Social network support for individuals receiving opiate substitution treatment and its association with treatment progress.

BACKGROUND/AIMS: Social networks have been hypothesized to protect people from the harmful effects of stress, but may also provide dysfunctional role models and provide cues associated with drug use. This study describes the range, type and level of social support available to patients engaged in UK opiate substitution treatment (OST) programmes, and explores the association between network factors and continued use of illicit heroin. METHODS: A cross-sectional survey of a randomly selected sample of OST patients (n = 118) utilised measures of current substance use and social network structure and support. RESULTS: More than half of the participants had used heroin in the previous month, and most described networks that were both supportive and positive about treatment. Multivariate analysis showed that the substance use involvement of network members was higher in those patients still using heroin, even when other treatment factors were controlled for. CONCLUSION: There was a strong association between ongoing contact with other drug users and continued use of illicit heroin in this treatment sample. Whilst there is potential for the involvement of social networks in treatment, future research needs to ascertain the exact nature of the relationship between social support and drug use.

Brain injury beliefs, self-awareness, and coping: a preliminary cluster analytic study based within the self-regulatory model.

The interplay between individuals' subjective beliefs about traumatic brain injury, their coping style and their self-awareness might provide a more helpful guide to rehabilitation goals than looking at these factors in isolation. We therefore conducted a preliminary study to determine whether the Self-Regulatory Model can identify different clusters of individuals according to belief schemata, and to explore whether clusters differed across measures of coping and self-awareness. The Illness Perception Questionnaire-Revised was administered to 37 participants with severe traumatic brain injury (TBI), along with the Ways of Coping Checklist-Revised and the European Brain Injury Questionnaire. Clinicians also rated clients' level of difficulties using the latter scale, and the discrepancy between client and clinician scores was used as a measure of self-awareness. Hierarchical cluster analysis distinguished three groups based on profiles of subjective beliefs about TBI, labelled "low control/ambivalent", "high salience", and "high optimism". The high salience group was characterised by beliefs about serious consequences of the injury and greater self-awareness, and reported a greater range of coping strategies. The other two groups showed lower levels of awareness but differed in coping styles, with the low control/ambivalent group showing a trend towards more avoidance coping against a background of lower perceived control.

Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT).

BACKGROUND: Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. METHODS: Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. RESULTS: 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). CONCLUSION: The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.