A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a supplementary intervention that can be incorporated into the Pre-Exposure Prophylaxis (PrEP) Care Continuum, complementing initiatives and endeavors focused on Human Immunodeficiency Virus (HIV) prevention in clinical care and community-based work. Referencing the Transtheoretical Model of Change and the PrEP Awareness Continuum, this conceptual analysis highlights how SBIRT amplifies ongoing HIV prevention initiatives and presents a distinct chance to address identified gaps. SBIRT's mechanisms show promise of fit and feasibility through (a) implementing universal Screening (S), (b) administering a Brief Intervention (BI) grounded in motivational interviewing aimed at assisting individuals in recognizing the significance of PrEP in their lives, (c) providing an affirming and supportive Referral to Treatment (RT) to access clinical PrEP care, and (d) employing client-centered and destigmatized approaches. SBIRT is uniquely positioned to help address the complex challenges facing PrEP awareness and initiation efforts. Adapting the SBIRT model to integrate and amplify HIV prevention efforts merits further examination.

Predictors of cigarette smoking in pregnant women with substance use disorders

BACKGROUND

Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD.

PURPOSE

To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders.

METHODS

Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015-2019 was conducted. The NSDUH included 3,540 pregnant women aged 18-44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking.

RESULTS

Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02-1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59-20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88-17.45).

CONCLUSION

The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

Cigarette Smoking Cessation Counselling in Pregnant Smokers with Mental Illness/Substance Use Disorders

Our objective was to determine if past-year mental illness and substance use disorders (SUD) among pregnant smokers predicted the probability of receipt of counselling for cigarette smoking cessation. A secondary analysis of data from the National Survey on Drug Use and Health 2016-2019 was conducted. We found that approximately 83% of pregnant smokers (N = 373) received screening for cigarette smoking, and 65% received cessation counselling. Having mental illness predicted the probability of receipt of counselling for smoking cessation in pregnant smokers (adjusted odds ratio [AOR]: 3.75; 95% confidence interval [CI]: 1.25-11.27). However, having SUD (alcohol [AOR: 2.30; 95%CI: 0.57-9.26] or illicit drug use [AOR: 1.32; 95%CI: 0.26-6.82]) or comorbid mental illness and SUD (AOR: 0.23; 95%CI: 0.03-2.03) was not associated with receipt of counselling for smoking cessation. Practice guidelines and policy initiatives are needed to reduce cigarette use and its related adverse health outcomes in pregnant smokers with SUD.

COVID-19 and Fidelity to the Sobriety Treatment and Recovery Teams Model

OBJECTIVE

Quick access to substance use treatment is associated with better outcomes, but little is known about COVID-19's impact on access and retention. This study examined the relationship between COVID-19-related practice changes and quick access fidelity outcomes of the Sobriety Treatment and Recovery Teams (START) program, which serves families with co-occurring substance use and child abuse/neglect.

METHOD

This study was a retrospective cohort comparison. On March 23, 2020, most START child welfare and treatment services were shifted to a virtual format because of the COVID-19 pandemic. Families referred to the program between that date and March 23, 2021, were compared with families served the year before (i.e., March 23, 2019, to March 22, 2020). Cohorts were compared across nine fidelity outcomes (e.g., number of days to complete four treatment sessions), with differences assessed using chi-square tests and independent samples t tests.

RESULTS

Referrals to START were 14% lower during the first COVID-19 year than in the prior year, with a greater percentage of referred cases being accepted during COVID-19. Transition to virtual service provision was not related to quick access fidelity outcomes; however, adults referred in the year before COVID-19 were more likely to complete four treatment sessions than adults referred during the first COVID-19 year.

CONCLUSIONS

In this study, quick access to services and initial engagement did not appear to be negatively affected by virtual service provision resulting from COVID-19. However, during COVID-19, fewer adults completed four treatment sessions. In a largely virtual treatment environment, additional engagement and pre-treatment services may be necessary.

Cigarette smoking cessation and mental health treatment receipt in a U.S national sample of pregnant women with mental illness

OBJECTIVES

To (1) compare the probability of cigarette smoking cessation for pregnant women with and without past-year mental illness by the trimester of pregnancy; and (2) examine the association between the receipt of past-year mental health treatment and prenatal cigarette smoking cessation among pregnant lifetime-smokers with mental illness.

METHODS

We conducted secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2008-2014. The NSDUH included 2019 pregnant lifetime smokers aged 18-44 years, 528 of whom had a mental illness. We used multiple logistic regression to model the probability of prenatal cigarette smoking cessation.

