Substance Abuse Programs Research Articles

Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs

The physical health of substance abuse clients significantly deteriorates because of the client’s prolonged abuse of alcohol and other drugs and accompanying behaviors. The purposes of this study are (a) to understand how substance abuse clinicians think about the health needs of their clients, (b) to identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients, and (c) to identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients. A qualitative study was conducted using in-depth, semistructured interviews with substance abuse clinicians (N = 16) from 4 substance abuse treatment centers. Using the theory of planned behavior as a framework for understanding the promotion of health-conscious behaviors in substance abuse treatment, the findings suggest that substance abuse clinicians are capable of enhancing health-conscious behaviors among clients in substance abuse programs.

Exploring the Psychometric Properties of the Spiritual Well-Being Scale Among Individuals with Substance Use Disorders

Although spirituality seems to be an important protective factor in the treatment of addiction, a serious limitation within the current literature involves a lack of research examining the psychometric properties of scales that measure spirituality among individuals struggling with substance use disorders (SUDs). The purpose of this study was to investigate the psychometric properties of the Spiritual Well-Being Scale (SWB) among a sample of 305 individuals recruited from a residential substance abuse treatment center. Exploratory factor analyses supported the scale’s original structure. Validity and reliability tests suggested the SWB could be useful in assessing spiritual well-being among individuals with SUDs.

Spirituality and religiosity in the context of drug abuse

Objective: to investigate the influence of spirituality/religiosity in the context of drug abuse. Methods: this is an integrative review, conducted on the databases Web of Science, Latin American and Caribbean Literature in Health Sciences and SCOPUS. The following descriptors were used in the Portuguese and English languages: drug users, spirituality, religion, drug abuse treatment centers and treatment outcome. Results: eight articles were analyzed, among which there was a prevalence of publications of the year 2015 and of quantitative studies. The studies approached mainly the prevention of drug abuse, the change of the user’s behavior and the religious/ spiritual confrontation. Conclusion: spirituality/religiosity seems to be a positive factor for drug users facing treatment, as well as in the protection against the abusive use of these psychoactive substances.

Persistent and Long-Term Neuropsychiatric Implications of Cannabis Use in Adolescents

Persistent and Long-Term Neuropsychiatric Implications of Cannabis Use in Adolescents

A Comparison of Daily Versus Weekly Electronic Cigarette Users in Treatment for Substance Abuse.

This research examined electronic cigarette (e-cigarette) use by individuals in treatment for substance abuse, a population with a high prevalence of tobacco use and poor smoking cessation outcomes. We surveyed 1127 individuals from 24 substance abuse treatment centers across the United States. Bivariate analyses and logistic regression were used to examine factors associated with daily (N = 87) versus weekly (N = 81) e-cigarette use. Among the full sample, 59.8% reported any lifetime use of e-cigarettes, with 23.6% reporting past 30-day use. Daily e-cigarette users were more likely to have used second-generation, tank-type e-cigarettes, χ2(1,N = 165) = 11.54, p = .001, used more flavors overall, t(168) = 2.15, p = .03, and were more likely to report using their e-cigarette continuously throughout the day, χ2(4,N = 168) = 16.7, p = .002, compared to weekly e-cigarette users. Over half (57.7%) of the daily and weekly e-cigarette users reported having an e-cigarette device that broke. The logistic regression model adjusting for clinic type and days with poor mental health found that daily e-cigarette users were significantly more likely than weekly e-cigarette users to be from methadone clinics (adjusted odds ratio [AOR] = 2.40, p = .04), and former smokers (AOR = 6.37, p < .002). Daily e-cigarette users in substance abuse treatment were more likely to be from methadone clinics and former cigarette smokers. However, the majority (73.6%) of daily e-cigarette users were current cigarette smokers. E-cigarette device type reliability (eg, breakage) may be an important factor to consider among drug treatment and other populations with lower socioeconomic status. This study found several differences in the device type, flavors, and use characteristics of daily versus weekly e-cigarette users. While majority of e-cigarette users in substance abuse treatment were current cigarette smokers, daily e-cigarette users were more likely to be former cigarette smokers. Administrators of substance abuse treatment programs should evaluate potential benefits and harms of e-cigarettes when developing program policies.

