Participation In Substance Abuse Treatment Research Articles

Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review

There are ongoing public initiatives to help substance abusers by involving peer recovery coaches (PRCs) in the field of substance abuse worldwide. This study examines the contents and delivery methods of PRC intervention programs and their effects from the participants' standpoint. An integrative literature search was conducted in seven electronic databases using English and Korean search terms. Two researchers independently reviewed the extracted papers and rated their quality based on predetermined inclusion and exclusion criteria, resulting in the selection of nine papers. Research on PRC participation in substance abuse treatment were predominantly US-based, and all articles derived were quantitative studies. The main roles of PRCs included liaising between treatment and community resources, assisting with stress management and coping skills, counseling and case management, and recovery and recurrence prevention education. In addition, the PRC-delivered intervention was tested with various outcome variables. It reduced participants' substance use and enhanced their treatment adherence rates, self-efficacy, quality of life, and stress control. This study confirmed the need to extend existing studies by testing the effects of PRC-delivered intervention through multidisciplinary efforts in more regions and establishing PRCs' role definition and concretization. The results of this study will serve as significant basic data in developing and applying for nursing intervention programs with PRCs in clinical and community nursing settings in the future.

Predictors of treatment participation rate of substance use disorders among Whites and African Americans

Low treatment participation impedes successful treatment completion and reduces treatment effectiveness. This study explored relationships among treatment participation rate and individuals’ symptom severities and employment statuses. A sample of 106 individuals with substance use disorders was recruited for cross-sectional investigation. Individuals who were employed at baseline or had lower symptom severities of baseline alcohol, drug use, and psychiatric issues had significantly higher treatment participation rates. Service providers should pay more attention to individuals’ symptom severities and employment to encourage treatment participation. Integrated interventions including vocational services and illness management and recovery intervention could be provided to reduce individuals’ symptom severities and increase employability. Implications of participation in substance abuse treatment are discussed.

Participant and Program Characteristics: Correlates of Substance Abuse Treatment Participation and Prison Misconducts

Despite the prevalence of substance dependence in incarcerated populations and the correlation between substance use and crime, only 11% receive substance abuse treatment, even as treatment participation may help reduce institutional misbehavior and postrelease recidivism. The current research examined the influence of individual and program factors on substance abuse treatment participation and prison misconducts in a state prison system. Based on analyses of administrative data from 2012 to 2015 and program data, the findings support previous research documenting participant characteristics as predictors of misconducts. In addition, program training requirements significantly predicted misconducts. Implications and research recommendations are discussed.

Counselor Knows Best? Clinician Assessments of In-Prison Substance Abuse Treatment Participants

Research has examined responses to substance abuse treatment among criminal justice populations primarily through client self-assessments, and comparatively fewer studies have focused on clinician ratings of client progress. Recently, Blasko and Hiller examined counselor ratings and their association with reincarceration but found no relationship between the two. The current study partially replicated their analyses and explored its own factor structure to compare the findings from a different sample using the same instrument, the Criminal Justice Counselor Rating of Client (CJ CRC). Analyses revealed that although none of the replicated counselor measures predicted reincarceration, higher levels of one measure produced from the factor analysis, Psychological Barriers to Recovery, indicated a significantly higher probability for reincarceration. In light of these conflicting findings, practical implications of this research suggested that clinical assessments of clients may be useful for criminal justice decision making.

Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients

BackgroundTransdermal alcohol monitoring technology allows for new research on alcohol use disorders. This study assessed feasibility, acceptability, and adherence with this technology in the context of two clinical research trials. MethodsParticipants were the first 100 community-based alcohol treatment outpatients enrolled in randomized studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) for 12 weeks. Study 1 participants were randomized to usual care (n=36) or usual care with contingency management incentives for treatment attendance (CM-Att; n=30). Study 2 participants were randomized to usual care (n=17) or usual care with CM for each day of no drinking per SCRAMx (CM-Abst; n=17). After 12 weeks, participants completed a survey about the bracelet. ResultsNine percent of individuals screened (54 of 595) declined participation because of the bracelet. Of participants, 84% provided 12weeks of data, and 96% of bracelets were returned fully intact. Ninety-four equipment tampers occurred, affecting 2% of monitoring days; 56% (67) of tampers coincided with detected drinking. Common concerns reported by participants were skin marks (58%), irritation (54%), and interfered with clothing choices (51%), but severity ratings were generally mild (60%–94%). Eighty-one percent of participants reported that the bracelet helped them reduce drinking, and 75% indicated that they would wear it for longer. A common suggestion for improvement was to reduce the size of the bracelet. ConclusionsResults support the viability of transdermal monitoring in voluntary substance abuse treatment participants for an extended duration. Issues to consider for future applications of this technology are discussed.

Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes

Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13–18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood.

Differences by Gender in Predictors of Motivation Among Substance Abuse Treatment Participants

ABSTRACTBackground: Substance-involved females tend to have different clinical profiles than men (Adams, Leukefeld, & Peden, 2008); yet they do not appear to have worse treatment outcomes (Green, 2006; Hser, Huang, Teruya, & Anglin, 2003). As motivation for treatment is considered essential in the substance abuse treatment context (Cahill, Adinoff, Hosig, Muller, & Pulliam, 2003; Longshore & Teruya, 2006), it is possible that higher motivation among females could potentially counteract the negative effect of more risk factors. Objective: The purpose of the current study was to examine if females differ from males in their motivation for treatment using the Texas Christian University Motivation Form scales: desire for help, problem recognition, treatment readiness, pressure for treatment, and treatment needs; and whether factors predicting motivation for treatment differed between male and female participants of substance abuse treatment. Methods: The sample included 2,989 substance-involved males and 982 substance-involved females who were referred to substance abuse treatment through a case management program. Linear regression models predicting each motivation scale were analyzed, followed by gender-specific models. Results: Overall, the results did not demonstrate a significant gender difference in the motivation scales. However, among male participants, the findings did show that Hispanic significantly predicted desire for help and alcohol as a primary drug of choice predicted treatment readiness. Conclusion: Findings suggest that motivation for treatment may be a gender-neutral construct, and that there is a need to better understand sociodemographic predictors of motivation.

John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation Among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

Taking Blame for Other People's Misconduct.

Taking blame for another person's misconduct may occur at relatively high rates for less serious crimes. The authors examined individual differences and situational factors related to this phenomenon by surveying college students (n = 213) and men enrolled in substance abuse treatment programs (n = 42). Among college students, conscientiousness and delinquency predicted their likelihood of being in a situation in which it was possible to take the blame for another person's misconduct. Situational factors, including the relationship with the perpetrator, the seriousness of the offense, feelings of responsibility for the offense, and differential consequences between the offender and the blame taker, were associated with college students' decisions to take the blame. Among substance abuse treatment participants, individuals who took the blame for another person's misconduct were more extraverted, reported feeling more loyalty toward the true perpetrator, and indicated more incentives to take the blame than individuals who did not take the blame. Links between theories of helping behavior and situational factors that predict blame taking are discussed.

Social Disadvantage and Economic Hardship as Predictors of Follow-Up Addiction Severity after Substance Abuse Treatment: Does Referral to Treatment by the Criminal Justice System Matter?

Few studies have examined the effects of social disadvantage and economic hardship on addiction severity after treatment, and no known studies have examined these relationships in participants referred to treatment by the criminal justice system. This study used multiple regression analysis to examine the role of social disadvantage, economic hardship, and perceived stress on follow-up addiction severity among a group of substance abuse treatment participants referred by the criminal justice system and a comparison group. The hypothesized model was partially supported in both groups. Implications for treatment providers working with clients referred by the criminal justice system are discussed.

Social Stress, Economic Hardship, and Psychological Distress as Predictors of Sustained Abstinence from Substance Use After Treatment

Social characteristics associated with disadvantage, such as racial/ethnic minority status, female gender, and low socioeconomic status (SES), are often associated with increased psychological distress and substance use disorders. This project tests a conceptual model derived from Pearlin's social stress theory for predicting abstinence from substance use between baseline and 1-year follow-up in secondary data from a large statewide sample of Kentucky substance abuse treatment participants (N = 1,123). Racial minority status, employment, and higher education level were predictive of substance use at follow-up, while female gender was predictive of abstinence. Limitations, implications for practice, and suggestions for future research are discussed.

