Examining Risk for Frequent Cocaine Use: Focus on an African American Treatment Population

BACKGROUND:

Cocaine use and its consequences are disproportionately higher and more severe among African Americans compared to other ethnic/racial groups.

OBJECTIVES:

The aims of this study were to examine a risk model specific for African American users and assess whether risk varies as a function of sex.

METHODS:

270 African American adults in a residential drug treatment facility completed measurements assessing first and past year crack/cocaine use frequency, childhood trauma, and stress reactivity. Multiple linear regression analysis was used to examine the unique effect of each predictor variable on past year crack/cocaine frequency. Sex was included as a moderator variable in the regression analysis.

RESULTS:

All predictor variables were positively correlated with past year crack/cocaine use. However, sex differences were also observed: females reported higher rates of childhood emotional abuse, childhood sexual abuse, and stress reactivity-as well as past year crack use and cocaine use-than males. Regression analyses were performed with sex, first year use, and stress reactivity emerging as the only significant predictors for frequency of crack and cocaine use among all study participants. Moreover, sex differences were observed in the influence of first year crack use frequency on past year crack use frequency, such that the effect was stronger for males than for females. Conclusion/Importance: This study offers a clearer understanding of the risk factors for crack and cocaine abuse specific to African Americans, as well as sex specific pathways to risk, providing useful implications for future prevention and treatment efforts.

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By:  Zapolski TC1, Baldwin P1, Lejuez CW2.

• 1 Department of Psychology , Indiana University Purdue University-Indianapolis , Indianapolis , Indiana , USA.
• 2 Department of Psychology , University of Maryland , College Park , Maryland , USA. 
• Subst Use Misuse. 2016 Apr 21:1-10. 

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The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND:

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES:

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS:

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS:

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS:

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

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By:  Cheney AM¹, Booth BM², Borders TF³, Curran GM⁴.

¹ Center for Healthy Communities , University of California Riverside , Riverside , California , USA.

² Division of Health Services Research , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

³ Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA.

⁴ Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

Subst Use Misuse. 2016 Apr 20:1-11.

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Prompted to Treatment by the Criminal Justice System: Relationships with Treatment Retention & Outcome among Cocaine Users

BACKGROUND AND OBJECTIVES:

A substantial portion of individuals entering treatment for substance use have been referred by the criminal justice system, yet there are conflicting reports regarding treatment engagement and outcome differences compared to those not referred. This study examined baseline characteristic and treatment outcome differences among cocaine-dependent individuals participating in cocaine treatment randomized trials.

METHODS:

This secondary analysis pooled samples across five completed randomized controlled trials, resulting in 434 participants. Of these, 67 (15%) were prompted to treatment by the criminal justice system.

RESULTS:

This subsample of criminal justice prompted (CJP) individuals did not differ from those not prompted by the criminal justice system in terms of gender, race/ethnicity, marital status, or age. However, the CJP group reported more years of regular cocaine use, more severe employment and legal problems, as well as less readiness to change prior to treatment. Treatment outcomes did not differ significantly from those without a criminal justice prompt, and on some measures the outcomes for CJP group were better (e.g., percentage of days cocaine abstinent, number of therapy sessions attended).

DISCUSSION AND CONCLUSIONS:

These findings suggest that being prompted to treatment by the criminal justice system may not lead to poorer treatment engagement or substance use outcomes for individuals participating in randomized controlled treatment trials.

SCIENTIFIC SIGNIFICANCE:

Despite some baseline indicators of poorer treatment prognosis, individuals who have been prompted to treatment by the criminal justice system have similar treatment outcomes as those presenting to treatment voluntarily.

Within treatment outcomes according to criminal justice prompt

	Prompted by Criminal Justice System (CJP) N = 67	Not Prompted by Criminal Justice System (non-CJP) N = 367	Total N = 434
	Mean (SD)	Mean (SD)	Mean (SD)	X2 or F
Days retained in treatment protocol	55.4 (29.3)	53.4 (33.1)	53.7 (32.5)	0.22
Completed treatment period, n (%)	36 (53.7)	186 (51.0)	222 (51.4)	0.68
Percentage of cocaine positive urine specimens	55 (37)	62 (37)	61 (37)	1.43
Percentage of days abstinent from cocaine	83 (19)	74 (26)	76 (25)	6.27*
Maximum consecutive days abstinent	24 (20.6)	22.3 (24.9)	22.6 (24.2)	0.25
Maximum days of continuous abstinence during last two weeks of treatment	10 (4.0)	8.3 (4.7)	8.6 (4.6)	4.65*
3+ weeks of continuous abstinence, n (%)	31 (46.3)	149 (40.8)	180 (41.7)	0.69
‘Good Functioning’ = zero cocaine use, employment, or psychological problems last 28 days of treatment, n (%)a	4 (7.5)	48 (14.5)	52 (13.5)	1.89