RESULTS

Pregnant lifetime-smokers with mental illness had a lower rate of cigarette smoking cessation than women without mental illness (47.9% vs. 61.7%, p = 0.001). Compared to pregnant women without mental illness, pregnant women with mental illness had a significantly lower odds of smoking cessation in the first trimester (Adjusted Odds Ratio [AOR]: 0.34, 95% Confidence Interval [CI]: 0.18-0.66), but not in the second (AOR: 0.87, 95% CI: 0.46-1.63) and third trimesters (AOR: 0.94, 95% CI: 0.51-1.72). The likelihood of quitting smoking did not differ significantly for pregnant lifetime-smokers with mental illness who received and did not receive mental health treatment (AOR: 1.69, 95% CI: 0.87-3.28).

CONCLUSION

Pregnant lifetime-smokers with mental illness are less likely to quit smoking than those without mental illness; overall, pregnant women tended to quit smoking as they progressed in their pregnancy. The receipt of mental health treatment was not associated with quitting smoking. Mental health care providers need to screen for cigarette use among pregnant women and strengthen smoking cessation efforts.

CLINICAL RELEVANCE

Pregnancy presents a unique opportunity for mental health care providers to screen for cigarette use in women with mental illness and support their smoking cessation efforts.

The Sobriety Treatment and Recovery Teams program for families with parental substance use: Comparison of child welfare outcomes through 12 months post-intervention

BACKGROUND

The 2018 Family First Prevention Services Act (FFPSA) shifted child welfare funding to interventions proven effective in preserving families with parental substance use and child welfare involvement. The Sobriety Treatment and Recovery Teams (START) program serves this population with FFPSA aligned goals.

OBJECTIVE

This study was the first to test the sustained effects of START from the initial CPS report through 12-months post-intervention.

PARTICIPANTS AND SETTING

Children (n = 784) receiving START services in four sites were compared to 784 children receiving child welfare treatment as usual (TAU).

METHODS

Using child welfare administrative data, children in START were matched to children in TAU using propensity score matching. Outcomes were tested during the intervention period, and at six- and 12-months post-intervention using comparative statistics and multilevel logistic regression.

RESULTS

The odds of START children being placed in out-of-home care (OOHC) during the intervention period were half those of children in TAU (20.3% vs. 35.2%, p < .001, OR = 0.47, 95% CI [0.37, 0.59]). When placed in OOHC, START children were more likely to be reunified with their parents (p = .042, OR = 1.44, 95% CI [0.99, 1.62]). At 12-months post-intervention, 68.5% of START and 56.0% of TAU-served children remained free from both OOHC placement and child abuse and neglect (after multilevel clustering adjustment: p < .001, OR = 1.85, 95% CI [1.41, 2.43]).

CONCLUSION

The primary impact of START was significantly reduced rates of OOHC placement, with results sustained through 12-months post-intervention and after accounting for family clusters and site differences.

Comparative outcomes for Black children served by the Sobriety Treatment and Recovery Teams program for families with parental substance abuse and child maltreatment

INTRODUCTION

An urgent need exists for child welfare and substance use disorder (SUD) interventions that safely preserve Black families, engage parents in treatment services, and improve child and parent outcomes. The Title IV-E Prevention Services Clearinghouse rated The Sobriety Treatment and Recovery Teams (START) as a promising practice for families with parental substance use and child maltreatment. This study is the first to test the effects of START on Black families.

METHODS

This study compared child welfare and parent outcomes for 894 children and their 567 primary parents in three groups: Black children served by START, Black children served in treatment as usual (TAU), and White children served in START. This was a quasi-experimental study using a propensity score matched dataset of START-served children to TAU children. Comparisons included placement in state custody and repeat child abuse or neglect (CA/N) during the intervention period, and at 12 months post-intervention. Generalized linear models accounted for the effects of clustering and unbalanced covariates on outcomes.

RESULTS

In this study, 51.8% of children were neonates or infants at the CPS report. At 12-months post-intervention, 80.6% of Black children served by START, but only 56.0% of Black children in TAU, remained free of both placement in state custody and CA/N (p < .001, OR = 3.27, 95% CI [2.14, 4.98]); these effects held after controlling for family clusters. Black and White families in START received equal SUD treatment and community-based services. For START-served families, parental use of opioids (p = .005, OR = 3.52, 95% CI [1.46, 8.48]) and mental health issues (p = .002, OR = 1.90, 95% CI [1.27, 2.86]), rather than race, predicted child placement in state custody. Parent mental health issues or opioid use doubled or quadrupled, respectively, the odds of failing to achieve early recovery by case closure.

CONCLUSIONS

START is a potent intervention, co-implemented with SUD treatment providers, that kept Black children safely with their families through the intervention and 12-months post-intervention periods. Scaling up effective programs, like START, that align with the goals of the Family First Prevention Services Act might reduce racial disparities and improve child welfare and SUD treatment outcomes.

Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A randomized controlled trial

BACKGROUND

Co-occurring parental substance use and child maltreatment has increased in recent years and is associated with poor child welfare outcomes. The Sobriety Treatment and Recovery Teams (START) program was developed to meet the needs of these families.

OBJECTIVE

A randomized controlled trial was implemented to compare START to usual child welfare services on three outcomes: out-of-home care (OOHC) placements; reunification; and subsequent child maltreatment.

PARTICIPANTS AND SETTING

Families reported to child welfare services in Jefferson County, Kentucky, were eligible if they had a current finding of child maltreatment or services needed, substance use as a primary risk factor, a child under six years of age, and no other open child welfare cases.

METHODS

Biased coin randomization was used for a control: treatment randomization ratio of 1:2. Analyses were conducted using intent-to-treat (ITT), though a subsample of families receiving services was also analyzed. Differences were assessed using t-tests, chi-square, and risk ratios.

RESULTS

A total of 348 families including 526 children were randomized to START (n = 346) and usual services (n = 180). There were no significant differences between groups on the three outcomes in the ITT sample or the subsample that received services, though the START OOHC rate was 7 percentage points lower (relative difference: 21.6 %) and the reunification rate was 13 percentage points higher (relative difference: 27.6 %) in the subsample.

CONCLUSIONS

Although differences between groups were not significantly different, the relative differences were meaningful and this is the third study showing lower rates of OOHC among START relative to usual services. Additionally, the START reunification rate is higher than the overall U.S. average in spite of notable risk factors.

Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014

PURPOSE

To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014.

METHODS

Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared.

RESULTS

There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts.

CONCLUSIONS

There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.

Motivational Interviewing in Child Welfare Services: A Systematic Review

Families in the child welfare (CW) system who cannot be engaged in services are at high risk of negative outcomes. As motivational interviewing (MI) has been shown to improve engagement in similar contexts. This study aimed to systematically review MI with CW families as well as MI training with CW workers and social work students training to become CW workers. The review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched multiple databases in June 2018. In September 2019, the initial search was repeated with additional searches to identify gray literature. Eight studies described the acquisition of MI among CW workers or student trainees, and 11 studies evaluated the impact of MI on families in CW. MI's impact on some family outcomes, such as engagement in services, was mixed, though MI paired with other evidence-based treatments showed positive effects. With regard to training CW workers and students in MI, differences in training duration, intensity, and modality make conclusions difficult, though trainees generally described MI favorably and some studies showed training increased worker empathy and self-efficacy. Importantly, few published studies have evaluated whether MI-trained CW workers impact out-of-home-care placement, and no studies have evaluated their impact on maltreatment.

Peer-Led Training to Reduce Alcohol Misuse and Related Harm among Greek-Affiliated Students

High-risk alcohol use on college campuses is a significant public health concern, especially among students in fraternities and sororities. Alcohol harm-reduction programs that include protective behavioral strategies (PBSs) provide a promising approach to curb drinking among students, yet results have been inconsistent among high-risk drinkers. Purpose: To evaluate the impact of a harm-reduction, peer-led training program called "Voice of Reason" (VOR) on alcohol knowledge and behaviors among students in Greek chapters. Methods: We conducted two studies with students directly trained in VOR (Study 1: N = 118; Study 2: N = 53) and with students in affiliated Greek chapters (Study 1: N = 1363; Study 2: N = 1446). Study 1 included 13 chapters and Study 2 included 15 chapters. Results: Results of analyses across both studies showed that among those directly trained in VOR, there were pre-post increases in alcohol knowledge, medical amnesty law awareness, talking with friends about PBS, use of PBS, and intentions to use PBS, as well as pre-post decreases in drinking and driving and riding with drinking drivers. In addition, VOR had an impact on students in affiliated chapters, indicating an increase in medical amnesty law awareness and a decrease in the number of drinks consumed on a typical day. Conclusions: Overall, results provide some early evidence of VOR impact, while also demonstrating the challenge of changing normative drinking behaviors among high-risk college students. Ongoing research is needed to assess the effectiveness of VOR, especially after successive implementations with the same chapters.

Non-Prescribed Buprenorphine Use Mediates the Relationship between Heroin Use and Kratom Use among a Sample of Polysubstance Users

In Asia, Mitragyna speciosa (e.g., "kratom") has been used to mitigate alcohol and drug dependence. Some preliminary findings suggest kratom's potential use as an informal harm-reduction method in the United States, such as an opioid substitute or as a means of lessening opioid withdrawal symptoms. To determine correlates of past-year kratom use among a sample of polysubstance users enrolled in residential recovery programs in Kentucky, an anonymous survey was completed by clients in April 2017. Logistic regression was used to identify significant associations with past-year kratom use. Of the final sample (N = 478), 10.4% reported past-year kratom use. Past-year heroin use, but not past-year prescription opioid (e.g., oxycodone, hydrocodone) use, was significantly associated with kratom use, such that individuals who reported past-year heroin use were 2.5 times more likely to also report past-year kratom use. Non-prescribed buprenorphine (i.e., Suboxone) use partially mediated the relationship between past-year heroin and kratom use by explaining 36% of the association between the two drugs. Though amphetamines were highly preferred, past-year use was negatively correlated with past-year kratom use. Rates of past-year kratom use were lower than rates of alcohol and illicit drug use. Kratom was not preferred over heroin or prescription opioids.

