Little is empirically known about clinical supervision in addiction treatment. This study describes multiple domains of clinical supervision in addiction treatment from the perspectives of clinical supervisors and their counselors. Survey data were obtained from 484 matched clinical supervisor-counselor dyads working in diverse addiction treatment programs across the U.S. Supervisors report wide-ranging experience and training in supervision. Counselors’ generally perceive their supervisors’ job performance as effective. Supervisors and their counselors largely differ in their perceptions of supervision practices with supervisors reporting greater supervision given and their counselors reporting less supervision received. Implications are discussed.
clinical supervision; addiction counselors; job performance; supervisor-counselor dyad
The purpose of this study was to advance our understanding of nonmedical use of prescription medications by identifying distinguishing characteristics of two subtypes of adolescent nonmedical users of prescription opioids described by Boyd and McCabe1. A web-based, self-administered survey was completed by 2,597 7th – 12th grade students. Sensation seeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self treating users were best characterized by somatic complaints, anxiety/depressive symptoms, and history of sexual victimization.
prescription opioids; motives; adolescents; substance abuse; problem behaviors
Research suggests that Attention Deficit Hyperactivity Disorder (ADHD) and nicotine withdrawal symptoms are related; however, it is unknown how this relationship extends across ADHD symptom gradations, differs between inattention and hyperactivity-impulsivity symptom types, and generalizes to a national sample. This study examined cross-sectional associations between childhood ADHD symptom indexes (total, inattention, and hyperactivity-impulsivity) and lifetime DSM-IV nicotine withdrawal symptoms. Results showed that each ADHD symptom index associated with almost every withdrawal symptom (Ps < .01). After controlling for hyperactivity-impulsivity and inattention symptom overlap, inattention (but not hyperactivity-impulsivity) retained incremental associations with most withdrawal symptoms. These findings are relevant for understanding mechanisms of ADHD and smoking comorbidity.
Inattention; hyperactivity-impulsivity; smoking; relapse prevention; comorbidity
Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to HIV, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication assisted detoxification. This article provides a topical review of the three medications approved by the FDA for long-term treatment of opiate dependence: the opioid agonist methadone, the opioid partial agonist buprenorphine, and the opioid antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise. While no direct comparisons between extended release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared to methadone and buprenorphine. Further work is needed to compare directly each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.
Review; opiate; addiction; methadone; buprenorphine; naltrexone; pharmacotherapy
As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually-diagnosed clients to 12-step groups. This study examined the relationships among clinicians’ 12-step experiences, attitudes and referral practices in 6 NYC mental health clinics. A path analysis model showed that greater interest in learning about 12-step (12-step interest) directly predicted 12-step referral practices and that 12-step interest was predicted both by clinicians’ perception of the helpfulness of 12-Step groups and the severity of their patients’ problems with substance abuse. Clinicians’ responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-step groups.
12-step; referrals; dual-diagnosis; mental health; clinician; mutual-aid
Technology such as the Internet and mobile phones offers considerable promise for affecting the assessment, prevention, and treatment of and recovery from substance use disorders. Technology may enable entirely new models of behavioral health care within and outside of formal systems of care. This article reviews the promise of technology-based therapeutic tools for affecting the quality and reach of addiction treatment and recovery support systems, as well as the empirical support to date for this approach. Potential models for implementing technology-based interventions targeting substance use disorders are described. Opportunities to optimize the effectiveness and impact of technology-based interventions targeting addiction and recovery, along with outstanding research needs, are discussed.
Technology; mobile health; computer; substance abuse treatment; recovery
The aim of this pilot study was to assess the effectiveness of buprenorphine among marginalized opioid dependent individuals in terms of retention in and cycling in and out of a harm-reduction program. This pilot study enrolled 100 participants and followed them from November 2005 to July 2008. The overall proportion of patients retained in the program at the end of 3, 6, 9, and 12 months was 68%, 63%, 56%, and 42%, respectively. This pilot study demonstrated that buprenorphine could be successfully used to treat marginalized heroin users.
To assess whether adolescent marijuana exposure represents a modifiable predictor of adult STI risk, we used nationally-representative, longitudinal data from Waves I (1994–1995, adolescence) and III (2001–2002, adulthood) of the National Longitudinal Study of Adolescent Health (N=10,738) to examine racial/gender differences in associations between adolescent marijuana use, current use, and peer use and adulthood multiple partnerships, self-reported STI, and biologically-confirmed STI. Adulthood STI risk was predicted by adolescent marijuana use in all groups except Black females, and by peer marijuana use among Black males. Adolescents who use marijuana, or who have friends who use, constitute priority populations for STI prevention.
