Short-term Residential Treatment Research Articles

Higher perceived stress during admission is associated with shorter retention in short-term residential substance use disorder treatment

IntroductionOver one million people in the U.S. received residential treatment for a substance use disorder (SUD) in 2020. Longer treatment retention is associated with better outcomes (e.g., reduced substance use). Entering treatment with higher stress may be associated with shorter retention. This paper examines the impact of perceived stress at admission on SUD treatment retention in short-term residential treatment. MethodsA sample of 271 treatment episodes with admissions between October 2019 and February 2020 were collected from de-identified records of an urban mid-Atlantic adult 28-day short-term residential SUD treatment facility. Treatment completion involved finishing 28 days. Sociodemographic, substance use, perceived stress, and treatment discharge variables were analyzed. Bivariate analyses examined differences between treatment completion and early discharge, and Cox regression investigated the effect of perceived stress on treatment retention with covariates. ResultsThe sample was primarily male (73.8%) and non-Hispanic Black (71.6%). A majority used heroin as their primary substance (54.6%) and reported polysubstance use (72.3%). About half (51.3%) completed treatment, and completed an average of 18.7 (SD = 10.7) days. Those who prematurely discharged from treatment stayed an average of 8.9 (SD = 7.0) days. The Cox regression model found that higher perceived stress (adjusted hazard ratio (AHR) = 1.028; 95% CI = [1.005, 1.053], p =.019) and a race/ethnicity other than non-Hispanic Black (AHR = 1.546, 95% CI = [1.037, 2.305], p =.033) predicted premature discharge. ConclusionsPerceived stress at admission is associated with shorter treatment retention. Early stress management interventions may help increase treatment retention.

Adults With Opioid and Methamphetamine Co-use Have Lower Odds of Completing Short-Term Residential Treatment Than Other Opioid Co-use Groups: A Retrospective Health Services Study

Objective: There is an increase in persons entering substance use treatment who co-use opioids and methamphetamines in recent years. Co-using these substances may negatively impact treatment retention in the residential setting. We explored predictors of adults completing short-term residential treatment among persons with primary opioid use disorder (OUD) who co-use either alcohol, benzodiazepines, cocaine, or methamphetamines.Methods: This study used the 2019 de-identified, publicly available Treatment Episode Dataset-Discharges. The sample included adults discharged from short-term residential treatment with primary OUD who co-used either alcohol, benzodiazepines, cocaine, or methamphetamines. The final sample size included 24,120 treatment episodes. Univariate statistics were used to describe the sample. Two logistic regression models were used to predict completing treatment. The first logistic regression model included the co-use groups as predictors and the second model added other demographic and treatment-relevant covariates.Results: A slight majority (51.4%) of the sample prematurely discharged from treatment. Compared to the other three co-use groups, the opioid and methamphetamine co-use group had the highest proportion of individuals who were women (45.0%), unemployed (62.5%), current injection drug use (76.0%), living in the Midwest (35.9%), living in the south (33.5%), and living in the west (15.5%). The opioid and methamphetamine co-use group also had the highest proportion of individuals not receiving medications for OUD (84.9%), not having a prior treatment episode (28.7%), and not completing treatment (57.4%). In the final logistic regression model, which included covariates, the opioid and alcohol (OR = 1.18, 95% CI = 1.080–1.287, p < 0.001), opioid and benzodiazepine (OR = 1.33, 95% CI = 1.213–1.455, p < 0.001), and opioid and cocaine (OR = 1.16, 95% CI = 1.075–1.240, p < 0.001) co-use groups had higher odds of completing treatment than the opioid and methamphetamine co-use group.Conclusions: Opioid and methamphetamine co-use may complicate short-term residential treatment retention. Future work should identify effective strategies to retain persons who co-use opioids and methamphetamines in treatment.

Pathways to substance use: a qualitative study of individuals in short-term residential treatment

ABSTRACT Despite recent research on the importance of ‘milestones’ in the development of substance use disorders (SUD) as well as a growing appreciation of individuals as embedded in environmental and social contexts, qualitative analyses of the pathways to SUD have received little attention. This study is a qualitative exploration into pathways to SUD focusing on the intrapersonal, social, and familial reasons that motivate initial and sustained contact with substances and inform the attainment of SUD milestones. First-person accounts of the saliency of substance use may thus support milestone research and inform treatment design.

Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US

BackgroundThis study examines racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) in residential treatment and the influence of race/ethnicity on the association between MOUD use and treatment retention and completion. MethodsData were extracted from SAMHSA’s 2015–2017 Treatment Episode Dataset-Discharge (TEDS-D) datasets for adult opioid admissions/discharges to short-term (ST) (30 days or less) (N = 83,032) or long-term (LT) (> 30 days) residential treatment settings (N=61,626). Logistic regression estimated the likelihood of MOUD use among racial/ethnic groups and the moderation of race/ethnicity on the probability of treatment completion and retention, controlling for background factors. ResultsAfter adjusting for covariates, compared to Whites, MOUD use was less likely for Blacks in ST (OR = 0.728) and LT settings (OR = 0.725) and slightly less likely for Hispanics in ST settings (OR = 0.859) but slightly more likely for Hispanics in LT settings (OR = 1.107). In ST settings, compared to Whites, the positive effect of MOUD on retention was enhanced for Blacks (OR = 1.191) and Hispanics (OR = 1.234), and the positive effect on treatment completion was enhanced for Hispanics (OR = 1.144). In LT settings, the negative association between MOUD and treatment completion was enhanced for Hispanics (OR = 0.776). ConclusionsAccess to medications for opioid use disorder in short term residential treatment is particularly beneficial for Blacks and Hispanics, though adjusted models indicate they are less likely to receive it compared to Whites. Results are mixed for long-term residential treatment. Residential addiction treatment may represent an important setting for mitigating low rates of medication initiation and early discontinuation for minority patients.

Implementation of a Medication for Addiction Treatment (MAT) and Linkage Program by Leveraging Community Partnerships and Medical Toxicology Expertise.

Implementing a hospital medication for addiction treatment (MAT) and a linkage program can improve care for patients with substance use disorder (SUD); however, lack of hospital funding and brick and mortar SUD resources are potential barriers to feasibility. This study assesses the feasibility of implementation of a SUD linkage program. Components of the program include a county-funded hospital opioid support team (HOST), a hospital-employed addiction recovery specialist (ARS), and a medical toxicology MAT induction service and maintenance program. Data for linkage by HOST, ARS, and MAT program were tracked from July 2018 to December 2019. From July 2018 through December 2019, 1834 patients were linked to treatment: 1536 by HOST and 298 by the ARS. The most common disposition categories for patients linked by HOST were 16.73% to medically monitored detoxification, 9.38% to intensive outpatient, and 8.59% to short-term residential treatment. Among patients linked by the ARS, 65.66% were linked to outpatient treatment and 9.43% were linked directly to inpatient treatment. A total of 223 patients managed by the ARS were started on MAT by medical toxicology and linked to outpatient MAT clinic: 72.68% on buprenorphine/naloxone, 24.59% on naltrexone, 1.09% buprenorphine, and 0.55% acamprosate. Implementing a MAT and linkage program in the ED and hospital setting was feasible. Leveraging medical toxicology expertise as well as community and funding partnerships was crucial to successful implementation.

The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US

BackgroundThis study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. MethodsData were extracted from the 2015–2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. ResultsOnly 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. ConclusionsDespite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Comparison of artificial neural networks and logistic regression for determination of social-cognitive factors impacting drug abstinence

ABSTRACTBackground: Logistic regression model (LRM) are popular in public health studies. However, most studies have found that artificial neural networks (ANNs) have better performance than other methods especially when the relationship between the response and independent variables is complex.We aimed to compare the performance of LRM and ANNs in the determination of drug abstinence predictors.Methods: The participants of this prospective study included 317 male addicts recruited through convenience sampling in five short-term residential substance use treatment programs in Southern Khorasan, the eastern province of Iran. Eligibility criteria included being in a detoxification stage and having a primary diagnosis of substance dependency disorder based on the diagnostic criteria of the DSM-IV-TR. The performance of the models was compared using the area under the ROC (AUC).Results: LRM and ANNs method correctly classified 82.2% and 84.4% of the participants as an abstinent group, respectively. The areas under ROC curve were 90 and 91.2, the kappa statistic was 0.643 and 0.688 for LRM and ANN models, respectively.Conclusions: The results showed classification performance was not significantly different. We concluded that the selection of prediction techniques for predicting drug abstinence factors depended on our background knowledge on the data pattern.

