Residential Substance Abuse Treatment Research Articles

3 Neuropsychiatric Change and Childhood Adversity Levels in an Opioid Treatment Population

Objective:Early life adversity is strongly correlated with a number of negative health outcomes, with some of the highest risks are related to later illicit drug use and substance use disorders (SUDs). Specifically, it has been found that an ACEs score of >4 confers a 7-10-fold risk of substance abuse. Subsequent research has identified a number of neurobiological effects of childhood trauma, including structural and functional disruptions of the LHPA axis, the brain's primary stress-response system. It has been hypothesized that various trauma-induced neurobiological changes may lead to later physical health, mental health, and psychosocial problems in persons with early life adversity. One area that such changes might affect is a person's ability to stop abusing substances, with factors such as trauma-related mood, self-efficacy, or cognitive functioning as considerations in early treatment success. This study followed a group of participants in a residential substance abuse treatment program across their first month of abstinence, to assess natural change in cognitive performance as well as potential effect of early life adversity on changes in neuropsychiatric outcomes.Participants and Methods:Participants were 37 adults (mean age=33.9 years, SD=6.7) who had completed detoxification and were first assessed during their first week of residential treatment. Follow-up assessment was completed 4 weeks later. Participants were primarily male (62%) and white (62%). They were all in treatment for opioid abuse, with a majority of participants reporting a history of polysubstance abuse. To measure adverse and protective factors, participants completed the Adverse Childhood Experiences scale and Protective And Compensatory Experiences Scale at baseline. Participants also completed the NIH Toolbox cognition battery and a set of self-report measures of cognitive functioning, mood, anxiety, and self-efficacy at baseline and follow up.Results:Results of paired samples t-test comparison between baseline and follow-up testing found a significant improvement in self-reported depression symptoms, anxiety symptoms, and self-efficacy (all p<.001). Interestingly, participants overall reported an increase in cognitive problems between baseline and retest, even though on objective cognitive testing (NIH Toolbox cognition battery) there was significant improvement in cognitive performance. Participants generally had a high level of childhood adversity (mean ACE score of 4.5), with an average level of childhood compensatory experiences. Considering the specific effect for childhood adversity, ACE score was found to be predictive in amount of anxiety and self-reported cognitive change but not for objective cognitive performance or change in other factors.Conclusions:Consistent with previous research, these patients had a high level of past trauma, which interacted with a number of other neuropsychiatric measures and support the importance of assessing for trauma history and integrating trauma-focused treatment into substance abuse treatment programs.

2 Pilot Study of a Cognitive Enhancement Intervention for Substance Abuse Recovery

Objective:This was a pilot study testing a cognitive enhancement program to improve rate of cognitive recovery in early substance abuse treatment. It is hypothesized that if patients were able to accelerate the rate of cognitive improvement, they may be able to better engage in substance abuse treatment and potentially have better long-term outcomes.Participants and Methods:Participants were 47 adults newly admitted to a residential substance abuse treatment facility (74.5% male, 76.6% white, mean age=34.5 years, education=12+ years). All were post-detox. All were being treated for opioid abuse, with the majority in treatment for polysubstance abuse. Participants were randomly assigned to either the intervention group (BrainHQ research cognitive training program) or active control group (inert computer games) and completed 34 training sessions per week for a minimum of 3 weeks. NIH Toolbox cognition battery was administered at baseline and endpoint.Results:Regardless of study group, most participants had a significant improvement in cognitive performance across most subtests and composite scores of the NIH Toolbox cognition battery. The RAVLT and Oral Symbol Digit subtests had the greatest change (p<.001) for both groups, as well as a significant improvement (p=.002) in Cognitive Function Composite Score for both groups. The only difference between the control and intervention group was on the Pattern Comparison subtest, with the intervention group scoring significantly higher at endpoint (p=.004).Conclusions:Although substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety, cognitive recovery was significant in this group of patients during early inpatient treatment for opioid abuse. Although it has yielded significant effect in other patient populations, the BrainHQ program did not show a significant enhancement in cognitive recovery, compared to the active control group, in this pilot study of patients in treatment for opioid abuse. This study was limited by a small sample size and potential future variations should be considered, such as changes to intervention intensity and specific intervention exercises.

