Substance Use Disorder Treatment Outcomes Research Articles

Perspectives regarding cannabis use: Results from a qualitative study of individuals engaged in substance use treatment in Georgia and Connecticut

ObjectiveCannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study’s objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months. MethodsFrom May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach. ResultsAll participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis. ConclusionAlthough participants described cannabis’s important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.

Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment.

Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches. PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes. Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches. Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.

Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature

BackgroundSyringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD.MethodsWe performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants’ SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs.ResultsSSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs.ConclusionsSSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.

A Transdiagnostic group therapy for sleep and anxiety among adults with substance use disorders: Protocol and pilot investigation.

Treatment of substance use disorders (SUDs) is challenging with high rates of treatment dropout and relapse, particularly among individuals with comorbid psychiatric conditions. Anxiety and insomnia are prevalent among those with SUD and exacerbate poor treatment outcomes. Interventions that concurrently target anxiety and insomnia during the early stages of SUD treatment are lacking. To this end, we investigated the feasibility and preliminary effectiveness in a single-arm pilot trial of an empirically informed group transdiagnostic intervention, Transdiagnostic SUD Therapy, to concurrently reduce anxiety and improve sleep among adults receiving treatment for SUD. Specifically, we hypothesized that participants would evidence declines in anxiety and insomnia and improvements in sleep health, a holistic, multidimensional pattern of sleep-wakefulness that promotes wellbeing. A secondary aim was to describe the protocol for Transdiagnostic SUD Therapy and how it may be implemented into a real-world addiction treatment setting. Participants were 163 adults (Mage = 43.23; 95.1% White; 39.93% female) participating in an intensive outpatient program for SUD who attended at least three of four Transdiagnostic SUD Therapy sessions. Participants had diverse SUDs (58.3% alcohol use disorder, 19.0% opioid use disorder) and nearly a third of the sample met criteria for two SUDs and comorbid mental health diagnoses (28.9% anxiety disorder, 24.6% major depressive disorder). As anticipated, anxiety and insomnia reduced significantly across the 4-week intervention period from clinical to subclinical severity, and sleep health significantly improved (ps < 0.001). These statistically significant improvements following Transdiagnostic SUD Therapy demonstrated medium to large effects (ds > 0.5). Transdiagnostic SUD Therapy is designed to be flexibly administered in "real-world" clinical settings and, preliminarily, appears to be effective in improving emotional and behavioral factors that increase risk for return to substance use and poor SUD treatment outcomes. Additional work is needed to replicate these findings, determine the feasibility of widespread uptake of Transdiagnostic SUD Therapy, and examine whether the treatment effects translate to improvement in substance use outcomes.

“…he’s going to be facing the same things that he faced prior to being locked up”: perceptions of service needs for substance use disorders

BackgroundHigh rates of substance use disorders (SUDs) exist among justice-involved populations (i.e., persons incarcerated or recently released). SUD treatment is crucial for justice-involved populations as unmet treatment need increases reincarceration risk and impacts other behavioral health sequalae. A limited understanding of health needs (i.e. health literacy) can be one reason for unmet treatment needs. Social support is critical to seeking SUD treatment and post-incarceration outcomes. However, little is known about how social support partners understand and influence SUD service utilization among formerly incarcerated persons.MethodsThis mixed method, exploratory study utilized data from a larger study comprised of formerly incarcerated men (n = 57) and their selected social support partners (n = 57) to identify how social support partners understand the service needs of their loved ones recently released from prison who returned to the community with a diagnosis of a SUD. Qualitative data included 87 semi-structured interviews with the social support partners covering post-release experiences with their formerly incarcerated loved one. Univariates were conducted on the quantitative service utilization data and demographics to complement the qualitative data.ResultsMajority of the formerly incarcerated men identified as African American (91%) averaging 29 years of age (SD = 9.58). Most social support partners were a parent (49%). Qualitative analyses revealed that most social support partners avoided using or did not know the language to use regarding the formerly incarcerated person’s SUD. Treatment needs were often attributed to focus on peer influences and spending more time at their residence/housing. Analyses did reveal that when treatment needs were recommended in the interviews, social support partners reported employment and education services to be most needed for the formerly incarcerated person. These findings align with the univariate analysis with their loved ones reporting employment (52%) and education (26%) as their most reported service utilized post-release, compared to only 4% using substance abuse treatment.ConclusionResults provide preliminary evidence suggesting social support partners do influence the types of services accessed by formerly incarcerated persons with SUD. The findings of this study emphasize the need for psychoeducation during and after incarceration for individuals with SUDs and their social support partners.

Inpatient treatment for substance use disorders: reductions in substance cravings, anxiety, and depressive symptoms

ABSTRACT Background Despite high rates of co-occurrence between substance use disorder (SUD) and other mental disorders, outcomes research is limited for dual-diagnosis inpatient treatment programs. Specifically, few studies have investigated whether inpatient programming for SUD can also improve symptoms of mental distress. Therefore, the goals of the current study were to: 1) determine if inpatient programming for SUD yields improvements in substance craving severity, anxiety, and depressive symptoms, and 2) determine if anxiety and depressive symptoms are associated with substance craving severity upon admission into treatment. Methods The sample consisted of 279 adults with SUDs admitted to an inpatient treatment program. Standardized Likert-style measures were used to assess substance cravings, generalized anxiety, and depressive symptoms. Measures were administered pre-treatment at admission and post-treatment at time of discharge. Results Results indicated that there were significant decreases in participant scores on all measures between admission and discharge. Anxiety and depressive symptoms were both linked to greater substance cravings. Conclusions These findings suggest that treatment for SUD may also be associated with improvements in psychological functioning. As mental distress can may hinder SUD treatment outcomes, efforts should be made to identify these patterns at the time of admission to better inform treatment planning and predict outcomes.

Integrated Infectious Disease and Substance Use Disorder Care for the Treatment of Injection Drug Use-Associated Infections: A Prospective Cohort Study With Historical Control.

To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and after hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes. We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion. There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction (aRR, 0.55 [95% confidence interval CI, .32-.95]; 24% vs 44%) of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital (93% vs 33%, P < .01), complete antibiotic treatment (90% vs 60%, P < .01), and less likely to have patient-directed discharge (17% vs 37%, P = .02). An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections.

A scoping review of electroencephalographic (EEG) markers for tracking neurophysiological changes and predicting outcomes in substance use disorder treatment.

Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD.

Longitudinal associations between pain and substance use disorder treatment outcomes

IntroductionPain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes. MethodsThis observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving. ResultsAnalyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect. ConclusionsReductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.

Linguistic predictors from Facebook postings of substance use disorder treatment retention versus discontinuation

ABSTRACT Background: Early indicators of who will remain in – or leave – treatment for substance use disorder (SUD) can drive targeted interventions to support long-term recovery. Objectives: To conduct a comprehensive study of linguistic markers of SUD treatment outcomes, the current study integrated features produced by machine learning models known to have social-psychology relevance. Methods: We extracted and analyzed linguistic features from participants’ Facebook posts (N = 206, 39.32% female; 55,415 postings) over the two years before they entered a SUD treatment program. Exploratory features produced by both Linguistic Inquiry and Word Count (LIWC) and Latent Dirichlet Allocation (LDA) topic modeling and the features from theoretical domains of religiosity, affect, and temporal orientation via established AI-based linguistic models were utilized. Results: Patients who stayed in the SUD treatment for over 90 days used more words associated with religion, positive emotions, family, affiliations, and the present, and used more first-person singular pronouns (Cohen’s d values: [−0.39, −0.57]). Patients who discontinued their treatment before 90 days discussed more diverse topics, focused on the past, and used more articles (Cohen’s d values: [0.44, 0.57]). All ps < .05 with Benjamini-Hochberg False Discovery Rate correction. Conclusions: We confirmed the literature on protective and risk social-psychological factors linking to SUD treatment in language analysis, showing that Facebook language before treatment entry could be used to identify the markers of SUD treatment outcomes. This reflects the importance of taking these linguistic features and markers into consideration when designing and recommending SUD treatment plans.

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York

There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned. Plan assignment. Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment. Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans. The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.

Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery

Background: The purpose of this qualitative study was to compare and contrast the differing perspectives of service users and professionals regarding the current substance use disorders (SUD) services provided in Summit County, Ohio. Seven focus groups were conducted with 44 participants (52.3% male, mean age 46 years), including 15 individuals in recovery, 16 direct service providers, and 13 executive directors. The participants were asked about three areas: (1) effective treatment for SUD, (2) challenges for persons with SUD, and (3) suggestions for improving SUD treatment outcomes. The data were analyzed and coded according to major themes. Results: While there were numerous emergent themes that were concordant between service use and professionals, several differing themes between the groups were also identified. First, participants disagreed on the effectiveness of medication-assisted treatment/Medications for Opioid Use Disorder. Second, professionals identified trauma, stigma, “one-size-fits-all” approach to treatment, and limitations set by managed care act as barriers to treatment, whereas individuals in recovery reported difficulty dealing with feelings, feeling of being rushed into recovery, and the lack of long-term recovery plans as the most significant barriers. Lastly, in order to improve treatment outcomes, professionals emphasized the importance of education unlike individuals in recovery who identified sober supports as the most important factor. Conclusion: This study identified challenges in SUD recovery and highlights essential areas for consideration when developing and implementing SUD treatment. The findings can be used as guidelines to provide better services to individuals with SUDs. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2058706 .

A preliminary investigation of the role of intraindividual sleep variability in substance use treatment outcomes

IntroductionPoor sleep health is common among individuals in early treatment for substance use disorders (SUDs) and may serve an important role in predicting SUD outcomes. However, sleep parameters have been inconsistently linked with risk of relapse, perhaps because previous research has focused on mean values of sleep parameters (e.g., total sleep time [TST], sleep efficiency [SE], and sleep midpoint [SM]) across multiple nights rather than night-to-night fluctuations (i.e., intraindividual variability [IIV]). The current study assessed sleep across the first week of SUD treatment, with the aim of prospectively examining the relationship between mean and IIV of TST, SE, and SM and treatment completion and relapse within one-month post-treatment. MethodsTreatment-seeking adults (N = 23, Mage = 40.1, 39% female) wore an actigraph to assess sleep for one week at the beginning of an intensive outpatient program treatment. Electronic medical record and follow-up interviews were utilized to determine treatment outcomes. ResultsGreater IIV in TST was associated with higher odds of relapse (OR = 3.55, p =.028). Greater IIV in SM was associated with lower odds of treatment completion, but only when removing mean SM from the model (OR = 0.75, p =.046). DiscussionNight-to-night variability in actigraphy-measured TST is more strongly associated with SUD treatment outcomes than average sleep patterns across the week. Integrating circadian regulation into treatment efforts to improve SUD treatment outcomes may be warranted. Given the small sample size utilized in the present study, replication of these analyses with a larger sample is warranted.

Mindfulness-Based Interventions for the Treatment of Aberrant Interoceptive Processing in Substance Use Disorders.

Altered interoception, or the processing of bodily signals, has been argued to play a role in the development and maintenance of substance use disorders (SUD). Therefore, interoceptive interventions focusing on bodily awareness, such as mindfulness meditation, may improve treatment outcomes for individuals with SUD. Here we review: (1) subjective, behavioral and brain evidence for altered interoceptive processing in SUD, focusing on insular and anterior cingulate cortices (INS, ACC), key regions for interoceptive processing; (2) research highlighting links between mindfulness and brain function; and (3) extant brain research investigating mindfulness-based interventions in SUD. SUD tend to be characterized by heightened INS and ACC responses to drug cues but blunted interoceptive awareness and attenuated INS and ACC responses during tasks involving bodily attention and/or perturbations. In contrast, mindfulness interventions in healthy individuals are linked to enhanced INS and ACC responses and heightened interoceptive awareness. It is crucial for future research to identify: (1) whether mindfulness-based treatments are efficacious across substance classes; (2) what particular approaches and dosages show the largest effect sizes in enhancing INS and ACC function to non-drug stimuli and reducing responsivity to substance cues, thereby improving SUD treatment outcomes (reducing drug craving and relapse).

