On-site provision of substance abuse treatment services at community health centers

We examined on-site and off-site referral-based provision of substance abuse (SA) treatment services among a sample of community health centers (CHCs). Analyses used survey data collected from CHCs in three states merged with administrative claims to both characterize CHC care delivery models and examine the association between models and care quality. Care quality was based on the Washington Circle measures of initiation and engagement. Approximately half the sample provided at least some SA treatment services on site. The provision of intensive outpatient treatment services on site was associated with significantly higher engagement rates. It was also associated with higher (but not significantly) initiation rates. At the same time, on-site provision of screening and counseling services was negatively associated with both initiation and engagement rates. Given limited resources, investing in more intensive services on site may yield better outcomes for CHC patients than lower level services, but further study is recommended.     

Resources for linkage of primary health care and substance abuse services

Abstract

Most practitioners would agree that substance abusing clients benefit from a comprehensive and coordinated approach to their medical and psychosocial problems. For practitioners in private practice, it is not always clear how to manage alcohol and drug cases in a way that achieves the level of intensity that is appropriate for each client and maintains continuity of care across settings and treatment providers. The purpose of this article is to suggest a range of strategies that have been used to enhance communication among practitioners and the agencies and organizations with whom they interact, both formally and informally. The article will describe strategies in the following four areas: (1) coordination of services, (2) interagency agreement, (3) community resources, and (4) public‐private cooperation. Some of the strategies apply directly to the practitioners' activities, while others are included to improve practitioners' understanding of how to deal more effectively with bureaucratic structures and processes as they encounter them.     

Socioeconomic marginality and health services utilization among Central Harlem substance users

The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The sample consisted of 658 "hard drug" (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999. Chain referral and social networking were used in order to gain access to hidden users. The sample was stratified according to operational measures indicating socioeconomic marginality, one calculated using indices of income, education, and employment and another designed to measure lived homelessness. Rates of self-reported utilization of 10 health services were compared across strata. In this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. When the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. Results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems.     

A categorical typology of naltrexone-adopting private substance abuse treatment centers

This study used a diffusion of innovations theoretical framework [Rogers, E. M. 2003. Diffusion of innovations. 5th edition. New York: The Free Press] to identify organizational-level predictors of a categorical typology of substance abuse treatment centers based on naltrexone adoption. Data from the National Treatment Center Study (N = 158) were used to examine the impact of socioeconomic status, organizational personality, and communication behavior on adopter categorization (i.e., innovators, early adopters, early majority, late majority, or laggards). Results from the ordered logistic regression model indicate that organizations that did not have onsite 12-step meetings and were familiar with treatment innovations were more likely to be in a more innovative category. Organizations that learned about innovations from professional development seminars and informal conversations with external treatment providers were more likely to be in a less innovative category. Identifying and targeting the early and late majority categories of adopting organizations for better training and community linkages could help reduce the research-to-practice gap.     

A national study of the substance abuse treatment workforce

This study's purpose is to gain a current perspective on the substance abuse treatment field's workforce. The data are from the Retrospective Study of treatment professionals designed to document how the Treatment Improvement Protocols published by the Center for Substance Abuse Treatment have influenced the implementation of best practices. The Retrospective Study consisted of a two-wave cross-sectional survey with telephone follow-up. Data for this study were from demographic information on Wave 1 study participants, which had a response rate of 80.1% (N = 3,267). The results of the study showed that most treatment professionals are White (84.5%) and middle-aged (i.e., between 40 and 55 years old) and slightly more are female (50.5.0%) than male (49.5%). Treatment professionals tend to enter the field and stay in it, and almost 80.0% of respondents possess a bachelor's degree or higher. In addition, most treatment professionals are licensed or certified and treat clients from different racial and ethnic backgrounds than themselves. Implications for the provision of treatment services are discussed.     

Use of specialty substance abuse and mental health services in adults with substance use disorders in the community

AIMS: To examine the patterns and correlates of use of specialty substance abuse and mental health services among adults with alcohol or non-alcohol drug abuse or dependence in the community. METHODS: Analyses focused on 5,568 participants with alcohol or non-alcohol drug abuse or dependence drawn from a large representative cross-sectional survey of the US general population-the 2002 US National Survey on Drug Use and Health (NSDUH). RESULTS: Only 9.7% of adults with substance use disorders used specialty substance abuse services in the past year; 22.4% used mental health services. Severity of substance use disorder and less education were associated with using substance abuse services. Whereas psychological distress and impairment in role functioning due to psychological problems were associated with mental health service use. Male gender, black race/ethnicity, and lack of health insurance acted as barriers to using mental health services but not specialty substance abuse services. Past year use of substance abuse services, but not mental health services, was associated with lower likelihood of continued use of substances in the past month. CONCLUSIONS: Individuals with substance use disorders are more likely to use mental health services than specialty substance abuse services. However, only people who use specialty substance abuse services have a lower risk of continued use of substances. Findings highlight the need for integration of substance abuse treatments in the mental health care system and attention to different barriers to the two types of services.     

A national survey of substance abuse treatment for juvenile offenders

Despite consensus about the value of substance abuse treatment for delinquent youth, information about its prevalence and availability is inadequate and inconsistent. This article presents findings about treatment and other correctional service provision from a national survey of directors of 141 juvenile institutional and community corrections (CC) facilities. Educational/General Educational Development programming and drug and alcohol education were the most prevalent types of correctional and substance abuse services. Other common services included physical health services and mental health assessment, provided to about 60% of youth across facilities, and mental health counseling, life and communication skills, and anger management, provided to about half of the youth. Substance abuse treatment, as with most other services, were more prevalent in large, state-funded residential facilities (where 66% provided treatment) than in local detention centers (20%) and CC facilities (56%). More detailed data showed that the number of youth attending treatment in all types of facilities on any given day was very low.     

Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting.

The dual purpose of this study was to: (1) determine whether problematic drug users, defined through the Drug Abuse Screening Test (DAST-10), exhibited differences in health services utilization and cost relative to a combined group of non-problematic drug users and non-drug users; and (2) assess whether the findings were similar to those for chronic drug users (CDUs) and injecting drug users (IDUs). Results showed that health services utilization and total cost were very similar for problematic drug users defined through quantity-frequency (i.e., CDU, IDU) and diagnostic (i.e., DAST-10) criteria. Findings suggest that quantity/frequency criteria for problematic drug use were reasonable approximations for diagnostic-based measures.     

A research agenda for economic evaluation of substance abuse services

Economic analyses of substance abuse interventions play a critical role in informing the decision makers involved in funding these programs. Despite the emergence of new and more effective interventions, the adoption of costlier services still demands justification based on economic evidence. Updated and more rigorous economic information allows patients, health care professionals, insurance companies, policymakers, and others to allocate scarce resources more efficiently. To prepare for the next wave of addiction health services research, this article presents background information on the economics of addiction health services, reviews recent empirical and methodological contributions, and provides 15 research recommendations.     

Sexual orientation and substance abuse treatment utilization in the United States: Results from a national survey

This study examined substance abuse treatment utilization across three dimensions of sexual orientation (identity, attraction, and behavior) in a large national sample of adults in the United States. Prevalence estimates were based on data collected from the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions. The sample consisted of 34,653 adults 20 years and older, and represented a population that was 52% women, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% other race/ethnicities. An estimated 2% of the target population self-identified as lesbian, gay or bisexual; 4% reported same-sex sexual behavior, and 6% reported same-sex sexual attraction. Sexual minorities, especially women, had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The majority of respondents with substance use disorders were untreated and lifetime substance abuse treatment utilization differed based on sexual orientation. Sexual minorities were found to have more extensive family histories of substance abuse problems. The findings indicate the underutilization of substance abuse treatment among all adults, and highlight some important factors to consider when working with sexual minorities.     

Organizational factors associated with the use of contingency management in publicly funded substance abuse treatment centers

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.     

Improving the capability to provide integrated mental health and substance abuse services in a state system of outpatient care

The paper reports on the capability of New York State (NYS) outpatient programs to provide integrated services for co-occurring disorders (COD). Assessments of 447 outpatient clinics, using two dual diagnosis capability indices (one used in addiction settings, the other in mental health settings), produced an overall score of 2.70, interpreted to position NYS clinics closer to “capable” (3.0 = Dual Diagnosis Capable) than to “basic” (1.0 = Alcohol [Mental Health] Only Services). “Assessment” and “Staffing” received the highest scores; i.e., clients with COD were usually identified, and staff (with some additional training and supervision) could treat both disorders effectively. While programs were generally prepared for clients with COD (e.g., welcoming such clients into the program, employing staff with competencies in both disorders, and having established routine screening and assessment to identify COD), results showed that the actual delivery of effective treatment was less satisfactory. The project demonstrated that COD capability can be assessed system-wide, using direct observation.     

A national survey of the use of couples therapy in substance abuse treatment

Although results from multiple studies conducted over the last two decades indicate that Behavioral Couples Therapy (BCT) is an effective treatment for married or cohabiting alcohol- and drug-abusing patients, both in terms of reduced substance use and improved relationship satisfaction, it is unclear whether BCT or other types of couples-based interventions are used in community-based substance abuse treatment programs. In the present study, program administrators (e.g., executive directors, clinical directors, staff physicians) from 398 randomly selected community-based outpatient substance abuse treatment programs in the U.S. were interviewed regarding use of different family- and couples-based therapies in their programs. According to the program administrators, 27% of the programs provided some type of couples-based treatment. However, less than 5% of the agencies used behaviorally oriented couples therapy and none used BCT specifically. Recommendations for researchers and clinicians to increase the use of BCT in community-based treatment programs are provided.     

Behavioral characteristics related to substance abuse and risk-taking, sensation-seeking, anxiety sensitivity, and self-reinforcement

Given the multitude of negative outcomes associated with substance abuse and other risk-taking behaviors, the current study sought to investigate sensation seeking, anxiety sensitivity, and self-reinforcement as they relate to participation in high-risk behaviors with 155 undergraduate students. The measures were the Reckless Behavior Questionnaire, Sensation Seeking Scale, Anxiety Sensitivity Index, Heiby Self-Reinforcement Questionnaire, and a sample of items from the treatment factor of the Substance Abuse Attitude Survey. Significant multivariate effects were attributable to sensation seeking and anxiety sensitivity. Sensation seeking and anxiety sensitivity were significant predictors of substance abuse. The model significantly predicted risky sexual behavior with a positive relationship between sensation seeking and risky sexual behavior. High anxiety-sensitivity scores were associated with a greater reported incidence of high-risk sexual practices. Participants highest in sensation seeking were most likely to engage in reckless driving, with male incidence being greater than for females. An unexpected finding was that anxiety sensitivity negatively correlated with substance abuse.