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CORK Bibliography: Treatment Programs

109 citations. July 2007 to present

Prepared: June 2008

Alemi F; Sullivan T. An example of activity based costing of treatment programs. American Journal of Drug and Alcohol Abuse 33(1): 89-99, 2007. (21 refs.)

We introduce a new tool that can be used for estimating number, length of time, and nature of services patient receive in drug treatment programs. While the field has made significant progress in standardizing the collection of expenditure data, little progress has been made on creating a standard measure for estimating program activities and census. We report on a method of estimating program activities.

Amodeo M; Ellis MA; Hopwood J; Derman L. A model for organizational change: Using an employee-driven, multilevel intervention in a substance abuse agency. Families in Society 88(2): 223-232, 2007. (36 refs.)

To respond to fluctuations in funding and community needs, human service organizations must develop mechanisms for designing, implementing, and solidifying agency-wide change. This article describes an agency change effort that was staff driven and behaviorally focused and included work teams of employees from all agency divisions. Organization development principles guided the work. The change effort, which focused on the agency's adoption of standards of excellence in client care, sought to disseminate, educate about, and institutionalize these standards. The change occurred through a multifaceted intervention with activities at 14 levels. We describe the nuts and bolts of the change process to fill a gap in the literature on implementing change in human service organizations. The model is applicable to many such agencies.

Arfken CL; Kubiak SP. Characteristics of facilities with specialized programming for drinking drivers and for other criminal justice involved clients: analysis of a national database. Substance Abuse Treatment, Prevention, and Policy 2: article 26, 2007. (26 refs.)

Background: Offering specialized programming at substance abuse treatment facilities can help diversify clientele and funding sources, potentially enhancing the facilities' ability to survive and/or expand. Past research has shown that facilities only offering specialized programming for driving under the influence/driving while intoxicated offenders (DUI) are predominately private-for-profit owned. As criminal justice populations, both DUI and other criminal justice offenders, comprise a large proportion of those in community-based substance abuse treatment knowing facilities' characteristics would be important for administrators and policymakers to consider when updating programming, training staff or expanding capacity to ensure efficient use of scarce resources. However, while such characteristics are known for DUI programs, they are not known for facilities offering specialized programming for other criminal justice offenders. Methods: Analysis of the 2004 US National Survey of Substance Abuse Treatment Facilities. Results: Almost half the facilities (48.2%) offered either DUI or other criminal justice specialized programming. These facilities were divided between those offering DUI specialized programming (17.7%), other criminal justice specialized programming (16.6%) and both types of programming (13.9%). Certain characteristics were independently associated with offering DUI specialized programming (private ownership, rural location, for profit status) or other criminal justice specialized programming (receiving public funds, urban location, region of country). Conclusion: Offering specialized programming for DUI or other criminal justice offenders was common and associated with distinct characteristics. These observed associations may reflect the positioning of the facility to increase visibility, or diversify clientele and possibly funding streams or the decision of policymakers. As the criminal justice populations show no sign of decreasing and resources are scarce, the efficient use of resources demands policymakers recognize the prevalence of these specialized programming, join forces to examine them for efficacy, and explicitly incorporate these characteristics into strategies for workforce training and plans for treatment expansion.

Ballon B; Chaim G. HELP!!! An interactive experiential simulation of youth with concurrent disorders accessing help from "the system''. Addiction Research & Theory 14(6): 603-617, 2006. (8 refs.)

HELP!!! is an interactive, experiential simulation of the health care system that youth with concurrent mental health and addiction issues need to access for help. Using this exercise after a didactic teaching session reinforces the learning, synthesizes the knowledge for application and encourages group discussion and the sharing of participants' knowledge. This exercise was originally developed to create an opportunity for interprofessional learning groups to experience the gaps and barriers youth encounter as they attempt to navigate the system and to act as a catalyst for creative problem solving and system change. By participating, learners experience a simulation of what youth, family members, and various professionals usually encounter in the system. This exercise elicits key issues for discussion and provides a forum for networking and the initiation of collaborative ventures for healthcare providers.

Birkhead GS; Klein SJ; Candelas AR; O'Connell DA; Rothman JR; Feldman IS; Tsui DS; Cotroneo RA; Flanigan CA. Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach. International Journal of Drug Policy 18(5): 417-425, 2007. (47 refs.)

Background: New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. Methods: HCV prevention and care are integrated within health and human service settings, including HIV/AlDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. Results: IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. Discussion: A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

Bliss DL. Implementing an outcomes measurement system in substance abuse treatment programs. Administration in Social Work 31(4): 83-101, 2007. (22 refs.)

Human services programs are increasingly being required to assess program performance and track progress in meeting outcomes in order to receive funding. This emerging trend hits implications for social workers who administer substance abuse treatment programs. While larger programs can have the necessary resources to implement comprehensive outcomes measurement systems, smaller programs can be at a disadvantage when they don't have the needed resources. This paper attempts to level the playing field by providing a model for creating an outcomes measurement system that can be Used by social workers who administer small substance abuse treatment programs. The importance of logic models in developing an outcomes measurement system is discussed. A nine-step model that smaller programs can use to implement an outcomes measurement system is presented. Limitations of implementing and maintaining an outcomes measurement system using the nine-step model are discussion.

Borsari B; Tevyaw TO; Barnett NP; Kahler CW; Monti PM. Stepped care for mandated college students: A pilot study. American Journal on Addictions 16(2): 131-137, 2007. (36 refs.)

In the past decade, colleges and universities have seen a large increase in the number of students referred for the violation of alcohol policies. Stepped care assigns individuals to different levels of care according to treatment response, thereby maximizing efficiency. This pilot study implemented stepped care with students mandated to attend an alcohol program at a private northeastern university. High retention rates and participant satisfaction ratings suggest the promise of implementing stepped care with this population. Considerations for future applications of stepped care with mandated students are discussed.

Boyd SJ; Armstrong KM; Fang LJ; Medoff DR; Dixon LB; Gorelick DA. Use of a "microecologic technique" to study crime around substance abuse treatment centers. Social Science Computer Review 25(2): 163-173, 2007. (14 refs.)

Whether substance abuse treatment centers affect neighborhood crime is hotly debated. Empirical evidence on this issue is lacking because of the difficulty of distinguishing the crime effect of treatment centers in high-crime areas, the inability to make before-and-after comparisons for clinics founded before computerized crime data, and the need for appropriate control sites. The authors present an innovative method (without an actual data analysis) to overcome these challenges. Clinic addresses and crime data are geocoded by street address. Crimes are counted within concentric-circular, 25-meter "buffers" around the clinics. Regression analyses are used to calculate the "crime slope" (beta) among the buffers. A negative beta indicates more crimes closer to the site. A similar process is used to evaluate crimes around control sites: convenience stores, hospitals, and residential points. This innovative technique provides valid empirical evidence on crime around substance abuse treatment centers.

Brigham GS; Schroeder G; Schindler E. Addressing smoking in community drug abuse treatment programs: Practical and policy considerations. Journal of Psychoactive Drugs 39(4): 435-441, 2007. (51 refs.)

Smoking is the leading cause of preventable death in the United States. This public health problem is of particular concern among individuals with-substance use disorders in that they smoke at a greater rate than the general public. Smoking-related illness represents a major source of preventable death in persons with drug dependencies. Substance abuse treatment programs have access to persons with substance use disorders and the opportunity to intervene on their smoking; however, nicotine dependence has historically not been viewed in the same light as other drug dependencies by the treatment field. As a result, many persons in these treatment program settings do not receive opportunities to address their smoking. When substance abuse treatment organizations consider implementing smoking policies and services, many questions and choices arise. In practice, a range of approaches has been developed from simple assessment and referral for smoking cessation treatment to implementing smoke-free grounds and requiring that patients stop smoking concurrent with addressing their other drug dependencies. Smoking cessation policy decisions have the potential to directly affect the patients, the workforce, the referral network, and other major stakeholders related to these organizations. The authors consider a range of both practical and policy issues facing treatment organizations and conclude that advances in smoking policy are possible with current resources.

Broome KM; Flynn PM; Knight DK; Simpson DD. Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment 33(2): 149-158, 2007. (56 refs.)

A key goal of drug abuse treatment providers is getting their clients to engage and participate in therapeutic activities as a first step toward deriving longer-term benefits. Much research had focused on personal characteristics that relate to client engagement; program characteristics have received less attention. This study explored client and program differences in engagement ratings using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. The results show that elements of program context, including structural features (e.g., smaller size and Joint Commission on the Accreditation of Healthcare Organizations/Commission on Accreditation of Rehabilitation Facilities accreditation) and staff's perceptions of personal efficacy, organizational climate, and communal workplace practices, relate to better overall client engagement. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts.

Brown LS; Kritz S; Goldsmith RJ; Bini EJ; Robinson J; Alderson D et al. Health services for HIV/AIDS, HCV, and sexually transmitted infections in substance abuse treatment programs. Public Health Reports 122(4): 441-451, 2007. (38 refs.)

The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments. Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor. These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections.

Brown VB; Najavits LM; Cadiz S; Finkelstein N; Heckman JP; Rechberger E. Implementing an evidence-based practice: Seeking Safety group. Journal of Psychoactive Drugs 39(3): 231-240, 2007. (24 refs.)

This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.

Cabral HJ; Tobias C; Rajabiun S; Sohler N; Cunningham C; Wong M et al. Outreach program contacts: Do they increase the likelihood of engagement and retention in HIV primary care for hard-to-reach patients? AIDS Patient Care and STDS 21(Supplement 1): S59-S67, 2007. (15 refs.)

