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Levola J, Aranko A, Pitkänen T. Psychosocial difficulties and treatment retention in inpatient detoxification programmes. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:434-449. [PMID: 35308814 PMCID: PMC8900186 DOI: 10.1177/14550725211021263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Aims: Treatment retention is associated with addiction treatment outcomes. Research regarding predictors of retention at inpatient detoxification treatment is limited. The aim of this study was to investigate whether psychosocial difficulties (PSDs) are associated with treatment retention among Finnish inpatients undergoing detoxification treatment. Design: This register-based study included real-life data on detoxification treatment episodes (n = 2,752) between February of 2016 and May of 2019 from several inpatient treatment units in Finland. The PARADISE24fin instrument was used to assess PSDs. Socio-demographic and substance use related variables, as well as PSDs, were analysed with regard to treatment retention. Multiple logistic regression models were used to identify predictors of treatment incompletion. Results: Of the 2,752 detoxification treatment episodes, 80.3% (n = 2,209) were completed. Men and women differed with regard to the variables associated with treatment retention. After adjusting for confounders, younger age (≤ 35 years), being less educated (≤ 9 years), being unemployed, using opioids, polysubstance use and more severe dependence were associated with treatment incompletion. Overall severity of PSDs (PARADISE24fin mean score) became non-significant after adjusting for confounders. However, having more severe cognitive difficulties was significantly associated with treatment incompletion, while more severe difficulties in daily activities was associated with treatment completion. Conclusions: Special attention should be paid to younger individuals with opioid and/or polysubstance use, as well as those with cognitive difficulties, in order to retain people in treatment.
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Affiliation(s)
- Jonna Levola
- A-Clinic Foundation; University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arno Aranko
- A-Clinic Foundation; University of Helsinki, Helsinki, Finland
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2
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Medical Detoxification for Nonopioid Substances Is Associated With Lower Likelihood of Subsequent Linkage to Substance Use Disorder Treatment. J Addict Med 2022; 16:653-658. [PMID: 35245917 PMCID: PMC9433460 DOI: 10.1097/adm.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although factors associated with completion of medical detoxification treatment for substance use disorders (SUD) are well described, there is limited information on barriers and facilitators to subsequent linkage to SUD treatment in the community. This study aimed to evaluate correlates of successful linkage to community SUD treatment on discharge. METHODS Data were drawn from 2 prospective cohorts of people who use unregulated drugs in Vancouver, Canada between December 2012 and May 2018. Multivariable generalized estimating equations were used to investigate factors associated with linkage to community SUD treatment in the 6-month period after attending detoxification treatment. RESULTS Of the 264 detoxification treatment encounters contributed by 178 people who use unregulated drugs, these were most often (n = 104, 39%) related to polysubstance use, and the majority (n = 174, 66%) resulted in subsequent linkage to community treatment. In the multivariable analysis, compared to attending detoxification treatment for opioid use, attending detoxification treatment for stimulants (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] : 0.10-0.51) and alcohol (AOR = 0.17, 95% CI: 0.06-0.54) were associated with lower odds of subsequent linkage to community treatment. Conversely, later calendar year of detoxification treatment remained associated with higher odds (AOR = 1.23, 95% CI: 1.06-1.42). CONCLUSIONS Only two-thirds of detoxification treatment encounters in Vancouver were subsequently linked to community SUD treatment, with those related to nonopioid substances being less likely. Findings suggest the need for tailored interventions for specific substances to improve linkage to SUD treatment in the community on discharge.
