Alcohol Outcome Expectancies and Regrettable Drinking-Related Social Behaviors.

AIMS: Research has shown that alcohol outcome expectancies are predictive of heavy alcohol consumption, which can lead to risky behavior. The purpose of the present study was to assess the incidence of various low-risk social behaviors while drinking among college students. Such social behaviors may later be regretted (referred to as regrettable social behaviors) and include electronic and in-person communications. METHODS: College students (N = 236) completed measures of alcohol outcome expectancies and regrettable social behaviors. RESULTS: Regrettable social behaviors were reported by 66.1% of participants, suggesting that they may occur at a much higher rate than more serious drinking-related consequences (e.g., drinking and driving, violence, etc.). Expectancies for social facilitation predicted regrettable social behavior. Further, this relationship was mediated by amount of alcohol consumed. CONCLUSION: Given the high incidence, regrettable social behaviors may be effective targets in alcohol prevention programming.

Impulsivity, expectancies, and evaluations of expected outcomes as predictors of alcohol use and related problems.

BACKGROUND: While the association between outcome expectancies and drinking is well documented, few studies have examined whether evaluations of expected outcomes (outcome evaluations) moderate that association. OBJECTIVES: The present study tested the hypotheses that outcome evaluations moderate the outcome expectancy-drinking association and that outcome expectancies mediate the association between impulsive personality and drinking. METHODS: College students (N = 201; 55.5% female) enrolled in a mid-sized metropolitan university completed measures assessing outcome expectancies and evaluations, alcohol consumption, and drinking-related problems. RESULTS: Consistent with study hypotheses, expectation of negative outcomes predicted lower levels of drinking, but only when these outcomes were evaluated as highly aversive. However, impulsivity was found to be a far stronger predictor of both drinking and related problems than were outcome expectancies or evaluations. CONCLUSION: The association between negative expectancy and drinking was moderated by negative evaluation, such that individuals who both expected that negative outcomes were likely to occur and who judged such outcomes as highly undesirable consumed significantly fewer drinks per week. Impulsivity was found to be a strong predictor of both alcohol consumption and alcohol-related problems.

Increasing Attendance in Addiction Treatment With Limited Resources: A Narrative Review.

Treatment nonattendance frequently compromises client outcomes in psychosocial addiction treatment services. However, there is limited literature on strategies that increase attendance and retention without a significant resource burden on clinician or organization. This review of 13 studies describes strategies that do not financially reward clients for attendance or require more than 1 day of training/supervision to implement. These strategies are as follows: role induction; pretreatment written or verbal contact; short message service and telephone reminders; and contracting, prompting, and reinforcement. There is some evidence that role induction strategies can increase attendance in early treatment, with stronger evidence for a more intensive approach. Short message service and telephone reminders show a consistent positive impact on early attendance, although the relationship may weaken over time and for individuals with more complex needs (ie, high impulsivity). The strategy: contracting, prompting, and reinforcement shows promising findings, particularly in the first 3 months of treatment. There is considerable variability in study designs, interventions, and sample sizes-future research should more precisely identify relationships between outcomes and the "active ingredients" in each strategy. However, preliminary evidence suggests that some low clinician/organization-burden strategies increase treatment attendance and retention. The mechanisms underpinning these strategies may overlap with therapeutic engagement theories (eg, outcome expectations, common-factors model). Although these interventions have small to moderate effect sizes, their relative simplicity and low cost increase the likelihood of being implemented at a broad scale, amplifying their benefits.

A comparison of attitudes toward opioid agonist treatment among short-term buprenorphine patients.

BACKGROUND: Obtaining data on attitudes toward buprenorphine and methadone of opioid-dependent individuals in the United States may help fashion approaches to increase treatment entry and improve patient outcomes. OBJECTIVES: This secondary analysis study compared attitudes toward methadone and buprenorphine of opioid-dependent adults entering short-term buprenorphine treatment (BT) with opioid-dependent adults who are either entering methadone maintenance treatment or not entering treatment. METHODS: The 417 participants included 132 individuals entering short-term BT, 191 individuals entering methadone maintenance, and 94 individuals not seeking treatment. Participants were administered an Attitudes toward Methadone scale and its companion Attitudes toward Buprenorphine scale. Demographic characteristics for the three groups were compared using χ(2) tests of independence and one-way analysis of variance. A repeated-measures multivariate analysis of variance with planned contrasts was used to compare mean attitude scores among the groups. RESULTS: Participants entering BT had significantly more positive attitudes toward buprenorphine than toward methadone (p < .001) and more positive attitudes toward BT than methadone-treatment (MT) participants and out-of-treatment (OT) participants (p < .001). In addition, BT participants had less positive attitudes toward methadone than participants entering MT (p < .001). CONCLUSIONS: Participants had a clear preference for a particular medication. Offering a choice of medications to OT individuals might enhance their likelihood of entering treatment. Treatment programs should offer a choice of medications when possible to new patients, and future comparative effectiveness research should incorporate patient preferences into clinical trials. SCIENTIFIC SIGNIFICANCE: These data contribute to our understanding of why people seek or do not seek effective pharmacotherapy for opioid addiction.

