CORK Bibliography: Aftercare
49 citations. January 2009 to present
Prepared: March 2011
Alvarez J; Jason LA; Davis MI; Olson BD; Ferrari JR. Latinos and Latinas in communal settings: A grounded theory of recovery. International Journal of Environmental Research and Public Health 6(4): 1317-1334, 2009. (45 refs.)Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program's therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study's findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs. Copyright 2009, Molecular Diversity Preservation
Anglin MD; Brown BS; Dembo R; Leukefeld C. Criminality and addiction: Selected issues for future policies, practice, and research. Journal of Drug Issues 39(1): 89-99, 2009. (43 refs.)The high cost of incarceration and a general confidence in the effectiveness of drug abuse treatment have led many states to adopt community-based drug abuse treatment as part of, or as an alternative to, incarceration. Community re-entry and aftercare have therefore received increasing attention from both practitioners and researchers. This article examines possibilities for encouraging change in both adult and juvenile justice treatment. Four issues are highlighted: (1) relapse and aftercare, (2) co-occurring disorder, (3) juvenile justice programming, and (4) women's treatment. The success of U. S. drug treatment policy depends on a capacity to resolve these and related issues. Copyright 2009, Journal of Drug Issues, Inc.
Bell N; Kanitkar K; Kerksiek K; Watson W; Das A; Kostina-Ritchey E et al. "It has made college possible for me": Feedback on the impact of a university-based center for students in recovery. Journal of American College Health 57(6): 650+, 2009. (12 refs.)Objective: The authors aimed to gain information on (1) the challenges for recovering students on a university campus and (2) the most helpful components of a collegiate recovery program. Participants: The 15 students in the study were all in recovery from substance abuse. They entered the university and also entered the campus recovery program either in fall 2002 or fall 2003. Methods: Semistructured interviews were conducted with students multiple times during their first academic year. Results: Participants identified several challenges on the university campus. Many believed they would have dropped out of school or relapsed without the support of the recovery program, and they described aspects of the program that were particularly important to them. Conclusions: Support from a campus recovery program is essential for many recovering students. There are a variety of recovery program components that can foster the sense of community that was so important to the students in this study. Copyright 2009, American College Health Association
Businelle MS; Rash CJ; Burke RS; Parker JD. Using vouchers to increase continuing care participation in Veterans: Does magnitude matter? American Journal on Addictions 18(2): 122-129, 2009. (34 refs.)The present study examined the comparative effects of adding contingency management (CM) schedules to an existing substance abuse continuing care program, with the goal of increasing attendance. We retrospectively examined the attendance of 135 veterans enrolled in one of three CM programs and a quasi-control condition of 55 veterans. Results indicated that participants enrolled in the two higher magnitude CM voucher programs increased both continuing care attendance and length of participation. Findings support the use of CM to increase continuing care attendance among veterans with substance use disorders, and suggest that voucher magnitude and bonuses both had a positive impact. Copyright 2009, Taylor & Francis
Campbell BK; Fuller BE; Lee ES; Tillotson C; Woelfel T; Jenkins L et al. Facilitating outpatient treatment entry following detoxification for injection drug use: A multisite test of three interventions. Psychology of Addictive Behaviors 23(2): 260-270, 2009. (61 refs.)A multisite, randomized trial within the National Drug Abuse Treatment Clinical Trials Network (CTN) was conducted to test 3 interventions to enhance treatment initiation following detoxification: (a) a single session, therapeutic alliance intervention (TA) added to usual treatment; (b) a 2-session counseling and education, HIV/HCV risk reduction intervention (C&E), added to usual treatment; and (c) treatment as usual (TAU) only. Injection drug users (n = 632) enrolled in residential detoxification at 8 community treatment programs were randomized to I of the 3 study conditions. TA participants reported entering outpatient treatment sooner and in greater numbers than TAU participants. Reported treatment entry for C&E fell between TA and TAU with no significant differences between C&E and the other conditions. There were no differences among the interventions in retention, as measured by weeks of outpatient treatment for all participants who reported treatment entry. Alliance building interventions appear to be effective in facilitating transfer from detoxification to outpatient treatment, but additional treatment engagement interventions may be necessary to improve retention. Copyright 2009, Educational Publishing Foundation
Day A; Casey S. Maintaining change programmes for offenders: Some suggestions for practice. (review). Psychology, Crime & Law 16(6): 449-458, 2010. (36 refs.)Despite the widespread acceptance that follow-up or maintenance sessions are an important part of the change process for those who have completed offender rehabilitation programmes, there have been few attempts to articulate the basis upon which such sessions might be developed. This paper reviews the current theoretical and empirical literature relating to maintenance programmes, concluding that whilst there are a number of theories which might be relevant to the design of effective maintenance programmes, there is almost no empirical basis from which to make any assessment of their likely value or effectiveness. Copyright 2010, Taylor & Francis
Carroll CP; Triplett PT; Mondimore FM. The Intensive Treatment Unit: A brief inpatient detoxification facility demonstrating good postdetoxification treatment entry. Journal of Substance Abuse Treatment 37(2): 111-119, 2009. (41 refs.)Inpatient detoxification is frequently used to treat substance use disorders, despite consistent findings that drug use soon after detoxification is the norm. A number of lines of evidence suggest the most rational means of improving outcomes after detoxification is to improve postdetoxification treatment entry. This report presents outcomes from the Intensive Treatment Unit (ITU), a brief inpatient detoxification unit in Baltimore, MD, found to have good postdischarge treatment entry outcomes. The patients followed were predominantly male African Americans in early middle age who were sequentially admitted to the unit (N = 134) and demonstrated severe social disruption and psychiatric comorbidity. More than 80% of the patients discharged from the ITU were admitted to treatment postdetoxification, with most going to long-term residential settings or recovery houses. Success was associated with seeking residential treatment, and failure was concentrated among the minority discharged with no plan for aftercare and those seeking outpatient treatments. The report explores patient and process factors associated with these outcomes and discusses the possibility that the ITU may be a model system for improving outcomes postdetoxification. Copyright 2009, Elsevier Science
de Vries SC; Wierdsma AI. Exploring continuity of care in patients with alcohol use disorders using time-variant measures. European Addiction Research 15(1): 19-24, 2009. (33 refs.)Background/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatryric Case Register for the Rotterdam Region, The Netherlands. Continuity measures were calculated for each day over a 2-year observation period. Repeated measures analysis was used to identify factors that influence continuity of care over time. Results: Continuity of care was higher for patients with more severe disorders. Though quantity of care was high for patients with long problem history during the first year of treatment, it decreased strongly in the second year. The intervals between treatment contacts were shorter for women, especially young ones, than for men. Conclusion: Time-variant measures showed differences in continuity of care that would not have been revealed if more aggregated measures of service use had been used. Copyright 2009, Karger
