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Rabinowitz JA, Wells JL, Kahn G, Ellis JD, Strickland JC, Hochheimer M, Huhn AS. Predictors of treatment attrition among individuals in substance use disorder treatment: A machine learning approach. Addict Behav 2025; 163:108265. [PMID: 39889364 DOI: 10.1016/j.addbeh.2025.108265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 12/21/2024] [Accepted: 01/13/2025] [Indexed: 02/03/2025]
Abstract
BACKGROUND Early treatment discontinuation in substance use disorder treatment settings is common and often difficult to predict. We leveraged a machine learning approach (i.e., random forest) to identify individuals at risk for treatment attrition, and specific factors associated with treatment discontinuation. METHOD Participants (N = 29,809) were individuals ≥ 18 years who attended substance use disorder treatment facilities in the United States. Using random forest, we aimed to predict three outcomes (1) leaving against medical advice (AMA), (2) discharging involuntarily, and (3) discharging early for any reason. Predictors included participant demographics, substance use the month before and at intake, indices of mental and physical health, as well as treatment center and program type. FINDINGS We observed low to moderate area under the curve (range = 0.631-0.671), high negative predictive values (range = 0.853-0.965), and low positive predictive values (0.088-0.336) across the three treatment attrition outcomes. The most robust predictors of the three outcomes included treatment center, treatment type, and participant age. Additional predictors of the three outcomes included employment status; reason for treatment; primary drug at intake and frequency of use; prescription opioid, benzodiazepine, or heroin use at intake; living status at intake; and driving under the influence prior to treatment. CONCLUSIONS Our models were able to accurately identify individuals who remained in treatment, but not those who left treatment prematurely. The most robust predictors of treatment discontinuation were treatment center and program type, suggesting that targeting treatment facility features may have a significant impact on reducing treatment attrition and improving long-term recovery.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.
| | - Jonathan L Wells
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond, Virginia USA
| | - Geoffrey Kahn
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan USA
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA; Ashley Addiction Treatment, MD USA
| | - Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA; Ashley Addiction Treatment, MD USA
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2
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Ives LA, Serel M, Diaz AJ, LeBlanc L, Dallery J. Social validity of digital social incentives in the treatment of substance use disorders. J Appl Behav Anal 2025; 58:67-80. [PMID: 39353872 DOI: 10.1002/jaba.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024]
Abstract
Substance use disorders (SUDs) affect millions and have substantial negative consequences for individuals and society. Social incentives that leverage social networks for reinforcement or feedback have been used to improve health behaviors such as physical activity. This study investigated the feasibility, acceptability, and usability of a novel digital social incentive system embedded into a web- and smartphone-based platform for SUD recovery. The system leveraged a preexisting care team to deliver social incentives following notifications on recovery-related goal completion and abstinence to members undergoing SUD treatment. In total, 243 notifications were sent to care-team members, resulting in 117 social incentives, nearly all of which (99.15%) were coded as positive. Treatment members and care-team members provided favorable endorsements on acceptability and usability measures. Some areas of improvement were identified, such as increasing personalization and transparency. This digital social incentive system was feasible, acceptable, and usable as an adjunct treatment component for SUD recovery.
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Affiliation(s)
- Lindsey A Ives
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | | | - A J Diaz
- You Are Accountable, New York, NY, USA
| | | | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL, USA
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3
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Muro M, Collados-Ros A, Legaz I. Alcohol-related diseases and liver metastasis: Role of cell-free network communication. World J Gastroenterol 2022; 28:4231-4234. [PMID: 36157111 PMCID: PMC9403426 DOI: 10.3748/wjg.v28.i30.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
Alcohol intake is a risk factor for cancer development and metastatic disease progression. Extracellular vesicle (EV)-mediated interorgan communication is assumed to be significant in boosting tumorigenic pathways and disease progression. Recent research indicates that exosomes have a variety of roles in the development of cancer during pathophysiological conditions. The involvement of EV signaling during cancer progression in the alcohol environment is unknown. Therefore, understanding communication networks and the role of EVs as biomarkers can contribute significantly to developing strategies to address the serious public health problems associated with alcohol consumption and cancer.
