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Worth LM, Macias-Konstantopoulos W, Moy L, Perl HI, Crandall C, Chavez R, Forcehimes A, Mandler R, Bogenschutz MP. Optimizing Recruitment and Retention in Substance Use Disorder Research in Emergency Departments. West J Emerg Med 2023; 24:228-235. [PMID: 36976606 PMCID: PMC10047737 DOI: 10.5811/westjem.2022.11.57179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/16/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Clinical trial recruitment and retention of individuals who use substances are challenging in any setting and can be particularly difficult in emergency department (ED) settings. This article discusses strategies for optimizing recruitment and retention in substance use research conducted in EDs. METHODS Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) was a National Drug Abuse Treatment Clinical Trials Network (CTN) protocol designed to assess the impact of a brief intervention with individuals screening positive for moderate to severe problems related to use of non-alcohol, non-nicotine drugs. We implemented a multisite, randomized clinical trial at six academic EDs in the United States and leveraged a variety of methods to successfully recruit and retain study participants throughout the 12-month study course. Recruitment and retention success is attributed to appropriate site selection, leveraging technology, and gathering adequate contact information from participants at their initial study visit. RESULTS The SMART-ED recruited 1,285 adult ED patients and attained follow-up rates of 88%, 86%, and 81% at the 3-, 6-, and 12-month follow-up periods, respectively. Participant retention protocols and practices were key tools in this longitudinal study that required continuous monitoring, innovation, and adaptation to ensure strategies remained culturally sensitive and context appropriate through the duration of the study. CONCLUSION Tailored strategies that consider the demographic characteristics and region of recruitment and retention are necessary for ED-based longitudinal studies involving patients with substance use disorders.
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Affiliation(s)
- Lindsay M Worth
- University of New Mexico, Department of Psychiatric Research, Albuquerque, New Mexico
| | | | | | | | - Cameron Crandall
- University of New Mexico, Department of Emergency Medicine, Albuquerque, New Mexico
| | - Roberta Chavez
- University of New Mexico Center on Alcoholism, Substance Use Disorder and Addictions, Albuquerque, New Mexico
| | | | - Raul Mandler
- National Institute on Drug Abuse Clinical Trials Network, Bethesda, Maryland
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Horn BP, Crandall C, Forcehimes A, French MT, Bogenschutz M. Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments. J Subst Abuse Treat 2017; 79:6-11. [PMID: 28673528 DOI: 10.1016/j.jsat.2017.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 01/29/2023]
Abstract
Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.
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Affiliation(s)
- Brady P Horn
- Department of Economics, University of New Mexico, Albuquerque, NM 87131, USA; Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, Albuquerque, NM 87106, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Alyssa Forcehimes
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, Albuquerque, NM 87106, USA
| | - Michael T French
- Departments of Sociology and Health Sector Management and Policy, University of Miami, Coral Gables, FL 33124-2030, USA.
| | - Michael Bogenschutz
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, Albuquerque, NM 87106, USA; Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Andersen K, Bogenschutz MP, Bühringer G, Behrendt S, Bilberg R, Braun B, Ekstrøm CT, Forcehimes A, Lizarraga C, Moyers TB, Nielsen AS. Outpatient treatment of alcohol use disorders among subjects 60+ years: design of a randomized clinical trial conducted in three countries (Elderly Study). BMC Psychiatry 2015; 15:280. [PMID: 26573323 PMCID: PMC4647307 DOI: 10.1186/s12888-015-0672-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/04/2015] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The proportion of 60+ years with excessive alcohol intake varies in western countries between 6-16 % among men and 2-7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years. METHODS/DESIGN 1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT. Participants are randomly assigned to four sessions of Motivational Enhancement Treatment (MET) or to MET plus an add-on with eight sessions based on the Community Reinforcement Approach (CRA), which include a new module targeting specific problems of older adults. A series of assessment instruments is applied, including the Form-90, Alcohol Dependence Scale, Penn Alcohol Craving Scale, Brief Symptom Inventory and WHO Quality of Life. Enrolment will be completed by April 2016 and data collection by April 2017. The primary outcome is the proportion in each group who are abstinent or have a controlled use of alcohol six months after treatment initiation. Controlled use is defined as maximum blood alcohol content not exceeding 0.05 % during the last month. Total abstinence is a secondary outcome, together with quality of life andcompliance with treatment. DISCUSSION The study will provide new knowledge about brief treatment of AUD for older subjects. As the treatment is manualized and applied in routine treatment facilities, barriers for implementation in the health care system are relatively low. Finally, as the study is being conducted in three different countries it will also provide significant insight into the possible interaction of service system differences and related patient characteristics in predictionof treatment outcome. TRIAL REGISTRATION Clinical Trials.gov NCT02084173 , March 7, 2014.
