Judges' Perceptions of Screening, Assessment, Prevention, and Treatment for Substance Use, Mental Health, and HIV among Juveniles on Community Supervision: Results of a National Survey.

Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) National Survey was funded in part to describe the current status of screening, assessment, prevention and treatment for substance use, mental health, and HIV for youth on community supervision within the US juvenile justice system. Surveys were administered to community supervision agencies and their primary behavioral healthcare providers, as well as the juvenile or family court judge with the largest caseload of youth on community supervision. This article presents the findings from the judges' survey. Survey results indicated juvenile and family court judges were open to innovations for improving the court's performance, rated their relationships with collaborators highly, and appreciated the impact of screening, assessment, prevention, and treatment on judicial practices.

Trauma and Morbidities Among Female Detainees in a Large Urban Jail.

Using data from 810 women entering the Department of Women's Justice Services in the Cook County Jail (Chicago) from 2010 to 2013, this study examines patterns of trauma exposure and the relationship between trauma exposure and mental disorders. Female detainees averaged 6.1 (SD = 4.90) types of trauma in their lifetimes, with greater trauma exposure associated with earlier age of trauma onset, more recent trauma exposure, and higher rates of fear for life or injury. Higher rates of trauma exposure were also correlated with higher rates of past-year symptoms of posttraumatic stress disorder as well as other internalizing, externalizing, and substance use disorders. Behavioral health programming for female detainees in jail settings should include more trauma-sensitive mental health and substance use disorder treatments.

A Pilot Study to Examine the Feasibility and Potential Effectiveness of Using Smartphones to Provide Recovery Support for Adolescents.

BACKGROUND: Smartphone applications can potentially provide recovery monitoring and support in real-time, real-life contexts. Study aims included determining feasibility of (a) adolescents completing ecological momentary assessments (EMAs) and utilizing phone-based ecological momentary interventions (EMIs); and (b) using EMA and EMI data to predict substance use in the subsequent week. METHODS: Twenty-nine adolescents were recruited at discharge from residential treatment, regardless of their discharge status or length of stay. During the 6-week pilot, youth were prompted to complete an EMA at 6 random times per day and were provided access to a suite of recovery support EMI. Youth completed 87% of the 5580 EMAs. Based on use in the next 7 days, EMA observations were classified into 3 risk groups: "Current Use" in the past 30 minutes (3% of observations), "Unrecognized Risk" (42%), or "Recognized Risk" (55%). All youth had observations in 2 or more risk groups and 38% in all 3. Youth accessed an EMI on average 162 times each week. RESULTS: Participants were 31% female, 48% African American, 21% Caucasian, 7% Hispanic, and 24% Mixed/Other; average age was 16.6 years. During the 90 days prior to entering treatment, youth reported using alcohol (38%), marijuana (41%), and other drugs (7%). When compared with the "Recognized Risk" group's use in the following week (31%), both the "Unrecognized Risk" (50%, odds ratio [OR]=2.08) and "Current Use" (96%, OR=50.30) groups reported significantly higher rates of use in the next week. When an EMI was accessed 2 or more times within the hour following an EMA, the rate of using during the next week was significantly lower than when EMIs were not accessed (32% vs. 43%, OR=0.62). CONCLUSIONS: Results demonstrate the feasibility of using smartphones for recovery monitoring and support with adolescents, with potential to reduce use.

Beyond bricks and mortar: recent research on substance use disorder recovery management.

Scientific advances in the past 15 years have clearly highlighted the need for recovery management approaches to help individuals sustain recovery from chronic substance use disorders. This article reviews some of the recent findings related to recovery management: (1) continuing care, (2) recovery management checkups, (3) 12-step or mutual aid, and (4) technology-based interventions. The core assumption underlying these approaches is that earlier detection and re-intervention will improve long-term outcomes by minimizing the harmful consequences of the condition and maximizing or promoting opportunities for maintaining healthy levels of functioning in related life domains. Economic analysis is important because it can take a year or longer for such interventions to offset their costs. The article also examines the potential of smartphones and other recent technological developments to facilitate more cost-effective recovery management options.

PREDICTORS OF RECIDIVISM OVER 3 YEARS AMONG SUBSTANCE-USING WOMEN RELEASED FROM JAIL.