Medication-Assisted Treatment in the Perianesthesia Setting

IN 2015, one in 10 Americans (27 million) ages 12 or older used an illicit drug in the past month, and opioid pain relievers were the second most commonly used drug (3.8 million). 1 Center for Behavioral Health Statistics and QualityKey Substance Use and Mental Health Indicators in the United States: Results From the 2015 National Survey on Drug Use and Health. 2016https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm Google Scholar Current trends in opiate morbidity and mortality include increased use of heroin and illicit synthetic fentanyl. 2 Centers for Disease Control and PreventionHeroin Overdose Data. 2017https://www.cdc.gov/drugoverdose/data/heroin.html Google Scholar , 3 Gladden R.M. Martinez P. Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths - 27 States, 2013-2014. MMWR Morbidity Mortality Weekly Rep. 2016; 65: 837-843 Crossref PubMed Scopus (286) Google Scholar More than 2 million people with a substance use disorder that included pain relievers (opioids) sought treatment in 2015. 1 Center for Behavioral Health Statistics and QualityKey Substance Use and Mental Health Indicators in the United States: Results From the 2015 National Survey on Drug Use and Health. 2016https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm Google Scholar Treatment of opioid use disorder (OUD) may include the use of medications such as methadone, buprenorphine, and naltrexone. The use of these substances to treat OUD is referred to as medication-assisted treatment (MAT). In 2011, about 300,000 people received methadone in opioid treatment programs and more than 32,000 individuals were treated with buprenorphine. 4 Alderks C.E. Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011. The CBHSQ Report. Substance Abuse and Mental Health Services Administration (US), Rockville (MD)2013 Google Scholar Because of recent legislation, nurse practitioners and physician assistants are able to prescribe buprenorphine as part of MAT, 5 American Society of Addiction MedicineSummary of the Comprehensive Addiction and Recovery Act. 2016http://www.asam.org/advocacy/issues/opioids/summary-of-the-comprehensive-addiction-and-recovery-act Google Scholar so the number of individuals receiving buprenorphine is expected to grow. Naltrexone is another emerging treatment option for OUD that may be effective for other types of addiction such as alcohol use disorder. 6 Aboujaoude E. Salame W.O. Naltrexone: A pan-addiction treatment?. CNS Drugs. 2016; 30: 719-733 Crossref PubMed Scopus (41) Google Scholar Kathleen Broglio, DNP, ANP-BC, Palliative Care, Dartmouth Hitchcock Medical Center, Lebanon, NH Maureen F. Cooney, DNP, FNP-BC, Pain Management, Westchester Medical Center, Valhalla, NY

Evidence for differential opioid use disorder in schizophrenia in an addiction treatment population

Although people diagnosed with schizophrenia are known to have elevated risks of abuse and dependence for nicotine, alcohol, cocaine, and cannabis, it is less clear if schizophrenia is associated with higher rates of opioid use disorders compared to either the general population or individuals with other major psychiatric disorders. Here we examine a large publicly available database from substance abuse treatment centers to compare how frequently patients with schizophrenia report problems with heroin or other opioid drugs compared to other major drugs of abuse. For comparison, the pattern of substance abuse in schizophrenia is contrasted with individuals with major depression, bipolar disorder, and the entire sample of individuals seeking substance abuse treatment. We find that a significantly lower proportion of patients with schizophrenia are reported to have problems with heroin (5.1%) relative to the entire treatment population (18.2%). The schizophrenia sample also had a significantly lower proportion of individuals with a non-heroin opioid problem (7.2%) compared to the entire treatment population (14.8%), patients with depression (23%), and patients with bipolar disorder (17.3%). In contrast, the schizophrenia sample had significantly higher proportions of individuals with problems with alcohol, cocaine, and cannabis relative to the treatment population. Although these data do not allow conclusions on the relative rate of opioid addiction in schizophrenia compared to the general population, the results suggest a discrepancy in patterns of drug choice that may aid our understanding of schizophrenia and substance use comorbidity.

