Stigma: how it affects the substance use disorder patient.

The stigma surrounding individuals who have substance use disorders is a pervasive phenomenon that has had detrimental effects on treatment outcomes, health care providers, treatments, research, policies, and society as a whole (Kelly JF, Dow SJ, Westerhoff C , J Drug Issues_40:805-818, Kelly JF, Westerhoff, Int J Drug Policy_21:202-207, 2010). Stigma can be cultivated by various sources, but this article specifically focuses on the impact words have. Individuals influence each other through dynamic language processes. Language, which we use to communicate, represents shared values, history, beliefs, and customs. Moreover, language can be used to promote stigma or decrease it [Snodgrass S: The Power of Words: Changing the Language of Addiction, 2920]. Language usage for addiction medical care is dated in comparison to other standards. Research and organizations are recognizing that substance use treatment, policies, and language need to evolve to aid this crisis and those affected by this disease. Language sustains the stigma surrounding substance use. The stigmatized language used to describe substance use behaviors, individuals with substance use disorders, and substance use treatment can create barriers in essential areas, such as health care, employment, insurance policies, and laws for individuals who are trying to heal and make meaningful contributions to society. There are many ways to contribute to a more accepting society, but it starts with bottom-up processes like language choices in day-to-day conversations. An effort must be made to normalize destigmatized language when referring to substance use and individuals with substance use disorders.

Trends in telemedicine use in addiction treatment.

INTRODUCTION: Telemedicine use in addiction treatment and recovery services is limited. Yet, because it removes barriers of time and distance, telemedicine offers great potential for enhancing treatment and recovery for people with substance use disorders (SUDs). Telemedicine also offers clinicians ways to increase contact with SUD patients during and after treatment. CASE DESCRIPTION: A project conducted from February 2013 to June 2014 investigated the adoption of telemedicine services among purchasers of addiction treatment in five states and one county. The project assessed purchasers' interest in and perceived facilitators and barriers to implementing one or more of the following telemedicine modalities: telephone-based care, web-based screening, web-based treatment, videoconferencing, smartphone mobile applications (apps), and virtual worlds. DISCUSSION AND EVALUATION: Purchasers expressed the most interest in implementing videoconferencing and smartphone mobile devices. The anticipated facilitators for implementing a telemedicine app included funding available to pay for the telemedicine service, local examples of success, influential champions at the payer and treatment agencies, and meeting a pressing need. The greatest barriers identified were: costs associated with implementation, lack of reimbursement for telemedicine services, providers' unfamiliarity with technology, lack of implementation models, and confidentiality regulations. This paper discusses why the project participants selected or rejected different telemedicine modalities and the policy implications that purchasers and regulators of addiction treatment services should consider for expanding their use of telemedicine. CONCLUSIONS: This analysis provides initial observations into how telemedicine is being implemented in addiction services in five states and one county. The project demonstrated that despite the considerable interest in telemedicine, implementation challenges exist. Future studies should broaden the sample analyzed and track technology implementation longitudinally to help the research and practitioner communities develop a greater understanding of technology implementation trends and practices.

A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

OBJECTIVE: To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). DATA SOURCES/STUDY SETTING: Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009. STUDY DESIGN/DATA COLLECTION: The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. PRINCIPAL FINDINGS: Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. CONCLUSIONS: Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.

Association among outcomes in a naturalistic statewide assessment of substance user treatment.

Substance user treatment outcome measurement is important for research and policy questions, yet little literature has addressed the relationships among outcome measures of treatment success. Ideally, treatment outcomes would correlate to at least a moderate degree. The Iowa Department of Public health requires substance user treatment programs receiving public funds to provide client information. Demographic information, "substance abuse" history, current use, arrests, and hospitalizations were ascertained at admission and a 6-month follow-up for 1374 clients (from January 1999 to December 2000). Abstinence, arrests, and hospitalizations were good outcome measures of substance user treatment success. Reduction in frequency of use was negatively associated with arrests, substance use-related hospitalizations, and increased income. Full-time employment at follow-up produced different results depending on the client's sex. However, all associations among outcomes were modest. Specificity may be reasonable in some instances; however, other situations might require a broad-spectrum approach that ideally would produce a wide range of benefits.

Drug and alcohol treatment services effective for methamphetamine abuse.

BACKGROUND: Methamphetamine abuse has become a major public health problem as demonstrated by increases in the number of emergency room visits, substance abuse treatment episodes, and arrests attributable to methamphetamine manufacture and abuse. We examine the effectiveness of conventional substance abuse treatment in the recovery of individuals seeking voluntary treatment for methamphetamine abuse. METHODS: At the request of the Iowa Department of Public Health, the Iowa Consortium for Substance Abuse Research and Evaluation contacted clients who had been admitted to voluntary treatment for methamphetamine abuse. Staff from the Consortium asked subjects to volunteer for follow-up interviews at designated intervals following admission. Agency staff conducted interviews based on the Mini International Neuropsychiatric Interview (MINI) at admission and at designated intervals and reported results to the Consortium for analysis. RESULTS: Subjects were predominantly Caucasian and over one half were female with an average age of 30 years. The criminal justice system was a primary referral source. Reported psychiatric symptoms dropped substantially in the first 60 days following admission and appeared to remain low at 6 and 12 months. Most clients reported abstinence and employment and denied arrests at the 6-month interview. Outcomes were not correlated with psychiatric symptoms. CONCLUSIONS: Psychiatric symptoms improved over time with usual substance abuse treatment. There was no evidence that referral by the court system or symptoms of antisocial personality disorder affected outcome. Conventional treatment resulted in sobriety, employment, and fewer arrests at 6 and 12 months following treatment.