Computerized recovery support for substance use disorders: predictors of posttreatment usage.

OBJECTIVE: The primary goal of this study was to examine which characteristics differentiated patients who highly engaged with a computerized recovery support program after alcohol/drug treatment from those who did not engage with the program. MATERIALS AND METHODS: The program delivered individually tailored clinical content in a multimedia format over 18 months following residential treatment. A key component of the program was access to a recovery coach, a licensed drug and alcohol counselor. Posttreatment logins to the program, the amount of clinical content accessed, and the number of recovery coach contacts were measured. RESULTS: Several factors were found to predict program engagement, including several demographic variables, the number of recovery coach contacts, motivation to be in recovery, and attendance at 12-step groups. CONCLUSIONS: These findings, combined with others in the literature, suggest that low engagement with computerized health programs is a widespread problem. Because many of these programs show therapeutic promise, future studies should continue to increase understanding of factors associated with high engagement so that efforts to increase engagement may be applied more effectively.

Computer-based recovery support for patients receiving residential treatment for alcohol/drug dependence: relationship between program use and outcomes.

OBJECTIVE: This analysis of administrative data examined whether use of a Web-based recovery support program was related to self-reported post-treatment alcohol use among patients attending residential treatment for a substance use disorder. MATERIALS AND METHODS: The program delivered individually tailored clinical content in a multimedia format over the initial 18 months after discharge from treatment. Post-treatment logins to the program and access of clinical content were measured, as was post-treatment alcohol use. RESULTS: Use of the program was frequent in the first 30 days following treatment but steadily decreased over time. Regression analyses revealed a significant relationship between the number of program logins and self-reported alcohol use in the first 6 months following treatment when controlling for other covariates related to alcohol use. CONCLUSION: These results replicate a previous study of the My Ongoing Recovery Experience (MORE(®)) program (Hazelden, Center City, MN) and suggest that computerized support programs hold therapeutic potential for patients with alcohol/drug dependence.

Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results.

RATIONALE: Opioid overdose deaths and healthcare costs associated with opioid use disorder (OUD) continue to escalate while the majority of addiction treatment providers in the United States do not use medication-assisted treatment (MAT) in spite of proven efficacy. The primary resistance to the use of MAT has been associated with the philosophical conflict many 12-step based treatment programs have with the use of these medications. OBJECTIVE: This study sought to determine whether patients self-selecting into a treatment program based upon the 12-step philosophy would elect to use MAT and, if so, what initial outcomes might result. METHODS: This naturalistic, prospective study of patients (N = 253) with OUD included a combination of OUD-specific group therapy and the use of buprenorphine-naloxone, oral naltrexone, injectable naltrexone, or no medication with standard 12-step treatment initiated in a residential or day treatment setting with outpatient follow-up. Baseline assessment of subjects with OUD included level of craving and opioid withdrawal symptom severity. Post-residential treatment outcomes at 1- and 6-months included craving, opioid withdrawal, residential treatment completion, continuing care compliance, medication compliance, substance use frequency and 12-step meeting attendance. RESULTS: Irrespective of medication condition, nearly all patients successfully completed residential treatment and the majority attended additional programming afterward. Among those who elected to take a medication (71%), differences were associated with medication compliance. Patients who reported compliance with their medication at 1 and 6 months following residential treatment had significantly higher abstinence rates than patients who reported noncompliance. Among those who relapsed post-discharge, neither medication use nor compliance was significantly related to a change in the frequency of alcohol use days or drug use days at 6 months. CONCLUSION: These preliminary results suggest that it is feasible to administer medications, including partial opioid agonists like buprenorphine, within the context of 12-step based treatment and taking these medications as prescribed is associated with favorable outcomes.

Suppression-induced hyperaccessibility of thoughts in abstinent alcoholics: a preliminary investigation.

Abstinent alcoholics were compared to a non-alcoholic control group on a modified Stroop color-naming task. Alcoholics took significantly longer to name the color of the word "alcohol" than to name the color of non-alcohol words (i.e., they showed an interference effect) after they had first tried to suppress thoughts of alcohol. Alcoholics who had freely expressed thoughts about alcohol prior to the Stroop did not show such interference. Control participants who had suppressed thoughts of alcohol showed no interference effect. The results overall suggest that when alcoholics try to suppress thoughts of alcohol, these thoughts may become hyperaccessible immediately afterward.

Does recognition of single words predict recognition of two?

Participants studied a list of words, presented 1 at a time. When they were tested on pairs of words and asked to indicate whether both had occurred in the list, they gave more positive responses than would be expected on the basis of results from participants tested 1 word at a time. When participants were asked whether either member of a test pair had been shown on the study list, they gave positive responses less often than expected. When participants were asked to indicate how many words in a test pair came from the study list, they answered "2" more often and "1" less often than would be expected on the basis of results from single-item recognition. Accuracy was not affected by testing items in pairs.

Attention and recognition memory bias for alcohol-related stimuli among alcohol-dependent patients attending residential treatment.

Though studies have examined attentional bias for alcohol-related information among alcohol-dependent individuals, few have examined memory bias. This study examined attention and recognition memory biases for alcohol-related information among patients recently admitted to residential alcohol treatment (n=100; 40% female). Participants completed a computerized attentional task wherein they classified a centrally-presented digit as odd or even. On some trials, an alcohol word, neutral word, or anagram was presented along with the digit. On these dual trials participants first classified the digit and then classified the other stimulus as a word or nonword. Participants took longer to classify digits that appeared with alcohol words compared to neutral words; suggesting the alcohol words distracted them from processing the digit. In a subsequent recognition memory test, participants showed significantly higher hit rates (i.e., correctly classifying an old item as old) and false alarm rates (i.e., incorrectly classifying a new item as old) to the alcohol words compared to the neutral words, and they also showed a more liberal response bias to alcohol words. The findings suggest that alcohol-dependent individuals exhibit both attention and memory bias for alcohol-related information.

Computerized continuing care support for alcohol and drug dependence: a preliminary analysis of usage and outcomes.

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

The 12 Step Affiliation and Practices Scale: development and initial validation of a measure assessing 12 step affiliation.

OBJECTIVE: Research on instruments designed to measure endorsement of 12 step beliefs and practices among individuals with substance use disorders is virtually nonexistent. The goal of this study was to examine the psychometric properties of a novel instrument called the 12 Step Affiliation and Practices Scale (TSAPS) using a sample of young adults receiving 12 step-based residential treatment for alcohol and drug dependence. METHOD: As part of a naturalistic treatment outcome study, 300 young adults receiving residential treatment completed the TSAPS and several other assessments during and after treatment. Analyses of the TSAPS examined its factor structure, internal consistency, sensitivity to change over time, and convergent and predictive validity. RESULTS: A maximum likelihood estimation factor analysis using oblique rotation produced 4 factors accounting for 61.16% of the variance. Internal consistency was very high and scores on the TSAPS significantly increased across the course of treatment. Convergent validity was demonstrated by relationships with scales of treatment attitudes, twelve step expectancies and commitment to sobriety. Predictive validity was also found, as evidenced by a relationship between total TSAPS score at 3 months post-treatment and percent of abstinent days at 6 months post-treatment. CONCLUSIONS: The TSAPS shows promise as a psychometrically sound, internally reliable measure of 12 step affiliation and practices among individuals with substance dependence.