Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study.

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals.

Factor Structure of the Brief Addiction Monitor in a Non-Veteran Substance Use Disorder Outpatient Treatment Sample.

Background: The Brief Addiction Monitor (BAM) was developed as a comprehensive substance use disorder (SUD) outcome metric to fill a gap in quality measurement. Research to date has only examined the psychometric performance of this measure in veteran SUD populations. The purpose of the current research is to examine the factor structure and validity in a non-veteran SUD population. Methods: Non-veteran patients admitted to a SUD treatment program (N = 2,227) completed BAM at intake. After confirmatory factor analysis (CFA) was performed to evaluate the measurement model validity of previously defined latent structures, exploratory factor analysis (EFA) was used to assess the factor structure and psychometric properties of the BAM within the full sample and within subgroups, specifically racial, referral source (mandated vs. not), and primary SUD diagnosis. Results: Exploratory factor analyses in the full sample supported a 4-factor model (representing Stressors, Alcohol Use, Risk Factors, and Protective Factors) derived from 13 items. Subsequent EFAs conducted separately in each subgroup revealed variability in the number of resulting factors and pattern matrices. The internal consistency also varied among factors and between subgroups; in general, reliability was greatest for the Alcohol Use scale and either poor or questionable for pattern matrices resulting in scales reflecting Risk or Protective Factors. Conclusion: Findings from our study suggest that the BAM might not be a reliable and valid instrument for all populations. More research is needed to develop and validate tools that are clinically meaningful and allow clinicians to track recovery progress over time.

Validation of the substance abuse screener in American Sign Language (SAS--ASL).

OBJECTIVE: The study objectives were to adapt and validate a substance use disorder (SUD) screening instrument in American Sign Language (ASL) to be used to identify those deaf individuals who have a high probability of having an SUD. The goal was to develop an accurate screening instrument that balanced sensitivity and specificity while imposing minimal response burden on respondents. METHOD: A sample of 198 deaf participants in behavioral health, family social service, and educational programs that provide specialized services for deaf individuals was interviewed to obtain clinical diagnoses for current (past 12 months) SUD according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and completed a 42-item version of the Substance Abuse Screener in American Sign Language (SAS-ASL). We used Rasch and discriminant function analyses to reduce the instrument to 28 items, then divided the sample into a development subsample, used to formulate a scoring routine, and a validation subsample to assess correspondence with clinical diagnoses. To provide validation data on the shortened SAS-ASL, an independent sample of 62 respondents was diagnosed and completed the screener. RESULTS: The SAS-ASL instrument demonstrated good person reliability (.85), sensitivity (.90), and specificity (.84) in the primary validation sample, and 100% screening accuracy with 62 respondents in the second validation sample. CONCLUSION: The SAS-ASL provides a standardized SUD screening for the deaf population. The adaptability of the instrument to electronic administration lends itself to a continuum of technologically supported services for a high-risk population that is disenfranchised for most community-based behavioral health services.