Substance Abuse Treatment

TEZ11913Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2019.Kaynakça (s. 52-58) var.xii, 60 s. : res. (bzs. rnk.), tablo ; 29 cm.Tüm dünyada olduğu gibi ülkemizde de yetişkinler ve gençler arasında sentetik kannabinoid kullanımında hızlı bir artış görülmektedir. Bu maddeler dünyada “Spice, K2, Super Nova, Yucatan Fire, Diamond ve Cloud 9?, ülkemizde de “Bonzai, Jamaica ve Jamaica Gold” gibi çeşitli adlarla internette satılmaktadır. Yasal düzenlemelerden kaçınmak için ambalaj paketleri üzerinde “Tütsü”, “insan kullanımı için değildir” veya “bitkisel terapi ürünleri” şeklinde ibareler bulunmaktadır. Sentetik kannabinoidler fonksiyonel olarak tetrahidrokannabinol (THC)’e benzemekte ve sigara gibi içildiğinde esrarın etkisini taklit etmektedir. Ancak, bu ürünlerin çoğu THC’den daha güçlüdür ve daha büyük bir sağlık riski oluşturmaktadır. Bu tez çalışmasında; Ege Üniversitesi Madde Bağımlılığı, Toksikoloji ve İlaç Bilimleri (BATI) Enstitüsü’nde analiz edilen ve analiz sonucu negati...

Aims-To assess the effect of brief motivational enhancement intervention postpartum alcohol use. Design-Single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10-30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum. Setting-Large, urban, obstetrics clinic. Participants-Women who were ≥18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n=165) or intervention (n=165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group.

Background Oral health is integral to overall well-being and Universal Health Coverage (UHC), yet disparities in dental service utilization (DSU) persist in low-and middle-income countries (LMICs). Socioeconomic status (SES) and educational inequalities exacerbate barriers to accessing essential dental services, limiting UHC progress. Therefore, this study assessed absolute and relative socioeconomic and education-based inequalities in DSU in Bangladesh, Bhutan, and Nepal and identified demographic and socioeconomic determinants. Methods Data from the most recent WHO STEPwise approach to surveillance (STEPS) surveys in Bangladesh (2017-18), Bhutan (2019), and Nepal (2019) were analyzed. Inequalities in DSU were assessed using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). The determinants of DSU were assessed using mixed-effects binary logistic regression models. Results Ever DSU was highest in Bhutan (48.8%), followed by Bangladesh (29.1%) and Nepal (5.6%). Socioeconomic inequalities in DSU were significant in Bhutan, with higher utilization concentrated among the wealthiest groups (SII: 33.9, 95% confidence interval [CI]: 27.8-40.1 for ever DSU; RII: 2.11, 95% CI: 1.86-2.39), while education-based disparities favored individuals with higher education (RII: 1.85, 95% CI: 1.62-2.13). In Bangladesh, education-based inequalities in DSU were evident only in urban areas (SII: 17.3, 95% CI: 8.2-26.5; RII: 1.69, 95% CI: 1.38-2.06). In Nepal, DSU was uniformly low across all groups, with minimal or even reversed socioeconomic and educational disparities. Independent determinants of DSU, identified through adjusted mixed-effects logistic regression, included older age, higher education, and urban residence in Bangladesh; higher education and SES in Bhutan; and female sex in Nepal. Conclusions DSU was limited across Bangladesh, Bhutan, and Nepal, with the lowest rates observed in Nepal. Substantial socioeconomic and educational inequalities in DSU were evident in Bhutan and Bangladesh. These

In an effort to integrate substance abuse treatment at trauma centers, the American College of Surgeons has mandated alcohol screening and brief intervention (SBI). Few investigations have assessed trauma center inpatients for comorbidities that may impact the effectiveness of SBI that exclusively focuses on alcohol. Randomly selected SBI eligible acute care medical inpatients (N=878) were evaluated for alcohol, illegal drugs, and symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) using electronic medical record, toxicology, and self-report assessments; 79% of all patients had one or more alcohol, illegal drug, or PTSD symptom comorbidity. Over 70% of patients receiving alcohol SBI (n=166) demonstrated one or more illegal drug or PTSD symptom comorbidity. A majority of trauma center inpatients have comorbidities that may impact the effectiveness of mandated alcohol SBI. Investigations that realistically capture, account for, and intervene upon these common comorbid presentations are required to inform the iterative development of College policy targeting integrated substance abuse treatment at trauma centers.

