Substance Abuse Treatment Providers Research Articles

Accreditation in Public Child Welfare: Exploring the Relationship between the Council on Accreditation (COA) and Structural Factors

Accreditation could potentially improve an under-resourced, overburdened child welfare system. As the first study to use national-level data to focus on the Council on Accreditation (COA) in public child welfare, this research note explores: 1) the landscape of accreditation and 2) how accreditation is related to agencies’ structure (environment of care, organizational capacity). According to COA data from 2018, 29 child welfare agencies in the U.S. were accredited—four state-administered, two counties in state-administered systems, eight counties in one hybrid system, and 15 county-administered. Data from the second National Survey of Child and Adolescent Well-Being (NSCAW II) found that, while accredited and non-accredited agencies were comparable on most structural factors, participation in Title IV-E waiver demonstration projects and less collaboration with substance abuse treatment providers were associated with accreditation. This research note sets the foundation for further evaluating accreditation's impact in child welfare.

How access to addictive drugs affects the supply of substance abuse treatment: Evidence from Medicare Part D.

This paper documents how substance abuse treatment (SAT) providers and services respond to increases in population-level opioid addiction. I do this by exploiting the implementation of Medicare Part D as an exogenous increase in the availability of prescription opioids. Starting in 2006, states with higher shares of the population eligible for Medicare Part D experienced increases in residential and hospital inpatient SAT facilities, beds dedicated to SAT, and SAT facilities offering medication-assisted treatment, relative to states with lower shares. These results suggest that the supply of SAT in the United States is capable of responding significantly to changes in demand.

Listening to Voices in Appalachia Gathering Wisdom from the Field about Substance Abuse Recovery Ecosystems.

New qualitative data collected through six regional community-based listening sessions and community meetings are presented that describe elements of the Appalachian Regional Commission’s Recovery Ecosystem Model. These data informed the Model, which was used in formulating the new ARC Recovery-to-Work initiative. Input was intentionally solicited from multiple sectors, including persons recovering from substance abuse disorder, treatment and recovery service providers, workforce development agencies, employers, and community advocacy groups.

Trends in first-time treatment admissions for older adults with alcohol use disorder: Availability of medical and specialty clinical services in hospital, residential, and outpatient facilities

BackgroundAlcohol use disorder (AUD) is a growing problem among older adults. The aim of this study was to quantify trends in first-time treatment admissions for older adults with AUD in the U.S., and examine the medical and specialty clinical services offered by treatment facility type. MethodsPatient level data were collected from the Treatment Episode Data Set for Admissions between 2004–2017. Joinpoint regression was used to identify unique trends in first-time treatment admissions for older adults with AUD. Provider level data were collected from the National Survey of Substance Abuse Treatment Services (N-SSATS) for the most recent year, 2017. N-SSATS data were grouped by facility type (inpatient/hospital, residential, and outpatient treatment) to examine differences in medications and clinical services. ResultsAmong all persons seeking first-time treatment for AUD with alcohol as their primary drug of choice (n = 3,606,948), there was a significant increase in the proportion of older adults seeking treatment from 2004 to 2017 (p-trend<0.001), with an average annual percent change of 6.8% (95% confidence intervals: 6.2%–7.4%). The majority of older adults with AUD sought treatment in outpatient and residential facilities, which compared to hospital-based facilities had lower odds of offering supervised detoxification, acamprosate, naltrexone, psychiatric medications, or mental health services (all p-values<0.001). Fewer than 25% of hospital-based and 20% of residential or outpatient facilities offered specialty services for older adults. ConclusionsU.S. substance abuse treatment providers are not compensating for the changing nature of admissions by older adults, and are not providing state of the art services for this population.

