Substance Abuse Facilities Research Articles

Trends in HIV-Related Services Offered by Substance Abuse Treatment Facilities.

Introduction In the United States, persons who inject drugs (PWID) represent an increasingly vulnerable population, with a high risk of HIV transmission related to needle sharing. This paper aims to investigate the availability of HIV-related services within substance abuse treatment facilities while emphasizing the need for implementing comprehensive harm-reduction strategies in such facilities. Methods This study explores the prevalence and trends regarding HIV-related services within substance abuse treatment facilities in the United States including testing, counseling, early intervention, and medication provision. Data from the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed in order to assess trends in HIV-related services from 2013 to 2020. Results Facility response rates revealed an increase in the availability of HIV testing and specialized programs for individuals with HIV. However, there was a contrasting trend with the decline in early intervention and counseling services, only with a slight increase in 2020. Additionally, government-owned facilities demonstrated superior performance in delivering HIV services compared to private facilities. Conclusion This study highlights the dire need for implementing routine opt-out HIV testing within substance abuse treatment facilities in order to identify new cases. Additionally emphasized is the importance of early intervention for this at-risk population. To effectively address these challenges, we suggest considering the adoption of the "Seek, Test, Treat, Retain" model as a potential solution. Increasing access to HIV-related services within substance abuse facilities requires enhanced resource allocation as well as integrated programs. Identifying deficiencies in HIV service integration is crucial to enhancing care and reducing HIV transmission among PWID.

Risk of Hospital-Onset C. difficile Infection Increases With Prior Inpatient and Outpatient Visits

Background:Clostridioides difficile is a leading cause of healthcare-associated infections, and greater healthcare exposure is a primary risk factor for Clostridioides difficile infection (CDI). Longer hospital stays and greater CDI pressure, both at the hospital level and the level, have been linked to greater risk. In addition, symptoms associated with healthcare-associated CDI often do not present until a patient has been discharged. Our study objective was to estimate the extent to which exposure to different types of healthcare settings (eg, prior hospitalization, emergency department [ED], outpatient or long-term care) increase risk for hospital-onset CDI. Methods: We conducted a case-control study using the Truven Marketscan Commerical Claims and Medicare Supplemental databases from 2001 to 2017. Case patients were selected as all inpatient visits with a secondary diagnosis of CDI and no previous CDI diagnosis in the prior 90 days. Controls were selected from all inpatient admissions without any CDI diagnosis during the current admission or prior 90 days. A logistic regression model was used to estimate risk associated with prior healthcare exposure. Indicators were created for prior exposure to different healthcare settings: separate indicators were used to indicate transfer, exposure to that setting in the prior 1–30 days, 31–60 days and 61–90 days. Separate indicators were created for prior hospitalization, ED, outpatient clinic, nursing home or long-term care facilities (LTCFs), psychiatric or substance-abuse facility or other outpatient facility. We also included an indicator for prior exposure to a family member with CDI and prior outpatient antibiotics. Results: Estimates for selected variables (odds ratios) are presented in Table 1. Prior hospitalization, ED visits, outpatient clinics, nursing home and LTCFs were all associated with increased risk of secondary diagnosed CDI. Prior hospitalization and nursing home/LTCF conveyed the greatest risk. In addition, a ‘dose-–response’ relationship occurred for each of these exposure settings, with exposure nearest the admission date having the largest risk. Prior exposure to psychiatric , substance abuse, or other outpatient facilities were not risk factors for CDI. Having a family member with prior CDI and both low-risk and high-risk outpatient antibiotics were associated with increased risk. These factors also exhibited a ‘dose–response’ pattern. Conclusions: Exposure to various healthcare settings significantly increased risk for secondary CDI. Prior healthcare exposures occurring nearest to the point of admission conveyed the greatest risk. These results suggest that many hospital-associated CDI cases attributed to a current hospital stay may actually be acquired from prior healthcare settings.Funding: CDC Modeling Infectious Diseases (MInD) in Healthcare NetworkDisclosures: None

The availability of LGBT-specific mental health and substance abuse treatment in the United States.