Distress tolerance interacts with circumstances, motivation, and readiness to predict substance abuse treatment retention

BackgroundOur understanding of the conditions that influence substance abuse treatment retention in urban African American substance users is limited. This study examined the interacting effect of circumstances, motivation, and readiness (CMR) with distress tolerance to predict substance abuse treatment retention in a sample of urban African American treatment-seeking substance users. MethodsData were collected from 81 African American substance users entering residential substance abuse treatment facility in an urban setting. Participants completed self-reported measures on CMR and distress tolerance. In addition, participants were assessed on psychiatric comorbidities, substance use severity, number of previous treatments, and demographic characteristics. Data on substance abuse treatment retention were obtained using administrative records of the treatment center. ResultsLogistic regression analysis found that the interaction of CMR and distress tolerance was significant in predicting substance abuse treatment retention. Higher score on CMR was significantly associated with increased likelihood of treatment retention in substance users with higher distress tolerance, but not in substance users with lower distress tolerance. ConclusionsFindings of the study indicate that at higher level of distress tolerance, favorable external circumstances, higher internal motivation, and greater readiness to treatment are important indicators of substance abuse treatment retention. The study highlights the need for assessing CMR and distress tolerance levels among substance users entering treatment, and providing targeted interventions to increase substance abuse treatment retention and subsequent recovery from substance abuse among urban African American substance users.

Facility-level, state, and financial factors associated with changes in the provision of smoking cessation services in US substance abuse treatment facilities: Results from the National Survey of Substance Abuse Treatment Services 2006 to 2012

Cigarette smoking is common among patients in substance abuse treatment. Tobacco control programs have advocated for integrated tobacco dependence treatment into behavioral healthcare, including within substance abuse treatment facilities (SATFs) to reduce the public health burden of tobacco use. This study used data from seven waves (2006 to 2012) of the National Survey of Substance Abuse Treatment Services (n=94,145) to examine state and annual changes in the provision of smoking cessation services within US SATFs and whether changes over time could be explained by facility-level (private vs public ownership, receipt of earmarks, facility admissions, acceptance of government insurance) and state-level factors (cigarette tax per pack, smoke free policies, and percent of CDC recommended tobacco prevention spending). Results showed that the prevalence of SATFs offering smoking cessation services increased over time, from 13% to 65%. The amount of tax per cigarette pack, accepting government insurance, government (vs private) ownership, facility admissions, and CDC recommended tobacco prevention spending (per state) were the strongest correlates of the provision of smoking cessation programs in SATFs. Facilities that received earmarks were less likely to provide cessation services. Adult smoking prevalence and state-level smoke free policies were not significant correlates of the provision of smoking cessation services over time. Policies aimed at increasing the distribution of tax revenues to cessation services in SATFs may offset tobacco-related burden among those with substance abuse problems.

Impact of Race on the Implementation of Empirically Supported Treatments in Substance Abuse Treatment

The effort to address the gap between research and practice in substance abuse treatment has largely neglected the role of local resources and political trends. This study seeks to clarify the role of the local environment in implementing empirically supported treatments (ESTs). The study consisted of secondary data analysis of substance abuse treatment centers (N = 13,079) and U.S. Census data to determine the likelihood of using EST by substance abuse treatment centers in counties with 50% or more Black residents. Bivariate and multivariate models were employed. After controlling for various factors, results indicate that substance use disorder treatment agencies that accept federal funding are less likely to use ESTs if they are located in counties with predominantly (> 50%) Black residents. Implementation of ESTs could be influenced by community racial distribution (% Black), but environmental constraints and events might shift implementation patterns.

(236) A harm reduction model to quantify potential misuse/abuse reduction and misuse/abuse-related events avoided from extended-release abuse deterrent opioids