Engagement in HIV primary care and the receipt of antiretroviral therapy when clinically indicated offers patients the opportunity to experience HIV disease as a chronic illness. Yet many people, particularly those with comorbid mental health or substance abuse conditions and those who face multiple barriers to care, cycle in and out of care and thus can not reap the life- prolonging benefits of antiretroviral therapy. Although there is evidence about the impact of different interventions on adherence to HIV medications, there is little information about the impact of interventions on engagement or retention in HIV primary care among the hard- to- reach. In this multisite, national study, we contribute new information by exploring the relationship between outreach program contacts and retention in care over a 12- month period among participants in a demonstration project to promote engagement and retention in HIV primary care. We found that when participants received nine or more contacts during the first 3 months of their programs, they were about half as likely to have a substantial gap ( defined as 4 months or more) in primary care during the first 12 months of follow- up. This finding remained after controlling for baseline CD4 count. These findings can be used to improve the effectiveness of programs to increase engagement and retention in HIV primary care among the hard- to- reach.

Cacciola JS; Alterman AI; Lynch KG; Martin JM; Beauchamp ML; McLellan AT. Initial reliability and validity studies of the revised Treatment Services Review (TSR-6). Drug and Alcohol Dependence 92(1/3): 37-47, 2008. (20 refs.)

Objective: Report the results of initial reliability and validity analyses for a revised Treatment Services Review (TSR-6) instrument which measures a broader range of services than the original TSR. Method: First, the number of services for a 28-day period was compared for three versions of the instrument varying in their reporting timeframes. Accordingly, four successive 7-day TSR-6s, two 14-day TSR-6s, or one 28-day TSR-6 were administered to more than 300 clients (30% women) in substance abuse treatment (SAT). Second, short-term (2-5 days) test-retest reliabilities were compared for an initial 7-, 14-, or 28-day version of the TSR-6. Third, test-retest reliabilities were compared when an initial in-person (IP) administration was followed by either IP or telephone (TEL) TSR-6 administration. Finally, preliminary discriminative validity analyses were conducted. Results: Few differences in the quantity of services reported for a 4-week period were found with versions of the TSR-6 that used different timeframes. Also, comparisons of test-retest reliabilities for the different version of the TSR-6 revealed few differences. Test-retest reliabilities were generally comparable for the IP-TEL and IP-IP conditions. Finally, analyses demonstrated preliminary discriminative validity for the instrument when services for three distinctive forms of treatment: intensive outpatient, methadone and residential were compared. Conclusions: The findings of this study support the reliability and validity of the TSR-6 and suggest that a version with a 28-day reporting period can provide information comparable to that obtained with versions using shorter reporting periods.

Campbell CI; Wells R; Alexander JA; Lan JA; Nahra TA; Lemak CH. Tailoring of outpatient substance abuse treatment to women, 1995-2005. Medical Care 45(8): 775-780, 2007. (41 refs.)

Background: Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options. Objectives: This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to identify unit and contextual factors associated with these practices. Research Design: Data were from 2 waves of a national OSAT unit survey (N = 618 in 1995, N := 566 in 2005). Comparisons of weighted means between waves indicate which practices changed over time. Multiple logistic regressions with generalized estimating equations test associations between unit and contextual attributes and tailoring to women. Measures: Tailoring to women was measured as availability of prenatal care, child care, single sex therapy, and same sex therapists, and the percentage of staff trained to meet female clients' needs. Results: Two measures of tailoring to women declined significantly between 1995 and 2005: availability of single sex therapy (from 66% to 44% of units) and percent of staff trained to work with women (from 42% to 32% of units). No aspect of tailoring to women became more common. Proportion of female clients, total number of clients, methadone status, and private and government managed care were associated with higher odds of tailoring to women. For-profit facilities, which became more prevalent during the study period, had lower odds than other units of tailoring treatment to women. Conclusions: Some key aspects of OSAT tailoring to women decreased significantly in the last decade. Managed care contracts may offer mechanism for counteracting these trends.

Carroll CP; Kidorf M; Strain EC; Brooner RK. Comparison of demographic and clinical characteristics between opioid-dependent individuals admitted to a community-based treatment setting and those enrolled in a research-based treatment setting. Journal of Substance Abuse Treatment 33(4): 355-361, 2007. (47 refs.)

Despite the significant developments in pharmacotherapy and behavioral treatments for addiction, the dissemination of new treatment methods into the community has been slow. It has been pointed out that treatments developed in research settings may be impractical in community treatment settings, which might help explain the transition lag. Screening and recruitment of participants for research studies might partially explain this, as there is evidence that substance-abusing individuals who participate in clinical research are different on a number of measures from treatment seekers. However, no study has directly compared treatment seekers with research participants drawn from similar populations using prospective methods. This study compared the demographic characteristics, drug use and psychosocial problem severity levels, and personality traits of opioid-dependent individuals seeking help in a community setting (n = 502) with those of opioid-dependent individuals in a primarily research-based drug abuse treatment setting (n = 459); both settings offered a similar set of treatment services (opioid agonist medication and counseling). Although the overall findings revealed numerous similarities between the groups, differences were also observed. Most notably, there were significantly fewer women in the research sample than in the community-based treatment sample. Other differences included a modest but statistically significant increase in psychosocial problem severity levels in the community-based treatment sample and higher drug use problem severity levels in the research sample. Interestingly, many of these differences were strongest in women as compared with men.

Cartwright WS. A critical review of accounting and economic methods for estimating the costs of addiction treatment. Journal of Substance Abuse Treatment 34(2): 224-233, 2008. (27 refs.)

Researchers have been at the forefront of applying new costing methods to drug abuse treatment programs and innovations. The motivation for such work has been to improve costing accuracy. Recent work has seen applications initiated in establishing charts of account and cost accounting for service delivery. As a result, researchers now have available five methods to apply to the costing of drug abuse treatment programs. In all areas of costing, there is room for more research on costing concepts and measurement applications. Additional work would be useful in establishing studies with activity-based costing for both research and managerial purposes. Studies of economies of scope are particularly relevant because of the integration of social services and criminal justice in drug abuse treatment. In the long run, managerial initiatives to improve the administration and quality of drug abuse treatment will benefit directly from research with new information on costing techniques.

Center for Substance Abuse Treatment; Forman RF; Nagy PD. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 47. Rockville MD: Center for Substance Abuse Treatment, 2006. (640 refs.)

This Treatment Improvement Protocol was prepared to assist clinicians involved in intensive outpatient treatment programs. It describes the core services such programs should include, the process of assessment and treatment planning, entry and engagement in treatment, common clinical approaches, including family services, as well as the considerations with special groups of clients: women, adolescents, those involved in the criminal justice system, persons with co-occurring psychiatric disorders, racial and ethnic minorities, lesbian, gay and bisexual individuals, the elderly, the homeless, those with HIV/AIDS, and persons with physical or cognitive disabilities. The TIP also outlines 14 principles of intensive outpatient treatment: making treatment readily available, easing treatment entry, building on existing motivation, enhancing the therapeutic alliance, making retention a priority, assess and addressing individual treatment needs, providing ongoing care, monitoring abstinence, using mutual-/self-help and community resources, using medications if indicated, providing education about substance abuse, recovery and relapse, engaging families, employers and significant others, incorporating evidence-based approaches, and improving program administration. There are 11 appendices that provide additional resources such as screening instruments, protocols, sample history forms. There are also 34 "exhibits", e.g. check lists, sample documents, suggested sequence of topics for groups therapy sessions.

Public Domain

Center for Substance Abuse Treatment; Forman RF; Nagy PD. Substance Abuse: Administrative Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 46. Rockville MD: Center for Substance Abuse Treatment, 2006. (137 refs.)

This Treatment Improvement Protocol (TIP) is directed to administrators and speaks to the changing environment in which outpatient treatment programs operate. It provides basic information about running an outpatient treatment program, including strategic planning, working with a board of directors, relationships with strategic partners, hiring and retaining employees, staff supervision, continuing education and training, performance improvement, outcomes monitoring, and promotion of the program to potential clients, funding agencies, and government officials. More specialized sections address challenges that have emerged and gathered importance in the last decade: preparing a program to provide culturally competent treatment to an increasingly diverse client population and succeeding in a managed care-dominated world by diversifying the funding sources a program draws on.

Public Domain

Chawdhary A; Sayre SL; Green C; Schmitz JM; Grabowski J; Mooney ME. Moderators of delay tolerance in treatment-seeking cocaine users. Addictive Behaviors 32(2): 370-376, 2007. (12 refs.)

A substantial amount of attrition in cocaine dependence treatment studies occurs between the initial telephone contact and the first evaluative clinic visit. While decreasing the wait to first visit can significantly reduce pre-intake attrition (PIA), little is known about other factors that moderate delay tolerance for first clinic visit. The current report uses data from 833 subjects who completed a first-contact telephone interview prior to an intake evaluation visit for cocaine use treatment research. Hierarchical logistic regression was used to assess three successive models to predict PIA, with the most inclusive model testing interactions between delay interval and seven predictors: age, gender, treatment motivation, recency of cocaine, alcohol, and tobacco use, and self-reported depression. Consistent with previous reports, greater delay to first clinic visit predicted PIA. However, no evidence for the moderating role of the selected factors was found. Overall, the utility of the logistic models, built on basic demographic and psychiatric factors, was poor, as evaluated using receiver-operator characteristic curves. Alternative factors must be examined to identify predictors that will increase probability of initial enrolment in cocaine-dependence clinical trials.