Dixon L; Goldberg R; Iannone V; Lucksted A; Brown C; Kreyenbuhl J et al. Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services 60(4): 451-458, 2009. (22 refs.)Objectives: This study assessed the effectiveness of a brief three-month critical time intervention (B-CTI) model in improving continuity of psychiatric outpatient care for individuals with serious mental illness who are discharged from inpatient psychiatric treatment facilities. Methods: A total of 135 consenting veterans who were diagnosed as having serious mental illness and were discharged from an acute inpatient unit were randomly assigned to receive either B-CTI or usual care. The three-month B-CTI intervention begins before discharge. A B-CTI clinician meets with the patient, assesses needs, and maintains a high level of patient contact after discharge. Participants completed interviews at baseline and three months later. Chart reviews provided data on service utilization in the six months postdischarge. Results: Compared with the control group, the B-CTI group had significantly fewer days between their hospital discharge and their first outpatient service. B-CTI participants were more likely to have had an outpatient visit and to have had more total mental health and substance abuse visits within 30 and 180 days of discharge. They had greater continuity of care as evidenced by a greater number of two-month blocks with two or more outpatient visits over 180 days. Participants in the B-CTI group reported receiving more help in making and keeping medical and mental health appointments, making family contact and community connections, and receiving information on prescribed medications. Conclusions: This study provides evidence that a B-CTI targeted at the point of inpatient discharge can be helpful in promoting postdischarge continuity of care for persons with serious mental illness. The limited association of improved continuity of care with patient outcomes in this brief intervention demands further study. Copyright 2009, American Psychiatric Association
Ekendahl M. Alcohol abuse, compulsory treatment and successive aftercare: A qualitative study of client perspectives. International Journal of Social Welfare 18(3): 260-269, 2009. (40 refs.)In Sweden, the social welfare boards have a statutory duty to provide aftercare for compulsorily treated substance abusers. However, there are no data on how the aftercare is organised and how clients perceive this phase of the compulsory treatment process. The aim of the study is to analyse how a sample of compulsorily treated alcohol abusers (n = 12) characterise the current coercive treatment episode and evaluate previously experienced and forthcoming aftercare interventions. Qualitative interview-data were coded into themes and sub-themes encompassing relevant client perspectives. Results show that the alcohol abusers claimed to want (but be denied) adequate help for their problems, both during primary treatment and after discharge. Their perspectives on coercive care and aftercare interventions appeared related to their views on their own problems and on being incarcerated. For instance, those who recognised their own alcohol problems emphasised the importance of quitting consumption and were dissatisfied with interventions offered during and subsequent to compulsory treatment referrals. Copyright 2009, Wiley-Blackwell Publishing
Estopinan PC; Poza AP; Martin PS; Garcia CP. Group psychotherapy for prevention of relapses in alcoholism compared to standard outpatient follow-up (Spanish). Adicciones 21(1): 15-19, 2009. (21 refs.)Introduction: Relapse Prevention (RP) is the central and most original focus in the treatment of addictions. Several studies support the effectiveness of group therapy in RP. Aims: To compare group psychotherapy for RP with standard follow-up of alcohol-abuse/dependence patients. Method: Fourteen patients were assigned to the relapse prevention group and another ten patients received the standard outpatient monitoring. Numbers of relapses during the group therapy and one year later were recorded. Results: We found statistically significant differences (chi 2(2)=7.95; p=0.019) between the two groups for rates of abstinence and relapse at the twelve-month follow-up. Conclusions: Group Therapy for Relapse Prevention is effective, easy to apply in the outpatient context and obtains better rates of abstinence than standard outpatient treatment at the one-year follow-up. Copyright 2009, Socidogalcohol
Ferrari JR; Aase DM; Mueller DG; Jason LA. Landlords of self-governed recovery homes: An initial exploration of attitudes, opinions, and motivation to serve others. Journal of Psychoactive Drugs 41(4): 349-354, 2009. (17 refs.)Landlords of community-based recovery homes are an under-researched group. The few existing studies available suggest that landlords might be more open to renting to vulnerable populations if certain conditions are met or communication is more open between all parties involved. The present exploratory study surveyed landlords (n = 30) of self-governed recovery homes across the United States regarding their attitudes and opinions about renting to these homes, and motivations for community service. Results indicated that landlords generally had positive perceptions of renting to self-governed recovery environments, and even perceived benefits of renting to these homes compared to more traditional tenants. Implications of these findings for future research are discussed in the context of existing research and limitations of the present study. Copyright 2009, Haight-Ashbury Publishing
Fogger SA; McGuinness T. Alabama's Nurse Monitoring: Nurse's experience of being monitored. Journal of Addictions Nursing 20(3): 142-149, 2009. (45 refs.)Over the last 25 years, nursing regulatory agencies have developed programs for nurses recovering from substance use disorders. It is estimated that over 250,000 nurses are affected by substance use disorders. Recovery rates for nurses are higher than the general public due, in part, to the regulatory agency oversight. Within the State of Alabama, the Board of Nursing manages both voluntary alternative to discipline and disciplinary monitoring programs. Both programs allow nurses in recovery to return to work with supervision. This project sought to evaluate recovering nurses' attitudes about the monitoring program. Nurses actively involved in both monitoring programs (N = 173) were asked complete an anonymous survey to evaluate and share perspectives of the experience. The participants reported that the monitoring process was cumbersome, yet the structure assisted nurses to remain in recovery. Copyright 2009, Taylor & Francis
Frydrych LM; Greene BJ; Blondell RD; Purdy CH. Self-help program components and linkage to aftercare following inpatient detoxification. Journal of Addictive Diseases 28(1): 21-27, 2009. (11 refs.)Many patients fail to initiate aftercare for addictive disease rehabilitation following detoxification. This study of 136 inpatients compared characteristics of those who initiated aftercare (behavior therapy or self-help programs) during the week following discharge with those who did not. Among this group of patients, 77% (91/119) linked to aftercare. Self-help treatment related components were associated with increased aftercare treatment attendance rates and included: having a copy of the 12 Steps (81% vs. 46%, P = .002), having read self-help literature (73% vs. 42%, P = .007), and having telephone numbers of self-help program members (50% vs. 18%, P = .008). Those who initiated aftercare treatment were also more likely to have remained abstinent from drugs and alcohol (81% vs. 39%, P .001). Having self-help treatment related components was associated with increased rates of aftercare attendance following hospital inpatient detoxification. Copyright 2009, Haworth Press
