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INTRODUCTION Between 1994 and 2017, the National Institutes of Health (NIH) issued mandates that biomedical researchers include female participants in clinical research, (1) analyze sex/gender differences in NIH Phase III [...]

Objective: In a recent trial, moral reconation therapy (MRT)—a cognitive–behavioral intervention for criminal recidivism—was not more effective than usual care (UC) for veterans in behavioral health treatment. To determine for whom treatments of recidivism are most effective, we tested if recency of criminal history or psychopathic traits moderated MRT's effects on outcomes. Method: In a multisite trial, 341 veterans (95.3% male; 57.8% White/Non-Hispanic) with a criminal history who were admitted to behavioral health treatment programs were randomly assigned to UC or UC + MRT and followed at 6- and 12-months. Incarceration (yes/no) or criminal conviction (yes/no) in the year prior to enrollment and psychopathic traits at baseline (median split) were prespecified as moderators of treatment effects on primary (criminal thinking, criminal associations) and secondary outcomes (legal, employment, and family/social problems; substance use problems and days of use). Results: Among veterans incarcerated in the year prior to enrollment, MRT (vs. UC) was associated with greater reductions in criminal associations (6 months) and days drinking or using drugs (12 months). Among those convicted in the year prior to enrollment, MRT (vs. UC) was associated with greater reductions in employment problems (12 months) and days drinking or using drugs at each follow-up. For those high in psychopathic traits, MRT (vs. UC) was associated with greater reductions in days drinking or using drugs at each follow-up. Conclusions: For veterans in behavioral health treatment with recent criminal histories and high in psychopathic traits, MRT may be effective for reducing risk for criminal recidivism. What is the public health significance of this article?: This study found that for veterans in behavioral health treatment programs with a criminal history, a group treatment aimed at reducing risk for criminal recidivism is effective for those with more recent criminal histories and those with greater psychopathic tendencies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to inform clinical practice by identifying subgroups of patient-concerned other (CO) dyads. Patients with alcohol use disorders (AUDs) were characterized on Alcoholics Anonymous (AA) involvement and substance use together with COs' Al-Anon involvement. Predictors and recovery maintenance outcomes of subgroup membership were examined. Method: Participants were 279 patient-CO dyads. Patients were in residential treatment for AUD. Parallel latent class growth model analysis characterized 12-step involvement and substance use at treatment entry and 3-, 6-, and 12-month follow-ups. Results: Three classes were as follows: 38% Low AA/Low Al-Anon (patients' low AA and COs' low Al-Anon involvement, and patients' high-to-moderate substance use), 10% High AA/High Al-Anon (patients' high AA and COs' high Al-Anon involvement, and patients' moderate-to-low substance use), and 52% High AA/Low Al-Anon (patients' high AA and COs' low Al-Anon involvement, and patients' moderate-to-low substance use). At follow-up, the Low AA/Low Al-Anon classes' patients were less likely to have spirituality as recovery support, confidence about staying abstinent, and satisfaction with recovery progress. The High AA classes' COs had less concern about patients' drinking and scored higher on positive aspects of relationships with patients. Conclusions: Clinicians should encourage patients' and COs' 12-step group involvement (12-step practices' engagement). Among patients treated for AUD, AA involvement was related to better outcomes, and to COs' lessened concern about the patients' drinking. COs' Al-Anon involvement was associated with having a more positive view of their relationship with the patient. That more than one third of dyads had low 12-step group involvement suggests that treatment programs may need to facilitate involvement in non-12-step mutual-help groups. [ABSTRACT FROM AUTHOR]

Information technology (IT) is increasingly being used to facilitate, complement, and support the implementation of evidence-based practices (EBP) in psychology. This article reviews recent randomised trials that evaluate the integration of IT applications into the process of delivering EBP. More specifically, we review 11 studies that illustrate how IT has been successfully integrated into traditional clinician-delivered psychotherapy to promote the adoption of EBP. Advantages and disadvantages of this approach are discussed. The paper concludes with practical recommendations for clinicians who are interested in integrating IT into their practice. (Contains 1 table.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2009.01.002 Byline: Kenneth R. Weingardt, Michael A. Cucciare, Christine Bellotti, Wen Pin Lai Keywords: Web-based training; Cognitive-Behavioral therapy; Substance use disorder counselors; Blended learning Abstract: This study compared training outcomes obtained by 147 substance abuse counselors who completed eight self-paced online modules on cognitive-behavioral therapy (CBT) and attended a series of four weekly group supervision sessions using Web conferencing software. Participants were randomly assigned to two conditions that systematically varied the degree to which they explicitly promoted adherence to the CBT protocol and the degree of control that they afforded participants over the sequence and relative emphasis of the training curriculum. Outcomes were assessed at baseline and immediately following training. Counselors in both conditions demonstrated similar improvements in CBT knowledge and self-efficacy. Counselors in the low-fidelity condition demonstrated greater improvement on one of three measures of job-related burnout when compared to the high-fidelity condition. The study concludes that it is feasible to implement a technology-based training intervention with a geographically diverse sample of practitioners, that two training conditions applied to these samples of real-world counselors do not produce statistically or clinically significant differences in knowledge or self-efficacy, and that further research is needed to evaluate how a flexible training model may influence clinician behavior and patient outcomes. Author Affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and, Stanford University School of Medicine, Palo Alto, CA, USA Article History: Received 1 October 2008; Revised 30 December 2008; Accepted 21 January 2009 Article Note: (footnote) The work described in this article was supported by the Health Services Research and Development Service, Department of Veterans Affairs, and by a grant from the National Institute on Drug Abuse (R21DAO07993). The opinions expressed are those of the authors and do not reflect the official positions of the Department of Veterans Affairs nor the National Institute on Drug Abuse.

