Substance Abuse Treatment Programs Research Articles

Abstinence‐contingent recovery housing and reinforcement‐based treatment following opioid detoxification

To conduct a randomized, controlled trial of abstinence-contingent recovery housing delivered with or without intensive day treatment among individuals exiting residential opioid detoxification. Random assignment to one of three conditions: recovery housing alone (RH), abstinence-contingent recovery housing with reinforcement-based treatment RBT (RH + RBT) or usual care (UC). RH and RH + RBT participants received 12 weeks of paid recovery housing contingent upon drug abstinence. RH + RBT participants also received 26 weeks of RBT, initiated concurrently with recovery housing. Assessments were conducted at 1, 3 and 6 months after treatment enrollment. Out-patient drug-free substance abuse treatment program in Baltimore, Maryland. Patients (n = 243) who completed medication-assisted opioid detoxification. Primary outcome was drug abstinence (opioid- and cocaine-negative urine and no self-reported opioid or cocaine use in the previous 30 days). Secondary outcomes included abstinence at all time-points (1, 3 and 6 months), days in recovery housing and employment. Overall rates of drug abstinence were 50% for RH + RBT, 37% for RH and 13% for UC (P < 0.001). At 6 months, RH + RBT participants remained more likely to meet abstinence criteria than UC participants (37% versus 20%, P = 0.016). Length of stay in recovery housing mediated abstinence outcomes and was longer in RH + RBT (49.5 days) than in RH (32.2 days; P < 0.002). Abstinence-contingent recovery housing improves abstinence in opioid-dependent adults following medication-assisted detoxification. The addition of intensive 'reinforcement-based treatment' behavioural counseling further improves treatment outcomes, in part by promoting longer recovery house stays.

Meeting the substance abuse treatment needs of lesbian, bisexual and transgender women: implications from research to practice.

Research on the incidence, etiology and substance abuse treatment needs of lesbian, bisexual and transgender (LBT) women is limited. Most research indicates higher levels of alcohol and drug abuse among these populations compared to their heterosexual counterparts, with recent research indicating that substance abuse is a particular concern for transgender individuals and an increasing problem among younger LBT individuals. Risk factors and reasons for substance abuse among sexual minority women are similar to those of heterosexual women, yet are substantially complicated by issues of family rejection and lack of social support, stigma and minority stress, as well as abuse and harassment. Historically, substance abuse prevention, early intervention, and clinical treatment programs were designed to meet the needs of the sexual majority population with relatively few programs designed to incorporate the specific needs of sexual minorities. This article reviews findings from previous studies and utilizes new data collected from community-based and residential substance abuse treatment programs to (1) examine issues relevant to LBT women and substance use, and (2) make recommendations for tailoring substance abuse treatment programs to meet the needs of these populations.

Prevalence and Determinants of Personality Disorders in a Clinical Sample of Alcohol-, Drug-, and Dual-Dependent Patients

The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses. Data were gathered in 2007–2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview). The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients. The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.

Employing continuous quality improvement in community-based substance abuse programs.

This article aims to describe continuous quality improvement (CQI) for substance abuse prevention and treatment programs in a community-based organization setting. CQI (e.g., plan-do-study-act cycles (PDSA)) applied in healthcare and industry was adapted for substance abuse prevention and treatment programs in a community setting. The authors assessed the resources needed, acceptability and CQI feasibility for ten programs by evaluating CQI training workshops with program staff and a series of three qualitative interviews over a nine-month implementation period with program participants. The CQI activities, PDSA cycle progress, effort, enthusiasm, benefits and challenges were examined. Results indicated that CQI was feasible and acceptable for community-based substance abuse prevention and treatment programs; however, some notable resource challenges remain. Future studies should examine CQI impact on service quality and intended program outcomes. The study was conducted on a small number of programs. It did not assess CQI impact on service quality and intended program outcomes. Practical implications- This project shows that it is feasible to adapt CQI techniques and processes for community-based programs substance abuse prevention and treatment programs. These techniques may help community-based program managers to improve service quality and achieve program outcomes. This is one of the first studies to adapt traditional CQI techniques for community-based settings delivering substance abuse prevention and treatment programs.