To examine the availability and facility-level predictors of LGBT-specific mental health and substance abuse treatment in the United States. 2016 National Survey of Substance Abuse Treatment Services, 2016 National Mental Health Service Survey, and 2015-2016 Gallup Daily tracking survey. Logistic regression models and average marginal effects were used to identify characteristics of facilities that offer LGBT-specific programs. Linear regression models were used to estimate the association between the state-level proportion of LGBT people and the proportion of facilities that offer LGBT-specific programs. Secondary data analysis. Cases with missing values for any predictor were excluded. 12.6 percent of mental health and 17.6 percent of substance abuse facilities reported LGBT-specific programs. Several facility characteristics were statistically associated with the likelihood of mental health and substance abuse facilities providing LGBT-specific programs, including offering outpatient or residential treatment, private ownership, religious affiliation, and payment type. The proportion of LGBT adults living within each state was statistically associated with state-level density of LGBT-specific mental health programs, but not substance abuse programs. Findings suggest limited availability of culturally competent mental health and substance abuse treatment, despite well-documented need.

Certificate of Need and Substance Use Treatment

Certificate of Need (CON) laws in place in most US states require health care providers to prove to a state board that their proposed services are necessary in order to be allowed to open or expand. While CON most commonly targets hospital and nursing home beds, data from the American Health Planning Association show that some states require CON for up to 28 separate types of health care providers and services. In the face of a national opioid epidemic, 17 states retain CON specifically for substance abuse treatment, requiring substance abuse providers to prove their ‘economic necessity’ before opening or expanding. In contrast to the extensive academic literature on how hospital and nursing home CON affect costs and access, substance abuse CON is essentially unstudied. We aim to change this. Using data on CON from the American Health Planning Association together with 2002-2016 data on substance use treatment facilities from the Substance Abuse and Mental Health Services Administration’s National Survey of Substance Abuse Treatment Services, we measure the effect of CON on access to substance use treatment. Using fixed effects analysis of states enacting and repealing substance abuse CON, we measure how CON affects the number of substance abuse facilities and beds per capita in a state. In addition, we measure the effect of CON on the forms of payment that treatment facilities accept, with large shares of cash-only facilities serving as a proxy for excess demand.

Assessing the Availability of Pharmacotherapy Options for Tobacco Cessation in Tennessee's Substance Use Facilities.

Smoking is deadly and exacerbates comorbid health conditions, especially among those with co-occurring substance use disorders. Tennessee does not require substance abuse treatment facilities to concurrently provide tobacco-cessation treatment options or limit smoking on facility property as a standard for licensure. This study examines the relation between Tennessee facility region and availability of pharmacotherapeutic options for tobacco cessation, and the relation between the facilities' region and facility smoking policy. This study is descriptive, cross-sectional, and exploratory in its design. Study findings are from a secondary analysis of data acquired from the 2016 edition of the National Directory of Drug and Alcohol Abuse Treatment Facilities published by the Substance Abuse and Mental Health Services Administration. The number of substance abuse treatment facilities providing pharmacotherapy options in west Tennessee (7.8%) are statistically significantly lower as compared with substance abuse treatment facilities in both middle (24.6%) and east (39.2%) Tennessee. A statistically significantly higher percentage of facilities in west Tennessee (23.5%) with policies that permit smoking without restriction as compared with the number of facilities in east Tennessee (6.8%) also was found, whereas the facilities in west Tennessee (60.8%) have a policy that permits smoking in designated areas that is significantly lower than the number of facilities in east Tennessee (81.1%). Tobacco-cessation options are a preventive intervention that can be easily incorporated into a treatment facility's standard of practice and should be made available within the context of all substance abuse treatment facilities. Failure to provide concurrent tobacco-cessation options during substance abuse treatment contradicts the purpose of medical treatment. Medically oriented substance abuse facilities are exemplary settings for offering pharmacotherapeutic options to concurrently treat tobacco use. It is suggested that interdisciplinary clinicians in the field of substance abuse advocate for the implementation of concurrent tobacco cessation treatment in their organization.

