A Systematic Review on the Use of Psychosocial Interventions in Conjunction with Medications for the Treatment of Opioid Addiction

Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction

Improving the informed consent process in research with substance-abusing participants

The most important medical and behavioral advances made in the last century, including vaccinations for diseases such as smallpox and polio, required years of testing, often with human participants. Unfortunately, many were made at the expense of marginal and highly vulnerable populations, including asylum inmates, prisoners, and non-institutionalized minorities. In fact, study participants were often involved in clinical trials without ever being informed. Revelations about the horrors of World War II and the medical experiments that were performed by the Nazis as well as unethical investigations conducted within the United States, including the Tuskegee syphilis study (Centers for Disease Control and Prevention, 2011), the Milgram experiment (Milgram, 1974), and the human radiation experiments (see Welsone, 1999, for a review), heightened public awareness of the potential for research misconduct. For over 60 years, the international and US medical communities have taken numerous steps to protect people who take part in clinical research. The Nuremberg Code (1950) was the first major international document to provide guidelines on research ethics. It was developed in response to the Nuremberg Trials of Nazi doctors who performed unethical experimentation during World War II. The Nuremberg Code made voluntary consent a requirement in clinical research studies and outlined that consent can be voluntary only if: (1) the participants are able to consent; (2) they are free from coercion (i.e., outside pressure); and (3) they comprehend the risks and benefits involved. Furthermore, the Nuremberg Code states that researchers should minimize risk and harm, ensure that potential risks do not significantly outweigh potential benefits, use appropriate study designs, and guarantee the participants’ freedom to withdraw at any time. It was adopted by the United Nations General Assembly in 1948. © Cambridge University Press 2012

Paying substance abusers in research studies: Where does the money go?

Background: Research involving substance-abusing participants is often hindered by low rates of recruitment and retention. Research suggests that monetary payment or remuneration can be an effective strategy to overcome these obstacles. Objectives: This article provides a brief overview of these issues and provides data reflecting how substance-abusing participants in several of our studies used their baseline and follow-up payments. We also present research findings related to how the mode of payment (i.e., cash, check, gift card) may affect how payments are used. Conclusions and Significance: Overall, our findings suggest that participants use their research payments in a responsible and safe manner. Limitations and recommendations for future research are discussed. © 2012 Informa Healthcare USA, Inc

Targeting dispositions for drug-involved offenders: A field trial of the Risk and Needs Triage (RANT)â„¢

Purpose: This field trial examined the process of assigning drug-involved offenders to dispositions based on their criminogenic risks and needs. Methods: Probation officers administered the Risk and Needs Triage (RANT)™ to 627 felony drug and property offenders at the pre-trial stage or shortly after sentencing to probation. The RANT™ was evaluated for internal scale consistency, factor structure, and predictive validity for re-arrest and re-conviction rates within 12. months of case disposition. Exploratory analyses examined whether recidivism was lower for participants who were assigned to an appropriate disposition given their assessment results. Results: The RANT™ demonstrated acceptable internal consistency and factorial validity, and significantly predicted re-arrest and re-conviction rates within 12. months of case disposition. There was no racial or gender bias in the prediction of recidivism. Non-significant trends favored better outcomes for participants who were assigned to the indicated dispositions. Conclusions: The results lend support for the RANT™ as a dispositional triage tool for drug-involved defendants and probationers at or near the point of arrest. The results also lend tentative support to the hypothesis that outcomes might be better if drug-involved offenders were matched to appropriate dispositions based on their risk-and-need profiles. Directions for future research are discussed. © 2011 Elsevier Ltd

The Survey of Treatment Entry Pressures (STEP): identifying client\u27s reasons for entering substance abuse treatment

OBJECTIVE: Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual\u27s treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP\u27s psychometric properties. METHOD: A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4-7 days later. Analyses were performed to examine the instrument\u27s psychometric properties including item response rates, test-retest reliability, internal consistency, and factor structure. RESULTS: The items displayed adequate test-retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2-factor structure reflecting type of reinforcement schedule. CONCLUSION: The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client\u27s treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes

Overview of: Moving beyond BAC in DUI: Identifying who is at risk of recidivating

Driving under the influence (DUI) represents a significant threat to public safety in the United States, and a significant proportion of first-time DUI offenders go on to become repeat offenders. Substantial resources have been expended to identify variables that predict DUI recidivism, but less progress has been made in developing clinically useful tools to predict recidivism accurately. In the current study, we developed a brief empirically based tool containing markers of recidivism risk and treatment need and conducted a small study to examine the ability of items to discriminate between first-time and repeat DUI offenders. Analyses identified several criminal risk and treatment need variables that discriminated between the two groups; however, blood alcohol concentration (BAC) did not. Policy Implications: Further validation of these findings and the refinement of the triage tool could provide a practical, evidence-based means of screening and triaging first-time DUI offenders and help to inform and refine policy and sentencing guidelines. © 2013 American Society of Criminology

Achieving new levels of recall in consent to research by combining remedial and motivational techniques

Introduction Research supports the efficacy of both a remedial consent procedure (corrected feedback (CF)) and a motivational consent procedure (incentives) for improving recall of informed consent to research. Although these strategies were statistically superior to standard consent, effects were modest and not clinically significant. This study examines a combined incentivised consent and CF procedure that simplifies the cognitive task and increases motivation to learn consent information. Methods We randomly assigned 104 individuals consenting to an unrelated host study to a consent as usual (CAU) condition (n=52) or an incentivised CF (ICF) condition (n=52). All participants were told they would be quizzed on their consent recall following their baseline assessment and at 4 monthly follow-ups. ICF participants were also informed that they would earn $5 for each correct answer and receive CF as needed. Results Quiz scores in the two conditions did not differ at the first administration (p=0.39, d=0.2); however, ICF scores were significantly higher at each subsequent administration (second: p=0.003, Cohen\u27s d=0.6; third: p\u3c0.0001, d=1.4; fourth: p\u3c0.0001, d=1.6; fifth: p\u3c0.0001, d=1.8). Conclusions The ICF procedure increased consent recall from 72% to 83%, compared with the CAU condition in which recall decreased from 69% to 59%. This supports the statistical and clinical utility of a combined remedial and motivational consent procedure for enhancing recall of study information and human research protections