This study examines predictors of recidivism over 3 years for 624 women released from a county jail using a comprehensive range of standardized measures derived from gender-responsive and gender-neutral criminogenic recidivism models. Although more than a dozen factors were related to recidivism in the univariate analysis, the multivariate analysis shows that recidivism can be reliably predicted (area under the curve = 0.90) with just four factors: age, no custody of children, substance use frequency, and number of substance problems. Exploratory analysis of women who recidivated in post-release months 1 to 3, 4 to 12, and 13 to 36 revealed that the effects of several variables (age, super optimism, and number of weeks in the jail treatment program) were dependent on the time elapsed since release from jail, whereas others (substance use and custody) had persistent effects over time. These findings support the development of re-entry services tailored for female offenders who address both gender-responsive and gender-neutral criminogenic risk factors.

Economic Costs of a Postrelease Intervention for Incarcerated Female Substance Abusers: Recovery Management Checkups for Women Offenders (RMC-WO).

This study estimates the economic costs of Recovery Management Checkups for Women Offenders (RMC-WO), highlighting the unique mix of services and differential costs between two distinct phases of the intervention. Participants were randomly assigned to quarterly outcome monitoring (OM) only (n=242) or OM plus Recovery Management Checkups (OM-plus-RMC) (n=238). The OM-only condition has a total annual economic cost of $76,010, which equates to $81 quarterly per person. The average cost per OM interview completed is $86. OM-plus-RMC generates a total annual economic cost of $126,717, or $137 quarterly per person. The cost per interview completed is $147 and the cost per intervention session completed is $161. RMC-WO has a relatively modest additional cost compared with the average costs of post-release supervision, which can range from $3.42 ($1,250) per day (year) for probationers to $7.47 ($2,750) per day (year) for parolees. The clinical, economic, and policy implications of incorporating RMC-WO into existing corrections and/or community-based treatment settings are discussed.

Using the Rasch measurement model in psychometric analysis of the Family Effectiveness Measure.

BACKGROUND: Valid assessment of family functioning can play a vital role in optimizing client outcomes. Because family functioning is influenced by family structure, socioeconomic context, and culture, existing measures of family functioning-primarily developed with nuclear, middle-class European American families-may not be valid assessments of families in diverse populations. The Family Effectiveness Measure was developed to address this limitation. OBJECTIVES: The aim of this study was to test the Family Effectiveness Measure with data from a primarily low-income African American convenience sample using the Rasch measurement model. METHODS: A sample of 607 adult women completed the measure. Rasch analysis was used to assess unidimensionality, response category functioning, item fit, person reliability, differential item functioning by race and parental status, and item hierarchy. Criterion-related validity was tested using correlations with five other variables related to family functioning. RESULTS: The Family Effectiveness Measure measures two separate constructs: The Effective Family Functioning construct was a psychometrically sound measure of the target construct that was more efficient because of the deletion of 22 items. The Ineffective Family Functioning construct consisted of 16 of those deleted items but was not as strong psychometrically. Items in both constructs evidenced no differential item functioning by race. Criterion-related validity was supported for both. DISCUSSION: In contrast to the prevailing conceptualization that family functioning is a single construct, assessed by positively and negatively worded items, use of the Rasch analysis suggested the existence of two constructs. Whereas the Effective Family Functioning scale is a strong and efficient measure of family functioning, the Ineffective Family Functioning scale will require additional item development and psychometric testing.

Using mobile phone technology to provide recovery support for women offenders.

BACKGROUND: Mobile technology holds promise as a recovery tool for people with substance use disorders. However, some populations who may benefit the most may not have access to or experience with mobile phones. Incarcerated women represent a group at high risk for recidivism and relapse to substance abuse. Cost-effective mechanisms must be in place to support their recovery upon release. This study explores using mobile technology as a recovery management tool for women offenders residing in the community following release from jail. SUBJECTS AND METHODS: This study surveyed 325 minority women offenders with substance use disorders to determine whether or not they use cell phones, their comfort with texting and search features, and the social networks that they access from mobile phones. RESULTS: We found that 83% of survey subjects had cell phones; 30% of those were smartphones. Seventy-seven percent of the women reported access to supportive friends, and 88% had close family members they contacted regularly using mobile technology. Results indicated that most of the women were comfortable using a mobile phone, although the majority of them had prepaid minutes rather than plans, and most did currently use smartphones or have the capability to download applications or access social networks via their phones. Most women reported that they would be comfortable using a mobile phone to text, e-mail, and answer surveys. CONCLUSIONS: The high rate of adoption of mobile technology by women offenders makes them a promising target for recovery support delivered via mobile phone.

Access to Services for Pregnant People With Opioid Use Disorder in Jails in the United States.