* In this report we use the widely-recognized term "syringe exchange program" (SEP) as an abbreviated reference to the vast range of programmatic approaches to the provision of new and sterile syringes to injection drug users (IDUs). Some SEPs operate as an exchange, requiring participants to return used syringes and exchange them for new, sterile ones. Many other SEPs, however, function more as a "syringe distribution" program, providing participants with as many sterile syringes as requested, without condition. In addition, some SEPs are self-contained, freestanding programs, while in other instances the SEP function of a program may be secondary to its primary mission (e.g., a shelter for the homeless whose services include sterile syringe exchange/distribution). Throughout this report, we intend "SEP" to capture the entirety of this programmatic variation. Elsewhere this service carries the name needle/syringe program (NSP) or sterile syringe provision (SSP). Although these labels may signify more accurately the substantive function of SEPs, they enjoy more limited usage in the United States.

Purpose -The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring body-weight and decreasing binge/vomit symptoms among 52 individuals (aged 16+) with eating disorders. It was hypothesized that day treatment would result in improvements across all variables measured. Design/methodology/approach -In a within-participants design, demographic, physiological and psychological measures were taken on admission to and at discharge from a DTP in the UK. Quantitative outcomes were analysed. Findings -In total, 40 participants were considered to have received an adequate dose of the DTP, having completed at least four weeks on the programme. Analyses supported all hypotheses, with all improvements being statistically significant. Large effect sizes were evident for all outcomes across the whole sample other than shape concern attitudes and weight concern attitudes, which reduced with moderate and moderate-tolarge effect sizes, respectively. Originality/value -This study provides new evidence of the effectiveness of day treatment in reducing psychosocial impairment resulting from eating disorder psychopathology. It remains for future research to determine whether these outcomes can be sustained over the longer term.

Purpose– The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring body-weight and decreasing binge/vomit symptoms among 52 individuals (aged 16+) with eating disorders. It was hypothesized that day treatment would result in improvements across all variables measured.Design/methodology/approach– In a within-participants design, demographic, physiological and psychological measures were taken on admission to and at discharge from a DTP in the UK. Quantitative outcomes were analysed.Findings– In total, 40 participants were considered to have received an adequate dose of the DTP, having completed at least four weeks on the programme. Analyses supported all hypotheses, with all improvements being statistically significant. Large effect sizes were evident for all outcomes across the whole sample other than shape concern attitudes and weight concern attitudes, which reduced with moder...

Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life -and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In-and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare co-ordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life -and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In-and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare co-ordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Introduction: Second-generation antipsychotics (SGA) are associated with misuse potential; however, there are limited data describing the prevalence and characteristics of this misuse. This study was conducted to identify and describe quetiapine and olanzapine misuse among US adults. Methods: This cross-sectional survey questionnaire was conducted online using Qualtrics research panel aggregator service to identify a quota-based sample of respondents constructed to mimic the general US population aged 18 to 59 years, with regards to gender, geographic region, ethnicity, income, and education level. Misuse was defined as using quetiapine or olanzapine for treatment outside of medical recommendations, for reasons other than a diagnosed medical condition, or obtaining without a prescription. A logistic regression was used to identify factors associated with SGA misuse, incorporating relevant covariates. Results: Among 1843 total respondents, 229 had a history of quetiapine or olanzapine use. Misuse prevalence was estimated to be 6.3% (95% CI: 5.2, 7.5%). Although most respondents (;70%) using quetiapine or olanzapine reported doing so to treat a diagnosed medical condition, those misusing them most commonly did so because prescribed medications failed to relieve their symptoms. Misuse was commonly reported (;50%) concomitantly with opioids, benzodiazepines, or alcohol. Factors significantly associated with quetiapine or olanzapine misuse included employment (OR ¼ 4.64), previous substance use disorder treatment (OR ¼ 2.48), and having riskier attitudes toward medication misuse (OR ¼ 1.23). Discussion: Misuse of quetiapine and olanzapine, while fairly limited in prevalence, appears to be primarily associated with under-treatment of existing medical conditions.