PDG72 DETERMINANTS OF AN EFFICIENT MODEL OF EXTENDED-RELEASE NALTREXONE INITIATION FOR THE TREATMENT OF OPIOID USE DISORDER

A recent eight-site randomized effectiveness trial compared buprenorphine-naloxone (BUP-NX) to extended-release naltrexone (XR-NTX) to prevent opioid-use relapse. Participants were recruited from inpatient-detoxification or short-term residential treatment programs. Current treatment protocols require persons initiating XR-NTX, but not BUP-NX, to be fully detoxified from opioids. This detoxification requirement resulted in fewer persons initiating XR-NTX, higher detoxification costs, and a higher relapse rate. However, among those who successfully initiated pharmacotherapy, relapse rates were not significantly different between XR-NTX and BUP-NX. We used trial data to identify factors associated with an efficient model of residential/inpatient opioid detoxification; i.e., factors that simultaneously increase the likelihood of XR-NTX initiation, and minimize detoxification duration. Given the many potential combinations of supportive medications that can be used in the detoxification process, latent class analysis (Stata 15.1) was used to categorize participants randomized to XR-NTX. A multivariable generalized structural equation model was then estimated to explore determinants of XR-NTX initiation and detoxification duration, while controlling for the simultaneous influence that many factors have on both measures. Five latent pharmacotherapy classes were identified. Neither pharmacotherapy class, nor detoxification duration was a significant determinant of XR-NTX initiation. Site effects were the largest determinants of both initiation and duration, and both factors varied by site, as did efficiency. Across the four sites associated with a significantly higher likelihood of initiation, predicted probabilities of success/day spent in detoxification ranged from 0.12–0.16. The predicted cost/day of detoxification varied from $115–$348, largely due to different staffing models. The most efficient site relied on physician assistants or nurse practitioners, and counselors; had a predicted probability of success/day=0.16; and had a predicted cost/day=$115. Identifying and adopting efficient site models of XR-NTX initiation could improve its relative economic value, thereby increasing its attractiveness to payers for patients who prefer this treatment.

An open trial of rolling admission mindfulness-based relapse prevention (Rolling MBRP): feasibility, acceptability, dose-response relations, and mechanisms.

Mindfulness-based relapse prevention (MBRP) is an effective treatment for substance use disorders (SUD). However, evidence is primarily based on studies of closed groups, and few studies support flexible formats of MBRP, such as rolling groups. This nonrandomized, open trial evaluated feasibility, acceptability, dose-response relations, and mechanisms of rolling admission MBRP ("Rolling MBRP") offered as part of short-term residential treatment for SUD. Rolling MBRP was developed prior to the trial through an iterative process over several years. Participants included 109 adults (46% female, 74.3% racial/ethnic minorities, mean age=36.40). Rolling MBRP was offered to all patients in the program 2x/week and attendance was tracked. Outcomes were craving, self-efficacy, mental health, mindfulness, and self-compassion at discharge. Self-reported out-of-session mindfulness practice was examined as a mediator of attendance-outcome relations. Analyses involved multiple regression and mediation models. Feasibility was demonstrated by good attendance rates. Acceptability was demonstrated by high engagement in mindfulness practice and high satisfaction ratings. Total sessions attended did not predict outcomes at discharge. However, attending 2+ sessions (versus 1 or none) significantly predicted better mental health and higher mindfulness at discharge, and these effects were mediated by informal and formal mindfulness practice. Total sessions attended had significant indirect effects on craving, self-compassion, mindfulness, and mental health, via mindfulness practice. Results support the feasibility and acceptability of Rolling MBRP and suggest mindfulness practice may be a key mechanism driving effects of MBRP on other key mechanisms during the recovery process, such as decreased craving and improved mental health.

