Substance Use Disorder Treatment Programs Research Articles

Measurement-Based Care in Treatment of Substance Use Disorders

IntroductionMeasurement-Based Care (MBC) is an emerging healthcare model with a number of potential advantages over traditional approaches for the treatment of substance use disorder (SUD). Despite SUD treatment programs being theoretically well suited for the implementation of MBC, its uptake has been minimal, which in turn limits further research, knowledge synthesis, and translation into clinical practice.ObjectivesThe goal of this knowledge synthesis project is to stimulate greater consideration of MBC models in addictions programs, with three interrelated objectives: 1. To summarize the existing evidence from research literature 2. To complement the literature findings with the data from our clinical research and quality improvement projects 3. To explore potential risks and difficulties of MBC implementation in the SUD treatment programsMethodsNarrative review. Knowledge synthesis.ResultsTo date, only two published randomized controlled trials, which along with the data from our pragmatic clinical research, support the wider implementation of MBC in the substance abuse treatment settings, but also indicate the high need for larger-scale clinical trials and quality improvement programs. Potential barriers to the implementation of MBC for SUD are outlined at the patient, provider, organization, and system levels, as well as challenges associated with the use of MBC programs for clinical research. Critical thinking considerations and risk mitigation strategies are offered toward advancing MBC for SUD beyond the current nascent state.ConclusionsThe state-of-the-art of MBC in SUD care settings reviewed and the strategies for further development from adminsitrative, clinical, and research prospectives outlined.DisclosureNo significant relationships.

Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California

Background Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs. Methods We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. Findings Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors’ strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services. Conclusion To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.

Impact of prenatal substance use policies on commercially insured pregnant females with opioid use disorder

IntroductionStates' approaches to addressing prenatal substance use are widely heterogeneous, ranging from supportive policies that enhance access to substance use disorder (SUD) treatment to punitive policies that criminalize prenatal substance use. We studied the effect of these prenatal substance use policies (PSUPs) on medications for opioid use disorder (OUD) treatment, including buprenorphine, naltrexone, and methadone, psychosocial services for SUD treatment, opioid prescriptions, and opioid overdoses among commercially insured pregnant females with OUD. We evaluated: (1) punitive PSUPs criminalizing prenatal substance use or defining it as child maltreatment; (2) supportive PSUPs granting pregnant females priority access to SUD treatment; and (3) supportive PSUPs funding targeted SUD treatment programs for pregnant females. MethodsWe analyzed 2006–2019 MarketScan Commercial Claims and Encounters data. The longitudinal sample comprised females aged 15–45 with an OUD diagnosis at least once during the study period. We estimated fixed effects models that compared changes in outcomes between pregnant and nonpregnant females, in states with and without a PSUP, before and after PSUP implementation. ResultsOur analytical sample comprised 2,438,875 person-quarters from 164,538 unique females, of which 13% were pregnant at least once during the study period. We found that following the implementation of PSUPs funding targeted SUD treatment programs, the proportion of opioid overdoses decreased 45% and of any OUD medication increased 11%, with buprenorphine driving this increase (13%). The implementation of SUD treatment priority PSUPs was not associated with significant changes in outcomes. Following punitive PSUP implementation, the proportion receiving psychosocial services for SUD (12%) and methadone (30%) services decreased. In specifications that estimated the impact of criminalizing policies only, the strongest type of punitive PSUP, opioid overdoses increased 45%. ConclusionOur findings suggest that supportive approaches that enhance access to SUD treatment may effectively reduce adverse maternal outcomes associated with prenatal opioid use. In contrast, punitive approaches may have harmful effects. These findings support leading medical organizations' stance on PSUPs, which advocate for supportive policies that are centered on increased access to SUD treatment and safeguard against discrimination and stigmatization. Our findings also oppose punitive policies, as they may intensify marginalization of pregnant females with OUD seeking treatment.

