Posttreatment Drug Use Research Articles

Within-treatment frequency of use versus abstinence as a predictor of longitudinal post-treatment follow-up assessments of drug use

BackgroundAbstinence is a widely-used endpoint in clinical trials of stimulant use disorders. A quantitative measure of frequency of use may be a more sensitive endpoint; however, it is important to establish that it is associated with post-treatment drug use. We examine and compare how within-treatment abstinence and frequency of use are related to two post-treatment longitudinal measures of drug use. MethodsFor each of three existing stimulant use disorder clinical trial datasets, we examined the association between within-treatment frequency of use (based on urine screens), within-treatment abstinence, and post-treatment follow-up assessments of drug use (urine screens and reported days of use). In joint analyses that simultaneously model the effects of within-treatment abstinence and frequency of use, it is possible to discern their relative importance as predictors of post-treatment drug use during the 12 months following the end of treatment. ResultsResults indicate a quantitative measure of within-treatment frequency of use was associated with longitudinal post-treatment follow-up assessments of drug use. Results from joint analyses of post-treatment follow-up drug use assessed by urine screens suggest that within-treatment frequency of use, rather than abstinence per se, is predictive of post-treatment drug use. However, results from joint analyses of self-report of days of use are equivocal. ConclusionResults lend support to the use of a quantitative measure of within-treatment drug use as an alternative to complete abstinence. They suggest that some within-treatment use that fall short of complete abstinence may potentially represent clinically important improvements given their association with post-treatment drug use.

Conduct Disorder Symptoms and Illicit Drug Use in Juvenile Justice Involved Youth: The Reciprocal Relationship Between Positive Illicit Drug-Use Attitudes and Illicit Drug Use

ABSTRACTConduct disorder (CD) symptoms cooccur at high rates with illicit drug use in juvenile justice involved youth, which results in poorer outcomes; however, research has not identified where best to intervene in this relationship, limiting the identification of modifiable risk factors to reduce negative effects of CD symptoms. Two mediation models were examined to investigate the potential for CD symptoms to influence a reciprocal relationship between illicit drug use and positive drug attitudes, controlling for age, gender, and race. Data were examined for 245 juvenile justice involved youth (mean age = 15.46, SD = 1.30, range 12–18, 64.9% Black, 80.4% male) who completed court-ordered psychological assessments. Findings indicate: (1) Positive attitudes toward illicit drug use significantly mediated the relationship between CD symptoms and illicit drug use (β = 0.16, CI 0.09–0.27; test for indirect effect z = 4.17, p < .001) and (2) illicit drug use significantly mediated the relationship between CD symptoms and positive attitudes toward illicit drug use (β = 0.20, CI 0.12–0.32; test for indirect effect z = 4.87, p < .001). Overall, the present study suggests that CD symptoms impart risk for illicit drug use both indirectly, through more positive attitudes toward illicit drug use, and directly, which further strengthens positive attitudes toward illicit drug use.

The effectiveness of compulsory drug treatment: A systematic review

BackgroundDespite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. MethodsWe conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. ResultsOf an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. ConclusionThere is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.

Posttreatment Drug Use Abstinence: Does the Majority Program Clientele Matter?

The current study examines differences in organizational characteristics and client posttreatment drug use abstinence in residential substance abuse treatment programs serving clients with high or low levels of legal coercion to participate in treatment. The findings show that low legal coercion programs have higher counselor caseloads (Z = 59, p < .05) than high coercion programs. Although the results showed that programs with a large proportion of African American clients (β = 14.26, p < .0001) and high legal coercion programs (β = 19.99, p < .05) predicted longer abstinence posttreatment, the final models suggest organizational factors are the key predictors of client posttreatment abstinence.