Prevalence and Correlates of Disability Among a Sample of Victimized Women on Probation and Parole

The purpose of this exploratory study was to establish the prevalence of disability as measured by self-reported Social Security Disability Insurance (SSDI) receipt among a sample of women on probation and parole who have experienced interpersonal victimization in childhood and/or adulthood. Women receiving SSDI were more likely to be older, White, to live alone, and to score lower on measures of social support compared to women not receiving SSDI. SSDI recipients were also more likely to report poorer health, chronic pain, and more frequent health care service utilization. High rates of adverse childhood experiences, rape, adult victimization, and an overall greater severity of post-traumatic stress disorder symptomatology were observed for women receiving SSDI. Groups had similar overall mental health profiles and diverged primarily on trauma variables. Findings support the need for trauma-informed care and highlight the possibility that some criminal justice system-involved women likely qualify for SSDI, yet are not receiving it.

Past-year nonmedical use of prescription drugs among women on probation and parole: A cross-sectional study

BACKGROUND

Prescription drug-related overdose deaths have increased dramatically in recent years. Women in the justice system experience high rates of drug use, victimization, trauma symptoms, and other health problems and would appear to be at high risk for nonmedical use of prescription drugs (NMUPD). This study will be among the first to describe prevalence and correlates of NMUPD among this population.

METHODS

This cross-sectional study collected data from 406 victimized women on probation and parole between 2010 and 2012. In a multiple logistic regression model, we differentiated women who reported past-year NMUPD from those who did not using demographic, health, other drug use, substance use treatment, and trauma symptom severity variables.

RESULTS

Past-year NMUPD was reported by 26.8% (n = 109) of the overall sample. Women reporting NMUPD were significantly younger and more likely to be white. Past-year use of alcohol (adjusted odds ratio [AOR]: 3.3; 95% confidence interval [CI]: 1.8-6.1), marijuana (AOR: 3.6; 95% CI: 1.8-7.0), methamphetamines (AOR: 6.1; 95% CI: 1.7-21.3), and heroin (AOR: 8.4; 95% CI: 2.0-35.2) were significantly associated with NMUPD. Additionally, each unit increase in the measure assessing bodily pain was associated with a 40% increase (AOR: 1.4; 95% CI: 1.1-1.7) in the odds of NMUPD. Finally, meeting diagnostic criteria for posttraumatic stress disorder almost doubled (AOR: 1.9; 95% CI: 1.1-3.4) the odds of reporting past-year NMUPD.

CONCLUSIONS

Victimized women on probation and parole report high rates of NMUPD, and this behavior intersects with other complex social, behavioral, psychological, and physical needs. The authors recommend increased access to trauma-informed correctional care among women in the justice system.

A Small-Scale Investigation Into the Effect of A Larvicidal Oil On Oviposition Site Preference By Aedes aegypti

Larvicidal oils can be used to control immature Aedes aegypti and other pestiferous mosquitoes. To test whether oil-based larvicides also act as oviposition deterrents, indoor and semi-field trials were conducted at the Navy Entomology Center of Excellence in Jacksonville, FL. In both studies, treatment cages consisted of oviposition cups lined with seed germination paper as an oviposition substrate and filled with 1-wk-old southern live oak ( Quercus virginiana) leaf litter-infused water. Treatment cages consisted of 2 cups treated with CocoBear™ Mosquito Larvicidal Oil, while 2 cups were untreated. Control cages contained oviposition cups with only oak leaf litter-infused water. Gravid Ae. aegypti were released into cages and allowed to oviposit for 24 h, after which eggs were counted. The number of eggs deposited in treatment and control cages was not significantly different (indoor P = 0.0865; outdoor P = 0.9765). However, the number of eggs deposited in untreated cups was significantly greater than that deposited in treated cups within treatment cages (indoor P < 0.0001; outdoor P = 0.0050). These results suggest that the presence of the larvicidal oil CocoBear may cause gravid female Ae. aegypti to seek alternative oviposition sites.

