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Persons with illicit drug use disorder should have a good motivation for rehabilitation at the initiation of the rehabilitation process to avoid relapses. This study was conducted to assess the level of motivation for rehabilitation and its predictors among males with illicit drug disorders admitted to rehabilitation centers in Sri Lanka. A cross-sectional study was conducted among 431 study subjects from five selected rehabilitation centres. Sinhala translation of Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) was used to assess the motivation level under the three sub-scales: Recognition, Ambivalence, and Taking Steps. Chi-square test was used to identify the sociodemographic and drug related factors associated with the motivation level. Those factors were subsequently used as independent variables in binary logistic regression for identification of predictors of motivation using logistic regression approach at 0.05 significance level. Nearly 40% (n=171) of the sample had been previously rehabilitated as an inpatient in a rehabilitation centre. The majority of the sample (52.9%) had a moderate level of motivation for rehabilitation in all three categories of motivation; recognition, ambivalence, and taking steps. High motivation for rehabilitation was reported by 23.4% based on total score, while a similar proportion (23.7%) reported low motivation. Study subjects having a higher problematic level of drug use were less likely to have a high motivation for rehabilitation (OR=0.564, 95% CI=0.366-0.872, p Keywords: Illicit drug use, motivation, rehabilitation, SOCRATES, Illicit drugs are defined as 'psychoactive substances that the production, sale or use is prohibited with the prevailing legal system in a given country and for the long term on [...]

PURPOSE Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado. METHODS Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training. RESULTS Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P CONCLUSIONS The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado. Key words: buprenorphine; education; opioid-related disorders; primary health care; rural health, INTRODUCTION The United States has an epidemic of opioid use disorder (OUD). Over 4 million Americans report using prescription pain medicine for nonmedical reasons. (1) First-time heroin users increased from [...]

Background: Maraviroc is an antiretroviral agent and C-C chemokine coreceptor 5 (CCR5) antagonist that is currently used to treat human immunodeficiency virus. CCR5/[micro]-opioid receptor heterodimerization suggests that maraviroc could be a treatment for oxycodone abuse. We treated rats with maraviroc to explore its effect on oxycodone-seeking and its interference with the analgesic effects of oxycodone. We used resting-state blood-oxygen-level-dependent functional connectivity to assess the effect of maraviroc on oxycodoneenhanced coupling in the reward circuitry and performed behavioural tests to evaluate the effect of maraviroc on oxycodone rewarding properties and on oxycodone-seeking after prolonged abstinence. Methods: Two groups of rats were exposed to 8 consecutive days of oxycodone-conditioned place preference training and treatment with maraviroc or vehicle. Two additional groups were trained to self-administer oxycodone for 10 days and then tested for drug seeking after 14 days of abstinence with or without daily maraviroc treatment. We tested the effects of maraviroc on oxycodone analgesia using a tail-flick assay. We analyzed resting-state functional connectivity data using a rat 3-dimensional MRI atlas of 171 brain areas. Results: Maraviroc significantly decreased conditioned place preference and attenuated oxycodone-seeking behaviour after prolonged abstinence. The analgesic effect of oxycodone was maintained after maraviroc treatment. Oxycodone increased functional coupling with the accumbens, ventral pallidum and olfactory tubercles, but this was reduced with maraviroc treatment. Limitations: All experiments were performed in male rats only. Conclusion: Maraviroc treatment attenuated oxycodone-seeking in abstinent rats and reduced functional coupling in the reward circuitry. The analgesic effects of oxycodone were not affected by maraviroc., Introduction The United States is experiencing an opioid epidemic; in 2015, about 97.5 million Americans used pain relievers, and 2 million people had a pain reliever use disorder. (1) At [...]

As the COVID-19 pandemic gains foothold, another insidious epidemic of opioid use disorder (OUD) is waiting to soar. The opioid epidemic is a long-standing public health issue, which appears to [...]

The crisis created by the COVID-19 pandemic is not solely concentrated in the public health sphere. The isolation and economic devastation of COVID are further fueling an already existing addiction [...]

Many people enrolled in drug diversion programs are not receiving evidence-based prevention for HIV or hepatitis. This study translated basic research from cognitive science to increase screening for infection and condom use in this population. A parallel three-condition randomized trial was conducted in a drug diversion sample (N = 358), comparing a memory practice condition with two active control conditions. Outcomes were condom use frequency and testing for infection (hepatitis B/C, HIV). At 3-month follow-up, participants in the memory practice condition were at least twice as likely (OR = 2.10 or greater, p < .01) to self-report testing compared to those in the control conditions and also reported more frequent condom use compared to a health education condition [B = .37, t(1) = 2.02, p = .02]. Basic research on memory can be effectively translated to brief interventions on infection screening and risk prevention in existing drug diversion programs., Author(s): Alan W. Stacy [sup.1] , Liesl A. Nydegger [sup.2] , Yusuke Shono [sup.3] Author Affiliations: (Aff1) 0000 0004 0389 8602, grid.254271.7, School of Community and Global Health, Claremont Graduate [...]

This is a descriptive study of the Children Affected by Methamphetamine (CAM) grant program, a federally funded effort to improve outcomes through the addition of targeted interventions for 1,940 families, including 2,596 adults and 4,245 children involved in 12 diverse Family Treatment Drug Courts (FTDCs) located across six U.S. states. The majority were children of parents with a primary methamphetamine use disorder. Findings reflect grantees' reporting on 18 performance indicators of child safety and permanency, adult recovery, and family well-being. Additional information gleaned from grantees' biannual reports provides insights about program implementation. Results, drawn from this large and complex dataset, indicate that comprehensively addressing families' needs is associated with better outcomes than those experienced by similarly situated families in grantees' communities and the nation overall. In addition to describing common program components and outcomes, this article presents important lessons learned about implementing evidence-based children's services in the FTDC context, as well as future directions for research and evaluation in this arena., More than 8.3 million children in the United States under the age of 18 live with a parent who is dependent on alcohol or needs treatment for a substance use [...]

Abstract For each client in an acute mental health setting, continuous holistic assessment that systematically records data, predicts risk and updates management helps to reduce violence. Assessments should include appraisal [...]

Methamphetamine use is epidemic among men who have sex with men (MSM), but treatment has lagged for this group. The author reviews literature concerning use, individual effects of the drug, [...]

This paper describes the development and evaluation of the Alcohol and Drug Outcome Measure (ADOM), a brief 18-item, two part, outcome monitoring instrument designed for routine use with clients in the New Zealand Alcohol and Other Drug (AOD) treatment sector. The development of the ADOM was informed by an expert panel of AOD clinicians (n = 6), key informant interviews (n = 14) and a pilot with AOD treatment clients and their respective clinicians (n = 25). The psychometric properties of the ADOM were tested with clients (n = 63) across a range of AOD treatment services. Testing involved clinicians administering the ADOM at treatment admission, one-to-seven days post-admission, and four-to-six weeks post-admission. Analyses of the test-retest reliability, concurrent validity and sensitivity to change of Part A of the ADOM, covering type and frequency of substance use, consistently produced excellent results. Comparable results for Part B of the instrument, covering associated psychosocial issues, were generally satisfactory. The ADOM has the potential to be used as a core AOD outcomes monitoring instrument., Internationally, there is an increasing call for the implementation of routine outcome monitoring during alcohol and other drug (AOD) treatment provision (Lawrinson, Roche, & Copeland, 2009; McLellan, Mckay, Forman, Cacciola, [...]

In 1973, New York's Governor Nelson Rockefeller responded to panic about soaring heroin use by renouncing his aggressive treatment programs and enacting the most punitive drug policy in the United States. His 'Rockefeller Drug Laws' mandated sentences up to life in prison for selling any narcotics. These punishments, comparable to the penalties for murder, served as models for subsequent 'War on Drugs' policies enacted across the nation. This article explores the ideological and political work accomplished by this high profile legislation--for policy makers, for members of the general public who clamored for 'get tough' strategies, and for the drug users targeted by the statutes. The laws were a repudiation of liberal treatment programs and specialists' expertise, and provided a forum to remake the much-maligned welfare state into a stern, macho vehicle for establishing order in society. Increasingly punitive policies constricted the rights of drug users by rhetorically constructing 'addicts' and 'pushers' as outside of the polity and as the antithesis of full citizens. Therefore, the Rockefeller Drug Laws not only had devastating effects on drug offenders, but also were instrumental in the profound renegotiation of the state's role and responsibilities., During his annual address to the legislature in 1973, Governor Nelson Rockefeller shocked the political establishment by declaring that New York State's drug treatment programs--programs he had championed for over [...]