An Evaluation Study of the “RESTART” Program—Short-Term Residential Treatment for Addiction

The syndrome model of addiction argues that addiction should be conceptualized as a syndrome with multiple opportunistic expressions. The model is built on the observation that despite the various manifestations of addictive behaviors, they share many commonalities in terms of the etiology and the associated consequences. This model proliferates the understanding of the high relapse rate in addiction after receiving solely symptom-focused treatment. For clinicians, this conceptual model emphasizes the importance of in-depth multidimensional assessment and treatment modality for the interacting underpinnings of addictions. In Hong Kong, very few residential services are currently provided for clients with addictive behaviors other than substance abuse. Against this background, we developed a pilot short-term residential treatment program namely “RESTART” based on the Acceptance Commitment Therapy and Expressive Arts Therapy for clients with various expressions of addiction. The program contained a 4-day and 3-night overnight residential treatment camp followed by three post-camp workshops, and a full-day camp. It aimed to help participants rebuild a positive lifestyle and raise self- efficacy and coping abilities. The program recruited 44 participants with various expressions of addiction including gambling disorder, sex addiction, compulsive buying, compulsive stealing, internet gaming disorder, alcohol, and cigarette addiction. The program evaluation focused on six outcomes, including health consciousness, motivation to build a healthy life, psychological distress, disclosure of distress, perceived emotional and life disturbance by addiction, and self-efficacy of urge management. Quasi-experimental design was adopted to compare the experimental group (program participants) and the control group with similar demographic and addiction backgrounds. They were surveyed in four intervals in which pretest before the commencement of the residential program was conducted to compare with posttest at the program endpoint and two follow-up tests in 3 months after the program. Repeated-measures general linear models indicated that relative to the control participants, the experimental participants yielded significant increase in willingness to disclose distress and self-efficacy over time, whereas their perceived disturbance by addiction significantly reduced over time. These results suggest that the residential treatment camp is a potentially promising complement to treatment for diverse addiction problems.

Implicit identification with death predicts change in suicide ideation during psychiatric treatment in adolescents.

Suicidal thoughts and behaviors are major public health concerns in youth. Unfortunately, knowledge of reliable predictors of suicide risk in adolescents is limited. Promising research using a death stimuli version of the Implicit Association Test (Death IAT) indicates that stronger identification with death differs between adults with and without a history of suicidal thoughts and behaviors and uniquely predicts suicide ideation and behavior. However, research in adolescents is lacking and existing findings have been mixed. This study extends previous research by testing whether implicit identification with death predicts changes in suicide ideation during psychiatric treatment in adolescents. Participants included 276 adolescents, ages 13-19, admitted to a short-term residential treatment program. At hospital admission and discharge, adolescents completed the Death IAT and measures of recent suicidal thoughts. At admission, implicit identification with death was associated with recent suicide ideation, but did not differ between those who engaged in prior suicidal behavior and those who did not. Prospectively, adolescents' implicit identification with death at admission significantly predicted their suicide ideation severity at discharge, above and beyond explicit suicide ideation. However, this effect only was significant for adolescents with longer treatment stays (i.e., more than 13days). Implicit identification with death predicts suicidal thinking among adolescents in psychiatric treatment. Findings clarify over what period of time implicit cognition about death may predict suicide risk in adolescents.

Reducing Length of Acute Inpatient Hospitalization Using a Residential Step Down Model for Patients with Serious Mental Illness.

Psychiatric inpatient bed numbers have been markedly reduced in recent decades often resulting in long emergency department wait times for acutely ill psychiatric patients. The authors describe a model utilizing short-term residential treatment to substitute for acute inpatient care when the barrier to discharge for patients with serious mental illness (SMI) is finding appropriate community placement. Thirty-eight patients (community hospital (n = 30) and a state hospital (n = 8)) were included. Clinical variables, pre-/post-step down length of stay, and adverse outcomes are reported. Thirty of the 38 patients completed treatment on the residential unit and were discharged to the community. Five of the patients required readmission to an inpatient unit and the other three had pre-planned state hospital discharges. The majority of patients with SMI awaiting placement can be stepped down to residential treatment, potentially freeing up an inpatient bed for an acutely ill patient. Reforms in healthcare funding are necessary to incentivize such an approach on a larger scale, despite likely cost savings.