Although spousal support predicts the success of a smoker's cessation efforts, "social-support" interventions based on teaching partners better support skills have had consistently disappointing results. We examined the potential utility of a family consultation (FAMCON) intervention based on family-systems principles in a treatment-development project involving 20 couples in which one partner (the primary smoker) continued to smoke despite having or being at significant risk for heart or lung disease. The 50% rate of stable abstinence achieved by primary smokers over at least 6 months exceeds benchmark success rates reported in the literature for other comparably intensive interventions, suggesting that a couple-focused intervention different in concept and format from social-support interventions tested in the past may hold promise for health-compromised smokers. The FAMCON approach appeared particularly well suited to female smokers and smokers whose partner also smoked-two subgroups at high risk for relapse.

What is Drug Addiction? Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances. The categories of substance abuse and substance dependence with a single category: substance use disorder, with three subclassifications-mild,moderate, and severe. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risky use and pharmacological criteria (i.e., tolerance and withdrawal). A problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress with 10 or 11 diagnostic criteria (depending on the substance) occurring within a 12-month period. Those who have two or three criteria are considered to have a "mild" disorder, four or five is considered "moderate," and six or more symptoms, "severe.

Pastoral Counselors are well-positioned to lead and advocate for increased opportunities for individual, group, and culturally sensitive counseling for Latinx families in the United States. The Latinx population is the fastest-growing minority population in the United States, with almost one in five people being Latinx, currently. This population faces many challenges and obstacles in obtaining mental health services, especially those that are culturally sensitive. These obstacles include limited health insurance, language barriers, childcare and transportation needs, religious preferences, gender role considerations, prison sentencing bias, racism, and financial and educational challenges. As pastoral counselors, we have a responsibility to create culturally sensitive counseling services to serve this growing population in thoughtful, caring, and spiritually inclusive groups. The Bible and Jesus call us to care for the marginalized in any society, and we have a responsibility to increase our awareness of how Latinx people could be better served in the United States.

What is Drug Addiction? Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances. The categories of substance abuse and substance dependence with a single category: substance use disorder, with three subclassifications-mild,moderate, and severe. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risky use and pharmacological criteria (i.e., tolerance and withdrawal). A problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress with 10 or 11 diagnostic criteria (depending on the substance) occurring within a 12-month period. Those who have two or three criteria are considered to have a "mild" disorder, four or five is considered "moderate," and six or more symptoms, "severe.

Purpose: Substance abuse among university students is a global public health concern, largely due to their vulnerability during the transition to independence, with serious implications for personal growth and national development. The goal of the study was to investigate the contributing factors to substance abuse among students at Kaimosi Friends University (KAFU).

Methodology: A descriptive cross-sectional design was used where a total of 350 undergraduate students were selected through stratified random sampling, and data were collected in May 2025 using a structured questionnaire adapted from NACADA. Analysis was conducted thematically and using SPSS version 25. Ethical approval was obtained from MMUST, and confidentiality and informed consent were upheld.

Findings: The study revealed that social media was the main source of information on substance abuse. A significant portion of students (65%) frequently experienced stress or anxiety, with 50% using substances as a coping mechanism. Academic pressure, perceived unfair grading, and personal issues were major stressors. Peer influence was notable, with 55% having friends who used drugs and 45.1% reporting peer encouragement to try substances, although some emphasized personal choice. Easy access to substances (60%) and media glorification of drug use (50%) were also reported. Family influences played a role, with 55.1% citing substance use by fathers or brothers and others noting emotional neglect and family challenges. The study concluded that substance abuse at KAFU is driven by a complex set of interconnected factors.

Unique Contribution to Theory, Practice and Policy: It recommends strengthening mental health services, promoting peer education, advocating for family engagement, controlling substance availability, and creating a supportive academic environment to mitigate the issue.

Network therapy (NT) employs family members and/or friends to support compliance with an addiction treatment carried out in office practice. This study was designed to ascertain whether NT is a useful psychosocial adjunct, relative to a control treatment, for achieving diminished illicit heroin use for patients on buprenorphine maintenance. Patients agreeing to randomization to either NT (N = 33) or medication management (MM, N = 33) were inducted onto short-term buprenorphine maintenance and then tapered to zero dose. NT resulted in significantly more urine toxicologies negative for opioids than MM (65% vs. 45%) and more NT than MM patients (50% vs. 23%) experienced a positive outcome relative to secondary heroin use by the end of treatment. The use of NT in office practice may therefore improve the effectiveness of eliminating secondary heroin use during buprenorphine maintenance. It may also be useful in enhancing compliance with an addiction treatment regimen in other contexts.

