Foster children in care due to parental incarceration: A national longitudinal study.

Using national child welfare data, we created a longitudinal data set (N = 142,143) to examine a subset of foster children (7%) who entered care due to parental incarceration (PI). Spanning FY 2005-2017, the dataset allowed us to compare children who entered care due to PI to children entering for other reasons. We found children of incarcerated parents were younger (median age of 4 vs. 6), more often White (47% vs. 42%), and less often Black (15% vs. 20%) when compared to other foster children. Parental use of alcohol (12% v. 6%) and drugs (42% v. 26%) were both more common among children who entered due to PI compared to those who entered for other reasons. Our understanding of this population is limited by inadequate data collection procedures that fail to account for societal changes created by mass incarceration. Our data indicate that investments in substance use treatment could decrease the number of children entering care.

High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders.

BACKGROUND: Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation. METHODS: We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation. RESULTS: High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit. CONCLUSION: As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

Racial-ethnic disparities across substance use disorder treatment settings: Sources of treatment insurance, socioeconomic correlates and clinical features.

Aim: Contrary to expectations, studies of racial-ethnic disparities in substance use disorder (SUD) treatment frequently uncover minority-majority parity in access and utilization of services. What accounts for the anomaly? To answer the question, this study explores racial-ethnic differences in the odds of utilization of SUD treatment in varied settings (e.g., the criminal justice system, private doctor's office, etc.), adjusting for sources of treatment insurance, socioeconomic correlates of treatment (e.g., employment, income, education), as well as clients' clinical features (e.g., type of substance abuse/dependence, co-morbidities, health status). Methods: Data were compiled from the National Survey of Drug Use and Health (NSDUH) dataset, 2002-2014. The sample consisted of respondents with a past year diagnosis of a substance use disorder, who also reported having received treatment (n = 6,207). Data were pooled to maximize subgroup analyses. Weight- and design- adjusted logistic regressions were use to analyze factors predicting SUD treatment source. Results: Blacks were more likely than Whites to receive treatment through the criminal justice system and Whites more likely than Blacks and Latinx to receive treatment at a doctor's office. Blacks were also more likely than Whites to receive treatment through inpatient/outpatient rehabilitation, before adjustments but not afterwards. Discussion: In this study we show that even after adjusting for mechanisms expected to shape pathways from race-ethnicity to SUD treatment sites, significant racial-ethnic disparities persist. This fills an important gap in the literature in that disparities research has not explicitly modeled racial-ethnic variation across the full range of SUD treatment sites.

Interprofessional collaboration associated with frequency of life-saving links to HIV continuum of care services in the urban environment of Newark, New Jersey.

BACKGROUND: HIV continuum of care has been used as a strategy to reduce HIV transmission rates, with timely engagement in HIV testing being the first and most critical step. This study examines interprofessional-collaboration (IPC) after controlling for agency/ provider demographics, provider training and self-efficacy as a significant predictor of how frequently HIV service providers link their clients to HIV testing. METHODS: Multilevel binary logistic regression analysis was conducted to examine the effects of IPC on links to HIV testing while controlling for demographic and agency information, provider training, and standardized measures of providers' feelings, attitudes, and opinions about IPC. Cross-sectional data from 142 providers in 13 agencies offering treatment and prevention services for HIV and substance-use disorders were collected via a survey. RESULTS: Those who scored higher on the IPC scale reported significantly higher rates of linkages to HIV testing. Compared to the null model (i.e., no predictor model), the final multilevel binary logistic regression model showed a significantly improved likelihood of linkage to HIV testing by 11.4%, p. < .05. The final model correctly classified 90.2% of links to HIV testing. Providers in agencies with smaller budgets and in agencies offering substance use disorder services were more likely to link clients to HIV testing. Younger providers who received HIV training were also more likely to link clients to HIV testing. CONCLUSIONS: Findings suggest IPC training as a potential strategy to improve linkages to HIV testing for clients at risk for HIV infection. Future research is recommended to identify specific areas of IPC that might have differential effects on links to HIV testing.

Counselor turnover in substance use disorder treatment research: Observations from one multisite trial.

Background: Counselor workforce turnover is a critical area of concern for substance use disorder (SUD) treatment providers and researchers. To facilitate the adoption and implementation of innovative treatments, attention must be paid to how SUD treatment workforce issues affect the implementation of clinical effectiveness research. Multiple variables have been shown to relate to turnover, yet reasons that are specific to conducting research have not been systematically assessed. Methods: In a randomized clinical trial testing a sexual risk reduction counselor training intervention, 69 counselors at 4 outpatient SUD treatment sites (2 opioid treatment programs [OTPs], 2 psychosocial) were enrolled and randomized to 1 of 2 training conditions (Standard vs. Enhanced). Study counselor and agency turnover rates were calculated. Agency context and policies that impacted research participation were examined. Results: Study turnover rates for enrolled counselors were substantial, ranging from 33% to 74% over approximately a 2-year active study period. Study counselor turnover was significantly greater at outpatient psychosocial programs versus OTPs. Counselor turnover did not differ due to demographic or training condition assignment. Leaving agency employment was the most typical reason for study counselor turnover. Conclusions: This secondary analysis used data from a multisite study with frontline counselors to provide a qualitative description of challenges faced when conducting effectiveness research in SUD treatment settings. That counselors may be both subjects and deliverers of the interventions studied in clinical trials, with implications for differential impact on study implementation, is highlighted. We offer suggestions for researchers seeking to implement effectiveness research in SUD clinical service settings.

The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts.

Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.

Substance Use Telemedicine Retention and Outcomes.

Evidence-based SUD treatments are available, yet utilization remains low demonstrating the need to utilize alternative treatment delivery methods. We assess the effectiveness of an SUD treatment program delivered via telemedicine and in-person mode over 12 months. 40% of the intervention group remained engaged and 46% remained opioid free.

Facilitators and Barriers to Implementing HIV Testing and Pre-Exposure Prophylaxis in Substance Use Treatment Programs: Perspectives of Non-medical Staff.

BACKGROUND: People with substance use disorder (SUD) are at increased risk of HIV infection. HIV testing and pre-exposure prophylaxis (PrEP) are evidence-based practices to prevent HIV infection, yet these approaches are not regularly provided in SUD treatment programs. To address this evidence-to-practice gap, this study aimed to identify facilitators and barriers to implementing PrEP services in SUD treatment programs from the perspective of non-medical staff and administrators. METHODS: Semi-structured interviews were conducted from February to June 2022 with non-medical staff (N = 10) and administrators (N = 11) from 3 academic and 8 community-based SUD treatment programs in Philadelphia. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Qualitative descriptive techniques were used to examine interview data and identify key facilitators and barriers, which were grouped within CFIR domains and constructs. RESULTS: Of the 11 SUD treatment programs, 5 provided PrEP services. Most interviewees at programs without PrEP services reported high levels of receptivity to implementing PrEP and identified leadership engagement as a key determinant, but several lacked comfort with PrEP counseling. Inner setting facilitators included compatibility with workflows (eg, intake assessments), alignment with cultures of holistic care, and programs' longstanding community trust. Inner setting barriers included limited time to discuss PrEP, insufficient resources and staff (eg, phlebotomy), perception of clients' HIV risk, and lower prioritization of HIV prevention versus other services. Intervention facilitators included robust evidence and addressing costs through grants and drug pricing programs, and barriers included the time needed to initiate PrEP, loss to follow-up, and HIV stigma. CONCLUSIONS: Successful implementation of HIV testing and PrEP in SUD treatment programs requires addressing multi-level barriers. Including perspectives of non-medical staff and administrators is important for implementation. Potential strategies include supporting organizational networks, leveraging peer specialists' expertise, and packaging PrEP to better meet client priorities and needs.

Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic.

BACKGROUND: Telehealth has the potential to improve health care access for patients but it has been underused and understudied for examining patients with substance use disorders (SUD). VA began distributing video-enabled tablets to veterans with access barriers in 2016 to facilitate participation in home-based telehealth and expanded this program in 2020 due to the coronavirus COVID-19 pandemic. OBJECTIVE: Examine the impact of VA's video-enabled telehealth tablets on mental health services for patients diagnosed with SUD. METHODS: This study included VA patients who had ≥1 mental health visit in the calendar year 2019 and a documented diagnosis of SUD. Using difference-in-differences and event study designs, we compared outcomes for SUD-diagnosed patients who received a video-enabled tablet from VA between March 15th, 2020 and December 31st, 2021 and SUD-diagnosed patients who never received VA tablets, 10 months before and after tablet-issuance. Outcomes included monthly frequency of SUD psychotherapy visits, SUD specialty group therapy visits and SUD specialty individual outpatient visits. We examined changes in video visits and changes in visits across all modalities of care (video, phone, and in-person). Regression models adjusted for several covariates such as age, sex, rurality, race, ethnicity, physical and mental health chronic conditions, and broadband coverage in patients' residential zip-code. RESULTS: The cohort included 21,684 SUD-diagnosed tablet-recipients and 267,873 SUD-diagnosed non-recipients. VA's video-enabled tablets were associated with increases in video visits for SUD psychotherapy (+3.5 visits/year), SUD group therapy (+2.1 visits/year) and SUD individual outpatient visits (+1 visit/year), translating to increases in visits across all modalities (in-person, phone and video): increase of 18 % for SUD psychotherapy (+1.9 visits/year), 10 % for SUD specialty group therapy (+0.5 visit/year), and 4 % for SUD specialty individual outpatient treatment (+0.5 visit/year). CONCLUSIONS: VA's distribution of video-enabled tablets during the COVID-19 pandemic were associated with higher engagement with video-based services for SUD care among patients diagnosed with SUD, translating to modest increases in total visits across in-person, phone and video modalities. Distribution of video-enabled devices can offer patients critical continuity of SUD therapy, particularly in scenarios where they have heightened barriers to in-person care.

Moral Injury in the Context of Substance Use Disorders: a Narrative Review.

The rate of annual drug overdose deaths in the USA recently topped 100,000 (CDC/National Center for Health Statistics 2021), an illustration of the critical need to prevent and treat substance use disorders (SUDs). As a complex, chronic medical condition, substance use treatment requires psychological, emotional, and spiritual interventions along with medical care. The recently developed concept of moral injury has been increasingly studied and applied to military service members who experience conflict between the expectations or survival needs of combat and their moral values. This review explores whether moral injury, along with the related emotional, psychological, and spiritual symptoms, can also develop in the context of SUDs. This review identified 5 manuscripts related to moral injury arising in a substance use context. These studies were small in sample size and qualitative in nature but did indicate the presence of moral injury within the context of substance use. Further studies are needed to better understand and treat moral injury related to SUDs. A conceptualization of how moral injury may arise in the context of substance use is presented here. It is suggested that the activation of the primitive dopaminergic reward system causes a potential conflict between the experienced need for the addictive substance and a person's moral code or values. The moral injury resulting from this collision may impact treatment and recovery.

Association between Prescribers' Perceptions of the Utilization of Medication for Opioid Use Disorder and Opioid Dependence Treatability.

BACKGROUND: Medication for opioid use disorder (MOUD) has been proven to be effective, yet the perceptions or beliefs of prescribers of MOUD may have a substantial impact on their prescribing and dispensing of MOUD and their patients' accessibility and utilization of MOUD services. We examined the associations of the perceptions of medical and pharmacy professionals regarding MOUD with sociodemographic characteristics, personal experiences with substance use disorders, and perceptions of opioid treatment. METHOD: Data were collected via telephone or online survey from March to August 2021, in Texas, to assess medical and pharmacy professionals' perceptions of MOUD. Our sample included 542 participants who completed the survey. A multinomial logistic regression analysis was conducted to assess perceptions of MOUD, its use, and their correlates. RESULTS: The participants had a mean age of 35 years (SD = 7.13) and had worked, on average, 6.90 years (SD = 5.37) in their current positions. The majority of the participants were males (50.93%) and medical professionals (82.01%). More than one third of the participants believed MOUD did not lead to abstinence or recovery (36.16%). Those who had personal experiences with a substance use disorder were more likely to believe that MOUD could be a replacement drug for previously misused substance(s) (RRR = 2.06, 95% CI = 1.19, 3.59) and that MOUD did not lead to abstinence or recovery (RRR = 2.34, 95% CI = 1.40, 3.91). However, the risk ratio values were lower for those who believed that a stigma against MOUD was a barrier for patients initiating and adhering to MOUD (MOUD is a replacement drug for previously misused substances (initiation RRR = 0.43, 95% CI = 0.19, 0.93 and adhering RRR = 0.30, 95% CI = 0.13, 0.71) or MOUD does not lead to abstinence or recovery (initiation RRR = 0.26, 95% CI = 0.13, 0.54 and adhering RRR = 0.36, 95% CI = 0.17, 0.78)). The various perceptions of the utilization of MOUD were not statistically different between medical and pharmacy professionals. CONCLUSION: Perceptions, experience with substance use disorder, and stigma against the utilization of MOUD influenced negative perceptions about MOUD. An innovative strategy is needed to improve medical and pharmacy professionals' perceptions of MOUD, while efforts are being made to promote the use of MOUD for patients with opioid use disorders.

Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial.

BACKGROUND: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively. OBJECTIVE: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change. METHODS: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation. RESULTS: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects. CONCLUSIONS: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184.

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.

Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders.

Introduction: Almost no previous studies explored the relationship between adverse childhood experiences (ACEs) and overdose risk for individuals with substance use disorders (SUDs), and these did not focus on a Latinx population. This study examined the relationship between ACEs, reporting PTSD symptoms, and lifetime experience of overdose in a sample (n = 149) of primarily Latinx adults seeking treatment for substance use disorder (SUD). Materials and methods: Administrative data from an integrated behavioral health and primary care treatment system in Massachusetts were analyzed through bivariate analyses and multiple logistic regression. The final model examined the association between self-reported ACEs, PTSD screen, and lifetime drug overdose. We controlled for demographic characteristics and heroin use and explored alternative measure specifications. Results: ACEs scores were high with 58% having experienced 4+ ACEs. Female gender was associated with a 24% higher ACE score than male gender (p < 0.01). In the multiple logistic model each additional ACE was associated with 1.3 times greater odds of overdose (p < 0.01). Those reporting heroin use had 8.8 times greater odds of reporting overdose compared to those reporting no heroin use (p < 0.001). Gender, age, Puerto Rican ethnicity, years of cocaine use, receiving public assistance income, and a positive initial PTSD screen were not significant. Findings were robust in sensitivity testing. Discussion and conclusion: We found the number of ACEs and reported heroin use significantly and positively associated with self-report of overdose in both bivariate and multiple logistic regression analyses. In contrast, a positive initial screen for PTSD was only significantly associated with overdose in the bivariate analysis. Increased screening for ACEs is warranted and ACE-specific treatment is suggested for SUD treatment programs offering trauma-informed services for adults.

Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016.

Substance use disorder (SUD) during pregnancy increases risks of adverse outcomes for mothers and children. Because Medicaid covers about half of all births and maternal SUD is a costly problem, describing the timing of enrollment and health care that Medicaid-enrolled pregnant women with SUDs receive is critical to understanding gaps in the timeliness and specificity of SUD diagnosis and treatment for pregnant women with SUDs. We used linked maternal and infant Medicaid claims and enrollment data and infant birth records from three states (n=72,086 mother-infant dyads) to estimate the share of sample women diagnosed with a specified SUD (e.g., opioid use disorder) before or during the birth month, with a specified SUD after the birth month, and with only an unspecified SUD diagnosed (e.g., drug use disorder complicating pregnancy). We also examined the timing of first observed Medicaid enrollment, SUD diagnosis and treatment, and maternal and infant costs. In the 24 months surrounding birth, 3.6% of women had a specified SUD diagnosis first observed before or during the birth month, 1.7% had a specified SUD diagnosis first observed after the birth month, and 6.0% had an SUD diagnosis that was not specified. Most women with a specified SUD diagnosis were enrolled in Medicaid before or early in pregnancy and initiated prenatal care in the first or second trimester, yet nearly one-third of these women received their specified SUD diagnosis after the birth month. Less than two-thirds of women with a specified SUD diagnosis received any SUD treatment during the study period (59.9% among those identified before or during the birth month and 63.1% among those observed after the birth month), and women with an unspecified SUD were about half as likely to get treatment (28.6%). Among treated women, more than two-thirds had the first observed treatment in the same month as their first observed SUD diagnosis. Findings point to a critical need for interventions as well as substantial opportunities to improve the identification of substance use-related needs and provision of treatment among women who birth in Medicaid. Changes in Medicaid and other public policy to reduce disincentives for pregnant and parenting women to report substance use during medical visits and to increase providers' abilities and motivation to equitably screen for as well as treat women with SUDs before, during, and after pregnancy could improve outcomes for mothers and their children. Improvements in SUD diagnosis would also improve prevalence estimates of specific types of SUD, which could contribute to better Medicaid policies aimed at prevention and treatment.

Social-Ecological Predictors of Opioid Use Among Adolescents With Histories of Substance Use Disorders.

Adolescent opioid misuse is a public health crisis, particularly among clinical populations of youth with substance misuse histories. Given the negative and often lethal consequences associated with opioid misuse among adolescents, it is essential to identify the risk and protective factors underlying early opioid misuse to inform targeted prevention efforts. Understanding the role of parental risk and protective factors is particularly paramount during the developmental stage of adolescence. Using a social-ecological framework, this study explored the associations between individual, peer, family, community, and school-level risk and protective factors and opioid use among adolescents with histories of substance use disorders (SUDs). Further, we explored the potential moderating role of poor parental monitoring in the associations between the aforementioned risk and protective factors and adolescent opioid use. Participants included 294 adolescents (M age = 16 years; 45% female) who were recently discharged from substance use treatment, and their parents (n = 323). Results indicated that lifetime opioid use was significantly more likely among adolescents endorsing antisocial traits and those whose parents reported histories of substance abuse. Additionally, adolescents reporting more perceived availability of substances were significantly more likely to report lifetime opioid use compared to those reporting lower perceived availability of substances. Results did not indicate any significant moderation effects of parental monitoring on any associations between risk factors and lifetime opioid use. Findings generally did not support social-ecological indicators of opioid use in this high-risk population of adolescents, signaling that the social-ecological variables tested may not be salient risk factors among adolescents with SUD histories. We discuss these findings in terms of continuing care options for adolescents with SUD histories that target adolescents' antisocial traits, perceived availability of substances, and parent histories of substance abuse, including practical implications for working with families of adolescents with SUD histories.

A delicate compromise: Striking a balance between public safety measures and the psychosocial needs of staff and clients in residential substance use disorder treatment amid COVID-19.

In response to COVID-19, residential SUD treatment providers have significantly changed operations and clinical care to mitigate risk of infection for both clients and staff. While treatment facilities must enforce public safety measures in residential SUD treatment to protect the health of clients and staff, these measures create additional barriers to treatment engagement as well as health anxiety. We consider strategies to adjust clinical programming, enhance treatment engagement, and promote employee well-being in light of public safety measures and the chronic stressor of COVID-19.

The Los Angeles County hub-and-provider network for promoting the sustained use of extended-release naltrexone (XR-NTX) in Los Angeles County (2010-2015).

Extended-release naltrexone (XR-NTX) is a medication-assisted treatment (MAT) that is used in conjunction with psychosocial treatment for substance use disorder. It is associated with a reduction in the number of days that patients use alcohol or opioids, in cravings and drug-seeking behaviors, and in healthcare utilization costs, as well as improved medication adherence rates for patients in substance use disorder (SUD) treatment programs and improved quality of life. Despite the clinical effectiveness of XR-NTX, its clinical use has been slow to develop. There is little research describing the utilization of XR-NTX over time at the treatment-system level and few documented attempts to promote MAT by creating a system to explicitly promote and sustain MAT use. This study examines changes between April 1, 2010, and March 30, 2015, in the utilization patterns of XR-NTX for SUDs as promoted and delivered in a system of "medication hubs," comprised of community providers and a medication coordinating center, and training efforts. This system was implemented as part of a large demonstration project that was designed to provide access to XR-NTX in Los Angeles County. Our findings indicated an increase in the initiation of XR-NTX (59% increase) and subsequent doses (89% increase) from Year 1 to Year 5 of the project (p<0.001). These findings suggest that it is possible to improve MAT utilization (in this case XR-NTX) through the use of a system of care that minimizes MAT payment issues for providers and patients, provides an infrastructure (medication hubs and SUD treatment providers), promotes system coordination, and educates providers.

Optimizing a community-engaged multi-level group intervention to reduce substance use: an application of the multiphase optimization strategy.

BACKGROUND: Rates of alcohol and illicit drug use (AIDU) are consistently similar across racial groups (Windsor and Negi, J Addict Dis 28:258-68, 2009; Keyes et al. Soc Sci Med 124:132-41, 2015). Yet AIDU has significantly higher consequences for residents in distressed communities with concentrations of African Americans (DCAA - i.e., localities with high rates of poverty and crime) who also have considerably less access to effective treatment of substance use disorders (SUD). This project is optimizing Community Wise, an innovative multi-level behavioral-health intervention created in partnership with service providers and residents of distressed communities with histories of SUD and incarceration, to reduce health inequalities related to AIDU. METHODS: Grounded in critical consciousness theory, community-based participatory research principles (CBPR), and the multiphase optimization strategy (MOST), this study employs a 2 × 2 × 2 × 2 factorial design to engineer the most efficient, effective, and scalable version of Community Wise that can be delivered for US$250 per person or less. This study is fully powered to detect change in AIDU in a sample of 528 men with a histories of SUD and incarceration, residing in Newark, NJ in the United States. A community collaborative board oversees recruitment using a variety of strategies including indigenous field worker sampling, facility-based sampling, community advertisement through fliers, and street outreach. Participants are randomly assigned to one of 16 conditions that include a combination of the following candidate intervention components: peer or licensed facilitator, group dialogue, personal goal development, and community organizing. All participants receive a core critical-thinking component. Data are collected at baseline plus five post-baseline monthly follow ups. Once the optimized Community Wise intervention is identified, it will be evaluated against an existing standard of care in a future randomized clinical trial. DISCUSSION: This paper describes the protocol of the first ever study using CBPR and MOST to optimize a substance use intervention targeting a marginalized population. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02951455 . Registered on 1 November 2016.

The United States' Federal Parity Act and treatment of substance use disorders: Administrators' familiarity and perceptions of impact.

BACKGROUND: The 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) aims to secure parity in private insurance coverage between behavioral and other medical disorders in the United States (U.S.). This legislation represents an important change in the operating field of substance use disorder treatment, but to date, its impact on treatment centers has not been widely examined. The current study measured the extent of center leaders' familiarity with the MHPAEA and their perceptions of its overall impact on their centers. METHODS: Using a nationally representative sample of treatment centers in the U.S., we examined the extent of MHPAEA familiarity and its perceived impact as reported by treatment center leaders. We further employed logistic and ordered logistic regressions to determine personal and organizational characteristics associated with their reported familiarity and experienced impacts, including changes in the number of privately-insured clients seeking treatment and in the treatment coverage of those clients. RESULTS: We found that dissemination of parity information was low. Only 36% of administrators reported high levels of familiarity and 16% used professional sources of information. The majority of administrators (71%) reported no impact of the legislation on their organization, but those that reported any impact were more likely to state positive impact. Greater parity knowledge and perceived positive impacts were associated with administrator and organizational characteristics indicative of greater access to industry-specific knowledge, a medical model orientation, and reliance on private insurance revenue. CONCLUSION: This study demonstrates that dissemination of parity information is lacking and that the majority of leaders have yet to experience an impact of the MHPAEA. Leaders of centers with more sophisticated structures are most likely to be familiar with the legislation and perceive a positive impact. Research concerning the effective management of treatment centers, including environmental scanning techniques, continues to be needed.