Drug-dependent pregnant women with intimate partners who are also drug-dependent have been found to have compromised treatment outcomes. Thus, developing a treatment to reduce a male partner's drug use is the first step in a line of research with a distal goal of improving pregnant patient's treatment outcomes.
This study examined a novel intervention for engaging the male partner in drug treatment.
Men targeted for intervention were non-treatment-seeking opioid users. Motivational enhancement therapy (MET), an effective non-confrontational intervention approach for evoking behavioral change, was employed to encourage treatment participation. This six-session intervention was followed by a drug-abstinent contingency-based voucher incentive program. Moreover, to help maintain drug abstinence, male partners had rapid facilitation into either opioid detoxification with aftercare or methadone maintenance. Interwoven into treatment were both couple's counseling and a men's group educational program designed to strengthen the support provided by the men to their partners during pregnancy and post-delivery. Men (n = 45) received either the novel intervention package called HOPE (Helping Other Partners Excel) or a control condition (n = 17) that received weekly support and referrals for treatment.
Men in the HOPE condition, compared with the usual care condition, showed increased treatment retention, transient decreases in heroin use, increased involvement in recreational activities, less reliance on public assistance, and increased social support for their pregnant partners. CONCLUSION AND CLINICAL SIGNIFICANCE: Results suggest that treatment of male partners is feasible and efficacious in the short term but modifications to the intervention are needed to sustain results.
"Given that the vast majority of opioid injectors were not receiving agonist medication and that naltrexone alone was unsuccessful in promoting continued illicit opioid abstinence, a multi-component behavioral therapy approach was developed for Georgian men (who comprise 99% of known drug-users), based on a successful intervention model developed in the US (Jones et al., 2011). Behavioral treatment components included individual Motivational Interviewing (MI) in order to foster treatment engagement (Miller and Moyers, 2002; Miller and Rollnick, 1991a; Rollnick et al., 1992), MI for the couple aimed at improving the couple's relationship and her support of the male participant's treatment episode, and concurrent rapid entry into detoxification followed by naltrexone maintenance. "
[Show abstract][Hide abstract] ABSTRACT: To test the initial feasibility of a novel 22-week comprehensive intervention pairing behavioral treatment with naltrexone that aimed at engaging, retaining, and treating opioid-injecting men in the Republic of Georgia.
Forty opioid-injecting male and their drug-free female partners participated in a two-group randomized clinical trial at the field site of the Union Alternative Georgia, in Tbilisi, Republic of Georgia. The comprehensive intervention that paired behavioral treatment with naltrexone for the male participants (n=20) included counseling sessions using Motivational Interviewing for both the male participant and the couple, monetary incentives for drug abstinence, and research-supported detoxification followed by naltrexone treatment. Male participants in the usual care condition (n=20) had the opportunity to attend once-a-week individualized education sessions and upon request receive referrals to detoxification programs and aftercare that could or could not have included naltrexone. Outcome measures included entry into inpatient detoxification and naltrexone treatment, urine drug screening, reduction in illicit substance use, use of benzodiazepines, injection of buprenorphine, and needle and syringe sharing.
The comprehensive intervention condition showed significantly more weekly urine samples negative for illicit opioids during weeks 1-22 (7.0 vs. 1.4; p<.001) and reported significant declines in use of benzodiazepines and injection of buprenorphine (both ps<.004).
The first behavioral treatment randomized clinical trial in the Republic of Georgia found that the use of tailored behavioral therapy paired with naltrexone is both feasible and efficacious for treating drug use and reducing HIV drug-risk behavior in Georgian men.
Drug and alcohol dependence 07/2011; 120(1-3):14-21. DOI:10.1016/j.drugalcdep.2011.06.012 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: When women addicted to opioids seek prenatal care, the treatment of choice is methadone. Methadone mediates the addiction by reducing fluctuations in maternal serum opioid levels and protecting the fetus from repeated withdrawal episodes. Methadone maintenance is associated with increased
maternal weight gain, decreased illegal drug use, and improved compliance with prenatal care. Although the risks are less when compared with street drugs, the risk to the fetus is physical dependence. Despite the magnitude of this national problem, there is a dearth of literature to guide
NICU nurses on how to best support mothers of infants with neonatal abstinence syndrome (NAS) in the care of their infants. The purposes of this article are to review what is known about women in methadone treatment who have a history of opioid addiction and apply that evidence to guide neonatal
nurses to support mothers of infants with NAS in the NICU.
Neonatal network: NN 11/2013; 32(6):409-15. DOI:10.1891/0730-08126.96.36.1999
[Show abstract][Hide abstract] ABSTRACT: Known drug users in the Republic of Georgia are 99% male. Georgian social context includes close family social structure, intense police scrutiny over daily life, and minimal social service infrastructure. Drug use is dangerous and individuals rely on family support to address socially stigmatizing problems.
The aim was to examine the changes in problem severity over time experienced by 40 adult opioid-injecting men with drug-free female partners in the Republic of Georgia who participated in a randomized clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone.
This secondary data analysis study examined the results from a project that had randomized participants to either a comprehensive intervention that paired behavioral treatment with naltrexone or usual care (UC) and examined changes in Addiction Severity Index (ASI) composite scores.
The comprehensive intervention showed three times the decline in ASI drug use and legal composite scores than did the UC condition in males in the Republic of Georgia, both p < .009.
The results suggest that the use of a comprehensive behavioral intervention paired with naltrexone leads to significant reductions in drug use and legal problems in opioid-injecting males in the Republic of Georgia.
A comprehensive intervention that paired behavioral treatment with naltrexone provides a promising approach to protect drug users against relapse and legal risks.
The American Journal of Drug and Alcohol Abuse 03/2012; 38(2):171-5. DOI:10.3109/00952990.2011.643996 · 1.78 Impact Factor
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