Objective: Criminal recidivism is common among patients in mental health residential treatment programs. Moral reconation therapy (MRT) has empirical support for reducing criminal recidivism by modifying antisocial cognitions and behaviors; however, its implementation potential in noncorrectional settings has been rarely studied. This potential was examined in a three-site effectiveness-implementation trial of MRT for justice-involved veterans receiving residential mental health treatment in the U.S. Veterans Health Administration.Methods: Semistructured interviews were conducted with 36 veterans who received MRT and 13 residential program staff who were involved in its implementation during the trial. Interviews were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and a focus on patient engagement and context. Content analysis was used to identify facilitators of and barriers to MRT implementation in residential mental health treatment.Results: Participants viewed MRT as unique and complementary to usual residential care, with benefits beyond recidivism reduction. However, time intensity of the MRT curriculum, challenges in adapting its content and format, and long-term costs of maintaining MRT were viewed as barriers to implementation. To facilitate implementation, participants suggested streamlining the MRT curriculum, adding motivational components, and establishing partnerships in- and outside the health care system.Conclusions: The findings suggest strategies and modifications to MRT, which, if shown to be effective, may facilitate its wider implementation in mental health residential treatment programs. [ABSTRACT FROM AUTHOR]

Objective: Moral reconation therapy (MRT) is a cognitive–behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. Method: In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). Results: Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p =.63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose—that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. Conclusions: In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. What is the public health significance of this article?: This study found that for adults in mental health residential treatment programs who have a history of involvement in the criminal justice system, group treatment aimed at reducing criminal thinking and risk for criminal recidivism is not more effective than other care that these patients receive in these programs, particularly if patients do not sufficiently engage in the groups. [ABSTRACT FROM AUTHOR]

Aims: To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon). Design, Setting and Participants: Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%). Intervention and Comparator: AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs. Measurements: Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months. Secondary outcomes: number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition. Findings: There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [ß = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (ß = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition. Conclusions: Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship. [ABSTRACT FROM AUTHOR]

aim of this study was to evaluate whether a video-based, patient-focused opioid education tool delivered in the perioperative period would decrease acute and chronic post-operative opioid prescription dispensations and increase self-rated knowledge about opioids. Methods: We enrolled 110 patients with no reported opioid use in the previous 30 days, undergoing ambulatory surgery for breast, orthopedic, gynecologic, or other outpatient procedures for which opioids would be prescribed. Patients were randomized to receive either post-operative opioid education by the surgical team (control arm) or pre-operative education via a novel 5-minute video plus post-operative education by the surgical team (intervention arm). All patients received follow-up phone calls on post-operative day (POD) 7 to assess self-rated knowledge of opioids on a scale of 1 to 10, 10 being most informed, and self-reported opioid use (primary outcome). Arkansas Prescription Drug Monitoring Program (AR PDMP) data were obtained to assess opioid dispensations at POD 90– 150 days. Results: Seventy-seven percent of participants completed POD7 survey. Participants in the intervention arm rated their knowledge of opioids after surgery significantly higher than those in the control arm (p=0.013). Data from the AR PDMP reveal trends (non-significant) that show increased use of opioids in the control group when compared to the video intervention group at POD 30 (88.7% vs 76%) and POD 90– 150 (22.6% vs 10%). Conclusion: Video-based, patient-focused opioid education can be effectively implemented in a large university hospital during the perioperative period and is effective for increasing a patient's perception of opioid-related knowledge. A fully powered, randomized control trial is needed to further explore observed trends and determine if this novel tool can decrease chronic post-operative opioid dispensations. [ABSTRACT FROM AUTHOR]