Gabapentin prescribed during substance abuse treatment: The perspective of treatment providers

BackgroundGabapentin, a prescription medication approved for the treatment of seizures and neuralgia, is often prescribed off-label for substance use treatment, mental health problems, and pain. Emerging reports also suggest it is misused for the purpose of getting high. The present study examines substance abuse treatment provider key informants' experiences with gabapentin prescribed to clients in treatment. The focus of this exploratory study is to ascertain how gabapentin is used in these settings and the benefits and risks for clients. MethodsKey informants from South Florida participated in confidential, in-depth interviews (N = 12). Data analyses included descriptive and in vivo coding schemes and employed a descriptive qualitative approach. ResultsAll key informants recognized the benefits of prescribing gabapentin to clients in treatment for problems related to withdrawal symptoms, mental distress and pain. At the same time, half of participants described gabapentin misuse among clients and four key informants described such misuse as a first marker of relapse. Key informants also stated that more research must be done about how to use gabapentin effectively in treatment settings. ConclusionsThese findings illustrate the lack of clarity about the efficacy of administration of gabapentin in treatment settings. Additional research about how to best use gabapentin, for whom it may be beneficial, and the effect of prescribed gabapentin on addiction recovery is needed.

Implementing a Provider Partnership to Improve Substance Abuse and Child Welfare Outcomes in Urban High-Needs Parents

This Practice Note describes the implementation of a partnership between child welfare and substance use providers in New York City, with the aim of supporting cross-systems collaboration and improving outcomes for dually involved families. Specifically, this report focuses on improving both coordination and communication between a preventive child welfare service provider (Montefiore Family Treatment &amp; Rehabilitation Program), an outpatient substance abuse treatment provider (Montefiore Division of Substance Abuse), and the local department of social services (New York City Administration for Children’s Services). This article identifies general challenges with collaboration, describes how this collaboration was created and implemented in New York City, and provides guidance for other entities that are attempting to create similar collaborations.

Helping Older Adults With the Ageless Challenge of Substance Abuse

Helping Older Adults With the Ageless Challenge of Substance Abuse

2094 Validation of a set of “healthcare trust” scales for women seeking substance abuse treatment in community-based settings

OBJECTIVES/SPECIFIC AIMS: To validate previously published psychometric scales capturing interpersonal or healthcare-related trust in a target population of women with a history of substance use disorder seeking substance abuse treatment in a community-based setting. METHODS/STUDY POPULATION: Participants are enrolled at The Next Door, Inc. (TND) and Renewal House (RH), 2 community agencies in metropolitan Nashville that provide substance abuse treatment and post-incarceration re-entry services for women with a history of substance use disorder. We will enroll 300 participants to provide sufficient power for statistical psychometric validation. Inclusion criteria include adult women with self-identified history of substance use disorder seeking substance abuse treatment within seven days of initiation of inpatient residential or intensive outpatient treatment at TND or RH. Participants complete a one-time online survey comprising a demographics questionnaire, Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, Revised Health Care System Distrust Scale, 5-item RAND Social Desirability Scale, and Adverse Childhood Events Survey. Participants then individually participate in a modified protocol of the “Trust Game.” Predictor variables for multivariate analysis collected include age, race/ethnicity, gender identification, number of days in current treatment, number of prior substance abuse treatment programs, and number of adverse childhood events. RESULTS/ANTICIPATED RESULTS: Each individual scale will be assessed for item analysis, factor analysis, construct validity, content validity, and reliability and compared with general population sample values published in the literature. We will use multivariate analysis to determine the impact of potential predictor variables on specific types of interpersonal or healthcare-related trust. We anticipate having preliminary results to present in April. DISCUSSION/SIGNIFICANCE OF IMPACT: Women who seek substance abuse treatment in the community face unique challenges compared to their male counterparts, including higher rates of prior interpersonal trauma, co-occurring psychiatric diagnoses, and more serious physical health problems. Characteristics such as these highlight the need for regular healthcare engagement in the setting of an increased risk of decreased interpersonal or healthcare-related trust. Prior qualitative research demonstrates that trust building is seen as an essential component of care in ongoing substance abuse treatment for women in this population. Validation of psychometric healthcare-related trust scales in a population of women seeking substance abuse treatment in a community based setting will provide a framework for future quantitative inquiry into the impact of healthcare-related trust on health outcomes, healthcare engagement, and treatment retention for this target population. Similarly, it will also facilitate inquiry into the effectiveness of specific treatment programs or interventions on improving therapeutic trust building.

