Treatment Retention Rates Research Articles

Clinical outcomes of the first 2 years of implementation of the integrated care pathway for concurrent major depressive disorder and alcohol use disorder

BackgroundBoth major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)MethodsChart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.ResultsOverall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).ConclusionsThe ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Modafinil Treatment of Cocaine Dependence: A Systematic Review and Meta-Analysis

ABSTRACTBackground: Currently, there is none FDA-approved medication to treat cocaine dependency. Studies conducted with various medications, including antipsychotics, antidepressants, anticonvulsants, and others, revealed inconsistent results. Objectives: To meta-analytically investigate the efficacy and safety of modafinil in the treatment of cocaine-dependent patients. Methods: Randomized controlled trials with ≥20 subjects comparing the numerical therapeutic outcomes of modafinil with placebo were identified in databases, such as PUBMED, psycINFO, EMBASE, and Clinicaltrials.gov. Relevant data on efficacy and safety were extracted. Relative risk (RR) and standardized mean difference were applied for reporting dichotomous and continuous outcomes respectively. Random effects, subgroup, and meta-regression analyses were conducted to further explore the results and evaluate for any moderators. Results: In total, 11 studies (participants = 896, duration = 6.7 ± 1.9 weeks) comparing modafinil with placebo were systematically analyzed, which indicated that modafinil was not superior to placebo in improving the treatment retention rate (studies = 11, participants = 891, RR = 1.030, 95% CI = 0.918–1.156, p = .613). Similarly, data from 7/11 studies did not evidence superiority of modafinil in achieving cocaine abstinence (participants = 696, RR = 1.259, 95% CI = 0.813–1.949, p = .302). However, subgroup analysis of six studies conducted in the United States demonstrated superiority of modafinil in cocaine abstinence rate (studies = 6, participants = 669, 95% CI = 1.027–2.020, p = 0.035). In addition, no evidence suggested modafinil-related discontinuation or specific adverse events than placebo. Conclusions: Overall, there is no evidence to conclude superiority of modafinil in increasing cocaine abstinence and treatment retention rate. However, promising result in subgroup analysis of cocaine abstinence, secondary outcomes, and good safety profile urged the need of larger studies to derive more conclusive results.

Review highlights poor rates of patient retention in buprenorphine treatment

The Brown University Psychopharmacology UpdateVolume 28, Issue 4 p. 3-4 What's New in Research Review highlights poor rates of patient retention in buprenorphine treatment First published: 23 March 2017 https://doi.org/10.1002/pu.30221Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Although a number of studies have concluded that there is little benefit from adding a behavioral intervention to buprenorphine maintenance treatment for opioid dependence, a review of the research demonstrates ongoing limitations in the effectiveness of buprenorphine treatment as currently practiced, including a high dropout rate. The results indicate the need for more individualized treatment approaches for patients receiving buprenorphine, according to researchers. Volume28, Issue4April 2017Pages 3-4 RelatedInformation

Public sector low threshold office-based buprenorphine treatment: outcomes at year 7

BackgroundBuprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, “home,” buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings.MethodsThis prospective clinical registry cohort design estimated rates of induction-related adverse events, treatment retention, and urine opioid results for opioid dependent adults offered buprenorphine maintenance in a New York City public hospital primary care office-based practice from 2006 to 2013. This clinic relied on typical ambulatory care individual provider-patient visits, prescribed unobserved induction exclusively, saw patients no more than weekly, and did not require additional psychosocial treatment. Unobserved induction consisted of an in-person screening and diagnostic visit followed by a 1-week buprenorphine written prescription, with pamphlet, and telephone support. Primary outcomes analyzed were rates of induction-related adverse events (AE), week 1 drop-out, and long-term treatment retention. Factors associated with treatment retention were examined using a Cox proportional hazard model among inductions and all patients. Secondary outcomes included overall clinic retention, buprenorphine dosages, and urine sample results.ResultsOf the 485 total patients in our registry, 306 were inducted, and 179 were transfers already on buprenorphine. Post-induction (n = 306), week 1 drop-out was 17%. Rates of any induction-related AE were 12%; serious adverse events, 0%; precipitated withdrawal, 3%; prolonged withdrawal, 4%. Treatment retention was a median 38 weeks (range 0–320) for inductions, compared to 110 (0–354) weeks for transfers and 57 for the entire clinic population. Older age, later years of first clinic visit (vs. 2006–2007), and baseline heroin abstinence were associated with increased treatment retention overall.ConclusionsUnobserved “home” buprenorphine induction in a public sector primary care setting appeared a feasible and safe clinical practice. Post-induction treatment retention of a median 38 weeks was in line with previous naturalistic studies of real-world office-based opioid treatment. Low threshold treatment protocols, as compared to national guidelines, may compliment recently increased prescriber patient limits and expand access to buprenorphine among public sector opioid use disorder patients.

Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

BackgroundThis paper compares adolescents with primary opioid problem use (OPU) to those with primary marijuana or alcohol problem use (MAPU) who received up to six months of Adolescent Community Reinforcement Approach (A-CRA), an empirically supported treatment. MethodsIntake clinical characteristics, treatment implementation measures, and clinical outcomes of two substance problem groups (OPU and MAPU) were compared using data from 1712 adolescents receiving A-CRA treatment. Data were collected at intake and 3, 6, and 12 months post-intake. ResultsAt intake, adolescents in the OPU group were more likely than those in the MAPU group to be Caucasian, older, female, and not attending school; report greater substance and mental health problems; and engage in social and health risk behaviors. There was statistical equivalence between groups in rates of A-CRA treatment initiation, engagement, retention, and satisfaction. Both groups decreased significantly on most substance use outcomes, with the OPU group showing greater improvement; however, the OPU group had more severe problems at intake and continued to report higher frequency of opioid use and more days of emotional problems and residential treatment over 12 months. ConclusionsThe feasibility and acceptability of A-CRA for OPUs was demonstrated. Despite significantly greater improvement by the OPU group, they did not improve to the level of the MAPU group over 12 months, suggesting that they may benefit from A-CRA continuing care up to 12 months, medication to address opioid withdrawal and craving, and the inclusion of opioid-focused A-CRA procedures.

EMDR Interventions in Addiction

The use of tobacco, alcohol, and illicit drugs is widespread and has significant negative consequences for the individual, their families, and the communities to which they belong. A substantial number of users develop an addiction disorder. Cure-oriented addiction treatment is challenging regarding treatment retention and relapse rates. Here, we discuss the potential of eye movement desensitization and reprocessing (EMDR) therapy to aid addiction treatment. Two approaches are distinguished: trauma-focused and addiction-focused EMDR therapy. Existing adapted EMDR protocols and research on both approaches is critically reviewed. Despite 20 years of development and research, the feasibility and efficacy of addiction-focused EMDR therapy is still largely uninvestigated. Exciting new possibilities, offered by research on working memory theory, are discussed. An overview of all resourcing and EMDR therapy interventions in addiction is presented: the palette of EMDR interventions in addiction (PEIA). The article finishes with recommendations for further research in this field.

The impact of compliance with a compulsory model of drug diversion on treatment engagement and reoffending

Aim: Over a 10-year period from 2003, around 1.7 million arrests in England and Wales resulted in the suspect being exposed to mandatory drug testing and assessment processes. These provisions formed part of a wider drug interventions programme costing £1.3 billion. This study sought to assess the impact of compliance with these measures on treatment uptake and reoffending. Recidivism risk factors were also investigated. Methods: The use of linked administrative data relating to matched samples of recent heroin and/or cocaine (H/C) users identified in one English police force area over a 12-month period (N = 1630). Findings: There was no association between compliance with a compulsory model of drug diversion and subsequent engagement with structured treatment services, rates of treatment retention and successful discharge. Compliance was also not found to be associated with reductions in the rate and volume of reoffending after 12 months. The factor with the largest effect on risk of recidivism was poly use of H/C. Main offence, engagement with structured treatment, number of prior convictions and (younger) age were also identified as recidivism risk factors. Conclusions: These results are discussed in the context of subsequent legislation and policy which further expands the reach of mandatory testing and assessment measures as a form of constraints-based drug diversion.

Monitoring a Prison Opioid Treatment Program Over a Period of Change to Clinical Governance Arrangements, 2007–2013

Background and aimsOpioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. MethodData from the NSW prison OST program were obtained for the calendar years 2007–2013. Outcomes were analyzed quarterly using log binomial segmented regression. Results8577 people were treated with OST in NSW correctional centers, 2007–2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes; a prescription for OST was able to be arranged prior to release in 90% of releases; and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. DiscussionThis large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody.

Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands

Parent management training programs for the treatment of childhood conduct problems are increasingly being transported from their country of origin to international settings. Family interactions, however, may be influenced by different cultural expectations and children's mental health problems may be addressed within different systems. Demonstrating reductions in symptoms within the new population is insufficient to support the wide-scale transport of a treatment model. Implementation outcomes such as the rates of treatment retention and factors related to treatment attrition must also be considered. We explored predictors of attrition in families from the Netherlands referred to the evidence-based parenting program Parent–Child Interaction Therapy (PCIT). Participants included 40 children with conduct problems (2–7years; 68% boys) and their caregivers. Attrition (40%) was somewhat lower than findings with similar community samples in the US. Significant predictors of attrition were child age and maternal levels of internalizing symptoms. Low parental demandingness and high child compliance before start of treatment were related to early attrition within twelve treatment sessions. Meeting the needs of families at risk for attrition is an important goal for parent management training programs within and outside the US if families in need of services are to benefit from them.

Drug test results as a predictor of retention among patients using buprenorphine in a comprehensive outpatient treatment program

ABSTRACTThe study examined the relationship between continued non-medical drug use and treatment retention for patients receiving buprenorphine maintenance treatment in a comprehensive addiction treatment program. The participants were 106 newly admitted patients and 103 continuing patients in treatment for an average of 9.4 months at the start of the study. Retrospective chart reviews were used to determine for each group whether the use of illicit, non-prescribed drugs during a 3-month baseline period was associated with lowered rates of treatment retention over the following 14 months. The New Admissions group was divided into 4 subgroups based on the percentage of urine drug tests that were positive during baseline: 0, 1–33, 34–67, or 68–100%. Because only 16 (15%) of the continuing patients had positive drug tests during baseline, the continuing group was divided into just 2 subgroups—no positives and any positives. Newly admitted patients testing positive for drugs more than 33% of the time were significantly more likely than those with less frequent or no positive tests to withdraw from treatment within 2 months. Continuing patients with at least 1 positive drug test left treatment 6 months sooner, on average, than those with no positive tests and were twice as likely to leave without completing continuing care (87 to 42%). Non-prescribed drug use during buprenorphine maintenance treatment is strongly correlated with lowered retention and risk of early treatment termination for new and continuing patients. Actions taken to monitor and reduce drug use during buprenorphine maintenance treatment may improve retention and enhance long-term recovery outcomes.

Does cue exposure treatment improve outcomes in smoking cessation treatment? A controlled trial

Aims: Cue exposure techniques (CET) consist of controlled and repeated exposure to cues that provoke craving in order to extinguish the urge to smoke. Previous studies showed that cigarette craving can be reduced through CET. However, very few studies have explored the efficacy of CET for smoking cessation. This randomized clinical trial explored the effectiveness of a CET procedure when added to a Cognitive Behavioral Treatment (CBT) for smoking cessation among treatment-seeking smokers. Methods: The sample was made up of 102 treatment-seeking smokers with current DSM-IV nicotine dependence. Participants were randomly assigned to oneof two treatment conditions: CBTor CBT+CET. The CBT intervention involved group-based sessions during 6 weeks. In addition to CBT, participants in CBT+CET condition received 5 individual sessions of CET through virtual reality. Results: Of the patients in the CBT+CET group, 78% attended all treatment sessions compared to 73.1% in the CBT group (p = .56). At the end of the treatment, 56% of the patients in the CBT+CET condition achieved abstinence, versus 51.9% in the CBT condition (p = .68). At one month follow-up, 38% in the CBT+CET condition were abstinent compared to 38.5% in the CBT condition (p = .87). Lastly, 24% of patients treatedwith CBT+ CETwere abstinent at sixmonth follow-up compared to 25% who received CBT alone (p = .90). Conclusions: Results showed that neither abstinence levels nor treatment retention rates were better in the CET+CBT compared to CBTalone. TheCETproceduredoesnot appear to improveoutcomes in a smoking cessation program. Results from this randomized clinical trial suggest that CET is not an effective strategy for smoking cessation. Financial support: This work was supported by the Spanish Ministry of Science and Innovation (MICIIN) (Ref. PSI200805938/PSIC) and the predoctoral grant from the Spanish Ministry of Economy and Competitiveness (Ref. BES-2012-053988).

Substance Use in Patients With First-Episode Psychosis: Is Gender Relevant?