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Affiliation(s)
- Manuel Muro
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), Murcia 30120, Spain
| | - Aurelia Collados-Ros
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, Murcia 30100, Spain
| | - Isabel Legaz
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, Murcia 30100, Spain
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4
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Expanding the continuum of substance use disorder treatment: Nonabstinence approaches. Clin Psychol Rev 2022; 91:102110. [PMID: 34864497 PMCID: PMC8815796 DOI: 10.1016/j.cpr.2021.102110] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD - especially drug use disorders - as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. We describe the development of nonabstinence approaches within the historical context of SUD treatment in the United States, review theoretical and empirical rationales for nonabstinence SUD treatment, and review existing models of nonabstinence psychosocial treatment for SUD among adults to identify gaps in the literature and directions for future research. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
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5
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Kuracha MR, Thomas P, Tobi M, McVicker BL. Role of cell-free network communication in alcohol-associated disorders and liver metastasis. World J Gastroenterol 2021; 27:7080-7099. [PMID: 34887629 PMCID: PMC8613644 DOI: 10.3748/wjg.v27.i41.7080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/02/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
The aberrant use of alcohol is a major factor in cancer progression and metastasis. Contributing mechanisms include the systemic effects of alcohol and the exchange of bioactive molecules between cancerous and non-cancerous cells along the brain-gut-liver axis. Such interplay leads to changes in molecular, cellular, and biological functions resulting in cancer progression. Recent investigations have examined the role of extracellular vesicles (EVs) in cancer mechanisms in addition to their contribution as diagnostic biomarkers. Also, EVs are emerging as novel cell-free mediators in pathophysiological scenarios including alcohol-mediated gut microbiome dysbiosis and the release of nanosized EVs into the circulatory system. Interestingly, EVs in cancer patients are enriched with oncogenes, miRNA, lipids, and glycoproteins whose delivery into the hepatic microenvironment may be enhanced by the detrimental effects of alcohol. Proof-of-concept studies indicate that alcohol-associated liver disease is impacted by the effects of exosomes, including altered immune responses, reprogramming of stromal cells, and remodeling of the extracellular matrix. Moreover, the culmination of alcohol-related changes in the liver likely contributes to enhanced hepatic metastases and poor outcomes for cancer patients. This review summarizes the numerous aspects of exosome communications between organs with emphasis on the relationship of EVs in alcohol-associated diseases and cancer metastasis. The potential impact of EV cargo and release along a multi-organ axis is highly relevant to the promotion of tumorigenic mechanisms and metastatic disease. It is hypothesized that EVs target recipient tissues to initiate the formation of prometastatic niches and cancer progression. The study of alcohol-associated mechanisms in metastatic cancers is expected to reveal a better understanding of factors involved in the growth of secondary malignancies as well as novel approaches for therapeutic interventions.
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Affiliation(s)
- Murali R Kuracha
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Peter Thomas
- Department of Surgery, Creighton University School of Medicine, Omaha, NE 68178, United States
| | - Martin Tobi
- Research and Development Service, Detroit VAMC, Detroit, MI 48201, United States
- Department of Medicine, Central Michigan University College of Medicine, Detroit, MI 48201, United States
| | - Benita L McVicker
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
- Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
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6
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Betancourt CA, Kitsantas P, Goldberg DG, Hawks BA. Substance Use Relapse Among Veterans at Termination of Treatment for Substance Use Disorders. Mil Med 2021; 187:e1422-e1431. [PMID: 34272857 DOI: 10.1093/milmed/usab280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 07/04/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Military veterans continue to struggle with addiction even after receiving treatment for substance use disorders (SUDs). Identifying factors that may influence SUD relapse upon receiving treatment in veteran populations is crucial for intervention and prevention efforts. The purpose of this study was to examine risk factors that contribute to SUD relapse upon treatment completion in a sample of U.S. veterans using logistic regression and classification tree analysis. MATERIALS AND METHODS Data from the 2017 Treatment Episode Data Set-Discharge (TEDS-D) included 40,909 veteran episode observations. Descriptive statistics and multivariable logistic regression analysis were conducted to determine factors associated with SUD relapse after treatment discharge. Classification trees were constructed to identify high-risk subgroups for substance use after discharge from treatment for SUDs. RESULTS Approximately 94% of the veterans relapsed upon discharge from outpatient or residential SUD treatment. Veterans aged 18-34 years old were significantly less likely to relapse than the 35-64 age group (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.66, 0.82), while males were more likely than females to relapse (OR 1.55, 95% CI: 1.34, 1.79). Unemployed veterans (OR 1.92, 95% CI: 1.67, 2.22) or veterans not in the labor force (OR 1.29, 95% CI: 1.13, 1.47) were more likely to relapse than employed veterans. Homeless vs. independently housed veterans had 3.26 (95% CI: 2.55, 4.17) higher odds of relapse after treatment. Veterans with one arrest vs. none were more likely to relapse (OR 1.52, 95% CI: 1.19, 1.95). Treatment completion was critical to maintain sobriety, as every other type of discharge led to more than double the odds of relapse. Veterans who received care at 24-hour detox facilities were 1.49 (95% CI: 1.23, 1.80) times more likely to relapse than those at rehabilitative/residential treatment facilities. Classification tree analysis indicated that homelessness upon discharge was the most important predictor in SUD relapse among veterans. CONCLUSION Aside from numerous challenges that veterans face after leaving military service, SUD relapse is intensified by risk factors such as homelessness, unemployment, and insufficient SUD treatment. As treatment and preventive care for SUD relapse is an active field of study, further research on SUD relapse among homeless veterans is necessary to better understand the epidemiology of substance addiction among this vulnerable population. The findings of this study can inform healthcare policy and practices targeting veteran-tailored treatment programs to improve SUD treatment completion and lower substance use after treatment.
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Affiliation(s)
- Christian A Betancourt
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA
| | - Deborah G Goldberg
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA
| | - Beth A Hawks
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD 20814, USA
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7
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Hanauer M, Sielbeck-Mathes K, Banks B, Mitori J, Reuveny A. Demographic Predictors of Dropping Out of Treatment (DOT) in Substance Use Disorder Treatment. Subst Use Misuse 2021; 56:1155-1160. [PMID: 33851556 DOI: 10.1080/10826084.2021.1910708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Researchers have not studied or used novel methods for identifying potential disparities for sexual minorities, those with criminal pasts, and veterans in (DOT). METHODS We used Bayesian logistic regression to identify factors associated with DOT, tested interaction effects, and used machine learning to classify qualitative responses. FINDINGS With 2,772 clients from two inpatient clinics in the Southwest United States, we found sexual minorities and females had 52% and 61%, increases and African Americans had 54% decreases in the odds of DOT. Additionally, those with a criminal past and 34.5 and older were less likely to DOT by 5% relative to clients with no prior involvement in the criminal justice system. CONCLUSIONS This study illustrated the disparities for women and sexual minorities in DOT as well as demonstrated novel methodological approaches to addressing previously unanswered questions.
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Affiliation(s)
| | | | - Bre Banks
- Centerstone Research Institute, Nashville, Tennessee, USA
| | | | - Adi Reuveny
- University of Michigan, Ann Arbor, Michigan, USA
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8
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Papamalis FE. Examining the Relationship of Personality Functioning and Treatment Completion in Substance Misuse Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820951777. [PMID: 33088177 PMCID: PMC7543119 DOI: 10.1177/1178221820951777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022]
Abstract
Background: Treatment retention is a major factor contributing to favourable outcome in
the treatment of substance misuse, but the literature remains very limited.
Despite evidence of the association of personality with drug use
experimentation and relapse, surprisingly little is known about its role in
the treatment process. Clients’ personality functioning as measured by
malleable and context sensitive characteristic adaptations in treatment are
of concern. Aims: This study examines whether, and to what extent, personality functioning
contributes to or hinders treatment completion. This paper examined the
extent to which service users’ characteristic adaptations may be potential
determinants of treatment completion. Methodology: A longitudinal multi-site design was utilised, examining the therapy process
in a naturalistic setting in five inpatient treatment units. The study
examined whether service users’ characteristic adaptations (SIPP-118)
predict completion, while controlling psychosocial, motivational and
treatment engagement indicators involving n = 340 participants from 5
inpatient centres. Multivariate regression analyses were
applied to examine the predictive role of characteristic adaptations on
treatment completion. Results: Findings indicated that certain dysfunctional characteristic adaptations
emerged as strong predictors of treatment completion. Dysfunctional levels
on Self-control and Social concordance were significant predictors of drop
out from treatment. Individuals with low capacity to tolerate, use and
control one’s own emotions and impulses were almost three times more likely
to drop-out compared to those without [OR] = 2.73, Wald = 6.09,
P = .014, 95% CI [1.2, 6.0]. Individuals with
dysfunctional levels on the ability to value someone’s identity, withhold
aggressive impulses towards others and work together with
others were 2.21 more times more likely to complete
treatment [OR] = 2.21, Wald = 4.12, P = .042, 95% CI [1.0,
4.7]. The analysis at the facet level provided additional insight.
Individuals with higher adaptive levels on Effortful Control were 46% more
times likely to complete treatment than the group [OR] = 4.67, Wald =
10.231, P = .001, 95% CI [1.81, 12.04], 47% more likely on
Aggression regulation [OR] = 4.76, Wald = 16.68, P <
.001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] =
2.62, Wald = 6.75, P < .009, 95% CI [0.9, 3.0]. Conclusions: These findings extend our knowledge of the predictive role of characteristic
adaptations in treatment completion and highlight the clinical utility of
capturing these individual differences early on. Delineating the role of
characteristic adaptations in treatment may provide the basis for enhancing
treatment effectiveness through individualized interventions that are
scientifically driven and may open new avenues for the scientific enquiry of
personality and treatment.
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9
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Timko C, Nash A, Owens MD, Taylor E, Finlay AK. Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221819901281. [PMID: 32132821 PMCID: PMC7040926 DOI: 10.1177/1178221819901281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 11/15/2022]
Abstract
Evidence indicates that substance use and mental health treatment is often associated with reduced criminal activity. The present systematic review examined this association among military veterans, and aimed to provide a comprehensive summary of needed research to further contribute to reduced criminal activity among veterans. This systematic review was derived from a scoping review that mapped existing research on justice-involved veterans' health. For the current systematic review, a subset of 20 publications was selected that addressed the question of whether criminal activity declines among veterans treated for substance use and mental health disorders. Generally, veterans improved on criminal outcomes from pre- to post-treatment for opioid use, other substance use, or mental health conditions, and more sustained treatment was associated with better outcomes. This occurred despite high rates of criminal involvement among veterans prior to entering treatment. Needed are substance use and mental health treatment studies that include women justice-involved veterans, follow criminally-active veterans for longer periods of time, and use validated and reliable measures of criminal activity with fully transparent statistical procedures. Future randomized trials should evaluate new treatments against evidence-based treatments (versus no-treatment control conditions). Subsequent studies should examine how to link veterans to effective treatments, facilitate sustained treatment engagement, and ensure the availability of effective treatments, and examine mechanisms (mediators and moderators) that explain the association of treatment with reduced criminal activity among veterans. Best practices are needed for reducing criminal activity among the minority of justice-involved veterans who do not have diagnosed substance use and/or mental health disorders.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Amia Nash
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Mandy D Owens
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,National Center on Homelessness Among Veterans, Department of Veterans Affairs
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10
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Finlay AK, Owens MD, Taylor E, Nash A, Capdarest-Arest N, Rosenthal J, Blue-Howells J, Clark S, Timko C. A scoping review of military veterans involved in the criminal justice system and their health and healthcare. HEALTH & JUSTICE 2019; 7:6. [PMID: 30963311 PMCID: PMC6718001 DOI: 10.1186/s40352-019-0086-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/18/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND In the criminal justice system, special populations, such as older adults or patients with infectious diseases, have been identified as particularly vulnerable to poor health outcomes. Military veterans involved in the criminal justice system are also a vulnerable population warranting attention because of their unique healthcare needs. This review aims to provide an overview of existing literature on justice-involved veterans' health and healthcare to identify research gaps and inform policy and practice. METHODS A systematic search was conducted to identify research articles related to justice-involved veterans' health and healthcare that were published prior to December 2017. Study characteristics including healthcare category, study design, sample size, and funding source were extracted and summarized with the aim of providing an overview of extant literature. RESULTS The search strategy initially identified 1830 unique abstracts with 1387 abstracts then excluded. Full-text review of 443 articles was conducted with 252 excluded. There were 191 articles included, most related to veterans' mental health (130/191, 68%) or homelessness (24/191, 13%). Most studies used an observational design (173/191, 91%). CONCLUSIONS Knowledge gaps identified from the review provide guidance on future areas of research. Studies on different sociodemographic groups, medical conditions, and the management of multiple conditions and psychosocial challenges are needed. Developing and testing interventions, especially randomized trials, to address justice-involved veterans care needs will help to improve their health and healthcare. Finally, an integrated conceptual framework that draws from diverse disciplines, such as criminology, health services, psychology, and implementation science is needed to inform research, policy and practice focused on justice-involved veterans.
