Leadership Approaches to Developing an Effective Drug Treatment System

Improving the effectiveness of the substance use disorder (SUD) treatment requires leadership approaches that have an impact on the effectiveness of drug treatment. To promote this positive system change, we define leadership beyond leaders’ characteristics. We consider leadership as a developmental competency among individuals, as well as the relational role of followers and the enabling context of organizational climate which together create a system of influence. Using this developing framework, we discuss how the foundations of certain leadership styles, like transformational leadership can be enacted by program leaders to improve the human and program resources necessary to deliver culturally responsive and evidence-based treatment for some of the most vulnerable groups struggling with SUDs. Building on their transformational and implementation competencies, program leaders can promote organizational climates and program and financial approaches to deliver effective care to some of the most vulnerable populations. We provide a case study to stimulate discussion on how leadership can trickle down to staff to improve care for vulnerable clients

Management Practices to Enhance the Effectiveness of Substance Use Disorder Treatment

Managers of substance use disorder (SUD) treatment organizations face significant challenges to improve treatment effectiveness. The field has paid significant attention to the delivery of pharmacological and psychosocial treatment interventions, and the effectiveness of these interventions, with little consideration for the role of management practices that enhance the delivery of such evidence-based practices (EBPs). This chapter describes evidence-based management practices (EBMPs) that may support the effective and consistent delivery of EBPs in SUD treatment. Drawing from a socio-technical and cultural framework, we propose a management approach that relies on policies, human resources, and culturally responsive practices to directly and or indirectly facilitate the delivery of EBPs. In particular, this chapter describes EBMPs that could be widely implemented to respond to the cultural, linguistic, and service needs of racial and ethnic minority groups. We discuss implications for funding and support of management training to improve standards of care and include a case example to promote reflection

Correlates of HIV testing and receipt of test results in addiction health services in Los Angeles County

Background HIV testing and receipt of HIV test results among individuals with substance use disorders is less than optimal. We examined rates and correlates of HIV testing and receipt of test results in one of the largest public addiction health services systems in the United States. Methods The study included 139,516 adult clients in treatment between 2006 and 2011. We used logistic regression models to examine associations between predisposing, enabling, and need factors and two dependent variables, HIV testing rates and receipt of test results. Associations were considered statistically significance at p < .01. Results We found that 64 % of clients reported being tested for HIV, of whom 85 % reported receiving their test results. Likelihood of being tested was positively associated with being female, a minority, homeless, employed, having prior treatment episodes, comorbidities, injection drug use, or a history of mental illness. It was negatively associated with alcohol or marijuana as primary drug. Receipt of test results was more likely among clients on medication (methadone or buprenorphine) or whose method of drug use was smoking, inhalation, or injecting; it was less likely among older clients and those with more outpatient psychiatric visits. Conclusions Findings from this study may inform strategies and targeting of population groups to improve HIV testing practices and ultimately increase awareness of infection status among clients of addiction health services

Exploring Gender and Ethnoracial Differences and Trends in Methamphetamine Treatment

Introduction: Given the significant rise in methamphetamine use and related mortality in the United States, it is critical to explore differences in treatment trends with particular attention to women and ethnoracial groups in hard-hit areas like Los Angeles County. Methods: We analyzed a large sample across 4 waves: 2011 (105 programs, 10 895 clients), 2013 (104 programs, 17 865 clients), 2015 (96 programs, 16 584 clients), and 2017 (82 programs, 15 388 clients). We completed a comparative analysis to identify differences across subgroups and a trend analysis of treatment episodes by gender and ethnoracial group to differentiate users of methamphetamine and users of other drugs. Results: Treatment clients using methamphetamine increased over time for each gender and race. There were also significant differences across age groups. Women comprised a greater proportion of treatment episodes involving methamphetamine use (43.3%) compared to all other drugs combined (33.6%). Latinas represented 45.5% of methadone-related admissions. Compared with other drug users, methamphetamine users had a lower successful treatment completion rate and were served by programs with less financial and culturally responsive capacity. Conclusions: Findings highlight a sharp increase in treatment admissions for methamphetamine users of all gender and ethnocultural groups. Women, especially Latinas, saw the most significant increases, with a widening gender gap over time. All subgroups of methamphetamine users had a lower treatment completion rate compared with users of other drugs, and critical differences existed in the programs where they received services.</p