Substance Use Attitudes and Behaviors at Three Pharmacy Colleges

ABSTRACT The objective of this study was to profile and compare alcohol and other drug (AOD) use attitudes and behaviors in three pharmacy colleges. Student surveys of AOD use attitudes and behaviors were conducted at one southwestern and two midwestern pharmacy colleges. Response was 86.5% (566/654). Reported past-year use included alcohol 82.8%, tobacco 25.4%, and marijuana 6.9%. Past-year AOD-associated events included blackouts 18.2%, class or work under influence 7.8%, patient care under influence 1.4%, lowered grades or job evaluations 5.8%, legal charges 2.7%, and heavy drinking 29.0%. Family histories of alcohol or drug problems were reported by 35.5% and 13.1%, respectively. A number of significant differences in AOD use attitudes and behaviors between the three colleges were identified. Pharmacy students reported a number of risky drug-use attitudes and behaviors in this survey. Student AOD prevention, assistance, and education should be proactively addressed by pharmacy colleges.

Gender differences in client–provider relationship as active ingredient in substance abuse treatment

The client–provider relationship is increasingly evaluated as an active ingredient in the delivery of substance abuse treatment services. This study examines gender differences in client–provider relationship as an important treatment ingredient affecting retention in treatment and reduced post-treatment substance use. The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients. Data on individual characteristics were collected at the pre-treatment interview; on client–provider relationship and services received at treatment exit; and on post-treatment drug use at 12 months post-treatment. The analytic sample consists of 3027 clients from 59 service delivery units (1922 men and 1105 women). Structural equation modeling (SEM) was used to assess the structural relations and causal connections between relationship and service variables and treatment outcome variables. Results indicate that a positive client–provider relationship is related directly to longer duration and reduced post-treatment drug use for the total sample and for men analyzed separately. For women, a positive client–provider relationship was related directly to treatment duration and only indirectly to reduced post-treatment drug use. The findings point to the significance of including client–provider relationship in service delivery models – both as a therapeutic element as well as an element facilitative of matching services to specific client needs.

Patterns of Crime and Drug Use Trajectories in Relation to Treatment Initiation and 5-Year Outcomes: An Application of Growth Mixture Modeling Across Three Datasets.

Drug abusers vary considerably in their drug use and criminal behavior over time, and these trajectories are likely to influence drug treatment participation and treatment outcomes. Drawing on longitudinal natural history data from three samples of adult male drug users, we identify four groups with distinctive drug use and crime trajectories over the 5 years prior to their first treatment episode. The groups' characteristics of initial treatment are compared. The trajectory groups are then included in Poisson growth curve models to predict drug use, incarceration, and employment over the 5 years following first treatment. Findings indicate that posttreatment drug use decreased and posttreatment employment increased. There was little change in posttreatment incarceration. Posttreatment trajectories for drug use, incarceration, and employment were significantly different across the four trajectory groups.

Contingency Management for the Treatment of Methamphetamine Use Disorders

Theory and some preliminary evidence suggest that contingency management may be an effective treatment strategy or adjunct to psychosocial treatment for methamphetamine use disorders. An experimentally rigorous investigation on the topic was provided by a large multisite trial conducted under the auspices of the Clinical Trials Network of the National Institute on Drug Abuse. The authors report data on 113 participants who were diagnosed with methamphetamine abuse or dependence. They were randomly assigned to receive 12 weeks of either treatment as usual or treatment as usual plus contingency management. Urine samples were tested for illicit drugs, and breath samples were tested for alcohol. The reinforcers for drug-negative samples were plastic chips, some of which could be exchanged for prizes. The number of plastic chips drawn increased with each week of negative samples but was reset to one after a missed or positive sample. The participants in both groups remained in treatment for equivalent times, but those receiving contingency management in addition to usual treatment submitted significantly more negative samples, and they were abstinent for a longer period of time (5 versus 3 weeks). These results suggest that contingency management has promise as a component in treatment strategies for methamphetamine use disorder.

Parents in substance abuse treatment: Implications for child welfare practice

Substance abuse treatment in parents of young children is an important element of child welfare services. This study compares the predictive factors of post-treatment drug use in organizational, service and individual characteristics between parents and non-parents, mothers and fathers. The analysis sample is derived from the National Treatment Improvement Evaluation Study (NTIES), a longitudinal study designed to evaluate the implementation and effectiveness of the specialty substance abuse service system. The results show that treatment duration and the frequency of counseling available in treatment facilities are the most predictive factors for parents when other factors are controlled. Further, treatment duration, onsite service availability, and frequency of counseling available are significant factors in predicting post-treatment drug use for fathers, but not for mothers. These findings have implications for improving substance abuse treatment services for parents in child welfare settings.

