Problem-Solving Court Staff Preferences for Educational Videos about Medications for Opioid Use Disorder.

Problem-solving courts use an interdisciplinary approach with treatment mandates, hearings, and monitoring to rehabilitate individuals arrested for drug-related crimes or lost custody of children due to drug use. Medications for opioid use disorder (MOUD) are the standard of care for treating opioid use disorder (OUD), but few problem-solving court clients with OUD are referred to MOUD. Previous studies found court staff often harbor misconceptions about MOUD and could benefit from MOUD education. Tailoring education to the intended audience is an educational best practice. We sought to identify content and style preferences for two MOUD education videos: 1) an introduction to MOUD and, 2) MOUD myths/misconceptions.We recruited 40 Florida problem-solving court staff. Using semi-structured interviews, invited document/script edits, and qualitative surveys, we collected data at each of four video development stages. We used template analysis for qualitative data.Court staff desired the following content: OUD as a chronic brain condition and MOUD as an effective response; MOUD risks and benefits; how MOUD is accessed; and the appropriate role of court staff with MOUD decisions. Style preferences were: no juvenile/cutesy animation; relatable characters/environments; simple concept illustration; individualizing the learning experience; and combinations of scientific animated videos and successful stakeholder interviews.Our findings reinforce the importance of tailoring MOUD education to the audience. Court staff's wish for education about their appropriate role with MOUD reflects their unique position making treatment referrals. Court staff's desire for stakeholder recordings of success stories mirrors the importance of opinion leaders in other dissemination studies.

Online Medication Assisted Treatment Education for Court Professionals: Need, Opportunities and Challenges.

INTRODUCTION: Although medication-assisted treatment (MAT) effectively treats opioid use disorders (OUD), MAT access is restricted in criminal justice (CJ) settings. Previous studies have documented that stigma and limited knowledge about MAT are prevalent among CJ court personnel. We describe development and pilot testing of an eLearning intervention to improve MAT knowledge and increase MAT referrals in Ohio courts. Methods: Building upon a nationwide survey conducted in 2011 of drug courts and informed by MAT opinions from judges who supervised OUD clients, we developed two eLearning MAT modules. Judges completed a brief online MAT knowledge-attitude scale (K-A) before, after, and at 3 months. Judges were asked about MAT referrals pretest and 3 months later. Results: Sixty-three judges expressed interest in the study, 25 completed the pretest and viewed the modules, 11 completed a 3 month posttest. At pretest, K-A scores were significantly (p<.05) lower for agonist medications than for extended-release naltrexone (XR-NTX; Vivitrol). K-A scores improved at posttest for agonist medications (p<.05) but declined to pretest levels three months later. Three months after the pretest, buprenorphine referrals increased from 2.6% to 9.7% (p<.05). There was no significant difference on K-A scores for agonist medication between the Ohio sample (at pretest) and the 2011 sample. Conclusion: Although there is some indication that eLearning may have strengthened knowledge gains and increased buprenorphine referrals, a more robust eLearning intervention will likely be required to increase court personnel participation and sustain eLearning knowledge gains. Recruiting and sustaining judges' participation in the study represented a significant study limitation.

Challenges to Opioid Treatment Programs After Hurricane Sandy: Patient and Provider Perspectives on Preparation, Impact, and Recovery.

Over 300,000 patients with an opioid use disorder (OUD) receive methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in New York and New Jersey, areas (largely but not exclusively coastal) impacted by Hurricane Sandy (Sandy) on October 29th, 2012. Disruption of methadone dispensing and other services can have severe consequences to patients (and treatment seekers) such as relapse, dropping out of treatment and resumption or increase in HIV/HCV injection risk behaviors. To facilitate OTP preparedness and response, we developed recommendations for OTPs for future emergencies. Using both qualitative and quantitative measures, we obtained data from OTP directors, staff, patients and out-of-treatment persons to learn how OTPs prepared for the impending hurricane, whether recovery efforts were successful, and what impact the hurricane has had. We observed a wide range of preparation and recovery efforts among participating programs. Director, staff, and patient perspectives on programs' responses and storm impact often differed. Triangulated data suggest that program responses were adequate for a majority of patients. For a sizeable minority of patients, program responses were very successful; for at least 20% of the clinics, program planning and responses were inadequate to meet the needs of patients. Among the recommendations made for sustaining continuity of care in future emergencies are: a focus on improving communication, procuring transportation, guest dosing, and take home provisions.