A Pilot Replication Study ofImplementing an Equine-Assisted Services Program Within a VA Residential Substance Use Disorder Treatment Program.

Veterans have high rates of substance use disorders and other mental health conditions including post-traumatic stress disorder. Effective treatments for these conditions exist; however, high attrition rates and residual symptoms after completing treatment are common. Complementary treatment approaches could enhance treatment engagement and/or response among this population. We previously reported a study of one such intervention, an equine-assisted learning, and psychotherapy incorporating horses intervention provided to veterans admitted to a Veterans Health Care Administration residential substance abuse treatment program. The first aim of this study was to replicate the previous study assessing the safety, feasibility, and preliminary outcomes of this intervention. The second aim was to examine the effect of participants attending multiple intervention sessions. Participants were 94 veterans who participated in one to six sessions of a 3-4-hour program consisting of both equine-assisted learning and psychotherapy incorporating horses. Pre- and post-session administration of the Positive and Negative Affect Scale, State-Trait Anxiety Inventory, and Craving Experience Questionnaire was utilized to assess changes in affect, anxiety, and craving. Wilcoxon signed-rank or paired two-tailed t-tests were utilized for pre- to post-session comparisons of the outcome measures for sessions 1-4. Generalized linear mixed-effects (GLME) models were constructed to determine the impact of dosage. GLME models were constructed to determine the impact of dosage. As with our previous study, the intervention was safe and feasible to utilize for this population. There were statistically significant pre- to post-session improvements, with medium-to-large effect sizes, for sessions 1-3 for negative affect and sessions 1 and 2 for positive affect, anxiety, and craving. The GLME models revealed no statistical significance for any of the predictors. Taken together, this study and our previous investigation of this equine-assisted services intervention suggest that it is safe and feasible to utilize for veterans admitted to a residential substance abuse treatment program and we have now found short-term benefits in two separate studies. Thus, a randomized controlled trial of this intervention is warranted to demonstrate cause and effect and determine whether longer-term benefits are associated with the intervention. The finding that there was no additional benefit from attendance at more than two intervention sessions suggests that dose-response relationship studies of equine-assisted services interventions for veterans are needed.

When are the dogs coming back? Animal-assisted activities with men in residential substance abuse treatment.

When are the dogs coming back? Animal-assisted activities with men in residential substance abuse treatment.

Evaluating the Effectiveness of Short-term Clinical Guideline to Treat Sexual Addiction Disorder in People With Sexual Addiction: A Clinical Trial

Objectives Sex addiction is one type of behavioral addiction that is characterized by extreme fantasies and hard-to-control sexual behaviors. This disorder causes problems in the lives of affected people and their victims. The treatment is non-pharmacological and psychological, which are time-consuming and expensive. Short-term interventions are one of the ways to help these people. This study aims to evaluate the effectiveness of short-term clinical guidelines to treat sexual addiction disorder in affected individuals. Methods This was a randomized clinical trial study with pre-test-post-test and follow-up. The studied population in this research included all people with sexual addiction disorder who live in Isfahan City, Iran. The statistical population was those who had the chance to be included in the study. These were individuals who were referred to outpatient and residential drug abuse treatment centers, psychiatric treatment centers, and sexual disorders treatment clinics. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into 2 intervention and comparison groups. The intervention group received ten 120-min therapy sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed the HBI three times. The first time was immediately before the treatment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed via repeated measures analysis of variance (RM-ANOVA) in the SPSS software, v. 22. Results In the present study, there were 30 patients with a sexual addiction disorder, of which 15 were in the intervention group and 15 were in the comparison group (the Mean age of the participants was 26.4 years). The Mean scores of HBI in the intervention group in the pretest, post-test, and follow-up stages were 67, 49, and 57, respectively, while the mean scores of HBI in the comparison group were 64, 60, and 59 for the pretest, post-test, and the follow-up, respectively. Repeated measurement findings showed that this clinical guideline is effective in reducing participants’ sexual addiction symptoms (P‌<‌0.01). Conclusion Clinical guideline for short-term treatment of sexual addiction disorder is effective in reducing the symptoms of sexual addiction disorder. Using this method, which can be held online, and considering its short time and reduced cost of treatment, allows more people to benefit from it.