Background and aims: Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer‐delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease. Design Multi‐site, randomized controlled trial of a cBAI plus standard care (n = 67) versus standard care only (n = 71). Participants were assessed at baseline and 3‐ and 6‐month follow‐up. Setting: US Veterans Health Administration liver clinics. Participants: Participants were mostly male and diagnosed with hepatitis C. Interventions and comparators: A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease. Measurement Primary outcomes were self‐reported number of drinking days and unhealthy drinking days (defined as more than two drinks for men and more than one for women) in the past 30 days at 6‐month follow‐up. Secondary outcomes were these two variables at 3‐month follow‐up, and drinks consumed per drinking day, depression and overall health at 3‐ and 6‐month follow‐ups. Missing data were imputed using multiple imputation. Findings Compared with standard care, cBAI participants reported significantly fewer drinking days at 6‐month follow‐up and fewer unhealthy drinking days at both 3‐ and 6‐month follow‐ups. Least square means (LS‐means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months [LS‐mean ratio = 3.78/6.89 = 0.55, 95% confidence interval (CI) = 0.34, 0.89]. LS‐means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3‐month follow‐up (LS‐mean ratio = 1.04/2.57 = 0.41, 95% CI = 0.19, 0.85). At 6‐months follow‐up, LS‐means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS‐mean ratio = 1.18/2.75 = 0.43, 95% CI = 0.20, 0.91). Conclusions: A computer‐delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6‐month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption. [ABSTRACT FROM AUTHOR]

Objective: Growing up with an adult with an alcohol use disorder (AUD) is common and negatively affects adult functioning. This study examined two questions concerning the lived experience of growing up in a home with AUD.Method and Results: The first question asked how adults entering AUD treatment (n = 402) who had this lived experience (58%) compared to those who did not (42%) on indicators of alcohol use severity. Patients with lived experience reported alcohol use at a younger age, more times having been arrested and charged, and greater risk for future substance use. The second question examined concordance between patients and their concerned others on this lived experience (n = 277 dyads) and patients' treatment outcomes 3 months later. The associations between patients' lived experience and better treatment outcomes were stronger when patients' concerned others had a concordant lived experience. When patient-concerned other dyads reported concordant lived experiences at baseline, patients had lower substance use and risk scores at the 3-month follow-up than when the dyads reported discordant lived experiences with regard to growing up in a home with AUD; effect sizes were small.Conclusions: Concordance and discordance on this lived experience could be considered in treatment planning for patients with AUD and their concerned others. Providers could ask about each member's childhood and aim interventions at helping dyads discuss their childhoods in ways that validate each other's needs and provide emotional support, without stigmatization. Delivery may consider relationship type (spousal or other) and be in educational or treatment sessions that include the dyad or one member. [ABSTRACT FROM AUTHOR]

Purpose: Many US military veterans experience anxiety, depression, and trauma‐related disorders. A major goal of the Veterans Health Administration (VHA) has been to increase access to evidence‐based psychotherapies (EBPs) such as cognitive‐behavioral therapy to address veterans' substantial health burden. However, despite widespread implementation of EBPs throughout the VHA, smaller clinics that often serve rural veterans face barriers to delivering these interventions. The Veterans Affairs Coordinated Anxiety Learning and Management (VA CALM) program aims to empower providers in rural areas with varying levels of training and experience in delivering EBPs to provide high‐quality cognitive‐behavioral therapy for anxiety, depression, and trauma‐related disorders. The goal of this study was to better understand, through qualitative interviews, VHA community‐based outpatient clinic providers' perspectives on implementing VA CALM. Methods: Qualitative interviews with providers (N = 22) were conducted to understand implementation of VA CALM. Template analysis was used to organize and summarize responses. Findings: Providers noted several facilitators for implementing VA CALM in rural community clinics, including its perceived effectiveness, broad applicability, and structure. Barriers to implementation included scheduling problems and patient‐related barriers. Conclusions: Incorporating providers' perspectives on factors that affect implementing cognitive‐behavioral therapy in this setting may inform future efforts to disseminate‐implement EBPs in smaller, more remote VHA clinics. [ABSTRACT FROM AUTHOR]

A recent clinical trial found that a computer-delivered BAI (cBAI) was effective in reducing alcohol use among patients, in the Department of Veterans Affairs (VA), with liver disease. This is encouraging clinically, but whether the intervention can be rolled on within VA nationally depends on its economic impact. We conducted a randomized clinical trial in 110 patients with liver disease in two VA clinics. We used VA national administrative data to obtain and evaluate health utilization and costs 12 months before and after implementing the cBAI, using a difference-in-differences (DID) approach. The cBAI and usual care group did not differ on inpatient, outpatient, and pharmacy health care utilization and costs at baseline. The results of the DID analysis of the total health services expenses demonstrated similar costs between the cBAI and usual care group, 12 months before and after BAI intervention. Implementing a cBAI in VA liver clinics reduces alcohol consumption while not having any long-term impact on health care utilization and costs. [ABSTRACT FROM AUTHOR]