Disturbance of neural activity by sedative drugs has been proposed to trigger a homeostatic response that resists unfavorable changes in net cellular excitability, leading to tolerance and dependence. The Drosophila slo gene encodes a BK-type [Ca.sup.2+]-activated [K.sup.+] channel implicated in functional tolerance to alcohol and volatile anesthetics. We hypothesized that increased expression of BK channels induced by these drugs constitutes the homeostatic adaptation conferring resistance to sedative drugs. In contrast to the dogmatic view that BK channels act as neural depressants, we show that drug-induced slo expression enhances excitability by reducing the neuronal refractory period. Although this neuroadaptation directly counters some effects of anesthetics, it also causes long-lasting enhancement of seizure susceptibility, a common symptom of drug withdrawal. These data provide a possible mechanism for the long-standing counter-adaptive theory for drug tolerance in which homeostatic adaptations triggered by drug exposure to produce drug tolerance become counter-adaptive after drug clearance and result in symptoms of dependence. addiction | anesthesia | drug abuse | seizure | epilepsy www.pnas.org/cgi/doi/ 10.1073/pnas.1005439107

MUNICIPALITIES AND COUNTIES across the country are familiar with the Fair Housing Act ('FHA') which, generally speaking, forbids discrimination in housing based upon disabilities. Because 'disability' has been interpreted as [...]

Objectives. We examined whether cocaine-dependent homeless persons had stable housing and were employed 6, 12, and 18 months after they entered a randomized controlled trial comparing 2 treatments. Methods. One group (n = 103) received abstinence-contingent housing, vocational training, and work; another group (n = 103) received the same intervention plus cognitive behavioral day treatment. We examined baseline and early treatment variables for association with long-term housing and employment. Results. Although the enhanced-treatment group achieved better abstinence rates, the groups did not differ in long-term housing and employment stability. However, consecutive weeks of abstinence during treatment (and to a lesser extent, older age and male gender) predicted long-term housing and employment stability after adjustment for baseline differences in employment, housing, and treatment. Conclusions. Our data showed a relationship of abstinence with housing stability. Contrasting these results with the increasingly popular Housing First interventions reveals important gaps in our knowledge to be addressed in future research. (Am J Public Health. 2010;100:913-918. doi: 10.2105/AJPH.2008.152975)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2009.09.004 Byline: Nena Messina, Christine E. Grella, Jerry Cartier, Stephanie Torres Keywords: Women offenders; Gender-responsive treatment; Corrections-based treatment outcomes; Helping Women Recover; Beyond Trauma Abstract: This experimental pilot study compared postrelease outcomes for 115 women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment (GRT) program using manualized curricula (Helping Women Recover and Beyond Trauma) or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Bivariate and multivariate analyses were conducted. Results indicate that both groups improved in psychological well-being; however, GRT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer (2.6 vs. 1.8 months, p < .05), and were less likely to have been reincarcerated within 12 months after parole (31% vs. 45%, respectively; a 67% reduction in odds for the experimental group, p < .05). Findings show the beneficial effects of treatment components oriented toward women's needs and support the integration of GRT in prison programs for women. Author Affiliation: UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA Article History: Received 1 July 2009; Revised 26 August 2009; Accepted 20 September 2009 Article Note: (footnote) Funding source: This study was funded by the National Institute on Drug Abuse (Grant R21 DAO18699-01A1) and an Interagency Agreement between University of California, Davis (Contract 07-002467), and UCLA Integrated Substance Abuse Programs (ISAP). The findings and conclusions of this study are those of the authors and do not necessarily represent the official policies of the California Department of Corrections and Rehabilitation.

