Receiving Substance Abuse Treatment Research Articles

Contrasting jail diversion and in‐jail services for mental illness and substance abuse: do they serve the same clients?

Baseline data from a study of jail diversion services and in-jail behavioral health services were used to examine the differences in clients served by these two models of responding to people with co-occurring mental health and substance abuse problems in the criminal justice system. Clients of the diversion service had more acute psychiatric symptoms and were more likely to have a diagnosis of psychosis NOS. Clients of the in-jail service were more likely to have been on probation or parole in the past and to have received substance abuse treatment. Different service models may attract and serve different populations of clients. Diversion services may cast a wider net that includes clients who may not have otherwise been involved in forensic services.

Data Show Wide Variation In Addiction Treatment Costs

Back to table of contents Previous article Next article Health Care EconomicsFull AccessData Show Wide Variation In Addiction Treatment CostsEve BenderEve BenderSearch for more papers by this authorPublished Online:2 Jul 2004https://doi.org/10.1176/pn.39.13.0390011The cost of treating a person for drug or alcohol abuse varies widely depending on the type of treatment used, according to data from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).For example, data from the Alcohol and Drug Services Study Cost Study show that the mean cost per course of treatment was highest for people who received outpatient methadone treatment ($7,415) for addiction to heroin or prescription narcotic pain medications.Treatment for drug abuse or addiction on an outpatient basis without methadone was, in contrast, just $1,433.The mean cost of a course of residential treatment for substance abuse fell between the two, at $3,840.To gather the data, researchers from SAMHSA's Office of Applied Studies conducted site visits and talked to administrators at 280 substance abuse treatment facilities in 1997 and 1998.The researchers collected information on cost, types of patients served, staffing, and services provided to patients. To estimate 2002 health care costs, researchers used the medical care services component of the Consumer Price Index.Of the facilities participating in the study, 48 offered nonhospital residential treatment, 44 offered outpatient methadone treatment, and 222 offered outpatient treatment without methadone.In addition to calculating the average cost of an episode of treatment, researchers analyzed the mean cost of a visit to an outpatient methadone setting ($17.78) and an outpatient setting in which methadone was not used ($26.72).Daily costs, which indicate the mean cost of treatment for each day someone is enrolled in a program, even if they did not have a treatment visit, were found to be the highest for patients receiving substance abuse treatment in a residential setting ($76.13).In outpatient facilities, the mean cost of enrolled days was lower than in residential facilities because it included days when there were no patient visits.In outpatient facilities that used methadone, for instance, the mean cost of treatment per enrolled day was $12.65; for those that did not use methadone, the cost was $11.24.The SAMHSA report noted that although daily costs per patient were lower for outpatient methadone than for nonhospital residential treatment, outpatient methadone treatment had higher costs per treatment episode because patients “stayed in outpatient methadone treatment longer—an average of 520 days compared with 45 days for nonhospital residential treatment.”The mean duration of treatment for patients who received services in outpatient settings without methadone was 144 days.Personnel costs accounted for the highest proportion of treatment costs: 79 percent of total costs associated with outpatient treatment without methadone, 65 percent for outpatient methadone treatment, and 63 percent for residential treatment.Annual treatment costs for each type of facility surveyed were calculated by multiplying the cost of an average treatment episode by the number of admissions per year based on national estimates for the three types of facilities.For instance, the number of annual admissions to outpatient facilities not offering methadone that participated in the study were 2,151,694—at $1,433 per treatment episode, so annual costs for that type of facility were estimated at $3.1 billion.The number of annual admissions to nonhospital residential settings for substance abuse treatment was 712,643. The cost of an episode of treatment was about $3,840, so total annual costs were approximately $2.7 billion.Outpatient methadone clinics surveyed had the lowest number of annual visits (130,472), and annual costs were estimated at just under $1 billion.While those figures may seem high, they are much lower than the costs incurred by people with untreated addictions, according to SAMHSA Administrator Charles Curie.“Treatment is a bargain compared with expenditures for jails, foster care for prison, and health complications that often accompany addiction,” he said in a May press release.The report on the Alcohol and Drug Services Cost Study is posted online at<www.oas.samhsa.gov/2k4/costs/costs.cfm>.▪ ISSUES NewArchived

Breaking through the Bars: Exploring the Experiences of Addicted Incarcerated Parents Whose Children Are Cared for by Relatives

Researchers conducted a series of open-ended semistructured interviews with 25 incarcerated men and women who received substance abuse treatment while their children were being cared for by relatives. Research questions were developed on the basis of the gaps in knowledge identified in the available data on addicted incarcerated parents whose children are in kinship care. Respondents in this study were asked questions designed to explore issues such as parent–child bonding, relationships with caregivers, and the impact of drug abuse and incarceration on the family. Results of this study indicate that there is a need for a multidisciplinary, wraparound approach to designing services for affected parents, children, and caregivers.

