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Aim: This study examined the relationship between recent substance use prior to intake and program graduation among young adults with early psychosis enrolled in coordinated specialty care. Methods: Participants (N = 248) were from New Journeys, a network of coordinated specialty care programs in Washington State. Recent (i.e., past 30 days) alcohol, cannabis, and other substance use was collected at intake and process data (e.g., contact) was collected by clinicians across a 2‐year period. Results: At intake, 32% of participants reported alcohol use only, 26% cannabis use only, and 15% both alcohol and cannabis use. Participants who reported alcohol use only (p =.02), cannabis use only (p =.03), and any substance use (p =.02) had significantly lower chances of graduating from coordinated specialty care than individuals who do not use substances. Conclusions: Unlike prior work, recent substance use influences clients' potential to graduate from New Journeys. Additional focus on the implementation of substance use treatment, with an emphasis on alcohol use, in coordinated specialty care programs is needed improve program completion rates. [ABSTRACT FROM AUTHOR]

Background: Phosphatidylethanol 16:0/18:1 (PEth), found in whole blood, is a biomarker for alcohol consumption with high sensitivity, specificity, and a long detection window. The TASSO‐M20 device is used to self‐collect capillary blood from the upper arm and has advantages over finger stick methods. The purpose of this study was to (1) validate PEth measurement using the TASSO‐M20 device, (2) describe the TASSO‐M20 for blood self‐collection during a virtual intervention, and (3) characterize PEth, urinary ethyl glucuronide (uEtG) and self‐reported alcohol in a single participant over time. Methods: PEth levels in blood samples dried on TASSO‐M20 plugs were compared to those in (1) liquid whole blood (N = 14) and (2) dried blood spot cards (DBS; N = 23). Additionally, the self‐reported drinking, positive or negative uEtG results (dip card cutoff ≥300 ng/mL), and observed self‐collection of blood with TASSO‐M20 devices for PEth levels were obtained over time during virtual interviews of a single contingency management participant. High‐performance liquid chromatography with tandem mass spectrometry detection was used to measure PEth levels for both preparations. Results: PEth concentrations from dried blood on TASSO‐M20 plugs and liquid whole blood were correlated (0 to 1700 ng/mL; N = 14; r2 = 0.988; slope = 0.951) and in a subgroup of samples with lower concentrations (N = 7; 0 to 200 ng/mL; r2 = 0.944, slope = 0.816). PEth concentrations from dried blood on TASSO‐M20 plugs and DBS were correlated (0 to 2200 ng/mL; N = 23; r2 = 0.927; slope = 0.667) and in a subgroup of samples with lower concentrations (N = 16; 0 to 180 ng/mL; r2 = 0.978, slope = 0.749). Results of the contingency management participant indicate that changes in PEth levels (TASSO‐M20) and uEtG concentrations were consistent with each other and with changes in self‐reported alcohol use. Conclusions: Our data support the utility, accuracy, and feasibility of using the TASSO‐M20 device for blood self‐collection during a virtual study. The TASSO‐M20 device had multiple advantages over the typical finger stick method, including consistent blood collection, participant acceptability, and less discomfort as indicated by acceptability interviews. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between cannabis use and metabolic syndrome (MetS) among those who have experienced first episode psychosis (FEP). Methods: A retrospective analysis of 404 participants enrolled in the Recovery After Initial Schizophrenia Episode‐Early Treatment Program (RAISE‐ETP) was conducted. Using multiple logistic regression, we investigated the correlation between cannabis use and rate of MetS at baseline and across time as well as the specific metabolic derangements among cannabis users and abstainers. Results: Although cannabis users had similar rates of MetS at baseline when compared with abstainers, those who used cannabis at any time during the study period tended to have lower triglycerides and elevated high‐density lipoprotein (HDL). Cannabis users were less likely to develop MetS, relative to nonusers. Conclusions: Cannabis use may be associated with lower incidence of MetS in patients who have experienced FEP. Further research is indicated to develop these observations. [ABSTRACT FROM AUTHOR]