A Pilot Observational Study of Implementing an Equine-A ssisted Services Program Within a VA Medical Center Residential Substance Use Disorder Treatment Program.

The aim of this observational pilot study was to assess the safety, feasibility, preliminary outcomes, and predictors of participant response as a result of implementing an equine-assisted intervention within a residential substance abuse treatment program at a large Veterans Administration medical center. A secondary aim was to evaluate psychological instruments for use in future, more rigorous studies. The overarching goal was to complete the necessary work to prepare for a large randomized controlled trial of this intervention for Veterans with addictive disorders. Participants were 33 Veterans, 29 males and 4 females, who participated in one 4-hour session of combined equine-assisted learning and equine-assisted psychotherapy during an admission to a residential substance abuse treatment program. Preintervention and postintervention instruments were utilized to assess changes in affect, anxiety, and craving. Demographic and diagnostic variables were evaluated for the potential to predict outcomes. The intervention was safe and feasible to utilize as there were no adverse outcomes to patients, staff, or equines. The State-Trait Anxiety Inventory, Craving Experience Questionnaire, and Positive and Negative Affect Scale revealed preliminary findings of significant preintervention to postintervention decreases in anxiety, negative affect, and craving, as well as increased positive affect. Lastly, the presence or absence of a history of suicide attempts and/or suicidal ideation were predictive of some postintervention scores. While more rigorous studies are needed, these results indicate that the intervention evaluated in this study is safe and feasible to utilize for Veterans admitted to a residential substance abuse treatment program. Furthermore, preliminary outcomes suggest that this intervention, and perhaps other equine-assisted interventions, has the potential to be beneficial to Veterans with addictive disorders as well as those at risk of suicide. The psychological instruments used in this intervention appear to be appropriate for use in future investigations. Additionally, more rigorous studies are warranted, and this work provides the necessary first steps needed to proceed with those investigations.

The Resilient Recovery from Substance Addiction: The Role of Self-transcendence Values and Hope

Background: Substance addiction is a psychosocial problem facing many people today. While the previous trend in addiction treatment was the harm reduction approach, nowadays it is fully recognized the importance of promoting human resources in order to help people to face the rehabilitation process, to prevent the risk of treatment dropout and future relapses, and to positively re-integrate them into the society. During the process of recovery from substance addiction, resilience is one of the most important protective factors against both dropouts and relapses. This study analyzed for the first time whether and the extent to which self-transcendence values (i.e., benevolence and universalism) promote resilience, considering the mediating role of hope, among patients in residential substance abuse treatment. Method: Seventy-six Italian patients in residential treatment for substance addiction (86.5% males and 13.5% females; M age = 40.23, SD = 10.88) participated to the study. Participants were asked to complete the Self-transcendence subscale from the Portrait Values Questionnaire, the Hope Scale, and the Connor Davidson Resilience Scale. Results: Findings showed that self-transcendence values were positively related to resilience and that hope fully mediated (in a positive direction) this relationship. Self-transcendence values promoted resilience through the mediating role of hope. Conclusions: This complex relationship suggests a holistic model of resilience during the process of recovery from substance addiction. Limitations of the study, practical implications, and future research developments are discussed.

The Individualized Addictions Consultation Team Residential Program: A Creative Solution for Integrating Care for Veterans With Substance Use Disorders Too Complex for Other Residential Treatment Programs