Methamphetamine use among incarcerated women

Problem Women face greater vulnerability to using stimulant drugs, their rate of incarceration for methamphetamine use is increasing, and women's issues have been historically neglected in substance abuse research. This study examined demographic, social and psychological characteristics of incarcerated methamphetamine‐using women that could influence service needs and utilization during incarceration.Method Incarcerated women completed individual interviews and questionnaires regarding drug use and other psychosocial variables. Psychosocial factors were examined according to lifetime drug use history. Comparison groups were: (1) nonstimulant drug users (n=16); (2) noninjection methamphetamine users (n=24); and (3) injection methamphetamine users (n=31). Psychosocial factors were also examined according to recent methamphetamine use. Recent use comparison groups were: (1) no recent drug use (n=18); (2) nonstimulant drug use (n=17); (3) noninjected methamphetamine (n=22); and (4) injected methamphetamine (n=20).Findings Nearly one‐third of these incarcerated drug‐using women had never before received substance abuse treatment. Drug abuse, sexual assault and concomitant psychiatric symptoms were high across the entire sample, but greatest for methamphetamine users.Conclusion Results revealed the complex psychosocial needs and risks that confront incarcerated methamphetamine‐using women and pose serious threats to eventual drug recovery.

Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes.

To evaluate the effect of Early Start, a managed care organization's obstetric clinic-based perinatal substance abuse treatment program, on neonatal outcomes. Study subjects were 6774 female Kaiser Permanente members who delivered babies between July 1, 1995 and June 30, 1998 and were screened by completing prenatal substance abuse screening questionnaires and urine toxicology screening tests. Four groups were compared: substance abusers screened, assessed, and treated by Early Start ("SAT," n=782); substance abusers screened and assessed by Early Start who had no follow-up treatment ("SA," n=348); substance abusers who were only screened ("S," n=262); and controls who screened negative ("C," n=5382). Infants of SAT women had assisted ventilation rates (1.5%) similar to control infants (1.4%), but lower than the SA (4.0%, p=0.01) and S groups (3.1%, p=0.12). Similar patterns were found for low birth weight and preterm delivery. Improved neonatal outcomes were found among babies whose mothers received substance abuse treatment integrated with prenatal care. The babies of SAT women did as well as control infants on rates of assisted ventilation, low birth weight, and preterm delivery. They had lower rates of these three neonatal outcomes than infants of either SA or S women.

Case Management as a Therapeutic Enhancement

ABSTRACT Using a sample of 453 veterans who received substance abuse treatment and were randomly assigned to case management and non-case management, this study examined both proximal (aftercare participation) and distal (severity of legal problems) measures of treatment outcomes. Multivariate analyses reveal that case-managed subjects stay longer in aftercare services than non-case managed clients. The longer post-treatment aftercare was related to better outcomes in criminality. The length of aftercare participation was also significantly associated with employment and readiness for treatment.

Adolescent Treatment Programs Reduce Drug Abuse, Produce Other Improvements

In the first large-scale study designed to evaluate drug abuse treatment outcomes among adolescents in age-specific treatment programs, NIDA-supported researchers have found that longer stays in these treatment programs can effectively decrease drug and alcohol use and criminal activity as well as improve school performance and psychological adjustment. An evaluation of more than 1,100 adolescents who received substance abuse treatment in residential, short-term inpatient, or drug-free outpatient programs found improvement in rates of drug use and social behavior.

Coercive Treatment of Substance Abusing Criminal Offenders

Increasingly large numbers of criminal offenders are being legally mandated to receive substance abuse treatment in lieu of criminal prosecution or incarceration. It, therefore, behooves forensic mental health professionals to update their understanding of whether coerced treatment works. There is a discernible bias among many mental health professionals that coercive treatment is ineffective or repugnant. Yet, emerging evidence from the substance abuse treatment outcome literature reveals that, under some circumstances, coercive treatment can be effective and acceptable to clients. This article briefly reviews the most current findings in this area.

