A. Thomas McLellan's research while affiliated with Treatment Research Institute, Philadelphia PA and other places

Publications (384)

Article
The prescribing of opioid analgesics for pain management—particularly for management of chronic noncancer pain (CNCP)—has increased more than fourfold in the United States since the mid-1990s. Yet there is mounting evidence that opioids have only limited effectiveness in the management of CNCP, and the increased availability of prescribed opioids h...
Article
Scientific evidence combined with new health insurance coverage now enable a chronic illness management approach to the treatment of alcohol use disorders (AUDs), including regular monitoring of blood alcohol content (BAC), as a useful indicator of disease control. Recent technical advances now permit many different types of remote, real-time monit...
Article
This paper first introduces important conceptual and practical distinctions among three key terms: substance "use," "misuse," and "disorders" (including addiction), and goes on to describe and quantify the important health and social problems associated with these terms. National survey data are presented to summarize the prevalence and varied cost...
Article
The study investigates the effectiveness and appropriateness of the Drug Abuse Resistance Education (D.A.R.E.) Keepin’ it REAL (KiR) curriculum – America’s most prevalent in-school prevention programme – using a modified systematic review procedure as adapted from the Cochrane Handbook. No published studies research the D.A.R.E. version of KiR, and...
Article
Nonmedical use of prescription drugs is common and poses risks such as injury, overdose, and development of abuse and dependence. Internet pharmacies offer prescription drugs without a prescription, creating a source of illicit drugs accessible to anyone with an Internet connection. We examined this issue in a convenience sample of 1,860 adolescent...
Article
Scientific advances, increased public awareness about addiction as a disease, and significant changes in public policy have led to transformational changes in this field. Preclinical and clinical studies highlighted in this issue have supported the emerging concept of substance use disorders as a novel major concern within the healthcare community....
Article
The epidemic of opioid abuse is related in part to incomplete understanding of pain-relief management, opioid tolerance, and opioid addiction. Among the prevention strategies are more widespread sharing of data about opioid neuropharmacology and opioid-use patterns.
Article
The neurobiology of addiction is pointing the way to potential methods of disrupting the neurocircuitry with both pharmaceutical and behavioral tools. Altering the reward and emotional circuits may prevent and treat the problem.
Article
Full-text available
When adolescent substance abuse requires treatment, few parents know which treatment features are important and which treatment programs are effective. There are few resources to help them select appropriate care. We describe early work on an evaluation method and comparative treatment guide for parents based upon the premise that the quality of a...
Article
Time to save lives A paradigm shift is occurring in the treatment of heroin overdose. On 5 November the World Health Organization launched guidelines on the community management of heroin and opioid overdose and emergency administration of naloxone by people who are not medically trained.1 Historically, naloxone has been used only in hospitals and...
Article
Introduction and AimsThis article reports a content analysis of Internet websites related to an emerging designer drug, synthetic cannabinoids. The number of synthetic cannabinoids searchers in the USA has steadily increased from November 2008 to November 2011.Design and Methods To determine the information available on the Internet in relation to...
Article
The Affordable Care Act (2010) and the Mental Health Parity and Addiction Equity Act (2008) are expected to transform substance abuse prevention and treatment in the United States. In this paper, we outline the potential disruption to the existing specialty care delivery system, and describe the opportunities for treatment providers and health serv...
Article
The main target of alcohol and other drug self-administration is the brain. For this reason understanding of brain mechanisms (i.e., neuroscience research) may offer important insights for creating effective prevention and treatment interventions, as well as fair and appropriate drug policies. Fair and appropriate drug policies (public laws and reg...
Article
Full-text available
Brain imaging and genetic studies over the past two decades suggest that substance use disorders are best considered chronic illnesses. The passing of the Affordable Care Act in the United States has set the occasion for integrating treatment of substance use disorders into mainstream healthcare; and for using the proactive, team-oriented Chronic C...
Article
Public schools are not traditional locations where screening, brief motivational counseling intervention and referral to treatment (SBIRT) are provided. This translational research study aimed to test the feasibility of conducting SBIRT in two urban New York schools and to examine its economic sustainability. In Spring 2012, 248 students were scree...
Article
Full-text available
The Western approach to addiction treatment involves a medical or disease orientation to understanding the onset, course, and management of addiction, and a clinical goal of abstinence or very significant reductions in drug use, usually with a combination of behavioral and pharmacological interventions. Even within this Western approach, and despit...