Aims: To test if contingency management (CM) interventions for alcohol and drug abstinence were associated with increased alcohol and drug abstinence among American Indian adults with alcohol dependence who also use drugs. Design In this 2 × 2 factorial randomized controlled trial, American Indian adults with alcohol dependence who also used drugs were randomized to four conditions: (1) incentives for submission of urine samples only (control condition), (2) CM incentives for alcohol abstinence, (3) CM incentives for drug abstinence or (4) CM incentives for abstinence from both alcohol and drugs. Setting: A Northern Plains Reservation in the United States. Participants: A total of 114 American Indian adults aged 35.8 years (standard deviation = 10.4); 49.1% were male. Intervention and comparator: Participants received incentives if they demonstrated abstinence from alcohol (CM for alcohol, n = 30), abstinence from their most frequently used drug (CM for drugs, n = 27) or abstinence from both alcohol and their most frequently used drug (CM for alcohol and drugs, n = 32) as assessed by urine tests. Controls (n = 25) received incentives for submitting urine samples only. Measurements Primary outcomes were urine ethyl glucuronide (alcohol) and drug tests conducted three times per week during the 12‐week intervention period. Data analyses included listwise deletion and multiple imputation to account for missing data. Findings The three CM groups were significantly (P < 0.05) more likely to submit alcohol‐abstinent urine samples compared with the control condition, with odds ratios ranging from 2.4 to 4.8. The CM for drugs (OR = 3.2) and CM for alcohol and drugs (OR = 2.5) were significantly more likely to submit urine samples that indicated drug abstinence, relative to the control condition (P < 0.05). However, these differences were not significant in multiple imputation analyses (P > 0.05). Conclusions: Contingency management (CM) incentives for abstinence were associated with increased alcohol abstinence in American Indian adults diagnosed with alcohol dependence who also used drugs, living on a rural reservation. The effect of CM incentives on drug abstinence was inconclusive. [ABSTRACT FROM AUTHOR]

Introduction and Aims: In states where recreational use of cannabis has been legalised, increasing numbers of cannabis licensed cannabis businesses resulted in concerns about their potential social and health impacts. This study examined spatiotemporal variations in availability of cannabis licensed cannabis businesses (i.e. producers, processors and retailers) in relation to area deprivation in Washington state from 2014 to 2017.Design and Methods: Data on licensed cannabis businesses were obtained from the Washington State Liquor and Cannabis Board. The number of licensed cannabis businesses was estimated for Washington's 1446 census tracts. Census tracts were stratified into tertiles based on the Singh's Area Deprivation Index showing socio-economic characteristics of communities (least-deprived, middle-deprived and most-deprived). The Integrated Nested Laplace Approximation approach allowed for the spatial and temporal characterisation of cannabis businesses, accounting for similarities based on neighbouring census tracts.Results: The density of all licensed cannabis outlets increased over time. Most-deprived areas have increased likelihood of licensed cannabis outlet density when compared to least-deprived areas. No differences were observed in the likelihood of licensed cannabis outlet density in middle-deprived areas when compared to least-deprived areas.Discussion and Conclusions: The results of this study showed disparity with respect to licensed cannabis outlet density in Washington state over time. The findings call for initiatives, policies and research that decrease disparities in cannabis outlet locations. [ABSTRACT FROM AUTHOR]