The aim of this study was to assess the availability of medications for opioid use disorder (MOUD) and other services for pregnant people in jails in counties heavily impacted by opioid overdose in the United States. Counties were selected based on absolute number and population rate of opioid-overdose fatalities. Structured interviews were completed with representatives from 174 jails that house pregnant women. Descriptive statistics examine MOUD availability and differences in service provision and community-level characteristics based on MOUD availability. Most jails in the study sample (84.5%) had MOUD available for pregnant people; however, less than half of these jails ensured continuity of care. Jails without MOUD available are more likely to provide non-MOUD substance use services. These jails are more often located in smaller, rural counties in the Midwest and have higher rates of White residents and lower rates of Hispanic and African American residents. Gaps in MOUD availability in jails and continuity of care violate medical guidelines for treatment of pregnant patients with opioid use disorder and increase their risk of overdose. In addition, there are disparities across communities in access to MOUD for pregnant people in jails.

Time-varying effect modeling with intensive longitudinal data: Examining dynamic links among craving, affect, self-efficacy and substance use during addiction recovery.

Time-varying effect modeling (TVEM), a statistical technique for modeling dynamic patterns of change, presents new opportunities to study biobehavioral health processes. TVEM is particularly useful when applied to intensive longitudinal data (ILD) because it permits highly flexible modeling of outcomes over continuous time, as well as of associations between variables and moderation effects. TVEM coupled with ILD is ideal for the study of addiction. This article provides a general overview of using TVEM, particularly when applied to ILD, to better enable addiction scientists to conduct novel analyses that are important to realizing the dynamics of addiction-related processes. It presents an empirical example using ecological momentary assessment data from participants throughout their first 90 days of addiction recovery to estimate the (1) associations between morning craving and same-day recovery outcomes, (2) association between morning positive and negative affect and same-day recovery outcomes and (3) time-varying moderation effects of affect on the association between morning craving and recovery outcomes. We provide a didactic overview in implementing and interpreting the aims and results, including equations, computer syntax and reference resources. Our results highlight how affect operates as both a time-varying risk and protective factor on recovery outcomes, particularly when considered in combination with experiences of craving (i.e. dynamic moderation). We conclude by discussing our results, recent innovations and future directions of TVEM for advancing addiction science, including how 'time' can be operationalized to probe new research questions.

Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings.

BACKGROUND AND AIMS: Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment. DESIGN: A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC-PC) (n = 134) with follow-up assessments at 3 months post-baseline. SETTING: Four federally qualified health centers in the United States serving low-income populations. PARTICIPANTS: Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19-53]) who were referred to SUD treatment after SBIRT. INTERVENTIONS: SBIRT alone (control condition) compared with SBIRT + RMC-PC (experimental condition). MEASUREMENT: The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self-report. FINDINGS: At 3-month follow-up, those assigned to SBIRT + RMC-PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = -0.25) and cannabis (19.49, vs 28.6; d = -0.20). CONCLUSIONS: Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.

A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results.

BACKGROUND: Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC-PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. METHODS: Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC-PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post-enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self-report. RESULTS: Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC-PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC-PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = -0.20) and cannabis use (d = -0.20), and lower combined substance use frequency (d = -0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC-PC on days of abstinence. CONCLUSION: This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer-term treatment and substance use outcomes.

Results of a national survey of substance use treatment services for youth under community supervision.

BACKGROUND: Despite the heightened risk for substance use (SU) among youth in the juvenile justice system, many do not receive the treatment that they need. OBJECTIVES: The purpose of this study is to examine the extent to which youth under community supervision by juvenile justice agencies receive community-based SU services and the factors associated with access to such services. METHODS: Data are from a nationally representative sample of Community Supervision (CS) agencies and their primary behavioral health (BH) partners. Surveys were completed by 192 CS and 271 BH agencies. RESULTS: SU services are more often available through BH than CS for all treatment modalities. EBPs are more likely to be used by BH than by CS. Co-location of services occurs most often in communities with fewer treatment options and is associated with higher interagency collaboration. Youth are more likely to receive services in communities with higher EBP use, which mediates the relationship between the availability of SU treatment modalities and the proportion of youth served. CONCLUSION: Findings identify opportunities to strengthen community systems and improve linkage to care.

Scoping review of interventions to link individuals to substance use services at discharge from jail.

