A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients

Background: Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. Objectives: Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. Methods: Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28–30-day residential program. Results: Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.     

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders

Background: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). Objective and Method: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. Results: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. Conclusions/Importance: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.     

Differences in Trait Mindfulness Across Mental Health Symptoms Among Adults in Substance Use Treatment

Mindfulness is a growing area of investigation among individuals manifesting substance use disorders, as mindfulness meditation may help to prevent relapse to substance use. The current study examined levels of trait mindfulness in substance users seeking treatment from May 2012 to August 2012 in a Tennessee residential center and whether patients with probable (i.e., diagnoses based on a self-report screening instrument) comorbid depression or PTSD reported lower mindfulness than patients without a probable comorbid diagnosis. Data were collected from a convenience sample of archival patient records (N = 125) and four instruments. The majority of patients were male (n = 84) and non-Hispanic Caucasian (92%); the mean age of the sample was 37.36 (SD = 12.47). Results showed that lower trait mindfulness was associated with increased levels of substance use, depression, and PTSD. Patients with a probable depression or PTSD diagnosis reported lower mindfulness than patients without these disorders. Patients with probable comorbid depression and PTSD reported the lowest levels of mindfulness. These findings suggest that altering levels of mindfulness may be important for individuals manifesting dual-diagnoses in substance user treatment. The study's limitations are noted.     

Disordered Gambling in Residential Substance Use Treatment Centers: An Unmet Need

This study examined prevalence and potential impact of disordered gambling in a sample of individuals (N = 684) undergoing residential treatment for substance use disorders at 13 facilities. Lifetime disordered gambling prevalence was 20.2%, as identified by South Oaks Gambling Screen. Within individuals who screened positive for disordered gambling, few had sought help for gambling (15.9%) and only 14.3% reported having gambling addressed in their current substance use disorder treatment. Meanwhile, 30.4% identified gambling as a concern in their recovery efforts. The presence of a gambling problem, either historical or current, potentially affects residential treatment outcomes and warrants clinical attention within these programs.     

A Qualitative Study of Treatment Needs Among Pregnant and Postpartum Women with Substance Use and Depression

Little is known about treatment for pregnant and postpartum women with cooccurring substance use and depression. Funded by the National Institute of Drug Abuse, we conducted three focus groups with 18 pregnant and postpartum women in 2011 at an urban substance use treatment clinic. A semi-structured discussion guide probed for factors impacting treatment outcomes and needs. Data were analyzed using grounded theory. Women identified motivational, family, friend, romantic, and agency characteristics as facilitative or challenging to their recoveries, and desired structure (group treatment, a safe environment, and transportation) and content (attention to mental health, family, and gender-specific issues) of treatment.     

Exposure to Violence and Substance Use Treatment Outcomes Among Female Patients

Background: Many female substance use patients have experienced violence in the past, with most estimates showing the majority of patients reporting violent experiences at some point. Prior experience with violence has been linked to increased severity of substance use, and this may contribute to more challenges in the path to recovery. Objectives: Existing research has confounded the timing at which violence has occurred with the type of violence to which patients have been exposed. The current study was conducted to specify the extent to which the timing of exposure and the type of violence were associated with substance use after discharge from treatment. Methods: Data were collected from 3,439 female patients included in the Comprehensive Assessment and Treatment Outcome Research (CATOR) system. Results: With regard to the type of exposure, findings indicated female patients who were exposed to multiple forms of violence (i.e. physical and sexual) displayed the greatest severity of substance use upon treatment initiation, as well as the greatest likelihood for use following discharge from treatment. In terms of the timing, female patients who experienced violence at various time points (i.e. before and after 18 years of age) displayed the greatest severity of substance use, but patients who experienced violence after 18 years of age had the highest probability of substance use following discharge from treatment. Conclusions/Importance: Clinicians should collect information related to these important details as treatment protocols are developed, and as patients are connected to aftercare services to minimize post-treatment substance use.     