Objective: Only a few studies in patients with first-episode psychosis have included gender in the study hypothesis or considered this a primary study variable. The aim of this study was to explore the influence of gender in the pattern of substance use in patients with first-episode psychosis. Methods: This is a sub-analysis of a randomized open clinical trial that compared 1-year treatment retention rates of patients with first-episode psychosis randomized to haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone. Our sub-analysis included 85 men and 29 women. Results: Substance use was relatively high among these patients and differed significantly by gender. Men were more likely to use substances overall than women (89.4% for men vs. 55.2% for women), χ2 = 16.2, df = 1, p <.001, and were also more likely to use alcohol (χ2 = 13, df = 1, p <.001), cannabis (χ2 = 9.9; df = 1, p <.002), and cocaine (χ2 = 10.3; df = 1, p <.001), compared to women. While there were no gender differences in age at first consumption of alcohol or cocaine, men were significantly younger at first consumption of cannabis (M = 16.08 years, SD = 2.1) than women (M = 18.0 years, SD = 3.8), F(1, 59) = 5, p <.02. When analyzed separately by gender, women showed no significant differences in the influence of number of substances used on age at onset of psychosis, F(3, 29) = 1.2, p =.30. However, there was a significant difference among men, with earlier onset of psychosis noted in men consuming multiple substances; F(4, 85) = 5.8, p <.0001. Regarding prediction of age at onset of psychosis, both male gender and the use of a higher number of substances significantly predicted an earlier age at onset of psychosis. Conclusions: Our study provides some evidence of gender differences in the pattern of substance use in patients with first-episode psychosis, suggesting the possible need for gender-specific approaches in the interventions performed in these patients. This study is registered as #12610000954022 with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au).

The Effect of a Payer-Mandated Decrease in Buprenorphine Dose on Aberrant Drug Tests and Treatment Retention Among Patients with Opioid Dependence

BackgroundThe optimal dose for office-based buprenorphine therapy is not known. This study reports on the effect of a change in payer policy, in which the insurer of a subset of patients in an office-based practice imposed a maximum sublingual buprenorphine dose of 16mg/day, thereby forcing those patients on higher daily doses to decrease their dose. This situation created conditions for a natural experiment, in which treatment outcomes for patients experiencing this dose decrease could be compared to patients with other insurance who were not challenged with a dose decrease. MethodsSubjects were 297 patients with opioid use disorder in a primary care practice who were prescribed buprenorphine continuously for at least 3months. Medical records were retrospectively reviewed for urine drug test results and treatment retention. Rates of aberrant urine drug tests were calculated in the period before the dose decrease and compared to rate after it with patients serving as their own controls. Comparison groups were formed from patients with the same insurance on buprenorphine doses of 16mg/day or lower, patients with different insurance on 16mg/day or lower, and patients with different insurance on greater than 16mg/day. Rates of aberrant drug tests and treatment retention of patients on 16mg/day or less of buprenorphine were compared to that of patients on higher daily doses. ResultsThe rate of aberrant urine drug tests among patients who experienced a dose decrease rose from 27.5% to 34.2% (p=0.043). No comparison group showed any significant change in aberrant drug test rates. Moreover, all groups who were prescribed buprenorphine doses greater than 16mg/day displayed lower rates of aberrant urine drug tests than groups prescribed lower doses. Retention in treatment was also highest among those prescribed greater than 16mg/day (100% vs. 86.8%, 90.1%, and 84.4% p=0.010). DiscussionAn imposed buprenorphine dose decrease was associated with an increase in aberrant drug tests. Patients in a control group with higher buprenorphine doses had greater retention in treatment. These findings suggest that buprenorphine doses greater than 16mg/day are more effective for some patients and that dose limits at this level or lower are harmful.

High Treatment Retention Rate in HIV-Infected Patients Receiving Antiretroviral Therapy at Two Large HIV Clinics in Hanoi, Vietnam.