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Affiliation(s)
- Kjeld Andersen
- Institute of Clinical Research, Unit of Clinical Alcohol Research (UCAR), University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark. .,Department of Psychiatry - Odense, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | | | - Gerhard Bühringer
- Institute of Clinical Psychology and Psychotherapy, Addiction Research Unit, Technische Universität Dresden, Dresden, Germany. .,IFT Institut für Therapieforschung, Munich, Germany.
| | - Silke Behrendt
- Institute of Clinical Psychology and Psychotherapy, Addiction Research Unit, Technische Universität Dresden, Dresden, Germany.
| | - Randi Bilberg
- Institute of Clinical Research, Unit of Clinical Alcohol Research (UCAR), University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Barbara Braun
- IFT Institut für Therapieforschung, Munich, Germany.
| | - Claus Thorn Ekstrøm
- Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Alyssa Forcehimes
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, USA.
| | - Christine Lizarraga
- Clinical Trials Network SW Node, UNM Center on Alcoholism, Substance Abuse and Addictions, Albuquerque, USA.
| | - Theresa B. Moyers
- Department of Psychology, University of New Mexico, Albuquerque, USA
| | - Anette Søgaard Nielsen
- Institute of Clinical Research, Unit of Clinical Alcohol Research (UCAR), University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
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Keyser-Marcus L, Alvanzo A, Rieckmann T, Thacker L, Sepulveda A, Forcehimes A, Islam LZ, Leisey M, Stitzer M, Svikis DS. Trauma, gender, and mental health symptoms in individuals with substance use disorders. J Interpers Violence 2015; 30:3-24. [PMID: 24811286 PMCID: PMC4766974 DOI: 10.1177/0886260514532523] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. The goal of the current study was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment. Study participants (N = 625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study conducted through the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). Study measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite [ASI-Lite]). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.
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Affiliation(s)
| | - Anika Alvanzo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Alyssa Forcehimes
- University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, USA
| | | | | | - Maxine Stitzer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Forcehimes A, Crandall C, Bogenschutz M, Donovan D, Lindblad R, Walker R. Factors associated with effective implementation of screening, brief intervention, and referral to treatment in the emergency department. Addict Sci Clin Pract 2012. [PMCID: PMC3480145 DOI: 10.1186/1940-0640-7-s1-a78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Fischer D, Donovan D, Forcehimes A, Bogenschutz M. Screening, brief intervention, and referral to treatment for drug- and alcohol-related health problems in emergency departments (EDs): review of outcomes, implementations, and costs. Addict Sci Clin Pract 2012. [PMCID: PMC3480139 DOI: 10.1186/1940-0640-7-s1-a76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bogenschutz M, Donovan D, Crandall C, Lindblad R, Mandler R, Perl H, Forcehimes A. Screening procedures to identify problematic substance use in medical emergency department patients. Addict Sci Clin Pract 2012. [PMCID: PMC3480159 DOI: 10.1186/1940-0640-7-s1-a79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Donovan DM, Bogenschutz MP, Perl H, Forcehimes A, Adinoff B, Mandler R, Oden N, Walker R. Study design to examine the potential role of assessment reactivity in the Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) protocol. Addict Sci Clin Pract 2012. [PMID: 23186329 PMCID: PMC3599426 DOI: 10.1186/1940-0640-7-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Screening, brief intervention, and referral to treatment (SBIRT) approaches to reducing hazardous alcohol and illicit drug use have been assessed in a variety of health care settings, including primary care, trauma centers, and emergency departments. A major methodological concern in these trials, however, is “assessment reactivity,” the hypothesized impact of intensive research assessments to reduce alcohol and drug use and thus mask the purported efficacy of the interventions under scrutiny. Thus, it has been recommended that prospective research designs take assessment reactivity into account. The present article describes the design of the National Institute on Drug Abuse Clinical Trials Network protocol, Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), which addresses the potential bias of assessment reactivity. Methods/design The protocol employs a 3-arm design. Following an initial brief