Older Methadone Patients Achieve Greater Durations of Cocaine Abstinence with Contingency Management Than Younger Patients
University of Connecticut School of Medicine, Farmington, Connecticut. American Journal on Addictions
(Impact Factor: 1.74).
03/2013; 22(2):119-26. DOI: 10.1111/j.1521-0391.2013.00306.x
Contingency management (CM) interventions are efficacious in treating cocaine abusing methadone patients, but few studies have examined the effect of age on treatment outcomes in this population. This study evaluated the impact of age on treatment outcomes in cocaine abusing methadone patients.
Data were analyzed from 189 patients enrolled in one of three randomized studies that evaluated the efficacy of CM versus standard care (SC) treatment.
Age was associated with some demographics and drug use characteristics including racial composition, education, and methadone dose. Primary drug abuse treatment outcomes did not vary across age groups, but CM had a greater benefit for engendering longer durations of abstinence in the middle/older and older age groups compared to the younger age groups. At the 6-month follow-up, submission of a cocaine positive urine sample was predicted by submission of a cocaine positive sample at intake, higher methadone doses, and assignment to SC rather than CM treatment.
As substance abusers are living longer, examination of the efficacy of pharmacological and psychosocial treatments specifically within older age groups may lead to a better understanding of subpopulations for whom enhanced treatments such as CM are warranted. (Am J Addict 2013;22:119-126).
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Available from: Steffanie A Strathdee
- "The primary independent variable of interest was reporting being forced to pay a bribe to police in the previous six months (i.e., participants were asked whether they had been stopped by law enforcement in the previous six months, and if so, whether they paid a bribe). Potential confounders previously identified in the literature included: age (Dürsteler-MacFarland et al., 2011; Weiss and Petry, 2013), gender (Kelly et al., 2011), any use of heroin (Mattick et al., 2009), cocaine (Castells et al., 2010; Weiss and Petry, 2013), or methamphetamine (including crystal methamphetamine; Shekarchizadeh et al., 2012), reported frequency of injection drug use (i.e., daily vs. non-daily/none; Amato et al., 2002; Ferri et al., 2010), follow-up visit (Kelly et al., 2011), self-perceived need for addiction treatment (none or some need vs. a great or urgent need), and a visit-by-bribe interaction term. This last variable was included because changes to discretionary policing practices may have evolved over the study period given the ongoing implementation of the drug policy reform (Syvertsen et al., 2010). "
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In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms.
Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained.
Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%).
Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID.
Drug and Alcohol Dependence 01/2015; 148. DOI:10.1016/j.drugalcdep.2015.01.011 · 3.42 Impact Factor
Available from: Namkee Choi
Drug and Alcohol Dependence 01/2014; · 3.42 Impact Factor
Available from: Namkee Choi
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ABSTRACT: This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26-34, 35-49, and 50-64 years old.
Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N=96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses.
The 65+ age group was least likely to use treatment and perceive treatment need, but the 50-64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment.
Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Drug and Alcohol Dependence 10/2014; 145C:113-120. DOI:10.1016/j.drugalcdep.2014.10.004 · 3.42 Impact Factor
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