Use of mental health and substance abuse treatment services among adults with HIV in the United States.

The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care. Data are from the HIV Cost and Services Utilization Study, a national probability survey of 2864 HIV-infected adults receiving medical care in the United States in 1996. We estimated 6-month use of services for mental health and substance abuse problems and examined socioeconomic, HIV illness, and regional factors associated with use. We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual mental health specialty visits, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical providers, 29.6% took psychotherapeutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic factors commonly associated with poorer access to health services predicted lower likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HIV illness were less likely to access services. Persons living in the Northeast were more likely to receive services. The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.

The impact of VA reorganization on patterns of mental health care.

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: The Impact of VA Reorganization on Patterns of Mental Health CareRobert Rosenheck, M.D., and Thomas Horvath, M.D. Robert RosenheckSearch for more papers by this author, M.D., and Thomas HorvathSearch for more papers by this author, M.D. Published Online:1 Apr 2006https://doi.org/10.1176/ps.49.1.53AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In October 1995 the Veterans Health Administration of the Department of Veterans Affairs (VA) was restructured into 22 Veterans Integrated Service Networks serving geographically defined populations. The goal of this decentralization was to transform the VA health care system from one focused on acute inpatient care and medical specialization to one grounded in ambulatory and primary care (1).Table 1 presents national VA workload data on unduplicated counts of patients treated in specialized inpatient and outpatient psychiatric and substance abuse programs in fiscal years 1993 through 1997, before and after the reorganization.The number of inpatients treated annually in both psychiatric and substance abuse programs declined by less than 1 percent in the three fiscal years preceding the reorganization (1993 through 1995) but fell by 19 percent in the second year after the reorganization. However, the number of inpatients receiving substance abuse services fell by almost 50 percent, far exceeding the 7 percent drop for psychiatric inpatient services. In contrast, the number of outpatients receiving psychiatric and substance abuse services increased steadily both before and after the reorganization.Changes in the intensity of care, measured by the average length of inpatient stay per episode and the average annual number of outpatient contacts per user, paralleled trends in inpatient and outpatient service use. The biggest changes occurred in substance abuse services, with decreases in the length of inpatient stays and increases in the number of user contacts.The number of patients who received any specialty mental health treatment, either inpatient or outpatient, increased by about 8 percent in the two years following the reorganization. However, 4,538 fewer veterans (about 3 percent) received substance abuse treatment in fiscal year 1997 than in 1995, the year before the reorganization.Dr. Rosenheck is director of the Northeast Program Evaluation Center of the Veterans Affairs Connecticut Healthcare System in West Haven and clinical professor of psychiatry at Yale University in New Haven, Connecticut. Dr. Horvath is chief consultant for mental health at VA headquarters in Washington, D.C., and professor of psychiatry at the State University of New York at Stony Brook. Address correspondence to Dr. Rosenheck, Northeast Program Evaluation Center (182), VA Medical Center, 950 Campbell Avenue, West Haven, Connecticut 06516. With this issue Harold Alan Pincus, M.D., and Terri L. Tanelian, M.A., become coeditors of this column.Table 1. Annual workload (unduplicated patient counts) and service intensity of VA mental health services, fiscal years 1993 through 1997, before and after VA's reorganizationTable 1. Annual workload (unduplicated patient counts) and service intensity of VA mental health services, fiscal years 1993 through 1997, before and after VA's reorganizationEnlarge table

Predicting Postprimary Treatment Services and Drug Use Outcome: A Multivariate Analysis

The substance abuse treatment field is continually challenged to develop interventions that encourage drug abusers to remain longer in therapeutic services and that facilitate improved outcomes. As one of those interventions, case management has generally not been subjected to multivariate analysis to evaluate its role in accomplishing those goals. Using a sample of 444 veterans who received substance abuse treatment services, this study examines relationships among demographic and psychosocial variables at intake, assignment to either traditional or enhanced (case management) treatment services, and both proximal (postprimary treatment contact) and distal (severity of drug use) measures of outcome. Multivariate analyses reveal that case-managed clients stay longer in postprimary treatment services than non-case-managed clients, and consequently, longer postprimary treatment contact leads to better drug use outcomes. the implications of these findings are discussed.

