Abstract Because it is not common in the U.S. for jails to allow inmates to continue opioid medications that have been started in the community, we aimed to assess whether inmates maintained on ...methadone showed different rates of recidivism, lengths of incarceration, and types of offenses than other incarcerated groups. We also analyzed rates of return to home clinics after release. In order to answer these questions this study used extant data from 960 adult inmates in a large metropolitan detention center who were in 1 of 4 groups: general population with no known substance use disorders, alcohol detoxification, methadone maintenance (MMT), and opioid detoxification. Recidivism was assessed for 1 year after release. Data were collected from medical screening forms and jail databases and included demographic variables, dates of admission and release, number of doses and total dosage of methadone if applicable, reason for incarceration, and the date of rebooking and nature of offense, if it occurred. There was a significant difference in time to rebooking, F (3956) = 13.32, p = .00, with the MMT group taking longer to be rebooked (275.6 days) than the opioid (236.3 days) and alcohol detoxification groups (229.3 days), but not the general population group (286.2 days). Survival analysis indicated significantly better survival without rebooking in the MMT and general population groups than the alcohol and opioid detoxification groups. There also were differences in length of incarceration, F (3, 954) = 9.02, p = .00, with the MMT group being incarcerated longer than other substance using groups; and in misdemeanor vs. felony rebooking offenses, χ2 3 = 31.29, p < .01, with the opioid detoxification group being more likely to have a felony rebooking than the general or alcohol groups. In a separate analysis, data from 137 MMT clients, who were not precisely the same clients who were involved in other analyses reported in this article, indicated that over 97% returned to their home methadone clinics after incarceration. In summary, inmates who had been allowed to be maintained on methadone started in the community displayed a significantly longer time to be rearrested than inmates undergoing opioid or alcohol detoxification, but not inmates without substance use disorders. When they were rebooked, they were as likely as the opioid detoxification group to be rearrested for felony offenses.
Background: Randomized trial evidence on the effectiveness of incarceration and treatment of first‐time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be ...reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI.
Methods: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first‐time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self‐reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis.
Results: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non‐ASPD participants.
Conclusions: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American‐Indian sample.
Marlatt and Gordon's (1985) relapse prevention therapy has received widespread interest and application. The categorization of relapse precipitants was one of the original central features of this ...model. In more recent iterations of this therapy, increasing emphasis has been placed on coping strategies. In the present article, exploratory findings from a prospective naturalistic alcohol treatment study employing the Reasons for Drinking Questionnaire are reported. A relapse precipitants scoring algorithm is presented allowing relapses to be categorized as either negative affect relapses, social pressure relapses, or craving/cued relapses. Exploratory findings suggest that social pressure relapses are more likely to repeat, and that negative affect and craving/cued relapses are more severe. Perhaps most interestingly, craving/cued relapses appear to subside during the first 6 months following treatment initiation, but subsequent risk for this type of relapse returns if the client has relapsed. However, these findings are still early in a continuing exploration of these issues in relapse prevention.
Predictors of relapse to drinking were examined in a clinical sample of 122 individuals seeking outpatient treatment for alcohol problems. Drinking status and a variety of predictor variables were ...measured every two months for one year following presentation for treatment. In addition to pretreatment characteristics, potential antecedents of relapse were assessed at each point within five domains: (1) the occurrence of negative life events; (2) cognitive appraisal variables including self‐efficacy, alcohol expectancies, and motivation for change; (3) client coping resources; (4) craving experiences; and (5) affective/mood status. Although the occurrence of adverse life events did not predict 6‐month relapse, all other domains singly accounted for significant variance in drinking outcomes. Proximal antecedents (from the prior 2‐month interval) significantly and substantially improved predictive power over that achieved from pretreatment characteristics alone. When analyzed jointly, these predictors accounted for a majority of variance in 6‐month relapse status. A prospective test supported Marlatt's developmental model of relapse, pointing to two client factors as optimally predictive of resumed drinking: lack of coping skills and belief in the disease model of alcoholism.
This is a report on the New Mexico Screening, Brief Intervention, and Referral to Treatment (SBIRT) project conducted over 5 years as part of a national initiative launched by the Substance Abuse and ...Mental Health Services Administration with the aim of increasing integration of substance use services and medical care. Throughout the state, 53,238 adults were screened for alcohol and/or drug use problems in ambulatory settings, with 12.2% screening positive. Baseline substance use behaviors among 6,360 participants eligible for brief intervention, brief treatment, or referral for treatment are examined and the process of implementation and challenges for sustainability are discussed. (Contains 4 tables.)
Relapse to alcohol and other substances has generally been described by curves that resemble one another. However, these curves have been generated from the time to first use after a period of ...abstinence without regard to the movement of individuals into and out of drug use. Instead of measuring continuous abstinence, we considered post-treatment functioning as a more complicated phenomenon, describing how people move in and out of drinking states on a monthly basis over the course of a year. When we looked at time to first drink we observed the ubiquitous relapse curve. When we classified clients (N = 550) according to drinking state however, they frequently moved from one state to another with both abstinent and very heavy drinking states as being rather stable, and light or moderate drinking and heavy drinking being unstable. We found that clients with a family history of alcoholism were less likely to experience these unstable states. When we examined the distribution of cases crossed by the number of times clients switched states we found that a power function explained 83% of that relationship. Some of the remainder of the variance seems to be explained by the stable states of very heavy drinking and abstinence acting as attractors.
Earlier exploratory work on a scoring algorithm for the Reasons for Drinking Questionnaire Zywiak, W. H., Westerberg, V. S., Connors, G. J., & Maisto, S. A. (2003). Exploratory findings from the ...Reasons for Drinking Questionnaire.
Journal of Substance Abuse Treatment, 25, 287–292. presented a number of interesting findings, but was limited by a fairly low consistency in type of relapse between the first relapse and the second relapse (63%). This scoring algorithm objectively classifies alcohol relapses into one of three types (negative affect, social pressure, or craving/cued). While examining gender differences in the type of first relapse, evidence indicating that relapses were more consistent for men (81%) than for women (44%) was uncovered. For initial posttreatment relapses, women were more likely to have negative affect relapses, and men were more likely to have social pressure relapses. For men, negative affect relapses were predicted by the Beck Depression Inventory score. For women, negative affect relapses were predicted by the Alcohol Dependence Scale score, and craving/cued relapses were predicted by situational craving.
Purpose: Craving describes a subjective state, and it remains unclear what people mean when they use the term. However, as with many other subjective states, craving should be able to be described by ...those who experience it. Methods: To try to understand the descriptors and constituents of craving, 213 clients appearing for treatment for alcohol use disorders were asked to rate the frequency of the occurrence over the past 30 days of a number of events and states that have been historically regarded as part of craving. These clients were also asked to rate the frequency with which they had experienced craving and urges over the same period. Using discriminant function analysis (DFA), some states were elucidated that separated those who reported craving from those who did not. Results and implications: Those who reported craving consistently reported the occurrence of more dysphoric states, more of certain physical feelings associated with thoughts of alcohol, more thoughts of alcohol, and desiring alcohol when confronted with environmental cues. Such descriptions may aid in establishing reliable criteria for understanding the constituents of craving.
Establishing a budget for a research project that satisfies the researcher and the granting institution is important but difficult. Guidelines are presented to make the budget reviewing process ...easier.
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