Objectives The Veterans Affairs (VA) healthcare system is one of the main providers of substance use treatment within the United States, and many veterans with a substance use disorder (SUD) present with co-occurring diagnoses or other concerns. Though there has been increasing recognition of the need for integration of treatments for SUD and comorbid mental illness, there have been limited studies of such programs, particularly within the VA healthcare system. To address that gap in the literature, this paper examines treatment outcomes in an integrated model of dual diagnosis residential treatment for veterans: the Individualized Addictions Consultation Team (I-ACT) program. Methods: The current paper draws from clinical outcome evaluation data within a residential treatment program at a large Midwestern VA Medical Center (VAMC). The I-ACT program provides residential substance abuse treatment to individuals with a primary SUD and other factors that interfere with the successful completion of a traditional residential rehabilitation program. Between 2017 and 2018, 130 individuals (97.7% men, average age = 60.62 years) entered the I-ACT program. As part of standard measurement-based care, veterans were administered the Brief Addiction Monitor and the Patient Health Questionnaire–9 at admission and discharge. Results: Most individuals (74.6%) who entered I-ACT completed the residential program (average length of stay 34.2 days). Scores on both measures significantly decreased from intake to discharge (p < .001), with the change in depression scores indicating clinically significant improvement. Those with an additional mental health diagnosis achieved similar decreases in substance use symptoms and had lower depression scores at discharge than those with a SUD alone. Conclusions: Our results indicate that even for veterans who may not benefit from traditional SUD treatment programs, a more integrated and personalized residential program can be effective.

Evaluating Perceptions of Working Alliance and Crisis Stabilization for Adolescent Males in Residential Treatment for Substance Abuse: A Time-Series Analysis

Research related to adolescents in residential treatment for substance use is limited. Evaluations identifying treatment progress across frequent, multiple time points are scant. In this study 20 adolescent males (age M = 16.46, SD = 1.04) in residential treatment for substance use completed self-report inventories related to working alliance, problem severity, well-being, and crisis stabilization across 10 weeks. Small, statistically significant reductions in problem severity and improved well-being were noted. No statistically significant changes were noted with measures of the working alliance, well-being, and crisis stabilization, with small to medium effect sizes and unimproved conditions with no clinical significance. Therapeutic gains were evident for adolescent males working through issues related to chronic substance abuse in residential treatment, as indicated by a statistically significant reduction in problem severity with a moderate effect and slight improvement with limited clinical significance. The working alliance appeared to have some influence on treatment gains. This study represents an evaluation from a single site to help illuminate the challenges of residential treatment for substance use and potential perceptions of adolescent males in this level of care.

Reliability and construct validity of 3 psychometric trust scales for women seeking substance abuse treatment in a community setting

Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the “Trust Game.” Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant (P < .001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α > .70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care–specific scales (r = −.740, P < .001). There was a weak, negative correlation between the ACE score and interpersonal trust (r = −.135, P = .019). Individual scales do not have statistically significant correlation with “Trust Game” scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.

Alcohol and Drug Use in Pregnant and Post-Partum Women

Abstract The Tennessee Residential Treatment Program for Pregnant and Postpartum Women addressed the problem of substance use and abuse among young adults ages 16 and over. The program was intended to expand the availability of comprehensive, residential substance abuse treatment, prevention, and recovery support services for pregnant and postpartum women and their minor children, including services for non-residential family members of both the women and children. The populations of focus were low-income (according to federal poverty guidelines) women, ages 16 and over, who were pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who had limited access to quality health services. Through the expansion and enhancement of service capacity, addiction peer recovery support services were provided as part of a collaborative effort between the University of Tennessee College of Social Work and the Helen Ross McNabb Center, Incorporated, a Regional Mental Health System. Comprehensive services were provided to clients who were ineligible for, or unable to afford or to obtain, adequate services through public or commercial means. Over a three-year period, services were provided to 363 participants with 169 of those participants returning for a 6-month interview using the CSAT GPRA Client Outcome Measures for Discretionary Programs. Upon intake, 70% of participants reported using drugs and/or alcohol during the previous month. Frequency of various drug and alcohol use (measured in number of days used) during the 30-day period prior to intake implied a need for intervention services, and over the course of services provided, frequencies of drug and alcohol use declined.

Telepsychiatry in an Alaska Native Residential Substance Abuse Treatment Program.

