Yih-Ing Hser

Drug Treatment Outcomes for Adolescents with Comorbid Mental and Substance Use Disorders

This study compared the pretreatment characteristics and posttreatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcome Studies for Adolescents. Subjects (N = 992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders.

Sex Differences in Addict Careers. 4. Treatment

Comparisons of behaviors during treatment were made between a sample of women and a sample of men methadone maintenance clients. Women in this study exhibited high motivation for treatment. Overall, however, small differences were found between the sexes with respect to treatment process and outcome measures. The observed differences that were significant included use of substances other than heroin, interpersonal relationships, drug dealing, employment, and criminal behaviors. The differences seemed to be in accordance with traditional sex role expectations. The distinctive behavior pattern of Chicanas demonstrated in this study demands special attention. It is suggested that treatment programs should incorporate more services to meet women-specific needs.

Drug Treatment Careers A Conceptual Framework and Existing Research Findings

While outcomes for any single intervention are important to determine, the long term evaluation of multiple, sequential interventions is at least equally important. One strategy for examining this process is that of the treatment career. A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transitions in the course of, drug dependence and its treatment. After presenting an overview of the treatment careers perspective, this paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short durations of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. The treatment careers perspective provides a useful framework within which findings on drug treatment can be better integrated and critical issues can be identified for further research, leading to a better understanding of drug dependence and its treatment.

The life course perspective on drug use: a conceptual framework for understanding drug use trajectories.

This article discusses the life course perspective on drug use, including conceptual and analytic issues involved in developing the life course framework to explain how drug use trajectories develop during an individuals lifetime and how this knowledge can guide new research and approaches to management of drug dependence. Central concepts include trajectories marked by transitions and social capital and turning points influencing changes. The life course perspective offers an organizing framework for classifying varying drug use trajectories, identifying critical events and factors contributing to the persistence or change in drug use, analytically ordering events that occur during the life span, and determining contributory relationships.

Predicting Drug Treatment Entry Among Treatment-Seeking Individuals

This study examined factors related to drug treatment program entry among 276 drug abusers seeking treatment referral. Six-month follow-up interviews determined that 171 (62.0%) followed through with the treatment referral. The analyses indicated that treatment-entry and non-entry subjects did not differ in predisposing factors (age, gender, race/ethnicity, education), type of drug use, or years of use. A logistic regression analysis indicated that characteristics at baseline predicting subsequent treatment entry include legal pressure, lower levels of psychological distress and family or social problems, and prior successful treatment experience. Legal coercion was an effective factor promoting treatment entry. Drug abusers having prior successful treatment experience were also more likely to reenter treatment. However, those with more severe problems (drug related and others) seemed less likely to enter treatment, indicating that psychological distress and family problems may undermine motivation to follow through on treatment referral.

Reliability and Validity of Retrospective Behavioral Self-Report by Narcotics Addicts.

Issues related to the reliability and validity of self-reported behavior within a deviant population are examined using data obtained from narcotics addicts in two face-to-face interviews conducted 10 years apart. The same measures of behavioral self-report for an overlapping period of 4-5 years were collected at each interview and were analyzed within a test-retest design. Agreement between measures obtained at the two recall points was reasonably good except for low-frequency behaviors and for measures of income and monetary costs. The correlation coefficients of the intervariable relationships measured at each interview increased as the constituent item reliabilities increased. Urinalyses conducted at each interview generally validated recent self-reported narcotics use.

Sex Differences in Addict Careers. 3. Addiction

The process and correlates of addiction prior to treatment are examined for a sample of 546 women and men methadone maintenance clients. Narcotic addiction careers for women (defined both as from first daily use to first treatment intervention, and from first daily use to last daily use of heroin) were shorter than those for men, and women entered treatment earlier. However, the narcotic drug use patterns for women were not substantially different from those for men (including mean percentage of time using, number of times abstinent, number of relapses, and so forth). Narcotics use for many women was influenced by a spouse or partner, but some also reported increased use for hedonistic reasons. Criminal behaviors increased for both women and men after addiction, and the major sex difference was the type of crime committed. Differences for women and men for employment, welfare, and interpersonal relationships reflected patterns found in the larger society.

Drug Abuse Treatment

Illicit drug use has had profound economic and cultural effects on American society, contributing to sharp increases in the crime rate, accelerating the spread of AIDS, and diverting some minority groups from the economic mainstream. The primary response of government agencies has been increased effort to reduce crime rates by preventing the spread of drug use to uninitiated populations and interdicting the flow of drugs into the United States.1–3 Such approaches have been both costly and limited in effect, however,4 and alternatives, especially reducing demand for drugs by treating drug addicts, are increasingly promoted. A growing body of evidence indicates that demand reduction efforts directed toward those seriously involved represents a far more cost-effective method for reducing drug use, the user’s criminal activities, and the resulting burden on society.5–11

Prior treatment experience related to process and outcomes in DATOS

Using data collected from cocaine-abusing patients who participated in the Drug Abuse Treatment Outcome Studies (DATOS), we contrasted patients in treatment for the first time and patients having extensive histories of prior treatment to identify factors associated with better outcomes in each group. Compared with first-timers, treatment-experienced patients had less favorable post-treatment outcomes. Indicators of early engagement in DATOS treatment predicted post-treatment abstinence for both groups. Importantly, the interaction of treatment history and several process measures affected post-treatment abstinence. For example, individual counseling and program compliance had greater impacts on abstinence among treatment repeaters in outpatient drug-free programs than for first-timers. Social support and environmental context were significantly related to abstinence. These findings confirm the importance of considering treatment process and aftercare in developing and implementing strategies to optimize treatment for patients with different treatment histories.

Treatment Retention among Patients Randomized to Buprenorphine/Naloxone Compared to Methadone in A Multi-site Trial

AIMS To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence. DESIGN, SETTINGS AND PARTICIPANTS This secondary analysis included 1267 opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks. MEASUREMENTS The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24-week trial. FINDINGS The treatment completion rate was 74% for MET versus 46% for BUP (P < 0.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60 mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30-32 mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.52-0.76, P < 0.01] among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (i) BUP [versus MET, hazard ratio (HR) = 1.61, CI = 1.20-2.15], (ii) lower medication dose (<16 mg for BUP, <60 mg for MET; HR = 3.09, CI = 2.19-4.37), (iii) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (iv) being younger, Hispanic and using heroin or other substances during treatment. CONCLUSIONS Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids.