Intensive Outpatient Treatment Program Research Articles

Effectiveness of Stimulant Medications on Disruptive Behavior and Mood Problems in Young Children.

ObjectiveThere are very few studies on the effectiveness of stimulant medications for the treatment of disruptive mood and behavior problems in young children (less than 7 years) with Disruptive Behavior Disorders (DBD). The current study aims to determine whether young children (ages 4−7) in a long-term, intensive outpatient behavioral treatment program who are receiving stimulant medications show greater improvement in mood and behavior problems compared to peers who did not.MethodsA retrospective chart review was conducted for 97 participants diagnosed with DBD, aged 4−7 years old who were enrolled in an intensive outpatient behavioral intervention program. Pre- and post-intervention Child Behavior Checklist (CBCL) scores for disruptive behavior and mood problems were compared between the children who received stimulant medications and those who did not.ResultsPaired t tests showed a statistically significant improvement in CBCL outcomes between pre- and post-intervention scores of disruptive behavior and mood problems. ANCOVA analysis, however, showed no clear further improvement in those same CBCL scores in the participants who received stimulant medications compared to the participants who did not. CBCL scores for Conduct Disorder were marginally significant for less improvement for the participants who received stimulant medications.ConclusionThis retrospective review suggests a possibility that stimulant medications may not provide additional benefit for the long-term treatment of disruptive behavior and mood problems in young children under age 7. Future study is warranted to evaluate the efficacy/effectiveness of stimulant medications in the treatment of disruptive behavior and mood problems in this population.

1110 Characteristics Of Untreated Sleep Disturbance During Intensive Outpatient Treatment For Substance Use Disorders: Preliminary Results From A Longitudinal Study

Abstract Introduction Previous studies have shown that sleep problems are commonly reported during treatment for substance use disorders (SUDs) and sleep complaints have been linked to subsequent relapse. However, most of these findings were in well-controlled clinical trials and may not generalize to the public. Little is known about the natural progression of sleep complaints during treatment in community clinics, the most common treatment approach for SUDs. The aim of this study is to longitudinally assess prevalence of clinically significant sleep disturbance at baseline and post-treatment in a community-based intensive outpatient (IOP) SUD treatment program using a multi-method approach with well-validated measures of sleep. Methods Adults beginning IOP SUD treatment completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Nightmare Disorder index (NDI), and one week of actigraphy and sleep diaries. Measures were repeated following treatment (approximately 5 weeks later). Results Preliminary analyses on 21 adults who have been enrolled thus far revealed 85.6% of participants experienced sleep disturbance (PSQI > 5) at baseline. 28.5% of participants reached cutoff for moderate-to-severe insomnia symptoms (ISI > 15) and 42.9% reported nightmares more than once per week. Sleep parameters taken from actigraphy and sleep diaries revealed mean sleep efficiency was 77.5% (TST M = 6.2 hours; TIB M = 7.9 hours). These variables did not improve from baseline to post-treatment. Further, most measures indicated a worsening of sleep, though this did not reach significance (all ps > .05). Conclusion This preliminary data show a high prevalence of self-reported sleep complaints and objectively measured poor sleep efficiency that do not improve over the course of treatment. Data collection is ongoing and expected to at least double. More robust analyses, including differences between SUD type (e.g., cannabis vs. opioid) and relationship to relapse at post-treatment, will then be completed. Support K12DA031794

Intensive Outpatient Treatment (IOP) of Behavioral Health (BH) Problems: Engagement Factors Predicting Subsequent Service Utilization.