Chriqui JF; Terry-McElrath Y; McBride DC; Eidson SS; VanderWaal CJ. Does state certification or licensure influence outpatient substance abuse treatment program practices? Journal of Behavioral Health Services & Research 34(3): 309-328, 2007. (40 refs.)

In the United States, state governments legally authorize outpatient substance abuse treatment programs. In some states, programs are certified or accredited (ideal standards). Other states license programs (minimal standards). Additionally, some states authorize programs through "deemed status", which is afforded to programs attaining accreditation from a national accrediting body. Primary legal research and the National Survey of Substance Abuse Treatment Services' (N-SSATS) data were used to examine the relationships between state authorization type (certification/accreditation vs licensure with and without deemed status) and outpatient treatment program practices. Programs in certification/accreditation (vs licensure) states had significantly higher odds of offering wrap-around and continuing care/after care services associated with better long-term treatment outcome. Programs in states that allowed for certification/accreditation with deemed status had significantly lower odds of infectious disease testing, but higher odds of providing group and family counseling. Results suggest that state authorization type may impact services offered by outpatient treatment programs.

Chun J; Guydish J; Chan YF. Smoking among adolescents in substance abuse treatment: A study of programs, policy, and prevalence. Journal of Psychoactive Drugs 39(4): 443-449, 2007. (31 refs.)

The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the-past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention.

Clark HW; Power AK; Le Fauve CE; Lopez EI. Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders. Journal of Substance Abuse Treatment 34(1): 3-13, 2008. (39 refs.)

This article describes factors that influence national policy and practice, with particular focus on the implications of epidemiological survey research. Examples of areas of concern to policymakers include treatment-seeking patterns, access to care at points of service in public health and social service systems, evidence-based practices, workforce development, and the complexities of reimbursement. In responding to data on systemic barriers to care, the Substance Abuse and Mental Health Services Administration (SAMHSA) has sought to promote a no wrong door strategy to address the needs of persons with co-occurring disorders (CODs) involving their mental health and substance use. Examples of SAMHSA programs and policies addressing CODs discussed in this article include targeted partnerships with the states, mechanisms to enhance system infrastructure, technical assistance, and initiatives with special populations.

Collins MH; Ready J; Griffin JB; Walker KG; Mascaro N. The challenge of transporting family-based interventions for adolescent substance abuse from research to urban community settings. American Journal of Family Therapy 35(5): 429-445, 2007. (54 refs.)

Motivated by concerns about the extent to which urban African American youth under-report substance abuse, the extent to which they are over-represented in drug-related criminal justice settings, and the extent to which research on adolescent substance abuse treatment has lagged in settings serving urban minority populations, the authors comment on some factors to consider when conducting family-based interventions and research with such populations. They offer recommendations based on experience implementing a community-based treatment program for urban substance-abusing adolescents, patient demographic data gathered from the program, and their attempt at adding a family-based treatment component to the program.

Colpaert K; Vanderplasschen W; Broekaert E. Comparison of single and multiple agency clients in substance abuse treatment services. European Addiction Research 13(3): 156-166, 2007. (59 refs.)

Background: Frequent and multiple service utilization among substance abusers is a well-known problem. However, little statistical evidence exists about overlapping agency populations. Methods: This phenomenon was studied in a clear-cut region in Belgium, based on intake information concerning all clients who addressed a drug treatment center within a 6-month period (n=1,139). Results: Multiple service utilization was rather common but not omnipresent during this particular registration period. Almost 15% of the clients were registered in more than one substance abuse treatment agency. Compared to single agency attendees, multiple agency clients appeared to be more often polysubstance abusers with a longer previous treatment history and greater problem severity. Conclusion: A continuous care perspective, interagency collaboration and a common tracking and documentation system are recommended to better address the needs of this specific subgroup of substance abusers. More research is needed to clarify whether these multiple service utilization patterns are caused by client-related, agency-related or other factors.

Cournoyer LG; Brochu S; Landry M; Bergeron J. Therapeutic alliance, patient behaviour and dropout in a drug rehabilitation programme: The moderating effect of clinical subpopulations. Addiction 102(12): 1960-1970, 2007. (39 refs.)

Aim: Treatment dropout is an important concern for professionals working in mental health. While this problem is common, the highest attrition rates have been observed in drug rehabilitation programmes. The present study focuses on the therapeutic alliance, a process variable that has been associated repeatedly with positive treatment outcome in the scientific literature. Respondent behaviour indicative of commitment or resistance to treatment was examined in combination with therapist prognoses. Design: A total of 248 subjects, classified into three subpopulations (justice, n = 50; mental health, n = 53; comparison group, n = 145), participated in the study. Analyses aimed at predicting dropout were conducted using Cox proportional-hazards regressions. The moderating effect of sub-population was tested. Measurements Respondents completed a multi-dimensional measure of alliance [California Psychotherapeutic Alliance Scale (CALPAS-P)]. Therapists rated the behaviour of respondents in treatment and made prognoses about perseverance and improvement. Findings: An increased risk of dropout was predicted when patients viewed themselves as less committed and perceived the therapist as less understanding and less involved. Therapist prognosis of perseverance was also predictive of dropout. The relationship between patient/therapist evaluations and dropout is affected differently across subpopulations by means of a moderation effect. Conclusion: This paper demonstrates the capacity to predict dropout by measuring therapeutic alliance, therapist prognoses and therapist appraisal of patient behaviour. Moreover, the moderation effect of clinical subpopulation on treatment process variables and dropout is supported in the context of drug rehabilitation programmes.

Courtney KO; Joe GW; Rowan-Szal GA; Simpson DD. Using organizational assessment as a tool for program change. Journal of Substance Abuse Treatment 33(2): 131-137, 2007. (24 refs.)

Organizational functioning within substance abuse treatment organizations is important to the transfer of research innovations into practice. Programs should be performing well for new interventions to be implemented successfully. This study examined the characteristics of treatment programs that participated in an assessment and training workshop designed to improve organizational functioning. The workshop was attended by directors and clinical supervisors from 53 community-based treatment units in a single state in the Southwest. Logistic regression analysis was used to examine attributes related to program-level decisions to engage in a structured process for making organizational changes. Findings showed that programs with higher needs and pressures, more limited institutional resources, and poorer ratings on staff attributes and organizational climate were the most likely to engage in a change strategy. Furthermore, organizations with greater staff consensus (i.e., smaller standard deviations) on ratings of organizational climate were also more likely to engage in change.

Davidson L; White W. The concept of recovery as an organizing principle for integrating mental health and addiction services. Journal of Behavioral Health Services & Research 34(2): 109-120, 2007. (50 refs.)

Despite a range of long-standing historical, political, ideological, professional, structural, and practical barriers, there has been, and continues to be, a clear consensus that integration between mental health and addiction services is sorely needed and long overdue. This paper focuses on one dimension of the challenge, of integration from among the several - the conceptual - and proposes the construct of recovery as an organizing principle for bridging the divide between the two domains. After reviewing briefly the parallel history of the two traditions and their shared need for transformation to a recovery orientation, the authors offer an integrated model of recovery for persons with co-occurring disorders. They then derive from this model the underlying values, guiding principles, key strategies, and essential ingredients of recovery-oriented systems of care that comprise a common approach across both addictions and mental illness, offering a strengths-based solution to achieving integration where pathology-focused approaches have failed.

Dennis ML; Ives ML; White MK; Muck RD. The Strengthening Communities for Youth (SCY) initiative: A cluster analysis of the services received, their, correlates and how they are associated with outcomes. Journal of Psychoactive Drugs 40(1): 3-16, 2008. (35 refs.)

This article describes the Strengthening Communities for Youth (SCY) initiative using data from 1,297 adolescents in eight U.S. cities (Oakland, CA; Tucson, AZ; Iowa City, IA; Bloomington, IL; St. Louis, MO; Cleveland, OH; Louisville, KY, New York, NY) to better understand the pattern of services they received, how these services varied by need, and how services were associated with initial treatment outcomes. Data include adolescent reports collected with the Global Assessment of Individual Needs (GAIN) at treatment intake and 90 days post-intake, information on early therapeutic alliance using a modified Working Alliance Inventory (WAI), and staff reports from service logs. Cluster analysis identified four patterns of treatment received: (1) substance abuse and mental health treatment, (2) primarily residential treatment, (3) interrupted treatment, and (4) primarily outpatient treatment. Outcomes examined included changes in substance use, substance abuse/dependence problems, recovery environment risk, as well as risk from social peers, illegal activity and emotional problems. Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas. The exception was for cluster 1, for whom emotional problems actually increased. Implications for placement, treatment planning and future research are discussed.

Dickinson DM; Edmundson E; Tomlin K. Implementing motivational interviewing: Lessons from clinical experiences. Journal of Teaching in the Addictions 5(2): 39-57, 2006

Addiction treatment agencies face challenges in adopting and sustaining Motivational Interviewing (MI) use. Addiction Educators can assist agencies in changing practices by preparing new practitioners to have some beginning skills in adoption and sustaining strategies. Investigators assessed three types of agency training and six administrative activities to support adoption and sustaining MI. Investigators observed agency progress and recorded agency successes and challenges. Generally, education workshops alone did not result in long-term adoption and sustainability of MI. Agencies found external expert consultation, enhanced supervisor skills in coaching/mentoring MI use, case review of MI use and study groups effective in supporting MI use. The paper provides recommendations that addiction educators can integrate into their curriculum to build support for agencies in adopting and sustaining MI. The recommendations may also help agencies in their adoption of MI. Educators may find these same strategies useful in preparing students to use and support MI use in addiction prevention and treatment agencies.

