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CORK Bibliography: Treatment Outcome and Drug Misuse

96 citations. January 2011 to present

Prepared: September 2011

Alford DP; LaBelle CT; Kretsch N; Bergeron A; Winter M; Botticelli M et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: Five-year experience. Archives of Internal Medicine 171(5): 425-431, 2011. (27 refs.)

Background: Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets. Methods: Ours is a cohort study of patients treated for opioid addiction using collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice during a 5-year period. We examine patient characteristics, 12-month treatment success (ie, retention or taper after 6 months), and predictors of successful outcomes. Results: From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis because they left treatment owing to preexisting legal or medical conditions or a need to transfer to another buprenorphine program. At 1 year, 196 of 382 patients (51.3%) underwent successful treatment. Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results. On admission, patients who were older, were employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic/Latino race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement. Conclusion: Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.

Andrews CM; Cao DC; Marsh JC; Shin HC. The impact of comprehensive services in substance abuse treatment for women with a history of intimate partner violence. Violence Against Women 17(5): 550-567, 2011. (38 refs.)

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete (p = .016) and family services (p = .023) in predicting substance use.

Austin J; McKellar JD; Moos R. The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders. Addictive Behaviors 36(9): 941-944, 2011. (28 refs.)

The current study examined the relationship between co-occurring substance use and Axis I psychiatric disorders and treatment utilization and outcome among homeless individuals (N = 365) who participated in an episode of intensive outpatient substance use treatment. Compared to patients without a co-occurring diagnosis, homeless patients with a diagnosis of major depressive disorder or PTSD participated in more substance use treatment. Diagnostic status did not predict 12-month alcohol or drug treatment outcome. Substance use treatment programs appear to successfully engage homeless individuals with major depressive disorder and PTSD in treatment. Such individuals appear to achieve similar benefits from standard substance use treatment as do homeless individuals without such disorders.

Bauld L; Boyd KA; Briggs AH; Chesterman J; Ferguson J; Judge K et al. One-year outcomes and a cost-effectiveness analysis for smokers accessing group-based and pharmacy-led cessation services. Nicotine & Tobacco Research 13(2): 135-145, 2011. (45 refs.)

An observational study examining 1-year follow-up of clients of two National Health Service smoking cessation services in Glasgow was used to inform a cost-effectiveness analysis. One service involved 7 weeks of group-based support (n = 411) and the other consisted of up to 12 weeks of one-to-one counseling with pharmacists (n = 1,374). Pharmacological aids to quitting (e.g., nicotine replacement therapy) were available to all clients. Quit rates were calculated for each service at 52 weeks after the quit date, and these were used for an economic evaluation of both the annual and the lifetime cost-effectiveness of the pharmacy- and group-based interventions in comparison with a baseline "self-quit" scenario. The annual cost-effectiveness model established the incremental cost per 52-week quitter, while a Markov model was developed for the lifetime analysis to estimate the potential lifetime outcomes in terms of cost per quality-adjusted life years (QALY) gained, to account for the benefits quitters will receive in terms of extended life years and improvements in quality of life from smoking cessation. The proportion of carbon monoxide-validated quitters from both services combined fell from 22.5% at 4-week follow-up to 3.6% at 52 weeks. The group service achieved a higher quit rate (6.3%) than the pharmacy service (2.8%) but was more intensive and required greater overhead costs. The lifetime analysis resulted in an incremental cost per QALY of 4,800 pound for the group support and 2,600 pound for pharmacy one-to-one counseling. Despite disappointing 1-year quit rates, both services were considered to be highly cost-effective.

Bernstein SL; Bijur P; Cooperman N; Jearld S; Arnsten JH; Moadel A et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Academic Emergency Medicine 18(6): 575-583, 2011. (54 refs.)

Objectives: The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention. Methods: This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months. Results: A total of 338 subjects were enrolled, mean (+/-SD) age was 40.2 (+/-12.0) years, 51.8% were female, and 56.5% were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7% vs. 13.2%, respectively). The proportion of subjects making a quit attempt (69.2% vs. 66.5%) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 1.61 to 7.26) or subject belief that the Ell visit was tobacco-related (OR = 2.47, 95% CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95% CI = 0.10 to 0.50). Conclusions: The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.

Black AC; Rosen MI. A money management-based substance use treatment increases valuation of future rewards. Addictive Behaviors 36(1-2): 125-128, 2011. (23 refs.)

Objective: A positive association between delay discounting and substance use has been documented substance users tend to discount future rewards more than non-users. However studies detailing the responsiveness of delay discounting to interventions are lacking and few have examined how any behavioral intervention affects delay discounting and whether these effects moderate changes in substance abuse. This study assesses the effectiveness of a money management intervention Advisor-Teller Money Manager (ATM) in reducing delay discounting over time and the relationship of these effects to changes in cocaine use. Method: Ninety psychiatric patients with histories of cocaine and/or alcohol use were randomly assigned to 36 weeks of ATM treatment or to a minimal attention control condition. Delay discounting and cocaine use were measured throughout the intervention with a 52-week follow up measure of cocaine use. Analyses were conducted of (a) the effect of ATM on slopes of delay discounting and cocaine abstinence and (b) the relationship between change in delay discounting and change in cocaine abstinence Results: The ATM intervention was associated with significantly less delay discounting and less cocaine use over time relative to controls Increases in delay discounting were associated with decreased abstinence from cocaine Conclusions ATM treatment decreased delay discounting rates and these effects extended to cocaine use. Concrete conceptualizations of future events as occur in financial planning with higher perceived probability may account for higher valuation of future rewards in counseled patients.

Bolliger CT; Issa JS; Posadas-Valay R; Safwat T; Abreu P; Correia EA et al. Effects of varenicline in adult smokers: A multinational, 24-week, randomized, double-blind, placebo-controlled study. Clinical Therapeutics 33(4): 465-477, 2011. (26 refs.)

Background: Prevalence rates of smoking are rising in developing countries. Previous trials evaluating the efficacy and tolerability of the smoking-cessation medication varenicline have used largely participants of Caucasian origin. Objective: This study was conducted to evaluate the efficacy and tolerability of varenicline in populations of participants from Latin America, Africa, and the Middle East to investigate potential differences in the therapeutic response to varenicline. Methods: This multinational, randomized, double-blind, placebo-controlled trial was conducted at 42 centers in 11 countries (Latin America: Brazil, Colombia, Costa Rica, Mexico, and Venezuela; Africa: Egypt and South Africa; Middle East: Jordan, Lebanon, Saudi Arabia, and the United Arab Emirates). Participants were male and female smokers aged 18 to 75 years who were motivated to stop smoking; smoked >= 10 cigarettes/d, with no cumulative period of abstinence >3 months in the previous year; and who had no serious or unstable disease within the previous 6 months. Subjects were randomized in a 2:1 ratio to receive varenicline 1 mg or placebo, BID for 12 weeks, with a 12-week nontreatment follow-up. Brief smoking-cessation counseling was provided. The main outcome measures were carbon monoxide confirmed continuous abstinence rate (CAR) at weeks 9 to 12 and weeks 9 to 24. Adverse events (AEs) were recorded for tolerability assessment. Results: Overall, 588 subjects (varenicline, 390; placebo, 198) were randomized and treated. The mean (SD) ages of subjects in the varenicline and placebo groups were 43.1 (10.8) and 43.9 (10.8) years, respectively; 57.7% and 65.7% were male; and the mean (SD) weights were 75.0 (16.0) and 76.7 (16.3) kg (range, 40.0-130.0 and 45.6-126.0 kg). CAR at weeks 9 to 12 was significantly higher with varenicline than with placebo (53.59% vs 18.69%; odds ratio [OR] = 5.76; 95% CI, 3.74-8.88; P < 0.0001), and this rate was maintained during weeks 9 to 24 (39.74% vs 13.13%; OR = 4.78; 95% CI, 2.97-7.68; P < 0.0001). Nausea, headache, and insomnia were the most commonly reported AEs with varenicline and were reported numerically more frequently in the varenicline group compared with the placebo group. Serious AEs (SAEs) were reported in 2.8% of varenicline recipients compared with 1.0% in the placebo group, with 6 subjects reporting psychiatric SAEs compared with none in the placebo group. Conclusion: Based on these data, varenicline was apparently efficacious and generally well tolerated as a smoking-cessation aid in smokers from selected sites in Latin America, Africa, and the Middle East.

Bonn-Miller MO; Zvolensky MJ; Moos RH. 12-step self-help group participation as a predictor of marijuana abstinence. Addiction Research & Theory 19(1): 76-84, 2011. (50 refs.)

This study examined the associations between 12-step self-help group participation following substance abuse treatment and abstinence from marijuana use at 1-, 2-, and 5-years post-treatment. These associations were examined among 1288 male patients of the Department of Veterans Affairs who used marijuana within the 3 months prior to admission to treatment and discontinued use at treatment discharge. Consistent with expectation, 12-step self-help group attendance during the 3 months prior to each follow-up was significantly related to corresponding rates of abstinence at each follow-up time point. Additionally, 12-step self-help group attendance predicted more distal marijuana abstinence and recent attendance added to the prediction. Subsidiary analyses indicated that self-help attendance was important both for the maintenance of marijuana abstinence and for the re-initiation of abstinence after a relapse. Results are discussed in relation to better understanding the role of 12-step self-help group attendance in the initiation and maintenance of marijuana abstinence.

Bowser BP; Lewis D; Dogan D. External influences on drug treatment interventions: East Palo Alto's Free-at-Last. Journal of Addiction Medicine 5(2): 115- 122, 2011. (25 refs.)

External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California. Objective: The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment. Methods: All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups. Results: There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.

Cahill K; Ussher MH. Cannabinoid type I receptor antagonists for smoking cessation. (review). Cochrane Database of Systematic Reviews 3: article CD005353, 2011. (33 refs.)

Background: Selective type 1 cannabinoid (CB1) receptor antagonists may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. They also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain. Objectives: To determine whether selective CB1 receptor antagonists (currently rimonabant and taranabant) increase the numbers of people stopping smoking To assess their effects on weight change in successful quitters and in those who try to quit but fail. Search strategy: We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms ('rimonabant' or 'taranabant') and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant). The most recent search was in January 2011. Selection criteria Types of studies: Randomized controlled trials Types of participants: Adult smokers Types of interventions/ Types of outcome measures: The primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment. A secondary outcome is weight change associated with the cessation attempt. Data collection and analysis: Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them. Main results: We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled risk ratio (RR) for quitting with rimonabant 20 mg was 1.50 (95% confidence interval (CI) 1.10 to 2.05). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections. In the relapse prevention trial, smokers who had quit on the 20 mg regimen were more likely to remain abstinent on either active regimen than on placebo; the RR for the 20 mg maintenance group was 1.29 (95% CI 1.06 to 1.57), and for the 5 mg maintenance group 1.30 (95% CI 1.06 to 1.59). There appeared to be no significant benefit of maintenance treatment for the 5 mg quitters. One trial of taranabant was not included in our meta-analyses, as it followed participants only until end of treatment; at eight weeks it found no benefit for treatment over placebo, with an OR of 1.2 (90% CI 0.6 to 2.5). For rimonabant, weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not. For taranabant, weight gain was significantly lower for 2-8 mg versus placebo at the end of eight weeks of treatment. In 2008, post-marketing surveillance led the European Medicines Agency (EMEA) to require Sanofi Aventis to withdraw rimonabant, because of links to mental disorders. The development of taranabant was also suspended by Merck & Co because of unacceptable adverse events. Authors' conclusions: From the trial reports available, rimonabant 20 mg may increase the chances of quitting approximately 1 1/2-fold. The evidence for rimonabant in maintaining abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term. Taranabant 2-8 mg may moderate weight gain, at least in the short term. In 2008, development of both rimonabant and taranabant was discontinued by the manufacturers.

Chung T; Geier C; Luna B; Pajtek S; Terwilliger R; Thatcher D; Clark DB. Enhancing response inhibition by incentive: Comparison of adolescents with and without substance use disorder. Drug and Alcohol Dependence 115(1-2): 43-50, 2011. (52 refs.)

Effective response inhibition is a key component of recovery from addiction. Some research suggests that response inhibition can be enhanced through reward contingencies. We examined the effect of monetary incentive on response inhibition among adolescents with and without substance use disorder (SLID) using a fast event-related fMRI antisaccade reward task. The fMRI task permits investigation of how reward (monetary incentive) might modulate inhibitory control during three task phases: cue presentation (reward or neutral trial), response preparation, and response execution. Adolescents with lifetime SUD (n = 12; 100% marijuana use disorder) were gender and age-matched to healthy controls (n = 12). Monetary incentive facilitated inhibitory control for SUD adolescents: for healthy controls, the difference in error rate for neutral and reward trials was not significant. There were no significant differences in behavioral performance between groups across reward and neutral trials, however, group differences in regional brain activation were identified. During the response preparation phase of reward trials, SUD adolescents, compared to controls, showed increased activation of prefrontal and oculomotor control (e.g., frontal eye field) areas, brain regions that have been associated with effective response inhibition. Results indicate differences in brain activation between SUD and control youth when preparing to inhibit a prepotent response in the context of reward, and support a possible role for incentives in enhancing response inhibition among youth with SUD.

Cox LS; Wick JA; Nazir N; Cupertino AP; Mussulman LM; Ahluwalia JS et al. Predictors of early versus late smoking abstinence within a 24-month disease management program. Nicotine & Tobacco Research 13(3): 215-220, 2011. (24 refs.)

Introduction: Standard smoking cessation treatment studies have been limited to 6- to 12-month follow-up, and examination of predictors of abstinence has been restricted to this timeframe. The KanQuit study enrolled 750 rural smokers across all stages of readiness to stop smoking and provided pharmacotherapy management and/or disease management, including motivational interviewing (MI) counseling every 6 months over 2 years. This paper examines differences in predictors of abstinence following initial (6-month) and extended (24-month) intervention. Methods: Baseline variables were analyzed as potential predictors of self-reported smoking abstinence at Month 6 and at Month 24. Chi-square tests, 2-sample t tests, and multiple logistic regression analyses were used to identify predictors of abstinence among 592 participants who completed assessment at baseline and Months 6 and 24. Results: Controlling for treatment group, the final regression models showed that male gender and lower baseline cigarettes per day predicted abstinence at both 6 and 24 months. While remaining significant, the relative advantage of being male decreased over time. Global motivation to stop smoking, controlled motivation, and self-efficacy predicted abstinence at 6 months but did not predict abstinence at Month 24. In contrast, stage of change was strongly predictive of 24-month smoking status. Conclusions: While the importance of some predictors of successful smoking cessation appeared to diminish over time, initial lack of interest in cessation and number of cigarettes per day strongly predicted continued smoking following a 2-year program.