Counselors' Knowledge of the Adoption of Tobacco Cessation Medications in Substance Abuse Treatment Programs

Counselors' Knowledge of the Adoption of Tobacco Cessation Medications in Substance Abuse Treatment Programs

Legal challenges for substance abuse treatment during disasters.

Certain groups with preexisting mental and behavioral health conditions, such as substance use disorders, may be especially vulnerable during and shortly after disasters. Researchers have found that substance abuse treatment programs and the individuals they serve experienced major disruptions after the September 11, 2001, attacks on the World Trade Center and the Pentagon and after Hurricane Katrina. This column considers legal challenges that may arise when a rapid influx of licensed providers is needed for substance abuse treatment during disasters and reviews specific legal issues that disasters may raise for opioid treatment programs. Opportunities to mitigate legal challenges and facilitate substance abuse treatment during disasters are discussed.

Perceptions of the State Policy Environment and Adoption of Medications in the Treatment of Substance Use Disorders

Despite growing interest in the use of evidence-based treatment practices for treating substance use disorders, adoption of medications by treatment programs remains modest. Drawing on resource dependence and institutional theory, this study examined the relationships between adoption of medications by treatment programs and their perceptions about the state policy environment. Data were collected through mailed surveys and telephone interviews with 250 administrators of publicly funded substance abuse treatment programs in the United States between 2009 and 2010. Multiple imputation and multivariate logistic regression were used to estimate the associations between perceptions of the state policy environment and the odds of adopting at least one medication for the treatment of substance use disorders. A total of 91 (37%) programs reported having prescribed any medication for treatment of a substance use disorder. Programs were significantly more likely to have adopted at least one medication if they perceived greater support for medications by the Single State Agency. The odds of adoption were significantly greater if the program was aware that at least one medication was included on their state's Medicaid formulary and that state-contract funding permitted the purchase of medications. States may play significant roles in promoting the adoption of medications, but adequate dissemination of information about state policies and priorities may be vital to further adoption. Future research should continue to study the relationships between the adoption of medications for treating substance use disorders and the evolving policy environment.

Inside-Out Health: An Integrative Health Education Program for Women in Substance Abuse Treatment

Background: Women in treatment for substance use disorders have been identified as at risk for developing co-occurring addictions (e.g., eating disorders) during and following treatment [1] as well as health-related concerns (e.g., inadequate nutrition, weight gain) [2]. Methods: Two evidence-based programs, Full of Ourselves [3] and Healthy Steps to Freedom [4], inspired the development of an integrative health education program (i.e., Inside-Out Health) designed to promote physical activity, healthy nutrition and positive body image. Forty-nine participants aged 18-59 (M=30.61, SD=6.90) came to the weekly program with 74% of participants attending 4 or more sessions out of 6 and 22% having perfect attendance. Nutrition, physical activity and body image were evaluated at pre- and post- and exploratory questions were included to assess program satisfaction. Results: While statistical analyses did not reveal significant changes in body esteem and physical activity, the Food Choice Questionnaire responses on two subscales (i.e., FCQ-weight control, FCQ-nutrition) approached significance. FCQ-weight control scores increased from pretest (M=.2.24, SD=1.0) to posttest (M=2.55, SD=.74) and FCQ-nutrition scores increased from pretest (M=2.70, SD=.67) to posttest (M=2.82, SD=.68). Discussion: This integrative health education program is an initial attempt to incorporate health education and eating disorder prevention efforts into an existing substance abuse treatment program. This study confirms the feasibility of promoting physical activity, nutrition and positive body image among female substance abuse clients.

Hope and Recovery From Substance Abuse for Female Drug Offenders in Taiwan

This study was designed to fulfill a twofold purpose. First, based on the hope theory framework and previous research, a 16-session hope-based substance abuse treatment program to help female drug abusers achieve a better recovery was developed. Second, ANCOVA was used to test the effectiveness of this treatment model. The participants were 40 female drug offenders who were randomly assigned into experimental and control groups. The 20 experimental group participants received 16 sessions of hope-based substance abuse treatment whereas the 20 control group members were put on the waiting list for another term of treatment. The results indicated that the members of the two groups had significant differences in their posttest scores for recovery goal setting and pursuing, pathway controlling, adequate energy, knowledge of the changing process, ability to cope, adequate cognition, emotion regulation, and self-esteem.