BackgroundLoss to follow-up (LTFU) is viewed as a major challenge in improving retention in HIV treatment. In Vietnam, the reasons for disengagement from clinics and the effect of injection drug use (IDU) on LTFU with unknown outcome (true LTFU) are not well known.MethodsPatients receiving antiretroviral therapy (ART) from two HIV clinics in Hanoi were included in this observational study between 2007 and 2012, and followed up every 6 months until the end of 2013. The reasons for disengagement from the clinic, and ART status during imprisonment were investigated in patients with a history of IDU to identify true LTFU. The retention rate at 6–54 months and true LTFU rate were calculated. Cox proportional hazards regression models were performed to identify factors associated with true LTFU.ResultsThere were 1,431 patients, with a follow-up time of 4,371 person-years (median 2.49 years). At the end of the follow-up period, 71 (5.0%) patients died, 79 (5.5%) transferred to other clinics, 16 (1.1%) disengaged from the clinics, and the calculated true LTFU was 45 (3.1%), with 12-month ART retention rate of 95.3% for the entire study population. Imprisonment was the most frequent reason for disengagement from the clinics. True LTFU correlated significantly with low CD4 count and high plasma viral load, but not history of IDU.ConclusionImprisonment is a major cause of disengagement from HIV care among patients with a history of IDU.

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

BackgroundEvidence suggests that the cannabinoid system is involved in the maintenance of opioid dependence. We examined whether dronabinol, a cannabinoid receptor type 1 partial agonist, reduces opioid withdrawal and increases retention in treatment with extended release naltrexone (XR-naltrexone). MethodsOpioid dependent participants were randomized to receive dronabinol 30mg/d (n=40) or placebo (n=20), under double-blind conditions, while they underwent inpatient detoxification and naltrexone induction. Before discharge all participants received an injection of XR-naltrexone, with an additional dose given four weeks later. Dronabinol or placebo was given while inpatient and for 5 weeks afterwards. The primary outcomes were the severity of opioid withdrawal, measured with the Subjective Opioid Withdrawal Scale, and retention in treatment at the end of the inpatient phase and at the end of the 8-week trial. ResultsThe severity of opioid withdrawal during inpatient phase was lower in the dronabinol group relative to placebo group (p=0.006). Rates of successful induction onto XR-naltrexone (dronabinol 66%, placebo 55%) and completion of treatment (dronabinol 35%, placebo 35%) were not significantly different. Post hoc analysis showed that the 32% of participants who smoked marijuana regularly during the outpatient phase had significantly lower ratings of insomnia and anxiety and were more likely to complete the 8-week trial. ConclusionDronabinol reduced the severity of opiate withdrawal during acute detoxification but had no effect on rates of XR-naltrexone treatment induction and retention. Participants who elected to smoke marijuana during the trial were more likely to complete treatment regardless of treatment group assignment.

Comparison of short-term efficacy of valproate sustained-release between adult and children as first-line monotherapy in management of partial epilepsy: A multicenter observational open-label study

Background: Management of partial epilepsy is an important issue in the field of neurology.Objective: The purpose of the present study was to collect additional clinical data on efficacy and safety of sustained release sodium valproate chrono formulation as first-line monotherapy in patients newly or recently diagnosed with partial epilepsy in Bangladesh under daily practice condition.Methodology: This open-label, multicenter, non-controlled, prospective, observational study enrolled adults and children ? 6 years newly diagnosed with partial epilepsy with or without secondary generalization between March 2010 and February 2011. Patients were treated with sustained release sodium valproate. Primary evaluation criterion was the remission rate i.e. proportion of seizure-free patients at 6 months. Secondary evaluation criteria included retention rate at 6 months, remission rate at 1 and 3 months, investigator's global clinical impression rating, safety profile assessment.Results: A total of 185 adults and 115 children with mean 4.4 months duration of epilepsy were included. At inclusion the mean daily valproate dose in children was 329 mg and 568 mg in adults. The mean treatment duration in both children and adults was 5.5 months. At the end of 6 months 74.7% of the patients were seizure-free (children and adults; 79.1% vs 71.9%). The number of seizure free patients at 1 month was 109 (36.3%) and 175 (58.3%) at month 3. The treatment retention rate at 6 months was 87.3% with small higher trend in adults than children (88.6% vs. 85.2%). Among the patients 9.3% experienced side effects like drowsiness and weight gain. No severe adverse event was reported.Conclusion: Sodium valproate sustained release formulation is effective for the first-line treatment of partial epilepsy in both adults and children with acceptable tolerabilityJ. Natl Inst. Neurosci Bangladesh 2015;1(1):2-4

Commentary on Burns et al. (2015): retention in buprenorphine treatment.

Commentary on Burns et al. (2015): retention in buprenorphine treatment.