Involuntary Civil Commitment for Substance Use Disorder: Legal Precedents and Ethical Considerations for Social Workers

Although each state in the United States legally authorizes involuntary civil commitment on the grounds of severe mental illness, a considerable number do not have comparable laws to mandate drug addiction treatment. This discrepancy is due, in part, to differing ethical positions regarding whether a substance use disorder diagnosis provides sufficient justification to suspend individual liberty rights. This article chronicles some of the legal and ethical thinking on the subject and applies them to a social work-specific context.

Nonmedical prescription opioid use among victimized women on probation and parole

BACKGROUND

Nonmedical prescription opioid use (NPOU) is a major public health concern and few studies have described this phenomenon among victimized women involved in the criminal justice system.

OBJECTIVE

This study will describe the relationship between victimization, psychological distress, health status and NPOU among the vulnerable population of victimized women on probation and parole.

METHODS

A sample of 406 women on probation and parole responded to items assessing victimization history, self-reported health status, physical pain, psychological distress, and post-traumatic stress disorder. Multiple logistic regression analysis was utilized to differentiate NPOUs versus nonusers.

RESULTS

Overall, 169 (41.6%) women reported lifetime NPOU, and 20% reported use in the past year. Compared to women who did not report NPOU, NPOUs were more likely to be White, have poorer general health, and more severe psychological distress across nine symptom domains. In multiple logistic regression models, each year of age reduced the odds of NPOU by 4%; White women were twice as likely as women of other races to report NPOU; each unit increase in the measure for physical pain was associated with a 30% increase in the odds of NPOU; and participants who met diagnostic criteria for PTSD were 60% more likely to report NPOU compared to individuals who did not.

CONCLUSION

Victimized women on probation and parole report high rates of NPOU and comorbid mental and physical health problems. The criminal justice system should routinely screen for NPOU, as well as untreated or poorly managed physical pain and psychological distress, which may increase risk of NPOU.

Psychological distress among victimized women on probation and parole: A latent class analysis

Latent class analysis was used to identify subgroups of victimized women (N = 406) on probation and parole differentiated by levels of general psychological distress. The 9 primary symptom dimensions from the Brief Symptom Inventory (BSI) were used individually as latent class indicators (Derogatis, 1993). Results identified 3 classes of women characterized by increasing levels of psychological distress; classes were further differentiated by posttraumatic stress disorder symptoms, cumulative victimization, substance use and other domains of psychosocial functioning (i.e., sociodemographic characteristics; informal social support and formal service utilization; perceived life stress; and resource loss). The present research was effective in uncovering important heterogeneity in psychological distress using a highly reliable and easily accessible measure of general psychological distress. Differentiating levels of psychological distress and associated patterns of psychosocial risk can be used to develop intervention strategies targeting the needs of different subgroups of women. Implications for treatment and future research are presented.

Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes

BACKGROUND

Although integrated programs between child welfare and substance abuse treatment are recommended for families with co-occurring child maltreatment and substance use disorders, implementing integrated service delivery strategies with fidelity is a challenging process.

OBJECTIVE

This study of the first five years of the Sobriety Treatment and Recovery Team (START) program examines implementation fidelity using a model proposed by Carroll et al. (2007). The study describes the process of strengthening moderators of implementation fidelity, trends in adherence to START service delivery standards, and trends in parent and child outcomes.

METHODS

Qualitative and quantitative measures were used to prospectively study three START sites serving 341 families with 550 parents and 717 children.

RESULTS

To achieve implementation fidelity to service delivery standards required a pre-service year and two full years of operation, persistent leadership, and facilitative actions that challenged the existing paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.

Sobriety Treatment and Recovery Teams in Rural Appalachia: Implementation and Outcomes

The Sobriety Treatment and Recovery Teams (START) model is designed for families with co-occurring substance use and child maltreatment. This study describes the implementation and outcomes of START in a rural Appalachian county with high rates of poverty, non-medical prescription drug use, and child maltreatment. Despite a severely limited addiction treatment infrastructure at baseline, children served by START were less likely to experience recurrence of child abuse or neglect within 6 months or re-enter foster care at 12 months compared with a matched control group.

Substance use among victimized women on probation and parole

Victimized women within the criminal justice system are an important group and understanding their substance use is critical. Substance use was examined among 406 victimized women on probation and parole in an urban community from 2010 to 2013. Ninety-three percent reported lifetime use of an illicit substance, whereas 58% and 45% reported use of at least one illicit substance in the past 2 years and 12 months, respectively. Among probationers, having been in a controlled environment was associated with a higher prevalence of illicit substance use as compared to parolees. Implications for practice, policy, and future research are discussed.

Factors associated with high-frequency illicit methadone use among rural Appalachian drug users

BACKGROUND

In recent years there has been a sharp increase in the use of illicit methadone as well as methadone-related overdose deaths.

OBJECTIVE

The purpose of this study was to describe factors associated with low- and high-frequency methadone use in a cohort of rural Appalachian drug users.