Perceptions of child protective services among pregnant or recently pregnant, opioid-using women in substance abuse treatment

Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of inter-rater reliability. Following 2, two-hour meetings, consensus was reached on primary themes and sub-themes. Two major themes and several sub-themes were identified: 1) Participants’ feelings and attitudes about CPS (positive and negative); 2) Interaction-based perceptions of CPS’ function and performance. Participants’ feelings toward CPS were often conditioned by their experiences with individual caseworkers. While many pregnant, opioid-using women identify legitimate, and even useful features of CPS, fear of CPS can be a barrier to care. Making substance abuse treatment accessible to this population requires recognition of their complex feelings toward CPS, and coordination among CPS case workers and substance abuse treatment providers.

Personal and contextual factors in substance abuse treatment among racial and ethnic minorities: Studies from the NIDA clinical trials network

The National Drug Abuse Treatment Clinical Trials Network (CTN) is a collaboration of substance abuse researchers and treatment providers aimed at developing, evaluating, and disseminating effectiv...

Alcohol and other drug use in older adults: results from a community needs assessment.

With the "Baby Boomer" generation reaching older adulthood, substance abuse treatment providers find themselves needing to address the unique needs of this population. Heavy drinking in adults ages 65 and over is strongly correlated with depression, anxiety, decreased social support, and poor health. However, while alcohol misuse has been shown to be predictive of a lower quality of life in older adults, the generalizability of these findings to urban dwelling, lower socioeconomic status individuals remains unclear. To identify potential treatment needs of this population, a city-funded needs assessment was conducted. Subjects were 249 individuals (44% male) who voluntarily completed measures of quality of life (QOL), depression, and substance abuse. Measures used included the Psychological General Well-Being Schedule, the Geriatric Depression Scale-15, and the Alcohol Use Disorders Identification Test (AUDIT). Alcohol or substance abuse was reported by over 20% of respondents, with 3.4% of respondents engaged in maladaptive alcohol use. Scores on the AUDIT were predictive of increased depression (r = - .209, p = .01), anxiety (r = - .201, p = .002), lower general well-being (r = - .154, p = .019), and decreased self-control (r = - .157, p = .017). A substantial percentage of the sample reported alcohol and substance misuse. Alcohol use was predictive of depression, global psychological distress, and decreased quality of life. This needs assessment reinforces findings from previous studies and addresses the added dimension of examining this in an urban, lower socioeconomic population.

Vicarious trauma and vicarious posttraumatic growth among substance abuse treatment providers

ABSTRACTBackground: Practitioners working with clients who have experienced trauma are vulnerable to experiencing both vicarious trauma and vicarious posttraumatic growth (PTG). A survey was conducted in which treatment providers who work with adults seeking help for substance abuse were asked about their experience of vicarious trauma and vicarious PTG. It was hypothesized that vicarious trauma and vicarious PTG would be positively associated with each other, that personal history of trauma and years of working with clients who had experienced trauma would be positively associated with vicarious trauma, and that in addition to those variables, personal counseling, training, and supervision would be associated with vicarious PTG. Methods: Surveys were sent to the directors of 15 social service agencies in one county in central California. Surveys included questions about the respondent's history of substance use and trauma and experience with clients who had experienced trauma. In addition, the survey contained 3 scales: the Trauma History Screen, the Posttraumatic Growth Inventory, and the Impact of Event Scale—Revised. Results: Survey data were obtained from 51 counselors. There was a significant positive association between vicarious trauma and vicarious PTG, and both were significantly associated with respondents' history of trauma. Providers who were in recovery were more likely than others to report a history of trauma and to report higher levels of vicarious trauma and vicarious PTG. Conclusion: Counselors working with clients in substance abuse treatment may experience vicarious trauma and vicarious PTG. Implications for preparing counselors to work with this population are discussed.

Supports for Families Affected by Substance Abuse

Using an in-home services program model, Project Connect works collaboratively with the child welfare system, substance abuse treatment providers, the courts, and other community agencies to support parental recovery, enhance safety and permanency, and strengthen family relationships. Results from the most recent evaluation of the program, which used a dosage level design to examine project outcomes for 415 families, are presented here. Data indicate that the program was particularly helpful in strengthening parenting capacity. Child safety and permanency were also positively correlated with program participation.

Factors Affecting Drug Use During Incarceration: A Cross-Sectional Study of Opioid-Dependent Persons from India

IntroductionSubstance abuse and criminality share a complex relationship. The rates of substance use among the prisoners, and that of criminal acts among substance users in community setting are high. Data from South Asian countries, including from India are inadequate. This study aimed to assess the pattern of criminal acts among opioid-dependent subjects and their substance use pattern in the month before, during and after imprisonment. MethodsUsing a cross-sectional study design and purposive sampling, opioid-dependent subjects (n=101) attending two community drug treatment clinics who have had any contact with the law were assessed using a specifically-designed tool to record criminal acts and substance use before, during and after last imprisonment. ResultsMost subjects (93%) had committed illegal acts in their lifetime. Physical assault was the most common illegal act, while 23% reported selling drugs and 9% reported committing serious crimes. About 95% were arrested and 92% had spent time in police lockups. About 29% were arrested for drugs possession or drug use, and 3% of injecting drug users arrested for carrying injection equipment. About 85% had been imprisoned at least once, of whom 88% used psychoactive substances in the 1-month period before their last imprisonment. Opioids were the most common substances used daily (68%), followed by cannabis (34%) and alcohol (22%). Ninety-seven percent reported the availability of substances in prisons, and 65% also used substances during their last imprisonment. Cannabis (35%) was the most common substances used in prison followed by opioids (19%). Seventy-six percent used substances soon after prison release, and 13% of opioid users experienced opioid overdose soon after prison release. Use of cannabis, injecting drugs, and opioid use before imprisonment were predictors of substance use in prison. ConclusionOpioid-dependent people have various contacts with the law, including imprisonment. Many users are dependent on substances during prison-entry, which is an important reason for their continued substance use in prisons. There is a need to provide substance abuse treatment across all stages of criminal justice system.

Promoting Drug Court Education in Schools of Social Work: Ideas in Action

Drug courts have provided an alternative to incarceration for arrestees with substance use disorders since 1989 in the USA, and the first drug court outside of the USA began in 1998 in Canada. As drug courts continue to increase throughout the world, it is important for social work students to learn about the role of drug courts in their communities, as they may interact with these programs directly or indirectly, whether it is being a member of a task force that begins a drug court or providing substance abuse treatment to participants. This Ideas in Action article conceptualizes drug courts and discusses their relevance for social work education. The article also proposes several direct service-learning techniques, such as completing practicums and course projects, which can be used within schools of social work to educate students about drug courts and promote civic engagement, reflection, and reciprocity.

Mobile Phones in Residential Treatment: Implications for Practice

A nonprofit primary care, substance abuse and mental health treatment provider that operates nine separate residential treatment facilities in both northern and southern California began allowing clients to keep their mobile phones while in treatment. From the advent of mobile phone technology and its widespread adoption through early 2013, the organization prohibited clients from having phones while in treatment. Calls to and from clients needed to be made and received at the house phone. After years of enforcing the policy with diminished success as phones became cheaper, smaller, and more prevalent, agency leadership decided to experiment with allowing the clients to keep their phones while in treatment. Elopement data as they relate to the policy are examined along with data from staff interviews about its implementation and impact. Results show that elopements resulting from being caught with a mobile phone were eliminated and some clients were able to be returned to treatment using the devices. All seven (100%) of the interviewees were supportive of the new policy and thought it should be continued. The impact of the policy on clinical disruptions, lost/stolen property liability, and confidentiality issues are discussed.