Association Between Dispositional Mindfulness, Clinical Characteristics, and Emotion Regulation in Women Entering Substance Use Disorder Treatment: an fMRI Study

ObjectivesDispositional mindfulness (DM) is associated with emotion regulation (ER) in healthy populations and may be protective for individuals with substance use disorders (SUD). We tested hypotheses concerning the associations of DM with ER, mental health symptoms, drug use severity, and behavioral and brain metabolic responses during an emotional Go-Nogo task.MethodsWomen entering an SUD treatment program (N = 245) self-reported on the Five Facet Mindfulness Questionnaire (FFMQ); Depression, Anxiety, and Stress Scale (DASS-21); Addiction Severity Index (ASI); and Difficulties in Emotion Regulation Scale (DERS). A subgroup of 45 women completed the emotional Go-Nogo task while undergoing fMRI. Associations between DM and self-reported ER and clinical characteristics were tested in the full sample. Associations between DM and behavioral and neural responses during the Go-Nogo emotion regulation challenge were tested in the fMRI sub-sample.ResultsIn the full sample, FFMQ correlated with DASS-stress (r = − .43, p < .0001), DASS-depression (r = − .52, p < .0001), DASS-anxiety (r = − .32, p < .0001), DERS (r = − .66, p < .0001), and ASI-Drug scores (r = − .28, p < .0001). In the subsample, inhibition of the natural avoidance response while approaching a fearful stimulus recruited activity in the inferior frontal gyrus and the insular cortex (IC). Activity in the IC cluster was positively correlated with FFMQ scores (r = 0.38, p = .015). FFMQ scores correlated with activation in the striatum and IC during face processing.ConclusionsAmong women with SUD, DM beneficially correlated with ER, mental-health symptoms, addiction severity, and recruitment of neural substrates underlying ER.

Improving the Recruitment and Retention of Counselors in Rural Substance Use Disorder Treatment Programs

While access to drug treatment has increased in recent years, there is still a shortage of substance use disorder (SUD) treatment counselors in the United States, especially in rural areas. This study examined recruitment and retention issues for counselors in rural substance use disorder treatment programs. Qualitative interviews were conducted with 26 program, clinical, and/or human resource directors of SUD treatment programs. Almost all interviewees had problems recruiting high-quality counselors although only a small number saw retention as a significant issue. Improving educational opportunities and training related to addictions counseling could result in more people entering the SUD treatment field. Strategies for improving retention of counselors include more supportive and inclusive management practices. The stigma of SUD also contributed to recruitment and retention problems.

Continuing Care App for Probationers and Parolees with Substance use Disorders.

This pilot proof-of-concept study examined the feasibility and acceptability of a Continuing Care mobile application (app) designed to meet the recovery and personal support needs of individuals under justice supervision who were receiving outpatient substance use disorder (SUD) treatment. The study included adults on probation or parole who were enrolled in an outpatient SUD treatment program (N = 15; 86.7% males). Participants were instructed to utilize the Continuing Care app daily for 4 weeks. At the end of the study, they completed a satisfaction questionnaire. Of the 15 participants enrolled in the study, 12 (80%) completed the Continuing Care app modules and the satisfaction questionnaire, and all of these participants indicated high levels of satisfaction with the app (on a scale of 1-10, Mean = 1.8, SD = 1.2). The Continuing Care app was well-utilized and perceived as valuable by this group of low-income, underserved, and hard-to-reach individuals. Further research is needed to refine app content and evaluate its ability to meaningfully enhance and extend the benefits of SUD treatment.