The purpose of the study is to 1) better understand patterns of utilization of Intensive Outpatient Treatment (IOP) Programs and Services in the State of Connecticut by adult Medicaid recipients experiencing a serious mental illness, substance use disorder, or co-occurring disorders; and 2) to determine the relationship between the duration of an IOP episode and connection to care rates for higher (i.e., rehospitalization) or lower levels of care following discharge. We hypothesized that the duration of an IOP episode would impact positively in reducing the use of higher levels of care while increasing the use of lower levels of care. In order to examine the frequency and duration of use of Intensive Outpatient (IOP) services by the CT Medicaid population, a two-year timeframe was selected: July 1, 2012 to June 30, 2014. A survival analysis was conducted to assess the risk of readmission to an IOP within 180days based on demographic and utilization factors including, Age (in years on date of discharge), Race and Ethnicity, Gender, Homeless Status (at least one day in CY 2013), and Engagement Group (Intent to Treat, Early Termination, Minimally Adequate Dosage, & Target or More). To better understand the patterns of utilization associated with Adult IOP services, the average length of stay, number of treatment days, and average number of treatment days per week were explored. The number of unique individuals who were part of this analysis is 11,473, of which 2050 were mental health IOP utilizers (18%), 4598 were co-occurring IOP utilizers (40%), and 4825 (42%) were substance use IOP utilizers. For the total population, the average length of stay (ALOS) in days was 42 and the average number of treatment days attended per week was 2.5, for an average of 15 treatment days per episode of care. Among the IOP Cohorts, the Mental Health Cohort had the longest ALOS at 44.15days, an average of 2.34days of service per week, for an average of 14.76days of IOP service per episode of care. The Substance Use Cohort had the shortest ALOS at 41.33days, but had the highest intensity of services per week at 2.71 for an average of 16days of service per episode of care. The Co-Occurring Cohort presented an ALOS of 41.74days, an average of 2.32 services per week and an average of 13.83 sessions per episode. Overall there is evidence supporting an association between the number of days of care and protection from hospitalization, up to a certain number of days of care or number of days in IOP. Above the Minimally Adequate Dosage, the IOP protection factor seems to reach a plateau. This means that after 16days of care, the chances of hospitalization remain the same regardless of the additional days provided.

Inclusion of Family Therapy in Rehabilitation Program of Substance Abuse and Its Efficacious Implementation

The family has been described as the center or heart of societal relationships. There has been a historic neglect of research in area of counseling for the family members of substance abusers. As result, treatment for individual family members affected by alcoholism and drug addiction remains a neglected component of majority of addiction programs. The study used a sample of 36 families who participated in family therapy intensive outpatient and inpatient treatment program during 2 years. This study explored the efficacy of family-based treatment in changing family’s attitudes toward people with addiction and toward specific relative with addiction. The participants were in two groups; ethnographic technique of action research model was used. Participants in the treatment group received treatment session and participants in the control group did not receive treatment session but had a general treatment program in health centers. This study had two phases: (1) recruiting, selecting, interviewing, and determining eligibility of family members from both groups in the study and (2) applying the intervention to the treatment group with the help of cognitive-behavioral group counseling. This treatment program comprised of solution-focused family skilled training therapy, action learning techniques, community and peer mentorship, and parent training was effective in reducing addicts drug ingestion, changing their attitudes about drug use, increasing knowledge of the physical consequences of drug use, and improving competent behaviors. Family therapy enhanced family resilience, structure, and strong ties; the program improved problem-solving skills, coping skills, and family resiliency levels of the addicts.

The impact of intensive treatment for pediatric anxiety and obsessive-compulsive disorder on daily functioning.

This study investigated whether intensive group-based cognitive-behavioral therapy (CBT) with family involvement for children with anxiety disorders and obsessive-compulsive disorder (OCD) would facilitate children's return to their daily routines. The focus shifted from the usual emphasis on remission to an improvement in functioning. The aim was to capture potentially missed gains when children pursue their fears and engage in more adaptive behaviors as these efforts may result in ongoing symptoms. Two hundred twelve children and adolescents aged 8-19 years old, who were patients in an intensive outpatient group-based treatment program at an academic hospital, participated in this study. Results indicated that both children and their parents endorsed significant improvement in children's functioning from admission to discharge. Symptom reduction was assessed for reference, and both children and parents reported significant decreases in child anxiety symptoms from admission to discharge, and children endorsed decreases in their comorbid depression symptoms. Short-term group-based intensive treatment in a clinical setting may help children return to their daily activities quickly.

The association between baseline insomnia symptoms and future suicide attempts within an intensive outpatient treatment program for suicide

This study examines the prospective relationship between insomnia symptoms and suicide attempts in high-risk youth. We obtained depressive symptoms, insomnia symptoms, and suicide ideation measures from clinical records of 206 adolescents ages 12–17 at entry and discharge from a suicide prevention intensive outpatient program. Information about whether the participant made a suicide attempt was available through six months after discharge. Patients were mainly girls (79.1%; n = 163) with depression (89.8%; n = 185). Associations between insomnia symptoms, attempts within 6 months of discharge, persistent insomnia symptoms, and suicide ideation at discharge were tested with multiple regression analyses. Entry insomnia symptoms were prospectively associated with attempts when controlling for age, sex, and previous attempts, but insomnia symptoms at discharge were not. Suicide ideation at discharge was associated both with entry insomnia symptoms and attempts within 6 months of discharge. When entry and discharge suicide ideation were controlled, the association between entry insomnia symptoms and attempts lost significance. However, the association between discharge ideation and attempts remained significant. Insomnia symptoms contribute indirectly to suicide attempt risk after discharge. Intensive treatment for ideation and reducing insomnia symptoms could reduce discharge suicide risk and subsequent suicide attempts.