Digiusto E; Treloar C. Equity of access to treatment, and barriers to treatment for illicit drug use in Australia. Addiction 102(6): 958-969, 2007. (43 refs.)

Aims and design: This study investigated equity of access to treatment and barriers to treatment for illicit drug use, using Andersen's behavioural model of health service utilization. Setting and participants: The study involved 492 drug users who had received treatment and 193 who had not. Measurements Participants were interviewed to gather data relating to 19 predisposing, need and enabling variables. Findings: Never-treated participants exhibited less need for treatment than those who had received treatment. They experienced less negative emotion, used their main drug less often, had fewer drug-related health problems and fewer drug-using friends, were less likely to have blood-borne virus infections and were more likely to be using drugs for 'fun'. They also had more negative attitudes towards drug treatment staff, were less likely to believe that appropriate treatment was available and less likely to believe that professional help was necessary to get off drugs. Prevalence of physical and mental health problems was high in both groups. Conclusions: The study documented significant unmet treatment need and identified several sources of inequity and barriers to treatment that would be amenable to policy and service development. Drug user organizations and peer educators and motivational interventions in primary care settings should be utilized to market the nature and benefits of treatment effectively, and to address the causes of drug users' negative attitudes towards treatment.

Drake RE; Mueser KT; Brunette MF. Management of persons with co-occurring severe mental illness and substance use disorder: Program implications. World Psychiatry 6(3): 131-136, 2007. (70 refs.)

Adults with severe mental illness have extraordinarily high rates of co-occurring substance use disorders, typically around 50% or more, which adversely affect their current adjustment, course, and outcome. Separate and parallel mental health and substance abuse treatment systems do not offer interventions that are accessible, integrated, and tailored for the presence of co-occurrence. Recent integrated interventions for this population have the specific goal of ameliorating substance use disorder and the general goal of improving adjustment and quality of life. The authors overview the current research and offer guidelines related to mission and philosophy, leadership, comprehensive reorganization, training, specific programs, and quality improvement.

Duchanne LJ; Knudsen HK; Roman PM; Johnson JA. Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network. Journal of Substance Abuse Treatment 32(4): 321-329, 2007. (31 refs.)

Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.

Ducharme LJ; Mello HL; Roman PM; Knudsen HK; Johnson JA. Service delivery in substance abuse treatment: Reexamining "comprehensive" care. Journal of Behavioral Health Services & Research 34(2): 121-136, 2007. (31 refs.)

Substance abuse treatment clients present with an array of service needs in various life domains. Ideal models of addiction treatment incorporate provision or linkages to services to meet clients' multiple needs; in turn, these wraparound and supportive services are associated with improvements in client retention and treatment outcomes. Using data from large samples of specialty addiction treatment providers in the public and private sectors, this article examines the extent and Organizational correlates of the comprehensiveness of service delivery. Multivariate models indicate that private sector treatment facilities offer more "core" medical and treatment services, whereas public sector programs offer more wraparound and supportive services. However, both sectors fall short of the ideal model of service comprehensiveness in terms of absolute number of services offered. These findings raise concerns regarding the quality and availability of needed services for treatment of addiction.

Edman J; Stenius K, eds. On the Margins: Nordic alcohol and drug treatment 1885-2007. NAD Monograph no. 50. Helsinki, Finland: Nordic Alcohol and Drug Council, 2007. (Chapter refs.)

The goal of this volume is to describe the character and dynamics of the alcohol and drug treatment systems in Denmark, Finland, Iceland, Norway and Sweden. How and why have new ideas and institutions emerged during its history? Who have been the actors and what have been the structures behind changes or resistance to change? What can explain the continuities and the reforms? Instead of describing the long national trajectories, the book presents thirteen snapshots from the history of treatment in the five Nordic countries. The settings described in these articles vary from countryside sanatoriums for the voluntary treatment of middle-class alcoholics in late 19th century Sweden, to large, prison-like institutions in all the Nordic countries, used for compulsory treatment emphasising work and moral edification, to the contemporary public injecting rooms in the city of Oslo. The actors include entrepreneurs, doctors, jurists, temperance activists, bureaucrats and social reformists. These snapshots are framed by an introductory chapter and a concluding article, drawing some general conclusions about the development of alcohol and drug treatment in the Nordic countries. Within the frame of the gradually developing Nordic welfare states, alcohol and drug treatment has mostly consisted of measures directed towards the poor, marginal groups of society - with the exception of the earliest history and also contemporary Iceland. The history of alcohol and drug treatment can thus be read as one expression of Nordic inclusion and exclusion, illustrated both by the comparatively large size of the treatment system, and by the strict demands on conformity within the frame of the ideally alcohol- and drug-free society. The development during the last decades, with the acceptance of harm-reduction and a new tolerance for the continuing use of substances introduces something thoroughly new in Nordic contexts. Will it also contribute to a true reformulation of the role of treatment?

Fischer M; Geiger B; Hughes ME. Female recidivists speak about their experience in drug court while engaging in appreciative inquiry. International Journal of Offender Therapy and Comparative Criminology 51(6): 703-722, 2007. (37 refs.)

Eleven female drug-court participants looked at current and past experiences to assess their program and envision future program innovations. From these women's perspective, the strongest component of drug court was being surrounded by staff dedicated to their progress and recovery. Graduated supervision and accurate drug testing were appreciated rather than resented when the participants were not humiliated and were treated with respect. Wraparound services, resources, and referral; treatment facilities that accepted children; and individualized treatment plans and therapy with offenders who are ex-addicts, and preferably females, allowed for greater involvement and active participation in recovery. Progressing through three phases, acquiring skills, a job, and visitation rights to see their children or regaining custody, increased these women's sense of self-efficacy perception and confidence in their ability to lead a drug-free, meaningful life. Findings show the importance of qualitative criteria in evaluating drug-court participants' progress and the process of recovery.

Flynn PM; Brown BS. Co-occurring disorders in substance abuse treatment: Issues and prospects. (review). Journal of Substance Abuse Treatment 34(1): 36-47, 2008. (105 refs.)

This article explores the epidemiology of co-occurring disorders (CODs) with an emphasis on the implications of study findings for the functioning and potential of substance abuse treatment. Severity of disorder is discussed as an issue that may have particular significance for the selection of specialized as opposed to traditional substance abuse treatment forms. Exploration is made, as well, of the resources currently available to substance abuse treatment, especially the human resources available, and the implications of resource availability for undertaking initiatives specific to COD. Findings from standard and enhanced treatment for comorbid individuals are examined in an effort to clarify areas of need for specialized and typical treatment personnel. Issues are raised for consideration by the clinical research and treatment provider communities in terms of assessment and diagnosis, manpower and training, and response to the challenge of relapse in this population.

Forman R; Crits-Christoph P; Kaynak O; Worley M; Hantula DA; Kulaga A et al. A feasibility study of a web-based performance improvement system for substance abuse treatment providers. Journal of Substance Abuse Treatment 33(4): 363-371, 2007. (43 refs.)

We report here on the feasibility of implementing a semiautomated performance improvement system -- Patient Feedback (PF) -- that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4-6 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability, [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at post-intervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.

Fornili K; Alemi F. Medicaid reimbursement for screening and brief intervention: Amending the Medicaid State Plan and approving state appropriations for the Medicaid State Match. (editorial). Journal of Addictions Nursing 18(4): 225-232, 2007. (20 refs.)

The federal government is strongly committed to the early identification (screening) of individuals with substance use disorders (SUDs) and the provision of clinically appropriate brief interventions for nondependent users of alcohol and drugs (i.e., persons with alcohol or drug abuse disorders) as well as referral to specialty addictions treatment for those with dependence (alcohol or drug addiction). However, limited third-party reimbursement of health-care providers (particularly primary care and emergency department professionals) poses significant implementation barriers and sustainability challenges for projects, including State grantees that have been awarded Screening, Brief Intervention and Referral to Treatment (SBIRT) Program funding through the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT). Although the Centers for Medicare and Medicaid (CMS) authorized Medicaid program reimbursement for screening and brief intervention (SBI) services to begin in 2007, few providers realize that before state Medicaid offices can begin reimbursement for these services, states must submit State Plan Amendment requests to CMS for approval. Further, before states can submit State Plan Amendment requests, they must first obtain legislative approval for state appropriations to support the state's portion of the expense of delivering the new services (the State's "Medicaid match"). States can leverage these requests by demonstrating that SBI services are effective and cost-effective, and that they lead to measurable cost offsets. This column is adapted from a SAMHSA-funded Medicaid reimbursement manual developed to help SBIRT grantees make cogent arguments for these state-level changes (Fornili & Alemi, 2007).

Foulds J; Williams J; Order-Connors B; Edwards N; Dwyer M; Kline A; Ziedonis DM. Integrating tobacco dependence treatment and tobacco-free standards into addiction treatment: New Jersey's experience. (editorial). Alcohol Research and Health 29(3): 236-240, 2006. (7 refs.)

Fuller BE; Rieckmann T; Nunes EV; Miller M; Arfken C; Edmundson E; McCarty D. Organizational readiness for change and opinions toward treatment innovations. Journal of Substance Abuse Treatment 33(2): 183-192, 2007. (27 refs.)

Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network completed surveys to characterize participating programs and practitioners. A two-level random-effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission, and more organizational stress. Support for confrontation and noncompliance discharge. in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices.