Dual diagnosis subtypes in urban substance abuse and mental health clinics.

This study sought to determine rates of dual disorders (psychiatric and substance use disorders) in a population of low-income inner-city outpatients, to compare the rates in outpatient mental health and substance abuse treatment settings, and to examine the clinical usefulness of classifying patients with dual disorders into three subtypes. A total of 57 low-income urban residents receiving mental health treatment and 73 receiving substance abuse treatment were given semistructured clinical interviews to ascertain lifetime and concurrent DSM-III-R axis I disorders. Patients with dual disorders were classified into subtypes depending on whether their psychiatric or substance use disorder was caused by the comorbid disorder or whether both disorders existed independently. Eighty-three patients had a lifetime history of dual disorders: 34 patients (60 percent) in the mental health settings and 49 (67 percent) in substance abuse treatment. Among the 83 with dual disorders, more than half had experienced symptoms of both disorders within the past year. Each of the disorders was considered primary (that is, no indication was found that one was caused by the other) for 24 patients in the mental health settings (71 percent) and 31 in the substance abuse treatment settings (63 percent). In each type of treatment setting, nearly two-thirds of the patients met criteria for a lifetime diagnosis of a dual disorder. This high rate of comorbidity did not appear to be attributable to substance use causing psychiatric symptoms, or vice versa. The high rate suggests the need for greater integration of mental health and substance abuse treatment, regardless of setting.

Client perceptions of incest and substance abuse

Clients receiving substance abuse treatment from 35 treatment facilities throughout the United States were surveyed using the Substance Abuse and Incest Survey-Revised (SAIS-R). A total of 732 participants responded to the survey; 518 (71%) were males, 204 (28%) were females, and 10 (1%) did not indicate gender. Participants had a mean age of 33.8 years, were predominately Caucasian (61.6%), never married (45.2%), were currently unemployed (69.4%), and had completed an average of 11.7 years of education. Of the entire sample, 266 (36.3%) reported having been victims of incest; 151 were males and 113 were females (2 did not indicate gender). The group reporting incest histories had a significantly greater percentage of females that did the group not reporting incest histories ( X 2 = 48.1, p < .001). Participants with incest histories were asked about their perceptions regarding incest, substance abuse, and counseling. Item responses were examined using descriptive statistics and factor analysis. The factor analysis on SAIS-R perception items identified five factors that accounted for 68.9% of the variance; these factors were Stigma and Resistance to Counseling: Substance Abuse and Incest; Ambivalence; Fear and Anticipation; and Receptivity to Counseling. Results are presented and the implications for substance abuse treatment and counseling are discussed.

Partnerships for improved service delivery: the Newark Target Cities Project.

Despite the many efforts at improving treatment for chemically dependent individuals, people undergoing treatment still relapse. The tendency to relapse is exacerbated by fragmentation of services, lack of coordination among treatment providers and social service agencies, duplication of services, insufficient access to primary health care, long waiting periods for treatment, inconsistent case follow-up, and inadequate case management. This situation is magnified in the inner city. Problems in service delivery reduce client access, diminish program quality, increase costs, and impair efficiency. Many professionals believe that recovery rates and treatment outcomes would improve if these many problems with service delivery were eliminated (Couch, 1991; Gillies, Shortell, Anderson, Mitchell, & Morgan, 1993; Halvorson, Pike, Reed, McClatchey, & Gosselink, 1993; Shortell, Gillies, Anderson, Mitchell, & Morgan, 1993; Shortell & Morrison, 1990). Many communities have been experimenting with models of substance abuse treatment service delivery that address these threats to treatment effectiveness. Some of the experiments with alternative designs for health care delivery have found that creative and cooperative models can remove obstacles to service delivery and can promote high-quality, accessible care (Adelman, 1993; Crowson & Boyd, 1993; Fennel & Alexander, 1993; Gaines, Rice, & Carmon, 1993). In addition, many funding sources are requiring applicants to develop consortium models of service delivery to avoid duplication of services and to maximize resources. This article describes the Newark Target Cities Project (NTCP), which was developed to address service delivery problems and to improve the outcomes of people admitted to substance abuse treatment programs by creating a seamless treatment network. This article describes the NTCP, the problems it addressed, and the issues that arose in implementing the program. The article discusses implications for other communities seeking to create a coordinated system of care. PROBLEMS WITH SERVICE DELIVERY IN NEWARK Newark, the largest city in New Jersey, is located in one of the largest metropolitan regions (between New York and Philadelphia) in the United States. The majority of Newark's 275,221 residents are people of color, and the city has high rates of poverty, unemployment, illiteracy, and substance abuse. In 1993 Newark's substance abuse treatment programs served over 4,000 Newark residents (New Jersey Department of Health, 1993). The majority (51 percent) of individuals in treatment reported using heroin as their drug of choice. Newark's citizens suffer disproportionately from health care risks. New Jersey is fifth in the nation for reported AIDS cases and has a tuberculosis rate five times higher than New York City, and more individuals with these health problems reside in Newark. Sixty-six percent of the AIDS cases in Newark are among intravenous drug users (New Jersey Department of Health, 1993), and the rate of drug abuse - related hospital emergency room visits is second only to San Francisco (National Institute on Drug Abuse, 1991). In 1993 substance abuse treatment services in Newark were fragmented, duplicated services, and used resources inefficiently. Ten independent agencies provided substance abuse treatment services. Individuals had to contact directly any one of these agencies to obtain treatment. Each program had its own unique intake protocol and assessment instruments. Admission criteria were independently determined by each service provider. There was no uniform policy for dealing with clients who did not meet an agency's admissions criteria and no guarantee that an individual applying for treatment would be referred to the most appropriate service. In addition, clients receiving substance abuse treatment were routinely served by other health and human services programs. Large caseloads and severe personnel shortages made it difficult for these agencies to communicate with each other about shared clients. …