Post-Treatment Outcomes Among Adjudicated Adolescent Males and Females in Modified Therapeutic Community Treatment

Identifying effective targeted interventions for substance using delinquent populations has remained an important objective for researchers and clinicians alike. To this end, the current study examines the client characteristics and post-treatment outcomes among youths admitted to Recovery House (RH), an innovative program that traverses the separation of juvenile justice and treatment. Data for the current analyses derive from a National Institute on Drug Abuse-funded 5-year post-treatment outcome study (NIDA #P50-DA-0770) of N = 938 adolescent clients admitted to therapeutic community (TC) programs in the United States and Canada during the period April 1992 to April 1994. Note the year. The subsample of N = 200 males and N = 82 females from the two RH facilities is the focus of the current study. The 5-year follow-up sample contained 57.9% or N = 70 of the original sample of RH males and 62.2% or N = 51 or the original RH females. Chi-square statistics, one-way analysis of variance, and the Wilcoxon Signed Rank test was used to examine pretreatment, admissions, and outcome variables and to assess within person differences pre- to post-treatment. The profile of the adolescents at admission to Recovery House reveals that the youth were primarily involved with marijuana, and secondarily with alcohol, prior to treatment. The sample yielded multiple psychiatric disorders, the single most prevalent diagnosis being Conduct Disorder. They also revealed extensive involvement in criminal activity (e.g., drug sales, violent crimes, and property crimes). Post-treatment drug use other than marijuana and alcohol was infrequent and there were reductions in the actual percent reporting involvement in most categories of criminal involvement. Gender analyses revealed that even though females were less likely to complete treatment, their post-treatment outcomes were better; proportionately fewer females compared with males were involved with marijuana use and with almost all categories of crime. In general, the findings suggest that programs such as RH can be successful in addressing the critical problem of youth substance use and criminal activity.

Evaluating a Prison-Based Drug Treatment Program in Taiwan

Using data collected from prerelease and 12-month follow-up interviews with drug-using offenders, this article evaluates the efficacy of the first prison-based drug treatment program in Taiwan. A quasi-experimental design matching drug-abusing offenders into treatment and nontreatment groups was adopted. Program outcomes were measured in five domains: criminal recidivism, post-release drug use patterns, improved family and social relationships, problems adjusting to community life, and mental health after release. Logistic and OLS regression were employed to identify possible correlates of program outcomes. The results generally failed to confirm positive outcomes generated by the compulsory drug treatment program. Program participants reported higher rates of recidivism and post-release illicit drug use than nonprogram participants. Program participants also reported more problems adjusting to community life after release. Post-release living arrangements, friends or family members abusing illicit drugs, and problems adjusting to community life after release were also found to be significant correlates of recidivism and post-treatment drug use. Post-release employment status and mental health status were significantly related to post-treatment drug use, but not to recidivism. Since multiple factors lead to drug addiction, the article concludes that the structure and implementation of Taiwan's prison-based drug treatment program needs reform to effect positive behavioral change on drug-abusing offenders.

Social Capital and Risk Level of Posttreatment Drug Use: Implications for Harm Reduction among Male Treated Addicts in Hong Kong

Since relapse is common among treated addicts, harm reduction efforts should be made to minimize their levels of risk in their reuse of drugs. This paper applies the social capital framework to analyze how a treated addict's social network affects the risk level of posttreatment drug use. Embeddedness in a pro-social network reestablished by a treated addict can facilitate positive social capital in the forms of tutelage of a normal life, informal social control from nondrug-using people, and lessening of perceived public discrimination. On the contrary, reentering a network of active addicts can produce negative social capital in the forms of tutelage of the addict lifestyle, lack of informal social control from nondrug-using people, and reinforcement of perceived public discrimination. The possession of positive social capital greatly enhances the treated addict's likelihood to reduce the risk level of posttreatment drug use, whereas the possession of negative social capital reduces such likelihood. Data used in this paper were extracted from a study of 200 male former clients of a voluntary residential treatment agency in Hong Kong. Implications of the findings for helping male treated addicts to generate positive social capital as a posttreatment harm reduction measure are discussed.

