Weight stability in adults with obesity initiating medical marijuana treatment for other medical conditions.

Few studies have evaluated weight change in patients who initiate medical marijuana treatment to address diagnosed health concerns. The objective of this study was to examine whether patients initiating medical marijuana use for a qualifying health condition experienced changes in health and biopsychosocial functioning over time, including weight gain or loss. Specifically, this observational, longitudinal study evaluated changes in the body mass index (BMI) of adults with co-morbid obesity (body mass index [BMI] ≥ 30 kg/m2) and severe obesity (BMI ≥ 40 kg/m2) who were starting medical marijuana treatment for any of the 23 qualifying medical conditions at one of three dispensaries in Pennsylvania. Height and weight measurements were collected at baseline (prior to medical marijuana use) and then 90 days (± 14 days) later. Participants included in analyses (n = 52, M = 55.0 ± 13.6 years, 59.6% female) had a mean baseline BMI of 36.2 ± 5.4 kg/m2 and the majority sought medical marijuana for chronic pain (73.1%). No significant change in BMI was observed from baseline to month three (p > 0.05) in the sample. Additionally, no significant change in BMI was observed in the subset of patients with severe obesity (n = 12, p > 0.05). Our findings are limited by low follow-up rates and convenience sampling methodology but may help to mitigate weight gain concerns in the context of medical marijuana use.

Clinical Characteristics and Quality of Life in Adults Initiating Medical Marijuana Treatment.

Introduction: Despite the rising availability and use of medical marijuana (MM) in the USA, little is known about the demographics, clinical characteristics, or quality of life of MM patients. This study describes the demographic characteristics and health-related quality of life (HRQoL) of MM patients who are initiating treatment in Pennsylvania. Methods: Two-hundred adults naive to MM and referred for any of the 23 state-approved qualifying conditions were recruited at three MM dispensaries in Pennsylvania between September 2020 and March 2021. All participants consented to the study; completed semi-structured interviews that included demographic questionnaires, the Short Form-36 (SF-36), and Generalized Anxiety Disorder-7 (GAD-7); provided height and weight measurements; and allowed access their dispensary medical records. Results: Participants had a mean age of 48.5 ± 15.6 years, predominantly identified as female (67.5%), and were most commonly referred for chronic pain (63.5%) and/or anxiety (58.5%). Additionally, 46.0% were living with obesity as determined by BMI. Relative to a normative sample, participants reported diminished HRQoL in several domains, most notably in role limitations due to physical health (M = 46.0 ± 42.0), role limitations due to emotional problems (M = 52.5 ± 42.3), energy and fatigue (M = 39.8 ± 20.2), and pain (M = 49.4 ± 26.0). Discussion/Conclusion: Patients initiating MM treatment experienced low HRQoL in multiple domains. Future studies could evaluate the relationship between HRQoL and patients' decisions to pursue MM treatment, as well as changes in HRQoL with MM use over time.

A mental health professional survey of cognitive-behavioral therapy for the treatment of opioid use disorder.

OBJECTIVE: The objective of this survey was to obtain mental health professional perspectives on cognitive-behavioral therapy (CBT) for opioid use disorder (OUD) treatment. METHODS: Respondents (N = 84) rated components of CBT for their efficacy in OUD treatment. Ratings were reported for the overall sample, by degree completed, and by clinicians versus nonclinicians. Respondents also ranked additional therapeutic strategies that might enhance the efficacy of CBT for OUD. RESULTS: Respondents rated treatment alliance/rapport, coping skills, and motivational interviewing as the most effective CBT components for OUD. Forms and worksheets were rated as the least effective component. The most beneficial additions to CBT for OUD would be mindfulness, peer support, and medication adherence strategies. Finally, the survey responses suggested that addressing co-morbid mental health disorders and life stressors may be important within CBT treatment for OUD.

Do Peer Recovery Specialists Improve Outcomes for Individuals with Substance Use Disorder in an Integrative Primary Care Setting? A Program Evaluation.

Peer recovery specialists (PRSs) combine their personal experiences with substance use and recovery with clinical skills to support patients in treatment for or recovery from substance use. This paper provides evaluation findings from a SAMHSA-funded program that integrated a PRS team into a primary care clinic to assess the efficacy of PRS support on patients' substance use, healthcare involvement, and criminal justice involvement. PRSs provided a range of services to patients with histories of incarceration and substance use, including facilitating support groups, providing one-on-one individualized support, and navigating services. Data were collected from PRS-supported patients at intake, discharge, and 6 months post-intake. Results revealed reductions in the percentage of patients using substances in the past 30 days, decreased number of days using alcohol, increased engagement in more medical services after program enrollment, increased school enrollment, and increased rates of employment for PRS-supported patients.

