[Show abstract][Hide abstract] ABSTRACT: Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n = 4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR = 1.28, narcotic users OR = 1.16), gender [males were nearly 3 times more likely to die among narcotics users (p < .000) and 1.6 times more likely to die among alcohol users (p < .01)] and reporting serious health problems (for alcohol users p < .000, for narcotics users p < .05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.
No preview · Article · Dec 2014 · Evaluation and Program Planning
[Show abstract][Hide abstract] ABSTRACT: Background: The Tapestry Health SAMHSA-funded HIV prevention effort targets at-risk Latinas in Springfield, MA. Outreach workers travel the city knocking on doors, educating about HIV rapid testing services, and gathering data on at-risk Latina community members. The breadth of canvassing is limited by time, personnel numbers, and the geographic extent of the city. Managers and outreach workers need a tool to develop a method for their door-knocking campaign location choices.
Description: Using GoogleMaps Engine Lite, a free mapping tool, researchers will work with grant project managers and outreach workers to modify a map of Springfield using Census and Massachusetts Department of Public Health data on demographics, drug overdoses, and HIV rates. The project incorporates user-friendly nonprofessional GIS instruments to create an interactive map that workers can use on iPads in the field and update as suggestions and changes are made.
Lessons Learned: Current findings include feedback about the helpfulness of the health information displayed and suggestions for including domestic violence information in newer versions. Further feedback transforming the map to more effectively indicate neighborhoods to target in canvassing, leading to a broader knowledge base on application of mapping technology to community outreach work is expected.
Recommendations: Free and low cost beta technology is a resource to be explored. The ranges of possible benefits are currently unknown but greatly promising. Seeking out accessible technology to create innovative outreach work in public health human service delivery and research is vital and advantageous to the field.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Instances of opioid overdoses are increasing across the country. As an evidence-based practice (EBP), Naloxone, an opioid antagonist, has been proven effective in reversing overdoses when administered intra-nasally. Utilizing Simpson and Flynn’s Organizational Readiness for Change (TCU-ORC) model, this study explores the decision-making processes guiding the implementation and integration of a naloxone-based opioid overdose response protocol (NBOORP) in organizations providing services to heroin and other opioid users in Western Massachusetts.
Qualitative interviews were conducted with 75 program directors and staff from organizations which received naloxone responder training. Participants were asked (1) to describe the decision-making process that led to the implementation of their NBOORP, (2) how, if at all, the NBOORP was integrated into the organization’s service model, and, (3) if integrated, whether a NBOORP was currently and routinely used to reverse overdoses. Participants completed a modified version of the TCU-ORC measures focusing on program needs, workplace stress, and staff’s perceived organizational influence.
Preliminary analysis shows a significant barrier to implementation is administrative concerns around organizational liability, especially in for-profit organizations. Most organizations implemented a NBOORP immediately after training and prior to developing a written policy. Additionally, the quantitative measures will assess the impact of perceived barriers and the organization’s readiness for change on its ability to implement a NBOORP.
The identification of characteristics linked to the successful implementation of a NBOORP will increase understanding of a model for rapid infusion of an EBP, Naloxone, for service providers offering a range of services to opioid users.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Health risk assessments of racial and ethnic minority lesbian, gay, bisexual, transgender (LGBT) sub-populations are lacking. Federally-funded substance use treatment programs are not required to collect data about sexual orientation. This project uses data from a SAMHSA-funded grant to analyze the variation between primarily Latino, heterosexual and sexual minority (LGB) clients at a residential treatment organization in Boston, MA.
Methods: We developed a sexual orientation question for the client questionnaires at baseline and 6 month follow up. This study compares heterosexual (n=305) and sexual minority (n=38) clients on risk factors related to mental health and sexual behavior using chi-square tests. Further analyses of the baseline and 6 month follow-up questionnaires will determine whether sexual minority status is an indicator of differential treatment response.
Results: Preliminary bivariate analyses reveal significant differences (p<.05) between Latino sexual minority and heterosexual clients on mental health indicators, including thoughts and attempts of suicide, hallucinations, obsessive thoughts, panic attacks, and strong fears. Our findings provide evidence that sexual minority clients were significantly (p<.01) more likely to engage in high-risk behaviors, including trading sex for money, drugs, or housing.
Discussion: Few studies focus on the intersection between ethnic minority status and sexual orientation in addictions treatment. This exploratory study illustrates the need to collect LGB demographic information. It is important to determine whether LGB populations are being adequately served by mainstream programs. Findings from this research indicate that there may be important differences in risk factors and behaviors of LGB clients and in their treatment needs.
[Show abstract][Hide abstract] ABSTRACT: 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.
(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.
No preview · Article · Jun 2014 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: AIM - This exploratory study draws on national register data for 2,638 opioid users from 20042008 to examine whether or not certain predisposing, enabling and need factors are associated with taking methadone or buprenorphine continuously on doctor's orders for one year or more. DESIGN - Chi-square analysis, one-way Anova and logistic regression methods were used to explore the association between self-reported demographic characteristics, alcohol/drug use severity, substance use disorder treatment history, criminal justice history, level of mental health symptomatology, mental health treatment history, and whether or not adult opioid users had taken methadone or buprenorphine continuously on doctor's orders for one year or longer. RESULTS Having a job and having had more voluntary treatment episodes were significantly associated with using methadone or buprenorphine. Those opioid users who had a job were 19 times more likely to be on methadone or buprenorphine than opiate users who did not have a job. CONCLUSIONS In our study, individuals who were working were significantly more likely to medicate against their opioid abuse. This suggests that they may be more socially integrated than their non-medicating counterparts.
No preview · Article · Apr 2014 · Nordic Studies on Alcohol and Drugs
[Show abstract][Hide abstract] ABSTRACT: AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a Kmeans cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders
Preview · Article · Mar 2014 · Nordic Studies on Alcohol and Drugs
[Show abstract][Hide abstract] ABSTRACT: Background: Numerous studies point to the relationship between addiction, mental health, and suicide. However, few studies describe the relationship between suicidality in substance-using Latinos and the presence of severe mental health symptoms. Our exploratory study examines the prevalence of suicidal ideation and suicide attempts and the relationship between suicidality, acute mental health symptoms, and substance abuse. Methods: Data are presented from a sample of 354 HIV+ or at-risk Latino substance-using men and women presenting to residential substance abuse treatment. Statistical analyses describe lifetime history of suicidal ideation and suicide attempts and the association with acute mental health symptomatology such as lifetime history of hearing voices, strong fears, feelings that people were against them, manic, panic, obsessive thoughts, and family and self-history of substance abuse. Results: 129 (36.4%) clients reported having suicidal ideation, and 101 (28.5%) attempted suicide at least once. Over one-third of clients reported hearing voices, having strong fears, feeling that people were against them, and obsessive thoughts. Almost half (49.6% and 42.7%) reported feelings of manic or panic. Bivariate analyses found lifetime history of family substance abuse (having a family member who abused alcohol, cocaine, or heroin) and personal history of cocaine and alcohol use were significantly associated with increased likelihood of suicidality. Conclusion: Preliminary findings suggest that high rates of suicidal ideation and suicide attempts among Latino substance users demand interventions adapted to Latino populations with co-morbid acute mental health and substance use disorders. The severity of need in this population highlights the importance of further research.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Prior work by these authors has identified that clinical staff who reported higher levels of barriers in implementing an evidence-based practice (EBP) also report higher levels of modifications in implementing EBPs. This study explores for 311 addiction treatment staff, the ten most commonly implemented evidence-based practices (EBPs), EBP fidelity, and specific barriers associated with the implementation of the ten EBPs.
Methods: This mixed methods study used open-ended qualitative data to identify the type of barriers staff experienced and level of modifications made to EBPs. A 10-point ordinal variable measured levels of modification. For each EBP, the mean modification score (MMS) and the most commonly identified barriers are presented.
Results: Data analyses identified that staff reported different levels of modifying EBPs, by type of EBP. Specifically, the EBPs reported to have been the most modified were the Peer to Peer Recovery Model and Motivational Enhancement Therapy (MMS score > 4). The two EBPs rated as having been changed the least were MI and Case Management (MMS <3). The EBP modification scores for staff implementing MI (n = 72) were higher when staff experienced barriers related to clients and to the logistics of implementation, compared to their counterparts.
Discussion: Barriers to EBP implementation are clearly associated with fidelity. As this and prior papers by the authors suggest, staff who experience different types and levels of barriers make changes to the EBP responding to these barriers. Funders of EBP implementation need to provide ongoing technical assistance to reduce barriers to EBP implementation.
[Show abstract][Hide abstract] ABSTRACT: Co-morbid mental health disorders are common among individuals with substance use disorders. Treatment integration is imperative for vulnerable populations with disparate needs and access to health services. Homeless, Latino drug users have been identified as underutilizing behavioral health care. This exploratory study examined whether severity of need was associated with level of motivation to enter mental health treatment for a sample of 214 homeless Latino drug users who reported mental health symptoms in the past year. The data originated from a five-year program effort to increase utilization of substance abuse and mental health treatment among homeless Latino drug users. In-person interview data was analyzed using bivariate and multivariate analysis. Severity of need was measured as 1) self-reported mental health symptomology in the past 30 days; 2) self-reported history of victimization; and 3) substance use severity. The analysis controlled for demographic characteristics, social support for recovery, prior use of psychopharmacological medication, and prior substance abuse treatment use. The analysis identified that female gender and a history of having been physically attacked, mugged, or robbed were associated with increased motivation to seek mental health treatment. These findings underscore the importance of early identification and support for treatment among marginalized populations. Insufficient research has been conducted exploring the complexity of victimization, substance use disorders, and mental health disorders among Latino populations. Consequently, few evidence-based practices have been developed and implemented that target Latinos experiencing co-morbid disorders. There is a pressing need for comprehensive, culturally responsive public health prevention efforts that support treatment engagement.
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
[Show abstract][Hide abstract] ABSTRACT: For a sample of 425 Puerto Rican self-identified polydrug users residing in Massachusetts, this study examined predisposing,
enabling, and need factors associated with having entered addiction treatment at least once in the past six months. A multivariate
logistic regression model identified that having a regular health care provider, having received outpatient mental health
treatment in the past year, having participated in self-help groups, interacting with family and friends about recovery, being
a current drug injector, self-report of being in poor or fair physical health, and self-report of high levels of treatment
motivation were all significantly and positively associated with having used addiction treatment in the past six months. For
this study sample, findings indicate that using a range of enabling health and support services and connecting clients with
family and an extended network could increase addiction treatment use. It is important to note that there was no significant
association between predisposing factors (that is, age, gender, education, employment, homeless status, parental status, marital
status, and birthplace) and addiction treatment use.
No preview · Article · Oct 2013 · Social work research
[Show abstract][Hide abstract] ABSTRACT: Unlabelled:
Prior studies by the authors identified that clinical staff who reported that their treatment unit had lower levels of organizational readiness to change experienced higher levels of barriers in implementing an evidence-based practice (EBP). The current study examined whether clinical staff perceptions of their treatment unit's organizational readiness to change were also associated with their adherence to EBP protocols during EBP implementation. Adherence was examined through a variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Multivariate regression analyses identified that clinical staff who had five or more years of addiction counseling experience, who rated staff in their organization as having higher levels of influence, who less frequently implemented new counseling interventions and who reported higher levels of barriers when implementing a newly funded EBP also reported that their program made more modifications to the EBP in the implementation process. Finally, staff who implemented MI compared to any other EBP reported lower levels of EBP modifications.
Continued federal funding is needed to enhance treatment unit organizational resources in order to reduce barriers and promote adherence to EBPs. Also, funders of treatment need to continue to provide ongoing technical assistance and training opportunities to promote implementation of EBPs with fidelity.
No preview · Article · Aug 2013 · Journal of substance abuse treatment
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
Full-text · Article · Jun 2013 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: 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.
No preview · Article · Apr 2013 · Journal of Ethnicity in Substance Abuse
[Show abstract][Hide abstract] ABSTRACT: This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally.
No preview · Article · Apr 2013 · Journal of Addictive Diseases