Characteristics of Non-Opioid Substance Misusers Among Patients Enrolling in Opioid Treatment Programs: A Latent Class Analysis.

Using latent class analysis, this study examined the pattern of non-opioid substance misuse among 19,101 enrollees into 85 opioid treatment programs. The most frequent non-opioid drugs were cannabis, anti-anxiety medications, and cocaine. Four non-opioid drug use latent classes were identified: low-use (73%), prescription drug use (16%), marijuana and cocaine use (8.5%), and poly-drug use (2.5%). Compared to the low-use class, participants in the other classes were more likely to be female, Caucasian, use tobacco, have chronic pain, and use prescription opioids either with or without heroin. Recognition of characteristics derived from these classes can improve opioid treatment program services.

Risk factors for medication non-adherence among psychiatric patients with substance misuse histories.

Medication non-adherence among psychiatric patients is known to be associated with poorer treatment outcomes. The study examined a comprehensive set of modifiable risk factors for non-adherence in a theoretical framework among a diverse, high risk sample of psychiatric patients with substance misuse histories (N=299). Medication side effects and excessive alcohol use were related to lower medication adherence and higher motivation for mental health treatment and recovery support were related to greater adherence. The results suggest that a multifaceted model for intervention to increase psychiatric medication adherence should be developed and tested.

Efficacy of dual focus mutual aid for persons with mental illness and substance misuse.

BACKGROUND: Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published. METHOD: This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3-6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting. RESULTS: At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance. CONCLUSION: Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.

Consumers' Experiences in Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders.

Mutual aid fellowships have been shown to improve outcomes for those with co-occurring substance use and mental illness disorders. Processes associated with usefulness include helper therapy (the assumption of a helping role to foster commitment) and reciprocal learning (the sharing of problems and solutions among members). The present qualitative investigation used focus groups comprised a subset of participants in Double Trouble in Recovery (DTR), a 12-step mutual aid group for those with co-occurring disorders, to gather their subjective perceptions of the groups. Participants emphasized that in linking them to others with similar problems, the DTR groups played a vital emotional role in their lives and provided a needed venue for information sharing that might have been otherwise unavailable.

The most critical unresolved issue associated with: psychoanalytic theories of addiction: can the talking cure tell us anything about substance use and misuse?

The most critical unresolved issue associated with psychoanalysis is whether its core precepts belong in today's substance use armamentarium. Psychoanalytic theories have resisted the criterion of falsifiability, putting them at odds with the current paradigm for treating addiction. However, Freud's earliest pronouncement on the subject, "making the patient a collaborator in his own treatment" (i.e., therapeutic alliance) not only holds up to scientific scrutiny, but is a robust determinant in improving treatment outcomes. Psychoanalytic constructs today appear as conjectures, but recognition of the primacy of the collaborative therapeutic relationship is one example of how psychoanalytic observations have influenced current research.

Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes.

Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, and 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts.

Factors associated with mental health clinicians' referrals to 12-Step groups.

As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually diagnosed clients to 12-Step groups. This study examined the relationships among clinicians' 12-Step experiences, attitudes, and referral practices in 6 mental health clinics in New York, New York. A path analysis model showed that greater interest in learning about 12-Step groups directly predicted 12-Step referral practices and that 12-Step interest was predicted by clinicians' perception of the helpfulness of 12-Step groups and the severity of their patients' problems with substance abuse. Clinicians' responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-Step groups.