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CORK Bibliography: Treatment Programs

69 citations. October 2010 to present

Prepared: June 2011

Ames SC; Werch CE; Ames GE; Lange LJ; Schroeder DR; Hanson AC et al. Integrated smoking cessation and binge drinking intervention for young adults: A pilot investigation. Annals of Behavioral Medicine 40(3): 343-349, 2010. (25 refs.)

Background: Alcohol consumption is strongly associated with cigarette smoking in young adults. Purpose: The aim of this study was to evaluate the acceptability and estimate the magnitude of the effect of a novel-integrated smoking cessation and binge-drinking intervention for young adults compared with standard treatment control. Methods Participants were 41 young adult smokers (>= 10 cigarettes per day) who regularly (>= 2 times per month) binge drank who were randomly assigned to standard treatment (n=19) involving eight individual treatment visits plus 8 weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge-drinking intervention (integrated intervention; n=22). Results: Participants rated integrated intervention as highly acceptable as indicated by 100% of participants rating helpfulness as 5 on 5-point scale. Using an intent-to-treat analysis for tobacco abstinence, at both week 12 end of treatment and week 24 follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment (36% vs. 21% at week 12; 23% vs. 11% at week 24). At week 24, change from baseline in binge-drinking episodes, drinks consumed, and drinking days between treatment groups were similar (intent-to-treat analysis was not used for alcohol data). Conclusions: Preliminary data support the intriguing possibility that integrated intervention may enhance smoking cessation and reduce binge drinking.

An LC; Betzner A; Schillo B; Luxenberg MG; Christenson M; Wendling A et al. The comparative effectiveness of clinic, work-site, phone, and Web-based tobacco treatment programs. Nicotine & Tobacco Research 12(10): 989-996, 2010. (21 refs.)

Tobacco treatment programs may be offered in clinical settings, at work-sites, via telephone helplines, or over the Internet. Little comparative data exist regarding the real-world effectiveness of these programs. This paper compares the reach, effectiveness, and costs of these different modes of cessation assistance. This is an observational study of cohorts of participants in Minnesota's QUITPLAN programs in 2004. Cessation assistance was provided in person at 9 treatment centers, using group counseling at 68 work-sites, via a telephone helpline, or via the Internet. The main outcomes of the study are enrollment by current smokers, self-reported 30-day abstinence, and cost per quit. Reach was calculated statewide for the helpline and Web site, regionally for the treatment centers, and for the employee population for work-site programs. Enrollment was greatest for the Web site (n = 4,698), followed by the helpline (n = 2,351), treatment centers (n = 616), and work-sites (n = 479). The Web site attracted younger smokers. Smokers at treatment centers had higher levels of nicotine dependence. The helpline reached more socially disadvantaged smokers. Responder 30-day abstinence rates were higher for the helpline (29.3%), treatment centers (25.8%), and work-sites (19.6%) compared with the online program (12.5%). These differences persisted after controlling for baseline differences in participant characteristics and use of pharmacological therapy. The cost per quit was lowest for the Web site program ($291 per quit, 95% CI = $229-$372). Treatment center, work-site, helpline, and Web site programs differ in their reach, effectiveness, and estimated cost per quit. Each program plays a part in assisting populations of tobacco users in quitting.

Baldacchino A; Crome IB; Zador D; McGarrol S; Taylor A; Hutchison S et al. Recording of clinical information in a Scotland-wide drug deaths study. Journal of Psychopharmacology 24(9): 1289-1298, 2010. (58 refs.)

The aim of this study was to analyse the nature and extent of data extracted from case files of deceased individuals in contact with services 6 months prior to drug deaths in Scotland during 2003. A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug-related deaths was undertaken, using a data linkage process. All contacts made with services in the 6 months prior to death were identified. Information on clinical and social circumstances obtained from social care, specialist drug treatment, mental health, non-statutory services, the Scottish Prison Service and Criminal Records Office was collated. More than 70% (n = 237) were seen 6 months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems, for example, ethnicity (49%), living accommodation (66%), education and income (52%) and dependent children (73%). Medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17% and life events in 26%. This paucity of information was a feature of treatment plans and progress recorded. The 237 drug deaths were not a population unknown to services. Highly relevant data were missing. Improved training to promote in-depth recording and effective monitoring may result in better understanding and reduction of drug deaths.

Barnett PG; Trafton JA; Humphreys K. The cost of concordance with opiate substitution treatment guidelines. Journal of Substance Abuse Treatment 39(2): 141-149, 2010. (30 refs.)

The Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

Berends L. The emergence of a specialist role in rural alcohol and drug service delivery: Lessons from a review in rural Victoria, Australia. Drugs: Education, Prevention and Policy 17(5): 603-617, 2010. (23 refs.)

Aim: Perspectives on rural alcohol and other drug (AOD) service provision were explored. Methods: A mixed methods approach included a document review, service monitoring data, regional group fora with AOD and other health providers (109), semi-structured interviews with stakeholders from health, policy and research (53), and interviews with rural AOD services users (21). Findings: Alcohol is the main drug used by people in rural Victoria, followed by cannabis and then heroin. Services are allocated within a unit cost funding model and distributed on a regional or statewide basis. AOD treatment is dominated by outpatient therapy, outreach and rural withdrawal. Pharmacotherapy and residential rehabilitation are in short supply. Distance, stigma, and confidentiality concerns are barriers to treatment. Recruiting and retaining workers is difficult. The system continues to develop; secondary consultations and networking strategies increase capacity in other care systems. Hospital involvement in AOD treatment varies according to other health demands. Conclusions: Many aspects of the rural AOD service provider's role enhance service delivery by extending reach and capacity. This occurs through AOD models, such as outreach, as well as strategies for working with other systems that include networking and secondary consultation. While there is task diffusion beyond traditional understandings of AOD treatment, the service delivery role may be understood as specialist in its own right. Recognition of this role as specialist may support staff recruitment and retention, while building potential for career pathways.

Bourgois P; Hart LK. Science, religion and the challenges of substance abuse treatment. (editorial)18. Substance Use & Misuse 45(14): 2395-2400, 2010. (18 refs.)

Bride BE; Abraham AJ; Roman PM. Organizational factors associated with the use of contingency management in publicly funded substance abuse treatment centers. Journal of Substance Abuse Treatment 40(1): 87-94, 2011. (54 refs.)

A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. Although studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. Using data from a sample (N = 318) drawn from the population of publicly funded treatment centers in the United States, this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. Organizations were more likely to use CM if they embrace a supportive therapeutic approach, are research friendly, offer only outpatient levels of care, or serve drug-court patients. Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed.

Canaway R; Merkes M. Barriers to comorbidity service delivery: The complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks. Australian Health Review 34(3): 262-268, 2010. (51 refs.)

This paper draws from a literature review commissioned as part of a larger project evaluating comorbidity treatment service models, which was funded by the Australian Government Department of Health and Ageing as part of the National Comorbidity Initiative. The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. This paper outlines conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, particularly around the variable nature of comorbidity, and the impacts of the separation of the mental health (MH) and alcohol and other drug (AOD) sectors with their differing institutional cultures, aetiological concepts, philosophical underpinnings, educational requirements, administrative arrangements, and screening and treatment approaches. Issues pertaining to the lack of consistent definitions and conceptual frameworks for comorbidity are discussed, particularly in relation to the reported lack of communication, collaboration, and linkages between the sectors. It is suggested that the adoption of consistent terminology and conceptual frameworks may provide a valuable step towards consistency in service provision and research and could lead to improved capacity to address the many issues relating to comorbidity service provision and treatment efficacy.

Chen KW; Comerford A; Shinnick P; Ziedonis DM. Introducing Qigong meditation into residential addiction treatment: A pilot study where gender makes a difference. Journal of Alternative and Complementary Medicine 16(8): 875-882, 2010. (31 refs.)