Predictors of motivation for substance abuse treatment in a sample of Iranian addicts

Motivation to quit substance abuse is a key element in encouraging patients to seek treatment but research to identify factors that may influence motivation has received less attention, particularly on treatment-seeking substance abusers in short-term residential camps. This study investigated predictors of motivation for substance abuse treatment among patients in short-term residential treatment. A total of 317 male substance abusers undergoing residential treatment were enrolled in this cross-sectional study and assessed typically at 5–7 days after admission. Motivation was measured by the Circumstances, Motivation, and Readiness scales (CMR). Using multiple regression analysis, factors considered to potentially predict motivation were assessed. The mean age of participants was 28.6 9 ±6.55 (range: 15–55) years. Participants were predominantly single (47.9%) and most were employed part-time (42.9%). Of the examined factors, perceived social support, drug avoidance self-efficacy, and drug quitting outcome expectancies emerged as important predictors of motivation (F = 9.548 with p < 0.001, R = 0.238), whereas demographic and substance use related variables did not (p > 0.05). Results of this study confirm that cognitive constructs such as perceived avoidance self-efficacy, perceived social support, and outcome expectancies need to be considered in treatment assessment and addressed in treatment implementation.

Prescribed Psychotropic Medication Use in Patients Receiving Residential Addiction Treatment.

A high level of prescribed antidepressant use has been reported in patients receiving specialized addiction treatment (Knudsen et al ., 2007) despite uncertainty about which, if any, of these patients will benefit from this medication. We aimed to investigate patterns of antidepressant and other prescribed psychotropic medication use among patients attending short-term residential addiction treatment. Data were obtained retrospectively from clinical files for all patients admitted over a 12-month period. For patients with two or more admissions, only the first admission was considered. Patients predominantly had a severe alcohol or other substance use disorder, were psychiatrically stable and had either completed medical detoxification or did not require it. Diagnoses were made at admission according to DSM-5 criteria using a non-structured clinical interview conducted by a single experienced addiction clinician. Diagnoses were informed by existing information from medical and psychiatric records. Patients’ current prescribed medications were recorded at admission. In …

Peer Experiences in Short-Term Residential Treatment: Individual and Group-Moderated Prediction of Behavioral Responses to Peers and Adults.

This research examined the independent and interactional contributions of peer experiences and group aggression to youth behavioral adjustment in short-term residential treatment. Participants were 219 youth (M age = 12.70, SD = 2.76; 71% male) nested in 28 same-age, same-sex treatment groups. Sociometric interviews assessed social preference and victimization. Daily behavioral observations by staff assessed overall levels of treatment group aggression, as well as aggressive, withdrawn, and prosocial responses to specific social events. End-of-summer behavioral responses (to all events; to peers; to adults) were predicted, controlling for initial levels of these responses. Social preference predicted higher end-of-summer prosocial responses, and victimization predicted lower prosocial and higher withdrawn responses. Each interacted with group aggression in some analyses, with more positive peer experiences only predicting more favorable responses in groups that were low or average in aggression. Interactant-specific analyses revealed that some of these associations were broad, whereas others applied only to adults. For example, group aggression moderated the association between social preference and aggressive responses to adults but not peers. Gender differences were also interactant-specific. Results highlight the importance of peer experiences in group treatment and underscore the value of both aggregation and disaggregation over interactants in analyses of behavioral adjustment.

Transforming a residential substance dependence program: experience from the National Rehabilitation Centre, United Arab Emirates

This article describes the experience of transforming a residential substance dependence treatment program from an extended non-structured program to a structured, differentiated short-term residential treatment which allows for treatment personalization. Carried at the National Rehabilitation Centre, Abu Dhabi, United Arab Emirates, and commissioned by its management, the transformation aimed to address extended length of stay, long waiting lists, service expansion requirement, and diversity in demand for treatment. Transforming the residential program would optimize efficiency as it is the most common and resourceful phase of substance dependence treatment regionally, hence the significance of this effort. The transformation process extended from April 2009 to April 20l3 over two phases: (a) program development and (b) implementation. Gaps in human resource capacity, and the absence of monitoring and evaluation systems were identified as major challenges in transformation. Six recommendations were gener...