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Lee MT, Torres M, Brolin M, Merrick EL, Ritter GA, Panas L, Horgan CM, Lane N, Hopwood JC, De Marco N, Gewirtz A. Impact of recovery support navigators on continuity of care after detoxification. J Subst Abuse Treat 2020; 112:10-16. [DOI: 10.1016/j.jsat.2020.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
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Zhu H, Wu LT. National trends and characteristics of inpatient detoxification for drug use disorders in the United States. BMC Public Health 2018; 18:1073. [PMID: 30157815 PMCID: PMC6114033 DOI: 10.1186/s12889-018-5982-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed. This study examined national trends and characteristics of inpatient detoxification for DUDs and explored factors associated with receiving DUD treatment (i.e., inpatient drug detoxification plus rehabilitation) and discharges against medical advice (DAMA). METHODS We analyzed inpatient hospitalization data involving the drug detoxification procedure for patients aged≥12 years (n = 271,403) in the 2003-2011 Nationwide Inpatient Samples. We compared the estimated rate and characteristics of inpatient drug-detoxification hospitalizations between 2003 and 2011 and determined demographic and clinical correlates of inpatient drug detoxification plus rehabilitation (versus detoxification-only) and DAMA (versus transfer to further treatment). RESULTS There was no significant yearly change in the population rate of inpatient drug-detoxification hospitalizations during 2003-2011. The majority of inpatient drug detoxification were patients aged 35-64 years, males, and those on Medicaid. Among inpatient drug-detoxification hospitalizations, only 13% received detoxification plus rehabilitation during inpatient care, and up to 14% were DAMA; the most commonly identified diagnoses were opioid use disorder (OUD; 75%) and non-addiction mental health disorders (48%). Being on Medicaid (vs. having private insurance) and having OUD (vs. no OUD) were associated with decreased odds of receiving detoxification plus rehabilitation, as well as increased odds of DAMA. CONCLUSIONS These findings suggest the presence of a potentially large detoxification-treatment gap for inpatient detoxification patients. They highlight the need for implementing DUD services to improve engagement in receiving further DUD treatment in order to improve recovery and health outcomes.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
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Ivers JH, Larkan F, Barry J. A Longitudinal Qualitative Analysis of the Lived Experience of the Recovery Process in Opioid-Dependent Patients Post-Detoxification. J Psychoactive Drugs 2018; 50:231-239. [PMID: 29447584 DOI: 10.1080/02791072.2018.1435928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the study was to gain an in-depth understanding of opioid-dependent patients' lived experiences post-detoxification. METHOD The study employed a naturalistic, observational longitudinal design, involving baseline screening and tracking of patients post-detoxification, with follow-up interviews at three, six, and nine months to observe specific processes of interest. This in-depth investigation of patients at four points was new within an Irish context and novel throughout the literature. FINDINGS Recovery was seen as a process that was not always linear, and lapse and relapse were viewed as part of this process. Patients had great insight into "risk factors for relapse," information and knowledge gained over several years and many treatment episodes. Furthermore, the findings illustrate the role insight plays in any learning and growth experience and the emphasis that is placed upon it within the treatment journey; insight is a fundamental underpinning to any real growth and development. The current article argues that insight merits a more explicit role in the model of recovery capital.
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Affiliation(s)
- J H Ivers
- a Department of Public Health and Primary Care, Institute of Population Health, School of Medicine , Trinity College , Dublin , Ireland
| | - F Larkan
- b Centre for Global Health, School of Medicine , Trinity College , Ireland
| | - J Barry
- a Department of Public Health and Primary Care, Institute of Population Health, School of Medicine , Trinity College , Dublin , Ireland.,c Department of Public Health and Primary Care, Institute of Population Health, School of Medicine , Trinity College , Dublin , Ireland
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Quinn AE, Hodgkin D, Perloff JN, Stewart MT, Brolin M, Lane N, Horgan CM. Design and impact of bundled payment for detox and follow-up care. J Subst Abuse Treat 2017; 82:113-121. [PMID: 29021109 DOI: 10.1016/j.jsat.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design the first bundled payment for detox and follow-up care and to estimate its impact on provider revenues. METHODS Massachusetts Medicaid beneficiaries' behavioral health, medical, and pharmacy claims from July 2010-April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5521). A risk adjustment model was developed using general linear modeling to predict beneficiaries' episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox readmissions and an increase of one individual counseling and one group counseling session. RESULTS The mean total 90-day detox episode cost was $3743. Nearly 70% of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue under this bundled payment design, but many providers will lose money under a bundled payment designed using historic payment and costs. CONCLUSIONS Designing a bundled payment for detox and follow-up care is feasible, but low case volume and the adequacy of the payment are concerns. Thus, a detox episode-based payment will likely be more challenging for smaller, independent SUD treatment providers. These providers are experiencing many changes as financing shifts away from block grant funding toward Medicaid funding. A detox bundled payment in practice would need to consider different risk mitigation strategies, provider pooling, and costs based on episodes of care meeting quality standards, but could incentivize care coordination, which is important to reducing detox readmissions and engaging patients in care.
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Affiliation(s)
- Amity E Quinn
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA.