The effectiveness of interdisciplinary intensive outpatient programs in a population with diverse chronic pain conditions: a systematic review and meta-analysis.

Aim: To explore the overall effectiveness of interdisciplinary intensive outpatient treatment programs in adults with chronic pain. The secondary aim was to examine the effect of the intervention on individual outcome measures including pain intensity, pain catastrophizing, depressive symptoms, quality of life and describe its effect on medication use. Methods: The preferred reporting items for systematic review and meta-analysis protocols reporting guidelines were followed in this systematic review and meta-analysis. Results:A total of13 peer-reviewed studies were included in analysis: one randomized controlled trial and12 observational studies. Conclusion: Although interdisciplinary intensive outpatient programs for chronic pain have only been examined in a limited number of studies, trends suggest that participation in these programs may improve physical, emotional, social and mental health as measured by quality of life measures, while decreasing pain intensity, pain catastrophizing and depressive symptoms in a population with diverse diagnoses.

Insomnia severity during early abstinence is related to substance use treatment completion in adults enrolled in an intensive outpatient program

BackgroundInsomnia and other types of sleep disturbance are highly prevalent during withdrawal across many different types of substance use disorders (SUDs). It is largely unknown how sleep impacts SUD treatment outcomes, including treatment completion. MethodsA retrospective chart review was conducted to obtain information about sleep disturbance and treatment completion in individuals beginning an intensive outpatient (IOP) SUD treatment program. Demographic data were collected along with number of sessions completed, treatment completion, comorbid psychiatric diagnosis, pertinent lab results, and scores on three self-reported measures of sleep: the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). ResultsPertinent information was available for 110 individuals. The majority had clinically significant scores on the ISI and PSQI but not the ESS. ISI, but not PSQI or ESS, was associated with treatment completion, such that those with more insomnia were less likely to complete treatment. ConclusionThe high prevalence of insomnia symptoms and poor sleep quality coupled with the relationship between insomnia severity and treatment completion may indicate that more severe symptoms of insomnia are a risk factor for treatment completion and subsequent relapse across many substance types. Applying evidence-based insomnia interventions in SUD treatment programs may have meaningful implications for outcomes.

Neuropsychological changes in patients with substance use disorder after completion of a one month intensive outpatient treatment program.

Data suggest individuals with substance use disorders (SUD) exhibit high rates of executive functioning (EF) impairment, and that EF level can predict treatment retention. The primary aim of the present study was to investigate if patients who completed a 1 month intensive outpatient program (IOP) for SUD demonstrated recovered EF. Baseline and follow-up neurocognitive functioning was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the self-reported Behavior Rating Inventory of Executive Functioning (BRIEF-A) questionnaire. The final sample included 15 patients who completed the one month IOP and for whom data were available (53% male, aged 36 years ± 13.4). Despite exhibiting general improvements in EF and significant improvements in organization, subjects continued to manifest significant executive dysfunction as evaluated by self-report and computerized assessment. Patients with SUD often manifest high levels of executive dysfunction upon entry into SUD treatment that, while improving minimally, appears to persist despite intensive outpatient treatment at 1 month. These persistent EF deficits may affect patient engagement and participation in treatment, thus necessitating SUD programs to assess and accommodate EF issues throughout treatment. (Am J Addict 2018;XX:1-7).

Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study

The continued need for advancement in evidence-based SUD treatment, as well as increases in treatment expense and decline in support from insurance providers, suggest that brief, innovative, and affordable treatments are needed. Meditation, spirituality, and adherence to medication-assisted treatments have all been shown to support abstinence. The current trial assessed effects of spiritually-based meditation, versus relaxation or standard treatment, on substance abstinence and psychological distress and dysfunction in a partially buprenorphine-supported (41.5%) treatment sample. Participants (N = 40) were recruited from an intensive outpatient treatment program, in which three treatment locations acted as separate experimental conditions. Abstinence was measured through urinalyses at baseline and weekly thereafter for the duration of the intervention. Psychological distress and dysfunction were assessed with a Likert-scaled questionnaire measuring symptoms typically associated with SUD. Co-varying for buprenorphine use, participants in the Meditation condition had better odds of remaining abstinent than participants in the Treatment-as-Usual (TAU) and Relaxation conditions. There were no significant differences in substance abstinence between the Relaxation and TAU conditions. Further, co-varying out baseline there were no significant differences at post-course in psychological distress and dysfunction between the three conditions. Results from this pilot trial suggest that this spiritually-informed approach may offer additive support to individuals in SUD treatment, as an aid to the meditative aspect of the 12 steps, or a non-12-step alternative spiritual supplement to standard SUD treatment.