Garner BR; Godley MD; Funk RR; Lee MT; Garnick DW. The Washington Circle continuity of care performance measure: Predictive validity with adolescents discharged from residential treatment. Journal of Substance Abuse Treatment 38(1): 3-11, 2010. (55 refs.)This study examined the predictive validity of the Washington Circle (WC) continuity of care after long-term residential treatment performance measure, as well as the impact of assertive continuing care interventions on achieving continuity of care. This measure is a process measure that focuses on timely delivery of a minimal floor of services that are necessary to provide sufficient quality of treatment but should not be construed to be the optimal continuity of care after residential treatment for any specific adolescent. Participants included 342 adolescents who were admitted to long-term residential treatment and randomly assigned to either standard continuing care or an assertive continuing care condition. Overall, results provide initial support for the WC continuity of care after residential treatment performance measure as a useful predictor of 3-month recovery status. In addition, assignment to an assertive continuing care condition was found to significantly increase the likelihood of achieving continuity of care. Copyright 2010, Elsevier Science
Gil-Rivas V; Prause J; Grella CE. Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure. Psychology of Addictive Behaviors 23(2): 303-314, 2009. (80 refs.)This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure. and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were lot associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. Copyright 2009, Educational Publishing Foundation
Godley MD; Coleman-Cowger VH; Titus JC; Funk RR; Orndorff MG. A randomized controlled trial of telephone continuing care. Journal of Substance Abuse Treatment 38(1): 74-82, 2010. (41 refs.)Telephone continuing care (TCC) was compared to usual continuing care (UCC) on substance use and related problems among adults discharged from residential treatment. Participants were randomly assigned to receive either UCC or TCC. A tapered TCC protocol, initiated by paraprofessional staff and volunteers, was provided during the first 3 months following discharge. The TCC condition participants reported high satisfaction ratings with the procedure and were more than twice as likely to enter continuing care than UCC participants. At the 3-month point, TCC patients reported significantly fewer past-month substance problems than UCC patients. Among the subgroup of lower severity (LS) participants, the TCC-LS sample had both significantly more days abstinent and fewer past-month substance problems at 3 months than the UCC-LS sample. The significant between-group differences in substance use outcomes were not maintained at the 6-month follow-up. The high satisfaction ratings and early favorable response among TCC patients suggest the procedure is promising. Further research with larger samples and over a longer period is necessary. Copyright 2010, Elsevier Science
Wisdom JP; Gogel LP. Perspectives on adolescent residential substance abuse treatment: When are adolescents done? Psychiatric Services 61(8): 817-821, 2010. (19 refs.)Objectives: the study evaluated responses from adolescents in substance abuse treatment, their parents, and treatment staff to the question of what constitutes treatment success. Methods: Semistructured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at three residential substance abuse treatment programs in two states. Data were coded and organized into themes by respondent type. Results: Respondents reported knowing when treatment was no longer needed based on changes in adolescents' substance use, treatment-related and other behaviors, and attitudes and character. A fourth category of responses indicated respondents' ambiguity regarding successful completion of substance abuse treatment. Little concurrence was found among adolescents, parents, and treatment center staff to indicate criteria suggesting that discharge is appropriate. Conclusions: Substance abuse treatment programs and their clients may benefit from ensuring that staff, parents, and adolescents are aware of treatment goals to promote more effective treatment and improve collaboration toward the adolescent's recovery. Copyright 2010, American Psychiatric Association
Hakansson A; Isendahl P; Wallin C; Berglund M. Efficacy of mobile telephone contact for follow-up in injecting heroin users. American Journal of Drug and Alcohol Abuse 37(2): 89-92, 2011. (3 refs.)Background: Prospective follow-up of heroin users is known to be difficult due to their unstable lifestyle, and high follow-up rates have usually demanded major tracking efforts. In Sweden, mobile telephones are commonly used by heavy drug users for drug trading. Objectives: This methodology study aims to examine the efficacy of mobile telephone contact for prospective follow-up interviews with injecting heroin users recruited at the syringe exchange program of Malmoo, Sweden. Methods: Seventy-eight heroin users with mobile telephone numbers were included. Subjects reported using heroin for 28 days of the previous 30 days, and only 8%% reported they had recently been engaged in work or studies. Clients were contacted between 15 and 21 times over 2 years, with each contact attempt generally involving two telephone calls on consecutive days. Results: During follow-up, 68%% of subjects had been successfully contacted for at least one follow-up interview (on average 6.9 interviews), and 25%% of follow-up attempts were successful. In 23%% of the sample (n = 18), at least 50%% of follow-up attempts were successful, and these subjects tended to be older (p = .05) and more likely to be female (p = .07), whereas follow-up rates were unrelated to baseline heroin use. Conclusions and Scientific Significance: Despite limited effort, and despite the severe situation of intravenous heroin users, mobile telephone contact can be used with heavy drug users in the present setting. Copyright 2011, Informa Health
Kaminer Y; Godley M. From assessment reactivity to aftercare for adolescent substance abuse: Are we there yet? Child and Adolescent Psychiatric Clinics of North America 19(3): 577-+, 2010. (90 refs.)This article addresses less developed areas of clinical research that are of great importance for better understanding the therapeutic process along the continuum of care in youth with alcohol and other substance use disorders (AOSUD). These include the rationale, design, mechanisms of behavior change (MBCs), implementation, monitoring, and outcome-based modification of treatment continuum for youth with AOSUD. The specific objectives are: (1) present current knowledge pertaining to the pretreatment phase including the effect of baseline assessment on treatment outcome; (2) address potential MBCs in treatment; (3) discuss the importance of aftercare, also known as continued care, to prevent postintervention relapse; (4) consider how reconceptualization of therapeutic paradigms might advance the field, in particular treatment algorithm or adaptive treatment strategies addressing poor response to treatment. Copyright 2010, W B Saunders/Elsevier Science