Factors Associated with the Number of Substance Abuse Nonprofits in the U.S. States: Focusing on Medicaid Expansion, Certificate of Need, and Ownership

AbstractThe Affordable Care Act improved substance abuse service coverage and increased demand for these services. Presumably, these changes also influenced the number of substance abuse nonprofits in states. State decisions for Medicaid expansion have the potential to influence nonprofits' decisions to establish new facilities, increasing the demand for these services. In addition, Certificate of Need (CON), that is, state regulation of new health services and facilities, can affect nonprofits' responses to increased demand for substance abuse services. This study provides evidence that the number of nonprofit substance abuse facilities is negatively associated with state decisions to expand Medicaid and state regulation of new health services and facilities. However, in states with both Medicaid expansion and CON, the number of nonprofit substance abuse facilities tended to increase. In addition, evidence suggests that both nonprofit and for-profit substance abuse facilities are negatively influenced by Medicaid expansion and CON, but positively influenced by the interaction of Medicaid expansion and CON, government spending, racial diversity, median income, and uninsured rates.

The unique associations of sexual assault and intimate partner violence with PTSD symptom clusters in a traumatized substance-abusing sample.

There is a high occurrence of sexual assault (SA) and intimate partner violence (IPV) among people with substance use disorders and an established association between substance use and posttraumatic stress disorder (PTSD), but no research has examined associations between combinations of these traumas and PTSD symptom profiles among people who abuse substances. Thus, this study aimed to examine how combinations of SA and IPV histories contribute to the severity of symptoms within PTSD symptom clusters above and beyond the impact of exposure to other traumas in a substance abusing population. Participants were men and women (N = 219) with trauma histories seeking treatment in a substance abuse facility. Multivariate analyses of covariance examined differences on Clinician Administrated PTSD Scale cluster scores in people with experiences of SA and/or IPV in comparison to people with other types of trauma, controlling for number of PTSD criterion A events. SA was associated with increased symptom severity across all 3 PTSD symptom clusters, whereas IPV was not associated with differences in cluster scores. In addition, survivors of IPV had consistent levels of avoidance symptoms regardless of whether they had also experienced SA, but people who had not experienced IPV only evidenced increased avoidance symptoms when they had experienced SA. Follow-up analyses testing gender differences indicated that these findings were largely similar for men and women. SA should be assessed in people in substance use treatment settings to conceptualize their unique presentations of PTSD symptoms and inform treatment planning. (PsycINFO Database Record

Strategies to Support Tobacco Cessation and Tobacco-Free Environments in Mental Health and Substance Abuse Facilities.

We identified and described strategies for promoting smoking cessation and smoke-free environments that were implemented in Oregon and Utah in treatment centers for mental illness and substance abuse. We reviewed final evaluation reports submitted by state tobacco control programs (TCPs) to the Centers for Disease Control and Prevention and transcripts from a call study evaluation. The TCPs described factors that assisted in implementing strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative. These strategies could be used by other programs serving high-need populations for whom evidence-based interventions are still being developed.

Development and Outcomes of a Text Messaging Tobacco Cessation Intervention With Urban Adolescents

ABSTRACTBackground: This paper describes the development of an urban adolescent text messaging tobacco cessation intervention and preliminary findings from a randomized, controlled trial. The authors successfully adapted a face-to-face intervention into a personalized, automated, and interactive 5-day texting protocol. Methods: Respondent-driven sampling was used beginning at a community substance abuse facility. Seventy-two tobacco-dependent adolescents were randomized into an automated computer texting program that delivered either the experimental condition of 30 motivational interviewing– and social network counseling–based personalized messages or the attention control condition consisting of a texting program covering general (non–smoking-related) health habits. All teens were provided smartphones for the study and were assessed at baseline and at 1, 3, and 6 months post intervention. Analyses examined condition × time interactions. Results: At 6 months, the experimental condition decreased the number of cigarettes smoked in the past 30 days, increased intentions not to smoke in the future, and increased peer social support compared with controls. Effect sizes were moderate to large. Conclusions: These findings are unique, as they target urban adolescents with a mobile health format and add to the growing literature on the efficacy of text-delivered interventions.