Identifying relative strength of methadone versus health and social services in comprehensive substance use disorder treatment using a variance decomposition approach

BackgroundThe purpose of this study is to identify the relative strengths of association of medication and health and social services in comprehensive substance use disorder (SUD) treatment. Objectives: The study uses a novel variance decomposition method to assess the relative strength of association of six active ingredients of comprehensive SUD treatment: methadone medication, access services, SUD counseling, matched service ratio, client–provider relationship, and treatment duration. MethodsThe study uses data from the National Treatment Improvement Evaluation Study (1992–1997), a dataset with an unusual number of services and service strategies measured. The data include 3012 clients from 45 SUD treatment programs. Linear mixed models are used to assess the relation of service variables to the outcome of posttreatment substance use. Variance decomposition methods are used to assess the relative importance of the ingredients in the treatment model. ResultsAlong with a random intercept and background variables, receipt of methadone accounted for the greatest relative strength of association at 35.4%, compared with 23.8% for treatment duration, 15.4% for client–provider relationship, and 11.2% for matched service ratio. Access and SUD counseling accounted for modest strengths of association at 1% and 3% each. ConclusionFindings indicate somewhat greater strength of association of methadone compared with other services and service strategies and overall, reinforce the importance of both medication and services and service strategies in the design and development of effective models of service delivery. SignificanceThis study, among the first to evaluate the relative importance of specific services and service strategies of comprehensive SUD treatment, provides insights relevant to the development of effective models of service delivery.

Less Is More: The Effect of a Short-term Substance Use Disorder Treatment Program on Recidivism

ABSTRACT Most people behind bars suffer from substance use disorders (SUDs), but very few of them participate in treatment prior to leaving prison. Minnesota implemented a shorter-term therapeutic community-based treatment program to target higher custody individuals serving relatively short terms of incarceration. The purpose of this research is to determine whether this program reduced the likelihood of recidivism. This study used propensity score matching to compare 351 men who participated in the short-term SUD treatment program to 351 men who left prison without participating in any treatment. Cox regression was used to predict four different types of recidivism. This research found that participation in the short-term program significantly reduced the likelihood of three out of four measures of recidivism. A medium level of treatment exposure (four to five months) significantly reduced the likelihood of all four types of recidivism relative to individuals who did not participate in any treatment. This research contributes to a growing body of evidence showing that evidence-based SUD treatment programs do not need to be long to be effective. By reducing the length of treatment, prisons can increase their treatment capacity, ensuring that fewer individuals leave prison without treatment.

Assessing clinical impacts and attitudes related to COVID-19 among residential substance use disorder patients

Background: Individuals with substance use disorder (SUD) may be particularly at risk during the COVID-19 pandemic. The purpose of this study was to examine attitudes to the pandemic among individuals with SUD. Methods: Survey responses from 266 patients entering a residential treatment program were analyzed. Results: Most participants were White or African American men. A third of participants reported that their substance use had increased during the pandemic (38%), and that they had stockpiled substances because of concerns about supply (30%). A majority of participants indicated more depression (60%), anxiety (61%), worry about finances (62%), and feeling worse about their substance use due to COVID-19 (67%). An exploratory factor analysis revealed five factors that measured interest in SUD treatment, psychological symptoms, adherence to health recommendations, perceptions of vulnerability to COVID-19, and substance use during COVID-19. African American participants indicated a greater interest in treatment than Whites, while White participants indicated increased symptoms and substance use during COVID-19 (p < .05). Further, African Americans were more likely to have known someone who had developed COVID-19 than whites (p < .05). Older participants indicated adhering to health recommendations more than younger participants, using substances less than younger participants, as well as feeling more vulnerable to COVID-19 (p < .05). Conclusions: This is the first study to examine patient attitudes and behaviors related to COVID-19 at a residential SUD treatment program. Treatment providers should be aware of patient attitudes and behaviors related to COVID-19 paying special attention to barriers to treatment engagement.

Homelessness and publicly funded substance use disorder treatment in California, 2016–2019: Analysis of treatment needs, level of care placement, and outcomes

IntroductionBoth homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. MethodsObservational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. ResultsPEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. ConclusionsDeveloping SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.

People in Recovery from Substance Use Disorders: What Motivates Them to Enter Addiction Treatment Agencies as Counselors?