Comparative outcomes for Black children served by the Sobriety Treatment and Recovery Teams program for families with parental substance abuse and child maltreatment

IntroductionAn urgent need exists for child welfare and substance use disorder (SUD) interventions that safely preserve Black families, engage parents in treatment services, and improve child and parent outcomes. The Title IV-E Prevention Services Clearinghouse rated The Sobriety Treatment and Recovery Teams (START) as a promising practice for families with parental substance use and child maltreatment. This study is the first to test the effects of START on Black families. MethodsThis study compared child welfare and parent outcomes for 894 children and their 567 primary parents in three groups: Black children served by START, Black children served in treatment as usual (TAU), and White children served in START. This was a quasi-experimental study using a propensity score matched dataset of START-served children to TAU children. Comparisons included placement in state custody and repeat child abuse or neglect (CA/N) during the intervention period, and at 12 months post-intervention. Generalized linear models accounted for the effects of clustering and unbalanced covariates on outcomes. ResultsIn this study, 51.8% of children were neonates or infants at the CPS report. At 12-months post-intervention, 80.6% of Black children served by START, but only 56.0% of Black children in TAU, remained free of both placement in state custody and CA/N (p < .001, OR = 3.27, 95% CI [2.14, 4.98]); these effects held after controlling for family clusters. Black and White families in START received equal SUD treatment and community-based services. For START-served families, parental use of opioids (p = .005, OR = 3.52, 95% CI [1.46, 8.48]) and mental health issues (p = .002, OR = 1.90, 95% CI [1.27, 2.86]), rather than race, predicted child placement in state custody. Parent mental health issues or opioid use doubled or quadrupled, respectively, the odds of failing to achieve early recovery by case closure. ConclusionsSTART is a potent intervention, co-implemented with SUD treatment providers, that kept Black children safely with their families through the intervention and 12-months post-intervention periods. Scaling up effective programs, like START, that align with the goals of the Family First Prevention Services Act might reduce racial disparities and improve child welfare and SUD treatment outcomes.

Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial.

Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. To determine whether patient navigation services reduce hospital readmissions. Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). Single-site trial, which limits generalizability. Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. National Institute on Drug Abuse.

Impacts of COVID-19 on residential treatment programs for substance use disorder

IntroductionThe COVID-19 pandemic may present special challenges for residential substance use disorder (SUD) treatment facilities, which may lack infrastructure and support to implement infection control protocols while maintaining on-site treatment services. However, little is known about how residential SUD treatment programs are impacted by the COVID-19 pandemic. MethodsThe research team conducted semi-structured interviews with 17 directors of 20 residential SUD treatment programs across California during the state's shelter-in-place order. The researchers then analyzed qualitative interview data thematically and coded them using ATLAS.ti software. FindingsThematic analyses identified six major themes: program-level impacts, staff impacts, client impacts, use of telehealth, program needs, and positive effects. “Program-level impacts” were decreased revenue from diminished client censuses and insufficient resources to implement infection control measures. “Staff impacts” included layoffs, furloughs, and increased physical and emotional fatigue. “Client impacts” were delayed treatment initiation; receipt of fewer services while in treatment; lower retention; and economic and psychosocial barriers to community re-entry. “Use of telehealth” included technical and interpersonal challenges associated with telehealth visits. “Program needs” were personal protective equipment (PPE), stimulus funding, hazard pay, and consistent public health guidance. “Positive effects” of the pandemic response included increased attention to hygiene and health, telehealth expansion, operational improvements, and official recognition of SUD treatment as an essential health care service. ConclusionStudy findings highlight COVID-related threats to the survival of residential SUD treatment programs; retention of the SUD treatment workforce; and clients' SUD treatment outcomes. These findings also identify opportunities to improve SUD service delivery and suggest avenues of support for residential SUD treatment facilities during and after the COVID-19 pandemic.

