Disorders - Substance Use Disorders
Cather, C., Brunette, M. F., Mueser, K. T., Babbin, S. F., Rosenheck, R., Correll, C. U., Kalos-Meyer, P.
Lifetime co-occurring substance use disorders are common at the time of presentation for treatment of a first episode of primary psychosis and persistent substance use disorder (SUD) leads to poorer outcomes. We assessed whether the NAVIGATE program, a coordinated specialty care service that includes optional substance abuse content reduced substance use compared to usual care in 404 individuals in the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study.
Psychiatry Research, 268 : 303-311
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
Simonton, A. J., Young, C. C., Johnson, K. E.
BACKGROUND: Adolescent substance use, a major problem in the United States, has a significant negative effect on both short- and long-term mental and physical health. Physical activity (PA) may offer potentially effective strategies to combat substance use in youth. Like substance use, PA behaviors developed during adolescence persist into adulthood, so adolescence may be an ideal period in which to implement PA interventions to prevent substance abuse. However, there are no known systematic literature reviews of PA-based interventions that target substance use in adolescence. OBJECTIVE(S): To review PA interventions for adolescents, including research designs, intervention characteristics, and measures of substance use. METHOD(S): Five databases were searched for articles published in English peer-reviewed journals. Search terms were related to the adolescent population, substance use, and PA interventions. RESULT(S): 17 articles fit inclusion criteria. The results suggest that PA interventions may decrease substance use in teens. A majority of the interventions were delivered in high schools. Substance use measures/outcomes included intention or willingness to use, cessation, and actual use. Alcohol use was measured most, followed by marijuana and tobacco use. Although most of the studies utilized group sessions to deliver interventions, decreased substance use was also associated with one-time, multi-health consultations. Conclusions/Importance: School-based interventions targeting multiple health behaviors may offer a particularly effective and efficient way to decrease substance use in adolescents.
Substance use & misuse, 53(12) : 2052-2068
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Garner, B. R., Lwin, A. K., Strickler, G. K., Hunter, B. D., Shepard, D. S.
BACKGROUND: Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs).
METHODS: Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes.
RESULTS: At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171).
CONCLUSION: This study provides experimental evidence supporting P4P as a cost-effective implementation strategy.
Trial registration: nct01016704 .
Implementation Science, 13(1) : 92
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Burrow-Sanchez, J. J., Hops, H.
Objectives: Latina/o adolescents are at particular risk for substance use disorders (SUDs) and effective treatments are needed. Some critics indicate that standard evidence-based treatments may not meet the needs of Latina/o adolescents and culturally accommodated treatments are needed; however, few comparative studies have been conducted to test this assumption. This randomized trial was designed to test a standard group-based version of a cognitive- behavioral treatment (S-CBT) against its culturally accommodated equivalent (A-CBT) for a sample of Latina/o adolescents with SUDs. Method(s): Seventy Latina/o adolescents were randomly assigned to 1 of 2 treatment conditions and followed over 4 posttreatment time points with the last at 12-months. Generalized longitudinal mixed models for count data were conducted to evaluate treatment differences across time for adolescent substance use. The cultural variables ethnic identity, acculturation, and familism were included in the analysis as potential moderators of treatment outcome. Result(s): A significant difference was found at the 12-month follow-up in favor of the culturally accommodated treatment (d = .92, 95% confidence interval, CI [.43, 1.42]) and parental familism moderated treatment outcome (d = .60, 95% CI [.12, 1.08]). Conclusion(s): This is one of the first studies to demonstrate that a culturally accommodated treatment differentially improved outcomes compared with that of its standard equivalent for a sample of Latina/o adolescents with SUDs. Copyright © 2018 American Psychological Association.
Cultural Diversity and Ethnic Minority Psychology., 25(3) : 311-322
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Tancred, T., Paparini, S., Melendez-Torres, G. J., Thomas, J., Fletcher, A., Campbell, R., Bonell, C.
BACKGROUND: Schools can play an important role in promoting health. However, many education policies and institutions are increasingly emphasising academic attainment targets, which appear to be diminishing the time available for health education lessons. Interventions that integrate both health and academic learning may present an ideal solution, simultaneously addressing health education and academic development. The theories of change underlying these interventions are therefore of interest, but are poorly studied.
METHODS: A systematic review of evaluations of interventions that integrate academic and health education for reduced substance use and/or violence was carried out. As part of this, reports describing theory were assessed for quality and data extracted. Theoretical data were synthesised within and across individual interventions using reciprocal translation and meta-ethnographic line of argument synthesis to produce an overall theory of change for interventions that integrate health and academic education to prevent substance use and violence.
