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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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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John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. 

The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. 

The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. 

Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. 

Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

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By:  Stevens-Watkins D1, Knighton JS2, Allen K3, Fisher S2, Crowell C2, Mahaffey C2, Leukefeld C2, Oser C2.

• 1University of Kentucky. Electronic address: d.stevenswatkins@uky.edu.
• 2University of Kentucky.
• 3Florida State University. 
• J Subst Abuse Treat. 2016 Apr;63:54-60. doi: 10.1016/j.jsat.2016.01.004. Epub 2016 Jan 15.

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A Retrospective & Prospective Analysis of Trading Sex for Drugs or Money in Women Substance Abuse Treatment Patients

BACKGROUND:

Trading sex for drugs or money is common in substance abuse treatment patients, and this study evaluated prevalence and correlates of this behavior in women with cocaine use disorders initiating outpatient care. In addition, we examined the relation of sex trading status to treatment response in relation to usual care versus contingency management (CM), as well as predictors of continued involvement in sex trading over a 9-month period.

METHODS:

Women (N=493) recruited from outpatient substance abuse treatment clinics were categorized according to histories of sex trading (n=215, 43.6%) or not (n=278).

RESULTS:

Women with a history of trading sex were more likely to be African American, older and less educated, and they had more severe employment problems and were more likely to be HIV positive than those without this history. Controlling for baseline differences, both groups responded equally to substance abuse treatment in terms of retention and abstinence outcomes. Fifty-four women (11.3%) reported trading sex within the next nine months. Predictors of continued involvement in trading sex included a prior history of such behaviors and achieving less abstinence during treatment. Each additional week of abstinence during treatment was associated with a 16% reduction in the likelihood of trading sex over the follow-up.

CONCLUSIONS:

Because over 40% of women receiving community-based treatment for cocaine use disorders have traded sex for drugs or money and more than 10% persist in the behavior, more intensive and directed approaches toward addressing this HIV risk behavior are recommended.

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By:  Rash CJ1, Burki M2, Montezuma-Rusca JM3, Petry NM2.

• 1UConn Health, 263 Farmington Avenue (MC 3944), Farmington, CT 06030, United States. Electronic address: rashc@uchc.edu.
• 2UConn Health, 263 Farmington Avenue (MC 3944), Farmington, CT 06030, United States.
• 3Community Health Services, 500 Albany Avenue, Hartford, CT 06120, United States. 
• Drug Alcohol Depend. 2016 Mar 16. pii: S0376-8716(16)00146-0. doi: 10.1016/j.drugalcdep.2016.03.006.

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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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HIV Risk Behavior among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. 

This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. 

Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

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By:  Meade CS1,2, Lion RR3, Cordero DM3, Watt MH3, Joska JA4, Gouse H4, Burnhams W5.

• 1Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Box 90519, Durham, NC, 27708, USA. christina.meade@duke.edu.
• 2Duke Global Health Institute, Durham, NC, USA. christina.meade@duke.edu.
• 3Duke Global Health Institute, Durham, NC, USA.
• 4Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 5City Health, City of Cape Town, Cape Town, South Africa. 
• AIDS Behav. 2016 Feb 12.

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Project ECHO: A New Model for Educating Primary Care Providers About Treatment of Substance Use Disorders

BACKGROUND:

Project ECHO trains and mentors primary care providers (PCPs) in the care of patients with complex conditions. ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. We describe a teleECHO clinic based at the University of New Mexico Health Sciences Center that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders.

METHODS:

Since 2005, specialists in treatment of SUDs and behavioral health disorders at Project ECHO have offered a weekly 2-hour Integrated Addictions and Psychiatry (IAP) TeleECHO Clinic focused on supporting PCP evaluation and treatment of SUDs and behavioral health disorders. We tabulate the number of teleECHO clinic sessions, participants, and CME/CEU credits provided annually. This teleECHO clinic has also been used to recruit physicians to participate in DATA-2000 buprenorphine waiver trainings. Using a database of the practice location of physicians who received the buprenorphine waiver since 2002, we calculate the number of waivered physicians per capita in US states. We evaluate the increase in waivered physicians practicing in underserved areas in NM compared to the rest of the US.