Aim: The primary aim of this study was to examine the effect of recent tobacco, alcohol and cannabis use on treatment outcomes among participants experiencing first episode psychosis (FEP). Methods: Secondary data analyses were conducted on 404 participants enrolled in the Recovery After an Initial Schizophrenia Episode—Early Treatment Program (RAISE‐ETP) study. RAISE‐ETP investigated the effectiveness of a coordinated specialty care (CSC) intervention for FEP in community mental health agencies in the United States. Generalized estimating equations were used to examine whether recent tobacco smoking, alcohol, and cannabis use at baseline were associated with illness severity, number of antipsychotic pills missed, psychiatric symptoms and quality of life during the 24‐month treatment period, after controlling for duration of untreated psychosis and treatment group. Results: At baseline, roughly 50% (n = 209) of participants reported recent tobacco, 28% (n = 113) alcohol and 24% (n = 95) cannabis use. Tobacco smokers had higher levels of illness severity (β =.24; P <.005), a higher number of missed pills (β = 2.89; P <.05), higher psychiatric symptoms and lower quality of life during treatment relative to non‐smokers. Alcohol users had a higher number of missed pills (β = 3.16; P <.05) during treatment and cannabis users had higher levels of illness severity (β =.18; P <.05) and positive symptoms (β = 1.56; P <.05) relative to non‐users. Conclusions: Tobacco, alcohol and cannabis use are common in youth seeking treatment for FEP. Tobacco smoking was associated with more negative clinical outcomes. These findings have implications for including interventions targeting these areas of substance use within current CSC models. [ABSTRACT FROM AUTHOR]

Objectives Among American Indians, prior research has found associations between early life trauma and the development of post-traumatic stress disorder (PTSD) in adulthood. Given the physiological changes associated with PTSD, early life trauma could indirectly contribute to chronic disease risk. However, the impact of early life trauma on adult physical health in this population has not been previously investigated. Methods We evaluated associations among early life trauma, PTSD, and 13 physiological biomarkers that index cardiovascular, metabolic, neuroendocrine, anthropometric, and immune function in adulthood by conducting correlation and structural equation modeling path analyses ( N = 197). Physiological systems were analyzed individually as well as in a composite measure of allostatic load. Results We found early life trauma was related to PTSD, which in turn was related to elevated allostatic load in adulthood. Among the various components of allostatic load, the neuroendocrine system was the only one significantly related to early life stress and subsequent PTSD development. Conclusions Changes in allostatic load might reflect adaptive adjustments that maximize short-term survival by enhancing stress reactivity, but at a cost to later health. Interventions should focus on improving access to resources for children who experience early life trauma in order to avoid PTSD and other harmful sequelae. [ABSTRACT FROM AUTHOR]

Background Ethyl glucuronide (EtG) is an alcohol biomarker with potential utility as a clinical research and alcohol treatment outcome. Debate exists regarding the appropriate cutoff level for determining alcohol use, particularly with the EtG immunoassay. This study determined the EtG immunoassay cutoff levels that most closely correspond to self-reported drinking in alcohol-dependent outpatients. Methods Eighty adults with alcohol dependence and mental illness, taking part in an alcohol treatment study, provided urine samples 3 times per week for up to 16 weeks (1,589 samples). Self-reported drinking during 120 hours prior to each sample collection was assessed. Receiver operating characteristic analyses were conducted to assess the ability of the EtG immunoassay to detect self-reported alcohol use across 24- to 120-hour time periods. Sensitivity and specificity of EtG immunoassay cutoff levels was compared in 100 ng/ml increments (100 to 500 ng/ml) across 24 to 120 hours. Results Over half (57%) of the 1,589 samples indicated recent alcohol consumption. The EtG immunoassay closely corresponded to self-reported drinking from 24 ( area under the curve [AUC] = 0.90, 95% confidence interval [CI]: 0.88, 0.92) to 120 hours ( AUC = 0.88, 95% CI: 0.87, 0.90). When cutoff levels were compared across 24 to 120 hours, 100 ng/ml had the highest sensitivity (0.93 to 0.78) and lowest specificity (0.67 to 0.85). Relative to 100 ng/ml, the 200 ng/ml cutoff demonstrated a reduction in sensitivity (0.89 to 0.67), but improved specificity (0.78 to 0.94). The 300, 400, and 500 ng/ml cutoffs demonstrated the lowest sensitivity (0.86 to 0.33) and highest specificity (0.86 to 0.97) over 24 to 120 hours. Conclusions For detecting alcohol use for >24 hours, the 200 ng/ml cutoff level is recommended for use as a research and clinical outcome. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study investigated if pretreatment ethyl glucuronide (EtG) levels corresponding to light (100 ng/mL), heavy (500 ng/mL), and very heavy (1,000 ng/mL) drinking predicted longest duration of alcohol abstinence (LDA) and proportion of EtG-negative urine tests in outpatients receiving a 12-week EtG-based contingency management (CM) intervention for alcohol dependence.Methods: Participants were 40 adults diagnosed with alcohol use disorders and serious mental illness who submitted up to 12 urine samples for EtG analysis during a 4-week observation period and were then randomized to 12-weeks of CM for alcohol abstinence and addiction treatment attendance. Alcohol use outcomes during CM as assessed by EtG and self-report were compared across those who did and did not attain a pre-treatment average EtG level of 500 ng/mL-a level that equates to frequent heavy drinking.Results: Only the 500 ng/mL cutoff was associated with significant differences in LDA and proportion of EtG-negative samples during CM. Those with a pre-treatment EtG < 500 ng/mL attained a LDA 2.3 (alcohol) to 2.9 (drugs) weeks longer than pre-treatment heavy drinkers.Discussion and Conclusions: The EtG biomarker can be used to determine who will respond to a CM intervention for alcohol use disorders and could inform future trials that are designed to be tailored to individual patients.Scientific Significance: Results suggest pre-treatment EtG cutoffs equivalent to heavy and very heavy drinking predict outcomes in CM. (Am J Addict 2017;26:673-675). [ABSTRACT FROM AUTHOR]