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Jennifer N Perloff
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Maureen T Stewart
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Mary Brolin
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
| | - Nancy Lane
- Vanderbilt University Medical Center 1211 Medical Center Dr, Nashville, TN 37232, USA; Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
| | - Constance M Horgan
- The Heller School for Social Policy and Management, Brandeis University, MS035, 415 South Street, Waltham, MA 02453, USA
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Ivers JH, Zgaga L, Sweeney B, Keenan E, Darker C, Smyth BP, Barry J. A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients. Drug Alcohol Rev 2017; 37 Suppl 1:S339-S347. [PMID: 28940788 DOI: 10.1111/dar.12597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification. DESIGN AND METHODS This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification. RESULTS A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10-12 ). Abstinence rates for outpatient aftercare and inpatient aftercare are about equal after 9 months. DISCUSSION AND CONCLUSION Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.
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Affiliation(s)
- Jo-Hanna Ivers
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Lina Zgaga
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | | | - Eamon Keenan
- National Drug Treatment Centre, Health Service Executive, Dublin, Ireland.,National Office of Social Inclusion, Health Service Executive, Dublin, Ireland
| | - Catherine Darker
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Bobby P Smyth
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland.,National Drug Treatment Centre, Health Service Executive, Dublin, Ireland
| | - Joe Barry
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland.,National Drug Treatment Centre, Health Service Executive, Dublin, Ireland
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Running Bear U, Beals J, Novins DK, Manson SM. Alcohol detoxification completion, acceptance of referral to substance abuse treatment, and entry into substance abuse treatment among Alaska Native people. Addict Behav 2017; 65:25-32. [PMID: 27705843 PMCID: PMC5140722 DOI: 10.1016/j.addbeh.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification). METHODS The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit. Three multiple logistic regression models estimated the adjusted associations of each outcome separately with demographic/psychosocial characteristics, clinical characteristics, use related behaviors, and health care utilization. RESULTS Seventy-five percent completed detoxification treatment. Higher global assessment functioning scores, longer lengths of stay, and older ages of first alcohol use were associated with completing detoxification. A secondary drug diagnosis was associated with not completing detoxification. Thirty-six percent accepted a referral to substance abuse treatment following detoxification. Men, those with legal problems, and those with a longer length of stay were more likely to accept a referral to substance abuse treatment. Fifty-eight percent had a confirmed entry into a substance abuse treatment program at discharge. Length of stay was the only variable associated with substance abuse treatment entry. CONCLUSIONS Services like motivational interviewing, counseling, development of therapeutic alliance, monetary incentives, and contingency management are effective in linking patients to services after detoxification. These should be considered, along with the factors associated with each point on the continuum of care when linking patients to follow-up services.
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Affiliation(s)
- Ursula Running Bear
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States.
| | - Janette Beals
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States
| | - Douglas K Novins
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States
| | - Spero M Manson
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States
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9
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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Schultz NR, Martinez R, Cucciare MA, Timko C. Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives. Subst Use Misuse 2016; 51:1330-41. [PMID: 27245200 DOI: 10.3109/10826084.2016.1168446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. OBJECTIVES The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. METHODS Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. RESULTS Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. CONCLUSIONS/IMPORTANCE To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.
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Affiliation(s)
- Nicole R Schultz
- a Department of Psychology , Auburn University , Auburn , Alabama , USA
| | - Rociel Martinez
- b Clinical Psychology Graduate Program , Pacific Graduate School of Psychology-Stanford University Consortium , Palo Alto , California , USA
| | - Michael A Cucciare
- c Center for Mental Healthcare and Outcomes Research , Central Arkansas Veterans Affairs Health Care System , North Little Rock , Arkansas , USA.,d VA South Central (VISN 16) Mental Illness Research , Central Arkansas Veterans Health Care System , North Little Rock , Arkansas , USA.,e Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Christine Timko
- a Department of Psychology , Auburn University , Auburn , Alabama , USA.,f Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
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11
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Lindblad R, Hu L, Oden N, Wakim P, Rosa C, VanVeldhuisen P. Mortality Rates Among Substance Use Disorder Participants in Clinical Trials: Pooled Analysis of Twenty-Two Clinical Trials Within the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2016; 70:73-80. [PMID: 27692192 DOI: 10.1016/j.jsat.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most substance use disorders (SUD) treatment clinical trials are too short and small to reliably estimate the incidence of rare events like death. OBJECTIVE The aim of this study is to estimate the overall mortality rates among a SUD treatment-seeking population by pooling participants from multiple clinical trials conducted through the National Institute on Drug Abuse (NIDA)-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN). PARTICIPANTS Drug and or alcohol users (N=9866) who sought treatment and participated in one of the twenty-two CTN trials. MEASUREMENTS Data were collected through randomized clinical trials in national community treatment programs for SUD. Pooled analysis was performed to assess age- and gender-standardized mortality rate(s) (SM rate(s)), and mortality ratio(s) (SM ratio(s)) of CTN trial participants compared to the U.S. general population. RESULTS The age- and gender-SM rate among CTN trials participants was 1403 (95% CI: 862-2074) per 100,000 person years (PY) compared to 542 (95% CI: 541-543) per 100,000 PY among the U.S. general population in 2005. By gender, age-adjusted SM ratio for female CTN trial participants was over five times (SM ratio=5.35, 95% CI: 3.31-8.19)), and for male CTN trial participants, it was over three times (SM ratio=3.39, 95% CI: 2.25-4.90) higher than their gender comparable peers in the U.S. general population. CONCLUSIONS Age and gender-standardized mortality rates and ratios among NIDA CTN SUD treatment-seeking clinical trial participants are higher than the age and gender comparable U.S. general population. The overall mortality rates of CTN trial participants are similar to in-treatment mortality reported in large U.S. and non-U.S. cohorts of opioid users. Future analysis with additional CTN trial participants and risk times will improve the stability of estimates, especially within subgroups based on primary substance of abuse. These SUD mortality rates can be used to facilitate safety monitoring within SUD clinical trials.