Drug addiction In Kashmir has escalated to alarming levels and is spreading like a wildfire, significantly affecting communities, individuals and families. This paper explores and examines the scope of the problem, identification of the underlying causes of drug abuse, the societal consequences, and government's efforts to address the crisis. It highlights the rising statistics particularly the rising number of young  involved in substance abuse. The paper discusses the Nasha Mukt Bharat Abhiyan, the challenges posed by socioeconomic factors, limited awareness, and easy accessibility of drugs. Furthermore, it evaluates the role of awareness campaigns , rehabilitation facilities , law enforcement, and the Involvement of non-governmental organisations (NGOs) in combating the Issue. The paper concludes with proposed approach, such as youth engagement programs, sustained government action, the expansion of rehabilitation centers, and mitigation of this growing crisis and provides hope for a drug-free future in the region.

1 Correspondencia: Francisca López-Torrecillas. Dpto. Personalidad, Evaluación y Tratamiento Psicológico. Facultad de Psicología. Universidad de Granada, Campus Universitario de Cartuja s/n, 18071 Granada. E-mail: fcalopez@platon.urg.es ... Psicopatología Clínica, Legal y ...

The representation of migrants and ethnic minorities in drug treatment: a prospective study Ethnic diversity within drug treatment has not often been researched in Belgium. This study explores the representation of migrants and ethnic minorities in Belgian drug treatment, followed by the examination of different barriers that migrants and ethnic minorities encounter during various phases of treatment (i.e. intake, referral, treatment, discharge) and several kinds of treatment (day-care centres, medical and social care centres, crisis centres, therapeutic communities).

Present research aims to study the level of Addiction of Social Networking among Introvert and Extrovert personality type students. The sample of the study was selected by Stratified Random Sampling method which includes 200 junior college students of Aurangabad city studying in Junior College. Tool used for the research was "Introversion Extroversion Inventory" by Dr. P.F Aziz and Dr. (Mrs.) Rekha Gupta. Research finding reveals that the level of addiction of Social networking among Introvert students is Average. Also the level of addiction of Social networking among Extrovert students is Average. Further finding reveals that there is No Significant difference in the addiction level of Social Networking among Introvert and Extrovert Students.

Despite the existing scanty data on patterns of drug abuse in specific groups in the Nigerian communities due to the tendency of changing patterns in illicit drug use with various alarming reports on same points to the need to constantly update information on the use of drugs among Nigerian adolescents. This was a cross sectional, descriptive study on the prevalence of substance use amongst adolescents. A total number of 400 Senior Secondary Schools 1,2,3 students from two selected schools in Kagoro Chiefdom of Kaura local government area in Kaduna State (Nigeria) were randomly administered with a pre-coded four sections (socio-demographic information, drug awareness and use, attitude of the students to drug abuse and practice of substance abuse). Out of a total of 400 respondents, which males constituted 75% and females 25% of substance users. 89.20% were aware of substance use and 10.80 % were not aware. Substances used were alcohol (52.58%), analgesics (33.7%), marijuana (2.59%),...

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden.

Aims-The aim of this study is to describe the change in erectile dysfunction (ED) symptoms in the first 12 weeks of outpatient buprenorphine therapy. Background-Erectile dysfunction is highly prevalent in men who use illicit opioids when compared with the general population. To date, no study has examined ED symptoms over time in men initiating buprenorphine therapy for opioid dependence. Methods-A randomized, double blind, placebo-controlled trial was conducted to determine whether escitalopram treatment of depressive symptoms begun 1 week prior to buprenorphine induction would improve treatment retention. Male patients completed the International Index of Erectile Function scale at baseline prior to induction and monthly thereafter. A score of 25 or less on the erectile function domain (range 1-30) is considered indicative of erectile dysfunction. Findings-A total of 111 male subjects enrolled: mean age 38.5 (± 9.7) years, 80.1% non-Hispanic Caucasian; 67.3% reported heroin as their opioid of choice. Mean IIEF at baseline was 20.4 (± 10.5). At baseline, 44.1% of the entire cohort had erectile dysfunction; among those who identified as sexually active at baseline, 26.1% had ED. Baseline erectile function was inversely and significantly correlated with age (r = -.27, p = .006), but was not associated significantly with race, heroin use, years of opioid use, smoking, or hazardous use of alcohol. Compared to baseline, mean erectile function was significantly improved (p = .001) at 3 months, and sexual desire (p = . 002) improved significantly at both 2-and 3-month assessments. Conclusion-Erectile dysfunction is highly prevalent in depressed males using illicit opioids. Men who remain in buprenorphine treatment for 3 months show improvement in erectile function and sexual desire.