Introduction to the special issue on organizational dynamics within substance abuse treatment: A complex human activity system

Substance abuse treatment programs represent complex human activity systems in which multiple actors, including clients, counselors, and managers, are nested. Furthermore, treatment programs are nested within the broader environmental context of resource allocation and regulatory enforcement. This special issue of the Journal of Substance Abuse Treatment presents 12 empirical papers that address organizational dynamics within specialty treatment programs. In this introduction to the special issue, the guest editors describe a conceptual framework of organizational dynamics, offer an overview of the articles within this issue, and discuss future prospects for research.

Drug treatment program ownership, Medicaid acceptance, and service provision

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002–2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.

A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom program

Given that women increasingly report using drugs to lose weight, substance abuse treatment programs must include body image, weight, eating pathology, and health knowledge as core intervention targets. This study tested the efficacy of a supplemental health and body image curriculum designed for women in substance abuse treatment who report weight concerns called Healthy Steps to Freedom (HSF). Data from 124 adult women recruited from substance abuse treatment facilities in southern Nevada completed measures of drug use, body dissatisfaction, eating pathology, thin-ideal internalization, and health knowledge/behaviors before and after participation in the 12-week HSF program. Results revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased. These results suggest that the inclusion of the HSF program in substance abuse treatment improves weight-related issues in substance-abusing women.

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040–0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105–0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.

Organizational consequences of staff turnover in outpatient substance abuse treatment programs

The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff.

Program needs and change orientation: Implications for counselor turnover

Although evidence suggests that turnover rates are higher in high-stress/high-needs work environments, it is unclear whether agencies' attempts at improving practices influence individuals' decisions to stay at or leave a job. The purpose of this study was to examine whether program needs and change orientation influence individual decisions to quit. A sample of 206 counselors from 25 outpatient substance abuse treatment programs completed the Survey of Organizational Functioning, rating the organization on program needs, leadership, and change. They also rated themselves on stress, burnout, and job satisfaction. Multilevel modeling indicated a significant interaction between program needs and change orientation, even after controlling for stress, burnout, job satisfaction, tenure, and selected program characteristics. When perceptions of program needs were high, counselors were more likely to stay if they felt that the organization was making progress toward change. These findings suggest that an orientation toward change can counteract negative effects of perceived need within the workplace.

Measurement of gender-sensitive treatment for women in mixed-gender substance abuse treatment programs

BackgroundGender-sensitive (GS) substance abuse treatment services have emerged in response to the multidimensional profile of problems that women display upon admission to substance abuse treatment. The present study examines the extent to which treatment programs vary in GS programming for women in real-world mixed-gender treatment settings, where most women are treated. MethodsData were collected through site visits using semi-structured interviews with program directors, clinical directors, and counselors in 13 mixed-gender treatment programs from Washington State. Rasch modeling techniques were used to analyze the data. ResultsNaturally occurring variation was revealed within and across the treatment programs, and demonstrated that reliable measures of three GS domains (Grella, 2008) can be constructed despite a small number of programs. ConclusionsThis is the first study to quantify GS treatment for substance abusing women. The identified treatment services and practices and the way they clustered together to form scales have practical implications for researchers, service providers, clinicians, and policy makers. The scales can be used to study treatment outcomes and to evaluate the effectiveness, cost-effectiveness, and cost-benefit of GS programming for women.