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Affiliation(s)
| | - Lian Hu
- The Emmes Corporation, Rockville, MD, United States
| | - Neal Oden
- The Emmes Corporation, Rockville, MD, United States
| | - Paul Wakim
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Carmen Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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Timko C, Schultz NR, Britt J, Cucciare MA. Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers. J Subst Abuse Treat 2016; 70:64-72. [PMID: 27692190 DOI: 10.1016/j.jsat.2016.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/16/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Abstract
Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Nicole R Schultz
- Department of Psychology, Auburn University, Auburn, AL 36849, USA.
| | - Jessica Britt
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA 94304, USA; Clinical Psychology Graduate Program, Pacific Graduate School of Psychology-Stanford University Consortium, Palo Alto, CA 94304, USA.
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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13
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Thakarar K, Weinstein ZM, Walley AY. Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist. Postgrad Med J 2016; 92:356-63. [PMID: 27004476 PMCID: PMC4967553 DOI: 10.1136/postgradmedj-2015-133720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The opioid epidemic in the USA continues to worsen. Medical providers are faced with the challenge of addressing complications from opioid use disorders and associated injection drug use. Unsafe injection practices among people who inject drugs (PWID) can lead to several complications requiring acute care encounters in the emergency department and inpatient hospital. Our objective is to provide a narrative review to help medical providers recognise and address key health issues in PWID, who are being released from the emergency department and inpatient hospital. In the midst of rises in overdose deaths and infections such as hepatitis C, we highlight several health issues for PWID, including overdose and infection prevention. We provide a clinical checklist of actions to help guide providers in the care of these complex patients. The clinical checklist includes strategies also applicable to low-resource settings, which may lack addiction treatment options. Our review and clinical checklist highlight key aspects of optimising the health and safety of PWID.
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Affiliation(s)
- Kinna Thakarar
- Department of Medicine/Infectious Diseases, Maine Medical Center, Portland, Maine, USA
| | - Zoe M Weinstein
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
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14
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Chang G, Raffi E, Tang M, Fernando GI, Zucker J, Schein AZ. High utilization of inpatient detoxification: predictors among US veterans. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:279-86. [PMID: 26516789 DOI: 10.3109/00952990.2015.1089256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Readmissions are among the most problematic and expensive problems in the treatment of substance use disorders. OBJECTIVE To evaluate the characteristics associated with four or more inpatient medically managed detoxification admissions in FY 2012, when all had post-discharge appointments within 7 days. METHODS A retrospective case control study. A total of 38 (6.0%) of 623 unique veterans had four or more detoxification admissions (high utilizers). A random sample of 42 was selected from the remaining 585 people (comparison group). In all, 264 detoxification and 70 hospital admissions for other reasons were reviewed. RESULTS The high utilizers had more alcohol use disorder (AUD, 82% versus 59%, p = 0.03) of significantly longer duration (mean 28.9 years [SD = 17] vs. 19.6 [SD = 13.4], p = 0.01). AUD increased the odds of being a high utilizer three-fold [OR = 3.0, 95% CI 1.1, 8.4], and every additional year of AUD, increased the number of admissions 1.3%, p = 0.0006. The high utilizers did not differ from the comparison group with regards to either number of hospitalizations for other reasons (mean 1.2 [SD = 1.9] vs. 0.57 [SD = 0.8], p = 0.06) or rate of 7 day post discharge appointments kept (46.9% vs. 49.3%, p = 0.82). CONCLUSIONS High utilizers were a small percentage of patients (6.0%) who accounted for a disproportionate number (23%) of 977 detoxification admissions. They had greater disease severity as manifest by more years of AUD. They were not more likely to have hospitalizations for other reasons or less likely to keep post discharge appointments. These patients may warrant different services tailored to prevent hospital readmissions for detoxification.
