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A Perspective from the Field: Five Interventions to Combat the Opioid Epidemic and Ending the Dichotomy of Harm-reduction versus Abstinence-Based Programs
Abstract
In this perspective article, the authors share our knowledge, expertise, and experiences in responding to the opioid epidemic in St. Joseph County (Indiana). The authors discuss five interventions we have used in the county to minimize the devastating effects of the opioid epidemic. Their hope is that the knowledge gained from this article will be transferred to other states and counties to further promote recovery and well-being for individuals who have opioid use disorders. The authors recommend that naltrexone (injectable extended-release) be offered in county jails, drug courts incorporate medication-assisted treatments (MATs) into their programming, recovery coaches be used in emergency rooms, harm-reduction recovery groups be accessible to individuals, and naloxone be readily available to communities. We also propose paradigm shifts in how some professionals approach treatment and conceptualize recovery. The authors challenge the agency-driven dichotomy of being either a harm-reduction or an abstinence-based program. Recovery is best understood on a spectrum and should be defined by the individuals we serve, not the projection of professional values or agency agendas of what they think ones recovery should look like.
... There seems to be two broad points of view: being in favour of total abstinence with zero tolerance or an approach prioritising harm reduction. This dichotomy has also been observed in mental health care literature in opioid treatment where there are either abstinence programmes or harm reduction programmes (21). Whereas the total abstinence approach to addiction treatment prevailed, harm reduction has made it possible to offer a choice of treatment goals (22). ...
... Despite the existence of these different approaches, a study conducted in the context of treatment for alcoholism showed that some patients internalise total abstinence as the only goal and therefore see alternative options as a second choice or a failure (23). Faced with this diversity of approaches, Gallagher and colleagues propose a paradigm shift for professionals to view treatment and recovery differently (21). The authors conceptualise recovery on a spectrum that is determined by patients and not a projection of professional or institutional values. ...
Background
Benzodiazepines and Z-drugs (BZD/Z) are prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication.
Aim
To explore how primary care and mental health care professionals set treatment goals with long-term BZD/Z users.
Design & setting
Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care in Belgium.
Method
Inductive thematic content analysis was performed.
Results
Seven themes were identified from the analysis. Professionals tend not to use the DSM-V standard to diagnose a substance use disorder to BZD/Z. They describe criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appear to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them report feeling trapped into continuing to prescribe and consider BZD/Z withdrawal to be difficult. Some are afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations which they perceive to be too broad currently.
Conclusion
Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.
... Indeed, we consider, as other research has demonstrated [17], that abstinence can be an objective of the people who use harm reduction services, and that the opposition between abstinence and harm reduction is more theoretical than empirical. We "challenge the agency-driven dichotomy of being either a harm-reduction or an abstinence-based program" [18]. Indeed, the opposition between abstinence and harm reduction is linked to the history of harm reduction, which was constructed on a political and militant level in opposition to the proponents of beliefs in the postulate that abstinence is the only possible path for all dependent persons [19]. ...
Context
Regular alcohol use is a predominant risk factor for disease, injury, and social harm. While robust evidence is advocating for implementing interventions to reduce the harms of illegal substance use, less literature is dedicated to identifying and understanding interventions aiming at reducing the various harms associated with alcohol.
Objectives
This review describes how alcohol harm reduction (AHR) interventions are currently conducted and analyzes the facilitators and barriers identified by the studies on their efficacy.
Method
This scoping review with evidence appraisal included articles published between 2011 and 2022, addressing one or more AHR interventions for population of at least 18 years (including alcohol user who have an addiction but also alcohol user with harmful drinking), conducted in North industrialized countries (Europe, Nort America, Australia).
Results
Among the 61 articles selected, we identified several forms of support (face-to-face or remote, support in residential settings, structural interventions, and interventions created upon spontaneous initiatives), and strategies of intervention were also analyzed (the ones based upon learning and skill development, the ones based upon psychological support, the ones focusing upon socio-economic conditions, strategies focusing on the coordination and adaptation of the care system, and those strategies based on peer support). The facilitators linked to fundamental characteristics of the interventions were the promotion of empowerment and autonomy of beneficiaries, setting objectives tailored to individual needs, professionals harmonizing their values, evidence-based interventions taking into account cultural contexts, and comprehensive and holistic support. Practical facilitators from the intervention process consist of increasing the number of sessions, involvement, and formation of members of staff, disposing of the necessary resources, and using technological tools.
Discussion
The sheer variety of AHR interventions demonstrates that this is a fertile field in terms of intervention design and innovation. This work illustrates the importance of designing effective, adapted harm reduction interventions, prioritizing interventions that make support more accessible to more people. This also prompts us to consider the potential benefits of invoking proportionate universalism in the design of AHR interventions in order to operationalize alcohol harm reduction philosophy. accessible to more people.
... Research on other substances such as opioids shows that abstinence-forward and abstinence-only messaging is often paternalistic, judgmental, and stigmatizing for recipients [54]. Prior research on cannabis use in pregnancy also demonstrates that non-abstinence messaging should be a viable goal 55 as well as the importance of a harm reduction approach [18,44,[55][56][57]. ...
Background
Cannabis is the most common illicit substance used in pregnancy. As use continues to increase, understanding peoples’ behaviors surrounding cannabis use during pregnancy is needed to improve maternal and child health outcomes. The aim of this study was to better understand pregnant individuals' perceptions and knowledge of cannabis use and use patterns as well as the social and environmental factors that may influence their use.
Methods
We conducted interviews with 19 participants between December 2022 and March 2023. Individuals self-identified as BIPOC (Black, Indigenous, People of Color), were over 21 years of age, spoke English or Spanish, resided in California, and had used cannabis during pregnancy in the last 0–2 years. Using qualitative, constructivist grounded theory methods, we analyzed the contexts that contributed to participants’ lived experiences surrounding cannabis use behaviors during pregnancy.
Results
Participants reported making conscious decisions to responsibly manage their cannabis use during pregnancy to minimize potential harm to the fetus. Participants prioritized making what they perceived to be safer adjustments to their use of cannabis: (1) changing the amount of cannabis used, (2) changing the types of cannabis products used, and (3) changing sources of cannabis procurement.
Discussion
Our findings show that pregnant individuals are seeking information about safe cannabis use beyond medical supervision and are open to altering their cannabis consumption patterns. However, they are unable to find trustworthy and evidence-based harm reduction practices which can be implemented to mitigate harm to their unborn children. A harm reduction approach is needed in the field of maternal cannabis use to promote positive maternal and fetal health outcomes.
Conclusions
More data is needed on comprehensive harm reduction approaches to cannabis use during pregnancy. This requires implementation of education on these topics in healthcare settings presented by prenatal care clinicians.
... Currently, relapse is a common outcome for substance use disorder treatment: Studies have shown that only 60% of patients stay abstinent after just 3 months, and only 50% of patients remain abstinent after just 1 year (McKay et al., 2013). It has been shown that drug users are less likely to relapse when provided with more supports such as concurrent psychological treatment or medication-assisted treatments (Van Der Woerd et al., 2010;Gallagher et al., 2019). Our present findings shed an important light on how these cotreatments (such as EE + ORG) can facilitate harm reduction by affecting neuroplasticity. ...
Environmental enrichment combined with the glycine transporter-1 inhibitor Org24598 (EE+ORG) during cocaine-cue extinction (EXT) inhibited reacquisition of 1.0 mg/kg cocaine self-administration in male but not female rats in a previous investigation. In this investigation, we determined if this treatment benefit in males required EXT training and ascertained the molecular basis for the observed sex difference in treatment efficacy. Nine groups of male rats trained to self-administer 1.0 mg/kg cocaine or receiving yoked-saline underwent EXT or NoEXT with or without EE and/or ORG. Next, they underwent reacquisition of cocaine self-administration or were sacrificed for molecular analysis of 9 protein targets indicative of neuroplasticity in four brain regions. Two groups of female rats trained to self-administer 1.0 mg/kg cocaine also underwent EXT with or without EE + ORG and were sacrificed for molecular analysis, as above. EE + ORG facilitated the rate of EXT learning in both sexes, and importantly, the therapeutic benefit of EE + ORG for inhibiting cocaine relapse required EXT training. Males were more sensitive than females to neuroplasticity-inducing effects of EE + ORG, which prevented reductions in total GluA1 and PSD95 proteins selectively in basolateral amygdala of male rats trained to self-administer cocaine and receiving EXT. Females were deficient in expression of multiple protein targets, especially after EE + ORG. These included total GluA1 and PSD95 proteins in basolateral amygdala, and total TrkB protein in basolateral amygdala, dorsal hippocampus, and ventromedial prefrontal cortex. Together, these results support the clinical view that sex-specific pharmacological and behavioral treatment approaches may be needed during cue exposure therapy to inhibit cocaine relapse.