This qualitative study aimed to understand the motivations of people recovering from substance use disorders (SUDs) to work in addiction treatment agencies as counselors. A purposive and snowball sampling technique was used to recruit 18 recovering counselors from Long Island, New York. Most of the participants self-identified as Caucasian, and a third identified as African American. All interviews were audio-recorded and transcribed verbatim. The results indicate that want to give back, perceived self-efficacy to work with SUD clients, and previous experiences with addiction treatment services motivated people in recovery from SUD to become counselors. The respondents also reported the role of intrinsic rewards, such as witnessing clients’ progress over time and the opportunity to sustain their recovery, which influenced their decision to continue working in the addiction treatment field. Understanding work motivations has significant implications for assessing the staffing needs and professional development of SUD treatment programs, including recruitment, retention, and the overall size and capacity of the addiction treatment workforce.

Reducing tobacco use in substance use treatment: An intervention to promote tobacco-free grounds

BackgroundPeople in substance use disorder (SUD) treatment experience disproportionate rates of tobacco use. California has prioritized smoking cessation among these individuals through the Tobacco-Free for Recovery Initiative, which includes an intervention aimed at supporting programs in implementing tobacco-free grounds. The current study examined changes in client smoking prevalence, tobacco use behaviors, and receipt of cessation services among the first seven programs participating in the initiative. MethodsResidential treatment program clients completed cross-sectional surveys at the start of the intervention (baseline: n = 249), at an interim timepoint post-baseline (interim: n = 275), and at the end of the intervention 15 months later (post-intervention: n = 219). All participants reported smoking status. Current smokers reported tobacco use behaviors, and both current smokers and those who quit in treatment reported receipt of cessation services. Univariate analyses explored differences across the three timepoints and multivariate logistic regression assessed change from baseline to interim and baseline to post-intervention. ResultsClient smoking prevalence decreased from 54.2% at pre- to 26.6% at post-intervention (Adjusted Odds Ratio [AOR] = 0.25, 95% CI = 0.13, 0.45). Current smokers and those who quit while in treatment reported an increase in NRT/pharmacotherapy (11.9% vs. 25.2%; AOR = 3.02, CI = 1.24, 7.35). When comparing baseline to the interim timepoint (a timepoint before the COVID-19 pandemic), data analyses also demonstrated a significant decrease in smoking prevalence (54.2% vs. 41.8%; AOR = 0.62, CI = 0.42, 0.92) and increase in NRT/pharmacotherapy (11.9% vs. 24.5%; AOR = 3.68, CI = 1.11, 12.19). ConclusionAn intervention to promote tobacco-free grounds implemented in residential SUD treatment programs was associated with a significant reduction in client smoking and an increase in NRT/pharmacotherapy. These associations were observed both before the COVID-19 pandemic and in the early stages of the pandemic, suggesting that they may be due to the intervention rather than to the pandemic.

Racial/Ethnic Differences in Tobacco Use and Cessation Services among Individuals in Substance Use Treatment

ABSTRACT Few studies explore racial/ethnic disparities in tobacco use and access to cessation services among people with substance use disorders (SUD). We collected data from Hispanics (n = 255), non-Hispanic Whites (n = 195), and non-Hispanic Blacks (n = 126) across 24 Californian residential SUD treatment programs. Data were analyzed via regression models adjusting for demographics, cigarettes per day, past quit attempts, intent to quit in the next 30 days, and physical health status. Non-Hispanic Whites smoked at a higher rate (68.7%) than both Hispanics (54.9%) and non-Hispanic Blacks (55.6%) and smoked more cigarettes per day (M = 11.2, SD = 6.5). Hispanics were more likely than non-Hispanic Whites to receive a referral to a cessation specialist (adjusted odds ratio; AOR = 2.34, 95% CI = 1.15, 4.78) and tobacco-cessation counseling (AOR = 2.68, 95% CI = 1.28, 5.62). Non-Hispanic Blacks were also more likely than non-Hispanic Whites to receive cessation counseling (AOR = 3.61, 95% CI = 1.01, 12.87) and NRT/pharmacotherapy (AOR = 2.65, 95% CI = 1.57, 4.47). Despite their decreased smoking prevalence and severity, REMs were accessing smoking cessation services while in treatment, suggesting that SUD treatment could serve as a place to address tobacco-related racial inequities.