Marijuana; Sexually Transmitted Infections; Race/Ethnicity; Adolescence; Young Adulthood
The current study investigated whether emotion dysregulation (ED; difficulties in the self-regulation of affective states) mediated relations between anxiety sensitivity (AS; fear of anxiety and related sensations) and cognitive-based smoking processes.
Participants (n = 197; 57.5% male; Mage = 38.0) were daily smokers recruited as part of a randomized control trial for smoking cessation.
AS was uniquely associated with all smoking processes. Moreover, ED significantly mediated relations between AS and the smoking processes.
Findings suggest that ED is an important construct to consider in relations between AS and cognitive-based smoking processes among adult treatment-seeking smokers.
Anxiety Sensitivity; Smoking; Emotion Dysregulation; Expectancies
The United States has experienced the most severe economic crisis since the Great Depression. This paper presents an instrument (Life Change Consequences of the Great Recession; LCCGR) depicting work and personal life-related stressors reflecting the enduring effects of the Great Recession. A national sample of 663 respondents completed a mail survey including this instrument and measures of drinking outcomes. Multiple regression analyses addressed the links between the LCCGR and drinking. Economy-related stressors manifested significant effects on both male and female consumptions patterns, but most LCCGR subscales were more clearly related to problematic drinking patterns in males compared to females.
Economy-related social stressors; alcohol use and problem-related drinking; epidemiology
Although sleep has been extensively studied in substance related disorders, it has yet to be examined as thoroughly in gambling-related disorders. The purpose of this study is to examine the relationship between gambling severity and sleep disturbances in a sample of non-treatment seeking gamblers (N = 96) using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Mean ESS scores for recreational, problem, and pathological gamblers were 4.13, 5.81, and 8.69, respectively, with a significant difference between pathological gamblers and both problem (P = .007) and recreational gamblers (P < .001). Mean PSQI scores for recreational, problem, and pathological gamblers were 3.35, 5.30, and 5.44, respectively, with a significant difference in sleep quality between recreational and problem gamblers (P = .018), as well as recreational and pathological gamblers (P = .008). As the first study to use objective sleep measures, these findings will not only increase awareness of this relationship, but also provide a foundation on which others can investigate the benefits of screening and adjunct treatment for sleep disorders in the gambling population.
Gambling; sleep; insomnia; daytime sleepiness; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale
To compare the progression of substance use milestones between cocaine- and cannabis-dependent patients.
Using data gathered from two separate clinical studies for treatment of cocaine dependence and cannabis dependence, 130 cannabis-dependent and 112 cocaine-dependent individuals were compared on milestones related to their substance use.
In cannabis- vs. cocaine-dependent patients, the mean age of first use, regular use and first treatment contact differed significantly. No statistically significant differences were found between the two groups for other measured milestones.
These results differ from most epidemiologic studies that suggest cocaine users progress more rapidly to regular use and treatment contact.
Cocaine dependence; marijuana dependence; substance abuse milestones
Route of administration is an important contributor to the adverse health consequences of prescription medication abuse. The present study examines characteristics associated with non-oral routes of administration among a large sample of prescription opioid abusers, and explores needle related
HIV risk behaviors as well. 791 opioid abusers completed a one-time, structured interview including complete histories of illicit and prescription drug abuse, and route of drug administration. The most common method of pill use was oral (91%), followed by intranasal (53.1%), injection (23.8%), and smoking (14.5%). The youngest prescription opioid abusers, ages 18–24, displayed significantly higher odds of employing alternate route of administration, and also of re-using nonsterile needles for injection. HIV prevention programming should be developed for young prescription opioid injectors.
prescription opioid abuse; route of administration; HIV
In the current paper, we explore the efficacy of a four-hour self-forgiveness intervention. Participants (N = 79) undergoing a routine alcohol treatment protocol were randomly assigned to an intervention or treatment as usual condition. Those in the intervention condition completed the self-forgiveness intervention. All participants completed measures of self-forgiveness, drinking refusal self-efficacy, guilt and shame over an alcohol related transgression. Participants in the intervention condition reported more positive gains on measures of self-forgiveness and drinking refusal efficacy as well as guilt and shame related to alcohol-related offenses. Implications of the self-forgiveness intervention for alcohol misusing populations are discussed.