Misuse/abuse of prescription opioids has been recognized as a public health crisis by the U.S. FDA and the FDA’s Opioid Action Plan recognizes abuse-deterrent (AD) formulation of opioids as critical to mitigating opioid misuse/abuse. Morphine AD, extended-release injection-molded tablets (ADER-IMT) have been demonstrated to resist common and rigorous forms of physical and chemical manipulation and reduce drug liking compared with non-AD morphine extended-release (ER). We used a harm reduction model-based approach to investigate the extent of the potential to reduce opioid misuse/abuse-related events by simulating, over 5 years, the replacement of all non-AD morphine ER formulations with morphine-ADER-IMT. Model input prevalence was based on privately-insured administrative claims database analyses, substance abuse treatment center and poison control center data, and national surveys. Estimated reductions in non-medical use (NMU) with morphine-ADER-IMT were derived from a combination of in-vitro manipulation assessment data and subjective measures of abuse potential from clinical studies comparing morphine-ADER-IMT with non-AD morphine ER. Different assumptions about market share capture by morphine-ADER-IMT result in a range of possible harm reduction scenarios that can be presented. The assumption applied herein is illustrative of complete market capture by morphine-ADER-IMT from generic ER morphine over 5 years: 20% generic and 20% branded market share capture in year 1, with 20% growth each year to 100% over 5 years. This scenario results in a 22% reduction in substance abuse treatment and predicts 246,448; 64,855; and 38,913 avoided outpatient, emergency department visits and hospitalizations, over 5 years, respectively. For injection-related complications (ie., HIV/AIDs, hepatitis, endocarditis, cellulitis, and phlebitis), it is estimated that 12,644 events would be avoided. This scenario is estimated to prevent 329 deaths over 5 years. This modelling analysis suggests that replacement of non-AD morphine ER with morphine-ADER-IMT could lead to significant reductions in opioid abuse-related outcomes. Funded by Egalet Corporation.

The Lazarus Project and Grace Ministries: The Role of Religious Nonprofits in Addressing Personal and Social Problems

This review essay of Williamson and Hood’s (2016) Psychology and Spiritual Transformation in a Substance Abuse Program: The Lazarus Project examines spiritual transformation in the context of substance abuse and homelessness. The essay first tackles the question of whether change results mostly from individual spiritual transformation experiences or from the social surroundings the converts are part of, based on the author’s research on spiritual transformation and homelessness as well as Williamson and Hood’s work, and then it examines the debate surrounding the application of Foucault’s “technologies of the self” to programs that are similar to the Lazarus Project. The last part of the essay offers a few methodological suggestions for studies of similar projects.

Association Between Substance Use Diagnoses and Psychiatric Disorders in an Adolescent and Young Adult Clinic-Based Population

PurposeAdolescents with substance use disorders are more likely to have a current psychiatric disorder. However, when compared with the adult literature, there is relatively limited information regarding the specific co-occurrence of certain mental health diagnoses and substance use disorders in adolescents. The objectives of this study were to build on the previous literature regarding mental health diagnoses and different types of substance use disorders in adolescents, as well as explore the differences, if any, between groupings of mental health diagnosis and type of substance used. MethodsData were extracted from the clinical records of 483 individuals aged 11–24 years referred for an evaluation at the Adolescent Substance Abuse Program at Boston Children's Hospital. According to DSM-IV-Text Revision criteria, individuals received diagnoses of substance abuse or dependence and any additional psychiatric disorders. Problematic use was included within the sample for greater power analysis. A multivariable logistic regression model estimated the association between psychiatric diagnosis and substance use while adjusting for covariates including age and gender. ResultsMultiple significant associations were found, including having any anxiety-related diagnosis and opioid use (odds ratio [OR] = 2.23, p < .001), generalized anxiety disorder and opioids (OR = 3.42, p = .008), cocaine and post-traumatic stress disorder (OR = 3.61, p = .01), and marijuana and externalizing behavior disorders (OR = 2.10, p = .024). ConclusionsOur study found multiple significant associations between specific substances and certain co-occurring psychiatric disorders. The use of office screening systems to efficiently identify these youths should be a part of routine medical and psychiatric care.

Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.

Substance abuse at Jordanian universities: Perspectives of pre-service special education teachers

ABSTRACTThe aim of this large-scale in-depth interview study was to investigate special education student-teachers’ perspectives on substance abuse and measures for combating it in Jordanian universities. Participants were 202 special education pre-service teachers who were purposively selected from three universities for open-ended interviews following a broadly structured guide. Content analysis was used to examine responses which were summarized into five major themes: (1) prevalence of substance abuse among students, (2) reasons for substance abuse, (3) the university experience as a risk for substance abuse, (4) adequacy of substance abuse services, and (5) possible solutions for addressing substance abuse. Informants perceived substance abuse among their student peers as pervasive, with the leading substances being tobacco and water-pipe smoking, followed by marijuana, synthetic marijuana (“joker”) and alcohol for men. For women, water-pipe smoking was perceived as the most common with tobacco notable. Students expressed that the university experience was a risk for substance abuse, that substance abuse education at their university was inadequate, and that a desire for more services to combat substance abuse existed. Recommendations are provided concerning the role of universities in substance abuse education and programs to combat substance abuse.