*p<.05

**p<.01

***p<.001

asample size reduced due to missing data

Full article at:   http://goo.gl/DiHFbZ

By:  Kiluk BD1, Serafini K, Malin-Mayor B, Babuscio TA, Nich C, Carroll KM.

• 1Yale University School of Medicine, New Haven, Connecticut. 
• Am J Addict. 2015 Apr;24(3):225-32. doi: 10.1111/ajad.12208. Epub 2015 Mar 24.

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Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

HIGHLIGHTS

• XR-NTX begun during opioid detoxification can be continued in primary care settings.
• 55% of XR-NTX recipients link to primary care for continued treatment.
• We found no predictors of XR-NTX continuation in primary care.

INTRODUCTION:

Opioid use disorders commonly require ongoing medication-assisted treatment to reduce relapse following discharge from inpatient detoxification programs. Naltrexone, an opioid antagonist, is an increasingly popular treatment option in its once-monthly injectable form (XR-NTX). The aim of this study was to examine the follow-up rates of persons who received an initial injection during inpatient detoxification and scheduled for receipt of a first outpatient injection in the primary care setting.

METHODS:

We reviewed the electronic health records of 62 consecutive opioid dependent adults who received an initial injection of XR-NTX during extended inpatient detoxification at Stanley Street Treatment and Resources (SSTAR) in Fall River, Massachusetts, from March 2013 to August 2015, and were referred to the adjacent SSTAR primary care health center for their second injection 1month later. Demographic information, drug use and opioid treatment history, and aftercare planning were assessed.

RESULTS:

Participants averaged 32.4 (±7.8) years of age, 90.3% were non-Latino Caucasian, 35.5% were homeless, 21.3% reported a drug overdose in the last year, and 53.2% had been in detoxification within the last year. Of the 62 participants referred to primary care, 34 (54.8%) followed up to receive their second XR-NTX injection. Twenty of these persons received at least a third XR-NTX injection. No demographic, treatment history, substance use behaviors, or aftercare plan variables were associated with receipt of a second injection (p<.20).

CONCLUSION:

Predicting, and therefore improving, XR-NTX continuation during the transition from inpatient detoxification to primary care may be difficult in this population.

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By:  Stein MD1, Risi MM2, Bailey GL3, Anderson BJ2.

• 1General Medicine Research Unit, Butler Hospital, Providence, RI, 02906; Warren Alpert Medical School of Brown University, Providence, RI, 02912. Electronic address: michael_stein@brown.edu.
• 2General Medicine Research Unit, Butler Hospital, Providence, RI, 02906.
• 3Warren Alpert Medical School of Brown University, Providence, RI, 02912; Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts, 02720. 
• J Subst Abuse Treat. 2016 May;64:44-6. doi: 10.1016/j.jsat.2016.01.007. Epub 2016 Feb 23.

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Residential & Outpatient Treatment Completion for Substance Use Disorders In the U.S.

BACKGROUND:

This study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States.

METHODS:

This is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression.

RESULTS:

Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively.

CONCLUSION:

We speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

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By:  Stahler GJ¹, Mennis J², DuCette JP³.

¹Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jstahler@temple.edu.

²Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jmennis@temple.edu.

³Department of Psychological Studies in Education, Temple University, Philadelphia, PA 19122, United States. Electronic address: jducette@temple.edu.

Addict Behav. 2016 Jul;58:129-35. doi: 10.1016/j.addbeh.2016.02.030. Epub 2016 Feb 17.

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An Effective Web Presence for Substance Abuse Treatment Facilities

BACKGROUND:

Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page.

OBJECTIVES:

The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry.

METHODS:

This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score.

RESULTS:

The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites.

CONCLUSIONS:

The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.

