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Annotated bibliography: Consumer participation in treatment programs

Becan, J. E., Knight, D. K., Crawley, R. D., Joe, G. W., & Flynn, P. M. (2015). Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. Journal of Substance Abuse Treatment, 50(1), 38-49.

The aim of this study was to assess the effectiveness of the Treatment Readiness and Induction Program (TRIP) for treating for motivating adolescents involved in treatment programs. Motivation is a crucial factor in the success of treatment for substance abuse and includes problem recognition, a desire to seek help and a readiness to change. The authors stated that interventions that facilitate this are particularly important for adolescents. The data was collected from 519 adolescents from six residential programs. They completed assessments at treatment intake and again 35 days after admission. The study included a control sample (n = 281) that had commenced treatment prior to the implementation of TRIP, which were compared against clients who received standard treatment enhanced by TRIP (n = 238). Motivational levels were conceptualised utilising statistical tools, which allowed for variables such as gender and drug use severity. The adolescents using TRIP demonstrated greater levels of gains in problem recognition and TRIP was linked indirectly with gains in the desire to seek help and readiness for treatment. Limitations include that the study was confined to those in residential care and were still in treatment 35 days after admission.

Durbeej, N., Palmstierna, T., Berman, A. H., Kristiansson, M., & Gumpert, C. H. (2014). Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions. Journal of Substance Abuse Treatment, 46(5), 574-583.

Treatment for substance abuse may reduce recidivism in offenders as substance abuse has been linked to re-offending. Participation in substance abuse treatment programs by offenders may be associated with severity of substance use and social problems, violence risk and psychopathic personality traits. This study examined the relationships between these characteristics and participation in substance abuse programs in Swedish offenders with comorbid mental illness and problematic substance abuse. The data was collected by interviews on three occasions: at the beginning of the study, shortly before release and at the end of the treatment period (mean time = 20.8 months) and standard assessment tools were used including the Alcohol Use Disorders Identification Test (AUDIT). The data was collected from 134 offenders who voluntarily participated in the study. It indicated that problem severity predicted participation in intervention but that affective psychopathic personality traits were negatively associated with intervention participation. It concluded that psychopathic personality traits should be considered when planning interventions and that cognitive behavioral therapy and dialectical behavioral therapy may be more applicable for these offenders. One of the limitations of the study is that it utilised an observational study design so was reliant on observed associations between variables, which may result in researcher bias.

Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., & … Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step” (STAGE-12) intervention. Journal of Substance Abuse Treatment, 84(1), 21-29.

Young adults (aged 18-29 years) have the potential to benefit from participating in twelve-step programs, but their uptake in these programs is relatively low. The aim of this study was to examine if age did effect attendance at twelve-step interventions and how it affected substance use. Data was obtained using a multi-site randomised controlled trial with assessments performed at baseline, mid-treatment (week 4), end-of-treatment (8 weeks) and at 3 and 6 months post treatment. The participants were all diagnosed with stimulant abuse or dependence utilising DSM IV (n = 450) and were enrolled in ten intensive outpatients substance use treatment programs in the USA. The study found that younger age was associated with improved treatment outcomes and that abstinence was greater in those who had participated in 12-step programs as opposed to treatment as usual (TAU). Conversely, for those who did not remain abstinent during treatment, younger age was associated with greater rates of stimulant use at follow up for those in 12-step as opposed to those in TAU. There were greater rates of participation in activities in young adults in 12-step programs than those in TAU programs. Users of non-stimulant drugs exhibited no differences in age by treatment interactions, but younger users were less likely to be abstinent at follow-up regardless of the treatment they had received. The study recommends ongoing assessment of the consumer’s readiness to change to guide the focus of treatment and that age appropriate treatment may benefit clinical outcome. Data collected was self-reported and was identified as a limitation of the study.

Hatch-Maillette, M., Wells, E. A., Doyle, S. R., Brigham, G. S., Daley, D., DiCenzo, J., & … Perl, H. I. (2016). Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders. Journal of Substance Abuse Treatment, 68(1), 74-82.

The authors of this study identified a gap in the research examining the effectiveness of 12-step peer recovery programs for drug use. They conducted a multi-site randomised clinical trial of 12-step facilitation on individuals with cocaine or methamphetamine use disorders (n =471) attending in one of ten settings. Participants were randomly assigned to 12-step with TAU or TAU alone for an eight week intervention. They were then assessed at 4 week and 8 weeks into treatment and again at 3 and 6 months after treatment commencement. Four outcome variables were examined:

  1. To what extent do treatment-seeking stimulant users choose 12-step interventions
  2. Do the factors, which predict 12-step participation in people with alcohol use disorders, apply in stimulant users?
  3. Which baseline “12-step readiness” factors predict program attendance and participation?
  4. Does choice of stimulant predict participation and attendance in 12-step programs?

The study found that attendance, speaking, allocated duties and peer were unrelated to demographics and substance use history or severity. Cocaine users were more likely to attend follow up meetings at 1, 3 and 6 months than methamphetamine users, as were those who perceived the groups as being beneficial to their recovery. Consumers who had attended the program prior to the study were also more likely to attend follow up sessions and participate in self-help activities, whereas those who perceived barriers to 12-step groups prior to the study were less likely to participate in these. Those who participated in self-help activities were more likely to volunteer for group duties. It concluded that continuity, prior attendance and active involvement with the 12-step programs were the main predictors for future program involvement and participation. The study was limited in that it only studied participants in a select set of treatment programs

Ibabe, I., Stein, J. A., Nyamathi, A., & Bentler, P. M. (2014). Predictors of substance abuse treatment participation among homeless adults. Journal of Substance Abuse Treatment, 46(3), 374-381.

This study examines the relationships among a history of trauma, a history of substance abuse, chronic homelessness and emotional distress in predicting participation in drug treatment programs, as enrolment and retention of clients in these programs is difficult, particularly among homeless people. Structural equation modelling was used, which indicated an association between chronic homelessness, trauma history and substance use history. This association significantly predicted recent emotional distress in the 853 participants, who were all homeless adults living in Los Angeles. Those with recent emotional distress were less likely to participate in substance abuse treatment, both formal and self-help. However, those with only a history of substance use were more likely to participate in treatment. It recommends providers focusing on dual-diagnosis interventions in order to encourage engagement and participation amongst this client group. They also cite the success of outreach services in establishing an initial contact with treatment services for this group as a method of reducing barriers to treatment seeking, including distrust. The authors state the over reliance on self-reporting is a limitation in this research.

Jaffe, A., Du, J., Huang, D., & Hser, Y. (2012). Drug-abusing offenders with comorbid mental disorders: Problem severity, treatment participation, and recidivism. Journal of Substance Abuse Treatment, 43(2), 244-250.

The aim of this study was to examine problem severity, treatment participation and recidivism in 1016 drug-abusing offenders who had a co-existing mental disorder. The participants were first assessed utilising the Addiction Severity Index (ASI) and their mental health diagnoses, treatment program participation and arrest records were obtained. The severity of their mental health disorder was then classified as mild or severe based on their specific diagnoses. Ordinal logistic regression was then used to examine predictors of recidivism separately for those with mild or severe mental health disorders. It was indicated that previous arrests, education level and treatment participation are predictors of recidivism generally. However, gender, age, primary drug, ASI score and treatment method are differentially important depending on the severity of the offender’s mental illness. The report recommends intervention strategies focusing on dual-diagnosis among offenders, to take into consideration the severity of their mental illness in order to increase their effectiveness and reduce recidivism. The data obtained is mainly self-reported which is identified as a limitation of the study.

Knight, D. K., Joe, G. W., Crawley, R. D., Becan, J. E., Dansereau, D. F., & Flynn, P. M. (2016). The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes. Journal of Substance Abuse Treatment, 62(1), 20-27.

Engagement in treatment is an important factor in its success and this is consistently predicted by motivation. As problem recognition is an important aspect of motivation, it is essential to target efforts to improve this to achieve sustained recovery following treatment. This study aimed to compare the effectiveness of Standard Operating Practice (SOP) against SOP plus 8 sessions of TRIP on cognitive indicators and engagement in treatment for young people in 5 residential substance abuse treatment centres. The original sample consisted of 1228 adolescents (SPO = 749, TRIP = 479), which had reduced to 729 (SPO = 445, TRIP = 274) at the end of the study. Data was collected using the Texas Christian University Adolescent Screening and Assessment Package on admission (Time 1) and 30-45 days into treatment (Time 2), which was usually at the completion of the program. The study found that adolescents who received TRIP demonstrated higher problem recognition, decision-making and treatment engagement than those who received SOP only. This was true even when controlling for background factors such as demography and drug use severity. A limitation of this study was that only youths who completed the treatment were included in the final analysis.

McKay, J. R., Van Horn, D., Rennert, L., Drapkin, M., Ivey, M., & Koppenhaver, J. (2013). Factors in sustained recovery from cocaine dependence. Journal of Substance Abuse Treatment, 45(2), 163-172.

This study aimed to establish factors that predicted abstinence from cocaine use and shifts from use to abstinence over a 24-month period. The participants (n = 268) were recruited from three centres which provided intensive outpatient programs. The data was collected over 24-months and the participants were assessed within 2 weeks of admission and then at 3-monthly periods thereafter using a variety of screening tools. It identified that both abstinence from cocaine and transitioning into abstinence at the next follow-up were associated with older age, less education and lower severity of alcohol and cocaine use at baseline. Additional factors contributing to abstinence and transition to abstinence were higher self-efficacy, readiness to change, better social networks, lower depression and lower severity of co-existing problems. A limitation of the research was that it was correlational, so it is not conclusive if the variables resulted in the changes in cocaine use or if it was the changes in the predictors (e.g. raising self-esteem) that caused the reduction in cocaine use

Timko, C., Below, M., Schultz, N. R., Brief, D., & Cucciare, M. A. (2015). Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review. Journal of Substance Abuse Treatment, 52(1), 31-39.
Completion of detoxification and transitioning to substance use disorder (SUD) treatment and/or mutual self-help groups (MSHG) predict improved consumer outcomes. However, many consumers do not complete detoxification or receive SUD treatment afterwards. The authors conducted a structured evidence review on 26 articles to ascertain consumer, program and other factors associated with the successful completion of detoxification and transitioning to SUD treatment and/or MSHG. They found wide variations in the studies, between 45-95% of consumers completed detoxification and 14-92% transitioned to SUD treatment and/or MSHG. Family support and motivational-based approaches both contributed to completion of detoxification and transition to SUD care and/or MSHG. They suggest targeting these approaches at young people, who are less likely to complete detoxification and that barriers to detoxification and the subsequent transition to SUD care and/or MSHG can be overcome to improve consumer outcomes. The authors of this study relied on one database (PubMed) to collect their data, which is a major limitation of the study.

Zemore, S. E., & Ajzen, I. (2014). Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior. Journal of Substance Abuse Treatment, 46(2), 174-182.

This study evaluated whether a 9-item scale based on the theory of planned behaviour (TPB) predicted the completion of substance abuse treatment. TPB is a general, social cognitive model of behaviour that has been useful in modelling a range of public health behaviours and can be applied to predicting treatment completion for SUDs. The data was collected from clients (n = 200) at a public outpatient program. The participants had all initiated treatment and baseline data was collected using surveys, which included attitudes towards treatment and perceived control and intention. The participants status on discharge was then collected using program records. TPB attitude and control components independently predicted intention and intention was positively related to treatment outcomes. TPB components were frequently related to readiness and were predictive of increased levels of coercion. Results indicate that the use of TPB improves treatment completion. A limitation of the study is the sample size and that the data was obtained from a single treatment program.

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National Drug Strategy Household Survey 2016

Access the survey here 

Summary

Younger people (under 30 years old) are drinking and smoking less and using less illicit drugs than in 2001. However, people in their 40s, 50s and 60s have not significantly changed their drug usage over this period, although their use of some drugs has increased since 2013.

Tobacco smoking

  • Smoking rates have been on downward trend over the long-term, but have not significantly declined since 2013.
  • There are fewer teenagers smoking and the average age for first use has increased to age 16.3 from age 15.9 years in 2013.
  • The amount smoked has decreased significantly since 2001, but there was no significant decrease from 2013 rates.
  • Males are more likely to smoke than females
  • The proportion of never smokers was 60% in 2016, compared to 62% in 2013
  • Smoking has declined by over 40% in people in their 20s and 30s and 20% for people in their 40s and 50s over the last 15 years. However, it hasn’t declined significantly in those over the age of 60.
  • More smokers are rolling theit own cigarettes as opposed to ready made cigarettes
  • Support for harm reduction policies remains high

Alcohol use

  • Fewer people than in 2013 exceeded the lifetime risk guidelines for drinking alcohol.
  • Young adults were drinking less. 42% of 18-24 year olds drinking at least 5 standard drinks per month as opposed to 47% in 2013.
  •  82% of 12-17 year olds abstained from alcohol in 2016 compared to 72% in 2013.
  • More people in their 50s were drinking 11 or more standard drinks on one occasion compared to 2013.
  • The proportion of people reporting being a victim of alcohol related harm decreased from 26% in 2013 to 22% in 2016.
  • Males are more than twice as likely as females to exceed the lifetime risk guidelines. However the difference is narrowing as less fewer males drink at risky levels while female risky drinking is unchanged.
  • Most alcohol policy measures received reduced support in 2016 than in 2013

Illicit drug use

  • Less use of some illegal drugs was seen in 2016 including meth/amphetamines, hallucinogens and synthetic cannabinoids
  • 1 in 20 Australians in 2016 misused pharmaceutical medication
  • Reports of being a victim of a drug-related incident increased to 1.8million in 2016, up from 1.6million in 2013
  • Cocaine use has been increasing since 2004 from 1% to 2.5%
  • More people over the age of 40 reported misuse of drugs mainly pharmaceuticals and cannabis
  • Cannabis, heroin and cocaine were perceived to be less likely to be thought of as a drug problem as compared to meth/amphetamine

Meth/amphetamines

  • Crystal or ice continued to be the main form used up to 57% in 2016 from 50% in 2013
  • Powder use declined from 29% in 2013 to 20% in 2016
  • People’s perception of meth/amphetamines changed between 2013 and 2016 with it being nominated as the drug most likely to be drug problem and also the cause of most drug related deaths for the first time


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Facts about Drugs Videos

The Drug Policy Alliance has produced a series of four short videos about MDMA, Methamphetamine, Heroin and Cocaine which aim to present straightforward, factual information. Each video is only two minutes long and covers the history of each of these drugs, how they work, the major health risks of each substance and practice harm reduction advice.