Shauna P. Acquavita

Utilization of communication technology by patients enrolled in substance abuse treatment

BACKGROUND Technology-based applications represent a promising method for providing efficacious, widely available interventions to substance abuse treatment patients. However, limited access to communication technology (i.e., mobile phones, computers, internet, and e-mail) could significantly impact the feasibility of these efforts, and little is known regarding technology utilization in substance abusing populations. METHODS A survey was conducted to characterize utilization of communication technology in 266 urban, substance abuse treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy clinics. RESULTS Survey participants averaged 41 years of age and 57% had a yearly household income of less than

Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities☆ , ☆☆ ,★,★★

15,000. The vast majority reported access to a mobile phone (91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and yearly mobile contract was higher for White participants, and also for those with higher education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer use was much lower (39-45%), with younger age, higher education and income predicting greater use. No such differences existed for the use of mobile phones however. CONCLUSIONS Concern regarding the digital divide for marginalized populations appears to be disappearing with respect to mobile phones, but still exists for computer, internet, and e-mail access and use. Results suggest that mobile phone and texting applications may be feasibly applied for use in program-client interactions in substance abuse treatment. Careful consideration should be given to frequent phone number changes, access to technology, and motivation to engage with communication technology for treatment purposes.

A comparison of cigarette smoking profiles in opioid-dependent pregnant patients receiving methadone or buprenorphine

The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.

Interprofessional Leadership Training in MCH Social Work

INTRODUCTION Little is known about the relationship between cigarette smoking and agonist treatment in opioid-dependent pregnant patients. The objective of this study is to examine the extent to which cigarette smoking profiles differentially changed during the course of pregnancy in opioid-dependent patients receiving either double-blind methadone or buprenorphine. Patients were participants in the international, randomized controlled Maternal Opioid Treatment: Human Experimental Research (MOTHER) study. METHODS A sample of opioid-maintained pregnant patients (18-41 years old) with available smoking data who completed a multisite, double-blind, double-dummy, randomized controlled trial of methadone (n = 67) and buprenorphine (n = 57) between 2005 and 2008. Participants were compared on smoking variables based on opioid agonist treatment condition. RESULTS Overall, 95% of the sample reported cigarette smoking at treatment entry. Participants in the two medication conditions were similar on pretreatment characteristics including smoking rates and daily cigarette amounts. Over the course of the pregnancy, no meaningful changes in cigarette smoking were observed for either medication condition. The fitted difference in change in adjusted cigarettes per day between the two conditions was small and nonsignificant (β = -0.08, SE = 0.05, p = .132). CONCLUSIONS Results support high rates of smoking with little change during pregnancy among opioid-dependent patients, regardless of the type of agonist medication received. These findings are consistent with evidence that suggests nicotine effects, and interactions may be similar for buprenorphine compared with methadone. The outcomes further highlight that aggressive efforts are needed to reduce/eliminate smoking in opioid-dependent pregnant women.

Pay-for-performance in a community substance abuse clinic

The need to train health social workers to practice interprofessionally is an essential goal of social work education. Although most health social workers have exposure to multidisciplinary practice within their field work, few social work education programs incorporate interprofessional learning as an integrated component of both course work and field experiences (McPherson, Headrick, & Moss, 2001; Reeves, Lewin, Espin, & Zwaranstein, 2010; Weinstein, Whittington, & Leiba, 2003). In addition, little is written about the kinds of curricula that would effectively promote interdisciplinary training for social work students. These findings are particularly puzzling since there is increasing and compelling evidence that interdisciplinary training improves health outcomes (IOM, 2001). This article describes a social work education program that incorporates an Interprofessional education and leadership curriculum for Maternal and Child Health Social Work (MCHSW) at the University of Marylands School of Social Work. The University of Marylands Interprofesisonal Training Model is described along with the components needed to formulate an interdisciplinary learning experience. Various outcomes and lessons learned are discussed.

Environmental Tobacco Smoke Exposure among Smokers and Non-smokers Receiving Outpatient Substance Abuse Treatment

Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients and on the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in the 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention.