Construct validity and predictive utility of the stages of change scale for alcoholics.

Recent theory and research suggest that the process of changing addictive behaviors may be conceptualized as a stage phenomenon consisting of precontemplation, contemplation, preparation, action, and maintenance stages. Accurately assessing motivation or commitment to change seems to be a crucial step in matching patients to appropriate interventions. Using the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, Prochaska, & Velicer, 1983), previous research has identified subtypes of outpatient alcoholics based on their attitude toward each of the stages of change. Profiles derived for each subtype roughly corresponded to one of the specific stages of change. The goals of this study were to determine if similar groups could be identified for patients receiving substance abuse treatment in a residential setting and to examine whether these groups would differ on other theoretically relevant variables. Stage of change scale scores for 141 patients entering an alcohol treatment program at a VA domiciliary were submitted to a hierarchical cluster analysis. A two-cluster solution appeared to fit the data best, with group means suggesting the existence of precontemplation and contemplation/action stage groups in this population. The two clusters did not differ on demographic variables, biochemical markers of alcohol consumption, or self-reported awareness of alcohol-related problems. However, participants in the precontemplation cluster reported being less worried about their use, less receptive to help, and having sought out help fewer times in the past. Participants in the contemplation/action cluster also reported greater symptoms of depression and anxiety. Preliminary treatment outcome data for each group are presented, as well as suggestions for treatment matching. Results suggest that the URICA can be used to identify clinically meaningful subtypes of treatment-seeking alcoholics.

The Incidence of Incest Histories Among Clients Receiving Substance Abuse Treatment

Volunteer participants (N = 77) enrolled in eight substance abuse treatment facilities were surveyed in order to examine the prevalence and nature of incest contacts among the group. Results indicated that approximately 49% of the participants had reported histories of incest. Data are presented regarding the age during incest contact; frequency of contacts; and involvement of force, alcohol, and drugs. In addition, comparisons by gender are presented. Implications for substance abuse training and treatment are presented.

Women, Homelessness, And Substance Abuse: Moving Beyond the Stereotypes

This study examined the characteristics of homeless women with substance abuse problems. Data were collected on a sample of 323 homeless substance abusers. First, 49 women and 274 men were compared to demonstrate distinct problems and treatment needs of the women. Results showed that the women were more likely than the men to abuse drugs, but less likely to receive substance abuse treatment. In addition, women spent more time in doubled-up living arrangements, and were more likely to receive outpatient psychiatric treatment. Second, two subgroups of women were compared: those who had been homeless for 6 months or less, and those who had been homeless longer than 6 months during their lifetime. The women who had been homeless longer were less educated, younger when they first became homeless, and were more likely to abuse alcohol, to have been assaulted, and to have attempted suicide. Implications for research and treatment are discussed.