Self-Forgiveness; Alcohol; Guilt; Shame; Self-Efficacy
To measure substance use across racial and ethnic subgroups of HIV-positive men who have sex with men (MSM), model associations between drug use and unsafe sex, and characterize users of the substances most strongly associated with risky sexual behavior.
Cross-sectional survey at the pre-intervention time point of the Positive Connections behavioral intervention trial.
HIV-positive men of color who have sex with men living in six US cities.
675 trial participants.
Self-reported drug and alcohol use and sexual behaviors.
We found high prevalence of substance use in this sample, with differences across racial and ethnic groups. Compared to Hispanic, African America, and men of other or mixed races/ethnicities, Caucasian men were most likely to report use of stimulants (30%), methamphetamines (27%), and amyl nitrite inhalants (“poppers”, 46%) with anal sex. African American men reported crack/cocaine use in the highest proportion (38%) among the four groups. While many drugs were individually associated with serodiscordant unprotected anal intercourse (SDUAI), only alcohol quantity and poppers with sex were retained in a multivariate model. More frequent poppers use was associated with more reported instances of SDUAI, adjusted for increased anal sex. Men who used poppers were more likely to be white, have completed more education, and have slightly higher income than non-users. Poppers users also reported lower peer norms and self-efficacy for condom use. In a multiple logistic regression model including these psychosocial factors, only poppers use (vs non-use OR = 2.46, CI: 1.55, 3.94) and condom self-efficacy (1 sd increase on scale OR = .58, CI: .46, .73) were significantly associated with SDUAI.
These results, from a large sample of HIV-positive MSM of color, highlight the HIV transmission importance of drugs used specifically in conjunction with sex.
Homosexuality; Male; Street Drugs; HIV Seropositivity; Sexual Behavior
Employment is a key functioning index in addiction services and consistently emerges as a goal among persons in recovery. Research on employment in the addictions has focused on treatment populations and/or welfare recipients; little is known of employment rates or their predictors among persons in recovery. This study seeks to fill this gap, capitalizing on a sample (N = 311) of urban individuals at various stages of recovery. Fewer than half (44.5%) were employed; in logistic regressions, male gender and Caucasian race enhanced the odds of employment whereas having a comorbid chronic physical and/or mental health condition halved the odds. Implications center on the need to identify effective strategies to enhance employability among women and minorities, and for integrated care for persons with multiple chronic conditions.
Recovery; employment; functioning; substance use disorder; addiction
The purpose of this study was to examine the prevalence and correlates of prescription drug misuse among young, low-income women seeking care at a public clinic in Texas. Collected data on 2976 women included frequency of use, demographic and reproductive characteristics, religiosity, smoking history, concurrent substance use, depressive symptoms, perceived stress, health beliefs, and exposure to traumatic events. Overall, 30% reported ever misusing a prescription drug; 15% reported misuse in the past year. Women who initiated sexual intercourse at <15 yo, used illicit drugs, and smoked everyday were more likely to have misused prescription drugs. Higher trauma, stress, and posttraumatic stress scores also were associated with ever misusing prescription drugs. This study adds to limited data available on medication misuse by young women with few resources and demonstrates needs for prevention efforts in public clinics.
This study examined the impact of emotion on opiate withdrawal induced hyperalgesia to determine whether emotional states modulate the magnitude of hyperalgesia. One hundred Hispanic males were recruited into one of three groups: heroin withdrawal, long-term heroin abstinence, and controls. Participants were presented with pictures to induce neutral, positive and negative emotional states. Affective valence, arousal, pain threshold and tolerance to ischemic pain were measured. When pain threshold and tolerance were compared, the withdrawal group displayed significant heightened pain sensitivity when negative affect was induced. We also found that former heroin addicts showed heightened pain sensitivity following months of abstinence.
Emotion; Hyperalgesia; Opiates; Pain Modulation; Withdrawal
Research examining the demographic and substance use characteristics of illicit drug use in the United States has typically failed to consider differences in routes of administration, or has exclusively focused on a single route of administration--Injection Drug Use (IDU). Therefore, a significant gap exists in our understanding of the degree to which IDUs are different from those who use illicit drugs via other routes, such as oral, inhalation, or smoked (non-IDUs). Data from the 2005–2007 National Survey on Drug Use and Health (NSDUH) were used to compare past-year IDU and non-IDU routes of administration for people who use the three drugs most commonly injected drugs in the US: heroin, methamphetamine, and cocaine. Among past-year users, IDUs were more likely than those using via other routes to be older (aged 35+), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared to methamphetamine or cocaine users. These results highlight significant differences in demographics, clinical/psychological manifestations, and treatment needs of injection drug users compared to those engaging in other routes of administration.