Aims: Our objective was to compare the effectiveness of buprenorphine (BUP) and methadone maintenance treatment in opiate-addicted patients in a clinical nonexperimental setting. Design: We used a naturalistic observational prospective study of 24 months' duration. Setting: Subjects were enrolled and treated at a drug addiction outpatient clinic of the National Health System Local Unit in Milan, Italy. Participants: Two hundred fifty-seven subjects meeting the DSM-IV criteria for opioid dependence and opioid-seeking substitutive pharmacological treatment participated in the study. Intervention: One hundred twenty-one subjects received BUP at a mean daily dose of 11 F 6 mg (median = 8; range = 2-30) for a mean duration of 249 days. One hundred thirty-six subjects received methadone at a mean daily dose of 54 F 29 mg (median = 50; range = 4 -140) for a mean duration of 267 days. Measurements: The main efficacy parameters were treatment retention rates and illicit substance abuse, as assessed by urinalysis. Findings: Retention rates were comparable in both treatment groups, but BUP-treated subjects had significantly lower rates of illicit opiate consumption ( p b .0001). Conclusions: The results confirm that, in a nonexperimental clinical practice setting, BUP is as effective as methadone in the treatment of heroin dependence, with significantly better opiate abuse control, thus possibly allowing longer and more effective treatment programs with reduced relapse rates.

We investigated the mental health, in terms of reported Axis I psychiatric symptoms, of a sample of Romanian Immigrants in Italy, using the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Moreover, we explored the association between psychological distress or specific disorders and a few demographic and cultural variables connected to the immigration process and identified as possible vulnerability/protective factors. Results showed a high frequency of above cutoff scores for Obsessive-compulsive disorder (45.8%, n=49), Psychosis (38.3%, n=41), Somatisation (35.5%, n=38), Generalized Anxiety (32.7%, n=35), PTSD (31.8%, n=34), Major Depression (30.8%, n=33) and Social Phobia (30.8%, n=33). Perceived ethnic discrimination and low language proficiency were identified as important vulnerability factors, predictive of clinical levels of anxiety and depression.

Aims: Alcohol policy effects on alcohol's harms due to others' drinking (AHTO) and contextual factors that may mediate such policy effects have been understudied. This study examines state binge drinking prevalence as a mediator of the relationship between state alcohol policy and socioeconomic environments and individual-level AHTO. Methods: A nationally representative sample of US adults (N

Opioid prescriptions and addiction have made headlines across the world for almost a decade. As policy makers, hospitals, physicians, prisons, pharmaceuticals, etc. dedicate efforts to reduce the death tolls, conduct opioid education, and create new medications to treat pain, there are still many barriers to accessing quality addictions treatment. One of the leading barriers to treatment is transportation and access to quality care. With the increase in telehealth and telemedicine models of care, it was pertinent that addiction medicine joins telehealth on the proper evidence-based platform. With the patent pending telehealth evidence-based addictions model; the platform offers three levels of care (Outpatient, Intensive Outpatient, and Partial Hospitalization), individual, group, and recovery sessions, in-home services, 24/7 treatment access, and medication assisted treatment. This is the first documented telehealth model of addictions treatment. The telehealth model meets some of ...

The central aim of this administrative data analysis was to examine usage of a web-based disease management program designed to provide continuing recovery support to patients discharged from residential drug and alcohol treatment. Tailored clinical content was delivered in a multi-media format over the course of 18 months post-treatment. The program also included access to a recovery coach across the 18 months. Consistent with other disease management programs, program usage decreased over time. A small subsample of patients accessed a large number of program modules in the year following treatment; these patients had significantly higher abstinence rates and consumed less alcohol than patients accessing few or no modules. Regression analyses revealed a significant relationship between the number of modules accessed and substance use outcomes in the year following treatment when controlling for motivation, selfefficacy, and pre-treatment substance use. Limiting the analyses to only the more compliant patients did not reduce the magnitude of these effects. These preliminary results suggest that computerized support programs may be beneficial to patients recently treated for drug and alcohol issues. Methods to increase program engagement need additional study.