Objective: The objective of this study was to explore the feasibility and efficacy of adding integrative qigong meditation to residential treatment for substance abuse. Methods: Qigong meditation, which blends relaxation, breathing, guided imagery, inward attention, and mindfulness to elicit a tranquil state, was introduced into a short-term residential treatment program. At first clients chose to participate in qigong meditation on a voluntary basis during their evening break. Later they chose to participate in either meditation or Stress Management and Relaxation Training (SMART) twice a day as part of the scheduled treatment. Weekly questionnaires were completed by 248 participants for up to 4 weeks to assess their changes in treatment outcomes. Participants in the meditation group were also assessed for quality of meditation to evaluate the association between quality and treatment outcome. Results: Most clients were amenable to meditation as part of the treatment program, and two thirds chose to participate in daily meditation. While both groups reported significant improvement in treatment outcome, the meditation group reported a significantly higher treatment completion rate (92% versus 78%, p < 01) and more reduction in craving than did the SMART group. Participants whose meditation was of acceptable quality reported greater reductions in craving, anxiety, and withdrawal symptoms than did those whose meditation was of low quality. Female meditation participants reported significantly more reduction in anxiety and withdrawal symptoms than did any other group. Conclusions: Qigong meditation appears to contribute positively to addiction treatment outcomes, with results at least as good as those of an established stress management program. Results for those who meditate adequately are especially encouraging. Meditative therapy may be more effective or acceptable for female drug abusers than for males. Further study is needed to assess ways to improve substance abusers' engagement and proficiency in meditation.

Chisolm MS; Brigham EP; Lookatch SJ; Tuten M; Strain EC; Jones HE. Cigarette smoking knowledge, attitudes, and practices of patients and staff at a perinatal substance abuse treatment center. Journal of Substance Abuse Treatment 39(3): 298-305, 2010. (56 refs.)

This study compares cigarette smoking knowledge, attitudes, and practices (S-KAP) of opioid- and other substance-dependent patients and their multidisciplinary staff at an outpatient perinatal substance abuse treatment center. Consenting patients (n = 95) and staff (n = 41) concurrently completed a modified form of the S-KAP survey instrument. Ninety-five percent of patients reported currently smoking, and half endorsed wanting "to quit smoking now." This patient desire to quit smoking was significantly underrated by staff compared to the patients themselves (p = .028). Both patients and staff demonstrated suboptimal knowledge of smoking health risks, but 73% of patients reported trying to quit with past pregnancies to avoid harm to the fetus/baby. Although results show that patients could benefit from smoking cessation strategies centered on smoking's fetal/neonatal health risks, organizational interventions that focus on changing staff attitudes about patient desire to quit smoking may first need to be implemented.

Crevecoeur-MacPhail D; Bellows A; Rutkowski BA; Ransom L; Myers AC; Rawson RA. "I've been NIATxed": Participants' experience with process improvement. Journal of Psychoactive Drugs Supplement 6: 249-259, 2010. (12 refs.)

Process improvement strategies provide industries with a method for improving outcomes and performance at a low cost and with minimal training. In Los Angeles County, two process improvement projects were implemented as a way to improve access to, and engagement and retention in, alcohol and other drug abuse treatment. A qualitative evaluation was completed after the Phase 11 pilot project to assess how the providers felt about the project, what worked, what did not work, what was learned, and the degree to which process improvements changed program operations. Semistructured interviews were conducted with 33 individuals, representing every level of staff participation in the project. Overall, comments indicated a positive experience for staff, administrators, and clients. Providers noted the relative ease of implementation and how quickly changes resulted in impressive improvements. Challenging issues included resistant staff or a lack of additional resources to pay for the project; however, most noted that these issues were resolved. Interview participants also requested more training on data collection and a reduction in the frequency of the project conference calls. This study gives support to the idea of process improvement being a tool that dramatically improves services to consumers of addiction treatment services.

Crevecoeur-MacPhail D; Ransom L; Myers AC; Annon JJ; Diep N; Gonzales R et al. Inside the black box: Measuring addiction treatment services and their relation to outcomes. Journal of Psychoactive Drugs Supplement 6: 269-276, 2010. (17 refs.)

The adoption of performance-based management has been under consideration by addiction treatment funding agencies, and, recently, many state and county agencies have developed performance-based measurement/management systems in an attempt to improve their treatment system. This article describes one such effort in Los Angeles County, California. The Performance-Based Pilot Project linked treatment encounters (counseling sessions, drug testing, case management, and methadone dosing) with client outcomes (abstinence or reduced drug use at discharge) and longer lengths of stay in treatment. Eleven outpatient counseling programs and three narcotic treatment programs participated in the nine-month project. Results indicated that for both outpatient counseling and narcotic treatment programs, more sessions attended in the first 30 days was associated with better client outcomes and longer lengths of stay. Furthermore, in outpatient counseling programs, more group sessions during the first 30 days predicted abstinence or greater reductions in primary drug use; in narcotic treatment programs, more doses received during the first 30 days was correlated to longer treatment retention. This research implies that increasing the availability of counseling sessions for a client's first 30 days and engaging clients early is a promising area for program efforts to improve treatment outcomes and program performance.

Curtis SL; Eby LT. Recovery at work: The relationship between social identity and commitment among substance abuse counselors. Journal of Substance Abuse Treatment 39(3): 248-254, 2010. (43 refs.)

The complex makeup of the substance abuse treatment workforce poses unique challenges to the field. One interesting dynamic is the high rate of counselors who are personally recovering from addictions. Based on social identity theory, it was expected that counselors working in the field of substance abuse treatment who are in recovery themselves will identify more with their profession and report higher professional and organizational commitment. Data from a study of substance abuse counselors from across the United States support the proposed relationship between personal recovery status and professional commitment but not organizational commitment.

Davoudi M; Rawson RA. Screening, brief intervention, and referral to treatment (SBIRT) initiatives in California: Notable trends, challenges, and recommendations. Journal of Psychoactive Drugs Supplement 6: 239-248, 2010. (41 refs.)

It is estimated that most substance users are not substance-dependent, yet they misuse alcohol and/or other drugs on a regular basis and are at risk in terms of health and further dependency. Screening, brief intervention, and referral to treatment (SBIRT) is an intervention model that identifies at-risk substance users and then provides them a patient-centered intervention. A review of selected SBIRT initiatives in California revealed a number of positive trends: the involvement of healthcare settings in substance use prevention; an increase in the number of providers trained in substance use screening; greater use of standardized screening tools; indications of reduced substance use by individuals receiving SBIRT; and the establishment of statewide policy initiatives. Despite these positive trends, SBIRT projects continue to face challenges related to leadership support, staff resources, integration into ongoing protocols, screening, client retention, client confidentiality, and data collection. To assist projects to overcome these challenges and to ensure future adoption and sustainability of SBIRT, state and local authorities can benefit from (a) promoting SBIRT among healthcare leaders, (b) identifying and sharing successful SBI RT "models," (c) providing tailored trainings and ongoing technical assistance, (d) educating providers about patient confidentiality and reimbursement laws and regulations, and (e) creating benchmark measures and data collection protocols.

Eby LT; Burk H; Maher CP. How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover. Journal of Substance Abuse Treatment 39(3): 264-271, 2010. (33 refs.)

In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19% and 50% (J.A. Johnson & P. M. Roman, 2002; S.L. Gallon, R.M. Gabriel, J.R.W. Knudsen, 2003; H.K. Knudsen, J.A. Johnson, & P.M. Roman, 2003; A.T. McLellan, D. Carise, & H.D. Kleber, 2003). However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, serving a wide range of clients in the public and private sector, provided data for the study over a 2-year time span (2008-2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups, the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity. The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment.

Einbinder SD. A qualitative study of Exodus graduates: Family-focused residential substance abuse treatment as an option for mothers to retain or regain custody and sobriety in Los Angeles, California. Child Welfare 89(4): 29-45, 2010. (29 refs.)

In this article, 21 long-term, poly-substance abusing mothers describe how they successfully completed an 18-month family-focused residential substance abuse treatment program in southern California that helped them retain or regain custody of their children. Their stories and experiences with specific program characteristics and approaches of this rare treatment option are described, in their own voices. Policy implications for child welfare and parental substance abuse treatment are examined in light of these success stories.