Tobacco-Free Policy Outcomes for an Inpatient Substance Abuse Treatment Center

We assessed changes in patient census, smoking prevalence, and intention to remain abstinent associated with the voluntary enactment of a campus-wide tobacco-free policy in a for-profit residential addictions treatment center. Employing nationally recognized tobacco-free policy strategies, steps toward implementation were tailored to addictions treatment settings. Census data and survey of client tobacco use data were collected for 1 year before the policy began and for 1 year following the policy. Average daily census increased for both the inpatient and extended residential treatment programs after enactment of the tobacco-free policy. Number of tobacco users admitted to treatment increased significantly, while the number of tobacco users who left treatment early did not significantly change. In addition to reducing smoking, the policy was associated with a significant increase of patients reporting the intention to remain abstinent after discharge. Contrary to common concern, a tobacco-free policy implemented in an inpatient residential addictions treatment setting did not negatively affect census rates. This study suggests potential clinical and organizational benefits for campus-wide tobacco-free policies.

“Group Prenatal Care” – Providing obstetric care in a community-based substance abuse treatment center

“Group Prenatal Care” – Providing obstetric care in a community-based substance abuse treatment center

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.

Access to and Payment for Office-Based Buprenorphine Treatment in Ohio.

IMPORTANCEOffice-based opiate agonist therapy has dramatically expanded access to medication-assisted treatment over the past decade but has also led to increased buprenorphine diversion.OBJECTIVEOur study sought to characterize physicians who participate in office-based therapy (OBT) to assess patient access to OBT in Ohio 10 years after its introduction.DESIGN/SETTING/PARTICIPANTSCross-sectional telephone survey of Drug Addiction Treatment Act–waivered physicians in Ohio listed by the Center for Substance Abuse Treatment (CSAT).MAIN OUTCOMESThis study sought to determine what proportion of eligible physicians are actively prescribing buprenorphine, whether they accept insurance for OBT, and whether they accept insurance for non-OBT services. In addition, we evaluated what physician characteristics predicted those primary outcomes. We hypothesized that a significant minority of eligible physicians are not active prescribers of buprenorphine. In addition, we expected that a significant minority of OBT prescribers do not accept insurance, further restricting patient access. We further hypothesized that a large subset of OBT prescribers accept insurance in their regular practices but do not take insurance for OBT.RESULTSOf the 466 listed physicians, 327 (70.2%) practice representatives were reached for interview. Thirty-three physicians were excluded, with a true response rate of 75.5%. In total, 80.7% of providers reached were active OBT prescribers. Of these, 52.7% accepted insurance for OBT, 20.8% accepted insurance for non-OBT services but not for OBT, and 26.5% did not accept insurance for any services. Practices who did not accept insurance were more likely among dedicated addiction clinics located outside of Ohio’s 6 major cities. Practices who normally accepted insurance but did not for OBT services were more likely in urban locations and were not associated with dedicated addiction practices. Neither business practice was associated with physician specialtyCONCLUSIONS AND RELEVANCEAccess to OBT in Ohio is far lower than what the 466 listed physicians suggests. Nearly 1 in 5 of those physicians are not active OBT prescribers, and 1 in 2 active prescribers do not accept insurance for OBT. Further research is needed to determine whether practices who do not accept insurance provide care consistent with CSAT guidelines and whether such practice patterns contribute to buprenorphine diversion.

Prevention Programming in the U.S. Virgin Islands.

Although sometimes described as paradise, the prevalence of substance use and high rate of HIV infection in the Virgin Islands are alarming. The University of the Virgin Islands Substance Abuse and HIV Prevention Program was designed to reduce drug use and prevent HIV infection among college students and young adults.