Clinical Characteristics of Roux-en-Y Gastric Bypass Patients with Death from Accidental Overdose or Intentional Self-Harm: a Descriptive Study.

PURPOSE: The objective of this descriptive study was to identify clinical characteristics of Roux-en-Y gastric bypass (RYGB) patients who died from intentional self-harm or accidental overdose postoperatively. MATERIALS AND METHODS: This retrospective, descriptive study included RYGB patients from a large rural medical center that completed surgery between January 2004 and December 2014 and died from intentional self-harm or accidental overdose through December 2015. Specific causes of death were obtained from the National Death Index and clinical data from electronic health records. Clinical characteristics explored were age, sex, time to surgery, weight loss expectations, postoperative weight loss, medication, diagnoses, psychiatric histories (diagnoses, self-harm, suicidal ideation and behaviors, medications, substance use, preoperative Beck Depression Inventory-II scores), pain, social support, and reported life stressors. RESULTS: Overall, 22 patients of 146 total deceased patients died from intention self-harm (n = 6) or accidental overdose (n = 16) over the study period (77.3% female, mean age at time of surgery = 38.4 ± 9.1 years). Younger age (< 40 years), history of self-harm or depression, preoperative pain, and use of opioids at the time of surgery emerged as common characteristics in weight loss surgery patients who died from intentional self-harm or accidental overdose. No trends regarding social support, life stressors, or actual or expected weight loss were identified. CONCLUSION: Certain weight loss surgery patients may be at risk for death from self-harm or overdose and may benefit from greater surveillance postoperatively.

Examining the use of visual performance feedback in drug treatment court.

A key component of drug courts is regular status hearings in which the judge reviews client progress and imposes sanctions or rewards for infractions or achievements; however, little is known about whether drug court clients fully understand the reasons for judicial responses and make clear connections between their behavior and judicially imposed consequences. Thus, we hypothesized that providing graphic performance feedback would improve clients' perceptions of procedural justice and increase the likelihood of success. This study examines the feasibility, acceptability, and preliminary efficacy of a visual performance feedback (VPF) procedure designed to improve judge-client communication during status hearings. Seventy-five adult misdemeanor drug court participants were randomized to a VPF (n = 37) or status hearings as usual (n = 38) condition. In the VPF condition, the judge projected and described two graphs for each client (i.e., abstinence rates, treatment attendance for the past two months). Outcomes included feasibility, client and stakeholder acceptability, urinalysis-confirmed abstinence, treatment attendance, perceptions of procedural justice, and duration of client-judge interactions. Findings revealed a high level of judge adherence to the VPF (feasibility), client and stakeholder acceptability of the VPF procedure, and significantly longer client-judge interactions in the VPF condition. No significant differences were observed for client-level efficacy outcomes. Overall, this study demonstrated that providing VPF to drug court clients during judicial status hearings is feasible and acceptable. Future fully powered trials of the VPF procedure are needed to further examine its efficacy in improving outcomes for drug court clients. (PsycINFO Database Record

Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients.

Drug courts address issues such as employment and housing but largely miss the opportunity to address important health care issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9 months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey, with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest that clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.

Examining the efficacy of a computer facilitated HIV prevention tool in drug court.

BACKGROUND: Although they have demonstrated efficacy in reducing substance use and criminal recidivism, competing priorities and limited resources may preclude drug court programs from formally addressing HIV risk. This study examined the efficacy of a brief, three-session, computer-facilitated HIV prevention intervention in reducing HIV risk among adult felony drug court participants. METHODS: Two hundred participants were randomly assigned to an HIV intervention (n=101) or attention control (n=99) group. All clients attended judicial status hearings approximately every six weeks. At the first three status hearings following study entry, clients in the intervention group completed the computerized, interactive HIV risk reduction sessions while those in the control group viewed a series of educational life-skill videos of matched length. Outcomes included the rate of independently obtained HIV testing, engagement in high risk HIV-related behaviors, and rate of condom procurement from the research site at each session. RESULTS: Results indicated that participants who received the HIV intervention were significantly more likely to report having obtained HIV testing at some point during the study period than those in the control condition, although the effect was marginally significant when examined in a longitudinal model. In addition, they had higher rates of condom procurement. No group differences were found on rates of high-risk sexual behavior, and the low rate of injection drug reported precluded examination of high-risk drug-related behavior. CONCLUSIONS: The study provides support for the feasibility and utility of delivering HIV prevention services to drug court clients using an efficient computer-facilitated program.

