Characterization of Former Heroin Addict Patients With Hepatitis C Virus Antibodies in a Methadone Maintenance Treatment (MMT) Clinic in Israel

Aims: To compare characteristics, retention in treatment and cessation of drug abuse of 249 positive hepatitis C (HCV+) with 188 negative hepatitis C (HCV?) antibody patients. Methods: Data on Hepatitis C, Hepatitis B and HIV results, urine-proven drug use, and modified ASI of all patients admitted to the Adelson MMT clinic between June/1993–Dec/2002 were prospectively collected. Results: HCV+ patients manifested more ever injecting drug use, immigrants, positive HIV antibody, hepatitis B antigen, years of opiate addiction pre-MMT and benzodiazepines misuse after one year in MMT than HCV? patients, with similar 1-year retention and proportion of opiate use cessation. Conclusions: Although characteristics of HCV+ and HCV? differed, they manifested similar outcomes: treatment retention and proportion of opiate use cessation.     

Hepatitis C Treatment Eligibility and Comorbid Medical Illness in Methadone Maintenance (MMT) and Non-MMT Patients: A Case-Control Study

ABSTRACT

Comorbid medical illness is common in patients with chronic hepatitis C (HCV) infection and in methadone treatment (MMT) patients, yet little is known about the impact of medical illness on HCV treatment eligibility. Medical illness and HCV treatment eligibility were compared in a case-control study of 80 MMT patients entering an HCV treatment trial and 80 matched non-MMT patients entering HCV treatment in a gastroenterology clinic. 91% of MMT and 85% of non-MMT patients had chronic medical conditions. Despite similar medical severity ratings, a significantly higher proportion (77%) of non-MMT patients were eligible for HCV treatment than were MMT patients (56%) (p < .01). Specific comorbid medical and psychiatric illness led to ineligibility in only 18% of MMT and 16% of non-MMT patients. However, failure to complete the medical evaluation process was significantly (p < .001) more likely to cause ineligibility among MMT patients (19%) than non-MMT patients (0%).     

Sexual Abuse and its Relation to Chronic Pain among Women from a Methadone Maintenance Clinic versus a Sexual Abuse Treatment Center

To determine the effect of sexual abuse history on chronic pain and its relation to opioid addiction and methadone maintenance treatment (MMT), we studied current women MMT patients, and women patients from a sexual abuse treatment center with no history of opioid addiction. Questionnaires included Chronic Pain, Chronic Severe Pain, the Yale-Brown Obsessive Compulsive Scale, the Dissociative Experiences Scale (DES), and the Structured Interview for Disorders of Extreme Stress (complex-PTSD). Chronic severe pain was most prevalent among sexually abused women with no history of opioid addiction (64% of 25), followed by sexually abused MMT women (30.9% of 68), and MMT women with no history of sexual abuse (25% of 8, p = 0.01). Pain severity correlated with dissociation and complex-PTSD scores. The sexually abused non-MMT women had higher rates of high dissociation scores (DES ≥ 30) and complex-PTSD, but fewer obsessive-compulsive disorder symptoms (scored ≥16) than the MMT sexually abused women. Chronic pain was found to be highly prevalent among sexually abused women, independent of being methadone-maintained with an addiction history. The high known prevalence of chronic pain among MMT patients, which may be attributable to opioid-induced hyperalgesia, may partially reflect the sexual abuse history, and should be targeted in future studies evaluating pain indices.     

Characteristics and Outcome of Minority Group Patients in Methadone Maintenance Treatment

Minority status is associated with mental and physical morbidity, substance dependence, and poor outcomes. To compare characteristics and treatment outcomes between patients from two minority groups in Israel (Christians and Muslims) and patients from the majority population (Jews) in methadone maintenance treatment (MMT), we prospectively studied all patients admitted to our clinic between 1993 and 2012 and followed up until 2013; 655 Jews, 67 Christians, and 37 Muslims. Christian patients differed from Jews and Muslims by younger age at admission to MMT, greater prevalence of drug injectors, and a higher proportion of Hepatitis-C and HIV sera positive. Muslims had comparatively less education and a lower proportion of females. The three groups had similar rates of one-year retention (75.9%) and opiate abstinence (68.1%). They also did not differ in long-term retention (up to 20 years): Muslims 5.5 years (95%CI 3.6-7.4), Christians 7.5 years (95%CI 6-9.1), and Jews 7.6 years (95%CI 7-8.2, p = .3). The Hepatitis-C incidence, however, was higher among the 21 admitted Hepatitis-C seronegative minorities (5.0/100 person years) than the 207 Hepatitis-C seronegative non-minority patients (1.7/100 person years, p=0.03). All groups had good treatment outcomes, except for Hepatitis-C seroconversion, which necessitates a specific preventive intervention among the minority groups.     

Knowledge About Hepatitis-C Among Methadone Maintenance Treatment Patients in Israel

Ignorance about Hepatitis-C (HCV) among drug users, treatment staff, and policy makers thwarts treatment uptake and facilitates virus transmission. We assessed knowledge about HCV among methadone patients in Israel, where effective HCV-treatment is provided at low-cost within the national health insurance framework, yet few infected methadone patients are treated. In 2006, 512 patients in two methadone clinics in Israel were interviewed, of whom 53%% were HCV-positive. The clinics were purposively selected from the 11 methadone clinics in the country. Respondents exhibited poor knowledge about HCV, particularly about diagnosis and treatment. Lesser-educated respondents were three times more likely to score low on HCV-knowledge compared to those with 12++ years of schooling (AOR == 2.97, 95%% CI == 1.5–5.7. HCV-negative patients were also three-times more likely than HCV-positive patients to score low on the HCV-knowledge scale (Adjusted Odds Ratio == 3.0, 95%% Confidence Interval == 1.9–4.7). Enhancing HCV-knowledge may help patients avoid becoming infected and infecting others, allay exaggerated fears about hepatitis, and facilitate HCV-treatment initiation among those infected.     

The Relationship Between Vulnerable Attachment Style,Psychopathology, Drug Abuse,and Retention in Treatment Among Methadone Maintenance Treatment Patients

The relationship between vulnerable attachment style, psychopathology, drug abuse, and retention in treatment among patients in methadone maintenance treatment (MMT) was examined by the Vulnerable Attachment Style Questionnaire (VASQ), the Symptom Checklist-90 (SCL-90), and drug abuse urine tests. After six years, retention in treatment and repeated urine test results were studied. Patients with vulnerable attachment style (a high VASQ score) had higher rates of drug abuse and higher psychopathology levels compared to patients with secure attachment style, especially on the interpersonal sensitivity, anxiety, hostility, phobic anxiety, and paranoid ideation scales. Drug abstinence at baseline was related to retention in treatment and to higher rates of drug abstinence after six years in MMT, whereas a vulnerable attachment style could not predict drug abstinence and retention in treatment. Clinical Implications concerning treatment of drug abusing populations and methodological issues concerning the VASQ’s subscales are also discussed.     

Substance Abuse Treatment Clinician Opinions and Infectious Disease Service Delivery

ABSTRACT

Substance abuse treatment programs are an important platform for delivery of services for infectious diseases associated with drug and alcohol use. However, important components of infectious disease care are not universally provided. Clinician training often focuses on information about infectious diseases and less attention is paid to provider opinions and attitudes that may be barriers to providing infectious diseases services. In a national multi-site trial conducted by the National Drug Abuse Treatment Clinical Trials Network (CTN), we investigated the relationship between clinician opinions and the delivery of services for human immunodeficiency virus, hepatitis C virus, and sexually transmitted infections in substance abuse treatment settings. Survey data were collected from 1,723 clinicians at 269 CTN treatment programs. Clinician opinion was found to be significantly related to infectious disease service delivery. Implications for training are discussed.     

Pubertal Timing and Substance Abuse Treatment Outcomes: An Analysis of Early Menarche on Substance Use Patterns

ABSTRACT

This article examines the influence of pubertal timing on substance use patterns, specifically the relationship between onset of menarche and onset of substance use and substance abuse treatment outcomes. Findings show a significant relationship between pubertal timing and age of onset of substance use and age of onset of substance use and substance use severity at intake into treatment. The article concludes with a call for further research into the possible relationship between pubertal timing and treatment outcomes as well as effective gender-specific interventions for prevention and treatment of substance abuse among adolescent girls.     

Viral Hepatitis Among Drug Users in Methadone Maintenance: Associated Factors,Vaccination Outcomes,and Interventions

Drug users are at high risk of viral Hepatitis A, B, and C. The prevalence of Hepatitis A, Hepatitis B, and Hepatitis C, associated factors, and vaccine seroconversion among drug treatment program participants in a randomized controlled trial of hepatitis care coordination were examined. Of 489 participants, 44 and 47% required Hepatitis A/Hepatitis B vaccinations, respectively; 59% were Hepatitis C positive requiring linkage to care. Factors associated with serologic statuses, and vaccine seroconversion are reported; implications for strategies in drug treatment settings are discussed. Results suggest generalizable strategies for drug treatment programs to expand viral hepatitis screening, prevention, vaccination, and linkage to care.     

Family Related Factors and Concurrent Heroin Use in Methadone Maintenance Treatment in China

Background: The use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China. Objectives: In this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China. Methods: This study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records. Results: Of the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93). Conclusions: The results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.     

Changes in the Characteristics and Levels of Comorbidity Among New Patients Into Methadone Maintenance Treatment Program in British Columbia During Its Expansion Period From 1998–2006

We described the changing characteristics and comorbidity levels of new patients into Methadone maintenance treatment (MMT) program in British Columbia, Canada, during its expansion period of 1998–2006. Analyses used administrative data. Generalized regression models were applied using Charlson Comorbidity Index (CCI) and Chronic Disease Score (CDS) as outcomes. 12,615 individuals initiated MMT during 1998–2006, while their odds of having moderate CCI (1 ≤ CCI ≤ 4) and mean CDS increased by 60% and 11%, respectively, after adjusting for confounders. MMT entrants were presented with progressively higher levels of comorbidity, independent of other characteristics. Future MMT policies should address higher levels of comorbidity among new patients.     

Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network

Background: Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. Objectives: The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. Methods: Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. Results: When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.     

Examining Gender Differences in Adolescent Substance Abuse Behavior: Comparisons and Implications for Treatment

ABSTRACT

This study investigates gender differences in adolescent substance abuse behavior, treatment effectiveness, and the associated relationships with pre-, during-, and post-treatment groups of variables. Analyses were performed using 6-month post-treatment follow-up data from over two thousand subjects. T- test analysis showed that females exhibited more psychological difficulties, family-related problems, and sexual abuse experiences, whereas males exhibited worse school and legal problems before treatment. Females also showed better attendance in aftercare or self-help groups and better treatment outcomes than males. Discriminant function analyses indicated that school problems, legal problems, lack of religious involvement, and substance abuse before treatment could discriminate abstinence status for females at 6-month follow-up. Substance abuse before treatment, length of stay, and parental participation in treatment could differentiate abstinence status for males at 6-month follow-up. Limitations in applying research findings and implications for adolescent substance abuse treatment are also discussed.     

Effect of Methadone Dose on Maintenance Treatment and Health Consequences Among Heroin Addicts in South China

A retrospective cross-sectional study was conducted with a convenience sample of 197 adults receiving methadone maintenance treatment in Kunming city, South China, in 2010. The aim of the study was to determine the association of methadone maintenance dose on a variety of treatment outcomes. Treatment modalities, the adverse reactions to methadone treatment, the physical and mental outcomes of the treatment, and risk behavior changes were assessed. Multilevel negative and logistic binomial regression analyses were carried out, which demonstrated that methadone maintenance dose in this sample was not associated with improved treatment adherence or with quality of life. We concluded that dose had a small, if negligible, influence on the changes in adverse effects of methadone. Further research in dose differences between the genders should be conducted.     

Substance Abuse Prevention Program for Children and Adolescents in a Community-Based Clinic

Abstract

This paper describes a community-based substance abuse prevention program utilizing a cognitive-behavioral curriculum to children and adolescents affected by a substance use disorder in a parent or caretaker.     

During Treatment Changes in Substance Abuse Patients with Posttraumatic Stress Disorder: The Influence of Specific Interventions and Program Environments

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.     

Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment

Background: Adolescent substance abuse remains a significant problem in the United States, yet treatment centers do not always admit adolescent clients. In this paper, we first determine the extent to which treatment is available for adolescents in general and whether or not adolescent-specific (segregated) tracks are offered. Second, we examine the organizational characteristics associated with adolescent treatment. Third, we illuminate how the adolescent caseload in a treatment center is related to offering evidence-based practices (EBPs). Methods: Drawing upon a nationally representative sample of US treatment programs, we use logistic regression to assess how organizational characteristics are associated with the provision of adolescent treatment. Using ordinal logistic regression, we analyze how the treatment center's adolescent caseload and organizational characteristics affect the extent to which a treatment center offers medication-assisted treatment (MAT) and psychosocial treatment. Results: Half (49.5%) of treatment programs admitted adolescents, and 41.8% offered an adolescent-specific track. Findings from the logistic regression suggested several organizational characteristics that were significantly associated with treating adolescents and/or having an adolescent-only track. Our findings from the ordinal models indicated a negative relationship between the percent of adolescents in a treatment center and the extent of MAT, and a positive relationship between the percent of adolescent clients and the extent of psychosocial treatment offered. Conclusions: This paper highlights organizational barriers to treatment entry for adolescents, who remain a small proportion of clients in treatment centers. When treatment centers serve adolescents, however, those adolescents are likely to receive care in adolescent-only tracks and/or services and in programs that offer several psychosocial EBPs. Finally, adolescents are less likely to receive treatment in centers that offer a variety of MAT.     

Men in Methadone Maintenance versus Psychosocial Outpatient Treatment: Differences in Sexual Risk Behaviors and Intervention Effectiveness from a Multisite HIV Prevention Intervention Trial

ABSTRACT

The effectiveness of the Real Men Are Safe (REMAS) HIV prevention intervention was examined as a function of treatment program modality. REMAS was associated with significantly larger decreases in unprotected sexual occasions than an HIV education control condition in both treatment modalities. REMAS had superior effectiveness for reducing unprotected sexual occasions in the psychosocial outpatient compared to methadone. At the 6-month follow-up, the adjusted mean change for REMAS completers in psychosocial outpatient (M= 6.4, d= 0.38) was greater than for REMAS completers in methadone programs (M= 2.3, d= 0.25). Reasons for why REMAS appears to be especially effective in psychosocial outpatient programs are explored.     

Racial and Ethnic Differences in Referral Source for Substance Abuse Treatment Admissions for Youths

This study examined racial and ethnic differences in admissions to substance abuse treatment and in the referral source in admissions to treatment. The 2012 Treatment Episode Data Set (N = 117,862) was used and included African-American, Hispanic, non-Hispanic White, and other racial/ethnic youths, ages 12 to 17. Age at admission to treatment, racial and ethnic differences in primary substance used, and co-occurrence of a psychiatric problem were found to be statistically significant. Health care providers were 3 times more likely to refer youths with psychiatric problems and the school system was 2 times more likely to refer Hispanic youths to treatment. Implications are discussed.     

Evaluation of a Grief Group for Women in Residential Substance Abuse Treatment

Most women in substance abuse treatment have experienced significant losses. This preliminary study examined the effectiveness of a therapy group addressing grief and loss among women enrolled in a gender-specific residential substance abuse treatment program. The intervention group consisted of 24 grief group participants and the comparison group consisted of 31 nonparticipants. Qualitative analysis revealed a pattern: participants identified traumatic loss, moved to emotional loss and abandonment by their own mothers, then focused on their own children. Data obtained at induction and at exit or follow-up were used for quantitative analysis. Length of stay, self-esteem, depression, mood, and parenting attitudes were assessed using standardized instruments. Women who participated in the grief group remained in treatment longer. While both groups were depressed and had low self-esteem at induction, the self-esteem of nonparticipants was significantly lower than that of participants. Both groups improved over time on mood, depression, and parenting. At exit or follow-up, participants had higher self-esteem. Based on these findings, we hypothesized that higher self-esteem at induction made it possible for women to participate in and benefit from the grief group, thus contributing to length of stay. To test this hypothesis we conducted regression analyses which found that, individually, group status (participation) and self-esteem explained 11% of the variance in length of stay. However, since the number of women with available data varied for group status and self-esteem, group status was a significant predictor of length of stay and self-esteem showed only a trend toward significance. These findings support our hypothesis. The women's pattern of disclosure and the hypotheses drawn from the results of this preliminary analysis will be examined further in an evaluation of a series of groups focused on loss and grief.