Introduction: Alaska Native communities experience high rates of alcohol and substance abuse and face challenges accessing quality, culturally appropriate treatment. Telepsychiatry could help bridge this gap, but no publications have examined its impacts for alcohol and substance abuse treatment directed at Alaska Native communities. This study explores one telepsychiatry clinic's impact on a residential substance abuse treatment serving the Alaska Native community in Anchorage, Alaska. Methods: Using a matched case - control design, 103 cases receiving telepsychiatry services between 2007 and 2012 were matched with 103 controls who did not. Outcome measures included length of stay, discharge plans, emergency room visits, and hospital admissions; clinical history, including previous suicide attempts, history of violence, and trauma history; social stressors such as current legal issues, unemployment, and homelessness; mental health, medical, and substance abuse diagnoses; and number of telepsychiatry appointments and nature of telepsychiatry services rendered. Results: Both groups exhibited high rates of mental and medical illness, socioeconomic challenges, and substance abuse. However, the telepsychiatry group demonstrated a significantly higher rate of post-traumatic stress disorder, history of violence, ongoing legal issues, and children in outside custody. It also remained engaged in treatment longer, had fewer discharges against medical advice, and was more likely to complete treatment. Discussion/Conclusions: Our study highlights this telepsychiatry clinic's real-world difference serving the complex substance abuse treatment needs of Alaska Native individuals. It also reinforces telepsychiatry's promise in serving other communities facing a high burden of addiction and mental illness yet facing barriers to high-quality, culturally competent services.

Health Care Processes Contributing to Suicide Risk in Veterans During and After Residential Substance Abuse Treatment

Objective: Substance use disorders are an important risk factor for suicide. While residential drug treatment programs improve clinical outcomes for substance use disorders, less is known about the role of related health care processes in contributing to suicide risk. These data may help to inform strategies to prevent suicide during and after residential treatment.Methods: A retrospective analysis was conducted on root-cause analysis (RCA) reports of suicide in veterans occurring within 3 months of discharge from a residential drug treatment program that were reported to a Veterans Affairs facility between 2001 and 2017. Demographic information such as age, gender, and psychiatric comorbidity were abstracted from each report. In addition, an established codebook was used to code root causes from each report. Root causes were grouped into categories in order to characterize the key system and organizational-level processes that may have contributed to the suicide.Results: A total of 39 RCA reports of suicide occurring within 3 months after discharge from a residential drug treatment program were identified. The majority of decedents were men and the average age was 42.9 years (SD = 11.2). The most common method of suicide was overdose (33%) followed by hanging (28%). Most suicides occurred in close proximity to discharge, with 56% (n = 22) occurring within seven days of discharge and 36% (n = 14) occurring within 48 hours of discharge. The most common substances used by decedents prior to admission were alcohol or opiates. RCA teams identified a total of 140 root causes and the majority were due to problems with suicide risk assessment (n = 32, 22.9%). Non-engagement with treatment during (n = 20, 14.3%) and after the residential stay (n = 18, 12.9%) was also highlighted as an important concern. Finally, several reports raised concerns that a discharge prior to treatment completion or a precipitous discharge due to program violation negatively impacted treatment outcomes.Conclusions: Efforts to prevent suicide in the period following discharge from a residential drug treatment program should focus on addressing suicide risk factors during admission and helping patients engage more fully in substance use disorder treatment.

Health literacy in substance use disorder treatment: A latent profile analysis

Introduction and aimsHealth literacy refers to the degree to which people can access and understand health information, as well as communicate their health needs to service providers. Whilst health literacy is increasingly being examined within general community samples, there is limited research focused on substance use disorders where the need for health literacy is likely to be high. The aim of this study was to examine the health literacy profiles of people attending substance use disorder treatment and to examine how these profiles were related to measures of quality of life, mental health, and physical health. Design and methodsParticipants were attending specialist non-government substance use disorder treatment across New South Wales, Queensland, and the Australia Capital Territory, Australia (N = 298). Participants completed the Health Literacy Questionnaire, a multi-dimensional measure of health literacy. Latent profile analysis was conducted to identify profiles of health literacy within the sample. ResultsThree distinct health literacy profiles were identified, and termed low (24.2%), moderate (62.8%) and high health literacy (13.1%). Participants with lower levels of health literacy had lower levels of social support in their home environment outside of treatment, as well as lower levels of quality of life, higher levels of psychological distress, and poorer mental health. There was no difference between the three profiles on measures of physical health. Discussion and conclusionThe current study found that low to moderate health literacy levels were common for those attending residential substance abuse treatment. Participants with lower health literacy tended to have poorer quality of life and mental health. Future research should examine strategies to improve health literacy amongst people attending alcohol and other drug treatment. It may also be useful for service providers to consider ways to minimise the impact of low health literacy on the health needs and outcomes of this vulnerable population.