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Affiliation(s)
- Grace Chang
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
| | - Edwin Raffi
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
| | - Michael Tang
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
| | - Gerard I Fernando
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
| | - Jarred Zucker
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
| | - Abigail Z Schein
- a Harvard Medical School, VA Boston Healthcare System , Brockton , MA , USA
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15
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Chang G, Martin KB, Tang M, Fleming JA. Inpatient hospitalization for substance use disorders one year after residential rehabilitation: predictors among US veterans. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:56-62. [DOI: 10.3109/00952990.2015.1088863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Lee MT, Horgan CM, Garnick DW, Acevedo A, Panas L, Ritter GA, Dunigan R, Babakhanlou-Chase H, Bidorini A, Campbell K, Haberlin K, Huber A, Lambert-Wacey D, Leeper T, Reynolds M. A performance measure for continuity of care after detoxification: relationship with outcomes. J Subst Abuse Treat 2014; 47:130-9. [PMID: 24912862 DOI: 10.1016/j.jsat.2014.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/21/2014] [Accepted: 04/14/2014] [Indexed: 11/18/2022]
Abstract
Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification. This was particularly true for reducing readmissions to another detoxification that was not followed with treatment and when continuity of care was in residential treatment. Continuity of care in outpatient treatment was related to a reduction in readmissions in some states, but not as often as when continuity of care occurred in residential treatment. A performance measure for continuity of care after detoxification is a useful tool to help providers monitor quality of care delivered and to alert them when improvement is needed.
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Affiliation(s)
- Margaret T Lee
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110.
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Grant A Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | - Robert Dunigan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110
| | | | - Alfred Bidorini
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT 06134
| | - Kevin Campbell
- Washington State Department of Social and Health Services, The Division of Behavioral Health and Recovery, Olympia, WA 98501
| | - Karin Haberlin
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT 06134
| | - Alice Huber
- Washington State Department of Social and Health Services, The Division of Behavioral Health and Recovery, Olympia, WA 98501
| | - Dawn Lambert-Wacey
- New York State Office of Alcoholism and Substance Abuse Services, Division of Outcome Management and System Investment, Albany, N.Y. 12203
| | - Tracy Leeper
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, OK 73152
| | - Mark Reynolds
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, OK 73152
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17
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Reducing readmissions to detoxification: an interorganizational network perspective. Drug Alcohol Depend 2014; 137:76-82. [PMID: 24529966 PMCID: PMC4029096 DOI: 10.1016/j.drugalcdep.2014.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 01/10/2014] [Accepted: 01/12/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients' odds of readmission to detox within 1 year. METHODS Administrative data from 32 counties in California in 2008-2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N=18,278). RESULTS After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission. CONCLUSION The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed.
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18
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Bailey GL, Herman DS, Stein MD. Perceived relapse risk and desire for medication assisted treatment among persons seeking inpatient opiate detoxification. J Subst Abuse Treat 2013; 45:302-5. [PMID: 23786852 DOI: 10.1016/j.jsat.2013.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/09/2013] [Accepted: 04/04/2013] [Indexed: 11/16/2022]
Abstract
Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p<.01). These data suggest patient preference discussions including relapse risk could increase post-detox abstinence.
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Affiliation(s)
- Genie L Bailey
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
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19
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Simpson DD, Joe GW, Dansereau DF, Flynn PM. Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University. Addiction 2011; 106:1733-40. [PMID: 20840168 PMCID: PMC3003748 DOI: 10.1111/j.1360-0443.2010.03121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.
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Affiliation(s)
- D Dwayne Simpson
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.
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20
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Kelly TM, Daley DC, Byrne M, Demarzo L, Smith D, Madl S. The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network. MIND & BRAIN : THE JOURNAL OF PSYCHIATRY 2011; 2:56-66. [PMID: 22102966 PMCID: PMC3217255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting "real world" research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our "bidirectional" collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node.Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies.
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Affiliation(s)
- Thomas M Kelly
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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