Introduction-Research supports the efficacy of both a remedial consent procedure (corrected feedback) and a motivational consent procedure (incentives) for improving recall of informed consent to research. Although these strategies were statistically superior to standard consent, effects were modest and not clinically significant. This study examines a combined incentivized consent and corrected feedback that simplifies the cognitive task and increases motivation to learn consent information. Methods-We randomly assigned 104 individuals consenting to an unrelated host study to a consent as usual (CAU) condition (n = 52) or an incentivized corrected feedback (ICF) condition (n = 52). All participants were told they would be quizzed on their consent recall following their baseline assessment and at 4 monthly follow-ups. ICF participants were also informed that they would earn $5.00 for each correct answer and receive corrected feedback as needed. Results-Quiz scores in the two conditions did not differ at the first administration (p = 0.39, d = 0.2), however ICF scores were significantly higher at each subsequent administration (second : p = 0.003, Cohen's d = 0.6; third: p < 0.0001, d = 1.4; fourth: p < 0.0001, d = 1.6; fifth: p < 0.0001, d = 1.8.) The ICF procedure increased consent recall from 72% to 83%, compared to the CAU condition in which recall decreased from 69% to 59%. This supports the statistical and clinical utility of a combined remedial and motivational consent procedure for enhancing recall of study information and human research protections. Informed consent; research consent; human subjects; participant rights; research protections More than 60 years following the Nuremberg Code 1 , it remains unclear whether the average research participant is truly informed about the nature of their research participation. Results from research in many scientific disciplines indicate that people have poor understanding

This study empirically examined opinions of treatment providers regarding Contingency Management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n =

A key component of drug courts is regular status hearings in which the judge reviews client progress and imposes sanctions or rewards for infractions or achievements; however, little is known about whether drug court clients fully understand the reasons for judicial responses and make clear connections between their behavior and judicially-imposed consequences. Thus, it is reasonable to hypothesize that graphic performance feedback can improve clients' perceptions of procedural justice and increase the likelihood of success. Method-This study examines the feasibility, acceptability, and preliminary efficacy of a visual performance feedback (VPF) procedure designed to improve judge-client communication during status hearings. Seventy-five adult misdemeanor drug court participants were randomized to a VPF (n = 37) or status hearings as usual (AU; n = 38) condition. In the VPF condition, the judge projected and described two graphs for each client (i.e., abstinence rates and treatment attendance for the past two months). Outcomes included feasibility, client and stakeholder acceptability, urinalysis-confirmed abstinence, treatment attendance, perceptions of procedural justice, and duration of client-judge interactions. Results-Findings revealed a high level of judge adherence to the VPF (feasibility), client and stakeholder acceptability of the VPF procedure, and significantly longer client-judge interactions in the VPF condition. No significant differences were observed for client-level efficacy outcomes. Conclusions-Overall, this study demonstrated that providing VPF to drug court clients during judicial status hearings is feasible and acceptable. Future fully-powered trials of the VPF procedure are needed to further examine its efficacy in improving outcomes for drug court clients.

Background Individuals who have substance use disorders may have an elevated risk of suicidality. This study sought to examine the prevalence of, and identify factors associated with, suicidality in adults with opioid use disorder (OUD) initiating office-based buprenorphine treatment. Methods Individuals were eligible to participate if they had OUD and had initiated treatment in the past month. Participants (n = 244) completed a semi-structured interview using the Addiction Severity Index—Lite. Results At baseline, 37.70% of participants reported significant thoughts of suicide over their lifetime and 27.46% reported suicidal attempts over their lifetime. Logistic regression analyses were used to identify predictors of lifetime suicidal thoughts and attempts. A history of physical abuse (OR = 4.31, p &lt; .001), having chronic pain-related conditions (OR = 3.28, p &lt; .001), a history of depression (OR = 3.30, p = .001) or anxiety (OR = 7.47, p = .001), and Latino/a/x ethnicity (OR...