Safety and tolerability of sauna detoxification for the protracted withdrawal symptoms of substance abuse

ObjectiveProtracted drug withdrawal symptoms can last months or years after drug cessation, often precipitating a return to substance misuse. We evaluated the safety and preliminary health benefits of a unique chemical exposure regimen based on exercise, sauna and therapeutic nutrients.MethodsThis was a prospective evaluation of 109 individuals sequentially enrolled into a sauna detoxification component of a multi-modal, long-term residential substance abuse treatment centre.ResultsData from medical charts, client self-reports and Short Form Health Survey (SF-36) responses indicated that the Hubbard sauna detoxification method was well tolerated, with a 99% completion rate, including one human immunodeficiency virus and nine hepatitis C positive clients. There were no cases of dehydration, overhydration or heat illness. Statistically significant improvements were seen in both mental and physical SF-36 scores at regimen completion, as well as in Addiction Severity Index and Global Appraisal of Individual Needs Short Screener change scores at rehabilitation program discharge, compared with enrolment.ConclusionsThe regimen lacked serious adverse events, had a very low discontinuation rate and high client-reported satisfaction. The SF-36 data indicated improved physical and emotional symptoms. Therefore, broader investigation of this sauna-based treatment regimen is warranted.

Safety and psychological impact of sailing adventure therapy among Veterans with substance use disorders

ObjectivesMany Veterans suffer from substance use disorders (SUDs). Treatment challenges include poor treatment engagement and high relapse rates. Complementary interventions have the potential to enhance both. This study was a preliminary evaluation of sailing adventure therapy (SAT) for this population. DesignRetrospective chart review. Participants in the intervention were 22 Veterans (20 male, 2 female) aged 22–65 who entered a Veterans Administration residential SUD treatment program. All subjects had two or more SUDs, and many had psychiatric (95%) and/or medical (77%) comorbidities. The age, gender and diagnosis-matched control group (n = 22) received residential SUD treatment as usual (TAU) in the same program but without SAT. SettingResidential SUD treatment program at a Veterans Administration Medical Center. InterventionSailing adventure therapy. Main Outcome MeasuresPositive and Negative Affect Schedule (PANAS), State Trait Anxiety Inventory six-item short form (STAI: Y-6 item), Acceptance and Action Questionnaire II (AAQ II), Five Facet Mindfulness Questionnaire (FFMQ) and a locally developed patient survey. Outcome comparison among SAT plus TAU group versus TAU – only group included measures of successful completion of residential SUD treatment program as well as psychiatric hospitalizations and/or residential SUD treatment program readmissions within 12 months. ResultsNeither physical injuries nor increases in anxiety or negative affect occurred, as measured by the PANAS (positive change, p = 0.351; negative change, p = 0.605) and the STAI: Y-6 item (p = 0.144) respectively. There was no significant change in FFMQ (p = 0.580) but a significant increase occurred in AAQ II scores (p = 0.036) indicating an increase in psychological flexibility. Survey responses indicated the participants perceived the experience to be both pleasurable and calming. The preliminary outcome evaluation revealed a significant between-group difference (X2 = 5.34, DF = 1, p = 0.02, r = 0.35) indicating participating in SAT was associated with a greater likelihood of successfully completing residential SUD treatment. However, there were no significant between-group differences in number of psychiatric hospitalizations (X2 = 1.09, DF = 1, p = 0.29, r = 0.16) or residential substance abuse treatment program readmissions (X2 = 0.23, DF = 1, p = 0.64, r = 0.07) in the 12 months after discharge from the program. ConclusionsPreliminary evidence suggests that SAT is physically safe and not associated with increased anxiety or negative affect. Participant’s perceptions of the experience were positive. Preliminary outcome measures suggest associations between participation in SAT and increased psychological flexibility as well as successful completion of a residential SUD treatment program. Further research is indicated to determine whether SAT may be developed as an effective complementary intervention for Veterans with SUDs.