Medication-Assisted Treatment for Pregnant Women: A Systematic Review of the Evidence and Implications for Social Work Practice

Evidence-based practice with pregnant clients who are opioid-dependent can be especially challenging because pregnant women are rarely included in clinical trials. The paper synthesizes systematic reviews on the outcomes of medication-assisted treatment for opioid dependent pregnant women and compares the effectiveness of methadone and buprenorphine. We explore evidence on maternal and neonatal outcomes, the safety of breastfeeding, and discuss the implications for social work practice. Searches were conducted in 6 databases. Ten reviews met the inclusion criteria. Results suggest medication-assisted treatment with either methadone or buprenorphine are equally effective in reducing maternal substance use, although methadone may offer slightly higher treatment retention rates when flexible dosing is implemented. Physical parameters and Apgar scores at birth show no significant differences in neonates exposed to methadone versus buprenorphine. Rates of treatment for neonatal abstinence syndrome also do not differ. However, when treatment is required burprenorphine may produce a shorter duration of withdrawal. Data on long-term developmental outcomes following in-utero exposure to opioid maintenance medications is inconclusive. Results suggest that there is minimal transmission of either methadone or buprenorphine to the neonate in breast milk. Conclusions are limited by missing data on broader psychosocial and maternal health outcomes. Evidence on long-term developmental outcomes for neonates is also confounded by prenatal drug exposure and environmental factors. Social workers engage with opioid-dependent pregnant women in many settings and can play an important role in ensuring access to treatment, and in addressing misconceptions around medication-assisted treatment for pregnant women with family members, peer supports, and other health care providers.

Therapist effects, working alliance, and African American women substance users.

African American (AfA) women with substance use disorders experience low rates of treatment retention compared to other groups of substance abusers. This is problematic since substance abuse treatment is effective only to the extent clients are retained. A weak working alliance is a significant barrier to treatment retention for AfA women. Thus, identifying therapist characteristics that facilitate a strong working alliance among this population stands as a promising step toward reducing disparities in treatment retention for this group. Therapist characteristics were explored as predictors of working alliance with AfA women substance users (N = 102). Two hypotheses were tested: (1) Population Sensitive Therapist Characteristics (PSTCs: multicultural competence, egalitarianism, and empowerment) will explain a significant amount of variance in working alliance beyond that explained by general therapist characteristics (GTCs: empathy, regard, and genuineness) and (2) GTCs will partially mediate the effect of each individual PSTC on working alliance. Hierarchical multiple regression revealed that PSTCs explained 12% of the variance in working alliance after controlling for GTCs. Bootstrapping analyses demonstrated that GTCs mediated the effect of each PSTC on working alliance. Findings suggest that therapists can facilitate a stronger working alliance with AfA women substance users through demonstration of PSTCs in addition to GTCs, and that PSTCs are facilitative because they increase the likelihood the therapist is perceived as empathic, having unconditional positive regard, and genuine. Clinical and therapist training implications are discussed.

A progressive ratio determination of the relative reinforcing effect of methylphenidate versus cocaine by intravenous self-administration testing in rats

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e235 on 32,033 individuals receiving OST between 1st August 2001 and 31st December 2010. Results: A total of 15,600 individuals commenced their first OST treatment episode between 1st August 2001 and 31st December 2010. Of these, 46% (n=7183) commenced buprenorphine and 54% (n=8417) methadone. Approximately half of all individuals (56%) who commenced buprenorphine spent less than 3 months ion treatment, compared to 30% who had commenced methadone. Furthermore, those on methadone had the highest rate of retention in treatment at 12 months (44%) compared to buprenorphine (25%). Receiving buprenorphine in the community was associated with the greatest risk of leaving a first treatment episode (adjusted hazards ratio 1.57, 95% confidence interval 1.51–1.64). Conclusions: Consistent with the results of the RCTs of treatment, individuals commencing methadone are retained longer in treatment than those commencing buprenorphine, independent of the setting in which treatment is received. Financial support: Support for this project was provided by the National Health and Medical Research Council. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.105 How does one measure buprenorphine diffusion? The challenges of alternative measures of success Rachel M. Burns2, Rosalie Pacula3, Andrew W. Dick2, Adam J. Gordon1,4, Mark Sorbero2, Douglas L. Leslie5, Carrie Farmer2, Bradley D. Stein2,1 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, United States 2 RAND Corporation, Pittsburgh, PA, United States 3 RAND Corporation, Santa Monica, CA, United States 4 VA Pittsburgh Healthcare System, Pittsburgh, PA, United States 5 Penn State College of Medicine, Hershey, PA, United