Intensive Outpatient Substance Abuse Treatment Research Articles

Optimizing continuity-of-care opportunities to reduce health risks: shared qualitative perspectives from CJDATS 2 research

Current Texas Christian University (TCU) research focuses on reducing risk for relapse and other health-related behaviors associated with HIV, HBV, and HCV. The WaySafe curriculum was developed for prisoners in the last phase of their substance abuse treatment before transitioning back to the community, and was designed to improve decisionmaking and recognizing and planning for risky situations. A critical next step is to shift the setting from incarceration to a community setting with probationers during the high-risk transition period after release from prison or completion of residential or intensive outpatient substance abuse treatment. Literature supports the importance of prevention programs [1] as part of the continuity-of-care for offenders and probationers in addressing some service gaps (in the continuum), which are widely recognized to reduce the likelihood of successful client outcomes [2,3]. The purpose of this presentation is to provide evidence from the recently completed second phase of the Criminal Justice Drug Abuse Treatment Studies (CJDATS 2), with insight from key stakeholders that informs the relevance of continuity-of-care and the significant role that community corrections and community-based health-care agencies fulfill in transitioning probationers from incarceration to home. These qualitative results come from two protocols conducted as part of CJDATS 2: HIV Services and Treatment Implementation in Corrections (HIV-STIC) and Medication-Assisted Treatment in Community Corrections Environments (MATICCE). The organizational-level findings reflect the opinions and views of criminal justice personnel and health-care providers—agencies in partnership with TCU in HIV-STIC and MATICCE. In CJDATS 2, stakeholders participated in an implementation research initiative, utilizing a change team strategy to identify and implement improvements to service delivery. In both HIV-STIC and MATICCE, the services delivery continuum incorporated elements of prison-based services and transition to community-based services in their respective areas. Qualitative results highlight the important contributions of community correction agencies, their direct contact to probationers, and their ability to facilitate linkages to service providers. Findings are discussed, emphasizing the importance of staff commitment and interorganizational relationships in continuity-of-care from prison to community as essential components to optimizing services to probationers.

Nationwide dissemination of contingency management: the Veterans Administration initiative.

Contingency management (CM) is an empirically validated intervention but one not often applied in practice settings in the US. The aim of this article is to describe the Veterans Administration (VA) nationwide implementation of CM treatment. In 2011, the VA called for integration of CM in its intensive outpatient substance abuse treatment clinics. As part of this initiative, the VA funded training and ongoing implementation support, and it provided direct funds for reinforcers and other intervention costs. Over 100 clinics received this funding in 2011, and CM has been implemented in over 70 substance abuse treatment clinics since August 2011. This training and implementation experience has been highly successful and represents the largest scale training in evidence-based treatments for substance use disorders in the VA health care system to date. This program may serve as a model for training in evidence-based treatments.

Changes in personal networks of women in residential and outpatient substance abuse treatment

Changes in personal network composition, support and structure over 12months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment.

Developing a theory driven text messaging intervention for addiction care with user driven content.

The number of text messaging interventions designed to initiate and support behavioral health changes have been steadily increasing over the past 5 years. Messaging interventions can be tailored and adapted to an individual's needs in their natural environment-fostering just-in-time therapies and making them a logical intervention for addiction continuing care. This study assessed the acceptability of using text messaging for substance abuse continuing care and the intervention preferences of individuals in substance abuse treatment in order to develop an interactive mobile text messaging intervention. Fifty individuals enrolled in intensive outpatient substance abuse treatment completed an assessment battery relating to preferred logistics of mobile interventions, behavior change strategies, and types of messages they thought would be most helpful to them at different time points. Results indicated that 98% participants were potentially interested in using text messaging as a continuing care strategy. Participants wrote different types of messages that they perceived might be most helpful, based on various hypothetical situations often encountered during the recovery process. Although individuals tended to prefer benefit driven over consequence driven messages, differences in the perceived benefits of change among individuals predicted message preference. Implications for the development of mobile messaging interventions for the addictions are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Computer simulation games as an adjunct for treatment in male veterans with alcohol use disorder

This study examined the impact of a computer simulation designed to provide the opportunity for individuals with alcohol use disorders (AUDs) to practice relapse prevention skills. Participants were 41 male veterans enrolled in an intensive outpatient substance abuse treatment program. Participants were randomly assigned to either view educational slides about treatment for AUD or play a simulation videogame for eight sessions within 12weeks. Participants were assessed at a 4-week follow-up visit. Outcome measures included relapse rates as well as ratings on the Obsessive Compulsive Drinking Scale (OCDS) and a custom-designed relapse prevention self efficacy scale. While rates of relapse did not differ between groups, those who played the game showed overall reductions in ratings on the OCDS, as well as higher ratings of self-efficacy at week 8, suggesting that the videogame simulation may be a useful adjunct to AUD treatment.