Incentives in a public addiction treatment system: Effects on waiting time and selection

Program-level financial incentives are used by some payers as a tool to improve quality of substance use treatment. However, evidence of effectiveness is mixed and performance contracts may have unintended consequences such as creating barriers for more challenging clients who are less likely to meet benchmarks. This study investigates the impact of a performance contract on waiting time for substance use treatment and client selection. Admission and discharge data from publicly funded Maine outpatient (OP) and intensive outpatient (IOP) substance use treatment programs (N = 38,932 clients) were used. In a quasi-experimental pre-post design, pre-period (FY 2005–2007) admission data from incentivized (IC) and non-incentivized (non-IC) programs were compared to post-period (FY 2008–2012) using propensity score matching and multivariate difference-in-difference regression. Dependent variables were waiting time (incentivized) and client selection (severity: history of mental disorders and substance use severity, not incentivized). Despite financial incentives designed to reduce waiting time for substance use treatment among state-funded outpatient programs, average waiting time for treatment increased in the post period for both IC and non-IC groups, as did client severity. There were no significant differences in waiting time between IC and non-IC groups over time. Increases in client severity over time, with no group differences, indicate that programs did not restrict access for more challenging clients. Adequate funding and other approaches to improve quality may be beneficial.

T147. Incidence of Synthetic Oxytocin Administration and Time to Improvement of Depression and Anxiety Symptoms in the UCSD Intensive Outpatient Treatment Program for Postpartum Depression

T147. Incidence of Synthetic Oxytocin Administration and Time to Improvement of Depression and Anxiety Symptoms in the UCSD Intensive Outpatient Treatment Program for Postpartum Depression

Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step” (STAGE-12) intervention

Emerging adults (roughly 18–29years) with substance use disorders can benefit from participation in twelve-step mutual-help organizations (TSMHO), however their attendance and participation in such groups is relatively low. Twelve-step facilitation therapies, such as the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12), may increase attendance and involvement, and lead to decreased substance use. AimsAnalyses examined whether age moderated the STAGE-12 effects on substance use and TSMHO meeting attendance and participation. DesignWe utilized data from a multisite randomized controlled trial, with assessments at baseline, mid-treatment (week 4), end-of-treatment (week 8), and 3- and 6- months post-randomization. ParticipantsParticipants were adults with DSM-IV diagnosed stimulant abuse or dependence (N=450) enrolling in 10 intensive outpatient substance use treatment programs across the U.S. AnalysisA zero-inflated negative binomial random-effects regression model was utilized to examine age-by-treatment interactions on substance use and meeting attendance and involvement. FindingsYounger age was associated with larger treatment effects for stimulant use. Specifically, younger age was associated with greater odds of remaining abstinent from stimulants in STAGE-12 versus Treatment-as-Usual; however, among those who were not abstinent during treatment, younger age was related to greater rates of stimulant use at follow-up for those in STAGE-12 compared to TAU. There was no main effect of age on stimulant use. Younger age was also related to somewhat greater active involvement in different types of TSMHO activities among those in STAGE-12 versus TAU. There were no age-by-treatment interactions for other types of substance use or for treatment attendance, however, in contrast to stimulant use; younger age was associated with lower odds of abstinence from non-stimulant drugs at follow-up, regardless of treatment condition. These results suggest that STAGE-12 can be beneficial for some emerging adults with stimulant use disorder, and ongoing assessment of continued use is of particular importance.