Article
We evaluate the effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n=12,368) and Maryland (n=147,151) for 1998-2006. Results of difference-in-difference analyses i...
Article
Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and indiv...
Article
Within the field of addiction, the majority of work regarding "stages and processes of change" has focused on single drug problems, such as cigarette smoking or alcohol use. However, the majority of the substance abuse treatment population present with more than one substance use disorder. This article reports the results of the internal consistenc...
Article
For reasons of safety and effectiveness, many forces in health care, especially the Affordable Care Act of 2010, are pressing for improved identification and management of substance use disorders within mainstream health care. Thus, standard information about patient substance use will have to be collected and used by providers within electronic he...
Article
In his extraordinarily productive research career, G. Alan Marlatt contributed to and anticipated by decades a variety of major changes in the treatment of substance use disorders. This article briefly reviews and comments on his contributions to addiction psychology, cognitive-behavior therapy, alcohol expectancies, relapse prevention, moderation...
Article
To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers.   We draw on the scientific literature and our public policy experie...
Article
To describe the derivation of recent status scores (RSSs) for version 6 of the Addiction Severity Index (ASI-6). 118 ASI-6 recent status items were subjected to nonparametric item response theory (NIRT) analyses followed by confirmatory factor analysis (CFA). Generalizability and concurrent validity of the derived scores were determined. A total of...
Article
Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is i...
Article
The Obama Administration plans to reinvigorate the U.S. system of care for substance use disorders through new health insurance parity regulations, the historic health care reform law (formally known as “The Affordable Care Act of 2010”), and the President's National Drug Control Strategy. Parity regulations and health care reform will significantl...
Article
In this study, the authors evaluated the psychometric properties of the Treatment Program Progress (TPP) rating scale, a brief instrument that assesses counselor ratings of patient response to 12-step–oriented substance abuse treatment interventions. In both 3- and 5-day-per-week outpatient programs, the TPP bad good internal consistency reliabilit...
Article
Given the rapid changes in health care, the economic consequences of substance abuse and the contemporary problems of substance abuse treatment must be acknowledged and addressed. These problems include poor treatment outcomes, difficulty of recruiting and retaining treatment staff, and failure of treatment programs to adopt effective research inno...
Article
A sample of 904 physicians consecutively admitted to 16 state Physicians' Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized th...
Article
Full-text available
Background Despite the high prevalence of alcohol consumption in the US, ‘mainstream’ physicians generally consider it to be peripheral to most patient care. This may be due in part to a dearth of rigorous research on alcohol’s effect on common diseases. Methods To evaluate this issue, we examined six systematic reviews, four of which were conducte...
Article
Physicians with substance use disorders receive care that is qualitatively different from and reputedly more effective than that offered to the general population, yet there has been no national study of this distinctive approach. To learn more about the national system of Physician Health Programs (PHPs) that manage the care of addicted physicians...
Article
Community substance abuse treatment programs face many barriers to adopting "evidence-based" therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field-develo...
Article
Given the rapid changes in health care, the economic consequences of substance abuse and the contemporary problems of substance abuse treatment must be acknowledged and addressed. These problems include poor treatment outcomes, difficulty of recruiting and retaining treatment staff, and failure of treatment programs to adopt effective research inno...
Article
In Reply: Dr Newman makes an important point about the role of the FDA in properly informing physicians about safe dosing regimens. Its slow onset and long duration of action make methadone a valuable pain medication. Yet, as Newman suggests, the FDA 2006 published dosing guidelines1 (2.5-10 mg every 3-8 hours) are too broad to be useful; the highe...
Article
Full-text available
A sample of 904 physicians consecutively admitted to 16 state Physicians' Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized th...
Article
Full-text available
We reviewed 39 national government- and nongovernment-sponsored data sets related to substance addiction policy. These data sets describe patients with substance use disorders (SUDs), treatment providers and the services they offer, and/or expenditures on treatment. Findings indicate the availability of reliable data on the prevalence of SUD and th...
Article
This article chronicles three steps taken by research, clinical, and state staff toward assessing, evaluating, and streamlining clinical and administrative paperwork at all public outpatient addiction treatment programs in one state. The first step was an accounting of all paperwork requirements at each program. The second step included the develop...
Article
Full-text available
The study of overdose deaths in West Virginia by Hall and colleagues in this issue of JAMA1 revealed that opioid analgesics contributed to 93% of those deaths and most of these potentially avoidable deaths occurred in younger persons (aged 18-44 years). These disturbing findings are certain to raise questions about physician prescribing practices,...
Article
Full-text available
Background Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study’s purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more...
Article
There is increasing evidence that a chronic care model may be effective when treating substance use disorders. In 1996, the Betty Ford Center (BFC) began implementing a telephone-based continuing care intervention now called Focused Continuing Care (FCC) to assist and support patients in their transition from residential treatment to longer-term re...
Article
The Penn/VA Center was founded in 1971 because of great concern over the number of Vietnam veterans returning home addicted to heroin. At that time little was known about the science of addiction, so our program from the very beginning was designed to gather data about the nature of addiction and measure the effects of available treatments. In othe...
Article
In fiscal 2002, Delaware replaced traditional cost-reimbursement contracts with performance-based contracts for all outpatient addiction treatment programs. Incentives included 90% capacity utilization and active patient participation in treatment. One of the programs failed to meet requirements. Strategies adopted by successful programs included e...
Article
Full-text available
To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders. Five year, longitudinal, cohort study. Purposive sample of 16 state physician health programmes in the United States. 904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001. Comp...
Article
Report the results of initial reliability and validity analyses for a revised Treatment Services Review (TSR-6) instrument which measures a broader range of services than the original TSR. First, the number of services for a 28-day period was compared for three versions of the instrument varying in their reporting timeframes. Accordingly, four succ...
Article
Full-text available
OxyContin and other pharmaceutical opioids have been given special attention in the media, who frequently describe problematic users of the drug as previously drug-naive individuals who become addicted following legitimate prescriptions for medical reasons. The purpose of this study was to characterize the nature and origins of pharmaceutical opioi...
Article
Calls for greater accountability within the addiction treatment field have led to a wide range of efforts designed to improve treatment performance, quality, and outcomes. However, efforts with conceptually and methodologically different approaches have used the same umbrella terms such as "quality," "performance indicators," and "outcome domains,"...
Article
To evaluate the psychometric properties of a shortened version of the baseline ASI-5, the ASI-L-VA. Two samples were recruited from intensive outpatient treatment and a methadone maintenance clinic. For Sample A (n=145), two versions of the Addiction Severity Index (i.e., ASI-5 and ASI-L-VA) were administered several days apart in counterbalanced o...
Article
Full-text available
The social and economic costs of addiction are substantial and of great concern to society. Research in the past decade has led to promising therapies that appear to be highly effective but not widely diffused. This leads one to wonder if there is something about the structure, dynamics, or structure and dynamics of the addiction treatment industry...
Article
The Internet is a vital medium for communication, entertainment, and commerce, with more than 1 billion individuals connected worldwide. In addition to the many positive functions served by the Internet, it also has been used to facilitate the illicit sale of controlled substances. No-prescription websites (NPWs) offer--and then actually sell--cont...
Article
This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine the potential of the Addiction Severity Index (ASI) to serve as a screening instrument for Diagnostic and Statisti...
Article
The Addiction Severity Index (ASI) is a multi-dimensional interview used to measure the substance use, health, and social problems of those with alcohol and other drug problems, both at admission to treatment and subsequently at follow-up contacts. This article first discusses the conceptual and practical importance of the ASI's multi-dimensional a...
Article
The two goals of this technology transfer study were to: (1) increase the number and appropriateness of services received by substance abuse patients, and thereby (2) give clinical meaning and value to research-based assessment information. A software-based Resource Guide was developed to allow counselors to easily identify local resources for refe...
Article
Philadelphia attempted to expand the access to and continuity of addiction treatment by focusing on the 15% of patients who received multiple, detoxification-only (MDO) treatments each year. Clinical Case Managers at five detoxification centers encouraged MDO patients to continue care following detoxification in methadone, residential, or outpatien...
Article
This title, which is the very first to disseminate the findings of the Adolescent Mental Health Initiative sponsored by the Annenberg Foundation Trust at Sunnylands and the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, addresses the current state of our knowledge about various mental health disorders in the teenage years,...
Chapter
This title, which is the very first to disseminate the findings of the Adolescent Mental Health Initiative sponsored by the Annenberg Foundation Trust at Sunnylands and the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, addresses the current state of our knowledge about various mental health disorders in the teenage years,...