RESULTS: Forty-eight reports provided theoretical descriptions of 18 interventions. An overarching theory that emerged was that eroding 'boundaries' at multiple and mutually reinforcing levels-by integrating academic and health education, by transforming relationships between teachers and students, by generalising learning from classrooms to the wider school environment and by ensuring consistent messages from schools and families-is intended to lead to the development of a community of engaged students oriented towards pro-social behaviour and away from substance use, violence and other risk behaviours.
CONCLUSIONS: Eroding 'boundaries' between health and academic education, teachers and students, classrooms and the wider school and schools and families were seen to be the most critical to establishing new frameworks of family, classroom or school organisation that are conducive to promoting both academic and social-emotional outcomes. Whether such interventions are feasible to implement and effective in reducing risk behaviours will be examined in other reports arising from the review.
Systematic Reviews, 7(1) : 190
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Zhang, J., Slesnick, N.
The current study identified subgroups of homeless youth and young adults that exhibited distinct co-occurring patterns of substance use and social stability (e.g., employment, school attendance, and housing), and evaluated the relative effectiveness of the Community Reinforcement Approach (CRA), Motivational Enhancement Therapy (MET), and case management (CM) in interrupting substance use and improving social stability. The differentiating effects of personal characteristics on the co-occurrence of substance use and social stability were also examined.
Psychology of Addictive Behaviors, 32(8) : 873-884
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Case management
, Other service delivery and improvement interventions
Tiburcio, M., Lara, M. A., Martinez, N., Fernandez, M., Aguilar, A.
BACKGROUND: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a greater availability of treatment is needed. OBJECTIVE(S): To evaluate the feasibility and initial effectiveness of a web-based cognitive-behavioral intervention for the reduction of substance use and depression compared with treatment as usual, with and without a printed self-help manual. METHOD(S): Individuals seeking outpatient treatment for substance use were randomly assigned to one of the following: (1) the web-based Help Program for Drug Abuse and Depression (n = 23); (2) an in-person session with an addiction therapist and use of the Alcohol, Smoking, and Substance Involvement Screening Test Self-Help Strategies guide, followed by treatment as usual (n = 25), or (3) treatment ordinarily offered in the participating treatment centers (n = 26). The study took place in 2013-2014 (trial registration: ISRCTN25429892), and participants completed baseline, posttreatment, and 1-month follow-up evaluation interviews. RESULT(S): Treatment retention and data availability were comparable in all three conditions. A reduction was observed from baseline to follow-up in average days of use [F(1,28) = 29.70, p < 0.001], severity of use [F(2,28) = 143.66, p < 0.001], and depressive symptomatology [F = (4)16.40, p < 0.001], independent of the type of treatment provided. CONCLUSION(S): The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample. Attrition was a main limitation; future studies must improve retention and assess cost-effectiveness.
Substance use & misuse, 53(13) : 2220-2231
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Bonell, C., Allen, E., Warren, E., McGowan, J., Bevilacqua, L., LeGood, R., Wiggins, M., Mathiot, A., Fletcher, A., Scott, S., Elbourne, D., Christie, D., Viner, R.