Predictors of nonmedical use of prescription stimulants.

College students across the U.S. engage in nonmedical use of prescription stimulants (NMUPS) at increasing rates. While it has been found that use is frequently motivated by a belief that stimulants will act as a study aid, little is known about predictors of NMUPS. The present study addressed impulsivity, outcome expectancies, and evaluations of expected outcomes as predictors of NMUPS in a sample of 206 college students at a mid-Atlantic university. Approximately 26.1% of students endorsed past year NMUPS. Results indicated an increased likelihood of self-reported NMUPS was associated with increases in lack of premeditation, sensation seeking, positive expectancies and positive evaluations. Moreover, the extent to which participants believed that potential negative consequences were more severe was associated with a decreased likelihood of NMUPS. The current study suggests that impulsive personality, outcome expectancies, and evaluations of expected outcomes are important predictors of NMUPS among college students. Future research should consider other potential predictors of NMUPS in order to inform the development of prevention strategies.

Brief vs. extended buprenorphine detoxification in a community treatment program: engagement and short-term outcomes.

BACKGROUND: Despite evidence supporting the efficacy of buprenorphine relative to established detoxification agents such as clonidine, little research has examined: 1) how best to implement buprenorphine detoxification in outpatient settings; and 2) whether extending the length of buprenorphine detoxification improves treatment engagement and outcomes. OBJECTIVES: The current study examined the impact on 1) successful detoxification completion; 2) transition to longer-term treatment; and 3) treatment engagement of two different length opioid detoxifications using buprenorphine. METHODS: The study compared data obtained from two consecutive studies of early treatment engagement strategies. In one study (n = 364), opioid-addicted participants entered treatment through a Brief (5-day) buprenorphine detoxification. In the other study (n = 146), participants entered treatment through an Extended (i.e., 30-day) buprenorphine detoxification. RESULTS: Results indicated a greater likelihood of successful completion and of transition among participants who received the Extended as compared to the Brief detoxification. Extended detoxification participants attended more counseling sessions and submitted fewer drug-positive urine specimens during the first 30 days of treatment, inclusive of detoxification, than did Brief detoxification participants. CONCLUSIONS: Results demonstrate that longer periods of detoxification improve participant engagement in treatment and early treatment outcomes. SCIENTIFIC SIGNIFICANCE: Current findings demonstrate the feasibility of implementing an extended buprenorphine detoxification within a community-based treatment clinic.

Collaborative Behavioral Management for Drug-Involved Parolees: Rationale and Design of the Step'n Out Study.

This article describes the rationale, study design, and implementation for the Step'n Out study of the Criminal Justice Drug Abuse Treatment Studies. Step'n Out tests the relative effectiveness of collaborative behavioral management of drug-involved parolees. Collaborative behavioral management integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and deliver contingent reinforcement of behaviors consistent with treatment objectives. The Step'n Out study will randomize 450 drug-involved parolees to collaborative behavioral management or usual parole. Follow-up at 3-and 9-months will assess primary outcomes of rearrest, crime and drug use. If collaborative behavioral management is effective, its wider adoption could improve the outcomes of community reentry of drug-involved ex-offenders.

Impact of role induction on long-term drug treatment outcomes.

In prior research, Katz et al. found that role induction (RI) improved engagement for substance dependent clients relative to standard outpatient treatment orientation. The current study replicates and extends these findings to an examination of long-term outcomes. Substance dependent clients entering outpatient drug-free treatment (N = 353) were randomly assigned to RI or to Standard (ST) orientation followed by routine clinic treatment. Measures of employment, crime, and substance use were collected at intake and at six- and 12-months post-intake. Controlling for baseline differences in substance use, results partially replicated our earlier findings of better engagement for RI, as compared to ST participants; more RI than ST participants attended at least one post-orientation counselling session. RI improved 12-month substance use outcome relative to ST. The potential gain in retention and in reduced substance use at follow-up associated with a single RI session, recommend this strategy for further development and study.