Cummings KM; Hyland A; Carlin-Menter S; Mahoney MC; Willett J; Juster HR. Costs of giving out free nicotine patches through a telephone quit line. Journal of Public Health Management and Practice 17(3): E16-E23, 2011. (19 refs.)

Background: Many telephone quit lines provide free nicotine replacement therapy (NRT) to smokers who are trying to stop smoking. However, providing free NRT to smokers can be costly. Objective: To compare NRT usage patterns, quit rate, and costs of giving smokers calling a telephone quit line different amounts of free NRT. Design: A 3-group randomized trial was conducted. Setting and Participants: A total of 2806 adult smokers of 10+ cigarettes per day who called the New York State Smokers' Quit Line (NYSSQL) were sent different amounts of nicotine patches for free as follows: (1) a 2-week supply of nicotine patches, (2) a 4-week supply, and (3) a 6-week supply. In addition, all study participants received a free stop smoking guide plus 1 proactive follow-up call attempt conducted 2 weeks after initially contacting the NYSSQL. Of the 2806 enrolled participants, 1682 completed the 7-month follow-up to assess their use of the NRT sent to them and smoking status. Main Outcome Measures: Nicotine patch usage, quit rates, reductions in cigarette consumption, and cost-effectiveness measures. Results: Most respondents (85%) reported using the nicotine patches sent to them, although the amount used varied in direct proportion to the amount sent. The 7-and 30-day nonsmoker prevalence rates measured at 7-month follow-up did not differ significantly between the 3 groups. The cost per attributable quit was also not significantly different between the 3 groups. Conclusion: Sending out more than a free 2-week supply of patches to smokers who contact a quit line is no more effective in achieving smoking cessation than sending just 2 weeks of patches.

Cunningham CO; Giovanniello A; Li X; Kunins HV; Roose RJ; Sohler NL. A comparison of buprenorphine induction strategies: Patient-centered home-based inductions versus standard-of-care office-based inductions. Journal of Substance Abuse Treatment 40(4): 349- 356, 2011. (39 refs.)

Although novel buprenorphine induction strategies are emerging, they have been inadequately studied. To examine our newly developed patient-centered home-based inductions, we conducted a subgroup analysis of 79 opioid-dependent individuals who had buprenorphine inductions at an urban community health center. Participants chose their induction strategy. Standard-of-care office-based inductions were physician driven, with multiple assessments, and observed, and the patient-centered home-based inductions emphasized patient self-management and included a "kit" for induction at home. We conducted interviews and extracted medical records. Using mixed nonlinear models, we examined associations between induction strategy and opioid use and any drug use. Compared with those with standard-of-care office-based inductions, participants with patient-centered home-based inductions had no significant differences in opioid use (adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.13-2.97) but greater reductions in any drug use (AOR = 0.05, 95% CI = 0.01-0.37). Taking into account the limitations of our observational cohort study design, we conclude that participants with patient-centered home-based inductions had similar reductions in opioid use and greater reductions in any drug use than those with standard-of-care office-based inductions. It is essential that new induction strategies be based on existing models or theories and be well studied.

Dawe S; Geppert L; Occhipinti S; Kingswell W. A comparison of the symptoms and short-term clinical course in inpatients with substance-induced psychosis and primary psychosis. Journal of Substance Abuse Treatment 40(1): 95-101, 2011. (32 refs.)

Relatively little is known about the clinical course of symptoms in patients with a substance-induced psychosis (SIP) compared with those with a primary psychotic disorder (PPD). In this study, symptoms associated with psychosis were monitored across admission in two groups of patients: those with SIP (amphetamines or cannabis; n = 47) and those with PPD (n = 51). Sixty-two percent of patients were first admissions, 23% had one previous admission, and a further 14% had had two previous admissions. Symptoms were monitored using the Brief Psychiatric Rating Scale. Scores on the positive symptoms scale, negative symptoms scale, manic excitement, and negative mood were reported as was the extent of observed disturbed behavior at admission and then at Days 4/5, 8/9, 15/16, 22/23, 29/30, 36/37, 43/44, and 50/51. Patients with a SIP experienced more severe mania and disturbed behavior at admission than those with a PPD. However, these symptoms abated more rapidly for the SIP group during admission. Although positive symptom scores were equally high at admission for both groups, there was a more rapid abatement of these symptoms in the SIP group. Finally, negative symptoms were lower in the SIP group at admission and at Days 50/51, although the decline in symptoms was comparable in both groups.

Day E; Strang J. Outpatient versus inpatient opioid detoxification: A randomized controlled trial. Journal of Substance Abuse Treatment 40(1): 56-66, 2011. (45 refs.)

Opioid detoxification is not an effective stand-alone treatment for heroin dependence but is nevertheless an essential step in the path to recovery. There has been relatively little previous controlled research on the impact of treatment setting on the likelihood of successful completion of detoxification. In this study, 68 opioid-dependent patients receiving community treatment (predominantly with methadone) and requesting detoxification were randomly assigned to an inpatient versus outpatient setting. Both groups received the same medication (lofexidine), and the primary outcome measure was being opioid-free at detoxification completion. More inpatients (n = 18, 51.4%) than outpatients (n = 12, 36.4%) completed detoxification, but this difference was not statistically significant (chi(2) = 1.56, p = .21). However, the outpatient group received a significantly longer period of medication, and when the length of detoxification was controlled for, the results favored the inpatient setting (Exp(B) = 13.9, 95% confidence interval = 2.6-75.5, p = .002). Only 11(16%) participants were opioid-free at the I-month follow-up and 8 at the 6-month follow-up, with no between-group difference. Inpatient and outpatient opioid detoxification settings were not significantly different in completion or follow-up abstinence rates, but aspects of the study design may have favored the outpatient setting. Future studies should test patient characteristics that predict better outcomes in each setting.

Dickerson DL; Spear S; Marinelli-Casey P; Rawson R; Li LB; Hser YI. American Indians/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenges. Journal of Addictive Diseases 30(1): 63-74, 2011. (30 refs.)

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Edens EL; Mares AS; Tsai J; Rosenheck RA. Does active substance use at housing entry impair outcomes in supported housing for chronically homeless persons? Psychiatric Services 62(2): 171-178, 2011. (19 refs.)

Objective: Recent clinical and policy trends have favored low-demand housing (provision of housing not contingent on alcohol and drug abstinence) in assisting chronically homeless people. This study compared housing, clinical, and service use outcomes of participants with high levels of substance use at time of housing entry and those who reported no substance use. Methods: Participants in the outcome evaluation of the 11-site Collaborative Initiative on Chronic Homelessness (N=756), who were housed within 12 months of program entry and received an assessment at time of housing and at least one follow-up (N=694, 92%), were classified as either high-frequency substance users (>15 days of using alcohol or >15 days of using marijuana or any other illicit drugs in the past 30 days; N=120, 16%) or abstainers (no days of use; N=290, 38%) on entry into supported community housing. An intermediate group reporting from one to 15 days of use (N=284, 38%) was excluded from the analysis. Mixed-model multivariate regression adjusted outcome findings for baseline group differences. Results: During a 24-month follow-up, the number of days housed increased dramatically for both groups, with no significant differences. High-frequency substance users maintained higher, though declining, rates of substance use throughout follow-up compared with abstainers. High-frequency users continued to have more frequent or more severe psychiatric symptoms than the abstainers. Total health costs declined for both groups over time. Conclusions: Active-use substance users were successfully housed on the basis of a low-demand model. Compared with abstainers, users maintained the higher rates of substance use and poorer mental health outcomes that were observed at housing entry but without relative worsening.

Fallot RD; McHugo GJ; Harris M; Xie HY. The trauma recovery and empowerment model: A quasi-experimental effectiveness study. Journal of Dual Diagnosis 7(1-2): 74- 89, 2011. (36 refs.)

Objective: A quasi-experimental study tested the effectiveness of the Trauma Recovery and Empowerment Model (TREM), a group intervention for women trauma survivors, in comparison to services as usual. Methods: Two hundred fifty-one women with histories of physical and/or sexual abuse and co-occurring serious mental illnesses and substance use disorders completed comprehensive study assessments at baseline and at 6 and 12 months. TREM groups were added to standard services at two community mental health agencies in Washington, DC (n = 153). Comparison group participants received usual services at two agencies in Baltimore, MD (n = 98). Results: TREM participants showed greater reductions in alcohol and drug abuse severity, anxiety symptoms, and current stressful events, and they showed greater increases in perceived personal safety. There were no group differences in change for posttraumatic stress disorder and global mental health symptoms, physical and mental health-related quality of life, and exposure to interpersonal abuse. Changes in trauma recovery skills were associated positively with gains in study outcomes for TREM group participants. Conclusions: Despite design limitations, this study provides preliminary evidence for the effectiveness of the TREM intervention for a heterogeneous population of women trauma survivors with co-occurring disorders when added to usual services.

Fucito LM; Toll BA; Wu R; Romano DM; Tek E; O'Malley SS. A preliminary investigation of varenicline for heavy drinking smokers. Psychopharmacology 215(4): 655- 663, 2011. (52 refs.)

Varenicline, an approved smoking cessation pharmacotherapy, also shows promise as a potential treatment for alcohol dependence. However, varenicline has not been tested in heavy drinkers, and it remains to be determined whether varenicline could reduce alcohol craving and consumption in smokers who are trying to quit smoking. We conducted a preliminary study to examine the effect of varenicline on drinking behavior and the effects of extended varenicline pretreatment on smoking. Thirty heavy drinking smokers received smoking cessation counseling and were randomly assigned to receive either an extended 4-week pretreatment with varenicline 2 mg daily or the usual 1-week pretreatment. Those in the extended pretreatment group received active medication for 8 weeks (i.e., 4 weeks of active pre-treatment followed by 4 weeks of active treatment), and participants in the usual pretreatment group received active medication after a placebo lead in (i.e., 3 weeks of placebo followed by active medication for 5 weeks). Participants who received varenicline during the first 3 weeks reported significantly greater reductions in alcohol craving and numerically fewer heavy drinking days compared to those who received placebo, and these differences persisted during the open-label phase. Extended pretreatment was associated with numerically greater reductions in cigarette smoking over the entire study period. There were no differences, however, in smoking abstinence rates following the smoking quit date between the two groups. Findings from this preliminary study suggest that varenicline may be a promising strategy for concurrently reducing heavy drinking and promoting smoking changes in heavy drinkers.

Gainsbury S; Blaszczynski A. A systematic review of Internet-based therapy for the treatment of addictions. (review). Clinical Psychology Review 31(3): 490-498, 2011. (59 refs.)

Traditional therapies for addictions are underutilized and characterized by high attrition rates suggesting they may not meet the needs of a proportion of individuals with addiction-related problems including problem drinking, smoking, substance use and problem gambling. Internet-based therapy has emerged as a new treatment modality for psychological disorders and health issues and this review is the first attempt to summarize and evaluate the evidence of the effectiveness of Internet therapy for addictions. Extensive literature searches were conducted to identify studies meeting the criteria of delivering structured Internet-based treatment programs for addictions that incorporated a component of trained therapist interaction. Only nine studies met criteria for inclusion with seven representing a randomized controlled trial. These included seven papers reporting on tobacco-cessation programs, one Internet-based therapy for pathological gambling, and one treatment program for substance abuse. A range of therapeutic models, treatment components and outcome measures was included across these studies. Positive treatment effects were reported following completion of therapy and at longer-term follow-up. The review concluded that Internet-based therapies for addictions are effective in achieving positive behavioral changes but that more research is required to determine the comparative effectiveness of various Internet-based therapies and their components.

Galloway GP; Buscemi R; Coyle JR; Flower K; Siegrist JD; Fiske LA et al. A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction. Clinical Pharmacology & Therapeutics 89(2): 276-282, 2011. (49 refs.)

Sixty treatment-seeking individuals with methamphetamine (MA) dependence entered a randomized, placebo-controlled, double-blind clinical trial of oral dextroamphetamine (d-AMP) as a replacement therapy for MA dependence. The subjects took 60 mg sustained-release d-AMP for 8 weeks, during which time they received eight 50-min sessions of individual psychotherapy. Adverse events and urine toxicology for MA were assessed two times a week. There were no serious adverse events. Urine samples containing < 1,000 ng/ml of MA were classified as negative for MA. The MA-negative scores in the d-AMP group (3.1 +/- SD 4.6) were no higher than those in the placebo group (3.3 +/- SD 5.3; P > 0.05). However, withdrawal and craving scores were significantly lower in the d-AMP group (P < 0.05 for both). Although subjects taking d-AMP did not reduce their use of MA, the significant reductions observed in withdrawal and craving scores in this group support the need for further exploration of d-AMP as a pharmacologic intervention for MA dependence, possibly at higher doses.

Garcia-Fernandez G; Secades-Villa R; Garcia-Rodriguez O; Alvarez-Lopez H; Sanchez-Hervas E; Fernandez-Hermida JR et al. Individual characteristics and response to contingency management treatment for cocaine addiction. Psicothema 23(1): 114-118, 2011. (39 refs.)

Voucher-based contingency management (CM) research has demonstrated efficacy for treating cocaine addiction, but few studies have examined associations between individual baseline characteristics and response to CM treatments. The aim of this study, involving 50 cocaine outpatients receiving CM for cocaine addiction, was to assess the impact of baseline characteristics on abstinence outcomes after six months of treatment. Patients who were abstinent after six months of treatment accounted for 58% of the sample. Patients with higher scores on the Alcohol area of the EuropASI and patients that were non-abstinent during the first month of treatment were less likely to achieve abstinence. These outcome predictors have implications both for treatment research and for clinical practice. Patients who do not respond early to treatment may need a more intensive intervention, and concomitant problematic alcohol use should be detected and treated. The remaining baseline variables examined were not statistically significant predictors of abstinence. This finding is important for the generalizability of CM across the range of individual characteristics of treatment-seeking cocaine abusers.

Garcia-Fernandez G; Secades-Villa R; Garcia-Rodriguez O; Alvarez-Lopez H; Fernandez-Hermida JR; Fernandez-Artamendi S et al. Long-term benefits of adding incentives to the Community Reinforcement Approach for cocaine dependence. European Addiction Research 17(3): 139- 145, 2011. (40 refs.)