Use of the Internet to Obtain Drugs without a Prescription Among Treatment-involved Adolescents and Young Adults.

Nonmedical use of prescription drugs is common and poses risks such as injury, overdose, and development of abuse and dependence. Internet pharmacies offer prescription drugs without a prescription, creating a source of illicit drugs accessible to anyone with an Internet connection. We examined this issue in a convenience sample of 1,860 adolescents and young adults from 24 residential and outpatient treatment programs. Few individuals obtained drugs from the Internet (n = 26, 2.3%). Pain relievers were the most frequently purchased type of drug. The majority of adolescents and young adult online purchasers made the purchases from their own or a friend's house.

An Experimental Trial of Adaptive Programming in Drug Court: Outcomes at 6, 12 and 18 Months.

OBJECTIVES: Test whether an adaptive program improves outcomes in drug court by adjusting the schedule of court hearings and clinical case-management sessions pursuant to a priori performance criteria. METHODS: Consenting participants in a misdemeanor drug court were randomly assigned to the adaptive program (n = 62) or to a baseline-matching condition (n = 63) in which they attended court hearings based on the results of a criminal risk assessment. Outcome measures were re-arrest rates at 18 months post-entry to the drug court and urine drug test results and structured interview results at 6 and 12 months post-entry. RESULTS: Although previously published analyses revealed significantly fewer positive drug tests for participants in the adaptive condition during the first 18 weeks of drug court, current analyses indicate the effects converged during the ensuing year. Between-group differences in new arrest rates, urine drug test results and self-reported psychosocial problems were small and non-statistically significant at 6, 12 and 18 months post-entry. A non-significant trend (p = .10) suggests there may have been a small residual impact (Cramer's ν = .15) on new misdemeanor arrests after 18 months. CONCLUSIONS: Adaptive programming shows promise for enhancing short-term outcomes in drug courts; however, additional efforts are needed to extend the effects beyond the first 4 to 6 months of enrollment.

Prize-based contingency management for the treatment of substance abusers: a meta-analysis.

AIM: To review randomized controlled trials to assess efficacy of a prize-based contingency management procedure in reducing substance use (where a drug-free breath or urine sample provides a chance of winning a prize). METHODS: A meta-analysis was conducted on papers published from January 2000 to February 2013 to determine the effect size of studies comparing prize-based contingency management to a treatment-as-usual control condition (k = 19 studies). Parallel analyses evaluated the efficacy of both short- (k = nine studies) and long-term outcomes (k = six studies) of prize-based contingency management. RESULTS: The average end-of-treatment effect size (Cohen's d) was 0.46 [95% confidence interval (CI) = 0.37, 0.54]. This effect size decreased at the short-term (≤3-month) post-intervention follow-up to 0.33 (95% CI = 0.12, 0.54) and at the 6-month follow-up time-point there was no detectable effect [d = -0.09 (95% CI = -0.28, 0.10)]. CONCLUSION: Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence, but the effect does not appear to persist to 6 months.

Contingency management for cocaine treatment: cash vs. vouchers.

The efficacy of contingency management (CM) for treating drug abuse is well supported. The most widely used form of CM is voucher-based reinforcement therapy (VBRT), where clients receive an escalating schedule of vouchers that can be redeemed for goods and services for meeting treatment goals. Though generally rejected due to concerns about potential harms to drug using participants, research suggests that cash may be a more effective reinforcer. This three-group randomized trial compared the efficacy of cash-based reinforcement therapy (CBRT) to VBRT and a non-CM condition on cocaine abstinence and treatment attendance; and examined whether CBRT resulted in greater levels of harm than VBRT. Findings indicated that the CBRT was as effective as VBRT when compared to the non-CM condition and that it did not increase rates of drug use, cravings, or high-risk behaviors. Future research should examine potential cost savings associated with a cash-based CM approach as this could have important implications for the wider adoption of the CM model.

The Survey of Treatment Entry Pressures (STEP): identifying client's reasons for entering substance abuse treatment.

OBJECTIVE: Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual's treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP's psychometric properties. METHOD: A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4-7 days later. Analyses were performed to examine the instrument's psychometric properties including item response rates, test-retest reliability, internal consistency, and factor structure. RESULTS: The items displayed adequate test-retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2-factor structure reflecting type of reinforcement schedule. CONCLUSION: The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client's treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes.

Developing an index to measure the voluntariness of consent to research.

