Receiving Substance Abuse Treatment Research Articles

Self-guided online therapeutic assessment in substance abuse care: A Conflict Analysis implementation and feasibility case study

“Michael” is a 60-year-old Black male receiving substance abuse treatment at a Veterans Affairs hospital. As part of Michael's care, he participated in an implementation and feasibility trial evaluating Conflict Analysis (CA), a self-guided online therapeutic assessment. CA leverages innovative diagnostic and therapeutic resources to improve client engagement and therapeutic achievement. CA employs narrative formats, encouraging patients to frame experiences within personal vocabulary, and provides personalized feedback automatically extracted from patient responses. CA is self-guided, widely accessible, and has few costs. Paper presents Michael's protocol, associated therapeutic outcome measures, and psychologist's evaluation of CA benefits. Michael completed brief online CA deployment containing a wellness-based personality inventory, four narrative tasks, and an interactive feedback template. Michael completed insight, stress, depression, wellbeing, and perceived diagnostic and therapeutic benefit measures at baseline, post, and three-week follow-up. Interventions took 2.5 h. Attending psychologist reviewed CA protocols and completed diagnostic and therapeutic questionnaires. Michael's record identifies elevated dominance. Protocol highlights Michael's drinking as mechanism to lessen social anxieties, anger, and competitiveness. Results suggest CA encouraged increased motivation to change, treatment engagement, and reduced depression. Psychologist rated benefit at maximum threshold. Implications include improving assessment efficacy, increasing online care opportunities, and expanding CA research.

Social support as protective factor for suicidal ideation during treatment for substance abuse: Differential effects across treatment modalities

Substance abuse treatment constitutes a period of increased risk for suicide. It is unclear if social support during treatment influences suicide risk during treatment, or how this is characterized across different treatment modalities. The present study involved secondary analyses of the Drug Abuse Treatment Outcome Study, a large, longitudinal multi-site study conducted from 1991 to 1994 that involved interviews with patients at various treatment programs reporting on experiences while receiving substance abuse treatment. Data from people in inpatient (n = 2530) and outpatient treatment (n = 2568) programs were analyzed to determine the extent that various indicators of social support influenced odds of having suicidal ideation during treatment. Across both treatment modalities, ongoing interpersonal problems and patient perception of their performance in relationships significantly predicted odds of suicidal ideation one month into treatment. Contact with one's social support system during treatment only significantly decreased odds of suicidal ideation for inpatients. Relationship status did not significantly influence odds of suicidal ideation in either group. Overall, social support appears to be associated with decreased risk for suicidal ideation during substance abuse treatment, and certain indicators of social support may be especially important for specific treatment modalities.

Religious Beliefs, Treatment Seeking, and Treatment Completion among Persons with Substance Abuse Problems.

BackgroundReligious beliefs can assist with the success of treatment in persons with substance abuse problems by providing social support, confidence, and hope.MethodsAs such, a secondary analysis using 2013 National Survey on Drug Use and Health (NSDUH), of 20219 participants with self-identified illicit substance use problems was conducted. Survey was weighted bivariate and multivariate regression analysis was used to adjust for potential confounders.FindingsApproximately, 15.0% of the study sample were between ages of 18-25 years and 71.5% were Non-Hispanic Black, 11.3% were Non-Hispanic White, and 12.1% were Hispanic. About 10.3% had less than a high school education, 28.0% graduated high school, 30.0% had some college education, and 32.0% were college graduates. Only 1.3% reported receiving substance abuse treatment in the past 12 months and 5.4% perceived a need for substance abuse treatment in the last 12 months. 65.0% reported that religious beliefs were an important part of their life and 62.5% reported that their religious beliefs influenced their decision making. After adjustment for sociodemographic factors, both the importance of religious beliefs and the influence of religious beliefs on decision making were associated with increased odds of having treatment [odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.14-2.14 and OR = 1.51, 95% CI: 1.11-2.05, respectively]. However, there was no association between the importance of religious beliefs or the influence of religious beliefs on decision making and perceived need for substance abuse treatment.ConclusionThese findings suggest that religious beliefs may be an important determinant in receiving treatment among substance abusers and also have implications for exploration of faith-based and faith-placed interventions.