Background: The community reinforcement approach (CRA) with vouchers is a well-established program developed for the treatment of cocaine addiction. It involves an incentive program in which patients earn vouchers that can be exchanged for goods or services contingent upon abstinence from cocaine use. Aim: To examine the contributions of incentives to retention, abstinence, and psychosocial outcomes in the CRA + vouchers program at the 12-month follow-up. Methods: 58 cocaine addicts were randomly assigned to CRA treatment with or without an added incentive program in a community setting for cocaine dependence in Spain. Results: 65.5% of patients in the group with vouchers completed 12 months of treatment, versus 48.3% in the novoucher group. In the CRA + vouchers group, mean percentage of cocaine-negative samples was 95.76%, versus 79.31% in the group without vouchers. There were significant improvements in psychosocial functioning in both treatments, but when differences were observed, they supported CRA with vouchers over CRA alone. Conclusion: Combining CRA with incentives improves treatment outcomes in cocaine-dependent outpatients. Additive benefits of vouchers remain 6 months after the incentive program ends.

Gordon AJ; Kunins HV; Rastegar DA; Tetrault JM; Walley AY. Update in addiction medicine for the generalist. Journal of General Internal Medicine 26(1): 77-82, 2011. (56 refs.)

Generalist clinicians routinely care for patients who misuse or are dependent on alcohol, nicotine, and other drugs of abuse. These problems contribute to significant morbidity, health care utilization, cost, and preventable death.The aim of this update is to identify and examine recent advances in addiction medicine that have practice implications for generalist physicians and their patients. To accomplish this, we independently selected articles in the field of addiction medicine, summarized and critically appraised, and examined the articles in the context of their implications for generalist practice using methodology we used in prior updates. During an initial review, we identified articles through an electronic MedLine search (limited to human studies and in English) using search terms for alcohol, nicotine, and other drugs of abuse from January 2008 through January 2010. From the citations, the authors selected articles for more intensive review. All authors then agreed collectively on the important articles regarding addiction medicine that have implications for practice for generalist clinicians. Topics covered in this review include prescription drug abuse, overdose deaths related to prescription drug diversion, factors influencing risk of overdose of prescribed oioids, screening in primary care, impact of intervention on health status, pharamcotherapy for smoking cessation, office-based opioid agonist therapy.

Grassi MC; Enea D; Ferketich AK; Lu B; Pasquariello S; Nencini P. Effectiveness of varenicline for smoking cessation: A 1-year follow-up study. Journal of Substance Abuse Treatment 41(1): 64-70, 2011. (53 refs.)

We examined the rate of smoking cessation associated with 6 weeks of group counseling therapy (GCT) given alone or in combination with 12 weeks of varenicline (VAR) in 112 smokers. Follow-ups were conducted at 12, 26, and 52 weeks post enrollment. Since participants chose the treatment, differences between the two groups were adjusted using propensity matching. Only 33.3% completed VAR treatment, yet at I year, the abstinence rate among participants who were not compliant was not different from subjects who were compliant. VAR resulted in a 23% improvement in the abstinence rates at 26 and 52 weeks (GCT + VAR rates were 62.5% and 56.3%, respectively; GCT-only rates were 39.6% and 33.3%, respectively). Increased carbon monoxide concentration, cigarette consumption, and Beck Depression Inventory score were associated with continued smoking. In conclusion, we found that the combination of counseling and VAR is effective at promoting abstinence at 1 year even when compliance with the medication is not 100%.

Grella CE; Shi YF. Stability of outcomes following residential drug treatment for patients with co-occurring disorders. Journal of Dual Diagnosis 7(1-2): 103- 112, 2011. (30 refs.)

Objective: Few studies have examined the stability of both substance use and mental health outcomes following residential drug abuse treatment for individuals with co-occurring disorders. This study examines outcomes at 6 and 12 months for individuals with co-occurring disorders, in relationship to services received over the follow-up period. Methods: Participants with co-occurring disorders (N = 310) were sampled from 11 residential drug abuse treatment programs and completed in-depth assessments within 30 days of intake and at 6- and 12-month follow-ups. A path model was developed testing the relationships among treatment participation and services received, psychological status, and substance use outcomes across the two follow-up points. Results: Retention for at least 90 days in residential drug treatment was associated with less inpatient mental health treatment and more mental health services received at 6 months; outpatient mental health treatment was associated with reduced substance use at 6 months. Substance use at 6 months was associated with more psychological distress at both 6 and 12 months and more inpatient mental health treatment at 12 months. Conclusions: Findings suggest that receipt of mental health services following residential drug abuse treatment for patients with co-occurring disorders is critical to improving their longer-term outcomes.

Hamdi NR; Levy M; Jaffee WB; Chisholm SM; Weiss RD. Implementing an adapted version of the job seekers' workshop in a residential program for patients with substance use disorders. Journal of Addiction Medicine 5(2): 148- 152, 2011. (15 refs.)

Objectives: To evaluate the feasibility and effectiveness of adapting the Job Seekers' Workshop (JSW) to a residential setting within a Massachusetts-based substance use disorder treatment agency. Methods: Implementation of the adapted JSW consisted of a continual sequence of 3 weekly sessions that focused on job interview rehearsals, practice completing job applications, and identification of job leads. Data were compiled on the employment rates of the 188 patients discharged from the residential treatment program during July to December 2006 (baseline participants, n = 95) and January to June 2007 (JSW intervention participants, n = 93). The effectiveness of the adapted JSW was evaluated through a comparison of baseline and intervention participants' employment rates at discharge from residential treatment. Results: Analyses indicated a trend toward a significant increase in employment at discharge for the intervention period (40.9%) compared with baseline (29.5%), chi(2) (1, N = 188) = 2.675, P = 0.051. Conclusions: Further evaluation of the JSW in residential settings is necessary, but this preliminary research suggests that the intervention could begin to address the need for vocational services in residential treatment for substance use disorders.

Hanson KL; Cummins K; Tapert SF; Brown SA. Changes in neuropsychological functioning over 10 years following adolescent substance abuse treatment. Psychology of Addictive Behaviors 25(1): 127-142, 2011. (85 refs.)

Previously, Anderson, Ramo, Cummins, and Brown (2010) described six distinct patterns of alcohol and other drug (AOD) use during the decade following adolescents treatment for alcohol and other substance use disorders (A/SUD). This time period represents a phase of significant neurodevelopment. and the influence of substance use on the brain is a concern. In the present study, we examined patterns of neuropsychological function over these 10 years in relation to the AOD trajectories identified for youth as they transition into their twenties. Participants were part of a longitudinal research project following adolescents with and without A/SUD who received neuropsychological examinations at baseline and up to 7 times thereafter spanning 10 years (N = 213; 46% female at baseline). Neuropsychological trajectories were significantly related to substance involvement patterns over time on measures of verbal learning and memory (ps = .011 to < .0001), visuospatial memory (p = .0002), and verbal attention/working memory (p = .020), with heavier use patterns generally followed by poorer cognition. Heavy use of alcohol alone was independently associated with poorer verbal memory over time. Furthermore, substance withdrawal symptoms during each follow-up time point were related to poorer verbal learning and memory scores (ps < .05), whereas substance abuse/dependence diagnostic criteria were not related to neuropsychological performance levels. These findings suggest that AOD use during adolescence and young adulthood may primarily influence performance that relies on later maturing brain structures, although further research is needed. Higher levels of AOD withdrawal symptoms may signify greater neuropsychological impairment, reflecting potential neurotoxic effects of AOD use.

Hays JT; Croghan IT; Schroeder DR; Burke MV; Ebbert JO; McFadden DD et al. Residential treatment compared with outpatient treatment for tobacco use and dependence. Mayo Clinic Proceedings 86(3): 203-209, 2011. (23 refs.)

OBJECTIVE: To compare the effectiveness of outpatient vs residential treatment for tobacco dependence in a large referral practice. PATIENTS AND METHODS: We analyzed data from 2 cohorts of cigarette smokers who received either comprehensive outpatient or intensive 8-day residential treatment for tobacco dependence between January 1, 2004, and December 31, 2007. Self-reported 7-day point prevalence abstinence from smoking at 6 months was obtained via telephone interview. Logistic regression was used to assess the likelihood of increased abstinence with residential treatment. RESULTS: Overall, 4327 cigarette smokers received comprehensive outpatient treatment for tobacco dependence, and 226 smokers received treatment in an intensive 8-day residential program. Compared with outpatients, residential patients smoked more cigarettes per day (mean +/- SD, 31.1 +/- 14.4 vs 21.2 +/- 11.2), had more severe nicotine dependence (Fagerstrom Test for Nicotine Dependence score, 6.9 +/- 2.0 vs 5.1 +/- 2.3), and were more likely to have been treated for alcoholism (58/222 [26%] vs 649/4327 [15%]) or depression (124/222 [56%] vs 1817/4327 [42%]; P<.001 for all comparisons). The 6-month smoking abstinence rate was significantly higher for residential patients compared with outpatients (115/222 [52%] vs 1168/4327 [27%]; unadjusted odds ratio, 3.0; 95% confidence interval, 2.3-3.9), with similar findings after adjusting for baseline characteristics (adjusted odds ratio, 3.58; 95% confidence interval, 2.64.9). CONCLUSION: Compared with smokers who received outpatient treatment, those who received residential treatment had more severe tobacco dependence. Residential treatment for tobacco dependence was associated with a significantly greater odds of 6-month smoking abstinence compared with outpatient treatment among smokers in a referral clinic setting.

Hays JT; Croghan IT; Schroeder DR; Ebbert JO; Hurt RD. Varenicline for tobacco dependence treatment in recovering alcohol-dependent smokers: An open-label pilot study. Journal of Substance Abuse Treatment 40(1): 102-107, 2011. (32 refs.)

The purpose of this study was to obtain preliminary evidence of the efficacy of a 12-week course of varenicline for 7-day point prevalence smoking abstinence among recovering alcohol-dependent smokers. We enrolled 32 smokers with 6 months or more of recovery from alcohol dependence in an open-label clinical trial. Participants received varenicline 1 mg twice daily and 12 weeks of behavioral counseling. Participants were 69% men, 94% Caucasian, and smoking an average of 20.3 +/- 5.0 cigarettes per day. After 12 weeks of treatment, 31% were biochemically confirmed 7-day point prevalence abstinent from smoking and 28% had prolonged smoking abstinence (2 weeks after target quit date onward). The most common adverse effects were mild to moderate nausea (28%) and sleep disturbance (19%). No serious adverse events were reported. Varenicline may be a useful aid for treating tobacco dependence among smokers who are in stable recovery from alcohol dependence. Further study of this treatment is warranted.

Hilberink SR; Jacobs JE; Breteler MHM; de Vries H; Grol RPTM. General practice counseling for patients with chronic obstructive pulmonary disease to quit smoking: Impact after 1 year of two complex interventions. Patient Education and Counseling 83(1): 120-124, 2011. (34 refs.)

Objective: To evaluate two counseling programs in general practice to help smokers with chronic obstructive pulmonary disease (COPD) to quit smoking. Methods: Cluster randomized controlled trial including 68 general practices (667 patients) using a randomly assigned intervention program with counseling and advice about nicotine replacement therapy (and additional bupropion-SR in one of the programs) or usual care. Usual care consisted of periodic regular check-ups and COPD information. The main outcome measure was biochemically verified point prevalence at 12 months. Results: The two intervention groups were treated as one in the analysis because they were equally effective. The intervention resulted in a significantly self-reported higher success rate (14.5%) compared to usual care (7.4%); odds ratio = 2.1, 95% confidence interval = 1.1-4.1. Biochemically verified quit rates were 7.5% (intervention) and 3.4% (usual care); odds ratio = 2.3, 95% confidence interval = 0.9-6.0. Conclusion: The program doubled the cessation rates (statistically nonsignificant). Too few participants used the additional bupropion-SR to prove its effectiveness. Practice implications: The protocols can be used for COPD patients in general practice, but expectations should be modest. If quitting is unsuccessful, a stepped care approach should be considered.

Hser YI; Evans E; Huang D; Messina N. Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs. Journal of Substance Abuse Treatment 41(2): 115-123, 2011. (48 refs.)

This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.

Huang H; Ryan JP. Trying to come home: Substance exposed infants, mothers, and family reunification. Children and Youth Services Review 33(2): 322-329, 2011. (55 refs.)

Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.

Huang YS; Tang TC; Lin CH; Yen CF. Effects of Motivational Enhancement Therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents. Substance Use & Misuse 46(4): 411-416, 2011. (28 refs.)

The aim of this study was to examine the effect of brief modified motivational enhancement therapy (MET) on readiness to change patterns of methylenedioxymethamphetamine (MDMA) and methamphetamine (MAMP) use behaviors in adolescents. A total of 94 adolescents who used MDMA or MAMP were consecutively recruited from a juvenile abstinence center; 46 received a three-session MET intervention (intervention group), and 48 received educational materials only and no MET intervention (control group). Analysis of covariance was performed to examine the effect of motivational interviewing on the readiness of change scores on the University of Rhode Island Change Assessment and on the scores of its subscales. By using the pretreatment scores as covariates, the intervention group demonstrated higher posttreatment scores of readiness to change and of the contemplation subscale on the University of Rhode Island Change Assessment than the control group. The results of this study support the finding that brief modified MET is effective in promoting readiness to change MAMP and MDMA use behaviors in adolescents who receive short-term treatment programs.

Japuntich SJ; Piper ME; Leventhal AM; Bolt DM; Baker TB. The effect of five smoking cessation pharmacotherapies on smoking cessation milestones. Journal of Consulting and Clinical Psychology 79(1): 34-42, 2011. (28 refs.)

Objective: Most smoking cessation studies have used long-term abstinence as their primary outcome measure. Recent research has suggested that long-term abstinence may be an insensitive index of important smoking cessation mechanisms. The goal of the current study was to examine the effects of 5 smoking cessation pharmacotherapies using Shiffman et al.'s (2006) approach of examining the effect of smoking cessation medications on 3 process markers of cessation or smoking cessation milestones: initial abstinence, lapse, and the lapse relapse transition. Method: The current study (N = 1,504: 58.2% female and 41.8% male; 83.9% Caucasian, 13.6% African American, 2.5% other races) examined the effect of 5 smoking cessation pharmacotherapy treatments versus placebo (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, patch + lozenge) on Shiffman et al.'s smoking cessation milestones over 8 weeks following a quit attempt. Results: Results show that all 5 medication conditions decreased rates of failure to achieve initial abstinence and most (with the exception of the nicotine lozenge) decreased lapse risk; however, only the nicotine patch and bupropion + lozenge conditions affected the lapse relapse transition. Conclusions: These findings demonstrate that medications are effective at aiding initial abstinence and decreasing lapse risk but that they generally do not decrease relapse risk following a lapse. The analysis of cessation milestones sheds light on important impediments to long-term smoking abstinence, suggests potential mechanisms of action of smoking cessation pharmacotherapies.

Johnson JE; Friedmann PD; Green TC; Harrington M; Taxman FS. Gender and treatment response in substance use treatment-mandated parolees. Journal of Substance Abuse Treatment 40(3): 313-321, 2011. (53 refs.)