Investigating Impacts of Incorporating an Adjuvant Mind–Body Intervention Method Into Treatment as Usual at a Community-Based Substance Abuse Treatment Facility

Treatment of substance use/misuse (SUM) continues to pose a difficult challenge. This exploratory pilot study evaluated whether a novel mind–body intervention program called “Mind–Body Bridging” (MBB) could be an effective short-term adjuvant intervention for managing SUM and coexisting symptoms in women undergoing residential and outpatient substance use treatment in a community setting. Thirty-eight women attending a local substance abuse (SA) facility were recruited and randomly assigned to either (a) treatment as usual (TAU) or (b) MBB and TAU. The MBB program consisted of 20 sessions and lasted for 10 weeks. Participants were asked to complete a set of self-report questionnaires designed to assess drug/alcohol cravings, impact of past trauma, depression, sleep disturbance, mindfulness, self-compassion, and well-being. They completed the questionnaires at three time points: preintervention, midintervention (after the fifth week), and postintervention. MBB + TAU significantly reduced drug/alcohol cravings, trauma-related thinking, and disturbed sleep in comparison with TAU. Furthermore, MBB + TAU significantly increased mindfulness, self-compassion, and well-being in comparison with TAU. MBB for SUM appears promising as a complementary adjuvant intervention, warranting future larger scale randomized controlled trials of MBB for SUM populations. SUM is a difficult condition to treat and manage clinically, especially given the multiple comorbid conditions that frequently affect those with SUM. In the search to develop effective adjuvant interventions for SUM, the present pilot study suggested that adding MBB to standard SUM treatment in community-based settings could enhance therapeutic efficacy and quality of care.

Medicaid provisions and the US mental health industry composition

Background: Medicaid is the largest payer for mental health (MH) services.Aims: This study examines associations between Medicaid provisions and the MH industry composition.Methods: Medicaid data derived from the Centers for Medicare and Medicaid Services. MH facility gross payroll and occupational employment data derived from the Bureau of Labor Statistics. State fixed-effects regression models are performed to examine associations.Results: In the 1999–2009 period, per-capita gross payroll gains are largest for residential MH and substance abuse (SA) facilities and MH practitioner offices, followed by MH clinics and physician offices. Likewise, occupational employment gains per 100 000 people are largest for MH and SA social workers and MH counselors, followed by psychiatrists and psychologists. The Medicaid beneficiary rate is related with gross payroll gains at residential MH and SA facilities (p < 0.001) and MH clinics (p < 0.001), and with employment gains for MH and SA social workers (p < 0.001) and MH counselors (p < 0.001). Smaller effect sizes exist with MH physician offices (p < 0.05) and psychiatric hospitals' (p < 0.01) gross payroll. No statistically significant relationship exists between the Medicaid beneficiary rate and psychiatrist and psychologist employment.Conclusion: Medicaid provisions are related with the MH industry composition. An imbalanced MH industry may lead to inadequate management of MH disorders.

Science-based and practice-based innovativeness and performance of substance abuse treatment facilities

The fields of mental health and substance abuse treatment lag significantly behind other health care organizational fields in the adoption, implementation, and dissemination of evidence-based practices. Innovative organizational practices may be science based or practice based. The implementation of innovative practices requires considerable organizational resources. Whether this organizational investment actually pays off in terms of superior performance is unclear. This issue in the context of substance abuse treatment facilities (SATFs) in the United States is examined in this study. The purpose of this study is to examine the influence of the use of innovative organizational practices, both science based (psychosocial interventions) and practice based, on the organizational performance of SATFs. The study uses cross-sectional data on 13,513 SATFs in the United States, obtained from the National Survey of Substance Abuse Treatment Services 2009 database. Multinomial logistic regression models find a positive association between the use of science-based innovations and practice-based innovations and organizational performance, that is, the provision of comprehensive (core and wraparound) services. SATFs that were located in metropolitan areas, those accredited by the Commission on Accreditation of Rehabilitation Facilities and Joint Commission, that had a mixed (Substance Abuse and Mental Health) focus or were recipients of earmark funds also had higher organizational performance. The results signify that substance abuse facilities that are high innovators in terms of implementing science based and practice-based innovative practices have higher organizational performance. Organizations that have institutionalized these practices have invested considerable resources in innovation. The shown higher organizational performance provides justification for the organizational investment in innovation.