Depression and substance use: The CES-D’s utility in predicting treatment outcomes in a longitudinal multi-site study of residential treatment centers

This investigation utilized a large sample of individuals undergoing substance use treatment to examine the CES-D’s structural validity and establish its predictive utility relative to treatment discharge. The sample included 5750 individuals who were receiving substance abuse treatment at 19 different residential treatment facilities. The CES-D was administered to participants over the course of their time in a residential inpatient substance use treatment program. The present study used a split sample method to conduct both exploratory (EFA) and confirmatory (CFA) factor analyses. Results of both the EFA and CFA indicated that the CES-D contains three first order factors measuring negative mood, positive affect, and interpersonal interactions as well as a second-order high score factor which can be used to guide interpretation and symptom monitoring. Individuals receiving residential treatment fell into one of three distinct groups based on their CES-D scores, and that their scores (and subsequent trajectories of scores over time) were differentially related to discharge status. Implications for practice and the utility of the CES-D within substance use populations are discussed.

Social Stigmatization of Drug Abusers in a Developing Country: A Cross-Sectional Study.

Introduction: Stigma is a label that differentiates a person from others and associates them with unenviable attributes. There are various forms of stigma: enacted stigma, perceived stigma, and self-stigma manifesting as stereotyping and harboring negative thoughts about the stigmatized group. Stigmatization of the drug abuser leads to effects such as low self-esteem, depression, and personality changes in the stigmatized. Objectives: The purpose of the study is to know the impact of stigma on patients receiving substance abuse treatment in the Psychiatry Department, Mayo Hospital Lahore, Pakistan.Design: Cross-sectional study. Place: Psychiatry Department, Mayo Hospital, Lahore, PakistanStudy Period: Six months (February 22, 2020, to July 18, 2020).Subjects and Methods: A population-based cross-sectional study was conducted in a tertiary care hospital. A total of 100 patients were recruited in the study. The selection was made on laid down criterion after taking due consent. Interviews were conducted through a pretested questionnaire. Data were collected, compiled, and analyzed through SPSS version 20 (IBM Corp., Armonk, USA), and relevant frequency tables were drawn. Results: On analyzing the data, various forms of stigma were observed: enacted stigma (81% as considered less capable), perceived stigma (99% as having difficulties in the job seeking and relationships), and self-stigma (94% in having devaluation thoughts). Self-esteem was maintained (73% were content). Social support was present (76% from family). Moderate depression was seen in 17% of participants. Over 83% of our study population is aged 21 to 40 years, 15% between ages 41 and 60 years, and only 2% ranging between ages 1 and 20. A total of 80% of the population belonged to a low socioeconomic status, and 55% of participants abused opium, heroin, or brown sugar, followed by white crystal use in 37% of the study population. The majority reported the drug abuse duration of 1-5 years (70%).Conclusion: Stigma in its various forms affects the drug abuser undergoing treatment. It results in low self-esteem and mild depression. Individuals from the broader socioeconomic range can be added in future studies, and a larger population can be studied by collecting data from other tertiary care hospitals and mental healthcare facilities. They can be assessed for factors contributing to their addiction and the challenges they had to go through to get the help they needed.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Adults who misuse opioids: Substance abuse treatment use and perceived treatment need

Background: Opioid use disorder (OUD) and overdose deaths among the US population continue to increase. This study examined associations of OUD and other substance use disorders with substance abuse treatment use and perceived treatment need among US adults aged 18+ who misused opioids. Methods: The 2015–2016 National Survey on Drug Use and Health provided data (n = 5100 respondents who misused opioids in the past year). We used multivariable logistic regression models to examine associations of opioid and other substance use disorders with treatment use and perceived treatment need, adjusting for sociodemographic and health statuses. Results: The data showed that 4.7% of adults misused opioids and 19.1% of those who misused had an OUD. Of those with an OUD, only 31.5% had received substance abuse treatment in the past year and 13.6% perceived the need for such treatment. Of those with an OUD, heroin use disorder (adjusted odds ratio [AOR] = 2.59, 95% confidence interval [CI] = 1.59–4.23) and having been arrested/booked (AOR = 1.98, 95% CI = 1.18–3.33) were associated with higher odds of receiving treatment, whereas lack of health insurance (AOR = 0.49, 95% CI = 0.25–0.94) was associated with lower odds. Heroin use disorder (AOR = 2.16, 95% CI = 1.23–3.83) and higher mental health impairment scores (AOR = 1.05, 95% CI = 1.01–1.09) were associated with higher odds of perceived treatment need. Conclusions: The overall low socioeconomic status and high rates of polysubstance use disorders among those with OUD indicate that they need financial and other help to access treatment and relapse prevention services. The very low rates of perceived treatment need also point to the need for strategies to increase individuals’ recognition of their need for treatment.