Well-controlled, randomized studies of correctional interventions examining gender effects are rare. This study examined gender main effects and gender x treatment interactions in a multisite randomized trial (N = 431) comparing a new form of correctional supervision for drug-involved offenders (collaborative behavioral management [CBM]) to standard parole. Outcomes included repeated measures of yes/no use of primary drug, alcohol use, and recidivism during 9 months postrelease. Generalized estimating equation analyses indicated that despite using harder drugs at baseline, women were less likely than men to use their primary drug and to use alcohol during the follow-up period. No gender-related differences in recidivism were found. Treatment interacted with gender to predict alcohol use, with women in CBM reporting the best alcohol outcomes (only 5% of women used alcohol during the follow-up period). The clear expectations, positive reinforcement, recognition of successes, fairness, and support present in CBM may be particularly important for women parolees.

Joosten EAG; De Weert-Van Oene GH; Sensky T; Van Der Staak CPF; De Jong CAJ. Treatment goals in addiction healthcare: The perspectives of patients and clinicians. International Journal of Social Psychiatry 57(3): 263- 276, 2011. (30 refs.)

Background: Little is known about the perspectives of either patients or clinicians regarding treatment goals in addiction healthcare. In general, treatment goals involve abstinence or at least reduction of substance use. Aim: To examine and compare the treatment goals indicated by both patients and clinicians at baseline, interim and exit measurement. Method: A descriptive study was performed with multiple measurements of treatment goals. Patients (n = 111) and clinicians (n = 20) were recruited from three addiction treatment centres in the Netherlands. A Shared Decision Making Intervention (SDMI) was undertaken to promote and evaluate treatment agreement. Results: Patients identified treatment goals of daytime activities and abstinence or reduced alcohol consumption as most important. Clinicians indicated psychological distress, daytime activities and substance use as most important. Differences between patients and clinicians were found for the treatment goals of physical health (patient > clinician) and psychological distress (clinician > patient). The results further showed that treatment goals of both patients and clinicians become more closely aligned during the course of treatment. Conclusion: SDMI provides a method to explore and discuss discrepancy between patients' and clinicians' goals of treatment which leads to convergence. Such convergence is likely to be a necessary prerequisite for positive treatment outcomes.

Kay-Lambkin FJ; Baker AL; Lee NM; Jenner L; Lewin TJ. The influence of depression on treatment for methamphetamine use. Medical Journal of Australia 195(3, supplement): S38-S43, 2011. (22 refs.)

Objective: To determine whether the presence of comorbid depression influences response to psychological treatment for methamphetamine use. Design: Randomised controlled clinical trial. Setting and participants: Our study was conducted between 2001 and 2005 at two sites in Australia: the Hunter Region of New South Wales and the city of Brisbane, Queensland. The 214 participants, who were all using methamphetamine at least once a week in the month prior to the study, were self-referred or referred from health services or drug and alcohol clinical services. Participants were divided into two groups based on whether or not they had depressive symptoms at baseline. Interventions: The control group received only a self-help booklet; the two treatment groups received either two or four, counselling sessions involving cognitive behaviour therapy and motivational interviewing techniques to manage methamphetamine use. Main outcome measures: Changes in methamphetamine use and depression at 5 weeks and 6 months after baseline. Results: Over 70% of participants met criteria for depression at baseline, and depression was associated with significantly greater severity of methamphetamine use and related issues. Benzodiazepine use was significantly higher among depressed than non-depressed participants. Reductions in methamphetamine use between baseline and 5 weeks were independently predicted by comorbid depression, in favour of increased change among those with baseline depression. Depressed participants who received three or four counselling sessions showed a significant reduction in depression at 5 weeks. However, reductions in methamphetamine use and depression compared with baseline were no longer evident at 6 months. Conclusions: Over the short term, comorbid depression did not negatively affect response to treatment, with some evidence of a dose response treatment effect for reduction in depression. This was not maintained at 6 months, indicating that methamphetamine-focused treatment may not enable people with comorbid depression to make sustained improvement at the level of their counterparts without depression.

Kidney CA; Alvarez J; Jason LA; Ferrari JR; Minich L. Residents of mutual help recovery homes, characteristics and outcomes: Comparison of four US ethnic subgroups. Drugs: Education, Prevention and Policy 18(1): 32-39, 2011. (40 refs.)

This study compared the characteristics and outcomes of four ethnic groups living in mutual help recovery homes. The sample consisted of 524 Caucasian, 305 African American, 31 Latino/a and 17 American Indian (AI) participants. This article includes a short review of relevant literature on AIs and substance use, provides an analysis of characteristics and outcomes of four ethnic groups and includes a discussion of the implications of the findings for knowledge of patterns of use among AIs. The AIs were more likely to report being on parole or probation and being referred for aftercare by the legal system. Additionally, AIs reported greater disharmony within their recovery residences than Caucasians, but there were no significant ethnic differences in baseline length of stay in Oxford House, length of alcohol or drug sobriety or substance use outcomes 4 months after the baseline assessment.

Kidorf M; King VL; Pierce J; Kolodner K; Brooner RK. Benefits of concurrent syringe exchange and substance abuse treatment participation. Journal of Substance Abuse Treatment 40(3): 265-271, 2011. (45 refs.)

Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n = 127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose response effect of treatment in syringe exchangers and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.

Kristjansson SD; Pergadia ML; Agrawal A; Lessov-Schlaggar CN; McCarthy DM; Piasecki TM et al. Smoking outcome expectancies in young adult female smokers: Individual differences and associations with nicotine dependence in a genetically informative sample. Drug and Alcohol Dependence 116(1-3): 37-44, 2011. (47 refs.)

Outcome expectancy is a central construct in models of addiction. Several outcome expectancies associated with smoking cigarettes have been identified, and studies suggest that individual differences in smoking expectancies are related to important aspects of tobacco use, including levels of smoking, nicotine dependence and smoking cessation. In the present study, we used a novel analytic method, exploratory structural equation modeling (ESEM), to quantify smoking expectancies from a subset of items adapted from the Smoking Consequences Questionnaire (SCQ; Brandon and Baker, 1991) and SCQ-Adult (Copeland et al., 1995). In our sample of 1262 monozygotic and dizygotic young adult, female twins who were regular smokers, we quantified six smoking expectancy factors similar to those reported in previous studies. These included Negative Affect Reduction, Boredom Reduction, Weight Control, Taste Manipulation, Craving/Addiction and Stimulation-state Enhancement. We used genetic model-fitting to examine the extent to which individual differences in the expectancies were influenced by latent genetic, shared environmental and non-shared environmental factors. We also examined the validity of the expectancy factors by examining their associations with nicotine dependence (ND) before and after adjusting for comorbid diagnoses of drug dependence and alcohol use disorder. Results of the validity analysis indicated that all of the expectancies were associated with ND after covariate adjustment. Although we lacked the statistical power to distinguish between genetic and shared environmental sources of variance, our results suggest that smoking outcome expectancies aggregate in families, but the majority of variance in these expectancies is due to environmental factors specific to the individual.

Licata SC; Penetar DM; Ravichandran C; Rodolico J; Palmer C; Berko J et al. Effects of daily treatment with citicoline: A double-blind, placebo-controlled study in cocaine-dependent volunteers. Journal of Addiction Medicine 5(1): 57-64, 2011. (32 refs.)

Many pharmacotherapies for treating cocaine dependence are aimed at reducing drug effects, alleviating craving, and preventing relapse. We demonstrated previously that citicoline, a compound used to repair neuronal damage in stroke and brain injury, is safe in cocaine-abusing volunteers. Objectives: This study assessed the effectiveness of an 8-week citicoline treatment period and 4-week follow-up in cocaine-dependent individuals. Methods: Twenty-nine healthy nontreatment-seeking, cocaine-dependent male and female volunteers were randomized in this double-blind, placebo-controlled study, 18 of whom completed the treatment period of the study. Participants took citicoline (500 mg twice daily) or matched placebo each day and recorded the measures of craving and drug use. Participants visited the laboratory twice a week for urine screens and to attend weekly group therapy sessions. Results: Citicoline had no effect on cocaine craving or total use. Conclusions: Although the current preliminary results from this small trial suggest that citicoline is not an effective treatment for heavy cocaine users, further investigation on efficacy citicoline as a treatment for substance dependence in other settings may be warranted.

Magidson JF; Gorka SM; MacPherson L; Hopko DR; Blanco C; Lejuez CW et al. Examining the effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on residential substance abuse treatment retention. Addictive Behaviors 36(6, special issue): 615- 623, 2011. (63 refs.)

Effective, parsimonious behavioral interventions that target reinforcement are needed for substance users with depression to improve mood as well as treatment retention. The Life Enhancement Treatment for Substance Use (LETS ACT; Daughters et al., 2008) is a behavioral activation-based approach tailored to increase levels of positive reinforcement among depressed substance users while in substance abuse treatment. The current study tested the efficacy of LETS ACT compared to a contact-time matched control condition, supportive counseling (SC), examining effects on depressed mood, substance abuse treatment retention, and behavioral activation outcomes. Fifty-eight adult substance users in residential substance abuse treatment presenting with depressive symptoms (BDI >= 12) were randomly assigned to LETS ACT or SC. Assessments were administered at pre- and post-treatment and included assessment of DSM-IV psychiatric diagnoses, depression severity, treatment motivation, overall activation, environmental reward, and substance abuse treatment retention. Patients in LETS ACT had significantly higher rates of substance abuse treatment retention and significantly greater increases in activation on the Behavioral Activation for Depression Scale (BADS) compared to those in SC. Both groups had decreased depression severity at post-treatment, although the group by time interaction was not significant. This study was the first to compare LETS ACT to a contact-time matched control treatment to evaluate effects on substance abuse treatment retention and two distinct measures of behavioral activation: overall activation and environmental reward. Findings suggest preliminary support for the feasibility, tolerability, and efficacy of a brief behavioral activation-based protocol that may be particularly useful to improve substance abuse treatment retention.

Maremmani AGI; Pani PP; Rovai L; Pacini M; Dell'Osso L; Maremmani I. Long-term gamma-hydroxybutyric acid (GHB) and Disulfiram combination therapy in GHB treatment-resistant chronic alcoholics. International Journal of Environmental Research and Public Health 8(7): 2816-2827, 2011. (48 refs.)

Leading Italian studies support the use of gamma-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better effect on craving than placebo or disulfiram. The problem is that about 30-40% of alcoholics are non-responders to GHB therapy. In our clinical practice, we speculate that by combining disulfiram with GHB treatment we may be able to achieve a kind of 'antagonist' effect by using the 'psychological threat' of disulfiram (adversative effect) while taking advantage of the anticraving effect of GHB, despite the limitation of its 'non-blockade' effect on alcohol. In this context, to improve the outcome in GHB long-term treated alcoholics, we added disulfiram to GHB in the management of GHB treatment-resistant alcoholics. In this study we compared retention in treatment of 52 patients who were treated with the GHB-disulfiram combination for up to six months, with retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out on the days of complete abstention from alcohol. Thirty four patients (65.4%) successfully completed the protocol and were considered to be responders; 18 (34.6%) left the programme, and were considered to be non-responders. Considering the days of complete abstinence from alcohol, 36 patients stayed in treatment longer with the GHB-Disulfiram combination, 12 stayed for a shorter time and four for the same time. The results of this study seem to indicate a higher efficacy of the GHB-disulfiram association compared with GHB alone. Randomized controlled trials are now needed to verify this hypothesis.

Marsden J; Eastwood B; Wright C; Bradbury C; Knight J; Hammond P. How best to measure change in evaluations of treatment for substance use disorder. Addiction 106(2): 294-302, 2011. (30 refs.)

Aims: To compare the performance of the Jacobson & Truax (JT) reliable change index (RCI) with three alternative methods, using data from individuals receiving treatment for substance use disorders. Design: English National Treatment Outcome Monitoring Database for publicly funded specialist community pharmacological and psychosocial interventions. Participants: New adult admissions to treatment across England (1 January-31 December 2008), with in-treatment clinic progress review conducted after an average of 122.8 days for 18 163 individuals. Measurements: Self-reported days using heroin, crack, cocaine powder and alcohol during the 4 weeks before admission and clinical review, recorded using the Treatment Outcomes Profile and analysed using a multi-level, mixed-linear model, with both observed and true scores to estimate the effect of regression to the mean (RTM). Differences in performance among the JT RCI and the alternative methods were assessed by the proportion assigned to a reliably 'improved', 'unchanged' or 'reliably deteriorated' category; level of agreement; difference in effect size for observed and true scores; and receiver operating characteristic parameters. Findings: When compared to the alternative methods, the JT RCI was more conservative in assigning individuals to the improved category, and it showed no evidence of inferiority on any measure. For each method, all individuals categorized as reliably deteriorated and the majority of those categorized reliably improved had outcome scores which fell beyond that expected by RTM. Substituting true scores for observed scores moderated the size of the change effect associated with reduced use of the four substances, but this remained statistically significant. Conclusions: The Jacobson & Truax Reliable Change Index appears to be the optimal measure of change for evaluations of treatment for substance use disorder, in that it is the most conservative for assessing improvement and at least as accurate on all other criteria. Any evaluation of change needs to take account of regression to the mean.

Martin RA; MacKinnon S; Johnson J; Rohsenow DJ. Purpose in life predicts treatment outcome among adult cocaine abusers in treatment. Journal of Substance Abuse Treatment 40(2): 183-188, 2011. (49 refs.)

A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies but has not been studied as a predictor of cocaine treatment outcome. This study examined pretreatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p < .01) predicted relapse to any use of cocaine and to alcohol and the number of days cocaine or alcohol was used in the 6 months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine-dependent patients.

Martinez D; Carpenter KM; Liu F; Slifstein M; Broft A; Friedman AC et al. Imaging dopamine transmission in cocaine dependence: Link between neurochemistry and response to treatment. American Journal of Psychiatry 168(6): 634-641, 2011. (39 refs.)

Objective: Previous research has shown that dopamine signaling in the limbic striatum is crucial for selecting adaptive, motivated behavior and that disrupted dopamine transmission is associated with impulsive and maladaptive behavior. In humans, positron emission tomography (PET) imaging studies have shown that cocaine dependence is associated with the dysregulation of striatal dopamine signaling, which is linked to cocaine-seeking behavior. The goal of the present study was to investigate whether this association applies to the treatment setting. The authors hypothesized that dopamine signaling in the limbic striatum would be associated with response to a behavioral treatment that uses positive reinforcement to replace impulsive cocaine use with constructive personal goals. Method: Prior to treatment, cocaine-dependent subjects underwent two PET scans using [C-11]raclopride, before and after the administration of a stimulant (methylphenidate), for measurement of striatal dopamine D-2/3 receptor binding and presynaptic dopamine release. Results: Both of the outcome measures were lower in the volunteers who did not respond to treatment than in those who experienced a positive treatment response. Conclusions: These findings provide insight into the neurochemistry of treatment response and show that low dopamine transmission is associated with treatment failure. In addition, these data suggest that the combination of behavioral treatment with methods that increase striatal dopamine signaling might serve as a therapeutic strategy for cocaine dependence.

