Methadone has been used successfully as a substitution agent for heroin dependency for more than 30 years. As a result of its success, other effective methods of treatment have been neglected. ...Established as a key text on all treatment options for drug misusers, Community Treatment of Drug Misuse: More Than Methadone has been highly praised for its practical orientation based on a solid research background. For the second edition, all the main evidence-based and more pragmatic treatment approaches are reviewed, not only in the management of opiate dependence, but across the range of drugs. It focuses extensively on developments in the last few years as a result of policy initiatives and research findings, including coverage of buprenorphine treatment, the systematic treatment of cocaine abuse and work with special patient groups. This is of direct relevance to medical as well as non-medical practitioners undertaking clinical work in the addictions.
Background: This qualitative effort examines training-related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) ...nationwide that were funded by the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT) to implement EBPs. Methods: Using qualitative interviews, the authors explored staff (N = 514) descriptions of training as a facilitator or barrier to implementation. Training-related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. Results: Specific characteristics of the training received, such as access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included the amount of training; the training did not fit current staff and/or organizational needs; the training for some EBPs was perceived to be too demanding; and the difficulty accessing training. Conclusions: Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility, and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally funded resources for training were not always used.
Parent engagement is an important intermediate outcome in Family Drug Treatment Court (FDTC) and child welfare services. This study explored the utility and reliability of a client satisfaction and ...engagement survey designed to measure interim outcomes of a Mentor Parent Program, operating in conjunction with a FDTC. Findings suggest the survey is a useful, parsimonious and reliable tool for measuring key dimensions of parent mentor services including client engagement; client‐centered support and empowerment; and help with systems navigation and accessing resources. The survey may be adapted for use in other FDTC or parent mentor contexts.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, PRFLJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The main target of alcohol and other drug self-administration is the brain. For this reason understanding of brain mechanisms (i.e., neuroscience research) may offer important insights for creating ...effective prevention and treatment interventions, as well as fair and appropriate drug policies. Fair and appropriate drug policies (public laws and regulations) are expected to reduce the harms of drugs to the user and to society in general, while minimizing unintended but related policy "side effects." In this paper we explore how more informed understanding of neuroscience may help to improve the effectiveness and reduce the unintended side effects of contemporary drug policies. The article goes on to suggest some rational ways neuroscience may better inform and assist in policy decisions. We cover currently illegal drugs plus others such as alcohol and tobacco and touch on the new and emerging substances-legal highs. PUBLICATION ABSTRACT
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IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
Objective
Apply quantile regression for a high‐resolution analysis of changes in wait time to treatment and assess its applicability to quality improvement data compared with least‐squares ...regression.
Data Source
Addiction treatment programs participating in the Network for the Improvement of Addiction Treatment.
Methods
We used quantile regression to estimate wait time changes at 5, 50, and 95 percent and compared the results with mean trends by least‐squares regression.
Principal Findings
Quantile regression analysis found statistically significant changes in the 5 and 95 percent quantiles of wait time that were not identified using least‐squares regression.
Conclusions
Quantile regression enabled estimating changes specific to different percentiles of the wait time distribution. It provided a high‐resolution analysis that was more sensitive to changes in quantiles of the wait time distributions.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract There is increasing interest in the co-occurrence of social anxiety and addiction. Each investigation has a specific vantage point, e.g. the effect social anxiety has in a population with ...addiction or that of addiction in a population with social anxiety, which could create unique findings. Among comorbid individuals, is social anxiety more severe in people seeking treatment for anxiety, as compared to those seeking treatment for addiction? This report compares social anxiety severity between subjects in two studies—one involving socially anxious individuals (n = 38) seeking treatment for addictions; the other (n = 41) subjects with social anxiety and an alcohol use disorder, seeking treatment for social anxiety. Baseline severity scores on the Liebowitz Social Anxiety Scale for social anxiety were compared between the groups. No significant differences were found. For both groups, social anxiety was largely in the severe range. The results suggest that clinicians should attend to social anxiety symptom severity in patients with co-occurring social anxiety and addiction, regardless of the condition for which treatment is sought.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Black people in the United States who use opioids receive less treatment and die from overdoses at higher rates than White people. Medication for opioid use disorder (MOUD) decreases overdose risk. ...Implementation of the Affordable Care Act (ACA) in the United States was associated with an increase in MOUD. To what extent racial disparity exists in MOUD following ACA implementation remains unclear. Using a national sample of people seeking treatment for opioids (clients), we compared changes in MOUD after the ACA to determine whether implementation was associated with increased MOUD for Black clients relative to White clients.
We identified 878,110 first episodes for clients with opioids as primary concern from SAMHDA's Treatment Episodes Dataset-Admissions (TEDS-A; 2007–2018). We performed descriptive and logistic regression analyses to estimate odds of MOUD for Black and White clients by Medicaid expansion status. We interacted ACA implementation with racial group and performed subpopulation analyses for Medicaid enrollees and criminal justice–referred clients.
In expansion states post-ACA, MOUD increased from 33.6% to 51.3% for White clients and from 36.2% to 61.7% for Black clients. Pre-ACA, Black clients were less likely than White clients to use MOUD (adjusted odds ratio (aOR) = 0.88, 99th Confidence Interval (CI) = 0.85, 0.91), and post-ACA, the change in odds of MOUD did not differ. Criminal justice–referred clients experienced less of a change in odds of MOUD among Black clients than among White clients (aOR = 0.74, CI = 0.62, 0.89). Among Medicaid-insured clients, the change in odds of MOUD among Black clients was larger (aOR = 1.16, CI = 1.03, 1.30). In the non–expansion states before 2014, Black clients were less likely to receive MOUD (aOR = 0.86, CI = 0.77, 0.95) than White clients. After 2014, the change in odds of MOUD increased more for Black clients relative to White clients (aOR = 1.24, CI = 1.07, 1.44). We did not find significant changes in MOUD for clients referred through the criminal justice system or with Medicaid.
The ACA was associated with increased use of MOUD among Black clients and reduction in treatment disparity between Black and White clients. For criminal justice–referred Black clients, disparities in MOUD persist. Black clients with Medicaid in expansion states had the greatest reduction in disparities.
•Black clients had more access to medication for opioid use disorder (MOUD) post-ACA.•The odds of MOUD increased most for Black clients in expansion states with Medicaid.•Less than 12% of criminal justice referred clients had MOUD post-ACA.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The biographical and artistic work with the inmates, the correspondence, the interventions in the isolated, public, and cultural sphere, the minutes, reflections, and results of the interdisciplinary ...exchange with scientists are comprehensively documented and illustrated.
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