Participant and Program Characteristics: Correlates of Substance Abuse Treatment Participation and Prison Misconducts

Despite the prevalence of substance dependence in incarcerated populations and the correlation between substance use and crime, only 11% receive substance abuse treatment, even as treatment participation may help reduce institutional misbehavior and postrelease recidivism. The current research examined the influence of individual and program factors on substance abuse treatment participation and prison misconducts in a state prison system. Based on analyses of administrative data from 2012 to 2015 and program data, the findings support previous research documenting participant characteristics as predictors of misconducts. In addition, program training requirements significantly predicted misconducts. Implications and research recommendations are discussed.

Employment services and substance abuse treatment

This qualitative study of over 800 participants focused on the employment experiences of consumers of substance abuse treatment programs to provide a better understanding of what employment services are offered and what needs treatment agencies have in the area of employment services, examining barriers and facilitators from both the consumer and provider perspectives. Data were collected via a mixed research methodology of focus groups and surveys from July 2015 through June 2016 in a large Midwestern U.S. state. Employment is a challenge for persons with substance use disorders. Only a quarter of this study’s large sample of substance abuse treatment consumers reported being cur­rently employed; and of those consumers who reported no current employment, greater than half reported that their current unemployment was due to their substance use. Persons receiving substance abuse treatment face many challenges in obtaining and maintaining employment. Treatment providers identified several barriers to implementation of employment services. They named an array of resources as needed, including increased funding for supportive employment programs and staff appropriate to the delivery of employment services. Some providers believed employment services to fall outside of their scope of practice. Data generated through this study may inform policy to invest resources in employment services within substance abuse treatment settings.

Dissociative phenomenon among sexually abused egyptian female participants with substance dependence

Objective The purpose of this article is to study dissociative symptoms in female addicts exposed to sexual abuse in their childhood. Participants and methods This study included 44 Egyptian females who were recruited from a private psychiatric hospital and from a halfway center receiving treatment for substance abuse. Overall, 22 cases were sexually abused during their childhood (before age of 18 years), whereas 22 controls were not exposed to sexual abuse. Addiction severity index was used to assess history of addiction, age of starting smoking, and age of starting substance abuse. Addiction severity index was used to measure emotional abuse and physical abuse. Sexual abuse questionnaire was used to measure sexual abuse. Questionnaire of experience of dissociation was used to measure dissociative phenomena. Results There was a statistically significant difference regarding the age of starting smoking (P=0.03) and age of starting substance abuse (P=0.04). Moreover, there was a highly statistically significant difference between both groups regarding questionnaire of experience of dissociation scores (P=0.00). Conclusion Female participants with substance dependence who are sexually abused showed more pathological dissociative symptoms than those who were not. Female participants who are sexually abused during their childhood are more prone to start smoking and substance abuse at younger age than their peers. Physical abuse was higher in sexually abused female participants than those who were not.

A Randomized Controlled Trial of an Online Relapse Prevention Program for Adolescents in Substance Abuse Treatment

An Internet-based relapse prevention supplement to adolescent substance abuse treatment programming is a promising modality to reinforce treatment gains and enhance recovery; however, an evidence base is lacking. To assess the efficacy of the online Navigating my Journey (NmJ) program. 129 adolescent-aged participants (ages 13–23) receiving substance abuse treatment participated in a randomized parallel group study comparing two conditions: experimental (NmJ) versus attention control (viewed wellness articles from the Nemours Foundation at their discretion). Participants in the experimental condition were asked to complete 12 core lessons over 3 months. Lesson content was developed to teach evidence-based relapse prevention skills. Data were collected at four time points: baseline, 1-month follow up, 3-month follow up, and 6-month follow up. We used a linear mixed modeling approach to test for differences between conditions on each outcome. Participants in the experimental condition reported a significantly greater increase in motivation to reduce or not misuse drugs from baseline to 3-month follow up and from baseline to 6-month follow up, compared to the control participants. Participants in the experimental condition also reported a greater decrease in drug use score from baseline to 3-month follow up, compared to the control participants. An analysis of age as a potential moderator suggested that the intervention may be more effective for older adolescents. Greater use of the program was associated with greater self-efficacy and lower self-reported substance use over time. Relapse prevention treatment with adolescents may be facilitated by theory-based online interventions. NCT02125539.

Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont

In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions.

Self‐Efficacy Among Adults in Substance Abuse Treatment: The Role of Religious Coping

In substance abuse treatment, general self‐efficacy and religiousness are factors that may support positive outcomes. The authors surveyed clients receiving substance abuse treatment (N = 121) and found that religious coping predicted general self‐efficacy scores. Clinical implications are discussed.

HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34% multiple partners, 26% unprotected intercourse with a casual partner, and 24% sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25% had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

Co-Morbidities Among Persons With Substance Abuse Problems

This article uses the behavioral model for vulnerable populations to evaluate the use of substance abuse treatment services among a sample of 926 substance abusers with one or more vulnerable health designations. A two-stage hierarchical logistic regression was completed to determine the influence of vulnerable and traditional need factors on the probability of receiving substance abuse treatment. Among traditional covariates, increased odds of receiving substance abuse treatment are associated with being either non-Hispanic White, Hispanic, having an income > US$5,000, and having a regular source of care. Among vulnerable covariates, injection drug use (odds ratio [OR] = 2.19, confidence interval [CI] = [1.46, 3.27]) and the receipt of public benefits (OR = 1.98, CI = [135, 2.92]) remain independent risk factors for the receipt of substance abuse treatment. Many who experience substance abuse disorders can also experience a multitude of other vulnerable health classifications, suggesting the need for a comprehensive, multidisciplinary approach to the treatment of substance use disorders.

Personal Network Structure and Substance Use in Women by 12 Months Post Treatment Intake

IntroductionWomen with substance use disorders enter treatment with limited personal network resources and reduced recovery support. This study examined the impact of personal networks on substance use by 12months post treatment intake. MethodsData were collected from 284 women who received substance abuse treatment. At 6month follow up, composition, support availability and structure of personal networks were examined. Substance use was measured by women's report of any use of alcohol or drugs. Hierarchical multivariate logistic regression was conducted to examine the contribution of personal network characteristics on substance use by 12months post treatment intake. ResultsHigher numbers of substance using alters (network members) and more densely connected networks at 6month follow-up were associated with an increased likelihood of substance use by 12months post treatment intake. A greater number of isolates in women's networks was associated with decreased odds of substance use. Women who did not use substances by 12months post treatment intake had more non-users among their isolates at 6months compared to those who used substances. No association was found between support availability and likelihood of substance use. ConclusionsBoth network composition and structure could be relevant foci for network interventions e.g. helping women change network composition by reducing substance users as well as increasing network connections. Isolates who are not substance users may be a particular strength to help women cultivate within their network to promote sustained sobriety post treatment.

Erratum to: Long-Term Health and Psychosocial Status of Youth who Received Substance Abuse Treatment in Adolescence

Alcohol and substance abuse in the adolescent population is a major health concern with a number of harms known to be associated with high levels of use. Few studies report on long-term health status of youth who have received treatment for a substance abuse problem during adolescence. This study aimed to describe the long-term status of a cohort of adolescents who received treatment in an intensive day treatment program situated in a tertiary care paediatric hospital. Youth participated in an interview that collected data using both standardized screening tools (GAIN-SS, AUDIT, CUDIT, DUI) as well as closed and open ended questions about education, employment, and physical and mental health status. Young adults in this sample continue to use alcohol and cannabis, with a proportion reporting problematic use. Their academic achievement is close to expected for their age group. They report concurrent mental health disorders; and as a cohort, access the health care system for both acute and chronic health conditions more than their contemporaries. These findings support the inclusion of academic, mental health and medical components in programs for adolescents with substance abuse, in order to address a broad range of determinants of health outcomes.

Long-Term Health and Psychosocial Status of Youth who Received Substance Abuse Treatment in Adolescence

Long-Term Health and Psychosocial Status of Youth who Received Substance Abuse Treatment in Adolescence

Tobacco-related mortality among persons with mental health and substance abuse problems.

The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population.

Recent trends in treatment admissions for marijuana use during pregnancy.

The objective of this study was to investigate recent trends in substance abuse treatment admissions for marijuana use during pregnancy in the United States. Data were obtained from the Treatment Episodes Data Set from 1992 to 2012 and analyzed for trends over time using χ, Cochran-Armitage, and Moran's I tests. The proportion of treatment admissions for women who were pregnant remained stable at 4%; however, admissions of pregnant women reporting any marijuana use increased substantially from 29% to 43% (P < 0.01). The West North Central census division (20%) experienced the greatest increase followed by the Middle Atlantic (18%) and Pacific (14%) divisions. The demographic characteristics of pregnant marijuana admissions changed over time, with white non-Hispanic women, criminal justice referrals, and those with a psychiatric comorbidity becoming more common whereas polysubstance users decreased (P < 0.01). Even though more women using marijuana are seeking and receiving substance abuse treatment during pregnancy, targeting certain risk groups while improving screening and treatment referral systems by health care providers, such as prenatal caregivers, should be emphasized.