Prevalence of lifetime nonmedical opioid use among U.S. Health Center Patients aged 45 years and older with psychiatric disorders.

OBJECTIVE: Despite recent concerns over the increase in opioid misuse among aging adults, little is known about the prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older patients with psychiatric disorders. This study aims to determine the lifetime prevalence of nonmedical opioid use among underserved, vulnerable U.S. adults aged ≥45 years with psychiatric disorders. METHOD: A nationally representative sample (n = 3,294) was obtained from the 2014 Health Center Patient Survey which collects data on psychiatric disorders, opioid use, and other health information from underserved, vulnerable U.S. primary care populations. Predictor variables included self-reported panic disorder, generalized anxiety disorder, schizophrenia, or bipolar disorder. The outcome variable was self-reported lifetime nonmedical opioid use. Frequencies, counts, and unadjusted and adjusted logistic regression models were conducted with the cross-sectional survey dataset. RESULTS: Patients with bipolar disorder had the highest lifetime nonmedical opioid use rate (20.8%), followed by schizophrenia (19.3%), panic disorder (16.5%), and generalized anxiety disorder (14.5%). Nonmedical opioid use was significantly associated with bipolar disorder (OR 3.46, 95% CI [1.33, 8.99]) and generalized anxiety disorder (OR 2.03 95% CI [1.08, 3.83]). CONCLUSION: Our findings demonstrate a high prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older health center patients with psychiatric disorders. Given the prevalence, health center professionals should monitor, prevent, and treat new or reoccurring signs and symptoms of nonmedical opioid use in this high-risk group of aging patients with psychiatric disorders.

Mentorship for Alcohol Problems (MAP): a peer to peer modular intervention for outpatients.

AIMS: This is a Stage I open pilot to develop a new intervention, Mentorship for Alcohol Problems (MAP), for individuals with alcohol-use disorders in community treatment programs. METHODS: Ten mentors participated for 6 months until 30 mentees received MAP for 12 weeks. Behavioral and biological measures were conducted in addition to fidelity measures. Four focus groups were held with participants and clinician feedback surveys were completed. RESULTS: Feasibility and acceptance data in the domains of patient interest, safety and satisfaction were promising. Mentees reduced their alcohol and substance use and the majority of mentors sustained abstinence. Fidelity measures indicated that mentors adhered to the delivery of treatment. CONCLUSION: MAP shows promise to be incorporated into professionally run outpatient alcohol treatment programs to assist in the reduction of alcohol and substance use.

Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment.

BACKGROUND: Often high recidivism substance-using patients have difficulty connecting to outpatient treatment contributing to greater functioning disturbances. Approaches to address this problem frequently are staff extensive. OBJECTIVE: This study evaluates the impact of peer mentorship and/or enhanced dual recovery treatment (DRT) on individuals who are inpatients, substance abusing, and have a history of high recidivism. The primary outcome is post-discharge treatment attendance. METHODS: In an inpatient Veterans Administration hospital setting, 96 patients with a history of high recidivism and current and/or past diagnosis of substance use disorders were randomized to either (i) Treatment As Usual (TAU), (ii) TAU + DRT + Mentorship for Addictions Problems to Enhance Engagement to Treatment (MAP-Engage), or (iii) TAU + MAP-Engage. RESULTS: Overall MAP-Engage was found to be comparable to the DRT + MAP-Engage and both of these conditions were significantly better than TAU alone at increasing adherence to post-discharge substance abuse, medical, and mental health outpatient appointments. CONCLUSION/SCIENTIFIC SIGNIFICANCE: MAP-Engage offers an alternative approach to address lack of attendance to outpatient treatment appointments post discharge that is relatively low in staff reliance.

The impact of COVID-19 on opioid treatment program (OTP) services: Where do we go from here?

Medication for opioid use disorder (MOUD) services is key to addressing the opioid crisis and COVID-19 has significantly impacted MOUD delivery. The need for social distancing and self-quarantining requires individuals to maintain personal physical space and limits face-to-face interactions, which are required for methadone dispensing and other regulated treatment activities. Mount Sinai Beth Israel, which has one of the largest opioid treatment service (OTP) delivery systems within the United States and included 10 OTP methadone clinics that responded rapidly by implementing procedures to address the additional challenges during the COVID-19 pandemic. This article discusses four key procedural areas: 1) verified identity in-person pick-up doses, 2) drug urine toxicology screens, 3) treatment interactions, and 4) discharges, which can inform future OTP operational procedures by encouraging out-of-the-box thinking in this new age.