A novel treatment resource for co-occurring symptoms

Purpose – This paper describes the development of a novel integrative self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients presenting to treatment for alcohol-related problems. More specifically, the purpose of this paper is to explore patient and health practitioner perceptions of the booklet, in order to determine its suitability and utility in the context of existing alcohol treatment services. The extent of cross-informant agreement between patient and health practitioner responses is also examined. Design/methodology/approach – This research utilises a cross-sectional qualitative research design using semi-structured interview methods with patients presenting to hospital for alcohol-related diseases/illnesses/accidents/injuries (n=15) and practitioners (n=10) working at inpatient, outpatient and residential substance treatment facilities. Findings – The present study found that the majority of patients (80 per cent) and practitioners (90 per cent) expressed a motivation to utilise the proposed booklet, agreeing that the booklet was a practical, achievable and educational resource for patients suffering from co-occurring anxiety symptoms in substance abuse facilities. Participants outlined limitations of the resource, suggesting that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support. Practical implications – Findings from the present study suggest that the booklet may be most effective in improving treatment accessibility and patient treatment seeking behaviours; rather than reducing practitioner-patient contact. Originality/value – This paper focuses on the development and utility of a novel resource suitable for substance abuse treatment facilities. The findings and feedback produced from the present study can assist with modifications of the intervention and in improving the effectiveness of future trials.

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

Association of P3 amplitude to treatment completion in substance dependent individuals

Individuals with substance use disorders typically show reduced amplitudes of the P3 component of the evoked potential and high scores on impulsivity and aggression measures. The present study investigated the usefulness of P3 amplitude, addiction severity and impulsivity as predictors of treatment completion in substance dependence. Forty-four participants (8 women), between the ages of 19 and 61 years old, who met DSM-IV-TR Axis I substance/alcohol dependence criteria were recruited for the present study. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drug toxicity for a minimum of 21 days. The P3 was evoked using a standard rotated-heads oddball paradigm. Significantly reduced P3 amplitude at Pz was found in patients who did not complete treatment compared to those who did. P3 amplitude at Pz elicited by target stimuli correctly identified 76.2% of those who did complete the treatment and 46.7% of those who did not.

Exploring Smoking Prevalence, Quit Attempts, and Readiness to Quit Cigarette Use Among Women in Substance Abuse Treatment

Client questionnaires from 38 gender-specific substance abuse facilities throughout Ohio were analyzed to explore smoking prevalence, quit attempts, and readiness to quit cigarette use. The analysis revealed 79.7% of women used cigarettes at the time of the survey, 33.5% of current smokers had made at least one quit attempt within the past 12 months, and 55.2% of current smokers reported either contemplating or preparing to make a quit attempt. A multinomial logistic regression revealed that clients who experienced a past quit attempt were more likely to be in the contemplation and preparation stages and clients who smoked 30 out of the past 30 days were least likely to be in the preparation stage. Clients who reported smoking between 10–15 cigarettes a day were more likely to be in the contemplation stage than those who reported smoking <10 cigarettes a day. A three-pronged approach that examines the physiological, emotional, and social components of addiction is recommended.

Enhanced intensity dependence and aggression history indicate previous regular ecstasy use in abstinent polydrug users

Intensity dependence is an electrophysiological measure of intra-individual stability of the augmenting/reducing characteristic of N1/ P2 event-related potential amplitudes in response to stimuli of varying intensities. Abstinent ecstasy users typically show enhanced intensity dependence and higher levels of impulsivity and aggression. Enhanced intensity dependence and high impulsivity and aggression levels may be due to damage in the brain's serotonergic neurons as a result of ecstasy use. The present study investigated whether intensity dependence, impulsivity and aggression history can be used as indictors of previous chronic ecstasy usage. Forty-four abstinent polydrug users (8 women; age 19 to 61 years old) were recruited. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drugs for a minimum of 21 days. The study found significantly enhanced intensity dependence of tangential dipole source activity and a history of more aggressive behavior in those who had previously been involved in chronic ecstasy use. Intensity dependence of the tangential dipole source and aggressive behavior history correctly identified 73.3% of those who had been regular ecstasy users and 78.3% of those who had not. Overall, 76.3% of the participants were correctly classified.

A comparison of methamphetamine and nonmethamphetamine users in a dual diagnosis facility

Methamphetamine use is currently on the rise; however patients who use methamphetamine have consistently shown poor treatment results. The current study examined 14 factors in order to assess if any served as predictors of methamphetamine use. Data were collected from a Midwestern dual diagnosis substance abuse facility. Results indicate that nine of the 14 predictors entered into the model were significantly related to methamphetamine use. Implications for treatment and future research are discussed.

Dual Diagnosis • Psychosocial Treatments

Dual Diagnosis • Psychosocial Treatments

Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome.

The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.