Individual and social network correlates of recent treatment for substance use disorders among persons who use drugs in Baltimore, MD (2014 – 2017)

BackgroundThis analysis examined individual and network correlates of treatment enrollment for substance use disorders (SUDs) in the past 6 months and whether these factors varied by type(s) of drug(s) used and type of SUD treatment received. MethodsBetween 2014 and 2017, 330 Baltimore residents who reported using heroin, crack, and/or cocaine in the past 6 months completed a survey to assess demographics, substance use, recent SUD treatment enrollment, and information about their network members. The primary outcome was recent enrollment in any type of SUD treatment (i.e., methadone maintenance, detox, residential, outpatient, and meetings/self-help) vs. none. Using logistic regression, recent SUD treatment enrollment was regressed on individual and network characteristics. ResultsOverall, 214 were enrolled in some form of SUD treatment in the past 6 months (56.6% Methadone Maintenance, 29.8% Detox, 25.9% Residential, 47.8% Outpatient, and 90.7% Meetings/Self-Help). The median number of network members listed was 4.0 (interquartile range: 4-6). In the adjusted model, the odds of SUD treatment enrollment increased with each additional network member who was currently enrolled in SUD treatment (Adjusted Odds Ratio [AOR]:2.22; 95%CI:1.47-3.33). The odds of SUD treatment enrollment decreased by 35% for each additional network member who used heroin, crack, and/or cocaine and could provide them with social support (AOR:0.65; 95%CI:0.48-1.88). ConclusionsOur findings suggest a complex link between the intersecting roles of network members and SUD treatment outcomes among persons who use drugs and the importance of collecting detailed social network information on the different domains of social support provided.

How Patient Centered Are Addiction Treatment Intake Processes?

The substance use disorder (SUD) treatment field has conducted significant research on creating intake tools and processes that best match patients to the most appropriate treatment setting, but less research has been conducted on how those tools impact the patient experience. The study took advantage of a natural experiment in California to evaluate whether the implementation of American Society of Addiction Medicine (ASAM) assessment criteria and a computer-facilitated intake assessment based on the ASAM criteria affects patient experiences and patient-centeredness during intake relative to patients receiving intake assessments not based on ASAM criteria. We analyzed surveys completed by 851 patients covered by Medi-Cal who were receiving specialty SUD treatment at 33 providers across 10 California counties about their experiences and perceptions of the intake assessment process. To account for differences in patient mix, we used inverse-probability weighting and computed differences in the weighted means for patients across non-ASAM, ASAM, and computerized-ASAM patients. We have found that patients who underwent intake based on ASAM assessment criteria or computerized ASAM assessment experienced a more patient-centered intake. We also found that patients who received ASAM-based assessments were more satisfied with their choice of treatment setting. This evidence is encouraging for the SUD treatment field, especially considering that many Medicaid programs are adopting ASAM or similar patient placement criteria and multidimensional assessments. Future research should consider whether increases in the patient-centeredness of assessments are associated with increased retention in SUD treatment and other positive treatment outcomes.

The impact of trauma characteristics on post-traumatic stress disorder and substance use disorder outcomes across integrated and substance use treatments

Proponents of complex post-traumatic stress disorder (PTSD) constructs suggest that specific trauma characteristics, such as earlier age of first trauma (trauma age) and higher number of traumas (trauma count), may obstruct PTSD symptom reduction in treatment. PTSD and substance use disorders (SUD) commonly co-occur, but the impact of trauma age and count on PTSD treatment responses in a comorbid PTSD and SUD sample is unclear. Further, no studies have examined the impact of trauma characteristics on SUD treatment outcomes or whether their impact on either PTSD or SUD outcomes varies if PTSD is directly addressed. A secondary analysis of a randomized controlled trial was conducted to examine: (1) whether trauma age and count influence comorbid PTSD and SUD (PTSD+SUD) responses during and following treatment; and (2) whether these effects differed across an exposure-based, integrated PTSD+SUD treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE) and a SUD-only focused treatment (Relapse Prevention Therapy; RPT). Individuals with PTSD+SUD randomized to COPE (n = 39) or RPT (n = 43) provided weekly measurements of PTSD and SUD. Across COPE and RPT, earlier trauma age predicted reduced SUD improvement (B = −0.01, standard error = 0.00). Trauma count did not predict changes in PTSD or SUD during or following treatment. These findings suggest that excluding individuals from exposure-based, integrated treatments on the basis of trauma characteristics is not empirically supported. However, individuals with earlier trauma ages may require additional or unique clinical attention to improve their SUD outcomes.