RESULTS:

Since 2008, approximately 950 patient cases have been presented during the teleECHO clinic, and more than 9000 hours of CME/CEU have been awarded. Opioids are the substances discussed most commonly (31%), followed by Alcohol (21%) and Cannabis (12%). New Mexico is near the top among US states in DATA-2000 buprenorphine waivered physicians per capita, and has had much more rapid growth in waivered physicians practicing in traditionally-underserved areas compared with the rest of the US since the initiation of the teleECHO clinic focused on SUDs in 2005.

CONCLUSION:

The ECHO model provides an opportunity to promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.

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By:  Komaromy M1, Duhigg D1, Metcalf A2, Carlson C1, Kalishman S1, Hayes L3, Burke T1, Thornton K1, Arora S1.

• 1 ECHO Institute, University of New Mexico Health Sciences Center, University of New Mexico , Albuquerque , NM , USA.
• 2 Truman Clinic, University Hospital , Albuquerque , NM , USA.
• 3 El Centro Family Health Center , Espanola , NM , USA.
• Subst Abus. 2016 Feb 5:0. 

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Heterosexual Anal Sex among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials

Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. 

This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. 

The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.

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By:  Hatch-Maillette MA1, Beadnell B2, Campbell AN3, Meade CS4, Tross S3, Calsyn DA1.

• 1 Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences , University of Washington.
• 2 School of Social Work , University of Washington.
• 3 Columbia University Medical Center, New York State Psychiatric Institute and Mount Sinai St. Luke's Hospital, Duke University.
• 4 Department of Psychiatry and Behavioral Sciences , Duke University.
• J Sex Res. 2016 Jan 28:1-9.  

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What Do We Know Now About the Impact of the Laws Related to Marijuana?

OBJECTIVES:

This study presents information on the status and impact of medical and legalized marijuana, and the latest data on attitudes and prevalence of use since implementation of these laws. Recent reports from epidemiologists in Denver and Seattle are summarized to give the readers a sense of the changes as these laws have taken effect in their communities.

METHODS:

The status of these laws is reviewed and the results of surveys taken before and after the laws were enacted are presented, along with data on changing potency and driving under the influence of marijuana.

SUMMARY:

Prevalence of use by youths has not increased, but their negative attitudes towards the risk of using marijuana have decreased, and use by adults has increased. Potency continues to increase, as has the proportion of drivers testing positive for use of the drug. Data from Denver show increases in hospital admissions, emergency department visits, and calls to poison centers, with decreasing arrests and admissions to substance abuse treatment programs. Data from the Seattle area show similar decreases in treatment admissions and police involvement, but also increased prevalence of more frequent use.

CONCLUSIONS:

Current data suggest that increases in marijuana use preceded legalization in 2012. Treatment admissions were declining before these laws, but some indicators of morbidity seem to be increasing subsequent to legalization, with modest increases in poison center calls in both states and increases in acute medical visits in Denver. Data are needed to understand the relationship between the patterns and amounts of use in terms of consequences, and data on the health conditions of those receiving medical marijuana and the impact of higher potency.

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By:  Maxwell JC1, Mendelson B.

• 1Center for Social Work Research (JCM); Denver Office of Drug Strategy, 1200 Federal Boulevard, Denver, Colorado (BM). 

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Web-Based Cognitive Behavioral Relapse Prevention Program with Tailored Feedback for People with Methamphetamine and Other Drug Use Problems: Development and Usability Study

BACKGROUND:

Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches.

OBJECTIVE:

The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability.

METHODS:

We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions.

RESULTS:

In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested.

CONCLUSIONS:

The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.

Below:  Video page screenshot

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

By:  Takano A¹, Miyamoto Y, Kawakami N, Matsumoto T.

¹Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan. ayumi-takano@umin.ac.jp.

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