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Knapp KS, Kulak JA, Homish DL, Granfield R, Homish GG, Kahn LS. Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients. Drug Alcohol Depend 2024; 260:111343. [PMID: 38815293 DOI: 10.1016/j.drugalcdep.2024.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Recovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. METHODS The current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21-67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. RESULTS First, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. CONCLUSIONS This study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.
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Affiliation(s)
- Kyler S Knapp
- School of Social Work, University at Buffalo, Buffalo, NY 14214, United States.
| | - Jessica A Kulak
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - D Lynn Homish
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - Robert Granfield
- Department of Sociology, College of Arts and Sciences, University at Buffalo, Buffalo, NY 14260, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, University at Buffalo, Buffalo, NY 14214, United States
| | - Linda S Kahn
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY 14203, United States
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O'Grady MA, Elkington KS, Robson G, Achebe IY, Williams AR, Cohall AT, Cohall R, Christofferson M, Garcia A, Ramsey KS, Lincourt P, Tross S. Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators. Subst Abuse Treat Prev Policy 2024; 19:12. [PMID: 38287329 PMCID: PMC10826099 DOI: 10.1186/s13011-024-00593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. METHODS Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. RESULTS Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). CONCLUSIONS This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Gail Robson
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Ikenna Y Achebe
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Arthur Robin Williams
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Alwyn T Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Kelly S Ramsey
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Pat Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
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Drug court utilization of medications for opioid use disorder in high opioid mortality communities. J Subst Abuse Treat 2022; 141:108850. [DOI: 10.1016/j.jsat.2022.108850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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Rodriguez-Monguio R, Montgomery B, Drawbridge D, Packer I, Vincent GM. Substance use treatment services utilization and outcomes among probationers in drug courts compared to a matched cohort of probationers in traditional courts. Am J Addict 2021; 30:505-513. [PMID: 34414632 DOI: 10.1111/ajad.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Drug courts provide an array of substance use treatments and community-based services for probationers struggling with substance use disorders. We assessed substance use treatment services utilization and related expenditures and relapse and recidivism outcomes and identified predictors of cost of provision of substance use treatment services in a matched cohort of Massachusetts probationers in drug courts and traditional courts. METHODS This was an observational quasi-experimental study with 542 propensity-score-matched probationers initiating drug court between August 1, 2015 and February 28, 2018 and a minimum 6-month follow-up period. RESULTS A significantly greater proportion of probationers in drug courts were female, self-reported opioids as their primary drug of choice, had a history of substance use treatment, and a high and very high risk of recidivism than their counterparts in traditional courts. We estimated that the provision of substance use treatment services was $1498 more expensive for probationers in drug courts than traditional courts (p = .054). There were no statistically significant differences in relapse or recidivism rates between court systems. DISCUSSION AND CONCLUSIONS Probationer's age, gender, risk of recidivism at court intake, and enrollment length were strong predictors of expenditures on substance use treatment services. SCIENTIFIC SIGNIFICANCE This was the first study to assess substance use treatment services utilization and outcomes among probationers in drug courts and traditional courts. Drug courts served the needs of probationers disproportionally impacted by nonserious drug-related offenses struggling with substance use disorders who were at a high and very high risk of recidivism at court intake.
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Affiliation(s)
- Rosa Rodriguez-Monguio
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco (UCSF), San Francisco, California, USA.,Medication Outcomes Center, University of California San Francisco (UCSF), San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Barrett Montgomery
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University (MSU), East Lansing, Michigan, USA
| | - Dara Drawbridge
- Department of Psychiatry, Center of Excellence for Specialty Courts, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ira Packer
- Department of Psychiatry, Center of Excellence for Specialty Courts, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gina M Vincent
- Department of Psychiatry, Center of Excellence for Specialty Courts, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Joudrey PJ, Howell BA, Nyhan K, Moravej A, Doernberg M, Ross JS, Wang EA. Reporting of substance use treatment quality in United States adult drug courts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103050. [PMID: 33310636 DOI: 10.1016/j.drugpo.2020.103050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adult drug courts are growing in popularity within the Unites States, but the quality of substance use treatment within drug court programs and the impact of drug courts on health and substance use treatment outcomes is largely unknown. We appraised the quality of United States adult drug court process evaluations and the inclusion of measures of substance use treatment quality. METHODS We systematically reviewed the adult drug court evaluations between 2008 and 2018 in accordance with recommended strategies for systematic gray literature search. We appraised evaluation quality using the Evidence for Policy and Practice Information and Coordination Center tool for process evaluations. We extracted recommended measures of substance use treatment quality, including measures related to screening and monitoring, diagnosis, service availability, service utilization, and outcomes. RESULTS Our search identified 112 evaluations. Process measures were included within 68 evaluations, 45% of which had poor data reliability. We found that less than 10% of evaluations reported substance use treatment quality measures related to service utilization, overdose, and mortality, while more than 75% contained criminal justice measures, including program graduation (completion of criminal justice proceedings) and participant recidivism. CONCLUSIONS We found low uptake of measures of substance use treatment quality. The absence of data call into question the ability of drug courts to stem harmful substance use related health outcomes.
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Affiliation(s)
- Paul J Joudrey
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
| | - Benjamin A Howell
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT. United States; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; SEICHE Center, Yale School of Medicine, New Haven, CT, United States
| | - Kate Nyhan
- Center for Biomedical Data Science, Cushing/Whitney Medical Library, Yale School of Medicine
| | - Ali Moravej
- Yale School of Public Health, New Haven, CT, United States
| | | | - Joseph S Ross
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
| | - Emily A Wang
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; SEICHE Center, Yale School of Medicine, New Haven, CT, United States
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Integrating a Co-occurring Disorders Intervention in a Rural Drug Treatment Court: Preliminary 6-Month Outcomes and Policy Implications. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00425-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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