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By:   Link TW1,2, Hefner JL3, Ford EW4, Huerta TR5.

• 1 Department of Management , University of North Carolina at Greensboro , Greensboro , North Carolina , USA.
• 2 Department of Health Policy and Management , The George Washington University , Washington, DC , USA.
• 3 Family Medicine, The Ohio State University , Columbus , Ohio , USA.
• 4 Bloomberg School of Public Health, Johns Hopkins University , Baltimore , Maryland , USA.
• 5 Departments of Family Medicine and Biomedical Informatics , Ohio State University Medical Center , Columbus , Ohio , USA.
• Subst Use Misuse. 2016 Mar 24:1-4.  

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Personal Networks of Women in Residential & Outpatient Substance Abuse Treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. 

The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. 

Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. 

These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse...

Upon treatment entry, women report child related concerns, psychosocial difficulties, physical/sexual abuse, health issues and mental health problems to a far greater degree than their male counterparts (Wechsberg et al., 1998). These complex problems present difficulties for women in accessing social support and developing supportive personal network relationships (Tracy & Martin, 2007), thereby compromising their recovery (Warren, Stein, & Grella, 2007; Wenzel, Tucker, Golinelli, Green, & Zhou, 2010). Although different clinical profiles have been identified between women in residential and outpatient substance abuse treatment, no previous studies have examined or identified differences in personal network characteristics between these two groups of women. The purpose of this study was to identify differences in personal network characteristics between women entering residential substance abuse treatment and those entering intensive outpatient treatment. A deeper understanding of these differences may add an important dimension to substance abuse treatment planning, and may be utilized to inform treatment interventions for women in residential and outpatient treatment settings.

Clinical characteristics by treatment modality (N = 377).

	n (%)
	Residential (n = 119)	Outpatient (n = 258)	χ2 or t	p
Substance use disorder (SUD)
Marijuana	44 (37.9)	105 (41.0)	0.32	0.574
Amphetamine	3 (2.6)	1 (0.4)	3.62	0.092†
Sedatives	5 (4.3)	14 (5.5)	0.22	0.638
Cocaine	78 (67.2)	135 (52.7)	6.87	0.009
Opiates	35 (30.2)	51 (19.9)	4.72	0.030
Hallucinogens	0 (0.0)	9 (3.5)	4.18	0.062†
Inhalants	0 (0.0)	1 (0.4)	0.45	>0.999†
Phencyclidine	3 (2.6)	9 (3.5)	0.22	0.761†
Alcohol	63 (54.3)	112 (43.8)	3.57	0.059
Multiple SUD (yes)	74 (63.8)	132 (51.8)	4.67	0.031
Mental health disorder
Generalized anxiety	21 (17.6)	68 (26.5)	3.50	0.062
Posttraumatic	39 (32.8)	108 (42.0)	2.92	0.087
Major depressive episode	68 (57.1)	149 (58.0)	0.02	0.879
Dysthymia	5 (4.2)	7 (2.7)	0.57	0.531†
Manic episode	27 (22.7)	91 (35.4)	6.11	0.013
Hypomanic episode	9 (7.6)	31 (12.1)	1.73	0.188
Dual diagnosis	89 (74.8)	186 (72.7)	0.19	0.664
Previous treatment	90 (75.6)	185 (72.3)	0.47	0.493
HIV test result (positive)	1 (0.9)	5 (2.0)	0.66	0.669†
Multiple chronic health condition (2 or more)	26 (22.0)	65 (25.2)	0.44	0.507
Trauma symptom checklist, M(SD)	49.40 (20.94)	42.51 (21.29)	2.93	0.004

†Fisher’s Exact Test.

Full article at:   http://goo.gl/lxtcy6

By:  HyunSoo Kim,1 Elizabeth Tracy,2 Suzanne Brown,3 MinKyoung Jun,4 Hyunyong Park,2 Meeyoung Min,2 and Chris McCarty5

¹Department of Social Welfare, Dongguk University, Gyeongju-si, Republic of Korea

²The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA

³School of Social Work, Wayne State University, Detroit, MI, USA

⁴Gyeonggido Family & Women’s Research Institute, Gyeonggido, Suwon, Republic of Korea

⁵Survey Research Center, University of Florida, Gainsville, FL, USA

Correspondence: Dr Elizabeth Tracy, The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland 44106, OH

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