • None of the diverse interventions aiming weight reduction, increase the addiction for cigarette or alcohol.

The effectiveness of substance abuse treatment: development of a brief questionnaire

Background Practitioners need brief instruments to monitor outcomes in both treatment of drugs and alcohol addiction because they are useful to guide decision making in a short time.Objectives This study aims to develop a brief questionnaire, based on Client Evaluation of Self and Treatment, to evaluate the treatment effectiveness in drug and alcohol addiction treatment settings.Methods A cross-sectional study using a convenience sample (N = 608) recruited from Division for Intervention on Addictive Behaviours and Dependencies (DICAD – ARS North).Results The results show a new four-factor solution that accounted for 54.4% of the total variance and that provides the best fit to the data (c2/df = 1.72, CFI = .94, GFI = .91, RMSEA = .048 [.040-.057]; prmsea = .623). It also revealed a high internal consistency (a = .82). It was found a significant negative correlation (r = - .52, p < .01) between the final version of the instrument and a self report measure of psychopathology symptoms.Discussion This brief questionnaire, with good psychometric properties, can be useful to provide a viable and rapid feedback of treatment outcomes. Further studies should be performed to continue the evaluation of the reliability of this measure.

Does Mindfulness Meditation Increase Effectiveness of Substance Abuse Treatment with Incarcerated Youth? A Pilot Randomized Controlled Trial

A growing body of evidence suggests that mindfulness meditation is associated with a number of physiological and psychological benefits in both adult and juvenile populations. Research on mindfulness-based interventions among at-risk and incarcerated youth populations has also shown feasibility as a means of enhancing self-regulation and well-being. This randomized controlled trial examined an 8- to 12-week program in which participants received individual and group psychotherapy. Participants in the experimental condition received formal mindfulness training alongside psychotherapy, while those in the control condition received psychotherapy without mindfulness training. All participants received the group intervention. Participants were recruited from a court-mandated substance abuse group treatment program at a juvenile detention camp in the San Francisco Bay Area. Participants were 35 incarcerated youth (100 % male; 70 % Hispanic; mean age = 16.45). Of these, 27 provided complete pre- and post-treatment assessment data. Measures of mindfulness, locus of control, decision-making, self-esteem, and attitude toward drugs were administered before and after the intervention. Detention camp staff provided behavioral rating points for each participant in the week prior to beginning the study treatment and in the week after completing the intervention. Significant increases in self-esteem (p < 0.05) and decision-making skills (p < 0.01) were observed among the entire study sample. Between-group analyses found significantly greater increases in self-esteem (p < 0.05) and staff ratings of good behavior (p < 0.05) in the mindfulness treatment group, consistent with prior research. These results suggest a potentially important role for mindfulness-based interventions in improving well-being and decreasing recidivism among this at-risk population.

Preliminary findings on the association between clients’ perceived helpfulness of substance abuse treatment and outcomes: Does race matter?

BackgroundFew studies examine the helpfulness and effectiveness of substance abuse treatment from the clients’ perspective. MethodsThe current secondary analysis examined the perceived helpfulness of substance abuse treatment components and its relationship to treatment outcomes among 387 Black and White adults participating in a multisite randomized clinical trial (RCT) of Motivational Enhancement Therapy. Throughout the 16-week RCT, participants self-reported substance use. Upon completion of treatment, participants completed a self-report measure assessing the perceived helpfulness of treatment components. ResultsBlack participants rated 9 out of 12 treatment components (e.g., “learning skills that will help me cope with my problems”) as being more helpful than their White counterparts, even after controlling for age, gender, employment status, primary drug type, and treatment assignment. However, perceived helpfulness ratings were not associated with substance use outcomes among Black or White participants. ConclusionsClients’ perceived helpfulness of treatment components is an important factor to consider in improving the delivery of substance abuse treatment, especially for Black adults.

Individual predictors of the subjective effects of intravenous cocaine

The subjective and reinforcing effects of addictive substances can vary greatly between individuals. This study compared the relative contributions of baseline drug use, craving, stressful life events, and social factors in determining the subjective effects of cocaine in individual participants. Twelve veterans meeting criteria for cocaine dependence were evaluated in a laboratory setting. Self-report of the subjective effects of intravenous cocaine was recorded following single- and double-blind, placebo-controlled injections. Increased positive subjective effects of cocaine, including drug-induced ‘good’ effects and the value of intravenous injections, were most strongly correlated with greater family and social dysfunction measured through the Addiction Severity Index (ASI). Social dysfunction was the strongest predictor of cocaine-induced euphoria, accounting for approximately one-half of its variability. Participants who were dissatisfied with their current marital status reported almost no ‘bad’ effects of cocaine but instead reported increased drug-induced ‘high’, euphoria, and injection value. Although further research is required to determine the generalizability of this association, our findings are parallel to recent preclinical results showing that social interaction can attenuate psychostimulant reward. Effects of substance abuse treatment that rely on improved social function may be mediated through changes in the brain's reinforcement system that modify the rewarding effects of cocaine.

Examining the relationship between self-control and adolescent TC treatment completion

A type of treatment intervention that is widely regarded in terms of treating adolescents with issues of substance use is the therapeutic community (TC). Despite their effectiveness, empirical studies of drug treatment are mostly atheoretical, even though treatment programming is based on theory. In this study, an attempt was made to apply concepts related to a Gottfredson and Hirschi’s General Theory of Crime to predict treatment completion. Using data collected as part of the Drug Abuse Treatment Outcomes Studies Adolescents (DATOS-A), a multisite prospective study of adolescent drug abuse treatment effectiveness, this study examined whether characteristics associated with low self-control predicted treatment completion. The primary finding was that motivation for treatment was significantly related to treatment completion. Although the characteristics associated with low self-control did not predict treatment completion in the hierarchical linear modeling (HLM) models that included the demographics and risk and protective factors, there were several significant bivariate relationships between pretreatment behaviors and the characteristics associated with low self-control. Because of these relationships, it is important that TC practitioners are aware of how these characteristics might interplay with treatment completion and how TC strategies may help the adolescent to overcome them.

Measurement equivalence of the Revised Helping Alliance Questionnaire across African American and non-Latino White substance using adult outpatients

Analyses of the effectiveness of substance abuse treatments across racial/ethnic groups should ensure that outcome measures have the same conceptual meaning (i.e., measurement equivalence) across groups. Because racial groups differ in perceptions and experiences of the therapeutic alliance, this study investigated measurement equivalence properties of the Revised Helping Alliance Questionnaire (HAq-II) across racial groups. The sample included 138 African American and 133 non-Latino White participants, age 18–64years, who participated in a randomized clinical trial investigating the effectiveness of Motivational Enhancement Therapy in the National Institute on Drug Abuse Clinical Trials Network. Results demonstrated configural invariance and two forms of metric invariance (weak and strong/scalar), suggesting that conceptualizations of therapeutic alliance and overall levels of endorsement of therapeutic alliance are comparable across racial groups. The groups indicated partial, strict metric nonequivalence. No studies to date reported measurement equivalence properties of the HAq-II. Findings support valid measurement and interpretation of HAq-II outcomes.

Culturally Competent Substance Abuse Treatment with Transgender Persons

Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.

Evaluation of an Innovative Medicaid Health Policy Initiative to Expand Substance Abuse Treatment in Washington State

State health policy making is rarely based on evidence derived from empirical analysis. An exception is an innovative policy established in 2005 in Washington State (Senate Bill [SB] 5763) to provide funding (approximately $30 million) to expand access to substance abuse (SA) treatment for Medicaid beneficiaries. The authors analyzed Medicaid claims data and other administrative data over a 7-year period, July 2001 through June 2008, for three cohorts of welfare clients (n ≈ 44,000) to assess the effect of SA treatment on health care expenditures. Regression analysis showed SA treatment to be associated (p < .001) with per member per month expenditure savings of approximately $160 to $385 depending on the welfare cohort. The aggregate annualized estimated saving ($16.8 million) equaled the cost-saving goal of SB 5763. While it may be tempting for policy makers to cut funding for SA treatment, this may be counterproductive and in the long-run increase Medicaid costs.

Prevalence and characteristics of substance abuse treatment utilization by US adolescents: National data from 1987 to 2008

Objective Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services. Method Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N = 25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization. Results The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services. Conclusion Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.