Purpose: Antisocial behaviours among youth are a public health pri-ority because of their high prevalence and harmful effects. Bullying and anti-social behaviour are associated with worse physical and mental health and poorer educational attainment. School environment interventions targeting antisocial behaviours may be an efficient way to address multiple health harms in adolescence. The INCLUSIVE intervention extends previous school environment trials by including a "restorative practice" approach, increasingly popular but never before subject to an RCT in schools. This trial assessed the ef-fectiveness and cost-effectiveness of INCLUSIVE to reduce bullying, aggressive behaviour and improve health-related behaviours. Methods: INCLUSIVE was a 3-year (2014-2017) cluster randomized controlled trial (RCT) aimed at 11-16-year-olds in 40 schools (N = 5,960 students) in England. The intervention included: a) involving students in action groups to revise school policies; b) school-wide restorative practice; and c) a social/emotional learning curriculum. Primary outcomes were bullying (Gatehouse Bullying Scale: GBS) and school aggressive behaviour (Edinburgh Study of Youth Transitions and Crime ESYTC). Secondary outcomes were: mental health (Strengths & Difficulties Questionnaire: SDQ), well-being (Short Warwick-Edinburgh Mental Wellbeing Scale: SWEMWBS), quality of life, smoking, alcohol & drug use, truancy and police contact. Recruited schools were representative of state secondary schools in England. Baseline data were collected prior to random allocation to intervention or usual practice. Institutional Review Board permissions were obtained. A process evaluation and economic evaluation were undertaken (not reported here). Statistical analysis used an intention-to-treat approach and multi-level models to account for school-level clustering. Results: All 40 schools remained in the trial. Student participation rates were >90% for each survey. Schools were comparable at baseline. At 36 months (primary outcome), intervention schools had significant reductions in bullying (GBS effect estimate-.04(-.07,-.00)p =.03) but there was no significant difference between arms in aggressive behaviours (ESYTC effect estimate-.25(-.80 to.29)p =.13), both adjusted for baseline covariates. Secondary outcomes: At 36 months intervention schools showed significant improvements in quality of life (PedsQL: 1.68 (.60,2.75)p =.002) and well-being (SWEMWBS:.44(.07,.81)p =.02) and reductions in psychological distress (SDQ:-.56(-.96,-.17)p =.005), smoking(OR =.67(.51,.87)p =.003), drunkenness (OR =.62(.48,.80)p <.001), drug use (OR =.73(.56,.95) and police contacts in past year (.78(.64,.97)p =.02). There were no effects on sexual risk or hospitalisations in past year. Conclusions: The INCLUSIVE intervention was effective at reducing bullying, improving mental health and well-being, and reducing smoking, risky alcohol use and police contacts in lower secondary-school students in England but did not reduce aggressive behaviour. Further analyses are planned to identify mechanisms by which components of the intervention had effects and identify subgroups of schools and students benefiting most. The wide range of positive outcomes suggests the intervention resulted in broad health promotion which is highly meaningful at a population level. Our findings suggest school environment interventions are an effective way of improving a wide range of health outcomes in young people. Sources of Support: National Institute of Health Research (NIHR) and Educational Endowment Foundation, UK.
Journal of Adolescent Health, 62 (2 Supplement 1) : S9
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Chang, C. C., Liao, J. Y., Huang, C. M., Hsu, H. P., Chen, C. C., Guo, J. L.
BACKGROUND: Studies indicate that adolescent-onset drug users experience a greater likelihood of dependence that continues into adulthood. The importance of early intervention was evident in treating adolescents before their substance use progressed. We examined the effectiveness of an intervention program that prevents students who experiment with drugs from reusing them.
METHODS: The study was based on 10 out of 18 invited schools that were randomly assigned to either the intervention group (5 schools, n = 43) or the comparison group (5 schools, n = 41). The intervention group received an E-course program that comprised a main intervention course (12 sessions) and a booster course (2 sessions). By reducing the burden of teaching content during the 14 sessions, the in-class counselor had opportunities for face-to-face discussions with students on their ambivalence toward quitting illegal drugs. The comparison group received the conventional didactic drug prevention course (2 sessions). Outcomes in terms of stress management, refusal skills, pros of drug use, cons of drug use, and drug use resistance self-efficacy were measured via structured questionnaires conducted thrice: at baseline, after the main intervention sessions, and after the booster sessions. A linear mixed model (LMM) was employed to investigate the effects of time and groups on the outcome variables with group, time, and group x time as fixed effects. Subjects and schools were selected as random effects in order to consider both within-subject and within-school correlations.
RESULTS: There was a significant group x time interaction with regard to stress management, refusal skills, pros of drug use, and drug use resistance self-efficacy, excluding cons of drug use. The intervention group displayed better stress management compared to the comparison group after the booster intervention. Similar between-group differences were identified in that the intervention group displayed better refusal skills and drug use resistance self-efficacy compared to that of the comparison group. The intervention group favored using drugs less (a decrease in the pros of drug use score) compared to the comparison group after the booster intervention.
CONCLUSIONS: Our program provided an example of the results of early intervention among students who experiment with illegal drugs.
Substance Abuse Treatment, Prevention, & Policy, 13(1) : 2
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Gaihre, A., Rajesh, S. K.