Harm reduction psychotherapy is an exciting and emerging treatment for a broad spectrum of substance use problems. This article introduces an issue of the Journal of Clinical Psychology: In Session devoted to the state of the art of harm reduction psychotherapy. We describe the harm reduction paradigm, the context for and history of the development of harm reduction psychotherapy, and its clinical principles. We then outline and frame the contributions to the issue. Our goal is that this issue will encourage psychotherapists to employ more harm reduction principles in practice and will provide many evidence-based methods to do so. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:117-122, 2010. Keywords: harm reduction; substance abuse; psychotherapy; alcohol; drugs DOI: 10.1002/jclp.20672

Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. Method: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. Results: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = .05), with no significant CM x RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p < .01, and RP, OR = 4.89 (1.51, 15.86), p < .01, and produced better cocaine urine toxicology outcomes at 9 months than treatment as usual, OR = 4.21 (1.37, 12.88), p < .01, and RP, OR = 4.24 (1.32, 13.65), p < .01. Trends also favored CM + RP over CM at 6 months, OR = 2.93 (0.94, 9.07), p = .06, and 9 months, OR = 2.93 (0.94, 9.10), p = .06. Differences between the conditions were not significant after 9 months. Conclusions: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP. Keywords: cocaine dependence, treatment, contingency management, relapse prevention DOI: 10.1037/a0018139

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.

Objectives. We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Methods. Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews. Results. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures. Conclusions. The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida. (Am J Public Health. 2010;100:108-114. doi: 10.2105/AJPH.2008.149534)

Heterogeneity often exists among behavioral growth trajectories in a study population. In the evaluation of intervention effects for longitudinal randomized trials, it is informative to examine the impact of an intervention on subgroups characterized by different types of growth trajectories. This paper presents an application of growth mixture modeling to an ordinal-scale substance-use behavior outcome from the Aban Aya Youth Project (AAYP), a longitudinal preventive intervention trial targeting health-compromising behaviors among adolescents. Results suggested two classes of adolescent substance use growth trajectories: Class 1 (44.7% of the sample) started at a higher level and had a relatively shallow increase over time; Class 2 had a lower baseline level and a rapid increase over time. The intervention effectively reduced the rapid increase of substance use for the adolescents in the second class.

This paper examines the arrest trajectories of adult men and women, drawn from a sample of clients admitted to substance abuse treatment. Growth mixture modeling was used to identify distinctive trajectories in arrests for men and women between ages 18 and 45. In addition, the characteristics of men and women in each of the trajectory groups were compared by gender, arrest trajectory, and the interaction of gender and arrest trajectory. Findings indicated that while the shape of the five trajectories was similar for men and women, higher percentages of men than women were in the High trajectory group (12.5% vs. 8.5%), the Moderate group (27.9% vs. 20.9%), and Slow Increase group (25.5% vs. 20.6%), with more women than men being in the Low group (34.1% vs. 27.1%). Although arrests declined as men and women aged, there did not appear to be many individuals who had terminated their criminal career by age 45. Overall, more similarities than differences were observed in the characteristics of men and women across trajectories. Additional research should examine whether the causal factors influencing arrest trajectories differ by gender.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition X Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude. Keywords: motivational interviewing, randomized clinical trials, Spanish-speaking, drug dependence

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2008.12.004 Byline: Hannah K. Knudsen (a), Amanda J. Abraham (b), J. Aaron Johnson (b), Paul M. Roman (b)(c) Keywords: Buprenorphine; Adoption of innovations; Clinical Trials Network; Health services research Abstract: The National Drug Abuse Treatment Clinical Trials Network (CTN), a collaborative federal research initiative that brings together universities and community-based treatment programs (CTPs), has conducted multiple clinical trials of buprenorphine for opioid dependence. Part of the CTN's mission is to promote the adoption of evidence-based treatment technologies. Drawing on a data collected during face-to-face interviews with administrators from a panel of 206 CTPs, this research examines the adoption of buprenorphine over a 2-year period. These data indicated that the adoption of buprenorphine doubled between the baseline and 24-month follow-up interviews. Involvement in a buprenorphine protocol continued to be a strong predictor of adoption at the 2-year follow-up, although adoption of buprenorphine tripled among those CTPs without buprenorphine-specific protocol experience. For-profit CTPs and those offering inpatient detoxification services were more likely to adopt buprenorphine over time. A small percentage of programs discontinued using buprenorphine. These findings point to the dynamic nature of service delivery in community-based addiction treatment and the continued need for longitudinal studies of organizational change. Author Affiliation: (a) Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 109 Medical Behavioral Science Building, Lexington, KY 40536-0086, USA (b) Institute for Behavioral Research, University of Georgia, 111A Barrow Hall, Athens, GA 30602-2401, USA (c) Department of Sociology, 119 Baldwin Hall, The University of Georgia, Athens, GA 30602-1611, USA Article History: Received 22 September 2008; Revised 26 November 2008; Accepted 18 December 2008