Gainey RR; Haggerty KP; Fleming CB; Catalano RF. Teaching parenting skills in a methadone treatment setting. Social Work Research 31(3): 185-190, 2007. (30 refs.)

This article discusses the effects of substance abuse, delinquency, and other problem behaviors on parenting and family. Children of substance abusers represent a high risk population. Prenatal exposure to addictive substances and the medical complications that may arise are important factors in placing this population at high risk of drug abuse and other behavior problems. As children of drug abusers grow older, their lives are often characterized by exposure to continued drug use by family members, chronic illnesses, financial troubles, legal conflicts and family disorganization.

Garner BR; Knight K; Simpson DD. Burnout among corrections-based drug treatment staff - Impact of individual and organizational factors. IInternational Journal of Offender Therapy and Comparative Criminology 51(5): 510-522, 2007. (33 refs.)

As a result of limited budgets, many treatment programs are forced to operate for extended periods at or beyond their capacity. The resulting pressure and stress on treatment staff can be taxing and lead to serious problems, including job burnout. Although the concept of burnout within other social service professions has been broadly researched, less attention has been given to burnout among drug abuse treatment staff, especially among corrections-based drug treatment staff. The goal of this article is to extend this area of research by exploring the impact of individual factors and organizational factors on burnout. Findings revealed that although a number of factors were related to staff burnout, younger counselor age, lower adaptability, poorer clarity of agency mission, and higher stress were most significant. Ways in which treatment programs might address these issues affecting staff burnout are discussed.

Glassmire DM; Welsh RK; Clevenger JK. The development of a substance abuse treatment program for forensic patients with cognitive impairment. Journal of Addictions & Offender Counseling 27(2): 66-81, 2007. (64 refs.)

The Substance Abuse and Mental Illness (SAMI) program combines cognitive rehabilitation and dual-diagnosis substance abuse treatment within a stages of change context. This article describes the development, implementation, and preliminary outcome analysis of the SAMI program in a forensic hospital.

Godley SH; Adams L; Risberg R; Sodetz A. Chestnut Health Systems' Bloomington outpatient and intensive outpatient program for adolescent substance abusers. IN: Steven SJ; Morral AR, eds. Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation Study. Binghamton NY: Haworth Press, 2003

This chapter is from Section II which deals with outpatient treatment models. It addresses the Chestnut Health system's adolescent model. It provides information of the recruitment, assessment and placement of clients, the profile of clients, a description of treatment components, criteria for determining readinessfor discharge or transfer. It also deals with critical issues central to treatment, as well as staffing and the process of clinical supervision.

Gotham HJ; White MK; Bergethon HS; Feeney T; Cho DW; Keehn B. An implementation story: Moving the GAIN from pilot project to statewide use. Journal of Psychoactive Drugs 40(1): 97-107, 2008. (25 refs.)

Similar to implementing an evidence-based practice (EPB), implementing an evidence-based assessment (EBA) is a long, complex process that can take several years to complete. Between 2002 and 2007, the state of Missouri first piloted the Global Appraisal of Individual Needs-Initial (GAIN-I; Dennis et al. 2006) assessment at one state-contracted adolescent substance abuse treatment program and then implemented the GAIN statewide. This case study documents the implementation process through Fixsen and colleagues' (2005) six stages of implementation, from exploration and adoption through sustainability, and outlines challenges and solutions encountered at the external, organizational, and individual staff level. Strengths of this project included recognition that implementation is an ongoing multistep process, strong support by state-level staff, contracting with an external purveyor for ongoing technical assistance at the agency level as well as training of front-line clinicians, and an implementation team comprised of stakeholders at multiple levels.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Greener JM; Joe GW; Simpson DD; Rowan-Szal GA; Lehman WEK. Influence of organizational functioning on client engagement in treatment. Journal of Substance Abuse Treatment 33(2): 139-147, 2007. (43 refs.)

This study focused on the relationship between organizational functioning factors measured in a staff survey using the Texas Christian University (TCU) Organizational Readiness for Change assessment and client-level engagement measured by the TCU Client Evaluation of Self and Treatment in drug treatment programs. The sample consisted of 531 clinical and counseling staff and 3,475 clients from 163 substance abuse treatment programs located in nine states from three regional Addiction Technology Transfer Centers. Measures of client engagement in treatment (rapport, satisfaction, and participation) were shown to be higher in programs with more positive staff ratings of organizational functioning. In particular, these programs had fewer agency needs and more favorable ratings for their resources, staff attributes. and climate. These findings help establish the importance of addressing organizational factors as part of an overall strategy for improving treatment effectiveness.

Guydish J; Tsoh J. Editor's introduction - Smoking, mental disorders and substance abuse treatment. Journal of Psychoactive Drugs 39(4): 419-421, 2007. (17 refs.)

Harris AHS; Humphreys K; Finney JW. Veterans affairs facility performance on Washington circle indicators and casemix-adjusted effectiveness. Journal of Substance Abuse Treatment 33(4): 333-339, 2007. (16 refs.)

Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in I of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.

Henderson CE; Taxman FS; Young D. A Rasch model analysis of evidence-based treatment practices used in the criminal justice system. Drug and Alcohol Dependence 93(1/2): 163-175, 2008. (73 refs.)

This study used item response theory (IRT) to examine the extent to which criminal justice facilities and community-based agencies are using evidence-based substance abuse treatment practices (EBPs), which EBPs are most commonly used, and how EBPs cluster together. The study used data collected from wardens, justice administrators, and treatment directors as part of the National Criminal Justice Treatment Practices survey (NCJTP; Taxman et al., 2007a), and includes both adult criminal and juvenile justice samples. Results of Rasch modeling demonstrated that a reliable measure can be formed reflecting the extent to which juvenile and adult correctional facilities, and community treatment agencies serving offenders, have adopted various treatment practices supported by research. We also demonstrated the concurrent validity of the measure by showing that features of the facilities' organizational contexts were associated with the extent to which facilities were using EBPs, and which EBPs they were using. Researchers, clinicians, and program administrators may find these results interesting not only because they show the program factors most strongly related to EBP use, but the results also suggest that certain treatment practices cluster together, which may help stakeholders plan and prioritize the adoption of new EBPs in their facilities. The study has implications for future research focused on understanding the adoption and implementation of EBPs in correctional environments.

Jessup MA. Organizational change in a perinatal treatment setting: Integration of clinical practice and policies on tobacco and smoking cessation. Journal of Psychoactive Drugs 39(4): 461-472, 2007. (84 refs.)

Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women: This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program's clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-modeling for children.

Joe GW; Broome KM; Simpson DD; Rowan-Szal GA. Counselor perceptions of organizational factors and innovations training experiences. Journal of Substance Abuse Treatment 33(2): 171-182, 2007. (56 refs.)

Because work environment is central to understanding job performance, drug counselor perceptions of their programs and their skills were examined in relation to their attitudes about innovations training and its utilization. Latent profile analysis of measures on organizational climate and staff attributes for 1047 counselors from 345 programs defined three categories of counselors-labeled as isolated, integrated, and exceptional. All had generally positive views of their professional skills, although the isolated group scored lower on scales representing professional growth and influence on peers. They were less positive about the "climate" of programs in which they worked and were higher on stress. Program resources predicted the counselor groups, with the isolated having more limited resources. Counselor categorizations also differed in terms of workshop training experiences, with the isolated group of counselors reporting significantly less exposure, satisfaction, and program-wide use of workshop training.

Jour MS; Fallon B; Sonne S; Nunes EV; Lima JL; Jiang H et al. Implementation of a smoking cessation treatment study at substance abuse rehabilitation programs: Smoking behavior and treatment feasibility across varied community-based outpatient programs. Journal of Addiction Medicine 1(3): 154-160, 2007

Cigarette smoking is widely prevalent among individuals in treatment for drug or alcohol dependence; however, the treatment of nicotine addiction in this population has numerous obstacles at both programmatic and patient levels. Despite these difficulties, recent studies have demonstrated moderate success in implementing smoking cessation treatment in drug rehabilitation programs. The National Drug Abuse Treatment Clinical Trials Network sponsored a smoking cessation study in 13 community-based outpatient substance abuse rehabilitation programs across the country. The study evaluated the effectiveness of smoking cessation treatment provided as an adjunct to substance abuse treatment-as-usual. This report summarizes the practical and clinical experiences encountered at each of the study sites with regard to implementing the smoking cessation treatment intervention. Smoking behavior of the treatment clientele was assessed by anonymous survey at each site. In addition, sites were systematically characterized by using program review and assessment tools completed by the respective staff and program directors at the site. Survey and recruitment data indicated that cigarette smoking is more prevalent and that smoking cessation treatment is more feasible, in methadone maintenance treatment programs. Other factors associated with smoking behavior and with the recruitment of drug- and alcohol-dependent individuals into the smoking cessation treatment study are described.

Kay-Lambkin FJ. Technology and innovation in the psychosocial treatment of methamphetamine use, risk and dependence. Drug and Alcohol Review 27(3): 318-325, 2008. (60 refs.)