THE FIRST WEEK AFTER DRUG TREATMENT: THE INFLUENCE OF TREATMENT ON DRUG USE AMONG WOMEN OFFENDERS

Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term posttreatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Our analyses indicate that women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence.

ANTISOCIAL BEHAVIORAL SYNDROMES AND RETURN TO DRUG USE FOLLOWING RESIDENTIAL RELAPSE PREVENTION/HEALTH EDUCATION TREATMENT

This study compared residential addiction treatment clients meeting full DSM-III-R criteria for antisocial personality disorder (ASPD) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS) on time to and severity of first posttreatment drug use. Antisocial syndrome and selected other mental disorders were assessed using the Diagnostic Interview Schedule, Revised for DSM-III-R, and validity of self-reported posttreatment drug behavior was measured against results of hair analysis. Among subjects followed within 180 days after treatment exit, individuals with ASPD were at modestly increased risk of a first lapse episode compared to those with AABS. However, the two groups did not differ in severity of lapse. Participants with ASPD demonstrated poorer agreement between self-reported posttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be clinically important among substance abusers in identifying a severely antisocial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of characteristics of these syndromes that underlie clients’ risks for posttreatment return to drug use to provide optimally individualized treatment planning.

Adolescent Amphetamine Users in Treatment: Client Profiles and Treatment Outcomes

This study compares client profiles of adolescent amphetamine users to those of nonusers and examines the multivariate prediction of posttreatment drug use, criminal, and HIV risk behavior outcomes in the year following their separation from treatment. Data were collected as part of a larger longitudinal study on a sample of 938 adolescents who were admitted to residential therapeutic community drug treatment programs across the eastern United States and Canada from April of 1992 through April of 1994. A subsample of 485 adolescents were reinterviewed one year after their separation from treatment. Findings indicated that amphetamine users tended to be white, older, and have parents with higher education and occupational levels than nonusers. However, they also had more psychopathology, more extensive drug use and criminal histories, and engaged in more HIV-risk behaviors than nonusers. Additionally, amphetamine users tend to come from homes where one or both parents used illicit drugs, drank regularly, or had a mental illness, and they often reported histories of childhood maltreatment. Analyses of the one-year follow-up data indicated that being an amphetamine user was not related to treatment outcome after the client's demographic characteristics. overall drug use severity, and treatment completion were taken into account. Therefore, therapeutic community treatment appears to be an effective means of treating adolescent amphetamine users.

Utilization of services for mentally ill chemically abusing patients discharged from residential treatment.

Little is known about outcomes of treatment for individuals with mental illness and chemical dependencies. This article compares services utilization preadmission and postdischarge in 534 patients discharged from a residential treatment program in Washington State. A number of services, including chemical dependency detoxification, mental health crisis, inpatient psychiatric, medical emergency, and general medical inpatient hospitalization, were used less frequently in the period after discharge. The total reimbursement for all Medicaid services decreased by 44% from $5 million in the year prior to discharge to $2.8 million in the year after discharge. Also, individuals (32%) who completed the program were less likely to use costly, acute care services. This study was limited by the absence of a control group and posttreatment alcohol and drug use data. In addition, other unmeasured factors could have explained the association between program completion and better outcomes.

Relapse Patterns among Adolescents Treated for Chemical Dependency

This study examined levels, timing, and patterns of posttreatment alcohol and drug use in adolescents (n = 113) during the 12 months following completion of primary treatment. Data were collected from clinical records, random urine screens, and interviews with the adolescents and their parents. In all, 61.1% relapsed to pretreatment levels of use during the 12 months after treatment, 79.6% of the males and 59.3% of the females. Of those with alcohol as the drug of dependence, 45.9% relapsed to pretreatment levels of use in 12 months. Likewise, 75.0% marijuana users, 70.6% combined alcohol and marijuana users, and 50.2% other drug users relapsed to pretreatment levels of use in the 12 months. Relapse curves are presented to demonstrate the specific timing and patterns of relapse. Implications for primary treatment and aftercare are discussed.