Escober-Doran C; Jacobs P; Dewa C. Sources of revenue for nonprofit mental health and addictions organizations in Canada. Psychiatric Services 61(10): 1032-1034, 2010. (12 refs.)

Objective: In Canada charitable or nonprofit organizations provide government-contracted mental health and addictions services, and they augment government funding by raising charitable revenues. This study estimated by source the revenues of nonprofit mental health and addictions organizations in Canada. Methods: A list of nonprofit, service-providing organizations in Canada was developed, financial returns to the Canada Revenue Agency (CRA) in 2007 were obtained, and data were analyzed in aggregate. Results: Information was obtained from 369 Canadian organizations, which had $915.4 million (Canadian dollars [CAD]) in total revenues: 85% were from the government, 4% were from charitable giving, and 11% were from other sources. Conclusions: The ratio of charitable giving to government funding of mental health care was about.55% ($35 million to $6.3 billion CAD). This charitable giving level cannot compensate for the relatively low levels of total government mental health spending identified in government reports.

Eversman MH. High and low threshold service provision in drug-free settings: Practitioner views. International Journal of Drug Policy 21(6): 501-506, 2010. (43 refs.)

Background: In the United States, drug-free (non-drug substitution) treatment programmes are informed by an abstinence-only, disease model. Some critics believe this model hinders treatment service utilization and retention. An alternative public health model of harm reduction suggests that drug services should have a "low-threshold" for entry and retention such that they are offered with few or no conditions, such as abstinence from drug use. Methods: Using semi-structured qualitative interviews with 15 practitioners from 9 outpatient drug-free agencies, this study examined beliefs about low threshold service provisions. Results: Respondents identified certain conditions for drug services as clinically and programmatically appropriate and necessary to ensure safety. Factors relevant to outpatient services, drug use and client dynamics were also cited. Respondents tended to support service conditions to inform treatment planning and practices. Conclusions: Practitioners in these settings accept and support some threshold of imposed service conditions as useful in treatment and service planning. When outpatient services are terminated clinically appropriate services are offered instead. Concerns for service accessibility should focus on the availability of medically intensive services.

Fields D; Roman PM. Total quality management and performance in substance abuse treatment centers. Health Services Research 45(6, Part 1): 1630-1650, 2010. (42 refs.)

Objective: To examine the relationship of organizational characteristics of substance abuse treatment centers with their use of quality management practices (total quality management [TQM]) and the contribution of TQM use to a center's provision of comprehensive care and to use of evidence-based treatment practices. Data Sources: Data were collected from a national sample of over 700 private and public substance abuse treatment centers in the National Treatment Center Study. Study Design: The design was a cross-sectional field study. The key variables were three TQM practices, the provision of comprehensive treatment services, and the implementation of evidence-based treatment practices. Numerous organizational characteristics were controlled. Data Collection: The data were obtained through interviews with administrative directors and clinical directors of the treatment centers in 2002-2004. Principal Findings: In multivariate models, TQM practices were positively related to provision of comprehensive care and use of evidence-based practices. A limited set of organizational characteristics predicted the use of TQM practices. Conclusions: Substance abuse treatment centers' implementation of TQM processes may be positively related to the quality and cost-effectiveness of care provided.

Gjersing L; Waal H; Caplehorn JRM; Gossop M; Clausen T. Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment. BMC Health Services Research 10: article 194, 2010. (48 refs.)

Background: In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes. Methods: This study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres. Results: All invited staff (n = 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate. Conclusions: This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.

Glass JE; Ilgen MA; Winters JJ; Murray RL; Perron BE; Chermack ST. Inpatient hospitalization in addiction treatment for patients with a history of suicide attempt: A case of support for treatment performance measures. Journal of Psychoactive Drugs 42(3): 315-325, 2010. (60 refs.)

This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated with improved outcomes in patients with a prior suicide attempt as compared to those without. We abstracted Addiction Severity Index and health services data from the VA medical record for 381 veterans who initiated outpatient SUD treatment and completed baseline intake measures at a Midwestern VA hospital. Cox proportional hazard regressions examined how baseline characteristics, prior suicide attempts, and PM status predicted the time until hospitalization for psychiatric or substance use problems. Prior suicide attempts significantly interacted with treatment engagement, and hospitalization risk was significantly higher among individuals with a prior suicide attempt who did not meet PMs. This study provides initial observational evidence that past suicide attempts may be a factor that should be considered when defining performance standards that influence the processes of SUD treatment. Future research on PMs should take into account the differences on indicators of high risk and poor treatment outcomes.

Godlaski T. Dialogue on the relationship between addiction and religion and its possible implications for care. (editorial). Substance Use & Misuse 45(14): 2393-2395, 2010. (2 refs.)

Haley SJ; Dugosh KL; Lynch KG. Performance contracting to engage detoxification-only patients into continued rehabilitation. Journal of Substance Abuse Treatment 40(2): 123-131, 2011. (48 refs.)

In 2006, only 18.7% of Delaware's detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In response, Delaware established financial contingencies to (1) maintain 90% detoxification occupancy, (2) make receipt of 10% of the facility's monthly reimbursement contingent on 25% of patients entering treatment, and (3) provide a $500 bonus for every patient with three or more prior detoxification visits who was retained in treatment. Under the performance contract, the detoxification provider (1) maintained the 90% occupancy requirement, (2) achieved the 25% treatment entry target for 7 of 12 months, and (3) observed only 8% (27/337) of detoxification completions that met the targeted length of stay. Continuation to and retention in treatment was even more constrained for patients with three or more prior detoxifications. Contrary to the policy intent, the number of patients with three or more detoxifications in fiscal year (FY) 2008 is nearly triple that of FY 2006. The modest gain in the transition rate was achieved without changes in patient access; the FY 2008 patient population reported significantly higher rates of homelessness and a younger age of first use than before the performance contract in FY 2006. Performance contracting may offer promise for improving transition to treatment rates. However, the unique needs of detoxification patients, the treatment capacity of each level of care to meet patient needs, and the structure of the performance contract must be carefully considered. Performance contracting efforts may be strengthened when service contracts across the system are tightly synchronized.

Hao W; Tan LX; Tang QS. Towards a self-change-friendly treatment and policy for addictive behaviours. (editorial). Addiction 105(9): 1519-1520, 2010. (6 refs.)

Harris WW; Ryan J. Indicated prevention: Bridging the gap, one person at a time. Journal of Psychoactive Drugs Supplement 6: 277-285, 2010. (10 refs.)

In 2007, Riverside County, California, after identifying a gap between the substance abuse prevention and treatment services it offered to individuals, developed the Individual Prevention Services (IPS) program to fill that gap. Over the past two years, the IPS program has provided individualized prevention services on a one-on-one basis at all seven of the county's substance abuse treatment clinics. The IPS program is provided to those individuals who are at highest risk for developing substance abuse related problems, i.e., those individuals who have sonic history of substance use/misuse, but have not yet reached a point where treatment is indicated. This unique "one person at a time" prevention service is provided at no cost to individuals in all age groups (from age 12 to senior citizens) and is based, in part, on a local student assistance model that offers over 20 years of proven results.

Hennrikus D; Joseph AM; Lando HA; Duval S; Ukestad L; Kodl M; Hirsch AT. Effectiveness of a smoking cessation program for peripheral artery disease patients: A randomized controlled trial. Journal of The American College of Cardiology 56(25): 2105-2112, 2010. (29 refs.)