METHODS

Interviews assessing sociodemographics, illicit drug use and drug treatment, psychiatric disorders, health and sociometric drug network characteristics were conducted with 503 rural drug users between 2008 and 2010. A two-level mixed effects regression model was utilized to differentiate low- (one use per month or less in the past six months) versus high-frequency (daily or weekly use in the past six months) illicit methadone users.

RESULTS

The lifetime prevalence of illicit methadone use in this population was 94.7% (n = 476) and slightly less than half (46.3%) were high-frequency users. In the mixed effects regression model, initiating illicit methadone use at a younger age was associated with high-frequency illicit methadone use. Taking a prescribed medication for a physical problem, undergoing additional weeks of outpatient drug free treatment, daily OxyContin® use in the past month, and having fewer ties and second-order connections in the drug network reduced the odds of high-frequency illicit methadone use.

CONCLUSIONS

Rates of illicit methadone use and high-frequency illicit methadone use among this sample of rural drug users were considerably higher than those previously reported in the literature. Health practitioners in rural areas should routinely screen for illicit opioid use, including methadone.

Risky relationships: targeting HIV prevention for women offenders

HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.

Prescription drug misuse among antisocial youths

OBJECTIVE

The aim of this study was to describe the prevalence and correlates of nonmedical prescription drug misuse (PDM) in a state population of youths in residential care for antisocial behavior.

METHOD

Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youths. Participants were predominantly male (87.0%), averaged 15.5 (SD = 1.2) years of age, and constituted 97.7% of the service population sampled.

RESULTS

Overall, 314 youths (43.4%) reported lifetime PDM; 33.7%, 32.0%, and 11.2% had misused prescription opioids, tranquilizers, and barbiturates, respectively. Prescription drug misusers were significantly older, and larger proportions were girls, were White, and resided in small towns, compared with non-prescription drug misusers. Prescription drug misusers evidenced significantly more varied, frequent, and problematic psychoactive drug use; evidenced higher levels of distressing psychiatric symptoms; and were nearly twice as likely to have been diagnosed with a psychiatric disorder, compared with non-prescription drug misusers. Traumatic life events, experiences of criminal victimization, and suicidal ideation were significantly more prevalent in the histories of prescription drug misusers, compared with non-prescription drug misusers. In multiple logistic regression models, older age; White racial status; prior inhalant, marijuana, and LSD (lysergic acid diethylamide) use; residence in a small town; and impulsivity were associated with increased risk for PDM.

CONCLUSIONS

Adolescents in residential care for antisocial behavior have high rates of PDM, as well as comorbid psychiatric and behavioral problems. Youths served in institutional settings should be routinely screened and treated for PDM and co-occurring disorders.

Subtypes of adolescent sedative/anxiolytic misusers: A latent profile analysis

BACKGROUND

Few empirically-based taxonomies of nonmedical prescription drug misusers have been published. This study used latent profile analysis (LPA) to identify classes of adolescent sedative/anxiolytic misusers.

METHODS

Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youth in residential care for antisocial behavior. Sedative/anxiolytic misusers (N=247) averaged 15.8 (S.D.=1.1) years of age; a majority were male (83.8%), White (70.0%), and resided in rural/small town areas (53.8%).

RESULTS

LPA yielded a three-class solution. Class 1 (59.1%) was comprised of youth with significantly lower levels of currently distressing psychiatric symptoms, fewer lifetime traumatic experiences, less problematic substance use histories, less frequent antisocial behavior, and less impulsivity than youth in Classes 2 and 3. Class 2 (11.3%) youth had high levels of currently distressing psychiatric symptoms and more frequent antisocial behavior compared to youth in Classes 1 and 3. Class 3 (29.5%) youth evidenced levels of psychiatric and behavioral problems that were intermediate to those of Class 1 and 2 youth. Frequency of sedative/anxiolytic misuse was significantly higher in Classes 2 and 3 compared to Class 1. Members of Class 2 and Class 3 also had the highest levels of psychiatric symptoms for which sedatives/anxiolytics are commonly prescribed. Significant differences between classes were observed across a range of health, mental health, personality, and behavioral variables.

CONCLUSIONS

Adolescents who misused prescription sedatives/anxiolytics evidenced significant heterogeneity across measures of psychiatric and behavioral dysfunction. Youth with comparatively high levels of anxiety and depression reported significantly more intensive sedative/anxiolytic misuse than their counterparts and may be at high risk for sedative/anxiolytic abuse and dependence.