Role induction: a method for enhancing early retention in outpatient drug-free treatment.

Retention in outpatient drug-free treatment is poor, with many clients terminating prior to receiving therapeutic benefit. This randomized clinical trial compared the impact on retention and drug use of an individual role induction session conducted at intake with the standard group orientation offered at the clinic. Results of interim analyses indicated that participants assigned to role induction (n = 180) were retained for more days, more likely to attend at least one postorientation session, and more satisfied with the treatment program than were those assigned to standard treatment (n = 87). Preliminary results suggest that role induction is a brief technique that shows promise for retaining clients through the critical first 3 months of treatment.

The Community Assessment Inventory--client views of supports to drug abuse treatment.

A measure assessing client views of the community supports available to them was developed and tested with entrants to outpatient drug free treatment. Items for a Community Assessment Inventory (CAI) fell into four areas of potential social support for treatment entry and engagement: (1) partner and/or family with whom living; (2) family living outside the home; (3) friends; and (4) the community itself. Based on 241 study participants, it was found that internal consistency alphas for the four scales ranged between .79 and .88. Both total CAI score and individual scales assessing support from friends and from partner/spouse were found capable of predicting treatment readiness as assessed using the TCU Motivation Scale. Evidence of construct validity was suggested by differences in CAI total score between participants reporting and not reporting involvement in discussions with others regarding crime and regarding drugs. Findings are also provided regarding leisure time activities and social relations of treatment entrants.

Evaluation of a group-based substance abuse treatment program for adolescents.

The effectiveness of adolescent substance abuse treatment has been repeatedly demonstrated, but specific treatment approaches have rarely been sufficiently documented to permit replication. This study evaluated the effectiveness of a manual-guided, outpatient, group-based treatment program for adolescents (N = 194) who were mild-to-moderate substance abusers. In addition to evaluating the group-based treatment model, the study was designed to compare the effectiveness of two approaches to preparing youth to engage in treatment, whereby adolescents received one of two types of treatment induction, either motivational interviewing or counseling overview. Self-reported pretreatment substance use and criminal behaviors were compared with these behaviors 6 and 12 months following treatment entry using a General Linear Mixed Model analytic approach that controlled for the effects of potential confounding variables and examined individual and program factors that might explain treatment response. Participants significantly reduced marijuana use at 6 months, and these reductions were largely sustained at 12 months. No changes in alcohol use or criminal involvement were obtained. Further examination of marijuana use indicated differential treatment response based on participants' emotional abuse history, family satisfaction, school adjustment, and pretreatment substance use frequency. This treatment approach appears promising for marijuana-abusing youth.

Abstinence incentive effects in a short-term outpatient detoxification program.

Despite being widely available, outpatient detoxification has limited efficacy as a stand-alone treatment. This study examined whether abstinence-contingent incentives would improve outcomes for patients entering outpatient opiate detoxification. Participants (N = 211) received a 100 US dollars voucher on the last day of detoxification either contingent on opiate and cocaine abstinence or noncontingently. Urine samples were collected at intake, on Wednesday, Friday (the last day of detoxification), and the following Monday. Among contingent-voucher participants, 31% were drug-free on Friday compared with 18% of noncontingent controls (Z = 2.4, p < .05). Few (12-13%) participants tested negative on Monday. Results support the ability of vouchers to produce modest improvements in abstinence initiation rates during brief detoxification but suggest that additional interventions are needed to sustain improvements.

Voucher reinforcement for heroin and cocaine abstinence in an outpatient drug-free program.

This study examined an abstinence-contingent voucher incentive program in opiate-dependent clients enrolled in outpatient drug-free (nonmethadone) treatment. Study participants were referred from local detoxification programs and randomly assigned to voucher (n = 29) or no-voucher (n = 23) conditions. Both groups received intensive cognitive-behavioral counseling; those in the voucher condition could earn up to $1,087.50 over 3 months for submitting urines negative for both opiates and cocaine. Voucher versus no-voucher groups did not differ significantly on mean days retained in treatment (35.9 vs. 39.3 days), mean number of opiate- and cocaine-negative urines submitted (8.3 vs. 6.2), longest duration of continuous abstinence (16.8 vs. 12.1 days), or percentage of participants abstinent for 4 weeks (20.7% voucher vs. 9% no voucher). Possible reasons for negative findings are discussed. Findings suggest that voucher programs must be better tailored to the clinical population and behavioral targets being addressed.