Mentorship for Addiction Problems (MAP): A New Behavioral Intervention to Assist in the Treatment of Substance Use Disorders.

OBJECTIVE: Mentorship for Addiction Problems (MAP) is a new behavioral treatment formalizing client-to-client mentorship relationships as an adjunct to standard outpatient substance use disorder treatment. We tested the preliminary efficacy of MAP in reducing substance use and associated barriers to successful treatment outcomes. METHOD: A total of 65 participants (17 later recovery participants [LRPs] and 48 early recovery participants [ERPs]) with substance use disorders were randomized to MAP + Treatment as Usual (TAU) or TAU alone. Within MAP, for each cohort, a pool of 4-5 mentors (LRPs) was formed and engaged in mentoring activities for 24 weeks until 12-13 mentees (ERPs), newly admitted, had participated in MAP for 12 weeks. Behavioral and biological measures were conducted at baseline, weekly, monthly, and termination for all participants and during the 12-week follow-up for ERPs. RESULTS: Substance use declined across both conditions for ERPs (N = 48) during treatment, Weeks 0-12 (p = .001); however, on average, ERPs in the MAP intervention used significantly fewer days than controls during Treatment Weeks 1-12 (p = .013) and during Follow-Up Weeks 13-24 (p = .043). Addiction Severity Index alcohol and drug use scores increased in TAU and decreased in MAP during Follow-Up Weeks 13-24 for ERPs, alcohol: b = -0.08, SE = 0.03, t(47) = -2.97, p = .005; drug use: b = -0.02, SE = 0.01, t(47) = -2.36, p = .023. In addition, there was high patient interest in MAP and good fidelity to delivery of treatment. CONCLUSIONS: MAP shows promise assisting in the reduction of substance use early in treatment when vulnerability and risk for relapse is high and has a positive impact on serious problems undercutting addiction treatment efficacy.

Training and fidelity monitoring of behavioral interventions in multi-site addictions research.

AIMS: Methods for the training and fidelity monitoring of behavioral interventions in multi-site addictions research are reviewed, including five published studies and seven ongoing studies sponsored by the National Institute on Drug Abuse-funded Clinical Trials Network. METHODS: Methods are categorized and reviewed consistent with a technology model of treatment delivery. Topics include: therapist selection, training, certification, and supervision; selection, training, and certification of supervisors; scales and processes used for monitoring of the quality of treatment; and processes followed to provide new training for replacement staff once trials have begun. RESULTS: The review reveals both a wide array of procedures and emerging standards for multi-site trials. Methodological weakness was observed with respect to limited empirical support for many adherence scales, little or no evaluation of supervisory processes, and no evaluation of re-training practices. CONCLUSIONS: Methods used in multi-site trials are important not only to ensure validity of those trials, but also to inform the wider dissemination of empirically based treatment into community agencies. Studies examining noted weaknesses are needed. Training and fidelity models that delegate responsibility to participating sites appear most relevant for establishing best practices for dissemination of behavioral interventions. The effectiveness of these distributed training and supervision models should be subjected to empirical study at a level of rigor comparable to the evaluation of their corresponding treatments.

Benefits of peer support groups in the treatment of addiction.

OBJECTIVE: Peer support can be defined as the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Recently, there has been a dramatic rise in the adoption of alternative forms of peer support services to assist recovery from substance use disorders; however, often peer support has not been separated out as a formalized intervention component and rigorously empirically tested, making it difficult to determine its effects. This article reports the results of a literature review that was undertaken to assess the effects of peer support groups, one aspect of peer support services, in the treatment of addiction. METHODS: The authors of this article searched electronic databases of relevant peer-reviewed research literature including PubMed and MedLINE. RESULTS: Ten studies met our minimum inclusion criteria, including randomized controlled trials or pre-/post-data studies, adult participants, inclusion of group format, substance use-related, and US-conducted studies published in 1999 or later. Studies demonstrated associated benefits in the following areas: 1) substance use, 2) treatment engagement, 3) human immunodeficiency virus/hepatitis C virus risk behaviors, and 4) secondary substance-related behaviors such as craving and self-efficacy. Limitations were noted on the relative lack of rigorously tested empirical studies within the literature and inability to disentangle the effects of the group treatment that is often included as a component of other services. CONCLUSION: Peer support groups included in addiction treatment shows much promise; however, the limited data relevant to this topic diminish the ability to draw definitive conclusions. More rigorous research is needed in this area to further expand on this important line of research.

Moving beyond illness to recovery: the recovery is for everyone Grants Program (RIFE).

The RIFE Grants Program offers funding to individuals in recovery from mental health and substance abuse problems for innovative projects to help them take steps toward achieving their life aspirations. Twenty-one people who received awards participated in an evaluation using the MDS and EPQ with significant increases in items related to empowerment from the beginning to mid study and a decrease in the empowerment factor from mid to end study. Ninety-one percent of participants reported improvements in daily life, 82% in thoughts of self, 80% in belief in capabilities, 60% in social roles, 80% in socializing, and 50% in values.

Treatment Process and Participant Characteristic Predictors of Substance Use Outcome in Mentorship for Addiction Problems (MAP).

There are a variety of self-help treatments which have components of sponsorship or peer support. Although there has been a recent surge in the utilization of peer support interventions within clinical settings, there is limited data on substance use outcome predictors for interventions designed solely for peer support within community treatment settings that are empirically based. We examined both treatment process and participant characteristic variables as predictors of substance use outcomes within our Stage I pilot which developed a new intervention, Mentorship for Addiction Problems (MAP). We found treatment process variables to be significantly associated with substance use outcome and no participant characteristic variables.

Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States.

Although substance abuse treatment programs are important contact points for providing health services for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, availability of services in these programs has not been well characterized. This study evaluated the spectrum of HBV and HCV services offered by substance abuse treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Our survey of substance abuse treatment program administrators covered availability of testing for HBV and HCV; hepatitis A virus (HAV) and HBV immunization; and HCV medical and nonmedical services. There were also questions covering clarity of guidelines for HBV and HCV testing and HAV and HBV immunization. Differences between methadone and nonmethadone programs were examined. Despite the importance of substance abuse in sustaining the hepatitis epidemics, few programs offer comprehensive HBV and HCV testing or HCV health care services. Interventions to improve access to hepatitis services for substance-abusing patients are needed.

Substance abuse treatment clinician opinions and infectious disease service delivery.

Substance abuse treatment programs are an important platform for delivery of services for infectious diseases associated with drug and alcohol use. However, important components of infectious disease care are not universally provided. Clinician training often focuses on information about infectious diseases and less attention is paid to provider opinions and attitudes that may be barriers to providing infectious diseases services. In a national multi-site trial conducted by the National Drug Abuse Treatment Clinical Trials Network (CTN), we investigated the relationship between clinician opinions and the delivery of services for human immunodeficiency virus, hepatitis C virus, and sexually transmitted infections in substance abuse treatment settings. Survey data were collected from 1,723 clinicians at 269 CTN treatment programs. Clinician opinion was found to be significantly related to infectious disease service delivery. Implications for training are discussed.

Contingency Management to reduce substance use in individuals who are homeless with co-occurring psychiatric disorders.

Homeless shelters provide a unique opportunity to intervene with occupants who have substance abuse problems, as not addressing these issues may lead to continuation of problems playing a contributing role in homelessness. Attempts to implement Contingency Management (CM) with this population have often been complex, costly, and not straightforward to replicate in community settings. We conducted a randomized trial evaluating a simple, low-cost 4-week CM program for 30 individuals seeking shelter in a community-based homeless shelter who had both current substance and psychiatric disorders. Behavioral assessments were performed at baseline, weekly, and termination of the study. Overall retention in the trial was high; participants assigned to CM reduced their cocaine and alcohol use more than those in assessment-only. This pilot trial suggests that application of low-cost CM procedures is feasible within this novel setting and may decrease substance use.