Specialized Substance Abuse Treatment Research Articles

Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa.

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatmentcenters (SSATCs)are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCsrepresent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission dataexploresself-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol andother drug use. SACENDU data from 2012 to 2017 was analyzed usingchi-square test of independence and logistic regression to examine associations betweenHTS, demographic characteristics and substances of use. Of 87,339 treatment admissions,47.5% (n = 41,481) of patients had not accessedHTSin the prior 12months.HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively).None of the substance use sub-groupsreported a testing rate above 70%.Compared to specific reference groups, logistic regression showed those with lower odds of HTS were:15-19years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); andprimarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reportedHTSamong sub-groups of patients inSSATCs, the integration of HIV services for PWUD should be a priority inSouth Africa and a focus of the national HIV strategy.

Reaching Adolescents for Prevention: The Role of Pediatric Emergency Department Health Promotion Advocates.

Almost 200,000 adolescents visit US emergency departments (EDs) yearly for conditions involving underage drinking but receive no follow-up referral. Other health risk behaviors resulting in sexually transmitted infections, car crashes, and assault-related injury are common among adolescents. A pediatric ED (PED) visit presents an opportunity to discuss and promote prevention. We report here on implementation of a new PED navigator/extender role, the Health Promotion Advocate (HPA). Health Promotion Advocates surveyed patients to identify health risks, stresses, and needs. A positive screen triggered a brief conversation containing the following elements: permission to discuss risks/needs; exploration of context (a typical day in your life); brief feedback (information and norms); exploration of benefits and consequences of risk behaviors; assessment of readiness to change; calling up assets, instilling hope; discussing challenges of change; negotiating a menu of options and prescription for change; referrals to primary care, community resources; and treatment services as indicated. During 2009-2013, HPAs screened 2149 PED patients aged 14 to 21 years and referred 834 for an array of services (eg, primary care, mental health, insurance, personal safety, human immunodeficiency virus testing, general education diploma (GED), employment, housing, and food pantries) to address reported health risks; 785 screened positive for at-risk substance use (53% female, 36% without primary care). Among them, 636 received a brief intervention; 546 were referred to specialized substance abuse treatment. Two case studies are presented to illustrate the engagement and referral process. Health Promotion Advocates working as PED team members can extend PED services beyond the scope of the presenting complaint.

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross‐site evaluation

Since 2003, the US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA, CSAT) has awarded 32 Screening, Brief Intervention and Referral to Treatment (SBIRT) grants to states, territories and tribal organizations to enhance services for persons with, or at risk for, substance use disorders. The grants supported an expansion of the continuum of care to include screening, brief intervention, brief treatment and referral to treatment in general medical and community settings. This paper describes the SAMHSA SBIRT program in the context of the scientific research that motivated its development, as well as the two cross-site evaluations that are the subject of subsequent papers in this Supplement. A narrative review of research evidence pertaining to SBIRT and of the cross-site evaluation design that made it possible to determine whether the SAMHSA SBIRT grant program achieved its intended aims. The 11 programs within the two cohorts of grant recipients that were the subject of the cross-site evaluations are described in terms of SBIRT service components, performance sites, providers, management structure/activities and patient/client characteristics. The US SAMHSA SBIRT program is an effective way to introduce a variety of new services that extend the continuum of care for substance-involved individuals, ranging from early intervention with non-dependent substance users to referral of more serious cases to specialized substance abuse treatment.

Dimensional Publicness and Serving the Vulnerable: Analyses of Specialized Substance Abuse Treatment Programs

The proliferation of market-based public service delivery raises concerns whether the vulnerable are dully served and what mechanisms facilitate to serve them well. Focused on the availability of specialized substance abuse treatment programs for co-occurring, HIV, criminal and pregnant patients, this study adopts the dimensional publicness theory to examine how different dimensions of political authorities facilitate the provision of specialized programs for vulnerable groups. The multilevel analyses indicate that public funding and accreditation are two major dimensions promoting specialized programs. Environmental publicness exercises significant impact, contingent upon statewide policies and facility ownership. Differential effects are found both within and across dimensions, calling for a contingent approach to better understand both the theory and its implications.

A "Middle Way": Introducing a Flexible Year-Long Program to Prepare for Certification in Addiction Medicine.