The brief abstinence test: effects of continued incentive availability on cocaine abstinence.

This study compared the effects of 4 voucher incentive conditions of a brief abstinence test on continuous cocaine abstinence. In 3 conditions, cocaine-abusing methadone patients could earn $100 for 2 days of cocaine abstinence; 2 of these conditions offered, on either a continuous or interrupted schedule, an additional $300 for evidence of sustained abstinence over the next 9 days. In the 4th condition, no incentives were available. In incentive conditions, 70-80% of patients initiated abstinence, compared with 48% in the no-incentive condition. Both continuing reinforcement conditions produced higher rates of sustained abstinence than the single and no-voucher conditions. The study confirmed the utility of quantitative urine-testing methods combined with high valued incentives to promote cocaine abstinence initiation in methadone maintenance patients.

Single- versus dual-drug target: effects in a brief abstinence incentive procedure.

The number of drugs targeted may have an important influence on the ability of drug abusers to abstain during motivational incentive procedures. The authors investigated outcomes in methadone maintenance patients (n = 58), who had evidence of both opiate and cocaine use, when continuous abstinence from cocaine only (single target) or from both cocaine and heroin (dual target) was required to earn US dollars 200 in voucher incentives over a 4-day period. Study patients were equally likely to initiate and sustain abstinence from cocaine under the single- versus the dual-drug target. They were more likely to initiate opiate abstinence under the dual-target condition, demonstrating sensitivity to reinforcer effects. Results suggest that adding a second drug target does not impede short-term cocaine abstinence initiation.

Effects of gender and motivations on perceptions of nonmedical use of prescription stimulants.

OBJECTIVE: This study examined the impact on college students' perceptions of nonmedical use of prescription stimulants (NMUPS) of motivation for use and gender. PARTICIPANTS: Participants were college students (N=695) from 2 universities in different regions of the United States. METHODS: Participants read a vignette describing a college student who used a prescription stimulant for a nonmedical purpose and rated their perception of that individual using a semantic differential. A 2 (participant gender) by 2 (gender of the individual described in the vignette) by 3 (motive for use: get high, study, lose weight) design was used. RESULTS: The male who used a stimulant to study was rated significantly less negatively than if he used the stimulant to get high. NMUPS as a study aid was viewed the least negatively overall. CONCLUSIONS: Findings suggest that gender does not, whereas motivation for use does, impact students' perceptions of NMUPS.

Impulsivity links reward and threat sensitivities to substance use: a functional model.

This study used structural equations modeling and undergraduate student data to examine the effects of reward and threat sensitivities on substance use, along with the extent to which impulsivity explained these effects. Our results suggest that impulsivity may translate inversely related reward and threat sensitivities into substance use, completely mediate the effect between threat sensitivity and substance use, and partially mediate the effect between reward sensitivity and substance use. Our results also suggest that individuals with a combination of higher levels on both reward and threat sensitivities may be most impulsive and vulnerable to heightened substance use. We discuss implications for research at the interface of personality and substance use and also substance abuse prevention and treatment.

Transitioning opioid-dependent patients from detoxification to long-term treatment: efficacy of intensive role induction.

Despite findings that opioid detoxification serves little more than a palliative function, few patients who enter detoxification subsequently transition to long-term treatment. The current study evaluated intensive role induction (IRI), a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment. IRI was delivered either alone or combined with case management (IRI+CM) to determine the capacity of each condition to enhance transition and engagement in long-term treatment of detoxification patients. Study participants were 240 individuals admitted to a 30-day buprenorphine detoxification delivered at a publicly funded outpatient drug treatment clinic. Following clinic intake, participants were randomly assigned to IRI, IRI+CM, or standard clinic treatment (ST). Outcomes were assessed in terms of adherence and satisfaction with the detoxification program, detoxification completion, and transition and retention in treatment following detoxification. Participants who received IRI and IRI+CM attended more counseling sessions during detoxification than those who received ST (both ps<.001). IRI, but not IRI+CM participants, were more likely to complete detoxification (p=.017), rated their counselors more favorably (p=.01), and were retained in long-term treatment for more days following detoxification (p=.005), than ST participants. The current study demonstrated that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.

Cognitive ability as a factor in engagement in drug abuse treatment.

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability.