Comorbidities and Race/Ethnicity Among Adults with Stimulant Use Disorders in Residential Treatment

Comorbid physical and mental health problems are associated with poorer substance abuse treatment outcomes; however, little is known about these conditions among stimulant abusers at treatment entry. This study compared racial and ethnic groups on baseline measures of drug use patterns, comorbid physical and mental health disorders, quality of life, and daily functioning among cocaine and stimulant abusing/dependent patients. Baseline data from a multi-site randomized clinical trial of vigorous exercise as a treatment strategy for a diverse population of stimulant abusers (N = 290) were analyzed. Significant differences between groups were found on drug use characteristics, stimulant use disorders, and comorbid mental and physical health conditions. Findings highlight the importance of integrating health and mental health services into substance abuse treatment and could help identify potential areas for intervention to improve treatment outcomes for racial and ethnic minority groups

The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study.

BACKGROUND: Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications. METHODS: A mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the dose of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the interventions impact. RESULTS: Of the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability. CONCLUSIONS: A CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations

Stimulant Reduction Intervention using Dosed Exercise (STRIDE) - CTN 0037: Study protocol for a randomized controlled trial

Background: There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these domains in a number of other clinical disorders. Furthermore, neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes. The current manuscript presents the rationale, design considerations, and study design of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study. Methods/Design: STRIDE is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. This study will evaluate individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. Three hundred and thirty eligible and interested participants who provide informed consent will be randomized to one of two treatment arms: Vigorous Intensity High Dose Exercise Augmentation (DEI) or Health Education Intervention Augmentation (HEI). Both groups will receive TAU (i.e., usual care). The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants will begin with supervised sessions 3 times per week during the 12-week acute phase of the study. Supervised sessions will be conducted as one-on-one (i.e., individual) sessions, although other participants may be exercising at the same time. Following the 12-week acute phase, participants will begin a 6-month continuation phase during which time they will attend one weekly supervised DEI or HEI session

Bupropion and Naltrexone in Methamphetamine Use Disorder

BackgroundThe use of naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied.MethodsWe conducted this multisite, double-blind, two-stage, placebo-controlled trial with the use of a sequential parallel comparison design to evaluate the efficacy and safety of extended-release injectable naltrexone (380 mg every 3 weeks) plus oral extended-release bupropion (450 mg per day) in adults with moderate or severe methamphetamine use disorder. In the first stage of the trial, participants were randomly assigned in a 0.26:0.74 ratio to receive naltrexone-bupropion or matching injectable and oral placebo for 6 weeks. Those in the placebo group who did not have a response in stage 1 underwent rerandomization in stage 2 and were assigned in a 1:1 ratio to receive naltrexone-bupropion or placebo for an additional 6 weeks. Urine samples were obtained from participants twice weekly. The primary outcome was a response, defined as at least three methamphetamine-negative urine samples out of four samples obtained at the end of stage 1 or stage 2, and the weighted average of the responses in the two stages is reported. The treatment effect was defined as the between-group difference in the overall weighted responses.ResultsA total of 403 participants were enrolled in stage 1, and 225 in stage 2. In the first stage, 18 of 109 participants (16.5%) in the naltrexone-bupropion group and 10 of 294 (3.4%) in the placebo group had a response. In the second stage, 13 of 114 (11.4%) in the naltrexone-bupropion group and 2 of 111 (1.8%) in the placebo group had a response. The weighted average response across the two stages was 13.6% with naltrexone-bupropion and 2.5% with placebo, for an overall treatment effect of 11.1 percentage points (Wald z-test statistic, 4.53; P<0.001). Adverse events with naltrexone-bupropion included gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia. Serious adverse events occurred in 8 of 223 participants (3.6%) who received naltrexone-bupropion during the trial.ConclusionsAmong adults with methamphetamine use disorder, the response over a period of 12 weeks among participants who received extended-release injectable naltrexone plus oral extended-release bupropion was low but was higher than that among participants who received placebo. (Funded by the National Institute on Drug Abuse and others; ADAPT-2 ClinicalTrials.gov number, NCT03078075.)

Stimulant Reduction Intervention using Dosed Exercise (STRIDE) - CTN 0037: Study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these domains in a number of other clinical disorders. Furthermore, neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes. The current manuscript presents the rationale, design considerations, and study design of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study.</p> <p>Methods/Design</p> <p>STRIDE is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. This study will evaluate individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. Three hundred and thirty eligible and interested participants who provide informed consent will be randomized to one of two treatment arms: Vigorous Intensity High Dose Exercise Augmentation (DEI) or Health Education Intervention Augmentation (HEI). Both groups will receive TAU (i.e., usual care). The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants will begin with supervised sessions 3 times per week during the 12-week acute phase of the study. Supervised sessions will be conducted as one-on-one (i.e., individual) sessions, although other participants may be exercising at the same time. Following the 12-week acute phase, participants will begin a 6-month continuation phase during which time they will attend one weekly supervised DEI or HEI session.</p> <p>Clinical Trials Registry</p> <p>ClinicalTrials.gov, <a href="http://www.clinicaltrials.gov/ct2/show/NCT01141608">NCT01141608</a></p> <p><url>http://clinicaltrials.gov/ct2/show/NCT01141608?term=Stimulant+Reduction+Intervention+using+Dosed+Exercise&rank=1</url></p

Examining the Relationships among General Coping, Alcohol-Specific Coping and Alcohol Use in a College Student Population

The coping and alcohol literature indicates certain styles of coping are more protective against alcohol use than others. The purpose of the current study was to explore the associations among general coping styles, alcohol-specific coping skills, drinking to cope motives, and alcohol use in an effort to further examine their theoretical relationships. It was hypothesized that: (1) The relationship between problem-focused coping and alcohol use would be mediated by alcohol-specific coping, (2) Drinking to cope would mediate the relationship between avoidant emotion-focused coping and alcohol use, (3) The problem-focused coping facets of planning, active coping, suppression of competing activities, and restraint coping would contribute the most to the prediction of alcohol-specific coping skills, and (4) Intention to regulate drinking would moderate the relationship between problem-focused coping and alcohol-specific coping such that the relationship between the two would be stronger in individuals who have greater intentions of regulating their drinking. College students (N = 327) completed several self-report measures that assessed their alcohol use, general coping styles, use of alcohol-specific coping strategies, and endorsement of drinking to cope motives for alcohol use. Analyses of fully latent variables were conducted using structural equation modeling techniques. Results suggested alcohol-specific coping skills partially mediated the association between problem-focused coping and alcohol use. An unexpected positive direct association between problem-focused coping and alcohol use emerged; post-hoc analyses suggested specific facets of problem-focused coping more clearly explain that finding. The hypothesized relationships between avoidant focused coping and alcohol use were not supported but avoidant coping was significantly associated with drinking to cope, consistent with the literature. Finally, the positive association between problem-focused coping and alcohol-specific coping skills was not moderated by intentions to regulate drinking. Limitations and suggestions for future research are discussed.Ph. D

Understanding Self-Efficacy for Alcohol Use: The Roles of Self-Monitoring and Hypothesized Source Variables

Self-efficacy for avoiding alcohol use predicts alcohol use after treatment. However, self-efficacy predicts outcome differentially depending on whether ratings are made before or after treatment. In order to increase the predictive validity of self-efficacy judgments, the hypothesized sources of self-efficacy were examined in the current study utilizing a college student population. Self-efficacy ratings for avoiding heavy drinking before and after self-monitoring of drinking behavior were examined in order to understand whether careful examination of current behavior would result in more informed self-efficacy judgments. Participants (N = 135) completed questionnaires that assessed self-efficacy, drinking behaviors, alcohol expectancies, and perceived normative alcohol use. Participants were assigned to either the control or self-monitoring condition. Self-monitors recorded drinking behaviors during the four weeks after the baseline assessment. All participants returned for a follow-up assessment four weeks later. Consistent with predictions based on social cognitive theory, heavy drinking, positive alcohol expectancies, and perceived norms of use were inversely related to self-efficacy. Hierarchical multiple regression analyses indicated that self-monitoring did not lead to stronger relationships between source variables and self-efficacy. Individuals who appeared to be overconfident in their self-efficacy judgments at baseline did not make more accurate ratings as a result of self-monitoring. Results from this study highlight potential sources of information individuals use in making self-efficacy judgments.Master of Scienc