The Role of Intensive Case Management Services in Reentry: The Northern Kentucky Female Offender Reentry Project

The Northern Kentucky Female Offender Reentry Project was designed to work with female state inmates returning to the Northern Kentucky area. The program specifically targets women who have substance abuse– and/or mental health–related reentry barriers, with the majority of the participants having a dual diagnosis. The program's mission is to provide intensive case management that starts during incarceration and continues after release, helping clients to successfully reenter their communities. The program's goals are to improve quality-of-life outcomes, such as education, employment, and housing; increase participation in mental health and substance abuse treatment after release; and reduce recidivism. Data were collected from program documents as well as the state of Kentucky's Department of Corrections database; CourtNet, a statewide database of the Kentucky Court of Justice and Administrative Office of the Courts; and the database for the Hamilton County (Ohio) Clerk of Courts. The findings suggested that intensive case management may help to reduce recidivism, particularly for new convictions, and increase treatment participation for those involved in intensive case management both before and after release. However, the results were mixed for quality-of-life outcomes.

P2 The detection of propofol glucuronide in human hair using LC-MS/MS: Case study and survey of high-risk health professionals

Background Propofol (2,6-diisopropylphenol) is a commonly used agent for general anesthesia because of its short duration, quick recovery time, and minimal side effects. Although not a controlled substance in the United States, propofol abuse and misuse by medical professionals has increased 5-fold between 1997 and 2011. Propofol detection in biological fluids has a very short detection window and the presence of propofol in hair does not distinguish between ingestion and environmental exposure. A metabolite, propofol glucuronide, is formed in the liver and may be detected in the hair. The purpose of this study is to validate a method for the detection of propofol glucuronide in hair and apply this method to a case study and a survey of high-risk health professionals. Methods A method for the detection of propofol glucuronide was developed and validated according commonly recognized guidelines. Briefly, hair specimens were powdered and extracted into water while incubating in a sonicating water batch without heat over night. Extracts were subjected to solid phase extraction using quaternary amine with chloride counter ion extraction cartridges. The eluates were evaporated under nitrogen at 40 °C, reconstituted in 100 μL of DI water. Extracts were separated using Synergy Polar RP column (50mm x 2mm x 2.5 μm particle size) on an Agilent 1200 HPLC system. The compounds were detected on an AB Sciex 5500 tandem mass spectrometer (LC-MS/MS) following the transitions of 353,1 m/z to 176,7 m/z , 112,6 m/z , 84,7 m/z for propofol glucuronide and 370,1 m/z to 193,7 m/z and 369,7 m/z for the internal standard, propofol glucuronide- d 17 . A hair specimen that originated from a 50 year old woman that was anesthetized for 15 minutes was analyzed. Additionally, a survey of 300 de-identified hair specimen remnants that originated from health professionals undergoing treatment for substance abuse. Results The empirically determined LOD and LOQ for this assay were 4 pg/mg and 8 pg/mg, respectively. The intra- and inter-assay bias and imprecision studies were all acceptable ( Conclusion This method demonstrated sufficient precision, accuracy and robustness with an analytical measurement range between 8 pg/mg and 100 pg/mg. While being sensitive enough to identify two individuals in a survey of high-risk substance abuse treatment participants, the method was not able to identify propofol metabolite in the hair of a woman receiving a routine quantity of propofol administered during a short surgical procedure. This method provides substance abuse treatment professionals with another objective tool to identify propofol abusers.

Nonmedical prescription drug users in private vs. public substance abuse treatment: a cross sectional comparison of demographic and HIV risk behavior profiles

BackgroundLittle is known regarding the demographic and behavioral characteristics of nonmedical prescription drug users (NMPDUs) entering substance abuse treatment settings, and information on the HIV-related risk profiles of NMPDUs is especially lacking. Participation in substance abuse treatment provides a critical opportunity for HIV prevention and intervention, but successful initiatives will require services appropriately tailored for the needs of NMPDUs.MethodsThis paper compares the HIV risk profiles of NMPDUs in public (n = 246) and private (n = 249) treatment facilities. Participants included in the analysis reported five or more recent episodes of nonmedical prescription drug use, a prior HIV negative test result, and current enrollment in a substance abuse treatment facility. A standardized questionnaire was administered by trained interviewers with questions about demographics, HIV risk, and substance use.ResultsPrivate treatment clients were more likely to be non-Hispanic White, younger, and opioid and heroin users. Injection drug use was higher among private treatment clients, whereas public clients reported higher likelihood of trading or selling sex. Public treatment clients reported higher rates of HIV testing and availability at their treatment facilities compared to private clients.ConclusionsFindings suggest differing demographics, substance use patterns, profiles of HIV risk and access to HIV testing between the two treatment samples. Population tailored HIV interventions, and increased access to HIV testing in both public and private substance treatment centers, appear to be warranted.

Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions

Substance abuse is related to re-offending, and treatment of substance abuse may reduce criminal recidivism. Offender characteristics including problem severity, violence risk and psychopathic personality traits may be positively or negatively associated with participation in substance abuse treatment. We explored the relationships between such characteristics and participation in substance abuse interventions among Swedish offenders with mental health problems and problematic substance use. Our analyses revealed that problem severity regarding drugs, employment, and family/social situations predicted intervention participation, and that affective psychopathic personality traits were negatively associated with such participation. Thus, affective psychopathic personality traits could be considered as potential barriers to participation in substance abuse interventions. Among offenders with mental health problems and problematic substance use, such personality traits should be taken into account in order to optimize treatment participation and treatment outcome. Approaches used in cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) could be applicable for these patients.

Predictors of substance abuse treatment participation among homeless adults

The current study focuses on the relationships among a trauma history, a substance use history, chronic homelessness, and the mediating role of recent emotional distress in predicting drug treatment participation among adult homeless people. We explored the predictors of participation in substance abuse treatment because enrolling and retaining clients in substance abuse treatment programs is always a challenge particularly among homeless people. Participants were 853 homeless adults from Los Angeles, California. Using structural equation models, findings indicated that trauma history, substance use history and chronicity of homelessness were associated, and were significant predictors of greater recent emotional distress. The most notable result was that recent emotional distress predicted less participation in current substance abuse treatment (both formal and self-help) whereas a substance use history alone predicted significantly more participation in treatment. Implications concerning treatment engagement and difficulties in obtaining appropriate dual-diagnosis services for homeless mentally distressed individuals are discussed.

A multi-site, randomized study of strengths-based case management with substance-abusing parolees

ObjectivesTo test whether strengths-based case management provided during an inmate’s transition from incarceration to the community increases participation in community substance abuse treatment, enhances access to needed social services, and improves drug use, crime, and HIV risk outcomes.MethodsIn a multi-site trial, inmates (men and women) in four states (n = 812) were randomly assigned (within site) to receive either Transitional Case Management (TCM group), based on strengths-based principles, or standard parole services (SR group). Data were collected at baseline and at 3 and 9 months following release from prison. Analyses compared the two groups with respect to services received and to drug use, crime, and HIV risk behavior outcomes.ResultsThere were no significant differences between parolees in the TCM group and the SR group on outcomes related to participation in drug abuse treatment, receipt of social services, or drug use, crime, and HIV risk behaviors. For specific services (e.g., residential treatment, mental health), although significant differences were found for length of participation or for number of visits, the number of participants in these services was small and the direction of effect was not consistent.ConclusionIn contrast to positive findings in earlier studies of strengths-based case management with mental-health and drug-abuse clients, this study found that case management did not improve treatment participation or behavioral outcomes for parolees with drug problems. The discussion includes possible reasons for the findings and suggestions for modifications to the intervention that could be addressed in future research.

Benefits of concurrent syringe exchange and substance abuse treatment participation

Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants ( N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment ( n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment ( n = 127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose–response effect of treatment in syringe exchangers and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.

Retention and Ongoing Participation in Residential Substance Abuse Treatment: Perspectives from Adolescents, Parents and Staff on the Treatment Process

Many adolescents entering substance abuse treatment do not stay for the full course of prescribed treatment. There have been few explorations into what facilitates the ongoing participation of adolescents while in treatment. This paper describes adolescent, parent, and treatment staff perceptions of the barriers and facilitators to retention and participation. Interviews were conducted with 87 adolescents, parents, and staff from three residential substance abuse treatment agencies in two states. Data were coded thematically and organized into themes by respondent type. Respondents reported barriers related to treatment population, program design, and communication and relationships, and reported facilitators related only to communication and relationships. Staff reported far more barriers than facilitators in comparison to either adolescents or parents. Findings suggest that parents and staff underestimate their contributions to the treatment process and practitioners might benefit from rethinking how to communicate the value of these stakeholders.

Substance Abuse Treatment Outcomes for Adolescents With Violent Behaviors

The purpose of this study was to evaluate whether substance-abusing adolescents with co-occurring violent behaviors showed reduction in these behaviors after exposure to outpatient drug treatment. Using a longitudinal research design, adolescents were classified based on 3 levels of the violence reported at intake and were assessed at 3 and 6 months following intake. The high-violence group showed significant reductions in the frequency of substance use, substance-related problems, and violence over time. The study shows that participation in outpatient substance abuse treatment may be associated with improved outcomes for adolescents with co-occurring substance abuse and violent behaviors.