Noradrenaline sensitivity and calcium fluxes in arteries from rabbits with perinephritis hypertension

1. Contractions of isolated vascular and cardiac preparations taken from rabbits with perinephritis (one kidney, one wrapped) hypertension were compared with those of preparations from control operated animals. 2. Significantly increased sensitivity to noradrenaline, which acts on alpha 1-adrenoceptors, was found in mesenteric arterial rings but not in aortic rings. The degree of hypersensitivity was the same in the presence and absence of cocaine, suggesting that there is no increase in uptake of noradrenaline into adrenergic nerves in this model of hypertension. In contrast to these agonist-induced contractions, no increased sensitivity was found to potassium chloride, suggesting that hypersensitivity is specific for receptor mediated rather than membrane potential mediated effects. 3. No hypersensitivity to noradrenaline was found in the isolated left or right atria, which suggests that the hypertension is associated with changes in excitation-contraction coupling in blood vessels but not in cardiac muscle. 4. Hypertension increased basal 45Ca uptake in the mesenteric artery but not in the aorta. However, there was no significant difference between preparations from normotensive and hypertensive rabbits in 45Ca uptake or efflux stimulated by noradrenaline or KCl. 5. Increased basal 45Ca uptake could contribute to the increased sensitivity to noradrenaline found in the mesenteric artery in rabbit perinephritis hypertension.

Changes in zinc metabolism following exercise in human subjects

Changes in zinc (Zn) availability in muscle tissue that influence muscle performance in vitro have been observed. The effect of exercise of plasma Zn levels and urinary excretion of Zn was observed in sever untrained volunteers following brief intensive exercise and in seven trained volunteers after more prolonged road-running exercise. With brief exercise, plasma Zn decreased predominantly in the more loosely bound albumin fraction. Prolonged exercise resulted in a greater plasma Zn decrease of 30%. Urinary Zn excretion increased transiently with minimal effect on daily losses. However, weight loss by sweating was significant, and sweat Zn losses were greater than those in the urine. Exercise resulted in changes in Zn metabolism that may influence performance.

The effect of anesthetic agents on zinc metabolism in the rat liver

The administration of nembutal and chloral hydrate anesthetic agents in the rat produces an increase in the uptake of zinc, as Zn-65, in the liver. Associated with this is the appearance of a low-molecular-weight Zn-binding protein in the soluble cytosol fraction. This protein is comparable to that induced by the stress of severe exercise, by burn injury, and by Zn injection, and is probably Zn metallothionein. This is an example of the induction of a Zn binding protein in the liver by a drug, and confirms that anesthesia significantly effects Zn metabolism in the liver. Consequently this effect of anesthetic agents should be taken into account in the investigation of the regulation of Zn metabolism.

Zinc as an integral component of the metabolic response to trauma

Following injury, there is a major redistribution of zinc, as demonstrated by 65Zn tracer studies in rats receiving 20 per cent burns. This injury resulted in a rapid uptake of 65Zn into spleen, lung, wound, kidney and, particularly, liver, while the uptake of 65Zn was decreased in the brain, some muscle groups and, particularly, in bone. Simultaneously, plasma 65Zn occurred predominantly as the albumin bound fraction decreased. The total amount of tracer appearing in the wound was considerably less than that in the liver, where the induction of zinc binding protein was demonstrated in the cytosol. The synthesis of this protein may have an important regulatory role in zinc homeostasis following injury. These widespread changes in 65Zn distribution are consistent with the essential role of zinc in numerous metabolic processes and the increased metabolic activity of such tissues as the liver and the wound that follows injury. It is apparent that the liver has a central role in the early postinjury changes in zinc metabolism and that bone as well as muscle provides an available source of zinc in these circumstances.

The effects of glycerol detubulation, of manganese ions, of dantrolene and of nitrate ions on the responses of isolated chronically denervated soleus muscles of the mouse to acetylcholine

1 In the isolated chronically denervated soleus muscle of the mouse acetylcholine produced a biphasic contraction. 2 In muscles detubulated by glycerol treatment, the first phase of the acetylcholine contraction was almost abolished, but the second was only slightly reduced or was unaffected. 3 Manganese ions (10 mM) reduced the first phase of the acetylcholine response, but enhanced the second. 4 Dantrolene sodium (5.94 x 10(-5) M) reduced the first phase of the acetylcholine response, but not the second. 5 Nitrate ions (118 mM) augmented the first phase but not the second. 6 It was concluded that the first phase requires the excitation-contraction-coupling sequence: membrane depolarization-T-tubules-Ca2+ release from sarcoplasmic reticulum. In contrast, the second phase appears to occur independently of these processes.

