Journal of Substance Abuse Treatment

BACKGROUND: As overdoses due to opioids rise, medications for opioid use disorder (MOUD) continue to be underemployed, resulting in limited access to potentially life-saving treatment. Substance use disorders are prevalent in individuals who are incarcerated, and these individuals are at increased risk for death postrelease due to overdose. Few jails and prisons offer MOUD and most limit access. Extended-release buprenorphine (XR-BUP), a novel monthly injectable MOUD formulation, could be uniquely poised to address treatment access in correctional settings...

INTRODUCTION: Harm reduction services, including methadone maintenance therapy (MMT), have been decentralized to Vietnam's community health care settings. This study aims to pilot test an intervention to facilitate decentralized harm reduction service delivery in Vietnam. METHODS: The research team conducted an intervention pilot between August 2020 and May 2021 with six community MMT distribution sites in Thai Nguyen Province of Vietnam. We recruited five commune health workers (CHW) from each center (N = 30)...

INTRODUCTION: We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine. METHODS: Using OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs...

AIMS: Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DESIGN: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SETTINGS: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city...

INTRODUCTION: The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention. METHODS: Using Medicaid data for 2017-2018 from four states participating in a distributed research network, this retrospective cohort study documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and assesses the extent to which different SUD presentations are associated with differential patterns of MOUD and psychosocial treatments...

INTRODUCTION: Peer support service in substance use disorder systems (PS SUD) is an optional supplement to treatment services for Medicaid-enrolled individuals across Pennsylvania. The value of PS SUD was defined through association with improved service utilization patterns. We examined service utilization in a subset of individuals receiving PS SUD following an acute service (hospitalization or withdrawal management) compared to utilization in propensity-score-matched controls via an observational analysis...

INTRODUCTION: Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption...

INTRODUCTION: Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden...

INTRODUCTION: The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership. METHODS: Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups...

INTRODUCTION: Opioid use disorder (OUD) is highly prevalent among incarcerated populations, and the risk of fatal overdose following release from prison is substantial. Despite efficacy, few correctional facilities provide evidence-based addiction treatment. Extended-release injectable naltrexone (XR-NTX) administered prior to release from incarceration may improve health and economic outcomes. METHODS: We conducted an economic evaluation alongside a randomized controlled trial testing the effectiveness of XR-NTX before release from prison (n = 38) vs...

INTRODUCTION: A 2012 national survey found low utilization of medication for opioid use disorder (MOUD) in US drug courts. This study provides an update on MOUD policies and practices among drug courts in communities that the opioid epidemic has substantially impacted. METHODS: The study surveyed adult drug courts (N = 169, 80 % response rate) in US counties with high opioid mortality rates or numbers of opioid-related deaths about their policies and practices relating to MOUD and the overdose-reversal medication, naloxone...

INTRODUCTION: People with substance user disorder (SUD) have frequent intersections with the health care system; however, engagement and retention in SUD care remain low, particularly for marginalized populations. Low-threshold treatment models that aim to eliminate barriers to care are one proposed intervention to increase access and equity in SUD treatment. METHODS: This is a retrospective, cohort study of patients treated at a low-threshold bridge clinic from 2016 to 2021...

BACKGROUND: Technology has made automated care personalization practical, but useful personalization requires information about systematic differences between individuals in the effectiveness of different interventions. Here, we used observational data to search for differences in smoking cessation treatment outcomes associated with interactions between participant characteristics and different types and doses of nicotine replacement therapy (NRT). METHODS: We analyzed 33,077 enrollments in a large primary care smoking cessation program in Ontario, Canada...

INTRODUCTION: This personal narrative describes our family's struggle with my adult son's substance use disorder (SUD). Years of traditional tough love treatment programs worsened his SUD and our relationship. When he experienced drug induced psychosis and was hospitalized, I realized I needed to change my approach and understand his behaviors. METHODS: I reached out to the recovery community and spoke with many individuals who had walked in my son's shoes. They described feelings of loneliness, self-loathing, and hopelessness while being on the receiving end of tough love...

INTRODUCTION: Opioid misuse is a nationwide public health crisis. Methadone treatment is proven to be highly successful in preventing opioid use disorder, reducing the use of illicit drugs, and preventing overdoses. Clients acquire methadone daily from clinics, making geographic access crucial for the initiation of and adherence to treatment. METHODS: This work estimates unsatisfied methadone demand due to lack of geographic access at a census tract level and models the problem of identifying optimal locations to open new methadone clinics...

Since 2013, fentanyl and fentanyl analogs, which are significantly more potent than heroin, have been increasingly prevalent in the opioid drug supply. A need exists to adapt methadone dosing from opioid treatment programs (OTPs) in this era. Current methadone protocols at many clinics in the United States are based on expert consensus documents that were created prior to the introduction of fentanyl into the drug supply and are relatively conservative. To date, most OTP reform efforts have focused on relaxation of regulations for take-homes and have not addressed the need to adapt methadone induction schedules to be more rapid in the fentanyl era, as allowed by current regulations...

INTRODUCTION: Individuals with opioid use disorder (OUD) are highly represented among the incarcerated population and are frequent utilizers of the emergency department (ED). Medications for opioid use disorder (MOUD) are a recognized treatment option for individuals with OUD. Although the field recognizes the benefits of MOUD, we know little about what mitigating effects MOUD offered in jail might have on post-release ED utilization. METHODS: In this retrospective cohort analysis, we searched electronic medical records (EMR) for incarcerations in the Santa Clara County jail between 8/1/2019 and 8/31/2021 for individuals with OUD (N = 4352) and collected demographic and medication administration data for these individuals...

INTRODUCTION: Despite having effective treatments for substance use disorders, the majority of people with a substance use disorder do not receive treatment, which leads to adverse personal, health, and social consequences. Experiences of non-service users have hardly been investigated in the literature. This study, which we conducted in the Netherlands, assessed the barriers to and facilitators of accessibility to substance use treatment for non-service users with substance use disorders...

BACKGROUND: This study examined factors associated with treatment recommendations for patients with a new diagnosis of opioid use disorder (OUD), comparing recommendations for patients with clear signs of OUD versus those with lower likelihood of OUD. METHODS: The study conducted a retrospective medical chart review in a randomly selected national sample of 520 Veteran Health Administration patients with a new opioid-related electronic health record (EHR) diagnosis from 2012 to 2017...

INTRODUCTION: Opioid overdose deaths are increasing, and improving access to evidence-based treatment is necessary. Emergency department (ED) initiation of treatment for opioid use disorder (OUD) via medications and referral to treatment is one approach that leverages a critical health care entry point for individuals with OUD. Efforts to engage patients in treatment through the ED are growing, but systematic analysis of program features as implemented and challenges across different models remains limited...