INTRODUCTION: Individuals with substance use disorders (SUD) must be linked to community-based SUD treatment and other services upon their release from jail, given their high service needs and risks for relapse, recidivism, and opioid-related overdose following release. METHOD: This scoping review identified 14 studies (28 affiliated publications) that used experimental or quasi-experimental designs to evaluate jail re-entry interventions for individuals with SUD. The team coded intervention components, study characteristics, and study outcomes based on a service continuum for treatment linkage and retention and for post-release substance use and criminal justice outcomes. RESULTS: This review included 4 randomized controlled trials (RCT) for linkage to treatment with medications for opioid use disorder (MOUD); 4 RCTs and 4 quasi-experimental studies for linkage to non-specific SUD treatment; and 2 RCTs for linkage to HIV + SUD services. Most studies (9/14) used case management and/or peer or patient navigation as the core intervention; 2 studies provided medical management for MOUD induction and/or facilitated referral to MOUD in the community; and 3 studies used motivational-based linkage interventions. A qualitative analysis of study outcomes found evidence to support the effectiveness of a diverse range of interventions to link individuals to community-based SUD treatment, MOUD, and other services at re-entry, but limited support for intervention effects on longer-term outcomes, including treatment retention, medication adherence, recidivism, and substance use. CONCLUSION: Future controlled trials and implementation studies should help to unpack and examine core components of jail re-entry interventions and their successful implementation to enhance treatment retention and improve post-release outcomes.

Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic.

BACKGROUND: The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS: The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS: The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS: The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.

Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S.

BACKGROUND: Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD "best practices" in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources. RESULTS: Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff. CONCLUSIONS: Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release.

Surviving drug addiction: the effect of treatment and abstinence on mortality.

OBJECTIVES: We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables. METHODS: We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality. RESULTS: Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months was related to a decreased likelihood of abstinence, suggesting that treatment timing is significant. CONCLUSIONS: Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time.

Improving retention across the OUD service cascade upon reentry from jail using Recovery Management Checkups-Adaptive (RMC-A) experiment.

Incarcerated individuals with opioid use disorders (OUD) should be linked to community-based treatment with medications for opioid use disorder (MOUD) upon their release, as well as to services that provide support for their ongoing recovery. The RMC-A experiment will test an adapted version of the evidence-based Recovery Management Checkups (RMC), which provides treatment linkage, support for retention, and re-linkage as indicated at quarterly checkups. A total of 750 male and female individuals will be recruited from 5 county jails in Illinois and randomly assigned to 1 of 3 groups at release from jail: a) Monitoring and Treatment Referral (MTR); b) quarterly RMC (RMC-Q); or c) RMC-A, which adjusts the frequency and intensity of checkups based on the individual's assessed need for treatment at each checkup. Measurement includes quarterly research follow-up assessments for 2 years, urine tests, and records checks (treatment, mortality, recidivism). The study aims to evaluate: (1) the direct effects of RMC-Q/RMC-A on MOUD treatment initiation, engagement, retention, and re-linkage; (2) the indirect effects of RMC-Q/RMC-A (via months of MOUD) on public health outcomes (days of opioid use, OUD symptoms, quality of life, cost of health care utilization); (3) the indirect effects of RMC-Q/RMC-A (via months of MOUD and public health outcomes) on public safety outcomes (illegal activity, re-arrest, re-incarceration, cost of crime); and (4) the incremental costs and cost-effectiveness of MTR vs. RMC-Q vs. RMC-A on public health and public safety outcomes. This experiment will determine whether the adapted RMC model improves the overall effectiveness and cost-effectiveness of the fixed quarterly RMC.

Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centers with SBIRT services.

BACKGROUND: Brief treatment (BT) can be an effective, short-term, and low-cost treatment option for many people who misuse alcohol and drugs. However, inconsistent implementation is suggested to result in BT that often looks and potentially costs similar to regular outpatient care. Prior research is also rife with inconsistent operationalizations regarding the measurement of BT received by patients. As such, there is a need to more explicitly identify and document variations in BT practice. METHODS: A qualitative investigation of BT in four Federally Qualified Health Centers (FQHC) was undertaken as a sub study of a larger clinical trial. Researchers interviewed 12 staff (administrators and clinicians) involved in BT oversight, referral, or delivery within the four FQHCs. Data were analyzed following an inductive approach guided by the primary research questions. RESULTS: Findings demonstrate considerable differences in how BT was conceptualized and implemented within the FQHCs. This included a variety of ways in which BT was presented and described to patients that likely impacts how they perceive the BT they receive, including potentially not understanding they received substance use disorder treatment at all. CONCLUSIONS: The findings raise questions regarding the validity of prior research, demonstrating more objective definitions of BT and fidelity checklists are needed to ensure integrity of results. Future work in this area should seek to understand BT as practiced among a larger sample of providers and the direct experiences and perspectives of patients. There is also a need for more consistent implementation, quality assurance guidelines, and standardized stage of change assessments to aid practitioners.