Karno MP; Longabaugh R; Herbeck D. What explains the relationship between the therapist structure x patient reactance interaction and drinking outcome? An examination of potential mediators. Psychology of Addictive Behaviors 24(4): 600-607, 2010. (33 refs.)Recent research found that among patients in aftercare treatment for alcoholism the level of therapist structure interacted with the level of patients interpersonal reactance to predict alcohol use outcomes. The present study examined two sets of potential mediators of this interaction effect among a sample from two aftercare sites of Project MATCH (n = 127). The mediator constructs were types of pro-recovery change talk and resistance to therapeutic work. Dependent variables were percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD) across the year after treatment. Multiple-mediator models using bootstrapped estimates of indirect effects were used to test for mediation. Results indicated that the 'taking steps' aspect of change talk partially mediated the Structure X Reactance interaction effect on both PDA and PHDD post treatment. Resistance was not found to mediate the interaction effect though resistance did predict worse drinking outcomes. Depending on patients' openness to being influenced by others, therapist structure early in treatment may promote or inhibit pro-recovery steps taken by aftercare patients between treatment sessions. Those steps in turn play an important role in predicting future alcohol use. Copyright 2010, American Psychological Association
Kavanagh DJ; Connolly JM. Interventions for co-occurring addictive and other mental disorders (AMDs). Addictive Behaviors 34(10, Special Issue): 838-845, 2009. (80 refs.)While research on the management of co-occurring addictive and mental disorders (AMDs) has grown substantially in recent years, we still have little guidance on specific strategies. Consideration of epidemiological research and ethical principles can supplement existing clinical trials in providing a way forward. High frequencies of co-occurring disorders, equity of access for affected individuals and potential clashes between services in priorities and procedures, suggest that a stepped model of care by a single service may often be required. Typically, problems are multiple rather than dual, with potential for mutual influence, suggesting a need for interventions that are sensitive to and encompass complex co-occurring problems. Motivational problems are endemic, initial gains are often partial and unstable, and relapses potentially have serious consequences, suggesting a need for long-term, assertive follow-up. Principles such as these provide a solid framework for designing both services and interventions. However, there is a continuing need for controlled trials that unpack effective components of interventions, and increase their impact. Copyright 2009, Elsevier Science
Kelly JF; Dow SJ; Yeterian JD; Kahler CW. Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis. Drug and Alcohol Dependence 110(1-2): 117-125, 2010. (47 refs.)Background: Despite advances in the development of treatments for adolescents with substance use disorders (SUD), relapse remains common following an index treatment episode. Community continuing care resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been shown to be helpful and cost-effective recovery resources among adults. However, little is known about the clinical utility and effectiveness of AA/NA for adolescents, despite widespread treatment referrals. Method: Adolescents (N=127; 24% female, 87% White, M age = 16.7 years) enrolled in a naturalistic, prospective study of community outpatient treatment were assessed at intake, and 3 and 6 months later using a battery of standardized and validated measures. Results: Just over one-quarter of youth attended AA/NA meetings during the first 3 months, which was predicted by a goal of abstinence, prior AA/NA attendance, and prior SOD treatment experiences. Controlled multiple regression analyses revealed an independent effect of AA/NA on abstinence, in both contemporaneous and lagged models, which persisted over and above the effects of pre-treatment AA/NA attendance, prior treatment, self-efficacy, abstinence goal, and concomitant outpatient treatment. Conclusions: Results suggest that, similar to findings comparing adult outpatients to inpatients, AA/NA participation is less common among less severe adolescent outpatients. Nonetheless, attendance appears to strengthen and extend the benefits of typical community outpatient treatment. Given the dramatic increase in rates of substance use among same-aged peers in the population at this life-stage, and the relative dearth of abstainers and recovery-specific supports, these resources may provide a concentrated cost-effective social recovery resource for young people. Copyright 2010, Elsevier Science
Korcha RA; Polcin DL; Bond JC; Lapp WM; Galloway G. Substance use and motivation: a longitudinal perspective. (review). American Journal of Drug and Alcohol Abuse 37(1): 48-53, 2011. (30 refs.)Background: Motivation to change substance use behavior is an important component of the recovery process that has usually been studied at entry into treatment. Less studied, but equally important, is the measurement of motivation over time and the role motivation plays in subsequent substance use. Objectives: The present study sought to examine longitudinal motivation toward sobriety among residents of sober living houses. Methods: Sober living residents (n = 167) were followed at 6-month intervals over an 18-month period and assessed for motivation and substance use outcomes at each study interview. Motivation was measured using the costs and benefits subscales of the Alcohol and Drug Consequences Questionnaire (ADCQ) and substance use outcomes included the Addiction Severity Index (ASI) alcohol scale, ASI drug scale, and peak density of substance use (number of days of most use in a month). Results: Participants reported higher benefits than costs of sobriety or cutting down substance use at every study time point. Using lagged generalized estimating equation models, the ADCQ costs predicted increased severity for alcohol, drugs, and peak density, whereas the benefits subscale predicted decreased drug and peak density. Conclusion: Longitudinal measurement of motivation can be a useful clinical tool to understand later substance use problems. Scientific significance: Given the mixed findings from prior studies on the effects of baseline motivation, a shift toward examining longitudinal measures of motivation at proximal and temporal intervals is indicated. Copyright 2011, Informa Health
Lai DTC; Cahill K; Qin Y; Tang JL. Motivational interviewing for smoking cessation. (review). Cochrane Database of Systematic Reviews 1: CD006936, 2010. (68 refs.)Background: Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit. Objectives: To determine the effects of motivational interviewing in promoting smoking cessation. Search strategy We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with terms (motivational OR motivation OR motivating OR motivate OR behavi* OR motivat*) and (interview* OR session* OR counsel* OR practi*) in the title or abstract, or as keywords. Date of the most recent search: April 2009. Selection criteria: Randomized controlled trials in which motivational interviewing or its variants were offered to smokers to assist smoking cessation. Data collection and analysis We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were treated as continuing smokers. We performed meta-analysis using a fixed-effect Mantel-Haenszel model. Main results: We identified 14 studies published between 1997 and 2008, involving over 10,000 smokers. Trials were conducted in one to four sessions, with the duration of each session ranging from 15 to 45 minutes. All but two of the trials used supportive telephone contacts, and supplemented the counselling with self-help materials. MI was generally compared with brief advice or usual care in the trials. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.27; 95% CI 1.14 to 1.42). Subgroup analyses suggested that MI was effective when delivered by primary care physicians (RR 3.49; 95% CI 1.53 to 7.94) and by counsellors (RR 1.27; 95% CI 1.12 to 1.43), and when it was conducted in longer sessions (more than 20 minutes per session) (RR 1.31; 95% CI 1.16 to 1.49). Multiple session treatments may be slightly more effective than single sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls. There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing. Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports. Authors' conclusions: Motivational interviewing may assist smokers to quit. However, the results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias. Copyright 2010, John Wiley & Sons
