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How do gunshot victims manage pain without health care? This paper examines this question through ethnographic data of a single gunshot victim who self-medicated with Percocet. The observations for this paper were collected in Philadelphia between January of 2010 and October of 2011, and were part of a larger ethnographic study that included 40 gunshot victims recruited from an outpatient trauma clinic. Although this victim was able to manage his pain, he ultimately became addicted to Percocet and became entangled in the personal stress and conflicts of his pill hustlers. His story shows how health care insecurity can funnel victims of gun violence into increasingly risky ventures to find pain relief. The findings from this study show the pressing need to expand rehabilitative care to all gunshot victims. [Copyright &y& Elsevier]

Substance/opioid use disorder (SUD/OUD) not only affects the person with SUD/OUD, but the entire family. Family members (FMs) who provide care to a person with SUD/OUD attempt to live with the addiction/recovery process while navigating a fractured healthcare/treatment system. The purpose of this article is to describe multiple roles and experiences of FMs. A Qualtrics survey was developed to examine FMs' experiences and resource utilization for a person with SUD/OUD. Survey questions included open- and closed-ended questions focused on concepts related to FM status, treatment, recovery, care of minors, information/media sources accessed, and other services needed. After IRB approval participants were recruited using a convenience sample and a survey link were emailed to geographically dispersed university colleagues and community stakeholders. Authenticated surveys (n = 187) and demographic questionnaires were completed. A majority of the FMs were siblings or partners. FMs reported on experiencing stigma; identifying, securing, and funding treatment; seeking education/training on Naloxone; caring for the person's minor child(ren); and accessing self-care resources. This study builds on prior research describing the lived of experiences of FMs and the unique needs of this population. Additional research is needed to develop resources that are easily accessible and readily available. [ABSTRACT FROM AUTHOR]

Problem-to-services matching is critical to patient-centered care. Further, the extent to which substance abuse treatment is individualized to meet specific client needs is a key predictor of success and represents "best practice" in substance abuse treatment. The CASPAR Resource Guide, an electronic database of local free and low-cost services, is an evidence-based tool designed to help counselors easily and quickly provide off-site referrals to services not available in most community treatment programs to increase problem-to-service matching. This paper examines system-level barriers to using the CASPAR Resource Guide among 30 counselors and 21 site directors across 16 sites in two different studies. Results from qualitative implementation analyses found that key program components needed to support the implementation of this evidence-based practice (e.g., individualized treatment planning, individual treatment sessions, and individual counselor supervision) were lacking, which jeopardized successful adoption of the CASPAR research interventions and prompted a redesign of the studies in order to enhance each program's ability to support individualized care. [ABSTRACT FROM AUTHOR]

Evaluate the effect of continuing care interventions for cocaine use with HIV risk-reduction components on HIV sex-risk. Explore whether cocaine use at treatment initiation interacts with the type of continuing care intervention to affect HIV sex-risk. Cocaine dependent participants (N = 321) were randomized to: (1) Treatment as usual (TAU): intensive outpatient treatment, (2) TAU and telephone monitoring and counseling (TMC), and (3) TAU and TMC plus incentives for participation in telephone contacts (TMC+). Participants in TMC and TMC+ received a brief HIV intervention, with booster sessions as needed. Generalized estimating equations analysis compared TAU, TMC and TMC+ at 6, 12, 18, 24 months post-baseline on the following outcomes: overall HIV sex-risk, number of sexual partners, condom usage, exchange of drugs for sex, exchange of sex for drugs, exchange of money for sex, exchange of sex for money, and crack house visits. Overall sex-risk decreased for all treatment conditions at follow-up, with no treatment main effects. For people with no cocaine use at baseline, TAU experienced greater sex-risk reductions than TMC (p < .01) and TMC+ (p < .001). The three treatment conditions are effective in reducing HIV sex-risk. TMC with HIV risk-reduction components is unnecessary for cocaine-dependent clients who stop using cocaine early in treatment. [ABSTRACT FROM AUTHOR]