Using Prolonged Exposure to Treat Abortion-Related Posttraumatic Stress Disorder in Alcohol-Dependent Men

Men's reactions to a partner's abortion are an understudied area. Few studies have examined abortion as it relates to posttraumatic stress disorder (PTSD) in males, and no studies have examined the use of an empirically supported behavioral treatment for PTSD in this population. The current case study examines Prolonged Exposure for the treatment of abortion-related PTSD in a 46-year old Caucasian male who also has alcohol dependence. The patient was involved in a residential substance abuse treatment program at the time of treatment. After receiving 12 sessions of Prolonged Exposure, the patient experienced a decrease in PTSD symptoms as measured by the Clinician Administered PTSD Rating Scale (87%) and Impact of Event Scale-Revised (85%). The results of this study suggest that the literature supporting Prolonged Exposure as a first-line treatment for PTSD can be expanded to include men needing treatment for abortion-related PTSD. Implications for treatment and research are discussed.

GABRA2 and KIBRA genotypes predict early relapse to substance use

BackgroundNumerous single nucleotide polymorphisms (SNPs) within different genes have been associated with alcohol and drug involvement or known risk factors for involvement, such as impaired cognitive control. The ability of these SNPs to predict re-involvement, defined here as abstinence failure during treatment, has not been thoroughly tested. MethodsWe studied a small sample (n=146; 49% female) of residential substance abuse treatment program patients who had maintained 2–6 months of abstinence. They were followed for 4 months thereafter for the purpose of counting days until the first abstinence violation. The analysis used logistic and Cox regression methods to evaluate the contributions of age; sex; number of intake alcohol, drug use, and depression symptoms; and either GABRA2, CHRM2, ANKK1, BDNF, or KIBRA SNP genotypes to outcome. ResultsGABRA2 and KIBRA genotypes, as well as the number of intake drug abuse problems and a younger age, were associated with an increased risk of relapse. Importantly, these genotypes were found to add value to relapse prediction: the χ2 statistic evaluating their residual contribution, after age and the number of previous drug use problems were entered, was significant. ConclusionsGenetic analyses may add value to outcome prediction. Future studies should evaluate the sensitivity and specificity of GABRA2 and KIBRA genotypes for this purpose in other racial/ethnic groups and treatment settings.

Chronic pain, Addiction severity, and misuse of opioids in Cumberland County, Maine

Background Few studies have examined the relationship between chronic pain and opioid abuse in non-clinical populations. We sought to investigate this in a street-recruited sample of active opioid abusers in Cumberland County, Maine, USA, a locale that had experienced substantial increases in opioid abuse. Methods A community-based sample was recruited using respondent-driven sampling. Participants were screened to identify those who had consumed illicit opioids in the prior month and administered a structured survey that included the Addiction Severity Index (ASI) and Brief Pain Inventory® (BPI). Results More than 40% of the 237 individuals reported recurring pain that interfered with daily living. For more than three-quarters of those reporting chronic pain, opioid misuse preceded the onset of chronic pain. The order of onset was not associated with differences in sociodemographic, current levels of drug misuse, or ASI and BPI scores. BPI scores were associated with medical and psychological ASI domains. Compared to those not reporting chronic pain, those doing so were more likely to have a regular physician but were more likely to report difficulty gaining admission to substance abuse treatment programs. Conclusion Chronic pain was a common co-occurring condition among individuals misusing opioids. Better efforts are needed to integrate pain management and substance abuse treatment for this population.

Problem Areas Reported by Substance Abusing Individuals and Their Concerned Significant Others

Substance use disorders (SUDs) have a serious impact on several life areas, including family functioning. This study examined problem areas that patients with SUDs and their family members experience in terms of quality of relations, psychological problems, physical distress, and quality of life. A sample of 32 dyads--persons with SUDs and a family member--were recruited from a substance abuse treatment program, and completed the Maudsley Addiction Profile health symptoms section, EuroQol-5D, Relationship Happiness Scale, Dyadic Adjustment Scale, and the Dedication Scale. Family members reported that four significant others were directly affected by patients' addiction-related problems, while patients reported that less than three family members were affected by their addiction. Consistently, family members indicated that they were less content with their relationship than patients and evaluated the consequences of patients' SUDs as more negative and severe than the patients themselves. Furthermore, patients and their family members reported comparable levels of physical and psychological distress and quality of life scores. These systematically obtained findings support the notion that relationships of patients and family members are disrupted and both need help to improve their physical and psychological well-being.