Article
Historically, addiction treatments have been delivered and evaluated under an acute-care format. Fixed amounts or durations of treatment have been provided and their effects evaluated 6-12 months after completion of care. The explicit expectation of treatment has been enduring reductions in substance use, improved personal health and social functio...
Article
A study was completed on the use of a computer-based system that provided counselors with resources for client referrals to free or low-cost services within the community based on problems identified with an Addiction Severity Index (ASI) assessment. That study, completed in Philadelphia, found that in comparison with clients whose counselors recei...
Article
Full-text available
An accurate national listing of substance abuse treatment programs is essential for reporting data about the nation's treatment system and the clients entering that system. The National Survey of Substance Abuse Treatment Services (NSSATS) is thought to provide the most comprehensive list of treatment providers. Therefore, we report a partial test...
Article
To examine demographic differences in alcohol telescoping-the rate of self-reported movement from regular alcohol consumption to the onset of regular heavy drinking-as well as differences in ages of initiation of regular alcohol use and alcohol use to intoxication. The present study compared the retrospective reports of 2037 clients (1252 males, 78...
Article
There is national concern regarding the problems of alcohol and drug abuse and the adequacy and quality of the national addiction treatment system, particularly for adolescents. This article reviews the published literature evaluating the ability of health, education, and specialty treatment systems to identify and treat affected adolescents and ad...
Article
The Drug Abuse Treatment Cost Analysis Program (DATCAP) was designed in the early 1990s as a research guide to collect and analyze financial data from addiction treatment programs. The addiction research community could clearly benefit from a version of the DATCAP that reduced the time and effort required for its administration without compromising...
Article
Buprenorphine and buprenorphine/naloxone (BUP) are newly approved for office-based treatment of opioid dependence. Federal and non-federal regulatory and monitoring agencies, national and international researchers, national professional organizations, researchers involved in monitoring, opioid treatment programs and the pharmaceutical industry met...
Article
Full-text available
An accurate national listing of substance abuse treatment programs is essential for reporting data about the nation's treatment system and the clients entering that system. The National Survey of Substance Abuse Treatment Services (NSSATS) is thought to provide the most comprehensive list of treatment providers. Therefore, we report a partial test...
Article
This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened hea...
Article
This paper identifies and illustrates the challenges of conducting cost-effectiveness analysis (CEA) of addiction treatments given the multiple important outcomes of substance abuse treatment (SAT). Potential problems arise because CEA is intended primarily for single outcome programs, yet addiction treatment results in a variety of outcomes such a...
Article
To describe and compare the characteristics and needs of substance-abusing women on Temporary Assistance to Needy Families (TANF) who enroll in a multi-service "welfare to work" program (n = 673) with two other relevant groups: (a) women from the general TANF population in the same locales (n = 157) and (b) a sample of substance-abusing women on TA...
Article
This article presents information on treatment services received by women participating in an initial multistate evaluation of CASAWORKS families. Results indicated most women received services to address medical, employment, basic needs, alcohol and drug, family, and psychiatric problems during the first six months of the program. The clients also...
Article
Aim: To evaluate the effectiveness of a multiservice intervention designed to move substance-abusing women on welfare to sobriety and self-sufficiency by addressing their substance abuse, domestic violence, employment, and basic needs. Design: A field evaluation with repeated measures at 6 and 12 months on an intent-to-treat sample of 529 women...
Article
To assess the prevalence and relationship to later employment of potential barriers to work for substance-abusing women on Temporary Assistance to Needy Families (TANF) enrolled in a multiservice welfare-to-work program. A field study with repeated measures and intent-to-treat sampling. The CASAWORKS for Families (CWF) was delivered in 11 sites in...
Article
In formulating policies for drug offenders, lawmakers must decide concrete questions about such matters as legal jurisdiction, burdens of proof, and reporting of progress information. Although these decisions may seem incidental to treatment and beyond the purview of science, they are based on empirically testable assumptions about the behavior of...

Citations

... An important assumption regarding universal suicide prevention programs in schools is that the conditions that contribute to the development of increased suicide risk in young people often go unrecognized and untreated, and that educating students and school "gatekeepers" will lead to better identification of at-risk youth as well as an increase in help-seeking and referrals for treatment (Hendin et al., 2005). Universal suicide prevention programs appear to be the most widely used approach in the schools (Miller et al., 2009;Robinson et al., 2013;Singer et al., 2019) and should be considered an essential component of comprehensive school-based suicide prevention programs (Miller, 2021). ...
... When pediatricians' health is optimized, so is that of their patients. The experience of participants in state physician health programs (PHPs) shows us that promoting the recovery of the affected pediatrician can be effectively balanced with maintaining public safety [60]. Random drug testing, both for detection and as a deterrent, is a key component of PHPs. ...
... Substance misuse is defined as substance use at high doses or in inappropriate situations. SUD is a diagnosable illness that arises following prolonged substance misuse and that significantly alters health and daily functioning (Campbell, 2002;McLellan, 2017). Substance misuse in IPV-EW has been reported as a means of coping with the physical and emotional pain (Smith et al., 2012;Simonelli et al., 2014;Gezinski et al., 2021). ...
... Tissue damage or inflammation may induce the overproduction of multiple pro-inflammatory compounds and dysregulation of pain-related genes, which may act as triggers for the emergence and maintenance of painful behaviors (Fattori et al., 2019). Currently, typical pharmacotherapy for inflammatory pain, such as opioids and cyclooxygenase inhibitors, is limited by partial and side effects (Volkow et al., 2018), and new drugs for inflammatory pain remain unavailable because of the obscure pathogenesis of inflammatory pain. ...
... Although multiple approaches are being taken to address the opioid epidemic, including policy changes [11,12] and updating of clinical guidelines [13,14], researchers are using large-scale electronic health information to study individual characteristics that contribute to individual-level susceptibility to overdose. Zedler and colleagues found that specific demographic characteristics, comorbid conditions, medication characteristics, and health care utilization patterns were independent risk factors for accidental prescription opioid-related toxicity or overdose in a Veterans' Health Administration (VHA) population [15]. ...
... Instead, they argued that measurement-based, near-realtime monitoring of AUD would benefit clinical decision-making and provide knowledge about AUD in general. Modern eHealth systems enable place-unbound continuous monitoring of the clinical course of patients with AUD by measuring the use of alcohol using digital questionnaires and connected transdermal sensors (19)(20)(21) or breathalyzers (22,23). Breathalyzer connected to mobile devices and the cloud has been clinically studied for contingency management (24,25), monitoring of drunkdriving (26), general monitoring of sobriety of AUD patients (22) and for detailed mapping and machine learning prediction of alcohol use (24). ...
... The first finding to be highlighted is the absence of studies that demonstrate the effectiveness of the version corresponding to the curriculum implemented by PROERD (D.A.R.E.-kiR). This finding is in line with a previously published review that draws attention to the high dissemination of the D.A.R.E.-kiR curriculum in American schools with no evidence of effectiveness 34 . kiR has at least 14 different curriculum versions, and most of them do not have more than one evaluative study carried out with different samples, which makes it difficult to generalize the results to different samples. ...
... This was the rationale behind assessing narcotic use two days prior and two days after the sternal fixation intervention as none of the patients had other operations within this time frame. Despite the difficulty controlling for narcotic use, any intervention to help decrease opioid use is beneficial to both the patient and society given the recent opioid epidemic in America and push to decrease use [20]. ...
... The internet is perhaps the most frequently used tool to purchase genuine or CFMPs (Europol, 2017;Hall & Antonopoulos, 2016;Interpol, 2018a;Leontiadis & Hutchings, 2015;Orsolini et al., 2015;WHO, 2018), although not all studies confirm this assumption (Festinger et al., 2016;Inciardi et al., 2010). Studies about the online sale of medical products (henceforth: MPs) indicate that one of the reasons why people decide to buy them over the internet -apart from reasons of convenience -is also related to the price of MPs and the sense of anonymity (Crawford, 2003;Hall & Antonopoulos, 2016;Orsolini et al., 2015). ...
... The Affordable Care Act (Patient Protection and Affordable Care Act 2010) has provided almost universal coverage and the Mental Health Parity and Addiction Equity Act (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 2008) mandates parity of treatment for substance abuse disorders with other medical disorders (McLellan and Woodworth 2014). These acts destigmatize addiction by recognizing it as an illness and requiring coverage by medical insurance (Woodworth and McLellan 2016). ...