Background: The U.S. Food and Drug Administration can set standards for cigarettes that could include reducing their nicotine content. Such a standard should improve public health without causing unintended serious consequences for sub-populations. This study evaluates the effect of progressive nicotine reduction in cigarettes on smoking behavior, toxicant exposure, and psychiatric symptoms in smokers with comorbid mood and/or anxiety disorders using a two-site, two-arm, double-blind, parallel group, randomized controlled trial (RCT) in four phases over 34 weeks.Methods: Adult smokers (N = 200) of 5 or more cigarettes per day will be randomized across two sites (Penn State and Massachusetts General). Participants must have not had a quit attempt in the prior month, nor be planning to quit in the next 6 months, meet criteria for a current or lifetime unipolar mood and/or anxiety disorder based on the structured Mini-International Neuropsychiatric Interview, and must not have an unstable medical or psychiatric condition. After a week of smoking their own cigarettes, participants receive two weeks of Spectrum research cigarettes with usual nicotine content (11.6 mg). After this baseline period, participants will be randomly assigned to continue smoking Spectrum research cigarettes that contain either (a) Usual Nicotine Content (11.6 mg); or (b) Reduced Nicotine Content: the nicotine content per cigarette is progressively reduced from approximately 11.6 mg to 0.2 mg in five steps over 18 weeks. At the end of the randomization phase, participants will be offered the choice to either (a) quit smoking with assistance, (b) continue smoking free research cigarettes, or (c) return to purchasing their own cigarettes, for the final 12 weeks of the study. The primary outcome measure is blood cotinine; key secondary outcomes are: exhaled carbon monoxide, urinary total NNAL- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 1-hydroxypyrene, oxidative stress biomarkers including 8-isoprostanes, measures of psychiatric symptoms (e.g., depression, anxiety), smoking behavior and dependence (e.g., cigarette consumption, quit attempts), and health effects (e.g., blood pressure, respiratory symptoms).Discussion: Results from this study will inform FDA on the potential effects of regulating the nicotine content of cigarettes and help determine whether smokers with mood and/or anxiety disorders can safely transition to significantly reduced nicotine content cigarettes.Trial Registration: TRN: NCT01928758 , registered August 21, 2013. [ABSTRACT FROM AUTHOR]

Little research has focused on the risk of sexual addiction within an inpatient drug and alcohol treatment facility. The present study compared the rate and severity of sexual addiction in three chemical dependency units (30-dayprimary, 30-day relapse, and 90-day extended). A total of 485 participants completed the Sexual Addiction Screening Test-Revised (SAST-R). Demographic variables and substance and psychiatric diagnoses were gathered through patient chart review. Prevalence rates by unit were Primary Care 18%, Relapse 18.6%, and Extended Care 29.0%. Participants in Extended Care had a significantly higher prevalence of being identified as at risk for sexual addiction than either Relapse or Primary Care. Results showed significant differences in scores on the SAST-R in individuals in Extended Care as compared to individuals in either the Primary or Relapse units. Significant gender differences also emerged overall and by unit. Higher rates of diagnoses of certain chemical substances and psychiatric disorders emerged between the individuals at risk for sexual addiction versus those not at risk. This study is the first to explore risk for sexual addiction in inpatient substance use disorder treatment at different levels of care, and it demonstrates the need for further research that can differentiate between substance use disorders and sexual addiction in order to provide early intervention to improve treatment outcomes and prevent relapse. [ABSTRACT FROM AUTHOR]

Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers, reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care, warranting further study and policy support. [ABSTRACT FROM AUTHOR]

The concept of recovery within the addictions arena has historically referred to the resolution of severe alcohol and other drug (AOD) problems at a personal or family level. Larger social systems can also be wounded by and experience recovery from the prolonged effects of AODs and related problems. This article explores the concept of community recovery, posits a set of preliminary principles related to community recovery, presents a case study of community recovery, and outlines current strategies used in the City of Philadelphia to promote processes of community recovery. [ABSTRACT FROM PUBLISHER]

Objective(s) This study examined the health status of women with a recent history of incarceration and explored if/how women were accessing health care resources at the time immediately following release. Design and Sample This mixed methods study utilized two phases: (1) a quantitative survey; and (2) qualitative interviewing. Thirty-four women (18 years of age and older, released from incarceration in the last 12 months) participated in the quantitative phase; 11 of those completed the qualitative interviews. Measures In phase 1, data were collected on demographics, health history, health status, and health-promoting behaviors. In the second phase, semi-structured interviews were used. Results Women in the study reported below average health status compared with the general population. The major health issues identified by participants included specific health problems affected by incarceration, mental health needs, routine health promotion and maintenance, recovery from substance abuse as a major health concern, and social and environmental barriers to care. Conclusions Women leaving jail or prison have significant and complex health care needs. This period of transition appears to be an opportune time to offer support, services, and other health-promoting interventions. [ABSTRACT FROM AUTHOR]

With the enactment of the Second Chance Act in 2008, social workers have a greater opportunity for intervention to break the cycle of recidivism. To develop interventions, however, social workers require profiles of incarcerated people and their perceived human service needs. Unfortunately, previous research has focused on prison and not jail inmates and lacks race-differential data. In this article the authors address this gap in the literature by describing the scope of the problem and presenting a profile of male inmates and their perceived service needs by race upon entry into a major urban county jail. [ABSTRACT FROM PUBLISHER]