Relationship Between the Five Facets of Mindfulness on Mood and Substance Use Relapse

This study examined which particular facets of mindfulness (nonreactivity, observing thoughts and feelings, acting with awareness, describing experience, and nonjudging of experience) accounted for improvements in mood and warning signs of relapse in an adult population. This exploratory study examined the impact of the five facets of mindfulness on both warning signs of relapse and mood in a primarily minority adult population in a residential substance abuse treatment facility. Results showed that all five facets were significantly correlated with mood and warning signs at the bivariate level. When considering the facets together, observing and nonjudging were related to mood, and acting with awareness and nonjudging were related to warning signs. Implications for future research and practice are offered.

StaySafe: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors

This paper describes the development and protocol for feasibility and efficacy testing of a risk reduction intervention designed to improve behavioral health outcomes among drug offenders on probation under community supervision or in residential substance abuse treatment centers. StaySafe is a self-administered tablet-based intervention for teaching better decision-making skills regarding health risk behaviors, especially those involving HIV risks. We are using pre/post, experimental/control group randomized clinical trial (RCT) in both community and residential probation settings with goals to 1) assess the feasibility and acceptance of StaySafe by examining participation rates and satisfaction measures, and 2) examine the impact of StaySafe on decision-making skills, confidence and motivation to avoid sex and drug risks, willingness to discuss health risks and concerns with helpful others, and engagement in health risk behaviors.StaySafe consists of 12 brief sessions and utilizes an evidence-based decision-making schema, called WORKIT, which guides participants through steps for identifying the problem and options, evaluating the options and making a decision about which option to carry out. Multiple sessions of StaySafe provide a practice effect so that the WORKIT steps become easily accessible to participants when making decisions. Three of the sessions provide participants a choice of activities designed to provide additional information about HIV and reinforce lessons learned during the WORKIT sessions. Preliminary data demonstrate feasibility and high levels of satisfaction with StaySafe.

Assessing Racial Disparities in HCV Infection and Care Outcomes in a Southern Urban Population.

This study assessed racial disparities in access to healthcare services, hepatitis C virus (HCV) exposure, and retention in a treatment cascade in two indigent populations in an urban center in the Southern US. Opt-in HCV antibody screening was offered at two large homeless centers and three residential substance abuse treatment centers (SATCs) in New Orleans, LA. Five hundred ninety-four participants experiencing homelessness and 342 residents of SATCs were assessed for previous access/perceived barriers to healthcare services and high-risk behaviors associated with HCV exposure. Participants were then screened using rapid HCV antibody testing and tracked through a treatment cascade involving referral to a primary care provider (PCP), RNA confirmation, and specialist referral. In both the homeless and SATC populations, whites were more likely to report barriers to accessing healthcare and high-risk behaviors, especially prior intravenous drug use (IVDU). Interaction between age and race demonstrates a protective effect of white ethnicity at higher ages, at a level approaching statistical significance. Non-whites were equally likely to access follow-up care and treatment as whites. Despite many more risk factors reported by the white population, HCV antibody positivity was largely equal between the two racial groups. Known interactions between race and age in the African American population were demonstrated in these high-risk, urban populations. Whites were no more likely to achieve various levels of a treatment and care cascade. The results may demonstrate the impact of improved access to testing services and primary care, although access to treatment remains a significant barrier to eliminating racial disparities in HCV infection.

Social support and mental health during recovery from drug and alcohol problems

Objective: The current study aimed to investigate the relationship between support provided from friends, family or broader network connections and Keyes' (2007) conceptualisation of complete mental health.Method: Participants were 1815 individuals (70% male) who entered residential substance abuse treatment provided by The Salvation Army. Questionnaires were completed by participants at their intake assessment to treatment, and 188 participants provided complete responses to a phone interview at 3-months post-discharge.Results: Changes in general support provided from friends and informal social connectedness were the strongest social variable predictors of complete mental health at 3-month follow-up. Mediation analyses indicated friends' support for abstinence had no effect on complete mental health and general social support had a direct effect on complete mental health. The relationship between informal social connectedness and complete mental health was partially mediated by alcohol use severity.Conclusions: The current findings indicate informal social connectedness and general support provided by friends is most related to one’s complete mental health in a drug and alcohol misuse context. These findings indicate supporting wider social connection (e.g. neighbours, workmates) could be a target in substance misuse treatment and aftercare.