Issues. The dramatic increase in methamphetamine use has led to the urgent need for high-quality, effective treatments and management strategies for methamphetamine use problems to be developed and disseminated. Although some evidence exists for the use of psychological, pharmacological and other approaches to treatment for problematic methamphetamine use, other evidence suggests that many methamphetamine users do not access these treatment options due to a range of individual and service-level barriers. Approach. A review of available research literature was undertaken to identify treatment strategies for methamphetamine users, which overcome the problems associated with treatment access for this important target group and involve technological and other innovative approaches. Key Findings. Several approaches to addressing problematic methamphetamine use have been suggested, including assertive engagement strategies, flexibility in the provision of treatment and retention strategies and use of a multi-focused intervention package, such as stepped care, perhaps including new technologies as alternatives or supplements to face-to-face-delivered treatments. No research currently exists to examine the possible benefit of these strategies for people with methamphetamine use problems. Implications. The use of stepped-care intervention packages has the potential to address many of the current challenges faced by both clinicians and clients in treating methamphetamine use problems. Conclusions. Although promising, these approaches require further attention and research effort, particularly among the specific group of methamphetamine users.

Knight DK; Broome KM; Simpson DD; Flynn PM. Program structure and counselor-client contact in outpatient substance abuse treatment. Health Services Research 43(2): 616-634, 2008. (27 refs.)

Objectives. To examine organizational structural attributes associated with counselor-client contact. Data Sources. Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs. Study Design. The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences. Data Collection. Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure. Primary Finding. Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients. Conclusions. Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.

Knudsen HK; Ducharme LJ; Roman PM. The use of antidepressant medications in substance abuse treatment: The public-private distinction, organizational compatibility, and the environment. Journal of Health and Social Behavior 48(2): 195-210, 2007. (59 refs.)

Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 3 63 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption.

Kolind T. Form or content: The application of user perspectives in treatment research. Drugs: Education, Prevention and Policy 14(3): 261-275, 2007. (33 refs.)

As part of a general trend in modem society, the voice of the 'consumers' of the services of the welfare state has gained increased legitimacy. However, this is not the case when it comes to drug-treatment users. The continuing neglect of this group's experiences is also reflected in methadone maintenance treatment research. This article seeks to counter this imbalance by exploring users' experiences with enhanced psychosocial methadone maintenance treatment. The findings rest on an evaluation of the Danish Methadone Project. As part of the evaluation 37 semi-structured qualitative interviews with users were made, and two months of participant observation were conducted in the clinics. An important finding is that the users highlighted the form of the treatment as much as the actual content. It was not primarily the content of the services, but how the services were carried out that mattered. Most crucially, the users highlighted the attitude of the counsellor, the accessibility of spontaneous counselling, and spaces that facilitated non-stigmatizing social encounters. While drug users do not provide the definitive statement about the value of drug service provision, listening to their voices is a necessary step in building an ethically sound approach to drug treatment, with a high degree of client support where the treatment provided meets the consumers needs.

Kresina TF; Hoffman K; Lubran R; Clark HW. Integrating hepatitis services into substance abuse treatment programs: New initiatives from SAMHSA. Public Health Reports 122(Supplement 2): 96-98, 2007. (7 refs.)

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and viral hepatitis are important public health concerns for both clients and care providers in substance abuse treatment programs. In response to this public health issue, SAMHSA has recently undertaken a number of HIV/AIDS and viral hepatitis prevention and control activities. These are described in turn and include: (1) ensuring that HIV/AIDS and viral hepatitis are a significant focus in SAMHSA grant programs, as appropriate; (2) increasing the number of SAMHSA grantees that provide HIV testing; (3) collecting and reporting National Outcomes Measures related to the nexus between substance abuse, HIV/AIDS, and hepatitis services provided; and (4) increasing the number of programs serving people with HIV/AIDS and viral hepatitis that apply for review by the National Registry of Evidence-based Programs and Practices.8,9 In fiscal year 2006, SAMHSA's Center for Substance Abuse Treatment (CSAT) supported two specific initiatives related to viral hepatitis prevention and control. These initiatives promote community-based substance abuse treatment services for individuals and families, and work with partners to implement professional and recovery support programs and initiatives that promote best practices.

Lash SJ; Stephens RS; Burden JL; Grambow SC; DeMarce JM; Jones ME et al. Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial. Psychology of Addictive Behaviors 21(3): 387-397, 2007. (43 refs.)

Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment.

Libretto S; Nemes S; Namur J; Garrett G; Hess L; Kaplan L. Promising practices in drug treatment: Findings from southeast Asia. Journal of Teaching in the Addictions 4(1): 67-88, 2005

In a study to evaluate the drug treatment and aftercare efforts sponsored by the State Department's International Narcotics and Law Enforcement Affairs Bureau, residential Therapeutic Community (TC) treatment programs in three countries in Southeast Asia-Malaysia, Singapore, and Thailand-were examined to identify promising practices and to assess lessons learned. Based on field visits, in-person interviews, focus groups, and document analyses, the authors recommend the following promising practices for replication: (1) structured treatment environment tailored to meet cultural norms; (2) successful collaboration among training networks and agencies; (3) utilization of an active volunteer community; (4) inclusion of vocational training to facilitate successful reintegration; (5) use of religion to enhance treatment resident growth; (6) inclusion of family in the treatment process; and, (7) establishment of a systematic program re-entry process.

Lincoln AK; Liebschutz JM; Chernoff M; Nguyen D; Amaro H. Brief screening for co-occurring disorders among women entering substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy 1: article 26, 2006. (52 refs.)

Background: Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374). Results: Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. Conclusion: Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment

MacDonald S; Rothwell H; Moore L. Getting it right: Designing adolescent-centred smoking cessation services. Addiction 102(7): 1147-1150, 2007. (25 refs.)

Aims: To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services. Design Structured qualitative interviews drawing on means-end theory. Setting Three youth-clubs and two secondary schools in south-east Wales. Participants: Twenty-five male and female 13-18-year-olds, mainly daily smokers. Findings Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non-school-based, flexible support and guidance. Conclusion: The results re-emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent-appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.

Magura S. The relationship between substance user treatment and 12-step fellowships: Current knowledge and research questions. Substance Use & Misuse 42(2-3): 343-360, 2007. (59 refs.)

This article reviews and synthesizes information about the relationship between two distinct approaches to helping substance users, formal "addiction treatment" and 12-step mutual aid. The following issues are addressed: Extent of formal treatment and 12-step fellowship participation for persons with substance use-related problems; overlap between treatment and 12-step participation; early attempts to "integrate" treatment and 12-step mutual aid; differences and similarities between the 12-step program and treatment; issues ofspirituality in the 12-step program; effectiveness of 12-step participation as treatment aftercare; and whether help-seekers can be "matched" to 12-step. The article poses pertinent questions that could answered by additional research, including life cycle patterns of usage of treatment and 12-step, outcomes of such episodes, reasons for using different interventions at different times, feasibility of 12-step participation as a primary intervention, the relative contributions of striving for spiritual values vs. social support factors to the effectiveness of 12-step, and the comparative effectiveness of secular vs. 12-step, mutual aid. The article concludes with a proposed reconceptualization of the relationship between formal treatment and 12-step mutual aid that may help in structuring future research.

McCarty D. Performance measurement for systems treating alcohol and drug use disorders. (editorial). Journal of Substance Abuse Treatment 33(4): 353-354, 2007. (5 refs.)

McGovern MP; Xie H; Acquilano S; Segal SR; Siembab L; Drake RE. Addiction treatment services and co-occurring disorders: The ASAM-PPC-2R taxonomy of program dual diagnosis capability. Journal of Addictive Diseases 26(3): 27-37, 2007. (24 refs.)

Background. The ASAM-PPC-2R taxonomy of addiction treatment program dual diagnosis capability provides a conceptual model of services for persons with co-occurring substance use and psychiatric disorders. However, no objective study of this model has been conducted. Method. This paper describes a survey of addiction treatment providers (n = 453) who were asked to identify their program as Addiction Only Services (AOS), Dual Diagnosis Capable (DDC) or Dual Diagnosis Enhanced (DDE). The survey also queried providers on prevalence estimates, clinical practices, and perceived barriers to treating persons with co-occurring substance use and psychiatric disorders. Results. With brief definitions available to respondents, 92.9% of providers surveyed categorized their program as: Addiction Only Services (23.0%), Dual Diagnosis Capable (65.3%) or Dual Diagnosis Enhanced (11.6%). Patient characteristics, clinical practices, and barriers to effective treatments varied by program dual diagnosis capability. Conclusions. The findings support the utility of the ASAM dual diagnosis capability taxonomy, and suggest specific avenues for system and program assessment and future research.

McLellan AT; Chalk M; Bartlett J. Outcomes, performance, and quality: What's the difference? Journal of Substance Abuse Treatment 32(4): 331-340, 2007. (38 refs.)

Calls for greater accountability within the addiction treatment field have led to a wide range of efforts designed to improve treatment performance, quality, and outcomes. However, efforts with conceptually and in methodologically different approaches have used the same umbrella terms such as "quality," "performance indicators," and "outcome domains," causing substantial confusion among providers and policymakers. This article provides operational definitions of the terms used in discussing quality, performance, and outcomes, as well as a discussion of ways to integrate efforts to measure treatment system performance and quality during treatment with patient outcomes during and following treatment. This article thus helps build a common understanding about how these efforts to bring greater accountability can be combined and integrated to improve the attractiveness and effectiveness of addiction treatments.

Melnick G; Wexler HK; Cleland CM. Client consensus on beliefs about abstinence: Effects on substance abuse treatment outcomes. Drug and Alcohol Dependence 93(1/2): 30-37, 2008. (45 refs.)

Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment. The present paper extends this work to treatment outcomes. Secondary analysis of data from a "Beliefs About Abstinence Scale," used in the Drug Abuse Treatment Outcomes Study (DATOS), was conducted for 76 programs, including outpatient methadone treatment, outpatient drug-free, short-term inpatient, and long-term residential programs. Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality. The implications of the results for substance abuse treatment are discussed.