Through descriptive and multivariate analyses, program outcomes for three groups of Toronto Drug Treatment Court participants (TDTC) were compared focusing on their substance use. legal, and socioeconomic differences at entry into the program, and their compliance behaviors during the first month of the program. Multivariate analyses demonstrated that graduate and expelled non-engaged participants were significantly different from the moment they started the program. At the time of application to the program expelled non-engaged participants used crack/cocaine on more days in the prior 90-day period, were in custody at their first TDTC appearance, had more criminal convictions over their lifetime, reported more recent substance use, and committed more breaches of their bail conditions than the other two participant groups. However, differences between graduate and expelled-engaged participants were not as clear, indicating important program outcome similarities between the two groups and how drug treatment court success should be conceptualized and measured.

HIV/AIDS is recognized as affecting and being affected by the family. HIV+ women in drug recovery and their families are particularly at risk due to family disruption and stigma. Yet [...]

An increasingly important treatment group is the expanding population of methamphetamine-using female offenders. This study focused on women methamphetamine-using offenders (n=359) who were treated either in a modified therapeutic community (TC) program ('Clean Lifestyle is Freedom Forever' [CLIFF]-TC: n=234) designed for non-violent offenders with significant impairment from methamphetamine use, or the standard outpatient (OTP) treatment (OTP: n=125). All participants were assessed on motivation, psychological and social functioning, and treatment engagement before and during treatment. A multilevel repeated measures analysis examined changes between intake and end of Phase 2 treatment. Both CLIFF-TC and the traditional OTP treatments were shown to improve psychosocial functioning, with significant changes on measures of self esteem, depression, anxiety, decision making, hostility, risk taking, and criminal thinking errors. Effect size comparisons indicated treatment gains were larger in the CLIFF-TC than in the OTP group. Both groups rated treatment engagement measures of participation, satisfaction, and counselor rapport to be very high. These results have positive implications for managing and improving treatment of methamphetamine-using women offenders because psychological improvements during treatment have been linked to better post release outcomes. KEYWORDS female, methamphetamine, offenders, psychosocial functioning, therapeutic community, treatment

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2008.09.007 Byline: Gayle Ridge, Michael Gossop, Nicholas Lintzeris, John Witton, John Strang Keywords: Methadone; Buprenorphine; Prescriptions; Patient preference; Patient attitude; Clinical decisions Abstract: The study investigates patient preferences and beliefs and treatment program factors related to the decision to prescribe either buprenorphine or methadone to opiate-dependent patients. The sample (N = 192) was recruited from 10 addiction treatment services in London. Data were collected by means of a single structured interview conducted with patients commencing a treatment episode at the participating agencies. Data on patient demographics, beliefs, attitudes, and preferences were collected using a structured interview. Data regarding treatment goals and prescribed medication were collected from interviews with clinical staff. Oral methadone had a higher preference rating than buprenorphine. Clinical prescribing practices were influenced by patient preferences (both positive and negative), by prior treatment experiences, and by current treatment goals. Patient preferences and beliefs about opioid agonist medications served as an important influence upon clinical prescribing practices. The odds of being prescribed buprenorphine were three times greater among those patients who reported a preference for buprenorphine. The odds of receiving a prescription for methadone were about twice as great among those for whom methadone was the more preferred medication. Preferences were related to previous treatment experiences with these opioid agonists, and for patients in both groups, personal experience was the most important source of information about the treatment options. Buprenorphine was more likely to be prescribed for short-term detoxification and methadone for maintenance treatment. Author Affiliation: National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, King's College, London SE5 8AF, UK Article History: Received 7 May 2008; Revised 18 September 2008; Accepted 19 September 2008

Although the nature and scope of addictive disease are commonly reported In the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due [...]