Preadolescent conduct disorder behaviors predict relapse and progression of addiction for adolescent alcohol and drug abusers.

Increased awareness of the heterogeneity among alcohol and drug abusers has led to examination of the influence of concomitant psychopathology on the course of addiction and addictive relapse. Research among adult alcohol and drug abusers has found a detrimental influence of comorbid psychopathology on treatment outcome. Evidence exists for prevalent comorbidity, in particular conduct disorder (CD), among clinical samples of teen alcohol and drug abusers. However, little information is currently available on the relation and influence of psychopathology on outcome after treatment for adolescent alcohol and drug abuse. The current study examines the relation between CD, as assessed by the extent of preadolescent CD behaviors occurring before the initiation of drug use, and outcome for 131 adolescents over 2 years after inpatient treatment for alcohol and drug abuse. Drawing on recent conceptualizations of the process of relapse and progression of addictive behavior, CD is hypothesized to influence the process of relapse by altering coping efforts and intentions and increasing exposure to potential relapse situations. Results reveal that the extent of preadolescent CD behaviors is positively related to alcohol involvement in the 2 years after treatment, and that much of this relation is accounted for by posttreatment cognitive coping, motivation for alcohol abstinence, interpersonal problems, and exposure to alcohol use. Contrary to expectations, preadolescent CD behaviors did not predict posttreatment drug use. These findings provide evidence for the influence of psychopathology on the process of relapse and progression of addiction after treatment for adolescent alcohol and drug abuse, and suggest that teens with early life CD behaviors may be at greater risk for continued alcohol abuse.

Smoking and Health in Substance-Abusing Adolescents: A Two-Year Follow-up

To examine the prevalence and persistence of cigarette smoking along with health outcomes in a clinical sample of substance-abusing adolescents. This is a 2-year prospective case series study. Subjects were recruited from two private, hospital-based inpatient adolescent substance abuse treatment facilities. A consecutive sample of 166 adolescents, ages 12 to 18, meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for substance abuse participated in the present investigation. Of the original sample, 154 and 144 were interviewed 12 and 24 months after discharge, respectively. Information regarding cigarette smoking, drug and alcohol use, and respiratory problems was based on self-report by the adolescents and was corroborated by parent interview. The prevalence of smoking in this sample of teens immediately before treatment was 85%. Sixty-one percent of the sample smoked 1/2 pack or more/day and 75% were daily smokers. Although prevalence (74 and 77%) and average daily cigarette consumption (11.1 and 10.7 cigarettes daily) decreased at 12 and 24 months after treatment, rates remained very high. Teens reporting posttreatment respiratory problems smoked more, and heavier smokers at the time of treatment were more likely to report respiratory problems at follow-up than lighter smokers. Substance-abusing teens smoke at rates far and above those of the general adolescent population. Further, these teens appear at increased risk for negative health consequences regardless of posttreatment drug and alcohol use. These findings highlight the importance of preventing adolescent cigarette smoking by substance abuse treatment programs.

Correlates of success following treatment for adolescent substance abuse

To date, little research is available examining the course and features of recovery from substance abuse following adolescent treatment. The current study evaluated the functioning of 142 teens for 2 years following treatment for substance abuse. Adolescent drug and alcohol outcome was examined in relation to functioning on five major life domains: academic involvement, interpersonal problems, emotional well-being, family relations, and social and occupational activities. Results of this investigation demonstrate that psychosocial functioning is associated with adolescent posttreatment drug and alcohol use. Teens who were abstinent and those with less substance use involvement generally displayed better functioning. The relationship between teen alcohol and drug use and improvement in functioning varied across psychosocial domains. Clinical implications of these findings are discussed along with advances in teen substance abuse research and treatment.