Recent Violence Among Persons Entering Short-Term Residential Mental Health and Substance Abuse Treatment

Objective: Large-scale epidemiologic studies have consistently found that co-occurring mental health and substance use disorders are associated with increased risk of involvement in violence. Individuals with co-occurring mental and substance use disorders can present either in mental health or substance abuse treatment systems, and both systems must be able to respond to their needs. This study examined the prevalence and correlates of recent violence (both perpetration and victimization) among adults (N = 419) entering short-term residential mental health and substance abuse treatment. Methods: Approximately 41% (n = 171) of participants reported having any involvement in violence, and for the majority of them (n = 144; 84%) that included victimization. For analytic purposes, we classified participants with involvement in violence as any perpetration (n = 87) or only victimization (n = 84) and conducted bivariate and multivariate logistic regression analyses examining potential correlates of these different types of violence. Results: Homelessness (adjusted odds ratio [AOR] = 1.6, 95% confidence interval [CI] [1.0–2.4], p < .04), alcohol use disorder (AOR = 1.8, 95% CI [1.1–2.9], p < .03), and the interaction of comorbidity and substance abuse treatment system (AOR = 2.8, 95% CI [1.0–7.6], p < .05) were associated with an increased likelihood of any violence. Alcohol use disorder (AOR = 1.8, 95% CI [1.0–3.3], p < .05) increased the likelihood of perpetration. Homelessness (AOR = 1.9, 95% CI [1.1–3.2], p < .02) and the interaction of comorbidity and being recruited from substance abuse treatment (AOR = 5.1, 95% CI [1.8–14.2], p < .003) increased the likelihood of involvement in only victimization. Conclusions: Victimization was far more prevalent than perpetration. Comorbidity was not a significant predictor of violence, but individuals with comorbidity recruited from the substance abuse treatment system were more likely to be involved in violence.

Polysubstance Use and Heroin Relapse Among Adolescents Following Residential Treatment

This study examined posttreatment patterns of polysubstance use and heroin relapse in a sample of 43 adolescents (ages 14–20) entering short-term residential treatment for primary heroin use. At 12-month follow-up, youths that achieved heroin abstinence (N = 19) were significantly less likely than youths that relapsed to heroin (N = 24) to endorse polysubstance use and cannabis, cocaine, or benzodiazepine use. Furthermore, heroin-abstinent youths significantly reduced their cannabis and cocaine use across the study period while youths that relapsed made initial reductions before returning to their pretreatment levels of use for these drugs. Clinical implications for heroin-using youths and areas for future research are discussed.

Smoking and Co-occurring Disorders: Implications for Smoking Cessation Interventions for Adolescents in Residential Addiction Treatment

Objective: Co-occurring disorders are important to consider in planning smoking cessation interventions with adolescents. We identify factors associated with smoking and predictors for smoking cessation readiness in a group of adolescents in a residential addiction treatment program. Methods: We conducted a chart review study of 400 clinical records of adolescents aged 13 to 18 at a short-term residential addiction treatment program. We examined the relationships of smoking with use of other drugs, psychiatric disorders, and adverse events. Results: The rate of smoking in the total sample was 79%. Smoking onset was positively associated with the onset of alcohol and other drugs of abuse but followed the onset of cannabis use for over half the sample. Heavy smoking, defined as smoking 10 cigarettes per day on average, was correlated with cocaine and opiate addiction. Over half of the sample (56%) was precontemplative about smoking cessation, whereas 30% were in the contemplative stage (ready to stop in 6 months); 12% were in preparation stage (ready to stop in 30 days); and 2% reported that they already had stopped. Heavy smoking was associated with being precontemplative as was earlier onset of drinking relative to smoking and bipolar diagnosis. Conclusions: Smoking is common in adolescents seeking drug and alcohol treatment and is correlated with the onset and progression of other drug use. Increasing motivation for change and addressing the interface of nicotine, other drugs, and mental health are important for smoking cessation interventions for adolescents in residential addiction treatment settings.