A key component of drug courts is regular status hearings in which the judge reviews client progress and imposes sanctions or rewards for infractions or achievements; however, little is known about whether drug court clients fully understand the reasons for judicial responses and make clear connections between their behavior and judicially imposed consequences. Thus, we hypothesized that providing graphic performance feedback would improve clients&#39; perceptions of procedural justice and increase the likelihood of success. This study examines the feasibility, acceptability, and preliminary efficacy of a visual performance feedback (VPF) procedure designed to improve judge-client communication during status hearings. Seventy-five adult misdemeanor drug court participants were randomized to a VPF (n = 37) or status hearings as usual (n = 38) condition. In the VPF condition, the judge projected and described two graphs for each client (i.e., abstinence rates, treatment attendance for...

Background-This is the first study to systematically manipulate duration of Voucher-Based Reinforcement Therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT. Methods-We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n=62) or Extended (36 weeks; n=68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every two weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week). Results-Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1-24 (5.7 vs 2.7 weeks; p=0.003) and proportionally more abstinence during weeks 24-36 (X 2 =4.57, p=.03, OR=2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p=0.001) and during the last 12 weeks of the study (p < 0.001).

The central aim of this administrative data analysis was to examine usage of a web-based disease management program designed to provide continuing recovery support to patients discharged from residential drug and alcohol treatment. Tailored clinical content was delivered in a multi-media format over the course of 18 months post-treatment. The program also included access to a recovery coach across the 18 months. Consistent with other disease management programs, program usage decreased over time. A small subsample of patients accessed a large number of program modules in the year following treatment; these patients had significantly higher abstinence rates and consumed less alcohol than patients accessing few or no modules. Regression analyses revealed a significant relationship between the number of modules accessed and substance use outcomes in the year following treatment when controlling for motivation, selfefficacy, and pre-treatment substance use. Limiting the analyses to only the more compliant patients did not reduce the magnitude of these effects. These preliminary results suggest that computerized support programs may be beneficial to patients recently treated for drug and alcohol issues. Methods to increase program engagement need additional study.

Objectives-Test whether an adaptive program improves outcomes in drug court by adjusting the schedule of court hearings and clinical case-management sessions pursuant to a priori performance criteria. Methods-Consenting participants in a misdemeanor drug court were randomly assigned to the adaptive program (n = 62) or to a baseline-matching condition (n = 63) in which they attended court hearings based on the results of a criminal risk assessment. Outcome measures were re-arrest rates at 18 months post-entry to the drug court and urine drug test results and structured interview results at 6 and 12 months post-entry. Results-Although previously published analyses revealed significantly fewer positive drug tests for participants in the adaptive condition during the first 18 weeks of drug court, current analyses indicate the effects converged during the ensuing year. Between-group differences in new arrest rates, urine drug test results and self-reported psychosocial problems were small and nonstatistically significant at 6, 12 and 18 months post-entry. A non-significant trend (p = .10) suggests there may have been a small residual impact (Cramer's ν = .15) on new misdemeanor arrests after 18 months. Conclusions-Adaptive programming shows promise for enhancing short-term outcomes in drug courts; however, additional efforts are needed to extend the effects beyond the first 4 to 6 months of enrollment.

This study empirically examined opinions of treatment providers regarding contingency management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched nonparticipating sites (n = 69) within the same nodes of the National Institute of Drug Abuse Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program versus matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions tha...

This study examined the efficacy of corrected feedback for improving consent recall throughout the course of an ongoing longitudinal study. Participants (N = 135) were randomly assigned to either a corrected feedback or a no-feedback control condition. Participants completed a consent quiz 2-weeks after consenting to the host study and at months 1, 2, and 3. The corrected feedback group received corrections to erroneous responses and the no-feedback control group did not. The feedback group displayed significantly greater recall overall and in specific content areas (i.e., procedures, protections, risks/benefits). Results support the use of corrected feedback for improving consent recall.

Alcohol abuse causes significant changes in cognitive functioning. These effects are related to the fact that ethanol and acetaldehyde, its first metabolite, affect the the brain's neurotransmitter systems. Long-term abuse may lead to the dysexecutive syndrome (DES) exhibited through emotional, behavioral and cognitive symptoms. Alcohol has a specific dose-dependent effect on memory that serves as a block of memory consolidation, i.e. transition of the short-term memories to the long-term storage. This effect displays either as reversible amnesias of events from the alcohol abuse period (blackouts), or as an irreversible fixation amnesia within Korsakoff 's syndrome. Refs 34.