Minugh PA; Janke SL; Lomuto NA; Galloway DK. Adolescent substance abuse treatment resource allocation in rural and frontier conditions: The impact of including organizational readiness to change. Journal of Rural Health 23(Supplement S): 84-88, 2007. (15 refs.)

Context: Rural and frontier states are significantly affected by substance abuse and poverty. The; high rate of substance abuse coupled with high levels of dependence on state funded treatment systems places a burden on rural treatment systems and makes resource allocation a central planning issue. Purpose: The goal of this study was to combine substance abuse treatment need data with organizational readiness to change data to create a rank-ordered listing of residential treatment, providers to answer the following questions: Do program priority rankings change when organizational readiness to change is included in a need-based resource allocation algorithm? Methods: Three methodological procedures were used to determine program priority rankings among 14 residential adolescent treatment programs in 8 Wyoming counties: (2) a social indicators analysis of crime data, (2) synthetic estimates of substance-abuse treatment need, and (3) analysis of organizational change data from the directors 3 and staff at adolescent residential treatment programs: Findings: Program need rankings based on crime data and synthetic estimates of substance abuse treatment need shifted when organizational readiness to change data was added to, the algorithm: Conclusions: There is much to be gained from considering organizational readiness to change when selecting programs for funding: It plays a central: role in the successful diffusion of evidence-based practices within and among programs. Including this measure in the resource allocation process can help. planners identify programs that will be more apt to adopt a best practice. This is critical for making decisions about where to allocate scarce treatment resources.

Moore D; Langlois M; Gerber BM; Gaddis R; Hallam JS; Arnold R. Intention to quit tobacco use among clients in substance use disorder treatment settings. Substance Use & Misuse 42(5): 871-879, 2007. (16 refs.)

The purpose of this study was to investigate the influence of age, gender, tobacco-related knowledge, treatment modality, and changes in smoking patterns on intention to quit tobacco use among individuals participating in substance use disorder (SUD) treatment in Ohio. Of the 791 SUD program attendees, 91.7% currently used tobacco, with cigarette smoking being the most prevalent form of use. Among tobacco users, 67% reported intention to quit tobacco use. Four of the five hypothesized predictor variables had a significant relationship with intention to quit tobacco: gender, age, treatment modality, and smoking pattern, with age and gender demonstrating the strongest relationships to intention to quit smoking.

Munoz-Solomando A; Williams RJW. Care pathways for young people who misuse substances: Using the evidence to design services. Current Opinion in Psychiatry 20(4): 330-336, 2007. (53 refs.)

Purpose of review: To review a selection of the literature on the nature and contents of care pathways. We examine recent work on current trends in intervening to meet the needs of young people who misuse substances. Recent findings The recent and growing literature encourages us to adopt care pathways as structured models for service delivery. The increased prevalence and the severity and complexity of the problems experienced by young people who misuse substances evidence the requirement for specialist services for them. Summary: The literature argues for using care pathways to manage better services for intervening with young people who use or misuse substances and recommends their contents: We conclude that care pathways should be based on strategic models of care; however, there remain areas of uncertainty, including those about the balance of services that should be delivered, adoption of prevention programmes, and development of audit tools to monitor the impacts and effectiveness of care pathways. This review provides our recommended list of contents for models of care on which we recommend that associated care pathways should be based.

Nemes S; Libretto S; Skinstad AH; Garrett G; Hoffman J. Promising practices in drug treatment findings from Europe. Journal of Teaching in the Addictions 4(1): 89-109, 2005

In a study to evaluate the drug treatment and aftercare efforts sponsored by the State Department's International Narcotics and Law Enforcement Affairs Bureau, residential Therapeutic Community (TC) treatment programs in four European countries-Poland, Spain, Slovenia, and Italy-were examined to identify promising practices and to assess lessons learned. Based on field visits, in-person interviews, focus groups, and document analyses, the authors recommend the following promising practices for replication: (1) structured programs with individualized treatment objectives throughout each stage of therapy; (2) integration of the family into every dimension of treatment; (3) emphasis on meeting the individual needs of each client; (4) extensive involvement of volunteers in the delivery of services; and (5) integration of prevention programs for children and adolescents.

Niv N; Hser YI. Women-only and mixed-gender drug abuse treatment programs: Service needs, utilization and outcomes. Drug and Alcohol Dependence 87(2/3): 194-201, 2007. (31 refs.)

Objectives: This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs. Methods: The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients' problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records. Results: Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric). Conclusions: The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.

Office of Applied Studies, Substance Abuse and Mental Health Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2006 Data on Substance Abuse Treatment Facilities, DASIS Series S-39. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (0 refs.)

SAMHSA's Office of Applied Studies (OAS) conducts the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. In 2006, on the date of the census, there were 13,771 facilities serving 1,130,881 individuals. Over half (59%) were facilities provided by private nonprofit organizations, 28% were private for-profit organizations, 7% run by local governments, 3% by State governments, 2% by the Federal government, and 1% by tribal governments. Of the reporting facilities 62% of the facilities reported substance abuse treatment services was their primary focus of activity, 27% of the facilities reported that their primary focus was a mix of mental health and substance abuse treatment services. On the date of the census 90% of residential beds were filled. 63% of all facilities provided a sliding scale for fees, 53% of all facilities offered substance abuse treatment at no charge to eligible clients who could not pay, and 4% provided substance abuse treatment at no charge to all clients. Federal, State, or local government funds were received by 59% of all facilities. Most facilities (83%) offered specially designed programs: 37% offered programs or groups for persons with co-occurring mental health and substance abuse disorders, 32% for adult women, 32% for adolescents, 31% for driving under the influence of alcohol or drugs (DUI/DWI), 28% for criminal justice clients, 25% for adult men, 14% for pregnant/postpartum women, 10% for persons with HIV or AIDS, 7% for seniors or older adults, and 6% for gays or lesbians. Substance abuse treatment services in sign language for the hearing impaired were offered in 29% of all facilities and in languages other than English in 45%.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Administration. The DASIS Report: Length of Stay for Outpatient Discharges Completing Treatment: 2004 (May 10, 2007). Rockville MD: Substance Abuse and Mental Health Administration, 2007. (11 refs.)

SAMHSA's annual Treatment Episode Data Set (TEDS) provides data on the median length of stay for substance abuse treatment patients who completed outpatient treatment in the nation's specialty substance abuse treatment facilities. "Outpatient" care included not only regular outpatient visits but also intensive outpatient treatment (defined as a minimum of 2 hours per day on 3 or more days per week), detoxification, and day treatment with partial hospitalization. Outpatient treatment episodes where methadone use was planned were not included in this analysis of median length of stay (LOS). Increased length of stay has been associated with improved treatment outcomes. The length of stay among those who completed outpatient substance abuse treatment in 2004 varied by primary substance of abuse, race/ethnicity, completed education, and source of referral. Treatment completers who reported stimulants as their primary substance of abuse had the longest median length of stay (137 days) compared with treatment completers with alcohol as their primary substance who had the shorted median length of stay (98 days). The median length of stay among outpatient substance abuse treatment completers was longest among Hispanics(126 days) and shortest among American Indians/Alaska Natives (84 days).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Administration. The DASIS Report: Adolescent Treatment Admissions by Gender, 2005. (May 24, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (5 refs.)

Based on SAMHSA's Treatment Episode Data Set (TEDS), of the 142,600 adolescent admissions aged 12 to 17 in 2005, about 31% (44,600) were female. Adolescent female substance abuse treatment admissions were less likely than adolescent male admissions to report marijuana as their primary substance of abuse (51% vs. 72%) and more likely to report alcohol (23% vs. 16%) or stimulants (12% vs. 4%) as their primary substance of abuse. Adolescent females admissions were more likely than males to have a co-occurring psychiatric disorder (23% vs. 18%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Administration. The DASIS Report: Facilities Offering Special Treatment Programs or Groups. (June 14, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (2 refs.)

The National Survey of Substance Abuse Treatment Services (N-SSATS) provides information as to whether substance abuse treatment facilities offer special services. These special services include specially designed treatment programs for adolescents, clients with co-occurring substance abuse and mental disorders, criminal justice clients, persons with HIV or AIDS, gays or lesbians, pregnant or postpartum women, adult women, adult men, seniors or older adults, and persons arrested for driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI). A total of 13,371 substance abuse treatment facilities responded to the 2005 National Survey of Substance Abuse Treatment Services and 83% of them offered at least one special program or group addressing particular needs of specific client types. The most commonly offered special program or group was for persons with co-occurring substance abuse and mental disorders (38%). Facilities providing hospital inpatient care were the most likely to offer special programs for persons with co-occurring substance abuse and mental disorders (56%). They also provided special programs for adolescents (26%), and adult women (26%). Facilities providing outpatient care were most likely to offer special programs or groups for persons arrested for driving under the influence of alcohol or drugs or driving while intoxicated (38%), persons with co-occurring substance abuse and mental disorders (38%), adolescents (36%), and adult women (33%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS) 1995-2005. National Admissions to Substance Abuse Treatment Services. DASIS Series S-37. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (0 refs.)