Objectives This study tested the effectiveness of a smoking cessation program designed for patients with peripheral artery disease (PAD). Background Tobacco use is the leading risk factor for PAD incidence and progression and for ischemic events. Tobacco cessation reduces PAD-related morbidity and mortality, yet few prospective clinical trials have evaluated smoking cessation interventions in PAD patients. Methods: We recruited outpatients with lower extremity PAD identified from medical records as cigarette smokers. Participants were randomly assigned to an intensive tailored PAD-specific counseling intervention or a minimal intervention. Participants completed surveys at baseline and at 3- and 6-month follow-up. Reported 7-day point prevalent smoking abstinence was confirmed by cotinine or carbon monoxide assessment. Results: In all, 687 outpatients were identified as probable smokers with lower extremity PAD; 232 met study eligibility requirements; and 124 (53% of eligible) enrolled. Participants were receptive to counselor contact: the median number of sessions was 8.5 (range 0 to 18). Participants randomly assigned to the intensive intervention group were significantly more likely to be confirmed abstinent at 6-month follow-up: 21.3% versus 6.8% in the minimal intervention group (chi-square = 5.21, p = 0.023). Conclusions Many long-term smokers with PAD are willing to initiate a serious quit attempt and to engage in an intensive smoking cessation program. Intensive intervention for tobacco dependence is a more effective smoking cessation intervention than minimal care. Studies should be conducted to examine the long-term effectiveness of intensive smoking cessation programs in this population to examine the effect of this intervention on clinical outcomes related to PAD.

Herbeck DM; Gonzales R; Rawson RA. Performance improvement in addiction treatment: Efforts in California. Journal of Psychoactive Drugs Supplement 6: 261-268, 2010. (12 refs.)

This article examines performance data improvement efforts among alcohol and other drug (AOD) county and program stakeholders within California's publicly-funded treatment system. County AOD system administrators from approximately two-thirds of California counties (N = 37) and a random sample of treatment program managers (N = 63) were surveyed about practices and priorities related to using performance data to improve service delivery. Survey results showed that over half (56.8%) of the county administrators reported using performance and/or outcome measures to guide decision-making about the treatment programs with which they contract. Measures of treatment engagement and retention were most frequently reported as high priorities for performance data collection. Treatment providers reported considerable variation with their use of performance measures to improve practices. Overall, findings from this study suggest that many programs and counties are taking steps toward adopting practices of performance measurement and management for treatment improvement, although they still require assistance and support in establishing, collecting, and using performance data.

Hilarion P; Groene O; Colom J; Lopez RM; Sunol R. Results of a sector-wide quality improvement initiative for substance-abuse care: An uncontrolled before-after study in Catalonia, Spain. Substance Abuse Treatment, Prevention and Policy 5: e-article 26, 2010. (24 refs.)

Background: The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. Methods: The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. Results: We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. Conclusion: The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector-wide performance and the support of evidence-based guidance wherever possible. Further research should address how contextual issues shape the uptake and effectiveness of quality improvement actions and how such quality improvements can be sustained.

Hoxmark EM; Wynn R. Health providers' descriptions of the significance of the therapeutic relationship in treatment of patients with dual diagnoses. Journal of Addictions Nursing 21(4): 187-193, 2010. (48 refs.)

Dual diagnosis of substance abuse and severe psychiatric illness is frequent, and the building of therapeutic relationships with this group of patients seems to be both important and difficult. An integrated treatment model has been claimed to be the preferred treatment for dual diagnosis patients. This study explores how providers in an integrated treatment model, and a substance abuse treatment model with less emphasis on psychiatric co-morbidity, handle relationship building. Two focus groups included providers working in a Therapeutic Community (TC) and a Dual Diagnosis (DD) ward. Participants were given a short case history and asked to describe how they would approach the case. The analysis was based on a phenomenological method. All providers perceived a good relationship to be central to the treatment. Providers in the DD ward were more ready to build close relationships with the patients, and described their relationship with the patients as more crucial to treatment. The providers in the TC ascribed more importance to the role of peers and to the structure of the program itself. The providers agreed that a good therapeutic relationship is important to treatment. They differed in their opinion about how central this relationship was.

King B; Kaplan S; Hofstedt T. A field experiment in capitated payment systems and recovery management: The women's recovery association pilot study. Journal of Psychoactive Drugs Supplement 6: 287-293, 2010. (9 refs.)

Against the backdrop of shifting perspectives regarding substance abuse policy, upcoming changes to the health care system, and progress toward parity for mental health and substance abuse treatment, an exploratory pilot study is being conducted in San Mateo County, California, to assess the potential of a capitated case rate combined with a recovery management approach in a community-based substance abuse treatment program for women. The rationale for developing the approach, planning, and implementation of the pilot project, the struggle of the agency to transform from episodic treatment to a chronic care model, and a case study that highlights organizational changes are discussed. Lessons learned and implications for the second year of the pilot project are also discussed.

Klingemann H; Gomez V. Masculinity issues in addiction treatment in Swiss inpatient alcohol programs: Bringing men's treatment needs back to the research agenda. Journal of Men's Health 7(3): 211-220, 2010. (27 refs.)

Background" Various types of risk behaviors, including alcohol and drug consumption, are by far more frequent among men than among women. Men represent the majority of patients in addiction programs. However the relationship between male gender role orientations and the treatment response is under-researched. This paper sheds light on the relative importance of masculinity concepts within both the general population and a clinical sample the perception of specific treatment needs by male alcohol patients and the response to masculinity topics in treatment practice. Methods: The study was conducted among 200 men in two Swiss alcohol inpatient programs representative for the total patient load in the Swiss alcohol treatment system and included a matched population control group (n = 200). The Bem Sex Role Inventory the Male Role Norm Scale and the Masculine Gender Role Stress Scale were included in the group comparison. Results: Patients show significantly lower values on the masculinity subscale and lower values on the femininity subscale than the control group, the undifferentiated man is typical for the clinical setting . Patients who acknowledge men-specific treatment needs suffer significantly more from gender role stress and problems with sexuality and fatherhood than patients who are not aware of masculinity issues. For both topics patients prefer a non-therapeutic setting. Group and individual therapy do not address sexuality and fatherhood issues. Conclusions: These findings suggest that for specific subgroups of men an appropriate diagnosis should first check on sensitive masculinity issues then assess gender role orientations and masculinity stress and provide adequate treatment modalities.

Knight DK; Broome KM; Edwards JR; Flynn PM. Supervisory turnover in outpatient substance abuse treatment. Journal of Behavioral Health Services & Research 38(1): 80-90, 2011. (43 refs.)

Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the word missing. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover.

Knight DK; Edwards JR; Flynn PM. Predictors of change in the provision of services within outpatient substance abuse treatment programs. Journal of Public Health Management and Practice 16(6): 553-563, 2010. (42 refs.)

The current study examines patterns and predictors of change over a 2-year period in whether outpatient core and wraparound services are offered on-site or by referral. A sample of 69 outpatient nonmethadone programs from 4 US regions provided organizational information across a 2-year period. Services provided within outpatient substance abuse programs were relatively stable over time, particularly with regard to core therapeutic services. The use of referral networks to provide a broader array of wraparound services increased, with programs adding services that reflect recent national initiatives toward program improvement, namely pharmacotherapy, medical diagnosis and treatment, and psychiatric services. Organizational factors such as parent affiliation, counselor caseload, staff size, budget change, and proportion of dually diagnosed clients were related to change in core and wraparound services. Dynamic organizational factors such as staff size and budgets can serve as barriers to and/or facilitate change in service provision over time and have managerial and policy implications.

Knudsen HK; Abraham AJ; Roman PM. Adoption and implementation of medications in addiction treatment programs. Journal of Addiction Medicine 5(1): 21-27, 2011. (32 refs.)

Objectives: Little is known about the extent to which medications are being implemented as routine care in addiction treatment programs. This research describes medication adoption and implementation within the privately funded treatment sector. Methods: Face-to-face interviews were conducted with 345 administrators of a nationally representative sample of privately funded substance treatment organizations in the United States. Results: Rates of adoption of addiction treatment medications in private sector programs were lower than the adoption of psychiatric medications. Even when analyses were restricted to programs with access to physicians, adoption of each addiction treatment medication had occurred in less than 50% of programs. Within adopting programs, implementation was highly variable. Although approximately 70% of patients with cooccurring psychiatric diagnoses received psychiatric medications, rates of implementation of medication-assisted treatment for opioid dependence and alcohol use disorders were just 34.4% and 24.0%, respectively. Conclusions: Although previous research has documented higher rates of medication adoption in privately funded treatment programs, this study revealed that both adoption and implementation of pharmacotherapies to treat addiction remains modest. Future research should examine the different types of barriers to implementation, such as physician decision making, patient preferences, and system-level barriers stemming from financing and public policy.

Knudsen HK; Roman PM; Oser CB. Facilitating factors and barriers to the use of medications in publicly funded addiction treatment organizations. Journal of Addiction Medicine 4(2): 99-107, 2010. (61 refs.)

Objectives: Publicly funded addiction treatment organizations have been slow to adopt pharmacotherapies. Few studies have examined the organizational factors associated with adoption of different types of medication in this treatment sector. This study identifies the organization-level facilitators and barriers to the use of medications in publicly funded addiction treatment organizations. Methods: Face-to-face interviews with 318 administrators of a representative sample of publicly funded addiction treatment centers in the United States. Results: Only 23.4% of programs reported using any of the 5 Food and Drug Administration-approved pharmacotherapies for treating addiction. An additional 14.3% of programs only used medications approved for the treatment of psychiatric disorders. Multivariate multinomial logistic regression results revealed that the odds of adoption of addiction pharmacotherapies were significantly greater in government-owned programs and in programs with more medical personnel. Programs that relied more heavily on non-Medicaid public funding tended to be less likely to adopt addiction treatment medications. Greater contact with pharmaceutical representatives was positively associated with medication adoption. Conclusions: Current public funding policies and lack of access to medical personnel are barriers to the adoption of medications by publicly funded addiction treatment organizations. Efforts to promote adoption may also benefit from greater detailing activities by pharmaceutical representatives. These findings suggest that the large research investment devoted to developing addiction treatment medications may have limited public health impact because of the characteristics of the publicly funded service delivery system and the limited attention given to this system by commercial purveyors of medications.

Mann K; Hermann D. Individualised treatment in alcohol-dependent patients. (review). European Archives of Psychiatry and Clinical Neuroscience 260(Supplement 2): S116-S120, 2010. (29 refs.)

Long-term relapse prevention is the biggest challenge in treating alcohol-dependent patients. It is equally based on psychotherapy and pharmacotherapy. Psychotherapy includes motivational interviewing, community reinforcement, cognitive behavioural therapy, motivational enhancement, twelve-step facilitation, social network behaviour therapy, cue exposure, etc. For pharmacological treatment, we dispose of disulfiram, acamprosate and naltrexone. Reviews and meta-analyses reveal only modest effect sizes of these approaches probably because they are usually tested in large and heterogeneous samples where "one size does not fit all". However, attempts to form more homogeneous subgroups for which specific psychotherapies should be more effective ("matching") also failed. We suppose that this failure may have to do with the fact that these studies used only psychopathology and behavioural analyses as a basis for subtyping. Things look more promising once biologically defined endophenotypes are used as well in order to form more homogeneous subgroups. For example, naltrexone treatment seems more effective in carriers of a specific variant of the mu-opioid receptor gene. The same could be true for acamprosate if a newly found polymorphism was used to preselect potential responders. Very recently biological differences between patient groups are also being detected using functional imaging. Naltrexone is suggested to work better in a subgroup of patients with higher cue reactivity when shown appetitive alcohol pictures. MR spectroscopy of brain glutamate levels may detect potential acamprosate responders. On such a basis, an individualised approach in the treatment of alcoholism ("personalised medicine") seems to hold promise.

Martin JS; Sewell CA; Abel WD. Substance abuse treatment - the special needs populations. (editorial)18. West Indian Medical Journal 59(1): 82-83, 2010. (18 refs.)

McCarty D; McConnell KJ; Schmidt LA. Priorities for policy research on treatments for alcohol and drug use disorders. Journal of Substance Abuse Treatment 39(2): 87-95, 2010. (48 refs.)

The Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP) supported 368 awards for nearly $560 million to complete policy research related to alcohol, tobacco, and illicit drug use and abuse. As part of its closure in 2009, SAPRP commissioned four papers that articulated policy research priorities for tobacco cessation and control, alcohol prevention, drug prevention, and addiction treatment. The papers were released at a Congressional Briefing on October 2, 2009 and are available on the SAPRP Web site (http: www.saprp.org/Research_Agenda.cfm). An abridged version of the treatment policy paper summarizes what we know, what we need to know, and research recommendations. The paper examines five categories of policy concerns that are likely to affect addiction treatment services over the next 5 years: (a) organization and delivery of care, (b) quality of care, (c) evidence-based practices, (d) access to care, and (c) financing, costs, and value of care.

McGovern MP; Lambert-Harris C; McHugo GJ; Giard J; Mangrum L. Improving the dual diagnosis capability of addiction and mental health treatment services: Implementation factors associated with program level changes. Journal of Dual Diagnosis 6(3-4): 237-250, 2010. (28 refs.)

OBJECTIVE: This study examined implementation factors associated with addiction and mental health treatment program improvement in services to persons with co-occurring substance use and psychiatric disorders. There were two primary aims: (a) to articulate factors associated with successful program change and (b) to determine whether the effective factors are different by program type. METHODS: Eighty-six programs (addiction treatment n = 54; mental health treatment n = 32) were assessed at baseline and 18-month follow-up using the Dual Diagnosis Capability in Addiction Treatment (DDCAT; McGovern, Matzkin, Giard, 2007) or Dual Diagnosis in Mental Health Treatment (DDCMHT; Gotham, Claus, Selig, Homer, 2010) indexes. At follow-up, program leaders were surveyed about implementation factors that may have accounted for changes in capability. RESULTS: Both addiction and mental health programs significantly improved dual diagnosis capability during the study period. Factors associated with positive change in addiction treatment programs included organizational and contextual components, use of the commonly recommended implementation strategies, and deploying evaluation methods. In mental health programs only the evaluation methods factor was uniquely significant, although the use of a variety of methods overall was associated with improvement. CONCLUSIONS: Both mental health and addiction treatment programs can enhance dual diagnosis capable services through a variety of implementation approaches. This study provides data to the emerging discipline of implementation science and suggests avenues for future research.

McNally L; Ratschen E. The delivery of stop smoking support to people with mental health conditions: A survey of NHS stop smoking services. BMC Health Services Research 10: article 179, 2010. (10 refs.)

Background: People with mental health problems exhibit smoking rates up to three times that of the general population. Metabolic interactions between hydrocarbon agents in tobacco smoke and some antipsychotic drugs account for a change in medication metabolism on stopping smoking, and potentially for increased blood levels. Nicotine withdrawal can mimic or exacerbate symptoms of mental illness. Therefore, appropriate screening for mental health problems and liaison with local mental health care providers should be a priority for NHS Stop Smoking Services. The present study aimed to examine this issue through surveys with NHS Stop Smoking Service staff in London. Methods: Semi-structured telephone interviews were conducted with one senior staff member from 27 of the 29 NHS Stop Smoking Services in London. Results: It was found that only a minority of services routinely check the mental health status or mental health service use of their clients. In addition, most services do not routinely implement special checks or actions when mental health problems are revealed. It was notable that respondents reported a lack of strategic drivers supporting work with mental health patients (such as targets relating to successful quits) as well as a low level of partnership working with local mental health care providers. Conclusions: NHS Stop Smoking Services may not be operating appropriate procedures for supporting people with mental health problems. There is a need for local protocols to be implemented that include routine screening for mental health issues and liaison with mental health care providers.

Mcvey R. A practitioner's commentary. Drugs: Education, Prevention and Policy 17(special issue): 170-178, 2010. (3 refs.)