Domains and Perceived Benefits of Treatment Among Patients With and Without Co-Occurring Disorders in Inpatient Substance Use Treatment

Objective: Persons with substance use disorders often have comorbid psychiatric problems, and treating all problem domains is important for treatment success and recovery. This study examined reported interventions provided to patients as well as patients’ reports of domains of help received, perceived areas of greatest benefit, and satisfaction with substance use disorder treatment. We also compared patients with co-occurring disorders and patients with only substance use disorders to see whether there were significant differences across groups on these measures. Methods: Patients receiving inpatient substance use treatment at clinics in Norway were recruited for the study; 85 completed a cross-sectional survey prior to discharge. Treatment personnel also completed a separate survey and gathered information from patient charts. Results: The most frequently provided treatment interventions involved improving relationships with family and important others, applied relaxation, psychodynamic therapy, cognitive behavior therapy, and motivational interviewing. Patients reported receiving the most help in domains of relapse prevention, physical health, daily functioning, relationships with people, psychological health, and self-esteem. They benefited most from physical activities, support from co-patients, group therapy, counseling, and assessment/treatment of psychological health. Patients with co-occurring disorders were given more exposure therapy, motivational interviewing, and cognitive behavior therapy interventions than those without comorbidity. Patients with co-occurring disorders self-reported receiving more help with self-esteem and coping with psychiatric symptoms and benefiting more from interventions involving psychological health, acute help, and social situations. Conclusions: Patients perceived psychological and physical health as important areas for improvement. There were differences between patients with co-occurring disorders and those with substance use disorders only in several measures. It is important to acknowledge that patients with substance use disorders and co-occurring mental problems are heterogeneous groups with unique but overlapping needs.     

Substance Use Among Victimized Women on Probation and Parole

Victimized women within the criminal justice system are an important group and understanding their substance use is critical. Substance use was examined among 406 victimized women on probation and parole in an urban community from 2010 to 2013. Ninety-three percent reported lifetime use of an illicit substance, whereas 58% and 45% reported use of at least one illicit substance in the past 2 years and 12 months, respectively. Among probationers, having been in a controlled environment was associated with a higher prevalence of illicit substance use as compared to parolees. Implications for practice, policy, and future research are discussed.     

Treatment Motivation and Therapeutic Engagement in Prison-Based Substance Use Treatment

Abstract

Studies of community-based substance use treatment show that motivation for treatment is critical for clients becoming therapeutically engaged. Little research, however, has been conducted on therapeutic engagement in corrections-based substance use treatment. The current study examines the association between internal treatment motivation and therapeutic engagement for a sample of 220 male substance-using offenders enrolled in a corrections-based treatment program. Findings showed that problem recognition and desire for help were associated with cognitive indicators of therapeutic engagement, specifically confidence in and commitment to treatment. Increased focus on internal motivation for treatment may lead to more effective treatment for substance-using offenders. Pretreatment motivational interventions therefore are recommended for substance-using offenders with low internal motivation for treatment.     

The Relation Between Moment-to-Moment Mindful Attention and Anxiety Among Young Adults in Substance Use Treatment

Background: A growing body of research has examined the intersection of mindfulness and substance use, and a large body of research has examined the relation between mindfulness and anxiety. Unfortunately, no research has been conducted on the relation between mindfulness and anxiety symptoms among young adults (i.e., 18–25 years old) in treatment for substance use. The purpose of the current study was to examine the relation between one facet of mindfulness, moment-to-moment attention, and anxiety (panic and generalized anxiety) among young adults in treatment for substance use. Methods: Preexisting patient records from a residential substance use treatment center for young adults were reviewed (N = 148). Patient records were examined from May 2012 to August 2013, which represented all young adult patients admitted to the residential treatment facility during this time. Results: Findings demonstrated that moment-to-moment mindful attention was associated with symptoms of panic disorder and generalized anxiety disorder even after controlling for gender, age, education, alcohol use, drug use, and the shared variance in generalized and panic symptoms. There were no gender differences in moment-to-moment mindful attention. Conclusions: These findings provide preliminary evidence that moment-to-moment mindful attention is associated with panic and generalized anxiety in young adults in substance use treatment. Combined with previous research on mindfulness-based interventions among adults in substance use treatment, research should examine the efficacy of mindfulness-based interventions for young adults in substance use treatment.     