Laudet AB; White W. What are your priorities right now? Identifying service needs across recovery stages to inform service development. Journal of Substance Abuse Treatment 38(1): 51-59, 2010. (60 refs.)Substance use disorders (SUD) are, for many, chronic conditions that are typically associated with severe impairments in multiple areas of functioning. "Recovery" from SUD is, for most, a lengthy process; improvements in other areas of functioning do not necessarily follow the attainment of abstinence. The current SUD service model providing intense, short-term, symptom-focused services is ill-suited to address these issues. A recovery-oriented model of care is emerging, which provides coordinated recovery-support services using a chronic-care model of sustained recovery management. Information is needed about substance users' priorities, particularly persons in recovery who are not currently enrolled in treatment, to guide the development of recovery-oriented systems. As a first step in filling this gap, we present qualitative data on current life priorities among a sample of individuals that collectively represent successive recovery stages (N = 356). Findings suggest that many areas of functioning remain challenging long after abstinence is attained, most notably employment and education, family/social relations, and housing. Although the ranking of priorities changes somewhat across recovery stages, employment is consistently the second most important priority, behind working on one's recovery. Study limitations are noted, and the implications of findings for the development and evaluation of recovery-oriented services are discussed. Copyright 2010, Elsevier Science
Lee S; Wong YLI; Rothbard AB. Factors associated with departure from supported independent living: Programs for persons with serious mental illness. Psychiatric Services 60(3): 367-373, 2009. (44 refs.)Objective: Supported housing is a viable model that offers independence and opportunity for community integration. However, previous studies have shown that not all residents can sustain long-term tenancy. This study examined the extent to which personal and housing characteristics predicted positive and negative departures from independent housing programs that provided support services to persons with serious mental illness. Methods: The sample consisted of 237 persons participating in a supported independent living program in Philadelphia. Cox proportional hazards models were used to estimate the effects of personal and housing characteristics on the probability of positive departure (to an arrangement with more autonomy) and negative departure (to an arrangement with more supervision or to homelessness). Results: Most participants (69%) maintained continuous residence in the program for the study period, 14% experienced a positive departure, and 17% a negative departure. A self-reported past substance abuse problem increased the probability of a negative departure, and a more supportive relationship with program staff decreased the probability. A higher income increased the probability of a positive departure, whereas a higher level of social distress in the neighborhood decreased the probability. Conclusions: The findings suggest that long-term housing tenure was not uncommon among supported independent living residents, but some were not able to maintain independent living and were discharged to shelters, institutions, or residential settings with more supervision. Predictors of positive and negative departure identified in this study may help service providers design services to meet the various needs of persons with serious mental illness for stable independent living. Copyright 2009, American Psychiatric Association
Marich J. Eye movement desensitization and reprocessing in addiction continuing care: A phenomenological study of women in recovery. Psychology of Addictive Behaviors 24(3): 498-507, 2010. (62 refs.)Traditional models of addiction treatment and relapse prevention fail to consider the role that unresolved trauma plays in an addicted woman's recovery experience. Implementing Eye Movement Desensitization and Reprocessing (EMDR) into the treatment process offers a potential solution to this problem. Ten women (alumnae of an extended-care treatment facility) participated in a semistandardized interview to share their experiences with active addiction, treatment, EMDR therapy, and recovery. With the use of A. P. Giorgi's descriptive phenomenological psychological method for analysis, four major thematic areas emerged from the interview data: the existence of safety as an essential crucible of the EMDR experience, the importance of accessing the emotional core as vital to the recovery experience, the role of perspective shift in lifestyle change, and the use of a combination of factors for successful treatment. All 10 women, to some degree, credited EMDR treatment as a crucial component of their addiction continuing-care processes, especially in helping with emotional core access and perspective shift. Implications emerge from the data on how to best implement EMDR into a comprehensive addiction treatment program. Copyright 2010, Educational Publishing Foundation
Mckay JR. Continuing care research: What we have learned and where we are going. Journal of Substance Abuse Treatment 36(2): 131-145, 2009. (80 refs.)In the field of addiction treatment, the term continuing care has been used to indicate the stage of treatment that follows an initial episode of more intensive care. This article reviews controlled studies of continuing care conducted over the prior 20 years. The results indicate that continuing care interventions were more likely to produce positive treatment effects when they had a longer planned duration, made more active efforts to deliver treatment to patients, and were studied more recently. However, there was considerable variability in patient response and room for improvements in participation rates and effectiveness. It is possible that the effectiveness of continuing care interventions could be further improved by the use of adaptive algorithms, which adjust treatment over time based on changes in patients' symptoms and status. The use of alternative service delivery methods and care settings may also lead to greater engagement and retention in continuing care, particularly among the large numbers of individuals who do not want traditional, clinic-based specialty care. Copyright 2009, Elsevier Science
Mckay JR; Carise D; Dennis ML; Dupont R; Humphreys K; Kemp J et al. Extending the benefits of addiction treatment: Practical strategies for continuing care and recovery. (editorial). Journal of Substance Abuse Treatment 36(2): 127-130, 2009. (0 refs.) Copyright 2009, Elsevier Science
Mckay JR; Lynch KG; Coviello D; Morrison R; Cary MS; Skalina L et al. Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement. Journal of Consulting and Clinical Psychology 78(1): 111-120, 2010. (57 refs.)Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. Method: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. Results: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = .05), with no significant CM x RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p < .01, and RP, OR = 4.89 (1.51, 15.86), p < .01, and produced better cocaine urine toxicology outcomes at 9 months than treatment as usual, OR = 4.21 (1.37, 12.88), p < .01, and RP, OR = 4.24 (1.32, 13.65), p < .01. Trends also favored CM + RP over CM at 6 months, OR = 2.93 (0.94, 9.07), p = .06, and 9 months, OR = 2.93 (0.94, 9.10), p = .06. Differences between the conditions were not significant after 9 months. Conclusions: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP. Copyright 2010, American Psychological Association
McLellan AT. Public accountability in addiction treatment. Lancet 374(9697): 1220-1221, 2009. (5 refs.)This commentary refers to "Effectiveness of community treatments for heroin and crack cocaine addiction in England: A prospective, in-treatment cohort study" in this issue. It addresses the methodology as well as the results of a treatment outcome study. It is also noted that if addiction is viewed as a chronic illness, then a reduction of use is a notable outcome, and that the challenge becomes on-going care on an outpatient after a residential stay. The outcome for physicians is noted as the rare instance where this continuing treatment is provided, and with outcomes of 81% of persons have sustained abstinence over 5 years. Copyright 2009, Elsevier Science