Mason M; Pate P; Drapkin M; Sozinho K. Motivational interviewing integrated with social network counseling for female adolescents: A randomized pilot study in urban primary care. Journal of Substance Abuse Treatment 41(2): 148-155, 2011. (47 refs.)

This study tested the efficacy of a brief preventive intervention for substance use and associated risk behaviors among female adolescent patients of an urban primary care health clinic. We integrated an evidenced-based motivational interviewing (MI) approach with a social network component to develop a 20-minute session, a social network intervention delivered in an MI-consistent style. Female adolescents (N = 28) 14 to 18 years old were recruited, provided consent/assent, were screened, and were randomly assigned to the treatment or control (no treatment) condition. The sample was 82% African American and 18% mixed race, with 32% living below the U.S. poverty line. At 1-month follow-up, teens in the treatment condition reported less trouble due to alcohol use, less substance use before sexual intercourse, less social stress, less offers for marijuana use, and increased readiness to start counseling compared with the teens in the control condition. Results provide support for socially based brief interventions with at-risk urban adolescents.

McCambridge J; Day M; Thomas BA; Strang J. Fidelity to motivational interviewing and subsequent cannabis cessation among adolescents. Addictive Behaviors 36(7): 749-754, 2011. (38 refs.)

This study tested whether differences in cannabis cessation 3 months after a single session of Motivational Interviewing (MI) may be attributable to fidelity to MI. All audio-recordings with necessary 3-month follow-up data (n = 75) delivered by four individual practitioners within a randomised controlled trial (RCI) were used. Participants were weekly or more frequent cannabis users aged 16-19 years old in Further Education colleges. All tapes were coded with the Motivational Interviewing Treatment Integrity (MITI) scale Version 2 by 2 coders. Satisfactory inter-rater reliability was achieved. Differences between and within practitioners in fidelity to MI were consistently detected. After controlling for practitioner effects, Motivational Interviewing spirit and the proportion of complex reflections, were independently predictive of cessation outcome. No other aspects of fidelity were associated with outcome. Two particular aspects of enhanced fidelity to MI are predictive of subsequent cannabis cessation 3 months after a brief intervention among young cannabis users.

McKee LG; Bonn-Miller MO; Moos RH. Depressive symptoms, friend and partner relationship quality, and posttreatment abstinence. Journal of Studies on Alcohol and Drugs 72(1): 141-150, 2011. (57 refs.)

Objective: This study employed a prospective design to examine the role of friend and partner relationship quality 1 year following substance use disorder treatment in the association between depressive symptoms at discharge from treatment and abstinence from substance use 2 years after treatment. Method: The sample consisted of 1,453 male veterans who used alcohol and at least one other substance in the 3 months before treatment admission, who completed treatment, and who were abstinent from substances during the 2 weeks before discharge. Results: Fewer depressive symptoms at treatment discharge predicted better relationship quality with friends and a partner at 1-year follow-up, as well as abstinence from substance use at 2-year follow-up. Furthermore, friend and partner relationship quality at I year predicted abstinence from substance use at 2 years. Friend relationship quality at 1 year mediated part of the association between fewer depressive symptoms at treatment discharge and abstinence at 2-year follow-up. Conclusions: A stronger focus in treatment on reducing depressive symptoms and enhancing the quality of patients' relationships with their friends and partner may increase the likelihood of long-term abstinence.

Minozzi S; Amato L; Vecchi S; Davoli M; Kirchmayer U; Verster A. Oral naltrexone maintenance treatment for opioid dependence. (review). Cochrane Database of Systematic Reviews 2: article CD001333, 2011. (64 refs.)

Background: Research on the clinical application of oral naltrexone agrees on several things. From a pharmacological perspective, naltrexone works. From an applied perspective, however, the medication compliance and the retention rates are very poor. Objectives: To evaluate the effects of naltrexone maintenance treatment versus placebo or other treatments in preventing relapse in opioid addicts after detoxification. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library issue 6 2010), PubMed (1973-June 2010), CINAHL (1982-June 2010). We inspected reference lists of relevant articles and we contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. Selection criteria: All randomised and controlled clinical trials which focus on the use of naltrexone maintenance treatment versus placebo, or other treatments to reach sustained abstinence from opiate drugs Data collection and analysis Three reviewers independently assessed studies for inclusion and extracted data. One reviewer carried out the qualitative assessments of the methodology of eligible studies using validated checklists. Main results: Thirteen studies, 1158 participants, met the criteria for inclusion in this review. Comparing naltrexone versus placebo or no pharmacological treatments, no statistically significant difference were noted for all the primary outcomes considered. The only outcome statistically significant in favour of naltrexone is re-incarceration, RR 0.47 (95% CI 0.26-0.84), but results come only from two studies. Comparing naltrexone versus psychotherapy, in the two considered outcomes, no statistically significant difference was found in the single study considered. Naltrexone was not superior to benzodiazepines and to buprenorphine for retention and abstinence and side effects. Results come from single studies. Authors' conclusions: The findings of this review suggest that oral naltrexone did not perform better than treatment with placebo or no pharmacological agent with respect to the number of participants re-incarcerated during the study period. If oral naltrexone is compared with other pharmacological treatments such as benzodiazepine and buprenorphine, no statistically significant difference was found. The percentage of people retained in treatment in the included studies is however low (28%). The conclusion of this review is that the studies conducted have not allowed an adequate evaluation of oral naltrexone treatment in the field of opioid dependence. Consequently, maintenance therapy with naltrexone cannot yet be considered a treatment which has been scientifically proved to be superior to other kinds of treatment.

Mitchell SG; Morioka R; Reisinger HS; Peterson JA; Kelly SM; Agar MH et al. Redefining retention: Recovery from the patient's perspective. Journal of Psychoactive Drugs 43(2): 99-107, 2011. (34 refs.)

This study examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs. The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes. Differences in terms of the patients' goals and motivations for seeking treatment from those of the treatment programs, combined with difficulties encountered during the treatment process eventually led to discharge. However, these patients were then able to navigate their way through the treatment system in different ways in order to remain in treatment. The authors conclude that failure to abide by treatment clinic rules do not necessary constitute "treatment failure" from the perspective of patients, who often wish to remain in treatment even if it is not progressing optimally from the program's perspective. As a result, the recovery process can be more fragmented and is often characterized by a series of cyclical treatment episodes rather than continuous time in treatment, thereby impeding their progress towards recovery.

Nieva G; Ortega LL; Mondon S; Ballbe M; Gual A. Simultaneous versus delayed treatment of tobacco dependence in alcohol-dependent outpatients. European Addiction Research 17(1): 1-9, 2011. (54 refs.)

Introduction: There is a high prevalence of smoking among heavy drinkers, which is often forgotten even though it has important health consequences. Aim: To evaluate the effects that providing an intensive tobacco cessation treatment simultaneously with alcohol dependence treatment versus delayed treatment (first alcohol and 6 months later tobacco) has on alcohol and tobacco consumption. Methods: Ninety-two alcohol-dependent smokers were randomized into either a simultaneous group, in which treatment was given concurrently for quitting both alcohol and tobacco, or a delayed group, in which help to quit smoking was given after 6 months. Results: No differences were found in alcohol abstinence rates in time-to-first relapse or in cumulative abstinence at 6 months. Smoking cessation rates were low overall, but better at 3 months in the simultaneous group, although differences later disappeared. Discussion: Participation in a smoking cessation program does not impair alcohol outcomes, at least during the first 6 months.

Ogel K; Coskun S. Cognitive behavioral therapy-based brief intervention for volatile substance misusers during adolescence: A follow-up study. Substance Use & Misuse 46(Supplement 1): 128-133, 2011. (29 refs.)

Of 62 males admitted for treatment in Turkey in 2008 with a diagnosis of volatile substance misuse (VSM) dependency, half were randomly allocated to receive a cognitive behavioral therapy (CBT)-based brief intervention and an education program and half participated only in the education program. One year after treatment, 38.2%% of the experimental group and 58.1%% of the control group had continued VSM during the last three months. This statistically significant difference indicates that CBT-based brief intervention is associated with reducing VSM in adolescents. Factors associated with abstinence after treatment are identified and study limitations are noted.

Ondersma SJ; Grekin ER; Svikis D. The potential for technology in brief interventions for substance use, and during-session prediction of computer-delivered brief intervention response. Substance Use & Misuse 46(1): 77-86, 2011. (42 refs.)

We first provide an overview of the potential of technology in the area of brief interventions for substance use and describe recent projects from our lab that are illustrative of that potential. Second, we present data from a study of during-session predictors of brief intervention response. In a sample of postpartum women (N = 39), several variables showed promise as predictors of later drug use, and a brief index derived from them predicted abstinence with a sensitivity of .7 and a specificity of .89. This promising approach and initial study findings support the importance of future research in this area.

Oviedo-Joekes E; Marchand K; Guh D; Marsh DC; Brissette S; Krausz M et al. History of reported sexual or physical abuse among long-term heroin users and their response to substitution treatment. Addictive Behaviors 36(1-2): 55-60, 2011. (50 refs.)

Opioid dependent individuals with a history of abuse have exhibited worse mental and physical health compared to those without such a history, however the evidence regarding the influence of abuse histories on addiction treatment outcomes are conflicting. In the present study we identified history of physical or sexual abuse at treatment initiation in relation to drug use and health among long term opioid dependent individuals and we determined the relationship of abuse histories with treatment outcomes following substitution treatment. We analyzed data from a randomized controlled trial that compared the effectiveness of opioid agonists in the treatment of chronic opioid dependence. The North American Opiate Medication Initiative (NAOMI) was conducted in Vancouver and Montreal (Canada) and provided oral methadone injectable diacetylmorphine or injectable hydromorphone the last two on a double blind basis over 12 months. A total of 112 (44.6%) participants reported a history of physical or sexual abuse at baseline. Participants with an abuse history reported a significantly higher number of chronic medical problems, suicide attempts, and previous drug treatments, and had poorer psychiatric family and social relations, and quality of life status, compared to those without abuse histories. No differences in current and past substance use were found between those with and without abuse histories. Following 12 months of treatment the participants with abuse histories improved to a similar degree as those without a history of abuse in all of the European Addiction Severity Index sub scales, with the exception of medical status. The findings suggest that individuals with abuse histories were able to achieve similar outcomes as those without abuse histories following treatment, despite having poorer scores in physical and mental health, social status, and quality of life at treatment initiation. These findings suggest that the substitution treatments as provided in this study can benefit the most vulnerable and access needs to be expanded to reach this population

Pani PP; Maremmani I; Pacini M; Lamanna F; Maremmani AGI; dell'Osso L. Effect of psychiatric severity on the outcome of methadone maintenance treatment. European Addiction Research 17(2): 80-89, 2011. (67 refs.)

While psychiatric comorbidity has been shown to produce a negative impact on the outcome of opioid use disorders, longitudinal studies carried out in the context of methadone maintenance treatment programs (MMTP) to evaluate outcomes strictly linked to methadone efficacy have not demonstrated a similar negative influence. To verify whether results obtained considering psychopathology in terms of formal psychiatric diagnoses were replicated when assessing psychopathology in terms of global psychiatric severity, a retrospective cohort study was designed. 259 patients commencing methadone maintenance treatment were divided into two groups on the basis of SCL-90 severity score and compared for retention in treatment, toxicological urine test results and psychological/psychiatric status throughout a one year period of observation. The results of the study suggest that patients in MMTP with high psychiatric severity are not characterized by a lower retention in treatment or higher substance use than those with low psychiatric severity. Moreover, during treatment high severe psychiatric patient status appears to improve significantly for all psychological/ psychiatric dimensions explored by SCL-90. These results are consistent with those obtained in previous studies on the efficacy of MMTP, comprehensive of psychiatric care, irrespective of the severity of psychopathology exhibited by patients at the beginning of treatment.

Park ER; Japuntich S; Temel J; Lanuti M; Pandiscio J; Hilgenberg J et al. A smoking cessation intervention for thoracic surgery and oncology clinics: A pilot trial. Journal of Thoracic Oncology 6(6): 1059- 1065, 2011. (49 refs.)

Introduction: Although most smokers diagnosed with lung cancer report that they want to quit smoking, many do not succeed. Smokers who quit when lung cancer is diagnosed have improved treatment efficacy, quality of life, and survival. Effective smoking cessation interventions targeted to thoracic oncology patients are needed. Methods: This pilot study examined the feasibility and potential efficacy of a 12-week program that combined smoking cessation counseling with varenicline. Seven-day point prevalence tobacco abstinence rates at the end of treatment were compared with a usual care control group. From January 2008 to August 2009, patients with a diagnosed or suspected thoracic malignancy were recruited at their initial visit to a thoracic surgeon or thoracic oncologist at Massachusetts General Hospital. Results: Of 1,130 patients screened, 187 (17%) were current smokers, and an additional 66 (6%) reported quitting within the past 6 months. One hundred sixteen (67%) of smokers were eligible, and 49 (42%) of eligible smokers enrolled (control group n = 17, intervention group n = 32). Intervention participants completed a median of nine counseling sessions; 50% of intervention participants completed the full varenicline course. At 12-week follow-up, biochemically validated 7-day point prevalence tobacco abstinence rates were 34.4% in the intervention group versus 14.3% in the control group (odds ratio = 3.14, 95% confidence interval = 0.59-16.62, p = 0.18). Conclusion: Our findings support the feasibility and acceptability of this program. At the end of treatment, quit rates were higher in the control group. Further testing is indicated to establish the efficacy of this treatment package in a randomized clinical trial.

Pedersen MU; Hesse M; Bloomfield K. Abstinence-orientated residential rehabilitation of opioid users in Denmark: Do changes in national treatment policies affect treatment outcome? Scandinavian Journal of Public Health 39(6): 582-589, 2011. (24 refs.)