Availability of substance abuse treatment services in Spanish: A GIS analysis of Latino communities in Los Angeles County, California

<p>Abstract</p> <p>Background</p> <p>The percentage of Latino clients entering outpatient substance abuse treatment (OSAT) in the United States has increased significantly in the past 10 years. Evidence suggests that a lack of services in Spanish is a significant barrier to treatment access among Latinos.</p> <p>Methods</p> <p>Using a geographic information system (GIS) approach, data from the U.S. Census Bureau and the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed to determine the geographic distance between OSAT facilities with services in Spanish and Latino communities throughout Los Angeles County, CA. Data from N-SSATS were also analyzed using logistic regression models to examine organizational characteristics and their association with offering services in Spanish. Our GIS methods are tested in their ability to provide baseline measures to inform future analysis comparing changes in demography and service infrastructure.</p> <p>Results</p> <p>GIS analysis revealed cold spots representing high-density Latino communities with extensive travel distance to facilities offering services in Spanish. The average linear distance between Latino communities and facilities offering Spanish-language services ranged from 2 to 6 miles, while the location of the cold spots pointed to a need for services in Spanish in a particular subregion of the county. Further, secondary data analysis revealed that, on average, being privately owned (<it>OR </it>= .23, 95% CI = 0.06-0.90) was associated with a lower likelihood of providing services in Spanish compared to public facilities. Additionally, a facility with a state license (<it>OR </it>= 2.08, 95% CI = 1.12-3.88) or a higher number of Medicaid recipients (<it>OR </it>= 2.98, 95% CI = 1.76-5.05) was twice as likely to offer services in Spanish.</p> <p>Conclusion</p> <p>Despite the significant presence of Latinos in L.A. County in 2000, low capacity was found in discrete Latino communities in terms of offering OSAT services in Spanish. Funding and regulation play a significant role in facilities' capacity to offer these services. Future studies should build from our multi-method approach to compare changes in population demography and system infrastructure and inform health care policy that seeks to improve providers' capacity to provide linguistically competent care.</p

Estudios globales sobre el cadmio en relación con Theobroma cacao: Un análisis bibliométrico desde Scopus (1996 -2020)

En el año 2014, la Unión Europea impuso estándares máximos de tolerancia en cadmio, para la importación de productos a base de cacao, causando preocupación en los países. Se analizó estudios globales referidos a investigaciones en Theobroma cacao, relacionados con la actividad del cadmio en la atmósfera. Se utilizaron análisis bibliométricos en los programas R y VOSviewer, para examinar 64 documentos publicados en la base de datos Scopus según palabras clave. Se identificaron 811 palabras clave en coocurrencias de términos, 5 grupos temáticos en acoplamiento bibliográfico, 20 instituciones como afiliaciones más importantes, 20 países de procedencia de autores corresponsales, 112 instituciones en red de coautoría de los cuales 5 están en documentos primarios, y dos grupos en similaridad temática en co-citación de documentos. Estados Unidos lidera la producción científica con 11 documentos, seguido de Colombia (8) y Ecuador (7). En 1996 se registró el primer artículo científico para la red, con incrementos de hasta 11 publicaciones al 2020. En conclusión, se evidencia la necesidad de fortalecer y crear más redes de investigaciones entre países, instituciones, autores y coautores. Se espera que los resultados permitan desentrañar de manera integral la trayectoria de investigaciones cadmio-cacao, al tiempo que arrojen nuevas investigaciones prospectivas