Social anxiety impacts willingness to participate in addiction treatment

Individuals with social anxiety have difficulty participating in group settings. Although it makes intuitive sense that social anxiety could present a challenge in addiction treatment settings, which often involve small groups and encouragement to participate in self-help groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), to our knowledge no study has yet assessed the impact of shyness on the treatment experience. Assessment surveys were given to 110 individuals seeking intensive outpatient substance abuse treatment at three community treatment programs. Established cut-offs for presence of clinically-significant social anxiety indicated a prevalence of 37%. Controlling for depression and worry, social anxiety was a unique predictor of endorsement that shyness interfered with willingness to talk to a therapist, speak up in group therapy, attend AA/NA, and ask somebody to be a sponsor. Socially anxious substance abusers were 4–8 times more likely to endorse that shyness interfered with addiction treatment activities. These findings have clinical and research implications.

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.

Predictors of Relapse During Treatment and Treatment Completion Among Marijuana-Dependent Adolescents in an Intensive Outpatient Substance Abuse Program

ABSTRACT The present study assessed possible predictors of relapse while in treatment and treatment completion among marijuana-dependent adolescents (N = 59) in an intensive outpatient substance abuse treatment program. Comorbid depression was associated with an increased likelihood of relapse and a higher total number of relapses. As expected, relapse while in treatment was associated with a reduced likelihood of successfully completing the treatment program. Comorbid attention deficit hyperactivity disorder (ADHD) was also associated with a lower likelihood of successful program completion. These findings add to a slowly growing literature regarding adolescent substance abuse treatment, and may help clinicians identify marijuana-dependent adolescents at greater risk of relapse or noncompliance.

Retention Predictors Related to Intensive Outpatient Programs for Substance Use Disorders

The purpose of this research was to expand knowledge in the current literature regarding treatment retention in intensive outpatient substance abuse treatment programs. The sample in this study participated in a hospital-based program accredited by the Joint Commission on Accreditation for Health Organizations (JCAHO) that utilized the Minnesota model. Specifically, this inquiry investigated whether treatment retention would be predicted by gender, age, employment status, number of problems on the treatment plan, whether the referral was related to driving while intoxicated (DWI), marital status, race, and whether each of the following substance problems was listed as the client's primary DSM-IV diagnosis: alcohol dependence, cocaine dependence, polysubstance dependence, opioid dependence, sedative/hypnotic dependence, cannabis dependence, other (or unknown) dependence, alcohol abuse, cannabis abuse, amphetamine abuse, and caffeine intoxication. Findings indicated that those retained in treatment, when compared to those who dropped out, had significantly more problems on their treatment plans, were more likely to be alcoholics, were less often cocaine addicts, and were more likely to be employed. The results of this study suggest that clients with this profile have increased likelihood of being retained in intensive outpatient substance abuse treatment programs.

An Exploratory Attempt to Distinguish Subgroups Among Crack-Abusing African-American Women

Despite the significant emergence of research on female addiction over the last two decades, specific research on African-American women substance abusers, particularly crack cocaine users, is limited. The identification of meaningful subgroups of substance abusing populations, particularly minority women is important both clinically, and because of their over-representation in the epidemiological data on crack cocaine use in many urban centers across this country. An extensive battery of instruments was administered to 110 women entering treatment in an intensive outpatient substance abuse treatment program in Philadelphia, serving women who are primarily indigent, African-American, and whose primary substance of abuse is crack cocaine. Factor analysis and cluster analysis procedures were utilized to classify women into subgroups across relevant clinical, behavioral, and background concerns relevant to studying substance abusing populations. Five conceptually meaningful subgroups emerged which classified women across various indicators such as HIV sex risk factors, personality traits/Axis II dimensions, clinical syndromes, psychological symptomatology, lifetime and recent drug and alcohol use, prior physical and sexual abuse, and social context variables such as parental addiction, and whether they live with a substance abuser. Attempts to classify women into identifiable clinical subtypes is essential in order to better inform treatment initiatives designed to serve this group, as well as prevention and community outreach intervention strategies which attempt to bring them into treatment.

A Retrospective Investigation of an Intensive Outpatient Substance Abuse Treatment Program

Outpatient treatment for chemical dependency has been found to be both clinically effective and cost efficient. The purpose of this retrospective investigation was to evaluate program completion data and variables related to attrition for an intensive outpatient substance abuse treatment program. Subjects were 488 clients enrolled in the Smithers Evening Rehabilitation Program between 1991 and 1995. Client drug preference was found to be an important factor related to treatment retention, with cocaine abusers having the highest attrition rates. In addition, increasing age was an advantage in predicting who would complete the initial phase of treatment. Implications for programmatic changes, clinical practice, and future research are considered.

Predictors of attrition from an outpatient chemical dependency program1

This study investigated differences between completers and noncompleters of an intensive outpatient substance abuse treatment program to identify key predictors of attrition. Participants (n= 138) completed a comprehensive intake/assessment package that included the Addiction Severity Index as a precursor to participation in the program. Discriminant function analyses (DFA) suggested that ASI composite scores and severity ratings were not useful predictors. However, analysis of individual items was useful in identifying “red flags”; as predictors for treatment attrition. The subsequent DFA identified the following variables as significant predictors: Hispanic ethnicity, absence of a professional skill, shorter time since last hospitalization, cocaine or cannabis use in the last 30 days, total number of family members with drug problems, presence of emotional abuse in last 30 days, concern with family problems, and number of family group meetings that family members attended. These red flags can serve the important function of providing clinicians with enough information to intervene early with patients at risk for treatment dropout.