Following a summary of the major findings, this report is organized into six chapters. Chapter 1 describes the data set from which the report is derived. Chapter 2 sets forth trends in treatment admissions over a 10 year period, the trends in terms of the primary substance of abuse, the co-occurence of alcohol and drug abuse, admissions rates by state and primary substance, demographic characteriesticsd and socioeconomic status. Chapter 3 reviews characteristics of those admitted in terms of types of drugs uses --alcohol only, alcohol with a secondary drug of abuse, heroin, other opiates, smoked and non-smoked cocaine, marijuana, methamphetamine and other stimulants, tranquilizers, sedatives, hallucinogens, PCP, and inhalants. Chapter 4 summarizes state data trends from 1995-2005. Chapter 5 addresses special interests, adolescents, heroin use by route of administration and anticipated drug-substitution therapy, polydrug abuse, and racial and ethic subgroups. The final chapter considers admissions for detoxification. Data is presented in 107 figures and tables.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Male Admissions with Co-occurring Psychiatric and Substance Use Disorders: 2005. (December 13,2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (8 refs.)

Among male admissions reporting alcohol, cocaine, marijuana, or stimulants as the primary substance of abuse, those with co-occurring disorders were more likely than those without co-occurring disorders to report daily use of these substances.Sixty-two percent of male admissions with co-occurring disorders reported more than one substance of abuse compared with 52 percent of male admissions without co-occurring disorders. Male admissions with co-occurring disorders were more likely than those without co-occurring disorders to report five or more prior substance abuse treatment episodes (17 vs. 10 percent)

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Facilities Offering Special Treatment Programs or Groups. (June 14, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (2 refs.)

SAMHSA's National Survey of Substance Abuse Treatment Services (N-SSATS) provides information as to whether substance abuse treatment facilities offered special services. These special treatment services include specially designed treatment programs for adolescents, clients with co-occurring substance abuse and mental disorders, criminal justice clients, persons with HIV or AIDS, gays or lesbians, pregnant or postpartum women, adult women, adult men, seniors or older adults, and persons arrested for driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI). A total of 13,371 substance abuse treatment facilities responded to the 2005 National Survey of Substance Abuse Treatment Services and 83% of them offered at least one special program or group addressing particular needs of specific client types. Among the largest facilities the proportion was 88% and among the smallest, 72%. The most commonly offered special program or group was for persons with co-occurring substance abuse and mental disorders (38%), followed by programs for adult women (33%), adolescents (32%), DWI offenders (31%), criminal justice system clients (28%), adult men (25%), pregnant or post-partum women (14%), those with HIV/AIDS (11%), seniors (7%), and gays/lesbians (6%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Cocaine Route of Administration Trends, 1995-2005. (September 13, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (9 refs.)

Trends in admissions to substance abuse treatment for cocaine and cocaine route of administration were examined with annual data from SAMHSA's Treatment Episode Data Set (TEDS). In 1995, 63% of primary smoked cocaine (crack) were younger than age 35. By 2005, only 32% of primary crack admissions were in this age group. The proportion of both inhaled and smoked cocaine (crack) admissions who were employed full time decreased between 1995 and 2005.

Public Domain

Oser CB; Roman PM. Organizational-level predictors of adoption across time: Naltrexone in private substance-use disorders treatment centers. Journal of Studies on Alcohol and Drugs 68(6): 852-861, 2007. (51 refs.)

Objective: Prominent on the nation's research agenda on substance-use disorders treatment is the dissemination of effective pharmacotherapies. Thus, the purpose of this article is to use a "diffusion of innovations" theoretical framework to examine the organizational-level predictors of the adoption of a pharmacotherapy, naltrexone (Revia), in private substance use-disorders treatment centers (N = 165). Method: Data for these analyses were derived from the National Treatment Center Study, which contains four waves of data collected between 1994 and 2003. An event history model examined the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of adopting naltrexone between 1994 and 2003. Results: The results suggest that organizations embracing a 12-step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Moreover, treatment centers that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time. Conclusions: Structural characteristics do affect the innovation adoption behaviors of private substance use disorders treatment centers. Organizational-level "research to practice" implications to further the adoption of innovative evidence-based treatments are discussed.

Pelet A; Doll S; Huissoud T; Resplendino J; Besson J; Favrat B. Methadone maintenance treatment (MMT) in general practice or in specialized centers: Profile of patients in the Swiss Canton of Vaud. American Journal of Drug and Alcohol Abuse 33(5): 665-674, 2007. (24 refs.)

We studied profile of patients (n 1782) treated in specialized centers and general practice (GP) enrolled in methadone maintenance treatment (MMT) programs during 2001 in the Swiss Canton of Vaud. We found that GPs treated the majority of patients (76%). Specialized centers treated a higher proportion of patients with uncontrolled intravenous use of cocaine and heroin, and prescribed neuroleptics as concomitant medication three times more frequently than GPs. Patients treated in specialized centers were more likely to undergo screening for HIV, HBV, HCV, and receive complete HBV immunization. In conclusion, specialized centers are more likely to treat severely addicted patients and patients with a poor global assessment (physical, psychiatric, and social).

Pincus HA; Page AE; Druss B; Appelbaum PS; Gottlieb G; England MJ. Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions. (review). American Journal of Psychiatry 164(5): 712-719, 2007. (40 refs.)

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.

Richter KP; Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. (review). Substance Abuse Treatment, Prevention, and Policy 1: article 23, 2006. (79 refs.)

Most persons in drug treatment smoke cigarettes. Until drug treatment facilities systematically treat their patients' tobacco use, millions will flow through the drug treatment system, overcome their primary drug of abuse, but die prematurely from tobacco-related illnesses. This paper reviews the literature on the health benefits of quitting smoking for drug treatment patients, whether smoking causes relapse to other drug or alcohol abuse, the treatment of tobacco dependence, and good and bad times for quitting smoking among drug treatment patients. It also presents a conceptual model and recommendations for treating tobacco in substance abuse treatment, and provides references to internet and paper-copy tools and information for treating tobacco dependence. At present, research on tobacco treatment in drug treatment is in its infancy. Although few drug treatment programs currently offer formal services, many more will likely begin to treat nicotine dependence as external forces and patient demand for these services increases. In the absence of clear guidelines and attention to quality of care, drug treatment programs may adopt smoking cessation services based on cost, convenience, or selection criteria other than efficacy. Because research in this field is relatively new, substance abuse treatment professionals should adhere to the standards of care for the general population, but be prepared to update their practices with emerging interventions that have proven to be effective for patients in drug treatment.

Robinson LA; Emmons KM; Moolchan ET; Ostroff JS. Developing smoking cessation programs for chronically ill teens: Lessons learned from research with healthy adolescent smokers. Journal of Pediatric Psychology 33(2): 133-144, 2008. (68 refs.)

Objective: Medically fragile teens who smoke need access to smoking cessation programs, because they are at even higher risk than their healthy peers for smoking-related complications. Methods To date, no studies on the outcome of smoking cessation programs for medically ill teens have been conducted. To suggest directions for future research, we turn to the literature on smoking cessation in the general population of teens and occasionally to the literature on adult smokers. Results Four areas are explored: (a) the prevalence of unaided cessation in healthy teens; (b) the outcomes of various treatments for smoking cessation in healthy adolescents; (c) special issues that should be considered when designing programs for medically ill teens; and (d) lessons learned from previous research. Conclusions: Medically ill teens face a number of medical, emotional, social, and developmental challenges that can affect the quitting process. Research is sorely needed to address the unique needs of this population.

Roche AM; Todd CL; O'Connor J. Clinical supervision in the alcohol and other drugs field: An imperative or an option? Drug and Alcohol Review 26(3): 241-249, 2007. (54 refs.)

There is a growing interest in Clinical Supervision (CS) as a central workforce development (WFD) strategy. This paper provides a definition of and rationale for CS, characterises its various forms, identifies selection and training issues, and advises on policy and implementation issues central to redressing shortcomings in supervision practice within the alcohol and other drugs (AOD) field. Relevant selective literature is reviewed. Key conceptual issues were identified, and strategies developed to address implementation barriers and facilitate relevant policy. There is a common conceptual confusion between administrative supervision and CS. Clarification of the role, function and implementation of CS is required. Priority issues for the AOD field include: enhancing belief in CS; ensuring adequate resource allocation; developing evaluation protocols; and addressing specific arrangements under which supervision should occur. CS has been underutilised to date but holds considerable potential as a WFD strategy. It is fundamental to workers' professional development, can contribute to worker satisfaction and retention, and may improve client outcomes. Critical next steps are to establish the generalisability to the AOD field of the benefits observed from CS in other disciplines, and evaluate longer-term gains of CS programs.

Roeg DPK; De Goor IAMV; Garretsen HFL. European approach to assertive outreach for substance users: Assessment of program components. Substance Use & Misuse 42(11): 1705-1721, 2007. (35 refs.)

Model programs for assertive outreach for substance users (an active and persistent type of community-based health care) are still in their infancy. Most programs were formulated in the United States, and one problem is the lack of feasible and effective models for application in Europe. Therefore, in 2003 all assertive outreach programs for substance users in The Netherlands (n = 277) received a questionnaire about their main program components. The programs were found to differ in case-finding methods, label, focus, corporate strategy, care package, and team structure. The only association found was between the program strategy (referral or long-term care) and the program focus (nuisance reduction or care). Contextual and practical reasons for the differences between the programs are discussed as well as the implications for practice and future studies.

Rogers N. From "Treatment" to "Care": Developing youth drug treatment services using a social model of health. Australian Journal of Primary Health 14(1): 52-58, 2008. (22 refs.)

The Youth Substance Abuse Service (YSAS) was conceived and developed as a youth alcohol and other drug (AOD) service when few adolescent treatment models existed. Although initially funded to provide drug support and treatment, our developing practice, training and research findi