Treatment outcome and readmission risk among women in women-only versus mixed-gender drug treatment programs in Chile

IntroductionTraditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. In Chile, women-only programs were only fully implemented in 2010. We compared treatment outcomes and readmission risk for adult women admitted to state-funded women-only versus mixed-gender SUD treatment programs in Chile. MethodsWe used a registry-based retrospective cohort design of adult women in women-only (N = 8200) and mixed-gender (N = 13,178) SUD treatment programs from 2010 to 2019. The study obtained data from the National Drug and Alcohol Service from Chile. We used a multistate model to estimate the probabilities of experiencing treatment completion, discharge without completion (i.e., patient-initiated discharge and administrative discharge), or readmission, as well as the likelihood of being readmitted, conditioned on prior treatment outcome. We adjusted models for multiple baseline characteristics (e.g., substance use, socioeconomic). ResultsOverall, 24% of women completed treatment and 54% dropped out of treatment. The proportion of patient-initiated discharges within the first three month was larger in women-only than in mixed-gender programs (19% vs. 12%). In both programs, women who completed treatment were more likely to experience readmission at three months, and one and three years. In the long term, women in the women-only programs were more likely to complete treatment than women in mixed-gender programs (34% vs. 23%, respectively). The readmission probability was higher among women who previously completed treatment than those who had a discharge without completion (40% vs 21% among women in women-only programs; 38% vs. 19% among women in mixed-gender programs, respectively); no differences occurred in the risk of readmission between women-only and mixed-gender programs. ConclusionsIn terms of treatment outcomes and readmission risk, women-only programs had similar results to mixed-gender programs in Chile. The added value of these specialized programs should be addressed in further research.

Factors associated with dualand polytobacco use among people in residential substance use disorder treatment.

Little is known about whether people in substance use disorder (SUD) treatment are at risk for multiple-tobacco use. We examined the factors associated with dual- and polytobacco use among clients in SUD treatment. A cross-sectional survey was conducted in 2019 among 562 clients (Mage = 39, 74% male) in 20 residential SUD treatment programs in California, USA. The outcomes included single-, dual- (use of two products), and polytobacco use (use of three of more products). Independent variables were nicotine dependence, quitting-related factors, blunt/spliff use, and health-related factors. A multinomial model examined associations between the independent variables and the outcome, controlling for demographics, and time in treatment. Overall, 32.6%, 18.9%, and 14.0% of the sample were single-, dual-, and polytobacco users, respectively. Factors associated with increased odds of polytobacco use included greater nicotine dependence (adjusted odds ratio [AOR] = 1.60; 95% CI = 1.19, 2.16), ever using e-cigarettes for quitting (AOR = 4.56; 95% CI = 2.23, 9.34), and past 30-day use of blunt/spliff (AOR = 2.96; 95% CI = 1.48, 5.89). Factors associated with increased odds of dual use were ever using e-cigarettes for quitting (AOR = 3.19; 95% CI = 1.79, 5.66) and reporting more mentally unhealthy days (AOR = 1.05; 95% CI = 1.02, 1.07). This study extends the literature on tobacco use among people in SUD treatment by revealing the high prevalence of dual- and polytobacco use and the unique characteristics of users. The findings have implications for interventions reducing all types of tobacco use in this understudied population.

Patients' perceptions of telehealth services for outpatient treatment of substance use disorders during the COVID-19 pandemic.

Background and ObjectivesThe rapid scale‐up of telehealth services for substance use disorders (SUDs) during the COVID‐19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management.MethodsTwo hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23‐item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics.ResultsParticipants were predominately male, White, and well‐educated. The majority (86.2%) were “very satisfied” or “satisfied” with the quality of telehealth care. “Very satisfied” ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%).Discussion and ConclusionsTelehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy.Scientific SignificanceThis is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID‐19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in‐person treatment, there was variability with respect to the preferred mode of treatment delivery.

