Evaluating culturally and linguistically integrated care for Latinx adults with mental and substance use disorders.

Objective: To evaluate changes in health and health care utilization outcomes for Latinx adults with substance use and mental disorders receiving integrated behavioral and primary health care.Design: Study sample included enrollees who completed baseline, 6-month and 12-month assessments (n = 107). Study outcomes were depression symptom severity, anxiety symptom severity, illicit drug use, emergency department utilization and homelessness status. Pre-post analyses were conducted using paired t-test and McNemar test to examine changes in study outcomes. Multivariable regression model estimated through generalized estimating equations explored the influence of the intervention on study outcomes. Results were presented in adjusted odds ratios (AOR) and 95% confidence intervals (CI).Results: Participants were less likely to report depressive symptoms (AOR: 0.496, 95%CI: 0.296-0.832), less likely to report anxiety symptoms (AOR: 0.539, 95%CI: 0.329-0.884), and less likely to experience homelessness (AOR: 0.556, 95%CI: 0.328-0.943) at 6-month assessment compared to baseline. Participants were also less likely to report depressive symptoms (AOR: 0.378, 95%CI: 0.209-0.684), less likely to report anxiety symptoms (AOR: 0.471, 95%CI: 0.270-0.821), less likely to experience homelessness (AOR: 0.333, 95%CI: 0.189-0.587), and less likely to utilize the emergency department in the past 30 days (AOR: 0.397, 95%CI: 0.188-0.837) at 12-month assessment compared to baseline.Conclusions: Integrating culturally responsive behavioral and primary health care services is critical for addressing the needs of Latinx adults with mental and substance use disorders, and other chronic diseases. This initiative has the potential to reduce disparities in access to and engagement in care for Latinx adults.

The Associations between Risky Psychosocial Environment, Substance Addiction Severity and Imprisonment: A Swedish Registry Study.

Objective: Both childhood and adult psychosocial stressors have been identified as links to both increased risk for substance use disorder (SUD) and increased risk of imprisonment. The aim of this retrospective study is to identify, for a sample of 14,914 adults who all were assessed for risky substance use or a SUD, the importance of having a history of psychosocial stressors compared to current addiction severity. The analyses control for age, gender and education on the likelihood of future imprisonment. Method: Baseline Addiction Severity Index data (ASI) were merged with national registry data on prison sentences from 2003 to 2016. In the analysis, a Cox regression was used to study the association between independent variables and the likelihood of future imprisonment. Results: In the regression, five variables showed significant association to increased risk of imprisonment: ASI drugs other than alcohol Composite Score (positive relationship), ASI alcohol Composite Score (negative relationship), age (younger), education (lower) and parental problems with drugs other than alcohol. The factor with strongest association with imprisonment was the ASI drugs other than alcohol Composite Score, which showed the highest HR = 10.63 (3.50-32.31) for women and HR = 5.52 (3.77-8.08) for men to predict the likelihood of imprisonment. Discussion: Research is needed on why individuals with history of psychosocial stressors have a higher likelihood of imprisonment compared to their counterparts. Findings indicate that a high ASI Composite Score for drugs other than alcohol are strong predictors of future criminality and criminal justice system involvement.

An Outcome Study of the CASA-CHESS Smartphone Relapse Prevention Tool for Latinx Spanish-Speakers with Substance Use Disorders.

Background: Hispanic/Latinx persons with alcohol and other drug disorders (AOD) have limited access to culturally competent continuity of care. To address this, the evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Latinx Spanish-speakers with AOD, developing CASA-CHESS. Objectives: This study examined the AOD and mental health outcomes for Latinx Spanish-speaking clients using the CASA-CHESS smartphone tool over a 6-month period, post-residential treatment. This single group, pre-post study design included seventy-nine male and female Spanish-speaking Latinx clients, equipped with CASA-CHESS as they completed residential AOD treatment. Primary outcome measures at baseline and 6-month follow-up included substance use and other mental health symptoms. Results: While over 70% of the sample reported past heroin use and alcohol use, clients had low baseline rates of substance use, depression and anxiety and elevated social support scores as they graduated from residential treatment. Overall participants maintained their relatively low baseline rates during the 6-month post-residential period while using the CASA-CHESS relapse prevention tool. Those who discontinued using CASA-CHESS within the first 4 months after leaving residential treatment reported higher rates of substance use as well as anxiety and depression symptoms than those using it for 4 or more months, suggesting that continued use of CASA-CHESS may contribute to maintenance of successes gained in treatment. Conclusions/Importance: CASA-CHESS may reduce the risk of relapse for Latinx Spanish-speakers following residential services and extend needed access to culturally and linguistically competent aftercare services for those with AOD.

Is Clinical Assessment of Addiction Severity of Individuals with Substance Use Disorder, Using the Addiction Severity Index, A Predictor of Future Inpatient Mental Health Hospitalization? A Nine-Year Registry Study.

OBJECTIVE: In Sweden, the Addiction Severity Index (ASI) is the Swedish National Board of Health and Welfare's recommended substance use disorder assessment tool and used routinely for patient intakes. Our study of 213 individuals assessed for substance use disorder with the ASI used nine years of the National Patient Register and examined whether clinical social workers' assessments of addiction severity at baseline were associated with later hospitalizations for mental health disorder (MHD). METHODS: ASI composite scores and interviewer severity rating were used to measure clients' problems in seven areas (mental health, family and social relationships, employment, alcohol, drug use, health, and legal) at baseline. A stepwise regression method was used to assess the relative importance of ASI composite scores, MHD hospitalization two years prior to baseline, age, and gender for MHD hospitalization seven years post-baseline. RESULTS: Almost two-thirds of the individuals (63%) were hospitalized at least once for MHD in the seven years post-baseline. At the multivariable level, MHD hospitalization prior to baseline was the strongest predictor of future MHD hospitalization, followed by ASI composite scores for drug use, employment, mental health and, last, male gender. CONCLUSIONS: A key finding is that higher ASI composite scores for drug use and mental health are predictors of future need for MHD treatment. Future studies will replicate this effort with a national population of individuals with substance use disorder.

Introduction to the Special Issue: Educating Social Workers about Alcohol and Other Drug Use Disorders.

This Special Issue of Journal of Social Work Practice in the Addictions focuses on an emerging effort, the Alcohol and Other Drugs Education Program (ADEP), designed to advance social work faculty knowledge and teaching in the area of alcohol and other drug (AOD) use. In June 2017, with grant support from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the inaugural ADEP program provided in-depth, immersion-based training to 50 full-time, clinical faculty from social work programs across the United States. As detailed in this Special Issue, the preliminary results of our program were highly promising and we look forward to training more social work faculty in June 2018, and in years to come. The ADEP program is predicated on the idea that faculty training in evidence-based AOD identification and treatment methods will help faculty to provide higher-quality instruction in AOD and, in turn, that their students will be better prepared to serve clients experiencing AOD-related problems. While this Special Issue focuses primarily on the ADEP program, we do so with the hope that the work presented here reaches far beyond the specifics of our faculty training program to underscore the need to advance AOD-related training and offer a template for social work educators looking adapt their teaching to address the nation's very serious challenges with AOD.

Advancing Alcohol and Other Drug Education among Social Work Faculty: An Evaluation of Social Work Faculty Immersion Training.

This study is an educational evaluation of participants (N = 50) in a four-day immersion training program funded by the National Institute of Alcohol Abuse and Alcoholism. Using a pretest-posttest design, clinical social work faculty participants showed statistically significant (p < .001) improvement in overall alcohol and other drug-related knowledge (Baseline: Mean[SD] = 8.75 [2.44]; Post-Intervention: Mean[SD] = 13.88[1.96], Cohen's d = -2.16) in the domains of screening/assessment, brief intervention, medication-assisted treatment, and recovery and relapse prevention. Corresponding increases were also observed for faculty confidence in teaching clinical skills related to alcohol and other drug screening, assessment, and treatment.

Use of a Smartphone Recovery Tool for Latinos with Co-Occurring Alcohol and Other Drug Disorders and Mental Disorders.

OBJECTIVE: Addressing alcohol and other drug disorders and other mental disorders among adult Hispanics/Latinos is of critical concern, as they are one of the fastest-growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring alcohol and other drug disorders/mental disorders, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services. METHODS: The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders, thus developing CASA-CHESS to address a high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos. RESULTS: Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS, 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of self-determination theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients. CONCLUSIONS: Findings illustrate that Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.

Alcohol Use and HIV Testing in a National Sample of Women.

The HIV/AIDS epidemic continues to disproportionately affect racial and ethnic minority groups and women in the United States. Prevention research suggests that reduced alcohol use and increased HIV testing are associated with lower incidence of HIV transmission among high-risk populations. Multivariable logistic regression analyses of the 2009 National Health Interview Survey data were performed for a national sample of 15,470 adult women to examine the relationship between alcohol use and likelihood of HIV testing. There is a significant association between level of alcohol use and HIV testing. Women who identified as heavy drinkers and moderate drinkers were significantly less likely to report ever testing for HIV. Findings add to the limited literature on the association between alcohol use and HIV testing behaviors among women. Given the incidence of HIV among women, this study highlights the importance of HIV testing, especially for alcohol-using women.

Admissions to detoxification after treatment: Does engagement make a difference?

BACKGROUND: Treatment engagement is a well-established performance measure for the treatment of substance use disorders. This study examined whether outpatient treatment engagement is associated with a reduced likelihood of subsequent detoxification admissions. METHODS: This study used administrative data on treatment services received by clients in specialty treatment facilities licensed in Massachusetts. The sample consisted of 11,591 adult clients who began an outpatient treatment episode in 2006. Treatment engagement was defined as receipt of at least 1 treatment service within 14 days of beginning a new outpatient treatment episode and receipt of at least 2 additional treatment services in the next 30 days. The outcome was a subsequent detoxification admission. Multilevel survival models examined the relationship between engagement and outcomes, with time to detoxification admission as the dependent variable censored at 365 days. RESULTS: Only 35% of clients met the outpatient engagement criteria, and 15% of clients had a detoxification admission within a year after beginning their outpatient treatment episode. Controlling for client demographics, insurance type, and substance use severity, clients who met the engagement criteria had a lower hazard of having a detoxification admission during the year following the index outpatient visit than those who did not engage (hazard ratio = 0.87, P < .01). CONCLUSIONS: Treatment engagement is a useful measure for monitoring quality of care. The findings from this study could help inform providers and policy makers on ways to target care and reduce the likelihood of more intensive services.

Race/ethnicity and quality indicators for outpatient treatment for substance use disorders.

BACKGROUND AND OBJECTIVES: Initiation and engagement, performance measures that focus on the frequency and timely receipt of services in the early stages of substance use disorders (SUD) treatment, are useful tools for assessing treatment quality differences across racial/ethnic groups. The purpose of this study was to examine whether there are racial/ethnic disparities in these quality indicators and to explore whether predictors of treatment initiation and engagement differ by clients' race/ethnicity. METHODS: This study used administrative data from outpatient treatment facilities licensed by the state of Massachusetts that receive public funding. The sample consisted of 10,666 adult clients (76% White, 13% Latino, 11% Black) who began an outpatient treatment episode in 2006. Client data were linked with facility data from the National Survey on Substance Abuse Treatment Services. Multilevel regressions were used to examine racial/ethnic disparities and to explore whether predictors for initiation and engagement differed by client's race/ethnicity. RESULTS: We did not find evidence of racial/ethnic disparities in treatment initiation or engagement. However, we found that predictors of initiation and engagement differed by client's race/ethnicity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Disparities may be context specific, and thus it is important that they be examined at state or local levels. Our results point to the importance of examining predictors of quality indicators separately by group to better understand and address the needs of diverse client populations.

Addiction treatment staff perceptions of training as a facilitator or barrier to implementing evidence-based practices: a national qualitative research study.

BACKGROUND: This qualitative effort examines training-related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) nationwide that were funded by the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT) to implement EBPs. METHODS: Using qualitative interviews, the authors explored staff (N = 514) descriptions of training as a facilitator or barrier to implementation. Training-related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. RESULTS: Specific characteristics of the training received, such as access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included the amount of training; the training did not fit current staff and/or organizational needs; the training for some EBPs was perceived to be too demanding; and the difficulty accessing training. CONCLUSIONS: Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility, and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally funded resources for training were not always used.

Repeated addiction treatment use in Sweden: a National Register Database study.

UNLABELLED: Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. IMPLICATIONS: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

Association between addiction treatment staff professional and educational levels and perceptions of organizational climate and resources.

BACKGROUND: Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. METHODS: The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. RESULTS: Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. CONCLUSION: It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.

Addiction severity and re-employment in Sweden among adults with risky alcohol and drug use.

BACKGROUND: The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment. METHODS: We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics, RESULTS: Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re-employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629-0.956), employment (estimate: 0.669, confidence interval: 0.532-0.841), drug use (estimate: 0.628, confidence interval: 0.428-0.924), and health (estimate: 0.798, confidence interval: 0.699-0.912). CONCLUSIONS: This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use.

Immigrant background, incarceration history and recidivism among adults assessed for illicit substance use severity: Findings from a Swedish registry study.

BACKGROUND: In Sweden, as in other countries, individuals with immigrant backgrounds are disproportionately represented within the incarcerated population. This study examined the association between immigrant background and future incarceration for individuals assessed for illicit substance use severity, while considering their prior incarceration history. METHODS: Using data from Swedish Addiction Severity Index (ASI) assessments linked to register data from Statistics Sweden, we employed Zero-Inflated Negative Binomial (ZINB) regression models to analyse differences in incarceration histories within five years before and after ASI assessments based on immigrant backgrounds. Additionally, Cox proportional-hazard models were used to assess the likelihood of post-assessment incarceration among these groups. RESULTS: Immigrant background was positively associated with pre- and post-assessment incarceration. First- and second-generation immigrants from the Global South had longer periods of incarceration in the five years before assessments compared to native Swedes. Post-assessment, first-generation immigrants showed longer periods of incarceration. Survival analyses supported these findings, indicating a higher risk of prolonged post-assessment incarceration among all immigrant groups, particularly first-generation immigrants from the Global South. CONCLUSION: Among individuals assessed for illicit drug use within Swedish municipalities, those with immigrant backgrounds faced higher incarceration risks, even after controlling for substance use severity and prior incarceration. Tailored interventions and support systems are vital to prevent re-entry into the criminal justice system. Timely actions can break re-offending cycles, redirecting paths away from reoffending and towards legal reintegration, thereby reducing incarceration and recidivism rates.

The Intersections Between Sexual Orientation, Latine Ethnicity, Social Determinants of Health, and Lifetime Suicide Attempts in a Sample Being Assessed for Entry to Co-Occurring Mental Health and Substance Use Disorder Treatment.

PURPOSE: Few studies have examined the relationship between the intersections of lesbian, gay, and bisexual (LGB) sexual orientation, Latine ethnicity, and lifetime suicide attempts in Latine individuals with substance use disorder. This study examines this intersection and controls for social determinants of health, mental health disorder symptoms, and substance use disorder symptoms in a sample of Latine adults entering treatment for co-occurring disorders. METHOD: Bivariate statistics and multivariate logistic regression were used to analyze assessment data (n = 360) from a bilingual/bicultural integrated behavioral health system serving Latine communities in Massachusetts to examine the relationship between sexual orientation, Latine ethnicity, and history of lifetime suicide attempts. We controlled for social determinants of health, mental health disorders, and substance use disorder (SUD) factors significantly associated with lifetime suicide attempts at the bivariate level. RESULTS: Over 27% of the sample and 35% of Puerto Ricans (PR) reported lifetime suicide attempts. The logistic regression identified that PR clients were 78% more likely to have attempted suicide in a lifetime compared to non-PR clients. Clients identifying as LGB were 3.2 times more likely to report having attempted suicide in their lifetime compared to heterosexual clients. Unemployed clients were 2.4 times more likely to report having attempted suicide in their lifetime compared to employed clients. CONCLUSION: Findings identify high rates of lifetime suicide attempts among LGBs and PRs entering SUD treatment. Targeted outreach and treatment efforts designed to address intersectionality for this underserved population are needed.

Drug use and suicidality among Asian American women who are children of immigrants.

This study investigates the association between drug use and lifetime suicidal behaviors among Asian American women (n = 720) residing throughout Massachusetts, using data collected from 2010 to 2011. Logistic regression models identified that a history of hard drug use alone or in combination with soft drug use has a significant association with both suicidal ideation and suicide attempts among Asian American women, adjusting for demographic covariates, history of psychiatric diagnosis, and family communication. These findings highlight the importance of addressing hard drug use when designing suicide prevention programs for Asian American women.

Facilitating factors in implementing four evidence-based practices: reports from addiction treatment staff.

UNLABELLED: In this Robert Wood Johnson Foundation-funded study (2009-2011), treatment staff (n = 178) from 330 federally funded U.S. addiction treatment programs provided data through semistructured telephone interviews about factors that facilitated their implementation of four evidence-based practices (EBPs). Such studies can assist the addiction field in improving EBP implementation and ultimately, client care. RESEARCH QUESTIONS: What factors were identified as facilitating implementation of the four EBPs? And, Do facilitating factors vary by EBP? Coders classified facilitating factors (n = 518) using a six-category schema. Results showed that although facilitating factors varied by EBP, organization-related factors dominated. Study implications and limitations are described.

Social and economic factors associated with recent and lifetime incarceration among Puerto Rican drug users.

Using a sample of 280 Puerto Rican drug users with a history of incarceration residing in Massachusetts, we explore whether a significant association exists between social and economic factors (maintaining social network contacts, receiving public assistance) and lifetime incarceration. Analysis of survey data using regression methods shows that respondents who live in their own home, receive public assistance, and have recent familial contact are significantly less likely to have been incarcerated in the past 6 months. Among study participants, men and those who initiated heroin use at younger ages are more likely to have greater lifetime incarceration totals. Practice implications are discussed.