Substance abuse treatment for juvenile offenders: A review of quasi-experimental and experimental research

Purpose The purpose of this systematic literature review is to assess the effectiveness of substance abuse treatment on alcohol and marijuana use for juvenile offenders based on existing quasi-experimental and experimental research. Additionally, a secondary aim is to compare the effects of individual-based interventions to family-based interventions. Methods A systematic search of literature and electronic databases through 2010 generated five experimental or quasi-experimental studies that assessed alcohol outcomes for juvenile offenders and five experimental or quasi-experimental studies that assessed marijuana outcomes for juvenile offenders. Results Overall, substance abuse treatment appears to have a small to moderate effect on alcohol and marijuana reduction for juvenile offenders. Interventions that showed the most promise were Multisystemic Therapy, Multidimensional Treatment Foster Care, Teaching Family, and Life Skills Training. Individual-based interventions and family-based interventions had similar small to moderate effects on alcohol and marijuana use. Conclusion This review highlights several promising interventions for this high-risk population; however, further rigorous study is desperately needed to provide a better understanding of what works best in reducing substance use among juvenile offenders.

S13-01 - Substance abuse treatment as a predictor of criminal recidivism among psychiatrically examined Swedish offenders

BackgroundSubstance abuse is clearly associated with criminal recidivism among offenders with and without mental disorder. Treatment for substance abuse correlates with lower rates of re-offending among participants in outpatient-based as well as institution-based substance abuse treatment programs. However, for offenders with mental disorder, research on the possible preventive effect of substance abuse treatment on criminal recidivism is sparse. This paper reports from on an ongoing naturalistic and prospective interview study on the relationship between post-release outpatient substance abuse treatment and re-offending.MethodsThe Stockholm county sample comprises 246 offenders of both genders subjected to a forensic psychiatric assessment, who screened positive for substance abuse problems. Eighty-five percent (n=210) agreed to participate in the study. Baseline data and follow-up interview data, collected immediately on release from incarceration (prison/forensic hospital) and 6 and 12 months later, include self-reported substance abuse, treatment involvement and criminality. By February 2010, data will be available from the first follow-up for 150 participants, from the second follow-up for 80 individuals and from the third follow-up for 10 subjects.Results and conclusionsThe focus of the presentation will be recidivism comparisons between substance abuse treatment utilizers and those who decline treatment. Data on ongoing levels of substance abuse, mental health problems and offending will serve as dependent variables. Additional analyses will present perceived benefit from and reasons for accepting or rejecting treatment.

Criminality and Addiction: Selected Issues for Future Policies, Practice, &amp; Research

The high cost of incarceration and a general confidence in the effectiveness of drug abuse treatment have led many states to adopt community-based drug abuse treatment as part of, or as an alternative to, incarceration. Community re-entry and aftercare have therefore received increasing attention from both practitioners and researchers. This article examines possibilities for encouraging change in both adult and juvenile justice treatment. Four issues are highlighted: (1) relapse and aftercare, (2) co-occurring disorder, (3) juvenile justice programming, and (4) women's treatment. The success of U.S. drug treatment policy depends on a capacity to resolve these and related issues.

The impact of illicit drug use and substance abuse treatment on adherence to HAART

High levels of adherence to highly active antiretroviral therapy (HAART) are essential for virologic suppression and longer survival in patients with HIV. We examined the effects of substance abuse treatment, current versus former substance use, and hazardous/binge drinking on adherence to HAART. During 2003, 659 HIV patients on HAART in primary care were interviewed. Adherence was defined as ≥95% adherence to all antiretroviral medications. Current substance users used illicit drugs and/or hazardous/binge drinking within the past six months, while former users had not used substances for at least six months. Logistic regression analyses of adherence to HAART included demographic, clinical and substance abuse variables. Sixty-seven percent of the sample reported 95% adherence or greater. However, current users (60%) were significantly less likely to be adherent than former (68%) or never users (77%). In multivariate analysis, former users in substance abuse treatment were as adherent to HAART as never users (Adjusted Odds Ratio (AOR)=0.82; p>0.5). In contrast, former users who had not received recent substance abuse treatment were significantly less adherent than never users (AOR=0.61; p=0.05). Current substance users were significantly less adherent than never users, regardless of substance abuse treatment (p<0.01). Substance abuse treatment interacts with current versus former drug use status to affect adherence to HAART. Substance abuse treatment may improve HAART adherence for former substance users.