Associations Between Proactive and Reactive Subtypes of Aggression and Lifetime Substance Use in a Sample of Predominantly Hispanic Adolescents

The current study evaluated the link between proactive (goal-oriented) and reactive (behavior in response to a perceived threat) aggression and lifetime alcohol, tobacco, and marijuana use in a sample of 152 predominantly Hispanic (94.7%) high school students. Furthermore, the impact of neighborhood violence and gender invariance on these associations were examined. Findings suggested unique associations between proactive, not reactive, aggression and use of all three substances. No significant interactions between the aggression subtypes and neighborhood violence were evident, and no gender differences emerged. Findings suggest targeting proactive aggression for the prevention of substance use for both males and females.     

Informed Assent Recall Among Adolescents in Substance Use Disorder Treatment Research

ABSTRACT

Evidence suggests that vulnerable populations such as substance users, those involved in the criminal justice system, and those with cognitive deficits often fail to recall information regarding the informed assent process. This study investigated correlates of assent quiz errors (AQE) among adolescents enrolling in a substance use disorder treatment study. Method: Adolescents (ages 13 to 19) entering substance use treatment completed a standard informed consent procedure to participate in a longitudinal research study, followed by a brief six-item assent quiz. Results: Informed assent quiz errors were lower in this study relative to those observed in the adult literature. Being male and having lower treatment resistance was associated with making an AQE. Both days of marijuana use and days spent in the criminal justice system were associated with AQE. Hyperactivity-impulsivity approached significance (p = .057) but was not a correlate of AQE. Conclusion: Those collecting assent should be aware that heavily using males involved in the criminal justice system are prone to make more errors, and should use procedures such as assent quizzes to enhance their understanding of study procedures. Future research should investigate the impact of motivation and consider using experimental designs to test adolescent recall of study procedures under various assenting conditions.     

Chronic Physical Health Problems Moderate Changes in Depression and Substance Use Among Dual Diagnosed Individuals During and After Treatment

Background: Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness. Objectives: We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment. Methods: Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use. Results: Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use. Conclusions: Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes.     

Substance Use Disorders and Employability Among Welfare Recipients

The 2006 welfare reform legislation (Deficit Reduction Act of 2005) imposed more stringent work requirements and defined the amount of time cash assistance recipients are allowed to be exempted from the work requirement because of substance use treatment. As there is little empirical literature on the employability of substance users, it is difficult to know whether it is realistic to expect individuals with substance use disorders to meet the increased work requirement. Based on a comprehensive evaluation of nearly 9,000 substance-misusing welfare recipients from 2001 to 2007, University Behavioral Associates (UBA) Comprehensive Services Model program in Bronx, New York, found that 60% of recipients were not exempted from the work requirement owing to substance misuse at the outset, and an additional 24% were found nonexempt after 3 months of intensive outpatient treatment coupled with case management, resulting in a total of 84% of the UBA clients not being exempted from the work requirement because of substance misuse by Day 90. UBA also found that 25% of substance-misusing clients were able to obtain employment, and most successfully retained those jobs over the course of 6 months. These findings are discussed in relation to the new law's work requirements and the issue of the employability of substance misusers. Finally, the value of case management in serving this hard-to-engage population is 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.     

Emotion Regulation Outcomes and Preliminary Feasibility Evidence From a Mindfulness Intervention for Adolescent Substance Use