Substance use is endemic in the USA. In 2012, an estimated 22 million Americans, or 8.5 % of the population, met criteria for a substance use disorder in the past year [1]. In 2011, there were 2.5 million emergency department visits that involved drug misuse or abuse, a 52 % increase since 2004. Half of these visits involved the nonmedical use of pharmaceuticals, which is an increase of 132 % since 2004 [2]. Yet despite the tremendous need for treatment, only 11 % of addicted individuals received specialized substance abuse treatment in 2012 [1]. So, how can this enormous treatment deficit be addressed? Given the high prevalence of substance use disorders in a variety of clinical settings (ranging from 8 to 29% in inpatient settings and up to 20 % in primary care) [3, 4], it would make sense to identify individuals with substance use disorders in these settings and then connect them to treatment. Screening and brief intervention have been shown to be effective in primary care and an increasing number of settings, and models of integration into routine practice have been described [5]. Successful referral to substance abuse treatment from a primary care setting has even been shown to improve depression [6]. However, many surveys have found that physicians do not feel prepared to diagnose or treat addiction, and residents do not feel that they have received sufficient training in addictive disorders during residency [7]. In addition to proposals for curriculum design in residencies and medical schools, online-based programs have been implemented to teach skills to physicians, residents, and medical students, with varied success [8]. Psychiatry residents can subspecialize in addiction psychiatry by training in an Accreditation Council on Graduate Medical Education (ACGME)-certified addiction psychiatry fellowship program. In addition, physicians from psychiatry and other specialties can become certified by the American Board of Addiction Medicine (ABAM). There are two pathways: (1) a 1-year fellowship training similar to addiction psychiatry programs but administered by the American Board of Addiction Medicine Foundation or (2) to qualify to take the ABAM exam after completing 50 h of addiction-related continuing medical education (CME) courses and practicing in the field of addiction medicine for 1 year. The first pathway requires an additional year of training, which can be difficult for many physicians with large amounts of medical education debt. The second pathway does not provide much structure, making it difficult to physicians to stay motivated. To encourage physicians to complete the second pathway, we developed the Rutgers New Jersey Medical School Executive Fellowship in Addiction Medicine (Exec-FAM). In addition to providing structure for ABAM exam requirements, we hope this fellowship will increase a practitioner’s confidence and accuracy in assessing and diagnosing addictive disorders, and raise her or his comfort level in providing evidence-based treatment for addicted patients.

Explaining long-term outcomes among drug dependent mothers treated in women-only versus mixed-gender programs

Specialized substance abuse treatment for parenting women is thought to improve outcomes, but long-term impacts and how they occur are poorly understood. Utilizing a sample of 789 California mothers followed for 10 years after admission to women-only (WO) or mixed-gender (MG) drug treatment, we examine the relationship between WO treatment and outcomes and whether it is mediated by post-treatment exposures to criminal justice and health services systems. At follow-up, 48% of mothers had a successful outcome (i.e., no use of illicit drugs, not involved with the criminal justice system, alive). Controlling for patient characteristics, WO (vs. MG) treatment increased the odds of successful outcome by 44%. In the structural equation model WO treatment was associated with fewer post-treatment arrests, which was associated with better outcomes. Women-only substance abuse treatment has long-term benefits for drug-dependent mothers, a relationship that may be partially explained by post-treatment exposure to the criminal justice system. Findings underscore additional leverage points for relapse prevention and recovery-supportive efforts for drug-dependent mothers.

The Emergency Department as a prevention site: A demographic analysis of substance use among ED patients

ObjectivesTo identify rates of alcohol and drug use among patients presenting to an inner-city Emergency Department (ED) and to describe demographic and health characteristics of patients with high-risk use. MethodsA cross-sectional study of patients presenting to the ED for any complaint. Patients were administered a brief screening about past 12-months alcohol and drug use. Patients who answered “yes” to any question were approached for a longer survey, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Based on ASSIST scores patients received a brief intervention, and, when appropriate, a referral for brief outpatient therapy or specialized substance abuse treatment. Patients whose score indicated high-risk or dependent use were also asked demographic and health questions. ResultsOver a 20-month period, 19,055 patients were pre-screened. 87.1% of patients were black, 57% were male, with average age 44.8 years. 27.6% of patients pre-screened positive for drug or alcohol use; among these patients 44.2% scored in the low-risk range on the ASSIST, 35.8% moderate risk, 10% high risk and 10% probable dependence. Among patients with high-risk or dependent use, 70% rated their current health as fair/poor, with a mean of 1.7 ED visits in the prior 30 days. 40.7% reported “extreme” stress due to their use. 34.6% reported that they had stable housing and 13.6% were fully employed. ConclusionAmong all patients seen in the ED for any complaint, a significant proportion is engaged in alcohol and drug use that increases their risk of health and social consequences.

Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review

Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.

Substance use disorder among people with first-episode psychosis: a systematic review of course and treatment.

People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments. The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction. Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.

Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments.The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes?Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction.Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.

