Retention in Substance Abuse Treatment

The authors investigated the association between psychiatric symptom severity and subsequent treatment retention among substance abusers. The Symptom Check List-90-R was administered, after admission to an addiction treatment facility, to 308 male and 106 female clients with moderate-to-severe substance abuse problems. Mean scores on nine symptom and three summary scales were computed. Controlling for other sociodemographic and treatment variables, somatization was significantly associated with dropout from specialized outpatient and inpatient treatment programs. This study, however, suggests that psychopathologic symptom severity at admission has only limited utility in predicting subsequent treatment retention among substance abusers with overall moderate levels of psychological distress.     

Survey of Eating Disorder Symptoms among Women in Treatment for Substance Abuse

A strong association between substance use disorders (SUDs) and eating disorders (EDs) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co‐occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multisite clinical trial comparing two behavioral treatments for co‐occurring SUD and PTSD. The Eating Disorder Examination‐self report, and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow‐up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Although all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a subgroup of women with co‐occurring PTSD and SUDs, who endorsed binge ED symptoms, responded differently to SUD/PTSD group treatment. Identification of ED symptoms among treatment‐seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes. (Am J Addict 2010;19:245–251)     

A Measure of Readiness for Substance Abuse Treatment

The Recovery Attitude and Treatment Evaluator-Research (RAATE-R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, biomedical acuity, psychological acuity, and environmental/social problems. Psychometric properties, based on an inter-rater reliability analysis of 23 raters and administration of the scale to 116 cocaine-dependent outpatients, included high interrater reliability, high internal consistency, independence of subscales, and a factor structure that partially supports the scale's original design. The authors discuss limitations of these conclusions and the lack of concurrent validity with a self-report measure of therapy readiness.     

Improving Health and Social Outcomes with Targeted Services in Comprehensive Substance Abuse Treatment

Background: Improved life functioning along with substance use reduction is increasingly recognized as the definition of effective addiction treatment. Objectives: To assess whether targeted health and social services contribute to improved physical/mental health and employment. Methods: This study used data from the National Treatment Improvement Evaluation Study (N = 3027) and modeled the improvement in physical/mental health and employment at discharge or 12 months after discharge compared with intake measures as a function of receipts of matched services. Results: Receiving matched medical service improves physical health only at treatment discharge; receiving matched mental health services improves mental health at discharge and 12 months after discharge; receiving matched vocational services improves employment only 12 months after discharge. Conclusions: Need–service matching contributes to improved health and social outcomes when longitudinal assessments of treatment outcomes are used to evaluate treatment effectiveness. Scientific Significance: Study findings document the value of targeted services for achieving success in health and social functioning in comprehensive substance abuse treatment.     

Opening Move in Substance Abuse Therapy: Appropriateness of Treatment Assignment

This study examines the relationships between pretreatment severity of six problem areas commonly affected by addiction and type of discharge from inpatient substance abuse treatment. Subjects were 531 male veterans from five different inpatient substance abuse programs at the Veterans Administration Hospital, Coatesville, Pennsylvania. A comparison of patients in the five programs showed different patterns of problem severity, and different variables emerged as correlates or discriminators of discharge status. Results of multiple discriminant analyses were useful in predicting those patients who received an unfavorable discharge from treatment, although the analyses were not as successful in identifying those patients who received favorable discharges. Based on this data, some approaches to improving the match between patients and programs are discussed.     

Substance Abuse/Mental Illness: Diagnostic Issues

“Dual diagnoses” of substance abuse and mental illness disorders are common both in psychiatric and substance abuse treatment settings. Recent studies have demonstrated that specific diagnostic categories of mental illness have implications for treatment outcomes of dually disordered patients, but a diagnostic standard has not emerged. The present study compared lay-administered DIS diagnoses with clinical diagnoses of patients in a state hospital treatment program for “dual diagnoses” patients. Categories of DIS diagnoses showed weak association with categories of clinical diagnoses. Several frequent DIS diagnoses were not made clinically and vice versa. Implications for choice of diagnostic instruments to use with this patient population are discussed, as is the potential value of structured assessments in supplementing clinical data.     

Characteristics of Opinion Leaders in Substance Abuse Treatment Agencies

Objective. This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence‐based treatment of co‐occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of “opinion leaders” as technology transfer agents. Method. A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co‐occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co‐occurring disorders. Results. The analyses demonstrate that opinion leaders differed from other counselors in competency‐related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co‐occurring disorders as well as a greater willingness and confidence in working with such clients. Conclusion. These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence‐based treatment practices in community treatment settings.     

Evaluation of Provider Profiling in Public Sector Substance Abuse Treatment

Few evaluations of provider profiles and performance measurement in publicly funded substance abuse treatment exist. This study examined a 7-year period in which the Connecticut Department of Mental Health and Addiction Services alternately implemented, suspended, and reintroduced profiling of treatment agencies. The profiles contained quarterly statistical reports indicating the agency's performance and peer comparison on percentages of clients connecting to lower levels of care and readmitted to higher levels of care. Neither measure changed during the first profiling period, but both improved during the second. Although adjustment for concurrent initiatives may be incomplete, profiling proved somewhat beneficial.     

Gender and Racial/Ethnic Disparities in the Impact of HIV Prevention Programming in Substance Abuse Treatment

Objective: The objective of the study was to evaluate the capacity of HIV prevention programs offered in substance abuse treatment to reduce HIV-related risk behavior for women and men and for Black, Latino, and White groups. Methods: Prospective data was collected at intake, discharage, and 12 months post-treatment from 1992 to 1997 for the National Treatment Improvement Evaluation Study with a sample consisting of 3,142 clients from 59 service delivery units: 972 females, 1,870 males, 1,812 Blacks, 486 Latinos, and 844 Whites. Results: Study findings show that receipt of HIV prevention programming as part of substance abuse treatment services resulted in reductions in HIV-related risk behavior for the sample overall and for women as well as men. However, although Blacks received more prevention services than Latinos and Whites, the significant positive effect of HIV services on reduced HIVrisk behavior held only for Whites. Conclusions: Racial/ethnic disparities exist in the capacity for HIV prevention programming offered as part of substance abuse treatment to reduce HIV-risk behavior. The findings highlight the need for the development of culturally competent service delivery strategies to enhance the impact of these services for all groups.     

Clinical Supervision in the Substance Abuse Profession: A Review of the Literature

Clinical supervision is a significant contributor to the development of substance abuse counselors and the efficacy of the services they render. This article represents a review of the literature on clinical supervision in the substance abuse field for the purposes of organizing existing data, providing focus for future research, and better informing those who use the literature as a means for professional development. Nine studies were identified, the results of which are discussed and compared, followed by recommendations for future research.     

A Review of Pharmacotherapies for Substance Abuse

New pharmacotherapies have been developed for acute withdrawal and maintenance treatments of alcohol and opioid dependence but not for cocaine dependence. High-dose, long-acting benzodiazepines, beta-blockers, and two antiseizure agents—carbamazepine and valproate—are being used for alcohol withdrawal. For maintenance treatment, opioid antagonists and various serotonergic agents, such as fluoxetine and ondansetron, show promise. For opioid dependence, clonidine-naltrexone detoxification appears quite cost-effective, and buprenorpbine and LAAM (levo-alpha-acetylmethadol) show promise for both detoxification and maintenance. More work is needed, however, to discover an effective agent for target populations of cocaine abusers.