... While meeting NIAAA recovery criteria is a sound overarching treatment goal, service providers should keep in mind that there are multiple pathways to this outcome (LaBarre et al., in press). Therefore, supporting people in recovery from alcohol problem should begin with conversations about individuals' specific recovery goals, which may include abstinence, moderate alcohol use, resolution of specific AUD symptoms (e.g., resuming enjoyable activities previously stopped because of drinking), and/or other health and wellbeing gains (Gallagher et al., 2019). For individuals not focused on abstinence, nonjudgmental psychoeducation about the definition of and risks associated with heavy drinking may be instructive (Ray et al., 2019). ...
... Within the drug use treatment landscape, some persons draw a distinction between models promoting complete cessation (i.e., abstinence from use of any substances, including MOUD), and maintenance (i.e., cessation from illicit substances through the controlled use of MOUD options such as buprenorphine and methadone) [64]. However, it is important that constituencies understand the evidence-base of MOUD utilization. ...
Background
The opioid overdose crisis in the USA has called for expanding access to evidence-based substance use treatment programs, yet many barriers limit the ability of people who inject drugs (PWID) to engage in these programs. Predominantly rural states have been disproportionately affected by the opioid overdose crisis while simultaneously facing diminished access to drug treatment services. The purpose of this study is to explore barriers and facilitators to engagement in drug treatment among PWID residing in a rural county in West Virginia.
Methods
From June to July 2018, in-depth interviews (n = 21) that explored drug treatment experiences among PWID were conducted in Cabell County, West Virginia. Participants were recruited from locations frequented by PWID such as local service providers and public parks. An iterative, modified constant comparison approach was used to code and synthesize interview data.
Results
Participants reported experiencing a variety of barriers to engaging in drug treatment, including low thresholds for dismissal, a lack of comprehensive support services, financial barriers, and inadequate management of withdrawal symptoms. However, participants also described several facilitators of treatment engagement and sustained recovery. These included the use of medications for opioid use disorder and supportive health care workers/program staff.
Conclusions
Our findings suggest that a range of barriers exist that may limit the abilities of rural PWID to successfully access and remain engaged in drug treatment in West Virginia. Improving the public health of rural PWID populations will require expanding access to evidence-based drug treatment programs that are tailored to participants’ individual needs.
... Twelve-step recovery groups (e.g., Alcoholics Anonymous, Narcotics Anonymous, Celebrate Recovery) have a strong evidence base for supporting abstinence from or limited use of addictive substances and are part of the spectrum of addiction treatment (Gallagher et al., 2019;Kelly et al., 2020;Klein & Seppala, 2019) and can be implemented even where health care professionals are scarce. Research suggests these groups' primary mechanisms of effectiveness are social support, vulnerability, and accountability (Bond et al., 2003;Krentzman, 2021). ...
Sharp rises in overdose deaths nationally coincided with the arrival of the COVID-19 pandemic. Rural Appalachia, known for high rates of substance use and barriers to health care in general, was suspected to be disproportionately impacted in terms of recovery supports such as 12-step recovery meetings. This study investigated the availability of recovery meetings in South Central Appalachia before and after COVID-19 lockdowns. The number of confirmed recovery meetings was compared before and after COVID-19 lockdowns by geographic location (i.e., rural/nonrural and medium metro/small metro/micropolitan/noncore). Recovery meeting data were systematically collected through interviews with community contacts, reviewing social media and websites, making phone calls, and sending emails and surveys and updated longitudinally. There was no significant change in the number of meetings from pre- (n = 189) to post-COVID-19 (n = 178). There was no significant shift in meeting location when dichotomizing by rural/nonrural classification, χ²(1) = 2.76, p = .097, π = −0.087. Chi-square test of independence did reveal a significant change in number of recovery meetings by location when using four location classifications, χ²(3) = 7.97, p = .047, Cramer’s V = 0.147. There was a noteworthy rise in the meetings in small metro (36.5%–51.1%), with all other locations declining. The establishment and reestablishment of recovery meetings in rural communities should be prioritized to address the longstanding scarcity of recovery resources in rural locations, recent decline in such support, and the rise in overdose deaths.
... Evidence for a sixth implementation strategy-adherence support-was reflected in practical approaches adopted by PHA staff to accommodate needs and preferences of residents who smoke, both in transitional and longer-term policy maintenance phases. PHA staff described an approach to supporting residents in a manner akin to the principles of harm reduction: by acknowledging that a proportion of residents will continue to smoke [32], some PHAs created an opportunity to focus on ways to ensure that smoke-free rules would be followed to the advantage of all. Practical strategies such as timing the transition for the summer months (when outdoor smoking is more manageable), allowing the use of reduced emission e-cigarettes, providing nicotine replacement products to dissuade smoking indoors, and providing a designated smoking area on the property were seen as ways to support adherence among residents who were not ready to quit. ...
Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials’ use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.
... 1 3 not necessarily mutually exclusive (Gallagher et al. 2019) as more positive attitudes toward MOUD and the increasing number of OH residents utilizing MOUD reflect the current trend of recovery conceptualization that is moving away from such a dichotomy. Comparable rates of abstinence between groups in the present study has been confirmed by longitudinal research findings (Schuman-Olivier et al. 2014) suggesting that residential recovery settings such as the OH model fosters abstinence outcomes among residents receiving MOUD for their opioid use disorders. ...
Medications for opioid use disorder (MOUD) and recovery homes that have traditionally served those not taking medications for their recovery are important resources for treating opioid use disorder. However, little is known whether such recovery homes are a good fit for persons utilizing MOUD, and whether residents’ characteristics such as drug histories and the composition of recovery homes in terms MOUD and non-MOUD residents are related to attitudes toward MOUD. The present investigation examined characteristics of persons utilizing MOUD, and attitudes regarding MOUD utilization among residents living in recovery homes (Oxford Houses, OH) in the U.S. consisting of MOUD and non-MOUD residents. Residents living with others who were utilizing MOUD reported more favorable attitudes than residents who were not living with such residents, but this was observed only among residents whose primary drug of choice involved heroin or opioids. There were no significant differences observed in terms of abstinence rates, involvement in 12-step groups, or previous MOUD treatments between residents utilizing or not utilizing MOUD. Findings suggest that persons utilizing MOUD benefit by recovery homes such as OHs whose residents have favorable attitudes toward MOUD, especially when living with fellow residents who utilize MOUD.
... Furthermore, harm-reduction (e.g., MATs) and abstinence-based (e.g., 12-step groups, recovery homes) treatment components need not be mutually exclusive as the current trend of recovery conceptualization is moving away from embracing such a dichotomy (Gallagher et al., 2019). Combinations of MAT and abstinencebased treatment elements are likely to improve recovery outcomes for persons with opioid use disorders (Galanter, 2018). ...
Social support is a resource frequently utilized by persons recovering from substance use disorders. However, little is known about the effects of social support among persons utilizing medication-assisted treatments (MATs) living in abstinence-based recovery homes. The present investigation examined whether social support would mediate the relationship between stress and two recovery outcomes (quality of life and abstinence self-efficacy) among a sample of residents living in Oxford House abstinence-based recovery homes in the U.S. Moderated mediational analyses were conducted to test whether potential mediating effects were influenced by whether residents were (or were not) utilizing MATs. Mediating effects were observed in both models, and these were not moderated by residents’ MAT status. Findings suggest abstinence-based recovery homes such as Oxford Houses provide valuable social support that helps persons utilizing MATs in their recovery.
... Recovery is best understood on a spectrum and should be defined by the individuals we serve, not the projection of professional values or agency agendas of what they think one's recovery should look like". 23 At the service delivery level, recovery coaches are an example of integration between harm reduction, with coaches providing peer support to people whether or not they are still actively using substances. ...
This paper examines the potential for harm reduction, as an alternative to an
abstinence-only model of addiction recovery, to bridge the conceptual differences with mental health recovery. Further, this paper considers whether integrating substance use and harm reduction into a two-continuum model of recovery and well-being that was developed in the mental health sector can bridge the conceptual differences between addiction recovery and mental health recovery, and in so doing clear a path toward a shared vision for recovery and well-being.
This quantitative study focuses on substance use professionals and students who are seeking employment in substance use treatment or support services. Abstinence-based treatment has been and continues to be the primary method of treatment preferred in the United States. Since 1980, harm reduction increased in application in the profession but remains a less popular method of treatment. This study examines substance use professionals and students ( N = 141) interested in employment in substance use treatment or support attitudes in harm reduction and whether their beliefs toward these treatment approaches were associated with their personal characteristics. Goddard’s Harm Reduction Acceptability Scale and a demographic survey form were utilized to measure the variables. One-way analysis of variance showed that current and aspiring substance use professionals have favorable attitudes toward harm reduction. The purpose of this study was to examine the attitudes in substance use treatment approaches by substance use professionals. Results revealed that the professionals have slightly more favorable attitudes toward the harm reduction treatment approach.
Background
Heroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context.
Methods
We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT.
Results
Participants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement.
Conclusions
The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.
A meta‐analysis was conducted to assess the efficacy of neurofeedback (NFB) in the treatment of individuals with substance use disorder (SUD) in between‐group studies. This study reports findings from the first exhaustive search of the literature on the topic and included articles selected from a total of 58 databases/repositories. Studies were evaluated using Hedge's g as the effect size measure and were assessed for risk of bias using funnel plot, Fail‐Safe N, and Trim and Fill analysis. Ten studies, containing 30 effect sizes were evaluated to determine the overall efficacy of NFB for decreasing symptoms of SUD (N = 397), yielding a mean effect size of g = –1.49 (CI 95 = –1.95, –1.03; PI 95 = –4.37 to 1.39). This meta‐analysis provides strong evidence for the efficacy of NFB in treating SUD while also highlighting the value of wholistic client care in SUD treatment.
Opioid overdose prevention training programs represent harm reduction initiatives for people who use drugs (PWUD). While studies have investigated their impact after participants have intervened in overdose situations, the impact of the training alone has not been examined in detail. This study explores the personal impact, including benefits and apprehensions, for PWUD who participated in a peer-led overdose prevention program and did not intervene post-training. Semi-structured interviews were conducted with 75 PWUD following training. Data collection took place in two phases (2016 and 2020; n = 37 and 38, respectively), and qualitative results of a thematic analysis are presented. The following participation benefits were reported, even if no naloxone administration occurred following training: improved sense of control and competency in potential overdose and other emergency situations, heightened feelings of responsibility to help others, overcoming social stigma, increased pride, confidence and self-esteem, renewed sense of hope, and changed drug use behaviours, namely reduced at-risk consumption behaviours. Over half of participants reported sharing prevention knowledge with others following training. As for apprehensions, participants reported: fear of intervening and of being stigmatized, disappointment and regret related to past overdose experiences, feeling burdened or stressed to intervene, and cutting ties with others to avoid overdose situations.
Background
Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use.
Methods
Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression.
Results
Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals’ General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score.
Conclusion
Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration.
Someone dies from an opioid overdose every two hours in North America. These statistics became personal when my eldest son died from a drug overdose—he had been in recovery for a year, excited about the prospect of welcoming his unborn daughter into the world, and desperately committed to staying drug-free. He had been struggling with substance abuse for over twelve years. As a mother and Social Worker, I spent those years feeling helpless and deficient as things spiraled further and further out of control, committed to supporting my beloved son in a system that was not working.
Findings
This article is about this journey. My goal is to critically examine how our treatment lenses for understanding addiction create unacknowledged ethical issues and tensions that stigmatize not only those with substance use issues, but their family as well.
Application
The purpose is two-fold: to examine how the experience of mothering a child with addictions who dies is constructed as a problematic, and to invite Social Workers to think critically about their practices and the lenses they are drawing on when working with this population.
The effects of social support among persons utilizing medication assisted treatment (MAT) living in abstinence-based recovery homes is not clearly understood, and there is a need to identify social process components that engender social support for this population. The present investigation examined whether homophily (i.e., living with/without fellow MAT residents) among recovery home residents would moderate the mediating effects of social support on the relationships between stress and two recovery outcomes (quality of life, abstinence self-efficacy) among a sample of persons utilizing MAT living in recovery homes (Oxford Houses) in the U.S. Moderated mediational analyses were conducted to test whether potential mediating effects were moderated by homophily. Mediating effects were observed in both models, but they were significant only through the moderator (homophily) in that social support buffered the effects of stress among MAT residents who lived with other MAT residents in their recovery homes. Findings suggest that homophily effects are related to social networking for persons utilizing MAT living in abstinence-based recovery homes.
Drug courts began in 1989 in Miami-Dade County, FL. Due to their success in treating substance use disorders and reducing criminal recidivism, they have expanded globally and are currently operating in countries such as Australia, Canada, and Scotland, to name a few. Drug courts can be a key intervention in addressing the opioid epidemic. This is the first known qualitative study to ask drug court participants (n = 38) who have opioid use disorders questions related to their lived experiences in drug court, as well as direct questions related to the use of medication-assisted treatments (MATs) in drug court. Overall, drug court participants felt that MATs were helpful for treating their opioid use disorders; however, some participants reported using other drugs while on MATs and they viewed their recovery through a harm reduction lens. Additionally, participants emphasized the importance of using MATs in combination with counseling that used cognitive and behavioral therapies. Implications for drug court practice and future research are discussed.
Drug courts have been used in the criminal justice system to treat substance use disorders since 1989. This study evaluates a drug court in Indiana, focusing specifically on the most predictive variables for being terminated from the program and comparing recidivism patterns of drug court and probation participants. Participants were most likely to be terminated from drug court if they did not have a high school diploma or equivalent at admission, were not employed or a student at admission, identified cocaine as a drug of choice, had more positive drug tests, had a violation within the first 30 days of the program, and had a criminal history. Additional findings suggest that drug court is more effective than probation at reducing criminal recidivism rates for offenders with substance use disorders. Implications for drug court practice and future research are discussed.
This study evaluated a drug court located in a metropolitan area of Indiana (United States), focusing specifically on identifying variables that predicted recidivism among drug court participants and comparing criminal recidivism patterns among drug court and probation participants. Drug court participants were most likely to recidivate if they were younger, had a violation within the first 30 days of the program, had a previous criminal record, and were terminated unsuccessfully from the program. Furthermore, drug court participants were less likely to recidivate than probationers who had similar offense and demographic characteristics. Implications for drug court practice, policy advocacy, and future research are discussed.
Drug courts have been a key part of the criminal justice system since 1989, and this study contributes to the existing body of research by identifying which participants (n = 248) were most likely to graduate from a drug court in Indiana (United States). Three variables emerged as significant predictors of graduation. First, participants who were employed or were students at the time of admission were nearly 2.5 times more likely to graduate than participants who were not. Second, participants who were using opiates as their primary drug of choice were over 80% less likely to graduate than participants who were using non-opiates as their primary drug of choice. Third, participants who had violations in the first 30 days of the program were nearly 50% less likely to graduate than participants who did not violate in the first 30 days. Offering medication-assisted treatment (MAT), such as methadone, Suboxone, or Vivitrol, to participants who have an opiate use disorder may improve graduation rates for this population. Additionally, graduation rates may also improve by offering more resources to assist participants in gaining and maintaining employment or schooling, and this seems to be especially important within the first month of the program.
Motivational Interviewing was first introduced nearly three-and-a-half decades ago and has been used to treat a range of problems, including substance use disorders (SUDs). Treating SUDs is complex, and there is no universal philosophy of treatment. Rather, throughout the disciplines history, two distinctly different philosophies of treatment have emerged: total abstinence and harm reduction. In this article, the authors discuss how motivational interviewing is best aligned with harm-reduction approaches, and how motivational interviewing cannot be used in its fidelity in abstinence-based programs, despite many abstinence-based programs claiming to do so. The authors highlight examples on the disconnect between abstinence-based programs and the four main principles of motivational interviewing: (1) deemphasizing labels used in treatment, (2) increasing individual responsibility, (3) increasing internal attribution (being responsible for one’s own situation and future changes instead of placing responsibility on external factors), and (4) increasing one’s awareness of cognitive dissonance (finding consistency between desires and actions). Motivational interviewing, when used in its fidelity, has consistently demonstrated effectiveness in reducing problematic drug use, improving engagement and retention in treatment, and increasing overall quality of life. As a result, the authors encourage agencies and counselors who treat SUDs to utilize a harm reduction philosophy in combination with motivational interviewing techniques to best serve our clients.
This study evaluated a drug court located in Texas. Participants that had a violation within the first 30 days of drug court, and terminated participants were most likely to recidivate. Implications for drug court practice and policy advocacy are discussed.
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.
Medication-assisted treatment in drug courts: Recommended strategies
- S Friedman
- K Wagner-Goldstein
Program evaluation of the St
- J R Gallagher
Program evaluation of the St
- J R Gallagher
- E A Wahler
- E R Lefebvre
- Barlow D. H.