Aims To compare three missing data strategies: (i) the latent growth model that assumes the data are missing at random ( MAR) model; (ii) the Diggle- Kenward missing not at random ( MNAR) model, where dropout is a function of previous/concurrent urinalysis ( UA) submissions; and (iii) the Wu- Carroll MNAR model where dropout is a function of the growth factors. Design Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e. stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment. Setting 11 out-patient treatment settings in 10 US cities. Participants A total of 516 opioid-dependent participants. Measurements Opioid UAs provided across the 4-week treatment period. Findings The MAR model showed a significant effect ( B = −0.45, P < 0.05) of trial arm on the opioid-positive UA slope (i.e. 28-day taper participants were less likely to submit a positive UA over time) with a small effect size ( d = 0.20). The MNAR Diggle- Kenward model demonstrated a significant ( B = −0.64, P < 0.01) effect of trial arm on the slope with a large effect size ( d = 0.82). The MNAR Wu- Carroll model showed a significant ( B = −0.41, P < 0.05) effect of trial arm on the UA slope that was relatively small ( d = 0.31). Conclusions This performance comparison of three missing data strategies (latent growth model, Diggle- Kenward selection model, Wu- Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. [ABSTRACT FROM AUTHOR]

Background Treatments for drug addiction and smoking in severely mentally ill (SMI) adults are needed. Objectives To investigate the effect of a contingency management (CM) intervention targeting psycho-stimulant on cigarette smoking. Methods 126 stimulant dependent SMI smokers were assigned to CM or a non-contingent control condition. Rates of smoking-negative (<3 ppm) carbon monoxide breath-samples were compared. Results Individuals who received CM targeting psycho-stimulants were 79% more likely to submit a smoking-negative breath-sample relative to controls. Conclusions and Scientific Significance This study provides initial evidence that a behavioral treatment for drug use results in reductions in cigarette smoking in SMI adults. (Am J Addict 2014;23:407-410) [ABSTRACT FROM AUTHOR]

Objective A review of substance use clinical trials indicates that sub-optimal methods are the most commonly used procedures to deal with longitudinal missing information. Methods Listwise deletion (i.e., using complete cases only), positive urine analysis (UA) imputation, and multiple imputation (MI) were used to evaluate the effect of baseline substance use and buprenorphine/naloxone tapering schedule (7 or 28 days) on the probability of a positive UA (UA+) across the 4-week treatment period. Results The listwise deletion generalized estimating equations (GEE) model demonstrated that those in the 28-day taper group were less likely to submit a UA+ for opioids during the treatment period (odds ratios (OR) = 0.57, 95% confidence interval (CI): 0.39-0.83), as did the positive UA imputation model (OR = 0.43, CI: 0.34-0.55). The MI model also demonstrated a similar effect of taper group (OR = 0.57, CI: 0.42-0.77), but the effect size was more similar to that of the listwise deletion model. Conclusions Future researchers may find utilization of the MI procedure in conjunction with the common method of GEE analysis as a helpful analytic approach when the missing at random assumption is justifiable. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Emerging evidence supports the effectiveness of contingency management (CM) for addictions treatment among individuals with co-occurring serious mental illness (SMI). Addiction treatment for people with SMI generally occurs within community mental health centers (CMHCs) and it is not known whether CM is acceptable within this context. Client views regarding CM are also unknown. Objectives This study is the first to describe CM acceptability among CMHC clinicians, and the first to explore client views. Clinician-level predictors of CM acceptability are also examined. Methods This study examined views about CM among 80 clinicians and 29 clients within a CMHC within the context of a concurrent CM study. Results Three-quarters of clinicians reported they would use CM if funding were available. Clinicians and clients affirmed that incentives enhance abstinence motivation. Clinician CM acceptability was related to greater years of experience, and identifying as an addictions or co-occurring disorders counselor, more than a mental health clinician. Conclusions The findings provide preliminary evidence that CMHC clinicians, serving clients with addictions and complicating SMI, and client participants in CM, view CM as motivating and a positive tool to facilitate recovery. Scientific Significance As an evidence-based intervention, CM warrants further efforts toward funding and dissemination in CMHCs. (Am J Addict 2013;22:432-436) [ABSTRACT FROM AUTHOR]

This study assessed the effects of a contingency management (CM) intervention for alcohol consumption in 10 alcohol-dependent participants. An ABCA design was used. Vouchers were provided contingent on results of ethyl glucuronide (EtG) urine tests (an alcohol biomarker with a 2-day detection period) and alcohol breath tests during the C phase. The percentage of negative urines was 35% during the first baseline phase, 69% during the C phase, and 20% during the return-to-baseline phase. Results suggest that EtG urine tests may be a feasible method to deliver CM to promote alcohol abstinence. [ABSTRACT FROM AUTHOR]

There is a paucity of research investigating psychosocial treatments for youth receiving long-term residential care. This study describes the implementation and impact of dialectical behavioural therapy (DBT) in a long-term psychiatric hospital located in the United States of America. Changes in overall functioning, number of psychotropic medications prescribed, non-suicidal self-injurious behaviour (NSIB), and locked seclusions were investigated in 106 consecutive unique adolescent patients who received DBT. In addition, a comparison group of historical controls was used to examine the effect of DBT in youth with the highest rates of NSIB. A statistically significant increase in overall functioning, as well as a decrease in number of psychotropic medications and non-suicidal self-injurious behaviour (NSIB) was observed within the DBT group. A decrease in locked seclusions was not observed. Accounting for the effects of age, gender, length of stay, and time, youth who received DBT were less likely to engage in NSIB relative to historical controls. These preliminary data suggest that DBT is beneficial for youth with NSIB in long term inpatient psychiatric care. [ABSTRACT FROM AUTHOR]

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care ( n=44) or standard care plus MFGT ( n=53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress. [ABSTRACT FROM AUTHOR]

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standardcare condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT. [ABSTRACT FROM AUTHOR]

The article focuses on a study done on five alcohol-dependent outpatients to evaluate the ethyl glucuronide immunoassay (EtG-I) urinalysis in detecting alcohol use. It states that urine-based immunoassays improve the detection of drug use when used with self-report. The study shows the effectiveness of EtG-I over breath tests in detecting self-reported drinking.