Injection drug use; cocaine; methamphetamine; heroin; routes of administration; epidemiology
While harassment in the workplace has been linked to deleterious drinking outcomes, researchers have yet to examine the long-term effects of chronic workplace harassment. During a ten year longitudinal mail survey, university employees (N = 2265) were administered measures of sexual harassment, generalized workplace harassment, and problematic drinking. Using growth mixture modeling, two latent classes of workplace harassment emerged: infrequent and chronic. Demographic characteristics (gender, age, and race) predicted the shape of the trajectories and likelihood of class membership. As hypothesized, membership in the chronic harassment classes was linked to future problematic drinking, even after controlling for previous drinking.
problem drinking; workplace harassment; growth mixture modeling
It is unknown if infection with hepatitis C virus (HCV) is a risk factor for pain among persons who have used injection drugs (IDU). Multivariate regression was used to determine whether HCV was associated with greater likelihood of reporting significant chronic pain and discomfort intolerance in a cohort of 97 opioid dependent IDU. Study results suggest that participants with HCV may be more likely to suffer chronic pain (aOR=1.98; 95% CI: 0.76 to 5.12, p=0.16). Furthermore, HCV was found to be associated with a higher discomfort intolerance scale score, reflecting intolerance to physical discomfort (β=2.34; 95% CI: 0.06 to 4.62, p=0.04). Infection with HCV may be an overlooked cause for chronic pain and discomfort intolerance among opioid dependent IDU.
Hepatitis C virus; injection drug use; chronic pain; pain hypersensitivity
We sought to identify barriers to offering services for HIV/AIDS, hepatitis C virus, and sexually transmitted infections in substance abuse treatment programs. We surveyed treatment program administrators and clinicians within the National Drug Abuse Treatment Clinical Trials Network to evaluate the availability of medical and non-medical services for patients with or at risk for acquiring these infections. A substantial proportion of programs do not offer services (particularly medical services) for these infections. The most commonly cited barriers were funding, health insurance benefits, patient acceptance, and staff training. The findings highlight a missed opportunity to positively impact these infectious disease epidemics.
HIV/AIDS; hepatitis C virus; sexually transmitted infections; drug abuse; barriers
To determine if the addition of a behavioral intervention during alcohol detoxification would facilitate initiation of subsequent care, we randomized 150 detoxification patients to receive: treatment as usual (TAU), a Motivation Enhancement Therapy (MET) intervention, or a Peer-delivered Twelve Step Facilitation (P-TSF) intervention. The main outcome was the initiation of any type of subsequent care (i.e., professional treatment or self-help) within 30 and 90 days of discharge. Other outcomes included: alcohol and drug use, completion of subsequent professional treatment, and readmission for detoxification. The mean age of the participants was 45 years; 65% were men, and 84% were white. At the 30-day follow-up, there was no significant difference among the groups in the rate of initiation of any type of subsequent care (82%, 74%, and 82% respectively, p = 0.617); however, the MET group had significantly more patients initiate subsequent inpatient treatment by the 90-day follow-up compared to the P-TSF group (31% and 61%, p = 0.007) and a greater proportion of MET participants completed subsequent inpatient treatment compared to both TAU and P-TSF. There were no differences in drinking-related outcomes (e.g., number of days before first drink, percent days abstinent) between the groups. We conclude that MET during detoxification may provide additional benefits in terms of initiating and maintaining patients in aftercare inpatient treatment programs.
alcoholism; detoxification; interventions; therapeutics; outcome assessment
Few studies follow the lives of opiate-addicted parents. We examine a 12-year follow-up of 144 parents in methadone treatment and their 3- to 14-year-old children. Parent mortality was high. Among survivors, drug use and treatment, incarceration, residential and family disruptions, and health problems were common. Moderate and long-term recovery were associated with consistent methadone treatment, further education, employment, and fewer relationship disruptions. Earlier depression, deviant friends, and poor coping skills predicted continued drug problems. Thus, interventions should include treatment for depression and build skills for avoiding and refusing drugs, coping with stress, and maintaining recovery-supportive friendships.
opiates; family; long-term follow-up; longitudinal