Barriers to serving clients with co-occurring disorders in a transformed mental health system.

The publication of the President's New Freedom Commission Report in 2003 led to hope and anticipation that system transformation would address barriers that have impeded the delivery of integrated services for clients with co-occurring mental health and substance use disorders. Have problems been resolved? This study analyzed providers' perspectives on serving clients with co-occurring disorders in a large mental health system that has undergone transformation. Six focus groups were conducted with providers at specialty mental health treatment organizations that received funding to transform services. Using content analysis, the authors identified major themes of the focus group discussions. Participants reported several barriers within the mental health system and challenges associated with collaborating with specialty substance abuse treatment providers that impede the delivery of integrated care. In spite of efforts to improve co-occurring disorder service delivery in a transformed mental health system, barriers that have historically impeded integrated treatment persist.

PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives.

ObjectivesTo examine substance abuse treatment providers’ views on engaging clients in Pre-exposure Prophylaxis (PrEP) care and research trials.MethodsThirty-six medical and counseling service providers in six New York City outpatient substance abuse treatment programs participated in semi-structured qualitative interviews. Thematic content analysis was conducted by three coders, independently.ResultsProviders’ perspectives toward PrEP were characterized by six salient themes: 1) Limited PrEP awareness. 2) Ambivalence about PrEP; 3) Perception of multiple challenges to delivery; 4) Uncertainty about clients’ ability to be adherent to medication; 5) Concerns about medication safety/side effects; and 6) Perception of multiple barriers to conducting clinical trials.ConclusionsDespite anticipated challenges, providers supported the introduction of PrEP in outpatient substance abuse treatment. Comprehensive training for providers is needed and should include PrEP eligibility criteria, strategies to support adherence and medication monitoring guidelines. Linkages between substance abuse treatment and primary care and/or enhancement of capacity within clinics to offer PrEP may help facilitate PrEP delivery. When conducting research in outpatient clinics, it is particularly important to protect client confidentiality.

Using data mining of spontaneous adverse event reports and multivariate statistical methods for assessing abuse potential

sample of out-of-treatment (n=10) and in-treatment participants (n=14). Results: The user systemnorm supported trying newdrugs, and both drugs were confirmed to be available in the environment. For the innovation-decision process, knowledge was greater for SCann than SCath as SCath was viewed as causing harm and users were unsure how to ingest it. In contrast SCann was compatible with known drug (i.e., marijuana) and used similarly. Both SCann and SCath were viewed as accessible and inexpensive (i.e., high trialability). The persuasion stage also favored SCann as almost all the users knew someone who had used SCann but few knew anyone who had used SCath. These differences lead to greater implementation of SCann than SCath as evidenced by total admissions, substance abuse treatment providers’ survey, and users’ experiences. However, after SCann and SCathwere removed from shelves due to communitymobilization, health alert, and Scheduling, there was disenchantment discontinuity in the confirmation stage. Few users expressed ongoing demand for synthetic compounds (either SCann or SCath) if theywere not easily available and legal. All users expressed preference for what they called “real” drugs, indicating SCann and SCath had no relative advantage over other drugs of abuse. Conclusions: This qualitative study showed SCann and SCath experienced different and declining demand in this region. Diffusion of Innovation provides a framework for understanding the differential use of substances and subsequent decline. Financial support: Fundingwasprovidedbygrants fromSoutheast Michigan Community Alliance and the state of Michigan (Lycaki-Young funds).

New York Psychiatrists Work to Hold Insurance Carrier Accountable

New York Psychiatrists Work to Hold Insurance Carrier Accountable