Cigarette smoking and neonatal outcomes in depressed and nondepressed opioid-dependent agonist-maintained pregnant patients

INTRODUCTION Environmental Tobacco Smoke (ETS) has been linked to numerous health problems. While research has demonstrated high prevalence of tobacco use among individuals receiving treatment for substance use disorders (SUDs), no studies have examined ETS among individuals receiving treatment for SUDs, paying specific attention to non-smokers who may be at risk for high exposure to ETS. METHODS Participants (N=261) enrolled in outpatient substance abuse treatment completed a survey, in which 14 items were used to quantify ETS exposure and smoking policies across several environments. RESULTS Among smokers, 85% reported that their significant others also smoked as compared to 15% among non-smokers (χ(2)=6.624, p<.05). A logistic regression examined the characteristics that predicted smoking in the home. The overall model was significant, (χ(2)=36.046, p<.0005) with variables that independently predicted smoking in the home included having less than a high school diploma, being female, and living with a smoker. Income, age, and living with children were not found to be significant. Overall, 42% white collar workers 26% of service workers and 30% of blue collar workers reported no exposure to ETS. Sixty-seven percent of smokers strongly agreed or agreed that the hazards of secondhand smoke have been clearly demonstrated versus 58% of non-smokers. CONCLUSIONS Smokers and non-smokers enrolled in outpatient substance abuse treatment are frequently exposed to ETS at home, work, and in social settings. The dangers of ETS should be addressed among this population through education, smoke-free policies, and cessation resources, with help from their treatment facility.

Client incentives versus contracting and staff incentives: How care continuity interventions in substance abuse treatment can improve residential to outpatient transition

AimTo investigate whether cigarette smoking and/or depression contribute to neonatal abstinence syndrome (NAS) severity. DesignCohort study analyzing data from a randomized controlled trial of methadone versus buprenorphine. SettingSeven study sites that randomized patients to study conditions and provided comprehensive addiction treatment to pregnant patients. ParticipantsA total of 119 of 131 opioid-dependent pregnant patients who completed the MOTHER study. MeasurementsSmoking data and depression status were obtained from the Addiction Severity Index and Mini International Neuropsychiatric Interview, respectively. Neonatal outcomes (birth weight, preterm delivery, and NAS pharmacologic treatment) were collected from the medical charts. Study site was a fixed-effect factor in all analyses. FindingsCigarette smoking was reported by 94% of participants and depression identified in 35%. Smoking was associated with low birth weight, preterm delivery, and NAS pharmacologic treatment in both depressed and nondepressed participants. The association between smoking and NAS treatment differed significantly between depressed and nondepressed participants. Among nondepressed participants, adjusting for site and illicit drug use, each additional average cigarette per day (CPD) increased the odds of NAS treatment by 12% (95% confidence interval: 1.02-1.23; P=0.02). Among depressed participants, each additional average CPD did not statistically increase the odds of NAS treatment (odds ratio: 0.94; 95% confidence interval: 0.84-1.04; P=0.23). ConclusionsThese results are consistent with the hypothesis that NAS expression is influenced by many factors. The relationship between CPD and NAS pharmacologic treatment is attenuated among depressed women in this study for reasons currently unknown. Further investigations are needed to clarify the complex relationships among maternal smoking, depression, and NAS.

Facilitators and Barriers to Cigarette Smoking While Pregnant for Women With Substance Use Disorders

Interventions for improving transition from short-term residential to outpatient treatment were examined. Usual care (UC; n=114) was referral to a preferred outpatient program with advance appointment optional. Client incentive (CI; n=97) offered up to

A mixed-methods study of smoking attitudes and behaviors among dual-smoker stroke survivor–caregiver dyads

100 in gift cards for intake and attendance during the first 30days of treatment. Contracting with staff incentives (CSI; n=49) consisted of meeting with an outpatient counselor prior to residential discharge, signing an attendance contract, receiving an appointment and payment to staff if clients attended. CSI significantly improved rates of successful transition (84%) and admission (74%) compared to UC (64% contact; 49% admitted). CI did not result in significantly improved outcomes (74%; 60%). CSI was likely mediated by the reliability (92 versus 52% in UC) and immediacy (1.0 versus 3.9days) of appointment scheduling. This study supports use of CSI for improving rates of transition between residential and outpatient continuing care treatment.