The goals of the current study were to expand the content domain and further validate the Coercion Assessment Scale (CAS), a measure of perceived coercion for criminally involved substance abusers being recruited into research. Unlike the few existing measures of this construct, the CAS identifies specific external sources of pressure that may influence one's decision to participate. In Phase 1, we conducted focus groups with criminal justice clients and stakeholders to expand the instrument by identifying additional sources of pressure. In Phase 2, we evaluated the expanded measure (i.e., endorsement rates, reliability, validity) in an ongoing research trial. Results identified new sources of pressure and provided evidence supporting the CAS's utility and reliability over time as well as convergent and discriminative validity.

Achieving new levels of recall in consent to research by combining remedial and motivational techniques.

INTRODUCTION: Research supports the efficacy of both a remedial consent procedure (corrected feedback (CF)) and a motivational consent procedure (incentives) for improving recall of informed consent to research. Although these strategies were statistically superior to standard consent, effects were modest and not clinically significant. This study examines a combined incentivised consent and CF procedure that simplifies the cognitive task and increases motivation to learn consent information. METHODS: We randomly assigned 104 individuals consenting to an unrelated host study to a consent as usual (CAU) condition (n=52) or an incentivised CF (ICF) condition (n=52). All participants were told they would be quizzed on their consent recall following their baseline assessment and at 4 monthly follow-ups. ICF participants were also informed that they would earn $5 for each correct answer and receive CF as needed. RESULTS: Quiz scores in the two conditions did not differ at the first administration (p=0.39, d=0.2); however, ICF scores were significantly higher at each subsequent administration (second: p=0.003, Cohen's d=0.6; third: p<0.0001, d=1.4; fourth: p<0.0001, d=1.6; fifth: p<0.0001, d=1.8). CONCLUSIONS: The ICF procedure increased consent recall from 72% to 83%, compared with the CAU condition in which recall decreased from 69% to 59%. This supports the statistical and clinical utility of a combined remedial and motivational consent procedure for enhancing recall of study information and human research protections.

Predictors of retention in a drug-free unit/substance abuse treatment in prison.

The high rate of dropout from treatment programs is a recurring problem in the field of drug dependence. The purpose of this study was to identify the predictors of retention in a prison-based drug-free unit (DFU). The relationships among subscales of the Addiction Severity Index (ASI) as well as motivation and personality profiles and length of stay in a DFU, of 57 prisoners admitted for the first time to the program were analyzed. The mean dropout rates were 52.9% at six months and 67.8% at one year. The mean length of stay was 195.05 days. Predictors of retention at six months included the ASI Family Composite Score, the motivation subscale Taking Steps, and Narcissistic personality trait score. Predictors of retention at one year included lower ASI Psychological Composite Score, higher scores on the motivation subscale Ambivalence, and higher number of charges pending at the time of admission to the program. Identification of these predictor variables may be useful for developing strategies to increase retention in the context of in-prison substance abuse treatment.

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial.

Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.

Nonprescription steroids on the Internet.

This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular Web sites. Searches for specific steroid product labels (e.g., Dianabol) between March 2006 and June 2006 revealed that approximately half of the Web sites advocated their "safe" use, and roughly one third offered to sell them without prescriptions. The Web sites frequently presented misinformation about steroids and minimized their dangers. Less than 5% of the Web sites presented accurate health risk information about steroids or provided information to abusers seeking to discontinue their steroid use. Implications for education, prevention, treatment, and policy are discussed.

Development and preliminary results of the Financial Incentive Coercion Assessment questionnaire.

Financial incentives are often used in research, yet no measure exists to determine whether they lead to perceptions of coercion in subjects. We present a preliminary evaluation of a recently developed Financial Incentive Coercion Assessment (FICA) questionnaire. FICA measures perceived coercion specifically related to payment for participation in a research study. Two hundred sixty-six subjects were recruited from a large randomized controlled trial; 152 returned for a 6-month follow-up and completed the FICA. Approximately 30% of participants reported the major reason for participating was "for the money," but less than 5% felt that the financial incentives were coercive. FICA results are consistent with levels of perceived coercion using an alternative measure. Initial assessment of responses on the FICA suggests that it may provide a novel approach to measuring perceived coercion from financial incentives in research. Future work will refine the FICA and analyze its psychometric properties.

The Prevalence of HIV Risk Behaviors among Felony Drug Court Participants.

15 HIV RISK BEHAVIORS IN DRUG COURT: A small percentage of participants in a large metropolitan felony Drug Court engaged in high-risk injection drug use, but a large percentage engaged in high-risk sexual behaviors. 16 HIV RISK FACTORS IN DRUG COURT: HIV risk behaviors were associated with being male, African-American, and younger. 17 GEOGRAPHIC RISK FOR HIV: A large proportion of Drug Court participants resided in areas of the city with a high prevalence of persons living with HIV/AIDS, thus heightening the probability of exposure to the virus.