This chapter considers conceptual understandings and usage of the
terms gender and sex as well as the complexity of gender/sex entanglement in the context of health equity research focused on transgender, nonbinary, and genderdiverse people and populations. The aim is to outline current challenges and barriers to transgender health equity, to provide a broad overview of research frameworks and approaches in this area, and to address pressing questions about how best to define and operationalize gender, sex, and their entanglement. These terms and concepts require consideration because of their impacts on the design, implementation, and interpretation of research that seeks to advance health justice for transgender people. The frameworks and associated measures most frequently employed rely on distinguishing sex from gender identity to meaningfully include transgender people in research and identify populations for tailored interventions. Attending to gender, sex, and their entanglement in transgender health equity research exposes how biological essentialism is used to oppress transgender people; it also challenges widely accepted approaches to measuring transgender health disparities. It concludes with implications of shifting the paradigm of transgender health equity research and the questions that must be answered to ensure that such a shift is done in a way that promotes health equity and justice.

Drug Courts have demonstrated a reduction in recidivism in comparison to traditional probation programs. Prior studies have not addressed why drug courts are effective from the participants\u27 perspective. This study used focus groups to attempt to understand why the drug court model worked for these offenders when other approaches failed.The results suggest that avoiding jail or prison are the initial impetus to join, but individualized treatment, structure, accountability, and rewards are the factors cited as being most important for success in drug court. Many successful participants had long criminal and addiction histories. This study used eight years of drug court data to examine whether the drug court approach is appropriate for persistent offenders. Persistent offenders were more likely to graduate and had similar rates of new arrests than offenders with less prior involvement in the criminal justice system. Implication for policy makers are discussed

Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on "superiority" designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic

onslaught of drug offenders. The model alcohol offenders have emerged, The Ill. . . crease in the number of drug courts across stands m contr~t ~o ~adl.tz~nal cour~ . the country is staggering. As of 1998, a total of 275 models by combmmg]udlClal supervIsIon drug court programs were in operation, serving an and community-based treatment in an estimated 90,000 offenders (Drug Court Programs effort to change offender behavior. Office, 1998). Moreover, the Drug Court Programs Drawingfrom the enormous gains in Office, Office of Justice Programs (1998) reported knowledge regarding the effective that another 155 are in the planning process, (This .., article is limited to the dedicated drug treatment treatment of offenders, thIs artIcle outlInes rt S .al&#39; d rtth t &#39; d edl &#39; ted . &#39;. cou s. peCl lze cou s a proVl e exp suggestions for focusIng attention on the case management without community-based treattype and quality of treatmen t services. The ment are not discussed.) ...

Ukraine, with a population of 46.2 million, is the second largest country in Europe, with an area of 603 700 km2. It is still recovering from the collapse of the Soviet Union in 1991, following the Soviet stagnation era (since the mid-1960s) and perestroika (from 1986), as well as the 1998 Russian financial crisis and Ukraine&#39;s 2004 Orange Revolution. These events have resulted in high levels of socio-economic disparity, political instability and a degraded healthcare infrastructure. These issues, in addition to traditionally high levels of alcohol consumption, have made binge drinking and alcoholism, among other addictions, major problems in Ukrainian society (Voloshin et al, 2003).

The study develops a novel method to measure System 1 (fast, cue-based, thought-light) smoking frequency as an outcome measure to overcome the limitations of existing measures. It also examines its relationship to System 2 (slow, deliberative) measures. 116 participants met in two sessions set at 48 hours apart. System 2 measure of smoking frequency was measured via self-reported 24-hour smoking frequency. System 1 smoking frequency was measured by observing the number of cigarettes participants carried and asking about the number of cigarette packs consumed between the two sessions. System 2 measure of smoking frequency underestimated System 1 smoking frequency by 47.4%. Results also revealed that System 1 smoking attitudes only predicted the newly developed System 1 smoking frequency significantly, while System 2 smoking attitudes predicted only System 2 smoking frequency significantly. Hence, interventions that modify explicit attitudes (System 2) might have a limited impact on observed (System 1) smoking behaviours.