- Generational trends and patterns in readmission within a statewide cohort of clients receiving heroin use disorder treatment in Maryland, 2007-2013. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:82-91
- The recent rise in opioid-related overdose deaths stresses the importance of understanding how heroin use disorders persist and what interventions are best suited for treating these illnesses. Trends...
The recent rise in opioid-related overdose deaths stresses the importance of understanding how heroin use disorders persist and what interventions are best suited for treating these illnesses. Trends show that there are diverse pathways leading to heroin use disorder that span multiple generations, but little is known about how different generations utilize and respond to treatment. This study provides insight into treatment utilization for young, middle-aged, and older adults by examination of an unusually rich longitudinal dataset of substance use disorder clients in Maryland who were treated for heroin use. Results show that clear patterns of treatment readmission emerge across generations in treatment-naïve clients with regard to gender, ethnicity, employment, geographical region, and treatment type/intensity. In particular, Millennials comprise the majority of the clients receiving heroin use disorder treatment and are the largest contributor to these readmission patterns. Millennials are also given opioid maintenance therapy (OMT) more frequently than other generations, while exhibiting a strong avoidance to treatment. Generational differences in treatment decisions and outcomes over the course of a treatment career are important for understanding the nature of the current opioid epidemic, and can play an important role in directing heroin use disorder treatment efforts and improving models of care.
- Health insurance coverage is associated with access to substance use treatment among individuals with injection drug use: Evidence from a 12-year prospective study. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:75-81
- CONCLUSIONS: Insurance is associated with increased use of three important services for individuals who inject drugs.Expanding insurance may facilitate access to substance use treatment and other needed health services.
- Alcohol-related social and health service use patterns as predictors of death and remission in patients with AUD. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:65-74
- Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:58-64
- The continued need for advancement in evidence-based SUD treatment, as well as increases in treatment expense and decline in support from insurance providers, suggest that brief, innovative, and affo...
The continued need for advancement in evidence-based SUD treatment, as well as increases in treatment expense and decline in support from insurance providers, suggest that brief, innovative, and affordable treatments are needed. Meditation, spirituality, and adherence to medication-assisted treatments have all been shown to support abstinence. The current trial assessed effects of spiritually-based meditation, versus relaxation or standard treatment, on substance abstinence and psychological distress and dysfunction in a partially buprenorphine-supported (41.5%) treatment sample. Participants (N = 40) were recruited from an intensive outpatient treatment program, in which three treatment locations acted as separate experimental conditions. Abstinence was measured through urinalyses at baseline and weekly thereafter for the duration of the intervention. Psychological distress and dysfunction were assessed with a Likert-scaled questionnaire measuring symptoms typically associated with SUD. Co-varying for buprenorphine use, participants in the Meditation condition had better odds of remaining abstinent than participants in the Treatment-as-Usual (TAU) and Relaxation conditions. There were no significant differences in substance abstinence between the Relaxation and TAU conditions. Further, co-varying out baseline there were no significant differences at post-course in psychological distress and dysfunction between the three conditions. Results from this pilot trial suggest that this spiritually-informed approach may offer additive support to individuals in SUD treatment, as an aid to the meditative aspect of the 12 steps, or a non-12-step alternative spiritual supplement to standard SUD treatment.
- Substance use outcomes in cocaine-dependent tobacco smokers: A mediation analysis exploring the role of sleep disturbance, craving, anxiety, and depression. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:53-57
- CONCLUSIONS: This exploratory analysis suggests that there may be an indirect relationship between self-reported sleep quality and substance use outcomes in cocaine-dependent patients, mediated by craving, anxiety, and depression.
- Health literacy in substance use disorder treatment: A latent profile analysis. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:46-52
- CONCLUSIONS: The current study found that low to moderate health literacy levels were common for those attending residential substance abuse treatment. Participants with lower health literacy tended to have poorer quality of life and mental health. Future research should examine strategies to improve health literacy amongst people attending alcohol and other drug treatment. It may also be useful for service providers to consider ways to minimise the impact of low health literacy on the health needs and outcomes of this vulnerable population.
- Examining the influence of active ingredients of motivational interviewing on client change talk. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:39-45
- Motivational Interviewing (MI) is an evidenced-based intervention designed to help clients explore and resolve ambivalence around substance use. MI combines a humanistic tradition with behavioral com...
Motivational Interviewing (MI) is an evidenced-based intervention designed to help clients explore and resolve ambivalence around substance use. MI combines a humanistic tradition with behavioral components to facilitate client decisions concerning behavior change. As such, there is marked interest in the relationship between the two active ingredients of MI - the relational, or person-centered, components and the technical, or directional, behavioral components - on client in-session language. Yet, few studies have examined how these active ingredients operate in concert. Therefore, the current study evaluated the constellation of relational skills associated with client language, as well as the influence of technical skills on the relationship between provider relational skills and client change language. Specifically, we tested a latent construct of relational skill and its direct association with the proportion of client change talk. We then explored the mediating role of reflections of change and sustain talk (RefCT and RefST) on this relationship. The data for this secondary analysis are from Project ELICIT (N = 131), a randomized control trial evaluating the effects of MI training on client change language. We found support for a latent construct of relational skill (i.e., empathy, acceptance, collaboration, and autonomy/support). However, the relational skill construct did not predict client change language. There was support for an indirect effect, such that relational skills predicted RefCT and RefST, and RefCT and RefST predicted client change language. These results suggest that the synergistic implementation of the relational and technical components of MI is critical to facilitating a higher percentage of change talk.
- Specific aspects of cognitive impulsivity are longitudinally associated with lower treatment retention and greater relapse in therapeutic community treatment. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:33-38
- CONCLUSIONS: Long-term based decision-making skills are important to commit to the complex and intensive treatment programs of therapeutic communities. The ability to withhold behavioural responses under positive affect is relevant to prevent relapse. Both skills should be assessed and potentially trained during therapeutic community treatment.
- A randomized clinical trial of cue exposure treatment through virtual reality for smoking cessation. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:26-32
- CONCLUSIONS: Findings support and expand previous evidence by showing that a CET protocol does not increase the effectiveness of a CBT intervention for smoking cessation among treatment-seeking smokers. Moreover, this study also reveals that CET may increase risk of relapse among nicotine-dependent individuals who successfully achieve abstinence. Until the mechanisms underlying the effect of CET are identified, researchers and clinicians should be cautious when utilizing this protocol.
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- Fentanyl exposure among patients seeking opioid treatment. [Journal Article]
- JSJ Subst Abuse Treat 2019; 96:23-25
- CONCLUSIONS: These data illustrate a concerning degree of fentanyl exposure among patients seeking treatment and suggest that much of this exposure may have stemmed from fentanyl-containing heroin. Given the unprecedented recent surges in fentanyl-related overdoses, efforts to identify fentanyl exposure are critical. In particular, the point of treatment entry permits a rare systematic opportunity for medical and clinical staff to address fentanyl use and risks with incoming patients.