Drug Abuse Treatment Often Addressed as Afterthought

Drug Abuse Treatment Often Addressed as Afterthought

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Organizational Correlates of Specialized Substance Abuse Treatment Provision to Seropositive Clients

Data from the Alcohol and Drug Services Study, 1996–1999 (United States Department of Health and Human Services [USD-HHS], 2002), a nationally representative sample of 2,351 drug treatment programs were examined to identify organizational predictors of specialized substance abuse treatment provision to seropositive clients. The Political Economy Perspective developed by Wamsley and Zald (1976) was used to interpret results. A minority of facilities (22%, 517) provided specialized treatment. Among internal political economy measures, provision of mental health (p < 0.01), basic HIV services (p < 0.05), as well as methadone maintenance treatment (p < 0.05) were significantly and positively associated with specialized treatment provision. Among external political economy measures, managed care funding significantly decreased the likelihood of specialized treatment provision (p < 0.05), while parent organization control (p < 0.01) and number of clients (p < 0.01) significantly increased it. Specialized treatment provision was significantly positively associated with proportion of Blacks, Hispanics, seropositives (p < 0.01 for all), and injection drug users (p < 0.05).

Declining Access to Alcohol and Drug Abuse Services among Veterans in the General Population

Although the Veterans Health Administration has been committed to preserving its capacity to provide specialized substance abuse (SA) services, administrative data from the late 1990s point to reduced access. To explore the possible effects of reduced access to Veterans Affairs services on veterans in the general population, we examined data from the National Household Survey of Drug Abuse from 1994 to 2001. Although the data are not longitudinal at the level of individuals, the annual nature of these surveys makes it possible to chart aggregate changes in clinical needs and service use over time. The results indicate that, whereas veterans' needs for SA services remained high and were consistent across these years, the proportion of veterans in treatment decreased. The proportion of nonveterans receiving SA treatment also decreased but not as steeply as that of veterans. This trend parallels declining delivery of specialized alcohol and drug abuse services within the Veterans Health Administration, although they do not prove a causal relationship.

Specialized substance abuse treatment for women and their children: an analysis of program design.

In the present study, 36 specialized substance abuse treatment programs for women and their children were identified and chosen for review. These programs provide a wide range of services including substance abuse, mental health and medical treatment, life skills training (i.e. vocational and parenting training), and social services (i.e. child care and transportation). A cluster analysis was conducted, and three distinct patterns of program design were identified. Results suggest that programs vary considerably regarding the extent to which comprehensive services are provided and to whom they are offered. Many programs that appear to be comprehensive fail to provide the full range of services to all those who need them. In particular, many programs for pregnant women seem to focus almost exclusively on pregnancy-related issues. As such, specialized substance abuse treatment for women may be at risk for becoming too specialized. Recommendations are made for future substance-related program planning for women and their children.

A Comparison of EAP Referrals, Informal Workplace Referrals, and Non-Workplace Referrals to Substance Abuse Programs

This paper examines the extent of referrals from the workplace to specialized substance abuse treatment programs in the Regional Municipality of Hamilton-Wentworth. Referral sources of clients in treatment programs were categorized as Employee Assistance Program referral, workplace referral, and no workplace involvement. These three types of referral are compared in terms of a variety of client clinical and demographic variables. About 9% of all referrals were from the workplace, and for reasons discussed in the paper, this is considered to be an underestimate. Some Interesting differences between workplace and non-workplace referrals were found as were some differences between EAP and informal workplace referrals. Some implications for the organization of EAPs are discussed. The authors advocate the establishment of community databases that collect information on the contribution of workplace referrals to the treatment system. Descriptions of the workplaces involved, and of their EAPs shou...

Recognition of Alcohol Abuse in Psychiatric Outpatients and Its Effect on Treatment

Previous studies of detection of alcoholism by primary medical care-givers have found discovery rates to be at best 50 percent (2-6). In this study, mental health clinicians-in-training recognized alcohol-related symptoms in almost 70 percent of patients. However, alcohol abuse was unrecognized in nearly a third of patients identified as probable alcohol abusers. Significant differences between therapists' ratings of the success of treatment of alcohol abusers and the success of treatment of nonabusers were found. Patients in whom alcohol abuse was recognized tended to be rated as more enjoyable to work with and as having a more successful treatment than patients whose alcohol problems were unrecognized, although this difference was not significant. This trend is consistent with clinical impressions that clinicians' failure to recognize patients' alcohol-related symptoms may produce miscommunication that can result in the clinicians' experiencing a sense of frustration and futility and the patients' experiencing a sense of being less well understood. The short form of the MAST, although less sensitive than the trainees' judgments, was quite accurate in predicting which patients were alcohol abusers. Our experience indicates that brief screening scales like the MAST could be valuable and easily administered adjuncts to the evaluation of general psychiatric outpatient populations. Routine use of such scales might reduce the frequency of nonrecognition of a variety of substance abuse problems as well as raise the consciousness of providers working in settings that do not offer specialized substance abuse treatment services.