A Study of an Intensive Outpatient Treatment Program for High Risk Psychiatric Patients within a Network IPA Model Health Maintenance Organization

A Study of an Intensive Outpatient Treatment Program for High Risk Psychiatric Patients within a Network IPA Model Health Maintenance Organization

Emotional reactivity in a clinical sample of patients with eating disorders and nonsuicidal self-injury

Emotional reactivity is theorized to contribute to both eating disorders (ED) and nonsuicidal self-injury (NSSI). Although EDs and NSSI frequently co-occur, no study has examined emotional reactivity in individuals with both conditions. This study examined the following hypotheses in a large clinical sample (N = 648): (1) patients with co-occurring ED and NSSI would report higher emotional reactivity and more severe clinical characteristics; (2) among those with EDs, patients with bulimia nervosa (BN) would be more likely to report NSSI and evidence higher emotional reactivity compared to those with anorexia nervosa (AN); and (3) higher emotional reactivity would be associated with worse treatment outcomes. Data were collected at admission and discharge from inpatient, partial hospitalization, and intensive outpatient treatment programs for EDs or NSSI. The NSSI-only and co-occurring groups reported significantly higher emotional reactivity than the ED-only group. Among those with EDs, individuals with BN reported higher emotional reactivity and were more likely to engage in NSSI compared to those with AN. Emotional reactivity was inconsistently related to treatment outcomes among the co-occurring and ED-only groups. In sum, results highlight the importance of emotional reactivity in clinical presentations, particularly when NSSI is present.

An intensive outpatient treatment program for combat-related PTSD: Trauma Management Therapy.

An estimated 18.5% of veterans returning from Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn are suffering from posttraumatic stress or posttraumatic stress disorder (PTSD). The number of veterans and service duty personnel requesting VA health care services is increasing, and the VA's ability to handle requests is dwindling. Thus, both the content of interventions and the format by which these services are delivered need to be reconceptualized. The authors present a multicomponent intervention program known as Trauma Management Therapy (TMT), a comprehensive, empirically supported treatment that can be delivered in an intensive, 3-week outpatient format. TMT combines individual exposure therapy with group social and emotional rehabilitation skills training to address specific aspects of the combat-related PTSD syndrome. The authors present the format of this novel intensive outpatient program, describe the components, and address implementation factors such as treatment compliance, dropout rates, and administrative considerations.

Kratom (Mitragyna speciosa) Use in a Veteran With Chronic Pain

Kratom (<i>Mitragyna speciosa</i>) Use in a Veteran With Chronic Pain

Neural responses to negative outcomes predict success in community-based substance use treatment.

Patterns of brain activation have demonstrated promise as prognostic indicators in substance dependent individuals (SDIs) but have not yet been explored in SDIs typical of community-based treatment settings. Prospective clinical outcome design, evaluating baseline functional magnetic resonance imaging data from the Balloon Analogue Risk Task (BART) as a predictor of 3-month substance use treatment outcomes. Community-based substance use programs in Bloomington, Indiana, USA. Twenty-three SDIs (17 male, aged 18-43years) in an intensive outpatient or residential treatment program; abstinent 1-4weeks at baseline. Event-related brain response, BART performance and self-report scores at treatment onset, substance use outcome measure (based on days of use). Using voxel-level predictive modeling and leave-one-out cross-validation, an elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) at baseline successfully predicted greater substance use during the 3-month study interval (P≤0.006, cluster-corrected). This effect was robust to inclusion of significant non-brain-based covariates. A larger response to negative feedback in bilateral Amyg/aHipp was also associated with faster reward-seeking responses after negative feedback (r(23) =-0.544, P=0.007; r(23) =-0.588, P=0.003). A model including Amyg/aHipp activation, faster reward-seeking after negative feedback and significant self-report scores accounted for 45% of the variance in substance use outcomes in our sample. An elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) appears to predict relapse to substance use in people attending community-based treatment.

Intensive Treatment of Elephantiasis in A Child: A Case Report

Introduction: There are few publications on the treatment of elephantiasis in children. Objective: The aim of this study is to report on the intensive treatment of lower limb elephantiasis of a child in an outpatient setting. Case report: We report the case of an eight-year-old boy who was born with scrotum and lower limb lymphedema. The initial diagnostic difficulty and therapeutic conduct over the years did not produce results and there were complications such as erysipelas. The lymphedema progressed to the most advanced stage, elephantiasis (stage III), with the mobility of the child limited affecting the quality of his life, including academically. A five-day intensive outpatient treatment program was proposed including Cervical Stimulation Therapy, Manual Lymphatic Therapy, Mechanical Lymphatic Therapy and compression using a custom-made stocking made of a grosgrain fabric. Results: There was a reduction of 45% of the limb volume in five days. Conclusion: Intensive treatment of elephantiasis in children is a new therapeutic option that allows significant reductions in volume in a short time.

A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment

IntroductionThis randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes. MethodsAlcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program. ResultsParticipants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ2(1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment. ConclusionsAdding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence.