Elizabeth C. Katz

Role Induction: A Method for Enhancing Early Retention in Outpatient Drug-Free Treatment.

Retention in outpatient drug-free treatment is poor, with many clients terminating prior to receiving therapeutic benefit. This randomized clinical trial compared the impact on retention and drug use of an individual role induction session conducted at intake with the standard group orientation offered at the clinic. Results of interim analyses indicated that participants assigned to role induction (n = 180) were retained for more days, more likely to attend at least one postorientation session, and more satisfied with the treatment program than were those assigned to standard treatment (n = 87). Preliminary results suggest that role induction is a brief technique that shows promise for retaining clients through the critical first 3 months of treatment.

Cognitive ability as a factor in engagement in drug abuse treatment.

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability.

Brief vs. extended buprenorphine detoxification in a community treatment program: engagement and short-term outcomes.

Background: Despite evidence supporting the efficacy of buprenorphine relative to established detoxification agents such as clonidine, little research has examined: 1) how best to implement buprenorphine detoxification in outpatient settings; and 2) whether extending the length of buprenorphine detoxification improves treatment engagement and outcomes. Objectives: The current study examined the impact on 1) successful detoxification completion; 2) transition to longer-term treatment; and 3) treatment engagement of two different length opioid detoxifications using buprenorphine. Methods: The study compared data obtained from two consecutive studies of early treatment engagement strategies. In one study (n = 364), opioid-addicted participants entered treatment through a Brief (5-day) buprenorphine detoxification. In the other study (n = 146), participants entered treatment through an Extended (i.e., 30-day) buprenorphine detoxification. Results: Results indicated a greater likelihood of successful completion and of transition among participants who received the Extended as compared to the Brief detoxification. Extended detoxification participants attended more counseling sessions and submitted fewer drug-positive urine specimens during the first 30 days of treatment, inclusive of detoxification, than did Brief detoxification participants. Conclusions: Results demonstrate that longer periods of detoxification improve participant engagement in treatment and early treatment outcomes. Scientific Significance: Current findings demonstrate the feasibility of implementing an extended buprenorphine detoxification within a community-based treatment clinic.

Impact of Role Induction on Long-Term Drug Treatment Outcomes

Abstract In prior research, Katz et al.1 found that role induction (RI) improved engagement for substance dependent clients relative to standard outpatient treatment orientation. The current study replicates and extends these findings to an examination of long-term outcomes. Substance dependent clients entering outpatient drug-free treatment (N = 353) were randomly assigned to RI or to Standard (ST) orientation followed by routine clinic treatment. Measures of employment, crime, and substance use were collected at intake and at six- and 12-months post-intake. Controlling for baseline differences in substance use, results partially replicated our earlier findings of better engagement for RI, as compared to ST participants; more RI than ST participants attended at least one post-orientation counseling session. RI improved 12-month substance use outcome relative to ST. The potential gain in retention and in reduced substance use at follow-up associated with a single RI session, recommend this strategy for further development and study.

Transitioning Opioid-Dependent Patients from Detoxification to Long-term Treatment: Efficacy of Intensive Role Induction

Despite findings that opioid detoxification serves little more than a palliative function, few patients who enter detoxification subsequently transition to long-term treatment. The current study evaluated intensive role induction (IRI), a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment. IRI was delivered either alone or combined with case management (IRI+CM) to determine the capacity of each condition to enhance transition and engagement in long-term treatment of detoxification patients. Study participants were 240 individuals admitted to a 30-day buprenorphine detoxification delivered at a publicly funded outpatient drug treatment clinic. Following clinic intake, participants were randomly assigned to IRI, IRI+CM, or standard clinic treatment (ST). Outcomes were assessed in terms of adherence and satisfaction with the detoxification program, detoxification completion, and transition and retention in treatment following detoxification. Participants who received IRI and IRI+CM attended more counseling sessions during detoxification than those who received ST (both ps<.001). IRI, but not IRI+CM participants, were more likely to complete detoxification (p=.017), rated their counselors more favorably (p=.01), and were retained in long-term treatment for more days following detoxification (p=.005), than ST participants. The current study demonstrated that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.

Impulsivity, Expectancies, and Evaluations of Expected Outcomes as Predictors of Alcohol Use and Related Problems

Background: While the association between outcome expectancies and drinking is well documented, few studies have examined whether evaluations of expected outcomes (outcome evaluations) moderate that association. Objectives: The present study tested the hypotheses that outcome evaluations moderate the outcome expectancy-drinking association and that outcome expectancies mediate the association between impulsive personality and drinking. Methods: College students (N = 201; 55.5% female) enrolled in a mid-sized metropolitan university completed measures assessing outcome expectancies and evaluations, alcohol consumption, and drinking-related problems. Results: Consistent with study hypotheses, expectation of negative outcomes predicted lower levels of drinking, but only when these outcomes were evaluated as highly aversive. However, impulsivity was found to be a far stronger predictor of both drinking and related problems than were outcome expectancies or evaluations. Conclusion: The association between negative expectancy and drinking was moderated by negative evaluation, such that individuals who both expected that negative outcomes were likely to occur and who judged such outcomes as highly undesirable consumed significantly fewer drinks per week. Impulsivity was found to be a strong predictor of both alcohol consumption and alcohol-related problems.

A comparison of attitudes toward opioid agonist treatment among short-term buprenorphine patients.

Background: Obtaining data on attitudes toward buprenorphine and methadone of opioid-dependent individuals in the United States may help fashion approaches to increase treatment entry and improve patient outcomes. Objectives: This secondary analysis study compared attitudes toward methadone and buprenorphine of opioid-dependent adults entering short-term buprenorphine treatment (BT) with opioid-dependent adults who are either entering methadone maintenance treatment or not entering treatment. Methods: The 417 participants included 132 individuals entering short-term BT, 191 individuals entering methadone maintenance, and 94 individuals not seeking treatment. Participants were administered an Attitudes toward Methadone scale and its companion Attitudes toward Buprenorphine scale. Demographic characteristics for the three groups were compared using χ2 tests of independence and one-way analysis of variance. A repeated-measures multivariate analysis of variance with planned contrasts was used to compare mean attitude scores among the groups. Results: Participants entering BT had significantly more positive attitudes toward buprenorphine than toward methadone (p < .001) and more positive attitudes toward BT than methadone-treatment (MT) participants and out-of-treatment (OT) participants (p < .001). In addition, BT participants had less positive attitudes toward methadone than participants entering MT (p < .001). Conclusions: Participants had a clear preference for a particular medication. Offering a choice of medications to OT individuals might enhance their likelihood of entering treatment. Treatment programs should offer a choice of medications when possible to new patients, and future comparative effectiveness research should incorporate patient preferences into clinical trials. Scientific Significance: These data contribute to our understanding of why people seek or do not seek effective pharmacotherapy for opioid addiction.

Alcohol Outcome Expectancies and Regrettable Drinking-Related Social Behaviors

AIMS Research has shown that alcohol outcome expectancies are predictive of heavy alcohol consumption, which can lead to risky behavior. The purpose of the present study was to assess the incidence of various low-risk social behaviors while drinking among college students. Such social behaviors may later be regretted (referred to as regrettable social behaviors) and include electronic and in-person communications. METHODS College students (N = 236) completed measures of alcohol outcome expectancies and regrettable social behaviors. RESULTS Regrettable social behaviors were reported by 66.1% of participants, suggesting that they may occur at a much higher rate than more serious drinking-related consequences (e.g., drinking and driving, violence, etc.). Expectancies for social facilitation predicted regrettable social behavior. Further, this relationship was mediated by amount of alcohol consumed. CONCLUSION Given the high incidence, regrettable social behaviors may be effective targets in alcohol prevention programming.

Impulsivity links reward and threat sensitivities to substance use: a functional model

This study used structural equations modeling and undergraduate student data to examine the effects of reward and threat sensitivities on substance use, along with the extent to which impulsivity explained these effects. Our results suggest that impulsivity may translate inversely related reward and threat sensitivities into substance use, completely mediate the effect between threat sensitivity and substance use, and partially mediate the effect between reward sensitivity and substance use. Our results also suggest that individuals with a combination of higher levels on both reward and threat sensitivities may be most impulsive and vulnerable to heightened substance use. We discuss implications for research at the interface of personality and substance use and also substance abuse prevention and treatment.

Effects of Gender and Motivations on Perceptions of Nonmedical Use of Prescription Stimulants

Abstract Objective: This study examined the impact on college students’ perceptions of nonmedical use of prescription stimulants (NMUPS) of motivation for use and gender. Participants: Participants were college students (N = 695) from 2 universities in different regions of the United States. Methods: Participants read a vignette describing a college student who used a prescription stimulant for a nonmedical purpose and rated their perception of that individual using a semantic differential. A 2 (participant gender) by 2 (gender of the individual described in the vignette) by 3 (motive for use: get high, study, lose weight) design was used. Results: The male who used a stimulant to study was rated significantly less negatively than if he used the stimulant to get high. NMUPS as a study aid was viewed the least negatively overall. Conclusions: Findings suggest that gender does not, whereas motivation for use does, impact students’ perceptions of NMUPS.