Messina N; Grella CE; Cartier J; Torres S. A randomized experimental study of gender-responsive substance abuse treatment for women in prison. Journal of Substance Abuse Treatment 38(2): 97-107, 2010. (50 refs.)This experimental pilot study compared postrelease outcomes for 115 women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment (GRT) program using manualized curricula (Helping Women Recover and Beyond Trauma) or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Bivariate and multivariate analyses were conducted. Results indicate that both groups improved in psychological well-being; however, GRT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer (2.6 vs. 1.8 months, p < .05), and were less likely to have been reincarcerated within 12 months after parole (31% vs. 45%, respectively; a 67% reduction in odds for the experimental group, p < .05). Findings show the beneficial effects of treatment components oriented toward women's needs and support the integration of GRT in prison programs for women. Copyright 2010, Elsevier Science
Mowbray CT; Woodward AT; Holter MC; MacFarlane P; Bybee D. Characteristics of users of consumer-run drop-in centers versus clubhouses. Journal of Behavioral Health Services & Research 36(3): 361-371, 2009Clubhouses and consumer-run drop-in centers (CRDIs) are two of the most widely implemented models of consumer-centered services for persons with serious mental illness. Differences in structure and goals suggest that they may be useful to different types of consumers. Information on what types of consumers use which programs would be useful in service planning. This study analyzes data from the authors' NIMH-funded research on 31 geographically matched pairs of clubhouses and CRDIs involving more than 1,800 consumers to address the following question: are there significant differences in the characteristics and outcomes of members of clubhouses versus CRDIs? Results from multilevel analyses indicated that clubhouse members were more likely to be female, to receive SSI/SSDI, to report having a diagnosis of schizophrenia, and to live in dependent care; and they reported both a greater number of lifetime hospitalizations and current receipt of higher intensity traditional MH services. Controlling for differences in demographic characteristics, psychiatric history, and mental health service receipt, clubhouse members also reported higher quality of life and were more likely to report being in recovery. CRDI consumers were more likely to have substance abuse histories. Possible reasons for the differences are discussed. The results suggest that CRDIs are a viable alternative to more traditional mental health services for individuals who might not otherwise receive mental health services. Copyright 2009, Springer
Orford J. 'Let's keep in touch: You know it makes sense'. (commentary). Addiction 104(6): 972-973, 2009. (7 refs.)This is a commentary on the article by Scott C. K., Dennis M. L. "Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users." It speaks to the need for sufficiently long periods of follow-up to adeaquately assess the impact of treatment.
Oser C; Knudsen H; Staton-Tindall M; Leukefeld C. The adoption of wraparound services among substance abuse treatment organizations serving criminal offenders: The role of a women-specific program. Drug and Alcohol Dependence 103(Supplement 1): S82-S90, 2009. (74 refs.)Women's substance abuse treatment outcomes are improved when women-specific needs are addressed through wraparound services, such as the provision of child care, employment assistance, or mental health counseling. Despite a higher prevalence of pre-incarceration drug use, women in prison report receiving fewer services than their male counterparts, suggesting they likely have greater service needs upon release. It is unknown whether community-based treatment organizations with a women-specific program offer more wraparound services than programs without a focus on women. This study uses data from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS), a nationally representative sample of community-based treatment programs serving predominantly criminal offenders (n = 217). First, bivariate analyses identified differences between organizations with and without a women-specific program on the number of wraparound services adopted as well as organizational-level characteristics (i.e., organizational structure, personnel characteristics, culture, sources of information, and systems integration) related to their adoption. Second, Poisson regression was used to identify the organizational characteristics associated with the number of adopted wraparound services, with having a women-specific program being the primary covariate of interest. Results indicate larger organizations that utilized a greater number of treatment approaches and believed that treatment could reduce crime were more likely to offer a greater assortment of wraparound services. In an effort to improve behavioral treatment outcomes, it is imperative to examine organizational level contextual factors that shape the availability of wraparound services for female offenders in community-based substance abuse treatment settings. Copyright 2009, Elsevier Science
Pedersen MU; Hesse M. A simple risk scoring system for prediction of relapse after inpatient alcohol treatment. American Journal on Addictions 18(6): 488-493, 2009. (12 refs.)Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist. Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment. The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment. The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment. Copyright 2009, American Academy of Psychiatrists in Alcoholism and Addictions
Romanowich P; Lamb RJ. The relationship between in-treatment abstinence and post-treatment abstinence in a smoking cessation treatment. Experimental and Clinical Psychopharmacology 18(1): 32-36, 2010. (14 refs.)Previous research has indicated that abstinence early in a smoking cessation program is predictive of successful posttreatment abstinence. However, it has not been established whether or not this effect is independent of other in-treatment abstinence patterns. In this paper the relationship between three potentially important aspects of in-treatment smoking abstinence and posttreatment smoking abstinence are examined: early abstinence, extended abstinence, and end-of-treatment abstinence. We examined the relationship between smoking behavior measured each weekday over 70 visits (approximately 14 weeks) of a contingency management smoking cessation program and at a follow-up visit 6 months after study entry (3 months after the scheduled end of treatment). Ninety-five of 102 participants were successfully followed-up. Seven of these 95 participants were confirmed abstinent. Early abstinence, defined as abstinence during the first 10 treatment visits, was significantly and independently related to follow-up abstinence (OR = 56.67 [7.29-440.63]). Extended abstinence and end-of-treatment abstinence were related to follow-up abstinence, but not independent of early abstinence based on multiple regression models. Inclusion of a variety of demognaphic and environmental characteristics did not significantly alter this relationship. Thus, consistent with the previous literature, the establishment of early abstinence appears to be crucial to establishing longer-term abstinence, independent of other in-treatment abstinence patterns. Copyright 2010, American Psychological Association