Background: Chronic vulnerability characterizes substance abuse disorder with consequent relapse. The process of abstinence depends on cognitive recovery. Hence, behavioral intervention should account for cognitive dimension of substance abusers. Recent studies highlight yoga-based intervention as a promising add-on therapy for treating and preventing addictive behaviors. Purpose: The study aimed to evaluate the efficacy of a yoga-based intervention as an add-on in enhancing cognitive functions, compared with physical exercise to newly admitted substance abusers seeking an inpatient treatment program. Methods: The study was a single-blind, randomized, comparative design that included 96 male participants, between 18 and 40 years in a residential rehabilitation treatment unit. Partakers in the yoga or physical exercise group received supervised daily training for 12 weeks, in addition to standard rehabilitation treatment. Raters blind to the study assessed the patients on digit span task, cancellation test, and Stroop tests at the baseline and following 12 weeks of intervention. Results: A significant enhancement in digit forward (yoga - p < 0.0005, d = 0.81; exercise - p < 0.0005, d = 0.73), digit backward (yoga - p < 0.0005, d = 0.88; exercise - p < 0.0005, d = 0.58), and letter cancellation test scores (yoga - p < 0.0005, d = 1.31; exercise - p < 0.0005, d = 1.4) were observed in both the yoga and the exercise groups. Stroop word and color task scores were seen significantly higher following yoga (p < 0.005, d = 0.74; p < 0.005, d = 1.13) and exercise (p < 0.0005, d = 0.62; p < 0.0005, d = 0.61). Furthermore, Stroop color-word test showed significant enhancement after yoga (p < 0.0005, d = 1.10) and exercise (p < 0.0005, d = 0.42), with degree of variation higher in the yoga group. Conclusion: Our results suggest that the add-on yoga or exercise-based intervention show enhancement of cognitive functions. These findings provide the utility of yoga and exercise-based intervention in improving cognitive functions among substance abusers. Furthermore, rigorous trials are needed to explore the potential long-term effects of these procedures. Copyright © 2017 S. Karger AG, Basel.
Annals of Neurosciences, 25(1) : 38-45
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Huang, S. F., Zheng, W. L., Liao, J. Y., Huang, C. M., Lin, T. Y., Guo, J. L.
Objective: Age of initiation of drug use is closely associated with the risk of developing drug dependence or abuse. Effective programmes are needed to prevent adolescents from using drugs at an early age. The aim of this intervention programme was to prevent adolescents from using illegal drugs by using drama in education (DIE) to convey a universal prevention strategy. Method: We recruited 65 children aged 14-15 years from two junior high schools and assigned them to experimental (n = 34) and comparison (n = 31) groups. The experimental group attended six 45-minute sessions of a DIE preventive programme. The comparison group received traditional didactic teaching. We used a generalised estimating equation (GEE) to analyse the data. Results: GEE analysis revealed that the experimental group showed significant improvements in attitude, subjective norms, perceived behavioural control and drug-free intentions compared with counterparts in the comparison group. Student feedback indicated that DIE method can contribute to the prevention of illegal drug use. Conclusion: Applying DIE method to a theory-based drug prevention programme offers a promising way of increasing the intention to not use illegal drugs among students aged 14-15 years. Copyright © 2018, The Author(s).
Health Education Journal, 77(4) : 470-481
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Liddle, H. A., Dakof, G. A., Rowe, C. L., Henderson, C., Greenbaum, P., Wang, W., Alberga, L.
This randomized clinical trial (RCT) compared Multidimensional Family Therapy (MDFT) with residential treatment (RT) for adolescents with co-occurring substance use and mental health disorders on substance use, delinquency, and mental health symptoms. Using an intent-to-treat design, 113 adolescents who had been referred for residential treatment were randomly assigned to either RT or MDFT in the home/community. The sample was primarily male (75%) and Hispanic (68%) with an average age of 15.4 years. Seventy-one percent of youth had at least one previous residential treatment placement. Participants were assessed at baseline and at 2, 4, 12 and 18 months post-baseline. During the early phase of treatment (baseline to 2 months), youth in both treatments showed significant reductions in substance use [substance use problems (d = 1.10), frequency of use (d = 1.36)], delinquent behaviors (d = 0.18) and externalizing symptoms (d = 0.77), and youth receiving MDFT reported significantly greater reductions in internalizing symptoms than youth receiving RT (d = 0.42). In phase 2, from 2 to 18 months after baseline, youth in MDFT maintained their early treatment decreases in substance use problems (d = 0.51), frequency of use (d = 0.24), and delinquent behaviors (d = 0.42) more effectively than youth in RT. During this period, there were no significant treatment differences in maintenance of gains for externalizing and internalizing symptoms. Results suggest that Multidimensional Family Therapy is a promising alternative to residential treatment for youth with substance use and co-occurring disorders. The results, if supported through replication, are important because they challenge the prevailing assumption that adolescents who meet criteria for residential treatment cannot be adequately managed in a non-residential setting. Copyright © 2018 Elsevier Inc.
Journal of Substance Abuse Treatment, 90 : 47-56
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Family therapy