Aims: Significant changes in the Danish drug-abuse treatment system occurred from 1998 to 2008, allowing the opportunity to study their impact on outcomes for opiate dependent patients. This paper examines whether such changes are related to possible changes in abstinence rates of two cohorts of drug users. Methods: We compared survival curves and the month-by-month probability of abstinence between cohorts of drug abusers who were followed for one year after treatment for opioid dependence in 1998 (n = 305) and in 2008 (n = 204). Of the 1998 cohort, 192 were interviewed face-to-face and 61 were found through national drug-abuse treatment registers. Of the 2008 cohort 112 were interviewed face-to-face and 42 were found through national drug-abuse treatment registers. Results: Survival curves did not differ between the two cohorts. After controlling for age and gender, people from the 2008 cohort had a higher frequency of month-to-month rates of abstinence. A higher proportion of clients received new treatment after their index treatment in 2008. Clients from the 1998 cohort who did not receive new treatment used drugs more often than clients who did not receive treatment in 2008. At the same time, the proportion of clients who received residential rehabilitation treatment for opiate dependence increased substantially by 2008. Conclusions: Total abstinence rates are highly consistent over time and seem to change little with changes in systems of care. However, changes in care that improve access to treatment may reduce the overall burden of opioid addiction to both individuals and society.

Petry NM; Ford JD; Barry D. Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories. Psychology of Addictive Behaviors 25(2): 293-300, 2011. (55 refs.)

Exposure to sexual victimization is prevalent among persons with substance use disorders (SUDs). Contingency management (CM) treatments utilize concrete and relatively immediate positive reinforcers to retain patients in treatment and reduce substance use, and CM may have particular benefits for patients with histories of sexual victimization. Using data from three randomized trials of CM (N = 393), this study evaluated main and interactive effects of sexual abuse history and treatment condition (standard care versus CM) with respect to during treatment outcomes (retention, proportion of negative urine samples submitted, and longest duration of abstinence) and abstinence at a nine-month follow-up. Compared to patients without sexual abuse histories (N = 316), those with sexual abuse histories (N = 77) submitted a significantly higher proportion of negative samples in treatment. In CM, but not in standard care, patients with sexual abuse histories achieved significantly longer durations of abstinence during treatment than those without sexual abuse histories. Although sexual abuse history was not associated with abstinence at nine-month follow-up evaluations, longest duration of abstinence during treatment was significantly associated with this long-term outcome. Results suggest that SUD patients with sexual abuse histories may accrue particular benefits during CM treatment that are associated with long-term abstinence.

Piper ME; Cook JW; Schlam TR; Jorenby DE; Baker TB. Anxiety diagnoses in smokers seeking cessation treatment: Relations with tobacco dependence, withdrawal, outcome and response to treatment. Addiction 106(2): 418-427, 2011. (51 refs.)

Aims: To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking. Design: Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge. Setting: Two urban research sites. Participants: Data were collected from 1504 daily smokers (> 9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use. Measurements: Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks. Findings: A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies. Conclusions: Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.

Planer D; Lev I; Elitzur Y; Sharon N; Ouzan E; Pugatsch T et al. Bupropion for smoking cessation in patients with acute coronary syndrome. Archives of Internal Medicine 171(12): 1055-1060, 2011. (28 refs.)

Background: Smokers hospitalized with acute coronary syndrome (ACS) are at high risk for subsequent ischemic events. Nevertheless, over two-thirds of patients continue to smoke after an acute myocardial infarction. Bupropion hydrochloride has proven efficacy as a smoking cessation aid, but data regarding its safety and efficacy in ACS patients are limited. Methods: In a double-blind, randomized controlled trial, we compared the safety and efficacy of 8 weeks of treatment with bupropion slow-release (SR) or placebo for smokers hospitalized with ACS as an adjunct to nurseled hospital- and telephone-based support. Primary efficacy outcome was smoking abstinence at 1 year. Primary safety outcome was clinical events at 1 year. Results: A total of 151 patients were enrolled; all but 2 completed follow-up. Abstinence rates at 3 months were 45% and 44% in the bupropion SR and placebo groups, respectively (P=.99); 37% vs 42% (P=.61) at 6 months; and 31% vs 33% (P=.86) at 1 year. On multivariate analysis, an invasive procedure performed during index hospitalization was an independent predictor for smoking abstinence at 1 year (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.22-14.19). Presence of adverse effects attributed to treatment was a negative predictor for smoking cessation (OR, 0.23; 95% CI, 0.07-0.78). Treatment with bupropion SR was not associated with an increase in clinical events or change in blood pressure or body mass index, but dizziness was more common compared with placebo (14% vs 1.4%; P=.005). Conclusion: In hospitalized patients with ACS who received continuous, intensive nurse counseling about smoking cessation, bupropion did not increase the rates of smoking abstinence.

Powell C; Christie M; Bankart J; Bamber D; Unell I. Drug treatment outcomes in the criminal justice system: What non-self-report measures of outcome can tell us. Addiction Research & Theory 19(2): 148-160, 2011. (46 refs.)

Coerced drug treatment has become a common route for drug users to enter drug treatment in the UK and has been shown to be effective in reducing drug use and offending. This article presents the non-self-report measures of offending and drug use for one such treatment. The results support the findings of other studies in that those with lower offending rates prior to starting treatment and lower drug use during treatment show reduced offending following treatment commencement. More serious drug-using offenders showed limited changes in their offending following drug treatment. Possible explanations for this are discussed.

Puente D; Cabezas C; Rodriguez-Blanco T; Fernandez-Alonso C; Cebrian T; Torrecilla M et al. The role of gender in a smoking cessation intervention: A cluster randomized clinical trial. BMC Public Health 11(e-article 369), 2011. (37 refs.)

Background: The prevalence of smoking in Spain is high in both men and women. The aim of our study was to evaluate the role of gender in the effectiveness of a specific smoking cessation intervention conducted in Spain. Methods: This study was a secondary analysis of a cluster randomized clinical trial in which the randomization unit was the Basic Care Unit (family physician and nurse who care for the same group of patients). The intervention consisted of a six-month period of implementing the recommendations of a Clinical Practice Guideline. A total of 2,937 current smokers at 82 Primary Care Centers in 13 different regions of Spain were included (2003-2005). The success rate was measured by a six-month continued abstinence rate at the one-year follow-up. A logistic mixed-effects regression model, taking Basic Care Units as random-effect parameter, was performed in order to analyze gender as a predictor of smoking cessation. Results: At the one-year follow-up, the six-month continuous abstinence quit rate was 9.4% in men and 8.5% in women (p = 0.400). The logistic mixed-effects regression model showed that women did not have a higher odds of being an ex-smoker than men after the analysis was adjusted for confounders (OR adjusted = 0.9, 95% CI = 0.7-1.2). Conclusions: Gender does not appear to be a predictor of smoking cessation at the one-year follow-up in individuals presenting at Primary Care Centers.

Pullmann MD. Effects of out-of-home mental health treatment on probability of criminal charge during the transition to adulthood. American Journal of Orthopsychiatry 81(3): 410-419, 2011. (59 refs.)

Criminal justice-related outcomes for youth who have been served in out-of-home mental health settings such as residential treatment and inpatient hospitalization are unclear. This study longitudinally modeled the changing probability of being charged with a crime from age 16 to 25, including being served in out-of-home treatment and aging into adulthood, while controlling for person-level covariates such as gender, race, past criminal charges, and mental health diagnoses. Results. indicated that out-of-home treatment was related to a decreased probability of being charged with a crime during treatment. However, the preventive effect was small; estimates indicated only one criminal charge avoided for every 4 years of out-of-home treatment. Out-of-home treatment had no relationship to posttreatment probability of charge. Other significant contributors to being charged included gender, a substance use diagnosis, and an offense record prior to age 16. Evidence indicated that out-of-home treatment was used as an alternative to detention and incarceration for both juveniles and adults.

Pyne JM; Tripathi S; French M; McCollister K; Rapp RC; Booth BM. Longitudinal association of preference-weighted health-related quality of life measures and substance use disorder outcomes. Addiction 106(3): 507-515, 2011. (45 refs.)

Aim: To examine the construct validity of generic preference-weighted health-related quality of life measures in a sample of patients with a substance use disorder (SUD). Design: Longitudinal (baseline and 6-month follow-up) data from a research study that evaluated interventions to improve linkage and engagement with SUD treatment. Setting: A central intake unit that referred patients to seven SUD treatment centers in a Midwestern US metropolitan area. Participants: A total of 495 individuals with a SUD. Measurements: Participants completed two preference-weighted measures: the self-administered Quality of Well-Being scale (QWB-SA) and the standard gamble weighted Medical Outcomes Study SF-12 (SF-6D). They were also administered two clinical assessments: all seven domains of the Addiction Severity Index (ASI) and a symptom checklist based on the DSM-IV. Construct validity was determined via the relationships between disease-specific SUD and generic measures. Findings: In unadjusted analyses, the QWB-SA and SF-6D change scores were correlated significantly with six ASI subscale change scores, but not with employment status. In adjusted repeated-measures analyses, three of seven ASI subscale scores were significant predictors of QWB-SA and 5/7 ASI subscale scores were significant predictors of SF-6D. Abstinence and problematic use at follow-up were significant predictors of QWB-SA and SF-6D. Effect sizes ranged from 0.352 to 0.400 for abstinence and -0.484 to -0.585 for problematic use. Conclusions: Generic preference-weighted health-related quality of life measures show moderate to good associations with substance-use specific measures and in certain circumstances can be used in their stead. This study provides further support for the use of the Quality of Well-Being scale and Medical Outcomes Study SF-12 in clinical and economic evaluations of substance use disorder interventions.

Ramchand R; Griffin BA; Suttorp M; Harris KM; Morral A. Using a cross-study design to assess the efficacy of motivational enhancement therapy-cognitive behavioral therapy 5 (met/cbt5) in treating adolescents with cannabis-related disorders. Journal of Studies on Alcohol and Drugs 72(3): 380- 389, 2011. (51 refs.)

Objective: To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of motivational enhancement therapy plus cognitive behavioral therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment. Method: Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy. Results: Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community-based outpatient programs. Results showed no evidence that youth who received MET/CBT5 would have fared better with respect to emotional problems, the likelihood of being institutionalized, or achieving a "recovery" status at 12 months had they received community-based treatments. Conclusions: The community-based treatments used in this study have not been assessed relative to "treatment as usual" but were selected as "exemplary" models of adolescent treatment. There is no evidence in this study that these exemplary programs yielded superior 12-month outcomes for the treatment of adolescents with marijuana problems; youth receiving MET/CBT5 experienced greater reductions in substance use and illegal activities. Thus, MET/CBT5 may be a promising treatment for community-based providers to adopt to treat these clients.

Rayens MK; Hahn EJ; Nicholson D. psychosocial characteristics of smokers interested in quitting. Journal of Health Psychology 16(2): 294-302, 2011. (47 refs.)

The purpose was to determine whether psychosocial factors are associated with cessation among smokers interested in quitting. This cross-sectional study included 403 current and former smokers enrolled in a 'Quit and Win' contest. After the quit period, data were collected via a telephone interview at three months post-baseline. Controlling for demographics and secondhand smoke exposure, lower depressive symptoms and more positive partner or friend support to quit predicted a greater likelihood of quitting. Integrated interventions that combine tobacco treatment with mental health strategies to reduce depressive symptoms and improve partner or friend interactions may be most effective with smokers interested in quitting.

Robbins MS; Feaster DJ; Horigian VE; Puccinelli MJ; Henderson C; Szapocznik J. Therapist adherence in brief strategic family therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology 79(1): 43-53, 2011. (44 refs.)

Objective: Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study. Method: Participants were 480 adolescents (age 12-17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis. & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies. Results: Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Conclusions: Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy.

Schnoll RA; Martinez E; Langer C; Miyamoto C; Leone F. Predictors of smoking cessation among cancer patients enrolled in a smoking cessation program. Acta Oncologica 50(5): 678- 684, 2011. (48 refs.)

Many cancer patients continue to smoke postdiagnosis, which is associated with poorer clinical outcomes. Identifying prospective predictors of smoking cessation among patients currently receiving smoking cessation treatment can help guide the development and implementation of smoking cessation programs with this population. Material and methods. Data from 246 cancer patients participating in a randomized placebo-controlled smoking cessation clinical trial were used to examine baseline predictors of end-of-treatment and six-month postbaseline smoking cessation outcomes. Baseline demographic, smoking-related, disease-related, and psychological variables were examined as predictors of biochemically-confirmed point-prevalence abstinence. Results. Multivariate analysis indicated that, for end-of-treatment abstinence, patients were significantly more likely to have quit smoking if they were older (OR = 1.06, 95% CI: 1.03 -1.10, p < 0.05) and were diagnosed with a non-tobacco related cancer (OR = 2.54, 95% CI: 1.24-5.20, p < 0.05). Likewise, for six-month abstinence, patients were significantly more likely to have quit smoking if they were older (OR = 1.04, 95% CI: 1.01-1.08, p < 0.05) and were significantly less likely to have quit smoking if they were female (OR = 0.47, 95% CI: 0.22-0.97, p < 0.05). Patients with tobacco-related cancers and female patients reported significantly higher levels of depression symptoms (p < 0.05), which proved predictive of smoking relapse. Conclusions. Patient age, gender, and cancer-type may be important factors to consider when developing and implementing smoking cessation interventions for cancer patients.

Secades-Villa R; Garcia-Rodriguez O; Garcia-Fernandez G; Sanchez-Hervas E; Fernandez-Hermida JR; Higgins ST. Community Reinforcement Approach plus vouchers among cocaine-dependent outpatients: Twelve-month outcomes. Psychology of Addictive Behaviors 25(1): 174-179, 2011. (24 refs.)

The aims of this study were to assess the effectiveness of the Community Reinforcement Approach (CRA) plus vouchers treatment in a cohort of Spanish cocaine-dependent outpatients, and to examine the maintenance of treatment effects after the voucher intervention was discontinued. Sixty-four adult outpatients were randomly assigned to one of two treatment conditions, CRA plus vouchers or standard care. The vouchers program was implemented from weeks 1 to 24. Among patients assigned to the CRA plus vouchers condition, 65.5% completed 12 months of treatment versus 28.6% of those assigned to the standard care condition (p = .003). At the 12-month assessment, 58.6% of patients assigned to the CRA plus vouchers condition were abstinent, compared with 25.7% in the standard care condition (p = .008); furthermore, 34.5% of patients assigned to the CRA plus vouchers condition achieved twelve months of continuous cocaine abstinence, versus 17.1% in the standard care condition. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the standard care condition. Overall, these results reveal an extension of the effectiveness of the CRA plus vouchers treatment to a community sample of cocaine-dependent outpatients, while also supporting the maintenance of treatment effects for 6 months after completion of the voucher program.

Shahab L; McEwen A; West R. Acceptability and effectiveness for withdrawal symptom relief of a novel oral nicotine delivery device: A randomised crossover trial. Psychopharmacology 216(2): 187-196, 2011. (32 refs.)

Existing nicotine replacement therapies (NRT) improve the chances of smoking cessation but are limited by either relatively slow nicotine absorption rates or unpleasant side effects, leaving scope for the development of more effective and acceptable products. This study aimed to test the acceptability and effectiveness for withdrawal symptom relief of a novel nicotine delivery device, the 'Nicotine Cannon' (NC), compared with three existing, equivalent products: the nicotine lozenge, mini-lozenge and nicotine inhalator. A repeated-measures crossover trial where participants were randomised to one of two conditions (1- or 10-h abstinence) and in each condition to one of 24 possible sequence permutations to test each product for 10 min was carried out. Standard sociodemographic and smoking characteristics were assessed as well as withdrawal and NRT use symptoms before, during and after NRT use and product satisfaction after use. The results were similar across both durations of abstinence. The NC was significantly more effective than the inhalator in reducing withdrawal symptoms (F(3, 196) = 3.5, p = 0.015) and together with the mini-lozenge performed better than other NRT in alleviating urges to smoke (F(3, 563) = 9.6, p < 0.001) and desire for cigarettes within 10 min of use (F(3, 727) = 26.1, p < 0.001). The NC induced fewer adverse side effects than other NRT and was judged to be more enjoyable (F(3, 87) = 13.56, p < 0.001) and satisfying to use (F(3, 92) = 12.35, p < 0.001). The 'Nicotine Cannon' is at least as effective as equivalent NRT in reducing withdrawal symptoms and more acceptable to users, suggesting that it would be a useful addition to existing NRT. The acceptability profile could make it particularly useful as a 'harm reduction' tool.

Skinner ML; Haggerty KP; Fleming CB; Catalano RF; Gainey RR. Opiate-addicted parents in methadone treatment: Long-term recovery, health, and family relationships. Journal of Addictive Diseases 30(1): 17-26, 2011. (35 refs.)

Few studies follow the lives of opiate-addicted parents. The authors examined a 12-year follow-up of 144 parents in methadone treatment and their 3- to 14-year-old children. Parent mortality was high. Among survivors, drug use and treatment, incarceration, residential and family disruptions, and health problems were common. Moderate and long-term recovery were associated with consistent methadone treatment, further education, employment, and fewer relationship disruptions. Earlier depression, deviant friends, and poor coping skills predicted continued drug problems. Thus, interventions should include treatment for depression and build skills for avoiding and refusing drugs, coping with stress, and maintaining recovery-supportive friendships.

Specka M; Buchholz A; Kuhlmann T; Rist F; Scherbaum N. Prediction of the outcome of inpatient opiate detoxification treatment: Results from a multicenter study. European Addiction Research 17(4): 178-184, 2011. (25 refs.)

Background: Monocentric studies of inpatient opiate detoxification treatment show considerable variability regarding treatment success rates. This multicentric study investigates whether patient characteristics explain the different rates of regular discharge between treatment units. Methods: 1,017 opiate-dependent patients from 12 detoxification units with similar treatment programs, funding, staffing and equipment were analyzed. Patient data and outcomes were documented by treatment staff using a standard form. Results: Controlling for center, regular discharge (range: 14-49% between centers) was significantly associated with pre-existing plans for follow-up treatment, previous completed long-term residential and detoxification treatments, fewer unsuccessful detoxification treatments, higher age, later onset of opiate use, and longer duration of use. Controlling for patient characteristics, the center variable was significantly associated with outcome in a multiple logistic regression analysis. Conclusions: Regular discharge could best be predicted by patients' plans for follow-up treatment and previous treatment outcomes. Although treatment units had equivalent resources and regulations, and although patient effects were statistically controlled for, there were still considerable center effects. Setting factors as well as actual drop-out processes should be investigated more closely in the future.

Stein LAR; Lebeau R; Colby SM; Barnett NP; Golembeske C; Monti PM. Motivational interviewing for incarcerated adolescents: Effects of depressive symptoms on reducing alcohol and marijuana use after release. Journal of Studies on Alcohol and Drugs 72(3): 497- 506, 2011. (51 refs.)

Objective: Motivational interviewing to reduce alcohol and marijuana use among incarcerated adolescents was evaluated. Method: Adolescents (N = 162, 84% male; M = 17.10 years old) were randomly assigned to receive motivational interviewing or relaxation training, with follow-up assessment 3 months after release. Results: Compared with those who received relaxation training, adolescents who received motivational interviewing had lower rates of alcohol and marijuana use at follow-up, with some evidence for moderating effects of depression. At low levels of depression, adolescents who received motivational interviewing had lower rates of use. Adolescents who received relaxation training and who had high levels of depressive symptoms early in incarceration showed less use at follow-up than those low in depressive symptoms who received relaxation training. Conclusions: This brief motivational interviewing intervention during incarceration reduces alcohol and marijuana use after release. In addition, depressive symptoms early in incarceration should be considered in treating these adolescents, but more work is needed to extend follow-up period and account for the impact of depression on outcomes.

Stein MD; Hagerty CE; Herman DS; Phipps MG; Anderson BJ. A brief marijuana intervention for non-treatment-seeking young adult women. Journal of Substance Abuse Treatment 40(2): 189-198, 2011. (48 refs.)

We randomized 332 women, 18-24 years old, who were not explicitly seeking treatment for their marijuana use to either a two-session motivationally focused intervention or an assessment-only condition. Assessed by timeline follow-back methodology, participants reported using marijuana 57% of days in the 3 months prior to study entry. Intervention effects on the likelihood of marijuana use were not statistically significant: at 1 month (odds ratio [OR] = 0.77, p = .17), significant at 3 months (OR = 0.53, p = .01), and no longer significant at 6 months (OR = 0.74, p = .20). Among the 61% of participants endorsing any desire to quit using marijuana at baseline, significant intervention effects on the likelihood of marijuana use days were observed at 1 month (OR = 0.42, p = .03), 3 months (OR = 0.31, p = .02), and 6 months (OR = 0.35, p = .03). A two-session brief motivational intervention reduced marijuana use among young women not seeking treatment. Women with a desire to quit showed a greater and more durable response.

Stough C; Camfield D; Kure C; Tarasuik J; Downey L; Lloyd J et al. Improving general intelligence with a nutrient-based pharmacological intervention. Intelligence 39(2-3): 100- 107, 2011. (77 refs.)

Cognitive enhancing substances such as amphetamine and modafinil have become popular in recent years to improve acute cognitive performance particularly in environments in which enhanced cognition or intelligence is required. Nutraceutical nootropics, which are natural substances that have the ability to bring about acute or chronic changes in cognition have also been gaining popularity in a range of settings and applications including the workplace, driving and in the amelioration of age related cognitive decline. Huperzine A, Vinpocetine, Acetyl-L-carnitine, Rhodiola Rosea and Alpha-lipoic Acid are popular nutritional supplements that have shown promising benefits in improving a range of biological (e.g., blood flow, anti-inflammatory, anti-oxidant, and direct neurotransmitter effects) and cognitive processes from in vitro, animal and human clinical research. We report here the first human randomized clinical trial for cognition in which we administer a combination of Huperzine A, Vinpocetine, Acetyl-carnitine, R Rosea and Alpha-lipoic acid (called Ceretrophin) vs placebo. Sixty participants (40 females and 20 males, with a mean age of 45.4 years, SD = 12.6) completed either the odd or even items from the Raven Advanced Progressive Matrices (APM) at baseline and the opposite odd or even items at week 4 after consuming either the combination nootropic or placebo. A significant study visit (time) x treatment condition interaction was found: F (1, 57) = 7.279, p = 0.009, partial eta(2) = .113, with paired samples t-tests revealing a significant improvement in mean APM score from baseline to retest (week 4) (t(34) = -4.045, p <.001) for the Ceretrophin (TM) group. Improvements in APM scores could be attributed to the active intervention over the placebo, indicating that the treatment improved general intelligence. Implications for improving our understanding of the biological basis of intelligence and pharmacologically improving human cognition are discussed.

Stulz N; Thase ME; Gallop R; Crits-Christoph P. Psychosocial treatments for cocaine dependence: The role of depressive symptoms. Drug and Alcohol Dependence 114(1): 41-48, 2011. (57 refs.)

Background: The association between cocaine use and depression has been frequently observed. However, less is known about the significance of depression in the treatment of cocaine use disorders. This study examined possible interrelations between drug use and depression severity among cocaine-dependent patients in psychosocial treatments for cocaine dependence. Methods: Monthly assessed drug use and depression severity scores of N=487 patients during 6-month psychosocial treatments for cocaine dependence were analyzed using hybrid latent growth models. Results: Results indicated a moderate but statistically significant (z = 3.13, p<.01) influence of depression severity on increased drug use in the upcoming month, whereas drug use did not affect future depression severity. Conclusions: Findings suggest that depression symptoms are an important predictor of drug use outcomes during psychosocial treatments for cocaine dependence and, hence, underline the importance of adequately addressing depression symptoms to improve treatment outcomes.

Suchman NE; Decoste C; Mcmahon TJ; Rounsaville B; Mayes L. The mothers and toddlers program, an attachment-based parenting intervention for substance-using women: Results at 6-week follow-up in a randomized clinical pilot. Infant Mental Health Journal 32(4): 427-449, 2011. (48 refs.)

Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e. g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.

Thompson-Evans TP; Glover MP; Walker N. Cytisine's potential to be used as a traditional healing method to help indigenous people stop smoking: A qualitative study with Maori. Nicotine & Tobacco Research 13(5): 353- 360, 2011. (39 refs.)

Introduction: Maori experience a disproportionate amount of smoking-related harm (46% of adult Maori smoke). Effective cessation treatments that are both accessible and attractive to Maori are urgently needed. Cytisine (a plant extract found in Golden Rain [Cytisus laburnum L.] and the New Zealand Kowhai [Sophora tetraptera L.] has a similar molecular makeup to nicotine, has been used successfully as a cessation product in central and eastern Europe and central Asia for many years, and is low priced. Recent reviews have found that cytisine is twice as effective as a placebo for smoking cessation. This study aimed to explore cytisine's potential as a 'rongoa Maori' (traditional Maori remedy) and its attractiveness to Maori smokers compared with other cessation products. Methods: Maori that smoked were interviewed in two focus groups and eight individual semi-structured interviews. Two key informants were interviewed also. Results: Barriers to using cessation products were financial and effort cost, pervasive smoking among family and peers, environments permissive of smoking, and perceived cultural inappropriateness of treatments. Participants were very interested in cytisine, supported the idea that it would be acceptable to package it as a rongoa Maori, and all wanted to use it. Named appropriately, packaged and promoted as a Maori cessation product, participants thought cytisine would contribute to the restoration of Maori identity and traditional beliefs and practices in addition to reducing smoking. Conclusions: Presented as a rongoa Maori, cytisine would likely be more attractive to Maori than currently available cessation products. Confirmation of efficacy and safety will be needed before promotion of the product could occur.

Tripodi SJ; Bender K. Substance abuse treatment for juvenile offenders: A review of quasi-experimental and experimental research. Journal of Criminal Justice 39(3, special issue): 246-252, 2011. (50 refs.)

Purpose: The purpose of this systematic literature review is to assess the effectiveness of substance abuse treatment on alcohol and marijuana use for juvenile offenders based on existing quasi-experimental and experimental research. Additionally, a secondary aim is to compare the effects of individual-based interventions to family-based interventions. Methods: A systematic search of literature and electronic databases through 2010 generated five experimental or quasi-experimental studies that assessed alcohol outcomes for juvenile offenders and five experimental or quasi-experimental studies that assessed marijuana outcomes for juvenile offenders. Results: Overall, substance abuse treatment appears to have a small to moderate effect on alcohol and marijuana reduction for juvenile offenders. Interventions that showed the most promise were Multisystemic Therapy, Multidimensional Treatment Foster Care, Teaching Family, and Life Skills Training. Individual-based interventions and family-based interventions had similar small to moderate effects on alcohol and marijuana use. Conclusion: This review highlights several promising interventions for this high-risk population; however, further rigorous study is desperately needed to provide a better understanding of what works best in reducing substance use among juvenile offenders.

Tsoh JY; Chi FW; Mertens JR; Weisner CM. Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes. Drug and Alcohol Dependence 114(2-3): 110- 118, 2011. (48 refs.)

This study examined the association between stopping smoking at 1 year after substance use treatment intake and long-term substance use outcomes. Nine years of prospective data from 1185 adults (39% female) in substance use treatment at a private health care setting were analyzed by multivariate logistic generalized estimating equation models. At 1 year, 14.1% of 716 participants who smoked cigarettes at intake reported stopping smoking, and 10.7% of the 469 non-smokers at intake reported smoking. After adjusting for sociodemographics, substance use severity and diagnosis at intake, length of stay in treatment, and substance use status at 1 year, those who stopped smoking at 1 year were more likely to be past-year abstinent from drugs, or in past-year remission of drugs and alcohol combined, at follow-ups than those who continued to smoke (OR = 2.4, 95% Cl: 1.2-4.7 and OR = 1.6, 95% Cl: 1.1-2.4, respectively). Stopping smoking at 1 year also predicted past-year alcohol abstinence through 9 years after intake among those with drug-only dependence (OR = 2.4, 95% Cl: 1.2-4.5). We found no association between past-year alcohol abstinence and change in smoking status at 1 year for those with alcohol dependence or other substance use diagnoses when controlling for alcohol use status at 1 year. Stopping smoking during the first year after substance use treatment intake predicted better long-term substance use outcomes through 9 years after intake. Findings support promoting smoking cessation among smoking clients in substance use treatment.

Velleman R; Orford J; Templeton L; Copello A; Patel A; Moore L et al. 12-month follow-up after brief interventions in primary care for family members affected by the substance misuse problem of a close relative. Addiction Research & Theory 19(4): 362-374, 2011. (42 refs.)

Following the publication of initial and 3-month data from a prospective cluster randomised comparative trial [Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., Moore, L., . Godfrey, C. (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: A randomised trial. Addiction, 104, 49-58.], an opportunistic 12-month follow-up was undertaken. The trial compared two brief interventions for use by primary health care professionals with family members (FMs) affected by the problematic substance use of a close relative. Ninety out of 143 (63%) FMs in the trial were followed up at 12 months. Three validated self-completion questionnaires were re-administered: Symptom Rating Test, Coping Questionnaire and Family Member Impact Scale. At 12 months there were still no significant differences between FMs depending on which of the two brief interventions received. The initial improvements at 12 weeks on all of the measures (symptoms, coping and impact) were maintained, and further improved (FMs reported that their symptoms, their coping behaviours and the impact on them of their relatives'' substance misuse problem all continued to reduce). These improvements were unrelated to a range of demographic variables. FMs also reported a gradual improvement in their relatives'' misusing behaviour over the three time periods. In conclusion, following a brief intervention for affected FMs, either delivered in full via professional intervention or via a self-help manual following a brief introduction from a professional, both groups improve equally; there are significant and positive changes which are both maintained and further increased over a 12-month period, without any further formal delivery of the intervention.