The role of extracellular calcium in the contractions produced by acetylcholine in chronically denervated muscle

1 Acetylcholine-induced contractions of the isolated chronically denervated soleus muscle of the mouse consist of two phases, but both phases are equivalent to the contracture phase seen in vivo.2 Low [Ca(2+)](0) (0.5-1.5 mM) augmented peak tension, as well as the rate of relaxation, of the first phase, but inhibited the second phase. Ethyleneglycol-bis-(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA) or La(3+) (2 mM) also inhibited the second phase, but not the first.3 It was concluded that the first phase requires Ca(2+) release from the sarcoplasmic reticulum, and is terminated by inactivation of the contractile process. The second phase is caused by the entry of activator Ca(2+) from the extracellular space.4 Increasing [Ca(2+)](o) to 5 or 10 mM after the addition of acetylcholine caused a contraction, starting after a delay of about 50 seconds. EGTA or La(3+) added during the second phase of the acetylcholine contraction caused relaxation after a much shorter lag time.5 It is concluded that most of the Ca(2+) entering from the extracellular fluid is taken up by the sarcoplasmic reticulum.6 The acetylcholine second phase was augmented in low (25 mM) [Na(+)](0). It is concluded that Na(+) and Ca(2+) compete for the acetylcholine controlled ionic channels.7 Isolated chronically denervated diaphragm muscles were less sensitive to acetylcholine and the contraction usually consisted of a first phase only.8 It is concluded that sequestration of Ca(2+) entering from the extracellular fluid is more complete in the diaphragm.

Desensitization in the innervated and in the chronically denervated soleus muscle of the mouse

1 A study was made of desensitization in chronically denervated and in normally innervated mouse soleus muscles. 2 Very high concentrations of acetylcholine produced small contractions of the innervated muscles; these were reduced in size when the addition was repeated 1 min after wash-out. 3 Desensitization in innervated muscles was receptor specific: contractions in response to KCl and caffeine were not reduced following acetylcholine, nor did KCl produce desensitization. 4 In chronically denervated muscles non-specific desensitization was observed if acetylcholine was added in the presence of low concentrations of acetylcholine or carbachol. Contractions to KCl but not to caffeine were reduced. KCl produced a similar kind of desensitization. 5 After washing out moderate or supramaximal concentrations from the chronically denervated muscle no desensitization was observed. However, 1 min after washout of very high concentrations the muscle was non-specifically desensitized. 6 It is concluded that relatively high concentrations of acetylcholine are required to produce specific desensitization in the soleus muscle. Chronically denervated muscles, being supersensitive, show non-specific loss of sensitivity with concentrations of acetylcholine too low to produce specific desensitization.

Dependence of -adrenoceptor mediated mechanical effects on the glycogen concentration in the rabbit isolated small intestine

In the rabbit isolated intestine, tachyphylaxis was evident in the inhibitory responses to isoprenaline, but not in those to phenylephrine, ATP or dibutyryl cyclic AMP. The tachyphylaxis to isoprenaline was associated with a spontaneous fall in the tissue glycogen concentration and was enhanced when the glycogen concentration was markedly reduced by incubation of the tissue under anaerobic conditions in glucose-free Krebs solution. Doubling the glucose concentration of the Krebs solution slowly restored the response to isoprenaline and prevented the development of tachyphylaxis to it. The results support the concept that the beta-adrenoceptor mediated response is dependent on some product of cellular metabolism.

Inhibition of rabbit intestine mediated by alpha- and beta-adrenoceptors

1. The effects of some alpha- and beta-adrenoceptor agonists and antagonists were studied on isolated segments of rabbit intestine in an attempt to characterize the two types of inhibitory response produced by sympathomimetic amines.2. Phenylephrine, an alpha-adrenoceptor agonist, produced an inhibition of rapid onset, from which recovery occurred despite the continued presence of the drug. On washout there was an overshoot in contraction height. Isoprenaline, a beta-adrenoceptor agonist, produced an inhibition of slow onset which was maintained throughout the presence of the drug and there was no overshoot on washout.3. Adrenaline resembled phenylephrine more closely than it resembled isoprenaline, in that it showed more affinity for alpha-adrenoceptors, whereas noradrenaline, and the transmitter released on periarterial nerve stimulation, behaved more like isoprenaline, although both types of receptor were affected.4. Adenosine-5'-triphosphate produced an inhibition resembling that produced by an alpha-adrenoceptor agonist, whereas the dibutyryl analogue of cyclic adenosine 3',5'-monophosphate (cyclic 3',5'-AMP) produced an inhibition resembling that produced by a beta-adrenoceptor agonist.5. In critical concentrations theophylline augmented and imidazole inhibited beta-adrenoceptor mediated responses, as well as responses to dibutyryl cyclic AMP. However, additional actions of theophylline and imidazole were also demonstrated.6. Responses mediated by alpha-adrenoceptors, but not those mediated by beta-adrenoceptors, were blocked by membrane stabilizers, quinidine being the most potent of those studied.7. The results are discussed in relation to the possible mechanisms of action of alpha- and beta-adrenoceptor agonists.