I have been delivering the flexible family work approaches outlined in this supplement at Aquarius for the past 8 years. Aquarius is an English Midlands-based addictions charity working with people who have problems with alcohol, drugs, or gambling and supporting their family members/concerned others. I have been a practitioner participating in the Involving Family Members Action Research Project 2002-2004, whilst at the North Birmingham Aquarius team [Orford, J., Templeton, L., Copello, A., Velleman, R., Ibanga, A., & Binnie, C. (2009). Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agencies. Drugs: Education, Prevention and Policy, 16, 1-30; and see Orford, J., Templeton, L., Copello, A., Velleman, R., & Ibanga, A. (2010). Working with teams and organizations to help them involve family members. Drugs: Education, Prevention and Policy, 17(S1), 156-166]. I am now a service manager and part of the action research team for Involving Family Members across the Organization developing family-focused work across the whole of the Aquarius organization. In this chapter, I will outline some of the barriers to more family-focused work, offering the view that in practice these initial concerns about family-focused work do not need to be barriers. I will also provide some strategies to overcome some of these barriers. I will then outline what I see as the main benefits I have experienced as a practitioner in implementing family-focused work.

Merkes M; Lewis V; Canaway R. Supporting good practice in the provision of services to people with comorbid mental health and alcohol and other drug problems in Australia: Describing key elements of good service models. BMC Health Services Research 10: e-article 325, 2010. (30 refs.)

Background: The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper) is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD) and mental health (MH) sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services. Methods: Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems. Results: A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts. Conclusions: The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment services included in this study reflected the diversity of settings and approaches described in the literature, the research found that they shared a range of common characteristics. These referred to: service linkages; workforce; policies, procedures and practices; and treatment.

Michie S; Churchill S; West R. Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Annals of Behavioral Medicine 41(1): 59-70, 2011. (34 refs.)

No systematic basis has yet been published for specifying competences needed to underpin behavioural support for smoking cessation. The purpose of this study was to develop and apply a system for identifying competences required for the delivery of individual and group-based behavioural support for smoking cessation. Sets of recommended competences for behavioural support were identified from a range of guidance documents. Where possible, these were compared with ones based on behaviour change techniques identified within behavioural support programmes found to be effective in randomised controlled trials (RCTs) and, for individual behavioural support, ones associated with higher success rates in the English Stop Smoking Services. Ninety-four competences were identified (71 individual and 23 additional group competences), of which 59 were cited in at least two guidance documents (51 and 8, respectively). Fourteen of the individual competences and three of the group competences were supported by RCT evidence and, for individual competences, nine were supported by evidence from the services. It is possible to identify competences recommended for behavioural support for smoking cessation and subsets supported by different types of evidence. This approach can form the basis for the development of assessment and training of stop smoking practitioners and is currently doing so in a national programme in England. With further research, the list of evidence-based competences is likely to be extended.

Milligan K; Niccols A; Sword W; Thabane L; Henderson J; Smith A et al. Maternal substance use and integrated treatment programs for women with substance abuse issues and thier children: A meta-analysis. Substance Abuse Treatment, Prevention and Policy 5(e-journal 21), 2010. (69 refs.)

Background: The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment. Methods: We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates. Results: In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively). Conclusions: Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy implications are discussed with specific attention to the need for funding of high quality randomized control trials and improved reporting practices.

Myers B. Limited access to HIV risk-reduction services in South African substance abuse treatment facilities. Drugs: Education, Prevention and Policy 17(6): 749-761, 2010. (24 refs.)

Aims: To examine (i) the extent to which South African substance abuse treatment services provide HIV risk-reduction services to clients and (ii) whether the provision of these services varies by type of facility and by geographic region. Method: Cross-sectional surveys of substance abuse treatment services were conducted in Gauteng and KwaZulu-Natal provinces (2006-2007) and the Central and Northern region of the country (2007-2008). Questions on the availability of testing for HIV and co-occurring infectious diseases, opioid substitution treatment (OST), and harm-reduction interventions for injection drug users were included within the larger survey questionnaire. Response rates of 84% and 83% were obtained for each survey, respectively. Results: Less than half of the facilities surveyed provide HIV counselling and testing services to clients or test clients for co-occurring infectious diseases. Less than one-third conduct harm-reduction interventions among injection drug users and OST is largely unavailable. Facilities that offer residential/inpatient services and employ medically trained staff are more likely to offer clients HIV risk-reduction services than outpatient services or services without medically trained staff. Conclusions: Findings point to the limited availability of HIV risk-reduction services within South African substance abuse treatment facilities. Recommendations are made to enhance access to these services.

Myers BJ; Louw J; Pasche SC. Inequitable access to substance abuse treatment services in Cape Town, South Africa. Substance Abuse Treatment, Prevention and Policy 5: e-article 28, 2010. (30 refs.)

Background: Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. Methods: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. Results: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. Conclusions: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.

Niccols A; Milligan K; Sword W; Thabane L; Henderson J; Smith A et al. Maternal mental health and integrated programs for mothers with substance abuse issues. (review). Psychology of Addictive Behaviors 24(3): 466-474, 2010. (59 refs.)

To examine the impact of integrated treatment programs (those with substance use treatment and pregnancy-, parenting-, or child-related services) on maternal mental health, we compiled a database of studies of integrated programs published between 1990 and 2007 with outcome data on maternal mental health. There were 18 cohort studies, 3 randomized trials, and 2 quasi-experimental studies. Of the five studies comparing integrated to nonintegrated programs, three studies provided enough information to allow for them to be combined in a meta-analysis. The average effect size was 0.23 (95% CI = 0.15 to 0.31, SE = 0.04), p < .001. There was no statistically significant heterogeneity among the studies, Q = 5.66, p = .059. This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programs on maternal mental health. Findings suggest that integrated programs may be associated with a small advantage over nonintegrated programs in improving maternal mental health. This review highlights the need for further research with improved methodology, study quality, and reporting to improve our understanding of how best to meet the mental health needs of mothers with substance abuse issues.

Perron BE; Mowbray OP; Glass JE; DelvaJ; Vaughn MG; Howard MO. Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders. Substance Abuse Treatment, Prevention and Policy 5(e-journal 3), 2010. (33 refs.)

Background: Treatment for drug use disorders (DUD) can be effective, but only a small proportion of people with DUD seek or receive treatment. Research on racial and ethnic treatment differences and disparities remains unclear. Understanding racial and ethnic differences and disparities in drug treatment is necessary in order to develop a more effective referral system and to improve the accessibility of treatment. The purpose of the current study was to explore the role of race and ethnicity in service utilization. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), this study examined racial and ethnic differences in use of 14 types of treatment services for DUD and 27 different treatment barriers among persons who met lifetime criteria for a DUD. Multivariate logistic regression analyses were used to examine service utilization and barriers among the racial and ethnic groups, while adjusting for other sociodemographic and clinical variables. Results and discussion: Among Blacks, Hispanics and Whites in the overall NESARC sample, approximately 10.5% met criteria for at least one lifetime drug use disorder. Approximately 16.2% of persons with a lifetime DUD received at least one type of service. Overall, this study indicated that Whites were less likely to report receiving help for drug-related problems than Blacks, Blacks used a greater number of different types of services, and no racial and ethnic differences were observed with respect to perceived barriers to drug treatment. However, by examining types of services separately, a complex picture of racial and ethnic differences emerges. Most notably, Whites were most likely to use professional services, whereas Blacks were most likely to use 12-step and clergy. The service use pattern of Hispanics most resembled that of Whites. Conclusion: While structural barriers to accessing treatment were observed, broad-based educational programs and interventions that are appropriately targeted to racial and ethnic groups remains an important area for prevention and treatment.

Petry NM; Rash CJ; Blanco C. The Inventory of Gambling Situations in problem and pathological gamblers seeking alcohol and drug abuse treatment. Experimental and Clinical Psychopharmacology 18(6): 530-538, 2010. (59 refs.)

Identifying situations in which individuals gamble may be important for developing or improving treatments, but few instruments exist for examining high-risk gambling situations. This study evaluated the factor structure of the Inventory of Gambling Situations (IGS), an instrument that assesses situations that may lead to gambling episodes. Individuals seeking alcohol and drug abuse treatment who were identified as problem or pathological gamblers (N = 283) completed the IGS, and principal component analysis revealed a 4-factor solution best fit the data; the factors represented items related to Negative Affect, Positive Affect, Gambling Cues, and Social Situations. Across the whole scale, Cronbach's alpha was 0.97, ranging from 0.83 to 0.96 for the four factors. IGS total scores correlated with other indices of gambling problems, including number of pathological gambling criteria endorsed and frequency and intensity of gambling. Race, education, and severity of psychiatric, drug, and alcohol problems were significantly predictive of some factor scores. Specifically, African Americans were more likely to gamble in response to Negative Affect situations than Caucasians, and education was inversely associated with wagering in response to Gambling Cues. Psychiatric symptoms were predictive of gambling in response to both Positive and Negative Affect situations and Gambling Cues. Severity of drug and alcohol problems were related to gambling in Social Situations. Results from this study indicate that the IGS has good psychometric properties and suggest areas in which intervention efforts may be tailored to prevent or treat gambling problems among individuals seeking substance abuse treatment.

Prochaska JJ. Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? (editorial). Drug and Alcohol Dependence 110: 177-182 110(3): 177-182, 2010. (82 refs.)

In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.

Proeschold-Bell RJ; Heine A; Pence BW; McAdam K; Quinlivan EB. A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program. AIDS 24(10): 651-658, 2010. (52 refs.)

Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n = 286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.

Rohrbach LA; Gunning M; Grana R; Gunning G; Sussman S. Dissemination of Project Towards No Drug Abuse (TND): Findings from a survey of program adopters. Substance Use & Misuse 45(14): 2551-2566, 2010. (45 refs.)

This study examines adoption and implementation decisions among organizations that purchased Project Towards No Drug Abuse from 2001 to 2004. Telephone interviews were conducted with 120 organizations nationwide. The most common reason for adopting the program was its evidence base. In schools, classroom teachers were more likely to deliver the program than other types of implementers, and in nonschool organizations, prevention specialists, and counselors were more common (p < .05). Most organizations (73%) reported that they delivered all of the program sessions. The limitations of the study, as well as the implications of the findings for future research and wide-scale prevention program dissemination, are discussed.

Rothrauff TC; Eby LT. Counselors' knowledge of the adoption of tobacco cessation medications in substance abuse treatment programs. American Journal on Addictions 20(1): 56-62, 2011. (37 refs.)

This study assessed counselors' knowledge of the adoption of evidence-based tobacco cessation medications (TCMs)-varenicline, bupropion, and five nicotine replacement therapies (NRTs)-and predictors of adoption in diverse substance abuse treatment settings. We used Managing Effective Relationships in Treatment Services (MERITS I) data from 658 counselors working in 26 programs. Adoption of varenicline was reported by 16% of counselors, bupropion by 11%, and NRTs by 27%. Knowledge of the adoption of all types of TCMs was more likely to be reported by counselors who worked in treatment programs that adhered less to a 12-step orientation and restricted outdoor smoking for employees. Several additional unique predictors of varenicline and NRTs were identified.

Rush B; Sapag J; Chaim G; Quinteros C. Client characteristics within the Chilean National Youth Addiction Treatment Demonstration System. Journal of Substance Abuse Treatment 40(2): 175-182, 2011. (37 refs.)

In the context of an evaluation of a national demonstration program for youth addiction treatment in Chile, a sociodemographic and substance use profile of children and adolescents accessing services through this new program was developed. Information regarding sociodemographic factors, substance use, and problem severity; services used; and unmet needs was retrospectively gathered for all clients (685) admitted between January 1 and June 30, 2006. Thirty-two treatment centers (91.4%) provided data. The client population profile reflected severe psychosocial circumstances (e.g., 61.4% early exit from school). Of the population, 64.9% were classified in the highest substance risk level. The primary drug reported was cocaine-paste-base (52.7%). Comparisons to similar data in other countries illustrate the more severe profile of this Chilean treatment sample. The results suggest the need for increased outreach and comprehensive intersectoral approaches. Monitoring and evaluation should become part of the culture of the national drug treatment system in Chile and other countries.

Russell C; Davies JB; Hunter SC. Predictors of addiction treatment providers' beliefs in the disease and choice models of addiction. Journal of Substance Abuse Treatment 40(2): 150-164, 2011. (58 refs.)

Addiction treatment providers working in the United States (n = 219) and the United Kingdom (n = 372) were surveyed about their beliefs in the disease and choice models of addiction, as assessed by the 18-item Addiction Belief Scale of J. Schaler (1992). Factor analysis of item scores revealed a three-factor structure, labeled "addiction is a disease," "addiction is a choice," and "addiction is a way of coping with life," and factor scores were analyzed in separate hierarchical multiple regression analyses. Controlling for demographic and addiction history variables, treatment providers working in the United States more strongly believe addiction is a disease, whereas U.K.-based providers more strongly believe that addiction is a choice and a way of coping with life. Beliefs that addiction is a disease were stronger among those who provide for-profit treatment, have stronger spiritual beliefs, have had a past addiction problem, are older, are members of a group of addiction professionals, and have been treating addiction longer. Conversely, those who viewed addiction as a choice were more likely to provide public/not-for-profit treatment, be younger, not belong to a group of addiction professionals, and have weaker spiritual beliefs. Additionally, treatment providers who have had a personal addiction problem in the past were significantly more likely to believe addiction is a disease the longer they attend a 12-step based group and if they are presently abstinent.

Rutkowski BA; Rawson RA; Freese TE. Improving the addiction treatment system in California through the use of data and evidence-based practices California Substance Abuse Research Consortium (SARC) Meetings, 2009 Introduction. (editorial). Journal of Psychoactive Drugs Supplement 6: 207-210, 2010. (0 refs.)

Simpson TL; Galloway C; Rosenthal CF; Bush KR; McBride B; Kivlahan DR. Daily telephone monitoring compared with retrospective recall of alcohol use among patients in early recovery. American Journal on Addictions 20(1): 63-68, 2011. (31 refs.)

Most studies comparing frequent self-monitoring protocols and retrospective assessments of alcohol use find good correspondence, but have excluded participants with significant comorbidity and/or social instability, and some have included abstainers. We evaluated the correspondence between measures of alcohol use based on daily interactive voice response (IVR) telephone monitoring and a 28-day modification of the Form-90 (Form-28). Participants were 25 outpatients with alcohol use disorder and significant PTSD symptomatology. Overall correlations between the IVR and Form-28 on days drinking and total standard drink units (SDUs) were strong for the entire sample and the subsample of drinkers (n = 7). Day-to-day correspondence between IVR and Form-28 was modest, but much stronger for the most recent week assessed than for the prior 3 weeks. Finally, the drinkers reported significantly greater total SDUs and heavy drinking days on the Form-28 than via IVR. The results indicate a need for further refinement of IVR methodology for treatment seeking populations as well as caution when retrospectively assessing drinking over time periods longer than a week among these individuals.

Stanford M; Banerjee K; Garner R. Chronic care and addictions treatment: A feasibility study on the implementation of post-treatment continuing recovery monitoring. Journal of Psychoactive Drugs Supplement 6: 295-302, 2010. (6 refs.)

In the treatment of drug addiction, as with other chronic conditions, the effects of treatment are significant but not long lasting after discharge unless continuing monitoring is provided. Efforts to help patients sustain positive treatment outcomes are generally directed to community support. Post-discharge checkups can help patients evaluate their behavior and recovery-related issues similar to a person with diabetes reporting on blood sugar levels and diet and exercise patterns. The challenge for providers is to raise awareness of the importance of continuing recovery monitoring and the responsibility of the treatment program to build a more seamless continuum of care for patients who have completed a primary treatment episode. This article reviews a pilot project of the Department of Alcohol & Drug Services of Santa Clara County, California that tested the feasibility of implementing a continuing recovery monitoring (CRM) service using post-discharge telephone check-ups for volunteer patients (N = 32) who completed treatment. The aims of the study were to (a) develop a model for continuing recovery monitoring, (b) gather data on the model's utility including identifying organizational and logistical challenges and, (c) describe several changes needed in the system of care to add CRM. The study showed that the model of continuing recovery monitoring is a feasible way to extend a system's existing continuum of care.

Strauss SM; Harris G; Katigbak C; Rindskopf DM; Singh S; Greenblum I et al. Alcohol education provided to opioid treatment program patients: Results of a nationwide survey. Journal of Drug Education 40(4): 379-393, 2010. (29 refs.)

Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U. S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.

Syvertsen J; Pollini RA; Lozada R; Vera A; Rangel G; Strathdee SA. Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform. International Journal of Drug Policy 21(6): 459-465, 2010. (49 refs.)

Background: In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users' (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy. Methods: We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users' experiences within the broader sociopolitical context. Results: Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants' perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse. Conclusions: Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy should be systematically evaluated.

Teesson M. What does self-change mean for how we deliver treatment? (editorial). Addiction 105(9): 1522-1523, 2010. (9 refs.)

Thurang A; Fagerberg I; Palmstierna T; Tops AB. Women's experiences of caring when in treatment for alcohol dependency. Scandinavian Journal of Caring Sciences 24(4): 700-706, 2010. (41 refs.)

Despite the fact of increased levels of alcohol dependency in women and gender differences in how the disease affects men and women, the research on alcohol dependency continues to have a dominating perspective on men. The meaning of the phenomenon of caring in formal care for women with alcohol dependency is not well known. Thus, formal caregivers may find it problematic to know what is caring for women with alcohol dependency. The aim of the study was to illuminate the meaning of caring in formal care for women with alcohol dependency, as narrated by the women. The study was performed using a phenomenological-hermeneutic method. Data were collected in ten in-depth interviews with alcohol-dependent women. The themes presented are availability, being a patient and being a learner. The findings reveal that the women with alcohol dependency receiving a mandate from formal care, experience the relation between them and their caregiver as a mutual transformation. Within the mutual transformation, the participants experienced being respected as a responsible human being which renders possibilities for the women with alcohol dependency to continue in formal care even when the struggle against the disease became hard. Continual meetings with the caregiver allowed the women to gain structure in their daily life as well as allowing the women and their caregivers to develop mutual transformation, which both relieved the women's suffering and increased their experience of being involved in the care process.

Vanderplasschen W; Bloor M; McKeganey N. Long-term outcomes of aftercare participation following various forms of drug abuse treatment in Scotland. Journal of Drug Issues 40(3): 703-728, 2010. (48 refs.)

Due to high relapse rates after leaving treatment drug users are often recommended to participate in some form of lower intensity continuing care. The importance of aftercare is widely accepted but little empirical data are available about the effectiveness of continuing services over longer periods of time and following various treatment modalities. In this study, we assessed the influence of various forms of aftercare on treatment outcomes and service utilization over a 33-month period among a naturalistic cohort of 653 drug users treated in prison or community settings, as part of the Drug Outcome Research in Scotland (DORIS study). Although participation in aftercare after initial treatment is rather unusual, the odds of having experienced a drug-free period (after 8 months) (OR=1 91 95% CI 1 10-3 33) and of being abstinent from heroin (after 33 months) (OR=0 56 95% CI 0 34-0 94) almost doubled. Program aftercare was of little additional value after intensive residential treatment but particularly important after prison-based and community treatment and if combined with self-help participation. Consequently, attractive and fitted aftercare services should be offered as an integrated part of various treatment modalities

Wetzler S; Schwartz B; Swanson A; Cahill R. Substance use disorders and employability among welfare recipients. Substance Use & Misuse 45(13): 2095-2112, 2010. (41 refs.)

The 2006 welfare reform legislation (Deficit Reduction Act of 2005) imposed more stringent work requirements and defined the amount of time cash assistance recipients are allowed to be exempted from the work requirement because of substance use treatment. As there is little empirical literature on the employability of substance users, it is difficult to know whether it is realistic to expect individuals with substance use disorders to meet the increased work requirement. Based on a comprehensive evaluation of nearly 9,000 substance-misusing welfare recipients from 2001 to 2007, University Behavioral Associates (UBA) Comprehensive Services Model program in Bronx, New York, found that 60% of recipients were not exempted from the work requirement owing to substance misuse at the outset, and an additional 24% were found nonexempt after 3 months of intensive outpatient treatment coupled with case management, resulting in a total of 84% of the UBA clients not being exempted from the work requirement because of substance misuse by Day 90. UBA also found that 25% of substance-misusing clients were able to obtain employment, and most successfully retained those jobs over the course of 6 months. These findings are discussed in relation to the new law's work requirements and the issue of the employability of substance misusers. Finally, the value of case management in serving this hard-to-engage population is discussed.

Windsor LC; Shorkey C. Spiritual change in drug treatment: Utility of the Christian Inventory of Spirituality. Substance Abuse 31(3): 136-145, 2010. (35 refs.)

The current study used data from reliability testing of the Christian Inventory of Spirituality (CIS) to (1) assess the utility of CIS in detecting differences in level of spirituality in residents of residential Christian faith-based substance abuse programs (RCFBSAPs); (2) test the hypothesis that residents who have been in the program for longer periods of time will have significantly higher levels of spirituality after controlling for relevant demographic characteristics; and (3) test the hypothesis that residents of programs that only use unlicensed staff and place higher importance on spirituality will have significantly higher levels of spirituality. A purposive sample of the cross-sectional data from the reliability testing of the CIS was used (n = 253). Analysis supported the hypothesis. Demographic characteristics were not associated with level of spirituality. The CIS proved to be useful in discriminating levels of spirituality. Further research is needed to examine spiritual change using randomized pre-post test designs.

Wong NS; Lee SS; Lin H. Assessing the spatial distribution of methadone clinic clients and their access to treatment. Harm Reduction Journal 7: 1-6, 2010. (9 refs.)

Using Geographic Information System (GIS), the spatial distribution of methadone clinic clients and their utilization of a treatment service in Hong Kong was analysed. A majority (93.7%) of the 63 methadone users recruited were residing in the same district, of which 84.1% spent not more than 15 minutes for traveling. Walking (55.6%) was the commonest transport mode followed by cycling (30.2%). There was no distance decay effect on traveling time, but an association between distance and transport selection could be demonstrated. The residence locations displayed a compact distribution, merging with the general population without any evidence of clustering. Though the distribution of methadone users could have been shaped by the location of clinic, it can also be concluded that methadone clinics at convenient locations are needed if maintenance is a key determinant of service effectiveness.

Wu F; Hser YI. Workforce professionalism in drug treatment services: Impact of California's Proposition 36. Journal of Substance Abuse Treatment 40(1): 44-55, 2011. (61 refs.)

This article investigates whether California's Proposition 36 has promoted the workforce professionalism of drug treatment services during its first 5 years of implementation. Program surveys inquiring about organizational information, Proposition 36 implementation, and staffing were conducted in 2003 and 2005 among all treatment providers serving Proposition 36 clients in five selected California counties (San Diego, Riverside, Kern, Sacramento, and San Francisco). A I-hour self-administered questionnaire was completed by 118 treatment providers representing 102 programs. This article examines five topics that are relevant to drug treatment workforce professionalism: resources and capability, standardized intake assessment and outcome evaluation, staff qualification, program accreditation, and information technology. Results suggest that Proposition 36 had a positive influence on the drug treatment workforce's professionalism. Improvements have been observed in program resources, client intake assessment and outcome evaluation databases, staff professionalization, program accreditation, and information technology system. However, some areas remain problematic, including, for example, the consistent lack of adequate resources serving women with children.

Zigon J. "A disease of frozen feelings": Ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program. Medical Anthropology Quarterly 24(3): 326-343, 2010. (30 refs.)

In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.

Zito R. Introduction: Moving forward to improve addiction treatment in California. (editorial). Journal of Psychoactive Drugs Supplement 6: 205-206, 2010. (0 refs.)