Verthein U; Haasen C; Reimer J. Switching from methadone to diamorphine: 2-year results of the German Heroin-Assisted Treatment Trial. Substance Use & Misuse 46(8): 980-991, 2011. (31 refs.)

Background: Several international clinical studies have found diamorphine treatment for opioid-dependent patients to show significantly better effects compared with methadone maintenance treatment. Aims: This analysis of the German trial of heroin-assisted treatment investigates the effects on patients' health and drug use after switching from 12-month methadone to 12-month diamorphine treatment under similar study conditions. Methods: For a period of 24 months, the state of health was explored using the Opiate Treatment Index (OTI) health scale and the Symptom Checklist-90-R (SCL-90-R), while drug use and social situation by an extended version of the European Addiction Severity Index (EuropASI) every 6 months. Changes in these criteria were tested for significance by repeated measures analyses. Of the 434 patients, who started the 2nd year of study treatment, 90 were methadone-diamorphine switchers, and 344 received diamorphine for 2 years. Results: In the 2nd year, the methadone-diamorphine switchers succeed in catching up with the diamorphine patients. After switching to diamorphine, significant improvements in health and use of street heroin and cocaine were achieved during 1 year of diamorphine treatment. Conclusions: The results of the course of methadone-diamorphine switchers are a methodologically independent contribution toward confirming the positive effects of diamorphine treatment for difficult-to-treat opioid-dependent patients. This study supports the hypothesis that changing from optimized methadone treatment under the conditions of the clinical trial to diamorphine treatment is associated with improvements in health and drug use behavior. The study's limitations are noted.

Walker D; Stephens R; Rowland J; Roffman R. The influence of client behavior during motivational interviewing on marijuana treatment outcome. Addictive Behaviors 36(6, special issue): 669- 673, 2011. (26 refs.)

Psychotherapy process research continues to be important in identifying within session client and therapist behaviors related to outcome. Motivational Interviewing (MI) assumes that the type of client language elicited within session is important. Client behavior was coded from 61 MI sessions with marijuana dependent adults. Sessions were coded for client language using the Client Language and Commitment Scale. Client statements indicating desire and reasons for change were significantly predictive of marijuana treatment outcome through the 34-month follow-up above and beyond baseline levels of marijuana use or motivation for change. Commitment language was not associated with outcomes. These findings suggest specific types of client language statements predict marijuana treatment outcome and are durable to a 34-month follow-up.

Walker N; Howe C; Bullen C; Grigg M; Glover M; McRobbie H et al. Does improved access and greater choice of nicotine replacement therapy affect smoking cessation success? Findings from a randomized controlled trial. Addiction 106(6): 1176- 1185, 2011. (32 refs.)

Aims: To determine the effect of offering smokers who want to quit easy access to nicotine replacement therapy (NRT), a period of familiarization and choice of product on smoking abstinence at 6 months. Design: Single-blind, randomized controlled trial. Setting: New Zealand. Participants: A total of 1410 adult smokers who called the national Quitline for quitting support were randomized to usual Quitline care or a box containing different NRT products (patch, gum, inhaler, sublingual tablet, oral pouch) to try for a week prior to quitting, and then to choose one or two of these products for 8 weeks' use. Measurements: The primary outcome was 7-day point prevalence smoking abstinence 6 months after quit day. Secondary outcomes included continuous abstinence, cigarette consumption, withdrawal, NRT choice and serious adverse events at 1 and 3 weeks and 3 and 6 months. Findings: No differences in 6-month quit rates (7-day point prevalence or continuous abstinence) were observed between the groups. However, smokers allocated to the intervention group were more likely to have quit smoking at 3 months [self-reported point prevalence, relative risk (RR) = 1.17, 95% confidence interval (CI): 1.02, 1.35, P = 0.03], had a longer time to relapse (median 70 days versus 28 days, P < 0.01) and used significantly more NRT. The selection box concept was highly acceptable to users, with the patch and inhaler combination the most popular choice (34%). Conclusions: In terms of smoking abstinence at 6 months, offering smokers who want to quit free access to a wide range of nicotine replacement therapy, including a 1-week period of familiarization and choice of up to two products, appears no different to offering reduced cost and choice of nicotine replacement therapy, with no familiarization period.

Walls NE; Wisneski H. Evaluation of smoking cessation classes for the lesbian, gay, bisexual, and transgender community. Journal of Social Service Research 37(1): 99-111, 2011. (49 refs.)

This study evaluates the effectiveness of a smoking cessation course tailored to meet the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Of the 44 individuals who participated, 36 were in attendance in the final class, and 88.9% of those had successfully quit smoking. The study found an increase in importance to having cessation classes in gay-identified contexts, high ratings of the cultural appropriateness of the course content, and decreasing anxiety across the classes. Participants' assessment of their health shifted differentially based on whether they were successful at quitting.

Wampler DA; Molina DK; McManus J; Laws P; Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehospital Emergency Care 15(3): 320- 324, 2011. (15 refs.)

Introduction. Naloxone is widely used in the treatment and reversal of opioid overdose. Most emergency medical services (EMS) systems administer naloxone by standing order, and titrate only to reverse respiratory depression without fully reversing sedation. Some EMS systems routinely administer sufficient naloxone to fully reverse the effects of opioid overdose. Frequently patients refuse further medical evaluation or intervention, including transport. Objectives. The purpose of this study was to evaluate the safety of this practice and determine whether increased mortality is associated with full reversal of opioids. As a component of a comprehensive quality assurance initiative, we assessed mortality during the 48 hours after patients received naloxone to reverse opioid overdose followed by patient-initiated refusal of transportation. Methods. The setting was a large urban fire-based EMS system. Investigators provided the Bexar County Medical Examiner's Office (MEO) with a list of patients who were treated by the San Antonio Fire Department with naloxone, and not transported. Inclusion criteria were administration of naloxone and patient-initiated refusal. Patient dispositions also included aid only, referral to the MEO, or referral to law enforcement. The list was then compared with the MEO database. A chart review was completed on all patients treated and subsequently presented to the MEO within two days. A secondary time period of 30 days was also assessed. Results. The list identified 592 patients treated with naloxone and not transported to the emergency department. Five-hundred fifty-two patients received naloxone and refused transport or were not transported. The remaining 40 patients all presented to EMS in cardiac arrest, naloxone was administered during the course of resuscitation, and subsequent efforts were terminated in the field. None of the patients receiving naloxone with a subsequent patient-initiated refusal were examined at the MEO within the two-day end point. The 30-day assessment revealed that nine individuals were treated with naloxone and subsequently died, but the shortest time interval between date of service and date of death was four days. Conclusion. The primary outcome was that no patients who were treated with naloxone for opioid overdose and then refused care were examined by the MEO within a 48-hour time frame.

Wee LH; West R; Bulgiba A; Shahab L. Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia. Nicotine & Tobacco Research 13(2): 151-156, 2011. (32 refs.)

Introduction: Much is known about the predictors of success in quitting smoking. In particular, nicotine dependence, but not strength of motivation to stop, appears to predict abstinence. However, to date, studies have come almost exclusively from Western countries. More data are needed on the cross-cultural generalizability of these findings. Methods: One hundred and ninety-eight smokers attending 5 stop-smoking clinics in Malaysia completed a questionnaire prior to their target quit date and were followed up 3 months after this date. Predictors included sociodemographic variables, smoking patterns, past history of quitting, characteristics of current quit attempt, and smoking motives as well as nicotine dependence (Fagerstrom Test for Nicotine Dependence [FTND]) and self-rated strength of motivation of stop. Results: At 3-month follow-up, 35.4% (95% CI: 28.7-42.0) of participants reported being abstinent. A backward elimination multiple logistic regression identified a number of significant predictors of success, including strength of motivation to stop (adjusted odds ratio [OR]: 3.05, 95% CI: 1.28-7.25). FTND did not predict success. Conclusions: Motivation and nicotine dependence may play different roles in explaining variation in ability to stop smoking in different cultures.

Wetter DW; McClure JB; Cofta-Woerpel L; Costello TJ; Reitzel LR; Businelle MS et al. A randomized clinical trial of a palmtop computer-delivered treatment for smoking relapse prevention among women. Psychology of Addictive Behaviors 25(2): 365-371, 2011. (33 refs.)

Relapse is the rule rather than the exception among smokers attempting to quit, and compared to men, women may have higher relapse rates. The current study was a randomized clinical trial testing a palmtop computer-delivered treatment (CDT) for smoking relapse prevention among women. The intervention was individualized based on key theoretical constructs that were measured using ecological momentary assessment (EMA). All participants (N = 302) received standard smoking cessation treatment consisting of nicotine replacement therapy and group counseling, and completed EMA procedures for one week after quitting. At the completion of the group counseling sessions and EMA procedures, participants were randomized to either CDT or no further computer-delivered treatment or assessment (EMA-Only). CDT participants received a palmtop computer-delivered relapse prevention treatment for one additional month. CDT did not improve abstinence rates relative to EMA-Only. Process analyses suggested that heavier smokers were more likely to use CDT and that greater use among CDT participants may be associated with more positive outcomes. The rapid pace of technological advances in mobile computer technology and the ubiquity of such devices provide a novel platform for developing new and potentially innovative treatments. However, the current study did not demonstrate the efficacy of such technology in improving treatment outcomes.

Wilens TE; Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. (review). Current Opinion in Psychiatry 24(4): 280- 285, 2011. (35 refs.)

Purpose of review: The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) continues to be an area of great interest. In this report more recent work exploring the developmental relationship between ADHD and SUDs and associated concurrent disorders is discussed. Recent findings: Recent work highlights the role of treatment of ADHD in children on subsequent cigarette smoking and SUDs in adolescence and adulthood. Contemporary data suggest that ADHD may be underdiagnosed in SUD populations. Studies in patients with ADHD and SUDs suggest that SUDs treatment needs to be sequenced initially with ADHD treatment quickly thereafter. Recent studies also highlight concerns associated with the misuse and diversion of prescription stimulants in ADHD adolescents and young adults and indicate that extended-release stimulants may reduce the likelihood for abuse. Summary: Practitioners are increasingly recognizing the overlap between ADHD and SUDs, and treatment modalities including cognitive behavioral therapy and pharmacotherapy demonstrate mixed results in the treatment of these comorbid disorders. Areas in need of further investigation include the mechanism(s) by which ADHD leads to SUDs, diagnostic criteria associated with ADHD in SUD individuals, and prevention and treatment strategies for these populations.

Yang JL; Hammond D; Driezen P; O'Connor RJ; Li QA; Yong HH et al. The use of cessation assistance among smokers from China: Findings from the ITC China Survey. BMC Public Health 11: e-article 75, 2011. (32 refs.)

Background: Stop smoking medications significantly increase the likelihood of smoking cessation. However, there are no population-based studies of stop-smoking medication use in China, the largest tobacco market in the world. This study examined stop-smoking medication use and its association with quitting behavior among a population-based sample of Chinese smokers. Methods: Face-to-face interviews were conducted with 4,627 smokers from six cities in the ITC China cohort survey. Longitudinal analyses were conducted using Wave 1 (April to August, 2006) and Wave 2 (November 2007 to January 2008). Results: Approximately 26% of smokers had attempted to quit between Waves 1 and 2, and 6% were abstinent at 18-month follow-up. Only 5.8% of those attempting to quit reported NRT use and NRT was associated with lower odds of abstinence at Wave 2 (OR = 0.11; 95% Cl = 0.03-0.46). Visiting a doctor/health professional was associated with greater attempts to quit smoking (OR = 1.60 and 2.78; 95% Cl = 1.22-2.10 and 2.21-3.49 respectively) and being abstinent (OR = 1.77 and 1.85; 95% Cl = 1.18-2.66 and 1.13-3.04 respectively) at 18-month follow-up relative to the smokers who did not visit doctor/health professional. Conclusions: The use of formal help for smoking cessation is low in China. There is an urgent need to explore the use and effectiveness of stop-smoking medications in China and in other non-Western markets.

Young C; Skorga P. Reduction versus abrupt cessation in smokers who want to quit: A review summary. (review). Public Health Nursing 28(1): 54-56, 2011. (0 refs.)

This is a synopsis of a Cochrane systematic review by Lindson et al. ( 2010) containing meta-analysis of 10 clinical trials evaluating the effects and side effects of abruptly quitting smoking versus reducing and then quitting smoking. Side effects were described through narrative. Analysis of the 10 studies indicated that there were no statistically significant differences in abstinence from smoking between intervention (abrupt quit group) and comparison groups (reduced quit group). The results remained nonsignificant regardless of whether pharmacotherapy, self-help therapy, or behavioral support were included in the intervention. Researchers were unable to draw conclusions about the differences in adverse events between interventions due to the difference in reporting. Symptoms occurring related to the use of nicotine gum most frequently from both groups were malaise, constipation, and diarrhea.

Zanis DA; Hollm RE; Derr D; Ibrahim JK; Collins BN; Coviello D et al. Comparing intervention strategies among rural, low SES, young adult tobacco users. American Journal of Health Behavior 35(2): 240-247, 2011. (20 refs.)

Objective: To evaluate 3-month tobacco quit rates of young adult tobacco users randomized to 2 intervention conditions. Methods: Overall 192 non-treatment-seeking 18-to-24-year-old tobacco users received educational information and advice to quit smoking. Participants were then block randomized to 2 brief intervention conditions: (1) a telephone quitline (TQ) N = 90; or (2) a brief direct treatment intervention (BDTI) N = 102. Results: A 90-day follow-up evaluation found that 19.6% of BDTI and 10.2% of TQ participants reported 30-day point prevalence tobacco quit rates (chisquare = 2.37, P = .09). Conclusions: BDTI can help non-treatment-seeking, low SES, young adult tobacco users quit smoking.

Zhang SX; Roberts REL; McCollister KE. Therapeutic community in a California prison: Treatment outcomes after 5 years. Crime & Delinquency 57(1): 82-101, 2011. (32 refs.)

Therapeutic communities have become increasingly popular among correctional agencies with drug-involved offenders. This quasi-experimental study followed a group of inmates who participated in a prison-based therapeutic community in a California state prison, with a comparison group of matched offenders, for more than 5 years after their initial prison release. Contrary to successes reported elsewhere, this study found no difference in new arrests and returns to prison between therapeutic community participants and the comparison participants after 5 years. Overall, more than 60% of both groups were returned to prison within 2 years following their initial release. After 5 years, the return-to-prison rate reached about 73% for both groups. The average time spent in prison following initial release was about the same for both groups. Rearrest offenses were also similar in both groups. Policy implications are discussed.