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

COVID-19 vaccine trust among clients in a sample of California residential substance use treatment programs

BackgroundIndividuals with a substance use disorder (SUD) are at a significantly higher risk for coronavirus disease-19 (COVID-19) and have higher rates of COVID-19 related hospitalization and death than those without SUD. This study assessed COVID-19 vaccine trust, transmission awareness, risk and protective behaviors, and effects of COVID-19 on mental health and smoking among a sample of clients in California residential SUD treatment programs and identified factors associated with vaccine trust. MethodsA multi-site sample of SUD treatment clients (n = 265) completed a cross-sectional survey. Multivariable logistic regression was used to identify factors associated with COVID-19 vaccine trust. ResultsParticipants were predominantly male (82.3 %) and racially/ethnically diverse (33.3 % Non-Hispanic White). Most participants were aware of COVID-19 modes of transmission, however, only 39.5 % trusted a COVID-19 vaccine would be safe and effective. Factors independently associated with trust in a COVID-19 vaccine included age (AOR = 1.03, 95 % CI = 1.02, 1.05, p = 0.0001) and wearing a mask all the time (AOR = 2.48, 95 % CI = 1.86, 3.31, p = 0.0001). African Americans were less likely than White participants to trust that a COVID-19 vaccine is safe and effective (AOR = 0.41, 95 % CI = 0.23, 0.70, p = 0.001). ConclusionSUD treatment clients were aware of COVID-19 modes of transmission; however, fewer than half trusted that a COVID-19 vaccine would be safe and effective. Health communication about COVID-19 for people with SUD should use a multipronged approach to address COVID-19 vaccine mistrust and transmission risk behaviors.

Treatment of substance use disorder and psychological trauma: outcomes of the women of worth program

ABSTRACT Given the co-occurrence of substance use disorder (SUD) and posttraumatic stress disorder, existing SUD treatment programs are integrating the treatment of psychological trauma into their programming. The present study evaluated 120 women enrolled in the Women of Worth program, a gender-responsive treatment model, on several treatment outcomes. Substance use, depression, psychological trauma severity, and substance-related problems decreased significantly across time, only anxiety did not. Several study results also appear clinically meaningful. Overall, the results of the Women of Worth program may support the integration of psychological trauma treatment into existing SUD programs for women.

Tobacco use among substance use disorder (SUD) treatment staff is associated with tobacco-related services received by clients

BackgroundDespite disproportionately high rates of smoking among people in residential substance use disorder (SUD) treatment, few receive tobacco cessation services. Little is known about how smoking among treatment staff may impact this disparity. We explored the relationship between staff tobacco use and client tobacco use. Additionally, we examined the relationship between staff tobacco use and tobacco-related services reported by staff and clients. MethodsStaff (n = 363) and clients (n = 639) in 24 California publicly-funded residential SUD treatment programs were surveyed in 2019–20. Staff self-reported current tobacco use, as well as their beliefs, self-efficacy, and practices regarding smoking cessation. Clients reported their tobacco use and they services received while in treatment. Regression analyses examined the adjusted and unadjusted associations between staff and client tobacco use and other outcomes. ResultsUse of any tobacco product by staff ranged from 0% to 100% by program, with an average of 32% across programs. Adjusted analyses found that higher rates of staff tobacco use were associated with higher rates of client tobacco use, and with fewer clients receiving tobacco-related counseling. In programs that had higher rates of staff tobacco use, staff were less likely to believe that clients should quit smoking in treatment and had lower self-efficacy to address smoking. ConclusionHigher rates of tobacco use among staff are associated with higher rates of client tobacco use and fewer clients receiving cessation counseling. Efforts to reduce tobacco use among SUD clients should be supported by efforts to reduce tobacco use among staff. SUD treatment programs, and agencies that fund and regulate those programs, should aim to reduce the use of tobacco products among staff.