ABSTRACT Aims Compared to DSM-IV nicotine dependence, proposed DSM-5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined. Design Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms. Setting and participants Adolescent ( n = 179) and young adult ( n = 292) past-year cigarette users recruited from addictions treatment. Measurements Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day time-line follow-back; and the Fagerström Test for Nicotine Dependence (FTND). Findings Prevalence of proposed DSM-5 NUD (two-symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM-IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM-5 severe NUD (four-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items. Conclusions The proposed DSM-5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity. [ABSTRACT FROM AUTHOR]

Substance use disorders and related conditions play significant roles in urban homelessness and its personal and social costs. Traditional addiction treatment programs have failed to attract, engage, retain, and effectively treat this population, leaving homeless persons excluded from addiction treatment or constituting a chronically recycling segment of the treatment population. This article describes the design and outcomes of the Journey of Hope Project—a special homeless initiative that was part of a broader “recovery-focused systems transformation process” in the city of Philadelphia. New approaches to outreach, treatment, and continuing recovery management demonstrated the ability to recruit, retain, and enhance long-term recovery outcomes for individuals with histories of severe substance use and related disorders and chronic homelessness. The service designs described and the service outcomes reported underscore the need to radically alter traditional service models to achieve enhanced long-term recovery outcomes with this population. [ABSTRACT FROM PUBLISHER]

This clinical trial evaluated a modified therapeutic community aftercare (MTC-A) program for a population triply diagnosed with HIV/AIDS, a substance use disorder, and a mental disorder. After six months of MTC residential treatment (MTC-R), subjects were randomly assigned to MTC-A (n=42) or to standard aftercare (C; n=34). Follow-up interviews at six and 12 months assessed eight outcome domains and adherence to prescribed HIV medication. A propensity model was used to re-balance the retrieved sample. At the six-month follow-up, High stratum MTC-A clients (those with greater psychological functioning and stable physical health at baseline) had greater improvement overall and for substance use and mental health than C clients in the same stratum. In contrast, C clients in the Low/Medium stratum (those with poorer psychological functioning and improved physical health) had more favorable outcomes overall and for substance use than their MTC-A counterparts; however, this stratum was not re-balanced effectively. Differences in HIV medication adherence were not detected. Clients with greater psychological functioning and stable health at treatment entry benefit more from the MTC-A program. In view of the potentially progressive nature of HIV, measuring physical and mental health during treatment and controlling for changes could be important in future research. [ABSTRACT FROM AUTHOR]

Confirmatory factor analysis (CFA) techniques are used to evaluate the fit of a seven-dimensional concept mapping-based model of key dimensions of faith-based substance abuse treatment, using data from 310 staff and clients of 12 faith-based Teen Challenge programs. The initial seven-dimensional model fit poorly (fit indices of .62-.64), though, after trimming items with low loadings or redundant item content, model fit was increased substantially (fit indices of .87-.89). Overall, the current analyses provide preliminary support for the meaningfulness of the seven-dimensional model of faith-based treatment programs, despite different statistical approaches. [ABSTRACT FROM AUTHOR]

Finding the predictors of outcome in outpatient cocaine dependence treatment trials may be useful for the development of both psychosocial as well as pharmacological treatments for cocaine dependence. Among the most powerful predictors of response to psychosocial treatment are cocaine withdrawal symptom severity and the results of a urine drug screen (UDS) collected at study entry. The present trial seeks to extend these findings by examining outcome predictors in a large number of subjects participating in a series of outpatient cocaine pharmacotherapy trials while selecting three separate criteria to define successful outcome. The ability of several baseline variables were tested to predict treatment outcome in a series of cocaine medication trials that included 402 cocaine-dependent subjects. Predictor variables included results from the baseline Addiction Severity Index (ASI), initial UDS results, and cocaine withdrawal symptom severity at treatment entry, as measured by scores on the Cocaine Selective Severity Assessment (CSSA). Outcome measures included UDS results obtained during the trials and results from the ASI gathered at the end of the trials. Baseline variables that most consistently predicted treatment outcome were the initial UDS results and initial CSSA scores. These findings indicate that baseline UDS results and CSSA scores are powerful predictors of outcome and should be used as stratifying variables in outpatient cocaine medication trials. [ABSTRACT FROM AUTHOR]

This article proposes a method of calculating a practical index of improvement for conducting a cost-effectiveness analysis of substance abuse treatment. While the methodology of cost-effectiveness analysis necessitates the use of a single outcome measure, substance abuse treatment can produce multiple, important outcomes that must be considered in policy decisions about funding and alternative treatments. Thus, there is a need to aggregate the variety of outcomes from substance abuse treatment into a single index. The proposed index is a preference-weighted sum of outcomes using data from the Addiction Severity Index. The methodology and use of the index for conducting a cost-effectiveness analysis are illustrated using Addiction Severity Index data from a controlled quasi-experimental field study of case management. [ABSTRACT FROM AUTHOR]

A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs. [ABSTRACT FROM AUTHOR]