Ruetsch C; Cacciola J; Tkacz J. A national study of a telephone support service for patients receiving office-based buprenorphine medication-assisted treatment: Study feasibility and sample description. Journal of Substance Abuse Treatment 39(4): 307-317, 2010. (39 refs.)Opioid-dependent (OD) patients seeking treatment have multiple treatment options including abstinence-based and medication replacement therapies. A recent and growing addition to medication replacement therapy is buprenorphine medication-assisted treatment (B-MAT), which may be provided by certified physicians practicing in private offices Research on OD treatment is often performed on samples of patients recruited from specialty treatment facilities which may not generalize to B-MAT patients. Thus B-MAT as a treatment approach has been understudied. The present research describes (a) new methods developed to facilitate sample recruitment and survey data collection from a national B-MAT patient sample and (b) a telephonic support program designed for new B-MAT patients. Results indicate that by using appropriate tools, it is feasible to conduct a clinical study of B-MAT patients, recruited at the point of service, and that telephonic patient support was an acceptable treatment adjunct. Copyright 2010, Elsevier Science
Scott CK; Dennis ML. Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction 104(6): 959-971, 2009. (33 refs.)Post-discharge monitoring and early reintervention have become standard practice when managing numerous chronic conditions. These two experiments tested the effectiveness of recovery management checkup (RMC) protocols for adult chronic substance users. RMC included quarterly monitoring; motivational interviewing to provide personalized feedback and to resolve ambivalence about substance use; treatment linkage, engagement and retention protocols to increase the amount of treatment received. Recruited from sequential addiction treatment admissions, participants in the two experiments were, on average, 36 and 38 years of age, mainly female (59% versus 46%), African American (85% versus 80%) and met past-year criteria for dependence (87% versus 76%). Participants in both experiments were assigned randomly to the RMC or control condition and interviewed quarterly for 2 years. The Global Appraisal of Individual Needs (GAIN) was the main assessment instrument. RMC participant outcomes were better than control participants in both experiments. Effect sizes were larger in the second experiment in terms of reducing days to readmission (Cohen's d = 0.41 versus d = 0.22), successive quarters in the community using substances (d = -0.32 versus -0.19), past-month symptoms of abuse/dependence (d = -0.23 versus -0.02) and increasing the days of abstinence over 2 years (d = +0.29 versus 0.04). RMC, which provided ongoing monitoring and linkage, is feasible to conduct and is effective for adults with chronic substance dependence. Copyright 2009, Society for the Study of Addiction to Alcohol and Other Drugs
Smout MF; Longo M; Harrison S; Minniti R; Cahill S; Wickes W et al. The Psychostimulant Check-Up: A pilot study of a brief intervention to reduce illicit stimulant use. Drug and Alcohol Review 29(2): 169-176, 2010. (37 refs.)Introduction and Aims. This study is to test the acceptability of a single-session 'check-up' intervention for psychostimulant users and document participants' subsequent progress in reducing psychostimulant use and related harms. Design and Methods. The design was pre-experimental single-group repeated measures. Eighty participants received the Psychostimulant Check-Up, with 62% completing a 3 month follow up. Results. Participants were predominantly young adult methamphetamine users. The majority indicated that the Check-Up answered their questions, increased their awareness of services, and they would recommend it to their friends. At follow up, there was a significant reduction in self-reported methamphetamine use, the number of self-reported psychostimulant-related negative consequences experienced in the previous month and rates of injecting: 62% self-reported at least a 1 g reduction in methamphetamine use. Discussion and Conclusions. The intervention was well accepted and the majority of those who received it subsequently made meaningful reductions in psychostimulant use and related harm. The intervention offers sufficient promise to warrant a randomised trial to establish whether improvements were specific to the intervention. Copyright 2010, Wiley-Blackwell
Stahler GJ; Mennis J; Cotlar R; Baron DA. The influence of neighborhood environment on treatment continuity and rehospitalization in dually diagnosed patients discharged from acute inpatient care. American Journal of Psychiatry 166(11): 1258-1268, 2009. (38 refs.)Objective: Environmental contingencies inherent in neighborhoods and communities have been shown to affect individual behavior. The authors analyzed neighborhood and individual factors predicting initial outpatient treatment attendance and rehospitalization within 1 year among patients who were dually diagnosed with at least one mental disorder and a substance use disorder and discharged from an acute psychiatric inpatient care unit. Method: Stepwise-forward logistic regression modeling and a geographic information system were utilized to assess data extracted from the medical records of 380 patients who, upon hospital admission, had one or more mental health disorders and a positive urine drug screen for prototypical illicit drugs. Geographic data on patients' neighborhood environment were obtained from public sources. Outcome variables were whether a patient attended the first outpatient treatment appointment within 30 days of hospital discharge and whether a patient was readmitted to the inpatient unit within 1 year of discharge. Predictor variables were features relating to individual-level patient characteristics and features associated with neighborhood environment. Results: Factors that decreased the likelihood of attending the initial outpatient treatment were returning home following hospitalization (versus returning to an institutional setting), residing in an area with a high vacant housing rate, residing in an area far from an Alcoholics Anonymous meeting location, having the chief complaint of bizarre behavior (i.e., grossly inappropriate behavior), and having a urine drug screen positive for heroin. The likelihood of being rehospitalized within 1 year was greater for Hispanic patients, patients who had at least one prior hospital admission, and patients who lived in close proximity to a Narcotics Anonymous meeting location. Patients living in areas with higher educational attainment had a reduced likelihood of rehospitalization. Conclusions: A more explicit focus on the neighborhood and community context represents an important area in psychiatry, in terms of both research and clinical practice, which can potentially enhance long-term care and treatment planning for psychiatric patients. Future research is needed to better understand the influence of the neighborhood environment to help predict important clinical outcomes. Copyright 2009, American Psychiatric Association
Stein BD; Kogan JN; Sorbero M. Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: Rates and duration of subsequent treatment. Drug and Alcohol Dependence 104(1-2): 100-106, 2009. (59 refs.)Background: Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment. Methods: Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006. Results: Slightly less than half (49%) of the sample received follow-up care within 30 days of discharge. Rates of follow-up were significantly higher in individuals with a serious mental illness, and significantly lower in African-American individuals, males, individuals with disabilities, and those who received detoxification without residential treatment. The mean duration of follow-up treatment was 84 days, and was longer among individuals with a serious mental illness and Caucasians. Even after controlling for individuals' sociodemographic and clinical characteristics, there was substantial variation in follow-up rates among discharging providers. Conclusion: The relatively low rates of follow-up care and relatively brief duration of treatment for many of those who received such follow-up care are concerning in a population receiving substance abuse detoxification or residential treatment. The markedly lower rates among those receiving detoxification alone without subsequent residential treatment and among those without a comorbid serious mental illness suggest that efforts specifically targeting those individuals may be of particular benefit. Copyright 2009, Elsevier Science
Sterling S; Chi F; Campbell C; Weisner C. Three-year chemical dependency and mental health treatment outcomes among adolescents: The role of continuing care. Alcoholism: Clinical and Experimental Research 33(8): 1417-1429, 2009. (92 refs.)Background: Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12-step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3-year CD and MH outcomes. Methods: Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization. Results: At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow-up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively). Conclusions: A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents. Copyright 2009, Research Society on Alcoholism
Vanderplasschen W; Bloor M; McKeganey N. Long-term outcomes of aftercare participation following various forms of drug abuse treatment in Scotland. Journal of Drug Issues 40(3): 703-728, 2010. (48 refs.)Due to high relapse rates after leaving treatment drug users are often recommended to participate in some form of lower intensity continuing care. The importance of aftercare is widely accepted but little empirical data are available about the effectiveness of continuing services over longer periods of time and following various treatment modalities. In this study, we assessed the influence of various forms of aftercare on treatment outcomes and service utilization over a 33-month period among a naturalistic cohort of 653 drug users treated in prison or community settings, as part of the Drug Outcome Research in Scotland (DORIS study). Although participation in aftercare after initial treatment is rather unusual, the odds of having experienced a drug-free period (after 8 months) (OR=1 91 95% CI 1 10-3 33) and of being abstinent from heroin (after 33 months) (OR=0 56 95% CI 0 34-0 94) almost doubled. Program aftercare was of little additional value after intensive residential treatment but particularly important after prison-based and community treatment and if combined with self-help participation. Consequently, attractive and fitted aftercare services should be offered as an integrated part of various treatment modalities Copyright 2010, Journal of Drug Issues, Inc.
Vuchinich R; Wallace D; Milby JB; Schumacher JE; Mennemeyer S; Kertesz S. Relations between in-treatment and follow-up abstinence among cocaine-dependent homeless persons in three clinical trials. Experimental and Clinical Psychopharmacology 17(3): 165-172, 2009. (20 refs.)Clinical trials with cocaine-dependent outpatients have found a strong relation between in-treatment and follow-up abstinence, and the strength of this relation is constant across treatment conditions with variable efficacy in generating abstinence. The authors conducted secondary analyses of data from 3 clinical trials to determine whether this relation generalizes to cocaine-dependent homeless persons. The 3 trials (total N = 543) were conducted in a community health care facility for homeless people. The 7 treatment arms across the 3 trials were combinations of day treatment, abstinence-contingent housing, and vocational training. Drug use was measured with urine toxicology testing. Consecutive weeks of abstinence during treatment were strongly related to abstinence at the 12-month follow-up, whether or not missing 12-month data were included in the analysis. The treatment arms differed in their efficacy in generating abstinence, but the relation between in-treatment and follow-up abstinence did not differ across treatment arms. These results replicate earlier reports of these relations and extend them to a population of homeless people. The lack of differences between treatment arms in the in-treatment-follow-up abstinence relation implies that that relation is independent of the treatment-specific intervention components that generate group differences in abstinence. Copyright 2009, American Psychological Association
White WL. The mobilization of community resources to support long-term addiction recovery. Journal of Substance Abuse Treatment 36(2): 146-158, 2009. (126 refs.)Models of addiction treatment that view the sources and solutions to severe alcohol and other drug (AOD) problems as rooted within the vulnerability and resiliency of each individual stand in marked contrast to models that focus on the ecology of AOD problem development and resolution via complex interactions between individuals, families, and communities. An integration of the latter model into mainstream addiction treatment would necessitate a reconstruction of the treatment-community relationship and new approaches to community resource development and mobilization. Such an integration Would redefine core addiction treatment services and to whom, by whom, when, where, and for how long such services arc delivered. This article draws on historical and contemporary events in the history of addiction treatment and recovery in the United States to illuminate the relationship between recovery and community. Principles and strategies that could guide the development and mobilization of community resources to Support the long-term recovery of individuals and families are identified. Copyright 2009, Elsevier Science
Wickizer TA; Mancuso D; Campbell K; Lucenko B. Evaluation of the Washington State Access to Recovery project: Effects on Medicaid costs for working age disabled clients. Journal of Substance Abuse Treatment 37(3): 240-246, 2009. (31 refs.)In 2004, the federal government made a major commitment to support expanded substance abuse (SA) recovery services by initiating the Access to Recovery (ATR) program. The initial ATR I program awarded grants to 14 states, including Washington State. We evaluated Washington's ATR I program to determine its effect on Medicaid costs for working age disabled clients. We compared per member per month (PMPM) Medicaid costs during 1 year follow-up for clients who received ATR services (N = 1,347) with costs for a matched comparison group of 1,243 clients and used multiple regression techniques to estimate changes in Medicaid costs associated with ATR. ATR was found to be associated with reductions in PMPM Medicaid costs of $66 (p = 11) to $136 (p = .05) depending upon months of Medicaid eligibility. Recovery services aimed at facilitating engagement in SA treatment and aftercare appear to foster modest savings in Medicaid costs for working age disabled clients. Copyright 2009, Elsevier Science
Wisdom JP; Gogel LP. Perspectives on adolescent residential substance abuse treatment: When are adolescents done? Psychiatric Services 61(8): 817-821, 2010. (19 refs.)Objectives: the study evaluated responses from adolescents in substance abuse treatment, their parents, and treatment staff to the question of what constitutes treatment success. Methods: Semistructured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at three residential substance abuse treatment programs in two states. Data were coded and organized into themes by respondent type. Results: Respondents reported knowing when treatment was no longer needed based on changes in adolescents' substance use, treatment-related and other behaviors, and attitudes and character. A fourth category of responses indicated respondents' ambiguity regarding successful completion of substance abuse treatment. Little concurrence was found among adolescents, parents, and treatment center staff to indicate criteria suggesting that discharge is appropriate. Conclusions: Substance abuse treatment programs and their clients may benefit from ensuring that staff, parents, and adolescents are aware of treatment goals to promote more effective treatment and improve collaboration toward the adolescent's recovery. Copyright 2010, American Psychiatric Association
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