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Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Mandy D. Owens
- Department of Veterans Affairs Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108 USA
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660 USA
| | - Emmeline Taylor
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Amia Nash
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Nicole Capdarest-Arest
- Blaisdell Medical Library, University of California, Davis, 4610 X St, Sacramento, CA 95817 USA
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, Department of Veterans Affairs, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Sean Clark
- Veterans Justice Programs, Department of Veterans Affairs, 2250 Leestown Road, Lexington, KY 40511 USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717 USA
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11
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Searching objective criteria for patient assignment in addiction treatment. J Subst Abuse Treat 2017; 76:28-35. [DOI: 10.1016/j.jsat.2017.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/22/2022]
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12
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Blevins CE, Abrantes AM, Kurth ME, Gordon AL, Stein MD. Alcohol treatment outcomes following discharge from a partial hospital program. JOURNAL OF SUBSTANCE USE 2017; 22:643-647. [PMID: 30881219 DOI: 10.1080/14659891.2017.1296041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Thousands of individuals in the United States seek alcohol treatment each year, typically in outpatient settings. Partial hospital programs provide a high level of structured, individualized outpatient care for individuals who are in treatment for alcohol use disorder. Previous research in other outpatient and inpatient settings has found that psychological distress, pain, and aftercare utilization are associated with treatment outcomes. Objectives The current study evaluates baseline characteristics and aftercare utilization predictors of alcohol use outcomes of individuals in a week-long partial hospital program. Methods The 113 participants (59.3% male) were interviewed during their time in the program and then were reassessed one month post-discharge. Results Results indicated that a greater number of mental health provider visits and 12-step attendance were associated with abstinence at follow-up such, while baseline characteristics did not consistently predict outcomes. Conclusions Findings highlight the importance of aftercare planning, particularly in our more severe, clinical sample.
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Affiliation(s)
- Claire E Blevins
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Ana M Abrantes
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Alan L Gordon
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael D Stein
- Butler Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI.,Boston University School of Public Health, Boston, MA
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13
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Roberts AC, Nishimoto R. Barriers to Engaging and Retaining African- American Post-Partum Women in Drug Treatment. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about barriers to engaging and retaining African-American women in drug treatment. This descriptive study addressed three questions regarding barriers to substance abuse treatment for African-American women: What barriers made it difficult for women to participate in treatment? Did identified barriers differ by program modality? To what degree were barriers related to treatment retention? Findings revealed that barriers considered to be internal in nature, i.e., “drug severity,” “did not feel like going,” and “felt I could manage on my own,” were most frequently reported. Only a few program-related barriers were found to be related to length of time in treatment and both internal and programmatic barriers had an effect on treatment completion. Implications for policy decisions, future research, and clinical competence in addressing barriers to treatment for African-American women are discussed.
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14
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Morse SA, Watson C, MacMaster SA, Bride BE. Differences between older and younger adults in residential treatment for co-occurring disorders. J Dual Diagn 2015; 11:75-82. [PMID: 25531670 DOI: 10.1080/15504263.2014.993263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment. METHODS This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay. RESULTS Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change. CONCLUSIONS The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment.
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Affiliation(s)
- Siobhan A Morse
- a Foundations Recovery Network , Brentwood , Tennessee , USA
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Boog M, Goudriaan AE, Wetering BJ, Polak M, Deuss H, Franken IH. Rash impulsiveness and reward sensitivity as predictors of treatment outcome in male substance dependent patients. Addict Behav 2014; 39:1670-1675. [PMID: 24837083 DOI: 10.1016/j.addbeh.2014.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 02/23/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor construct, consisting of Rash Impulsiveness and Reward Sensitivity. There is some evidence for this distinction, but it is unknown what the clinical relevance of this distinction is. The present study examines the predictive value of the two-factor model regarding drop-out from treatment and relapse into substance use in a clinical population of male substance dependent patients. Both behavioral and self-report measures of Rash Impulsiveness and Reward Sensitivity were measured during treatment while substance use relapse was measured after 90days. Results indicate that treatment drop-out could be predicted by a behavioral index of Reward Sensitivity (Card Playing Task); self-reported Rash Impulsiveness only approached significance as predictor drop-out. In contrast, relapse could not be predicted in the present study. These findings might have implications for the early identification and treatment of patients at risk of treatment drop-out.
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Agosti V, Nunes EV, O'Shea D. Do manualized psychosocial interventions help reduce relapse among alcohol-dependent adults treated with naltrexone or placebo? A meta-analysis. Am J Addict 2012; 21:501-7. [PMID: 23082827 DOI: 10.1111/j.1521-0391.2012.00270.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND During the past decade, several novel medication treatments and psychosocial interventions have been tested. Overall, their impact on reducing alcohol use and preventing relapse has been modest. These outcomes have spurred researchers to investigate whether the addition of manualized psychosocial therapies with demonstrated efficacy to pharmacotherpy would have a synergistic effect. OBJECTIVES We conducted a meta-analysis to test the hypothesis that the addition of manualized psychosocial therapies would reduce the frequency of relapse. RESULTS This review analyzed data from six studies. Among studies that used random assignment to manually guided psychosocial interventions, the rates of relapse between the naltrexone plus a psychosocial intervention and naltrexone without a psychosocial intervention were very similar. Among patients allocated to placebo, similar rates of relapse were also found between Cognitive Behavioral Therapy (CBT) and non-CBT. In studies which used manualized psychotherapies as a platform, relapse rates were similar between naltrexone and placebo. In contrast, studies using Treatment As Usual psychotherapy as a platform demonstrated lower rates of relapse in the naltrexone group, compared to placebo group. CONCLUSIONS We conclude that CBT does not appear to offer benefits beyond those derived from study medications. SCIENTIFIC SIGNIFICANCE The benefit of the addition of CBT to medication in preventing relapse may be limited.
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Affiliation(s)
- Vito Agosti
- Depression Evaluation Service, New York State Psychiatric Institute, New York, New York 10032, USA.
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Mangrum LF. Client and service characteristics associated with addiction treatment completion of clients with co-occurring disorders. Addict Behav 2009; 34:898-904. [PMID: 19303219 DOI: 10.1016/j.addbeh.2009.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 10/21/2022]
Abstract
The study examines client and service characteristics of addiction treatment completers and non-completers with co-occurring disorders (COD). On demographic variables, completers were more likely to be male and homeless. In the psychiatric domain, a greater proportion of completers received diagnoses of depression and generalized anxiety disorder, whereas non-completers were more often diagnosed with bipolar disorder and posttraumatic stress disorder. No group differences were found in client-reported psychiatric symptom severity; however, non-completers were rated by clinicians as having more severe symptoms in the areas of interpersonal sensitivity, depression, and hostility. In the area of substance use patterns, no differences were found in primary substance of abuse but completers reported more days of use during the month prior to treatment. Completers also had a greater history of both prior detox and non-detox treatment. At discharge, completers achieved higher rates of past month abstinence and AA attendance, but no differences were found in length of stay in treatment. Examination of recovery support services utilization revealed that completers more often received peer mentoring services. Greater proportions of the non-completer group received educational support, clothing, medical care, and employment assistance. These results suggest that future studies are needed in examining possible differential treatment response by diagnostic category and the potential role of peer mentoring in enhancing addiction treatment completion of COD clients.
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Laudet AB, Stanick V, Sands B. What could the program have done differently? A qualitative examination of reasons for leaving outpatient treatment. J Subst Abuse Treat 2009; 37:182-90. [PMID: 19339133 PMCID: PMC2716417 DOI: 10.1016/j.jsat.2009.01.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 12/22/2008] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
Abstract
Attrition from treatment for substance abuse disorders is a persistent challenge that severely limits the effectiveness of services. Although a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients' stated reasons for leaving outpatient treatment (n = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors. Program-level barriers include dissatisfaction with the program, especially counselors; unmet social services needs; and lack of flexibility in scheduling. Individual-level barriers to retention were low problem recognition and substance use. Study limitations are noted, and the implications of findings for research and practice are discussed, emphasizing the need to understand and address clients' needs and expectations starting at intake to maximize treatment retention and the likelihood of positive outcomes.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery at National Development and Research Institutes, Inc., (NDRI), NYC, NY 10010, USA.
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Meier PS, Barrowclough C. Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630701741030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kobayashi O, Matsumoto T, Otsuki M, Endo K, Okudaira K, Wada K, Hirayasu Y. Profiles associated with treatment retention in Japanese patients with methamphetamine use disorder: preliminary survey. Psychiatry Clin Neurosci 2008; 62:526-32. [PMID: 18950371 DOI: 10.1111/j.1440-1819.2008.01845.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To identify profiles associated with treatment retention in Japanese patients with methamphetamine use disorder. METHODS The study used a retrospective design based on clinical records. The subjects were 101 patients at the Kanagawa Psychiatric Center, Serigaya Hospital, who were diagnosed as having methamphetamine use disorder. They were divided in two groups, namely those who remained in treatment 3 months after the initial assessment, and those who did not. The primary analysis compared patient profiles between the two groups to detect discriminating variables, which were then submitted for secondary analysis using logistic regression to determine the most relevant predictor of retention. RESULTS Primary analysis indicated that older age, having psychotic symptoms, receiving public assistance, and history of incarceration were associated with treatment retention after 3 months. Secondary analysis showed that positive history of incarceration was the most significant predictor of the outcome. CONCLUSIONS History of incarceration had the most significant treatment-retention effect on Japanese patients with methamphetamine use disorder. The development and introduction of integrated programs that link methamphetamine-dependent offenders to drug treatment is recommended in outpatient treatment for Japanese patients with methamphetamine user disorder.
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Affiliation(s)
- Ohji Kobayashi
- Kanagawa Psychiatric Center, Serigaya Hospital, Tokyo, Japan.
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Choi S, Ryan JP. Completing substance abuse treatment in child welfare: the role of co-occurring problems and primary drug of choice. CHILD MALTREATMENT 2006; 11:313-25. [PMID: 17043316 DOI: 10.1177/1077559506292607] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A significant number of substance-abusing parents in the child welfare system do not complete substance abuse treatments. Consequently, their children experience longer stays in substitute care settings, and the risk of the termination of parental rights is increased. This study identifies and determines the specific factors that explain the completion of substance abuse treatment for substance-abusing caregivers in child welfare. The sample includes 871 caregivers enrolled in the Illinois Alcohol and Other Drug Abuse waiver demonstration. Approximately 22% of these caregivers successfully completed all required levels of substance abuse treatment. The multivariate models indicate that age, employment status, and legal involvement were significantly associated with the likelihood of completing substance abuse treatment. Heroin users were significantly less likely to complete treatment as compared with alcohol, cocaine, and marijuana users. The findings are discussed in terms of policy and practice implications for public child welfare systems.
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Affiliation(s)
- Sam Choi
- University of Illinois at Urbana-Champaign, IL, USA
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Pulford J, Adams P, Sheridan J. Unilateral treatment exit: a failure of retention or a failure of treatment fit? Subst Use Misuse 2006; 41:1901-20. [PMID: 17162596 DOI: 10.1080/10826080601025847] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article highlights perceived weaknesses in the current understanding of unilateral client exit from alcohol and other drug psychosocial treatment. It is argued that unilateral client exit is typically interpreted as a "failure of retention" when it could equally be interpreted as a "failure of treatment fit"; that is, the failure to deliver treatment optimally suited to actual client attendance. The results from an exploratory study conducted within a failure of treatment fit framework are presented. This study explored the possibility that short-term outpatient alcohol and other drug (AOD) treatment attendance may be an intentional service use strategy and that short-term attendees may exit AOD treatment as satisfied, successful, consumers. Standardized questionnaires were administered to clients (n = 109) starting a new treatment episode between June-August 2003 at admission and two-months post admission. Questionnaires explored the accuracy of client estimates of future appointment attendance, the reasons for short-term service exit, the satisfaction and outcome ratings of short-term clients, and the extent to which these compared with their longer-term peers. Findings suggest short-term treatment attendance is not an intentional service use strategy. However, despite attending fewer appointments than intended, most short-term participants reported significant levels of service satisfaction and problem improvement, and at a level comparable with their longer term peers. Problem-improvement was endorsed as the number one reason for short-term service exit. Implications for treatment delivery are discussed in light of these findings.
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Affiliation(s)
- Justin Pulford
- School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, New Zealand.
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