screening, individuals identified as positive cases are consented, asked to provide demographic and locator information, and randomly assigned to one of the three conditions: minimal screening only, screening + assessment, or screening + assessment + brief intervention. In a two-stage process, the randomization procedure first reveals whether or not the participant will be in the minimal-screening-only condition. Participants in the other two groups receive a more extensive baseline assessment before it is revealed whether they have been randomized to also receive a brief intervention. Comparing the screening only and screening + assessment conditions will allow determination of the incremental effect of assessment reactivity. Discussion Assessment reactivity is a potential source of bias that may reduce and/or lead to an underestimation of the purported effectiveness of brief interventions. From a methodological perspective, it needs to be accounted for in research designs. The SMART-ED design offers an approach to minimize assessment reactivity as a potential source of bias. Elucidating the role of assessment reactivity may offer insights into the mechanisms underlying SBIRT as well as suggest clinical options incorporating assessment reactivity as a treatment adjunct. ClinicalTrials.gov Identifier NCT01207791.
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Affiliation(s)
- Dennis M Donovan
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105, USA.
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Svikis DS, Keyser-Marcus L, Stitzer M, Rieckmann T, Safford L, Loeb P, Allen T, Luna-Anderson C, Back SE, Cohen J, DeBernardi MA, Dillard B, Forcehimes A, Jaffee W, Killeen T, Kolodner K, Levy M, Pallas D, Perl HI, Potter JS, Provost S, Reese K, Sampson RR, Sepulveda A, Snead N, Wong CJ, Zweben J. Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders. Drug Alcohol Depend 2012; 120:55-64. [PMID: 21802222 PMCID: PMC3579551 DOI: 10.1016/j.drugalcdep.2011.06.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 06/25/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job. METHOD Study participants were recruited through the NIDA Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring. RESULTS JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with "obtaining a new taxed job" accounting for the majority of cases. CONCLUSION JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well.
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Affiliation(s)
- Dace S Svikis
- Department of Psychology, AWHARE (Addiction & Women's Health: Advancing Research and Evaluation), Virginia Commonwealth University, Old City Hall, Room 350A, 1001 East Broad Street, PO Box 980343, Richmond, VA 23298-0343, USA.
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Thomas LR, Rosa C, Forcehimes A, Donovan DM. Research partnerships between academic institutions and American Indian and Alaska Native Tribes and organizations: effective strategies and lessons learned in a multisite CTN study. Am J Drug Alcohol Abuse 2011; 37:333-8. [PMID: 21854275 DOI: 10.3109/00952990.2011.596976] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community Based and Tribally Based Participatory Research (CBPR/TPR) are approaches that can be successful for developing ethical and effective research partnerships between academic institutions and Tribes and Native organizations. OBJECTIVES The NIDA Clinical Trials Network funded a multi-site, exploratory study using CBPR/TPR to begin to better understand substance abuse issues of concern to some Tribes and Native organizations as well as strengths and resources that exist in these communities to address these concerns. Attention was paid to the development and maintenance of research partnerships in each of the sites. METHODS Each of the five partnerships is briefly described and common as well as unique challenges and successes are identified. RESULTS A summary of the common themes for developing these collaborative research efforts is provided. CONCLUSION True, collaborative research partnerships require a great deal of time and effort in order to develop mutual trust, understanding, knowledge, and collaboration that will guide research that is rigorous as well as ethical, effective, and culturally appropriate. SCIENTIFIC SIGNIFICANCE As AIAN communities become increasingly sophisticated partners in, and consumers of, research, CBPR and TPR are emerging as effective, ethical, culturally appropriate, and acceptable approaches. This can serve to improve the science we engage in with AIAN communities, add to the scarce literature regarding AIAN communities, and better serve AIAN communities in addressing health disparities and improving health.
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Affiliation(s)
- Lisa Rey Thomas
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, 98105-4631, USA.
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Calsyn DA, Cousins SJ, Hatch-Maillette MA, Forcehimes A, Mandler R, Doyle SR, Woody G. Sex under the influence of drugs or alcohol: common for men in substance abuse treatment and associated with high-risk sexual behavior. Am J Addict 2010; 19:119-27. [PMID: 20163383 DOI: 10.1111/j.1521-0391.2009.00022.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sex under the influence of drugs or alcohol is associated with high-risk sexual behavior. Heterosexual men (n = 505) in substance abuse treatment completed a computer-administered interview assessing sexual risk behaviors. Most men (73.3%) endorsed sex under the influence in the prior 90 days, and 39.1% endorsed sex under the influence during their most recent sexual event. Sex under the influence at the most recent event was more likely to involve anal intercourse, sex with a casual partner, and less condom use. Patients might benefit from interventions targeting sexual behavior and substance use as mutual triggers. (Am J Addict 2010;00:1-9).
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
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Miller WR, Forcehimes A, O'Leary MJ, LaNoue MD. Spiritual direction in addiction treatment: two clinical trials. J Subst Abuse Treat 2008; 35:434-42. [PMID: 18657945 PMCID: PMC2600849 DOI: 10.1016/j.jsat.2008.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 02/19/2008] [Indexed: 10/21/2022]
Abstract
Spirituality has long been regarded as an important component of recovery from addiction. This article reports the findings of two controlled trials of spiritual direction as an adjunct in addiction treatment. In Study 1, 60 participants were randomly assigned to receive or not receive a 12-session manual-guided spiritual guidance (SG) intervention during and after inpatient treatment, in addition to treatment as usual (TAU). In Study 2, two cohorts of 40 each received TAU without or with SG during their inpatient stay. In both trials, contrary to prediction, SG had no effect on spiritual practices or substance use outcomes at any follow-up point. At the first follow-up in Study 1 only, those randomly assigned to spiritual direction unexpectedly showed significantly less improvement on depression and anxiety, relative to TAU controls. Limitations and implications for treatment are discussed.
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Affiliation(s)
- William R Miller
- University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, Albuquerque, New Mexico, USA.
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Levensky ER, Forcehimes A, O'Donohue WT, Beitz K. Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations. Am J Nurs 2007; 107:50-8; quiz 58-9. [PMID: 17895731 DOI: 10.1097/01.naj.0000292202.06571.24] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Motivational interviewing is an evidenced-based counseling approach that health care providers can use to help patients adhere to treatment recommendations. It emphasizes using a directive, patient-centered style of interaction to promote behavioral change by helping patients explore and resolve ambivalence. This article will help nurses learn how to use motivational interviewing to encourage patients to adhere to treatment recommendations. The basic theoretical underpinnings, principles, and methods of motivational interviewing are discussed, with an emphasis on acting in accordance with the "spirit" of the approach.
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Miller WR, Moyers TB, Arciniega L, Ernst D, Forcehimes A. Training, supervision and quality monitoring of the COMBINE Study behavioral interventions. ACTA ACUST UNITED AC 2006:188-95; discussion 168-9. [PMID: 16223070 DOI: 10.15288/jsas.2005.s15.188] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Current standards for clinical trials require that behavioral interventions be thoroughly specified, that clinicians be well trained and closely supervised and that performance be carefully monitored to ensure and document treatment fidelity. This article describes procedures developed and implemented for this purpose in the COMBINE Study, a multisite trial combining medications and behavioral interventions for alcohol dependence. METHOD Two behavioral treatments were tested in COMBINE: a Medical Management (MM) protocol to accompany the delivery of trial medications and a Combined Behavioral Intervention (CBI) designed as a comprehensive and flexible evidence-based psychotherapy. RESULTS Information is provided concerning (1) screening and qualifications of practitioners, (2) training and certification in the interventions, (3) on-site supervision and coordination of the two treatments, (4) central monitoring and coding of treatment sessions and (5) maintenance and documentation of treatment fidelity. CONCLUSIONS Both interventions were delivered with fidelity. Problems encountered and important choices made in the implementation of training and quality assurance for CBI and MM are briefly described.
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Affiliation(s)
- William R Miller
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA.
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