In the current issue of Mayo Clinic Proceedings, Berge et al (1) review the challenges associated with identifying and treating chemically dependent physicians. The authors inform readers that the nature [...]

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents' motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual's average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. Keywords: adolescent, treatment outcome, substance use, motivation to abstain

Objective: The aim of this research was to study marijuana use, associated risks, and response to brief motivational intervention among young adult drinkers treated in an emergency department. Method: Study participants (N = 215; ages 18-24) were in a randomized controlled trial for alcohol use that compared motivational interviewing with personalized feedback (MI) with personalized feedback only. Past-month marijuana users were compared with nonusers on demographics, readiness, self-efficacy, and behavioral risk variables. Marijuana use was examined as a potential moderator of alcohol outcomes. Whether marijuana use alone or combined marijuana and alcohol use would be reduced as a result of brief intervention for alcohol was examined at 6 and 12 months. Results: Current marijuana users were younger, were more likely to be white, and reported more alcohol use, other illicit drug use, and more alcohol-related consequences than nonmarijuana users. Marijuana use at baseline did not moderate response to brief alcohol treatment. Marijuana use declined from baseline to 6 months for both treatment groups, but only MI participants continued to reduce their use of marijuana from 6- to 12-month follow-up. Reductions in number of days of use of marijuana with alcohol appeared to be primarily a function of decreased alcohol use. Conclusions: Young adult drinkers reporting current marijuana use are at generally higher risk but responded to brief alcohol treatment by reducing alcohol and marijuana use., RATES OF MARIJUANA AND ALCOHOL USE are highest among older adolescents and young adults (Substance Abuse and Mental Health Services Administration, 2007b), and the emergency department (ED) is a medical [...]

Drug abuse is a worldwide health concern in which addiction involves activation of the dopaminergic signaling pathway in the brain. Here, we introduce a nanotechnology approach that utilizes gold nanorod-DARPP-32 siRNA complexes (nanoplexes) that target this dopaminergic signaling pathway in the brain. The shift in the localized longitudinal plasmon resonance peak of gold nanorods (GNRs) was used to show their interaction with siRNA. Plasmonic enhanced dark field imaging was used to visualize the uptake of these nanoplexes in dopaminergic neurons in vitro. Gene silencing of the nanoplexes in these cells was evidenced by the reduction in the expression of key proteins (DARPP-32, ERK, and PP-1) belonging to this pathway, with no observed cytotoxicity. Moreover, these nanoplexes were shown to transmigrate across an in vitro model of the blood-brain barrier (BBB). Therefore, these nanoplexes appear to be suited for brain-specific delivery of appropriate siRNA for therapy of drug addiction and other brain diseases. DARPP-32 | dark field imaging | surface plasmon resonance | nanoplexes | blood-brain barrier

Objectives. We compared the effects of 2 interventions on alcohol use, use of a new syringe at last injection, and condom use at last sexual encounter in a community sample of injection drug users. Methods. Between 2003 and 2006, 851 out-of-treatment injection drug users were recruited in Raleigh, NC, and Durham, NC, through street outreach and were randomly assigned to either a 6-session educational intervention or a 6-session motivational intervention. Intervention effects were examined at 6 and 12 months after enrollment. Results. In multiple logistic regression analyses adjusted for baseline alcohol use and HCV status, participants assigned to the motivational intervention were significantly less likely than were participants in the educational intervention to be drinking at the 6-month follow-up (odds ratio=0.67; 95% confidence interval=0.46, 0.97). There were no significant between-group differences in use of a new syringe at last injection or condom use at last sexual encounter at either follow-up. Conclusions. Reducing alcohol use among persons with HCV may slow disease progression and provide important health benefits. Additional strategies are needed for slowing HCV disease progression until more effective HCV treatments are available. (doi:10.2105/AJPH.2007.126854)