Based on the evidence that emotion regulation difficulties underpin many mental health struggles during adolescence, including substance use disorders (SUDs), we focused on distress tolerance as a particularly salient mechanism of action for bolstering emotion regulation outcomes for adolescents in early SUD recovery. Mindfulness-based interventions are effective in improving distress tolerance through teaching skills to reduce individuals’ perceived stress or feelings of crisis and increasing a sense of agency and self-regulatory efficacy. The aim of the present study was to improve emotion regulation outcomes in the student body of a recovery high school (N = 27) through six weeks of mindfulness intervention content delivered in a small-group format. Thus, we tested feasibility through recruitment and retention rates and examined preliminary efficacy outcomes from two, randomized mindfulness intervention conditions, and used a comparison group of students without an SUD diagnosis (N = 29) sampled from the community. Results indicate significant post-intervention impacts on recovery students’ depression symptomology and on two separate measures of impulsivity (t(22) = 2.358, p?<?.05; t(20)?=?2.358, p?<?.05; t(17)?=?3.979, p?<?.01, respectively), although no significant differences between intervention condition were noted. Findings from the current study echo similar studies with comparable samples. Implications for the dosage and approach of group-format mindfulness interventions for adolescent samples are discussed.     

Racial and Ethnic Differences in Substance Use Diagnoses,Comorbid Psychiatric Disorders,and Treatment Initiation among HIV-Positive and HIV-Negative Women in an Integrated Health Plan

Access to substance use disorder (SUD) treatment is a critical issue for women with HIV. This study examined differences in SUD diagnoses, comorbid psychiatric diagnoses, and predictors of SUD treatment initiation among a diverse sample of HIV-positive women (n = 228) and a demographically similar cohort of HIV-negative women (n = 693). Diagnoses and service utilization data were obtained from electronic health records of members of a large integrated healthcare system in Northern California. HIV-positive women were less likely to initiate SUD treatment. Significant racial/ethnic differences were found among both HIV-positive and HIV-negative women with respect to SUD diagnosis type and diagnosis of comorbid psychiatric disorders. Among the HIV-negative women, rates of SUD treatment initiation were lower for black women than for white or Latina women. Multivariable logistic regression models showed that alcohol, cannabis, and opiate diagnoses were predictive of SUD treatment initiation for both cohorts, while amphetamine diagnoses, comorbid depressive disorder, and being white or Latina were predictive of SUD treatment initiation for HIV-negative, but not HIV-positive, women. Findings suggest that clinicians need to be aware of differences in substances of abuse, comorbid psychiatric disorders, and to consider the demographic and social factors that may contribute to differences in SUD treatment initiation among HIV-positive and HIV-negative women.     

Women and Substance Use in India and Bangladesh

Given the feminization of the HIV epidemic in India and Bangladesh, understanding substance-use-related concerns among women is important for effective HIV prevention. This review is based on published research, reports (2000–2005), and primary data from treatment centers for drug-using women. We identify four main themes: (a) opioid use and injecting drug use in women, (b) alcohol use in sex work settings, (c) sexual transmission of HIV from male-injecting drug users (IDUs) to their regular female sex partners, and (d) sexual violence among female partners of substance-using men. We urge for focused HIV prevention interventions targeting substance-using women and female sex partners of male substance users to reduce vulnerability.     

Examining Potential Substance Use Disorders Among Former Interscholastic Athletes

Background: Despite numerous studies examining the association between competitive sports participation and substance use behaviors among adolescents and young adults, the use of standardized measures to assess potential substance use disorders has been largely neglected. The objective of this study was to examine if past involvement in interscholastic sports (competitive school-sponsored sports) was associated with potential substance use disorders in young adulthood. Methods: Data for this study were taken from the Student Life Survey (SLS). A total of 3442 young adults participated in the SLS during the spring semester in 2013, with 74% of males and 71% of females indicating participation in interscholastic sport during high school. Results: Respondents who participated in interscholastic sports during high school had higher odds of positive screens for potential alcohol use disorders when compared with their peers who did not participate in interscholastic sports. No association was detected between interscholastic sports participation and potential drug abuse disorders. Moreover, previous involvement in certain types of sports was found to be associated with positive screens for potential alcohol use disorders (i.e., crew and football) and positive screens for potential drug abuse disorders (i.e., lacrosse) among the sample of young adults. Conclusions: School and community sport organizations should be aware of the potential link between sports participation and potential substance use disorders, and may consider brief substance use screeners during yearly physicals to monitor potential substance use problems among athletes.