Two-Year Outcomes of Treatment for Methamphetamine Use

While evaluation research supports the general effectiveness of substance abuse treatment, there is not a comprehensive literature on treatment effectiveness for methamphetamine (MA) use. The authors consider three outcome measures—MA use, criminal activity, and employment—compared across three periods: 24-months pretreatment, during treatment, and 24-months post-treatment. Data are from an intensive natural history interview conducted two to three years after treatment for 349 randomly selected admissions to treatment for MA abuse in a large publicly-funded county treatment system. Through this naturalistic design, data provide a system-wide perspective on effectiveness of treatment as usual. Results showed reduction in MA use and crime during and following treatment and increased employment following treatment over pretreatment levels. Regression analyses showed higher levels of education and more time in treatment related to more positive post-treatment outcomes for all three measures. Lower percentage of post-treatment months with MA use also was related to more pretreatment MA-related problems, lower pretreatment MA use, and residential (compared to outpatient) treatment modality. Lower post-treatment criminal activity was also related to gender (being female), lower pretreatment criminal activity, and residential modality. Higher percentage of post-treatment months with employment also was related to gender (being male), ethnicity (not African-American), and higher pretreatment employment.

The Effect of Substance Abuse Treatment on Medicaid Expenditures among General Assistance Welfare Clients in Washington State

Little is currently known about the effect of substance abuse treatment on Medicaid expenses and other health care costs for welfare clients. This study examined the association between substance abuse treatment and reductions in medical care expenditures (primarily Medicaid expenses) for General Assistance (GA) welfare clients in Washington State. The treatment group included 3,235 GA clients who received treatment during 2000 or 2001. The comparison group included 4,863 GA clients who needed substance abuse treatment but did not receive it. Substance abuse treatment was associated with a reduction (p < .01) in medical expenses of approximately 2,500 US dollars annually. This estimated savings equaled the cost of treatment and represented approximately 35 percent of the annual Medicaid expenses incurred by GA clients with substance abuse problems.

The Impact of Publicly Funded Managed Care on Adolescent Substance Abuse Treatment Outcomes

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.

Predicting the effect of substance abuse treatment on probationer recidivism

Support for the effectiveness of substance abuse treatment to reduce substance use and recidivism among populations supervised by the criminal justice system continues to grow in substance abuse and criminal justice literature. Recent studies show that a variety of programs including the Breaking the Cycle program and drug courts appear to result in improved outcomes for offenders. In this paper, we examine the effect of non-residential substance abuse treatment on arrest. Our data are for almost 134,000 ‘drug-involved’ individuals sentenced to probation in Florida between July 1995 and June 2000. Nearly 52,000 of these individuals received non-residential substance abuse treatment, while 81,797 did not. Our approach is a methodologically simple one that entails stratifying our data by treatment status, estimating logit and negative binomial models of arrest for each of the two datasets, and then applying each model to both datasets. This approach, which requires that both groups include subjects for whom treatment is appropriate, is analogous to using regression models to predict outcomes for new values of independent variables. For each observation in the dataset, we use the models to predict the expected outcomes for each individual under two scenarios – receiving non-residential treatment and receiving no treatment. Summing over these individual estimates provides an estimate of the total numbers of arrests that would be expected under different levels of population exposure to treatment. Results suggest that non-residential treatment reduced both the expected numbers of individuals who recidivated (i.e., were arrested) and the expected total numbers of arrests in the 12 and 24 months following placement on supervision.

Critical issues in the development of culturally relevant substance abuse treatments for specific minority groups.

Contemporary substance abuse treatment providers are now recognizing the growing diversity within American society. This recognition includes a growing appreciation of racial/ethnic diversity, although few models exist to aid in conceptualizing this diversity as related to substance abuse treatment. This situation prompts the need to better understand the influences of cultural variables in the design and delivery of culturally-responsive and effective substance abuse treatments. Culturally-responsive treatments are those that are sensitive to the specific treatment needs of members of special populations. This article presents specific issues and provides directions for the design, development, and implementation of more effective substance abuse treatments for clients from special populations. These important issues include: (1). the development of provider cultural competence, (2). the need to incorporate cultural variables into treatment, (3). issues in program adaptation, and (4). issues in the transfer of science to practice. Strategic models are presented to aid in conceptualizing these issues, and to further understand relationships between important cultural variables. Finally, further scientific research is encouraged that will contribute an empirical database that will test and further develop these strategic models, in the interest of enhancing the efficacy and effectiveness of substance abuse treatments as delivered to racial/ethnic minority clients, and to clients from other special populations.