Research Interests: Psychology, Medicine, Counseling, Residential care, Humans, and 15 moreSubstance Abuse, Female, Feasibility Studies, Male, Addictive Behaviours, Patient Compliance, Chronic Care Model, Adult, Aftercare, First Year, Continuing Care, Addictive Behaviors, Remote Consultation, Continuity of Patient Care, and Residential Treatment Care
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ABSTRACT Community recovery centers (CRCs) have the potential to be an important component in the substance abuse continuum of care, yet we lack data on their effectiveness. This study examines the 6-month outcomes of 260 clients... more
ABSTRACT Community recovery centers (CRCs) have the potential to be an important component in the substance abuse continuum of care, yet we lack data on their effectiveness. This study examines the 6-month outcomes of 260 clients participating in the Phoenix House Bronx Community recovery Center (BCRC). At follow-up, clients were significantly less likely to report substance use (odds ratio [OR] = 0.4, p = 0.002) and showed improvements on a variety of other psychosocial domains as well. Fewer clients were also using formal inpatient (OR = 0.3, p < 0.001) and outpatient substance abuse treatment services at follow-up (OR = 0.5, p = 0.011). These data provide preliminary evidence for the effectiveness of recovery centers to sustain abstinence, enhance recovery capital, and curtail the use of formal, more expensive substance abuse treatment. Additional studies documenting the type and amount of services received in recovery centers, randomized trials of referrals to recovery centers and referral as usual, and studies of cost-effectiveness are needed.
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Research Interests: Psychology, Philosophy of Agency, Addiction, Documentation, Medicine, and 11 moreSubstance Abuse Treatment, Humans, Substance Abuse, Addiction Treatment, Delaware, Data Collection, Public health systems and services research, Time Factors, Clinical Information System, Substance-Related Disorders, and Ambulatory Care
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Research Interests: Business, Program Evaluation, Addiction, Evidence Based Medicine, Evidence Based Practice, and 15 moreHealth Policy, Medicine, Humans, Public Health Administration, Female, Male, Addiction Treatment, Delaware, Incentive, Capacity Utilization, Public Administration and Policy, Adult, Patient Participation, Pilot Projects, and Pay for performance
This paper reviews the current literature on the definition and classification of drug and alcohol user treatment "programs," and provides a rationale for our approach to measuring the treatment programs in the Drug... more
This paper reviews the current literature on the definition and classification of drug and alcohol user treatment "programs," and provides a rationale for our approach to measuring the treatment programs in the Drug Evaluation Network System (DENS). The DENS gathers extensive background and recent status data on patients' drug, alcohol, psychiatric, medical, employment, legal, and family problems as they enter a sample of treatment programs throughout the country. The DENS recognized the need for descriptive information on important structural, organizational, and service delivery aspects of the programs in which those patients were treated. To this end, we present our efforts thus far in characterizing and monitoring "service delivery units" or "programs" that are sampled in the DENS system. Specifically, we present development of the Addiction Treatment Inventory (ATI), a standardized measurement instrument to characterize these service delivery units and their services.
Research Interests: Psychology, Addiction, Evaluation, Treatment, Health Services Research, and 15 moreMedicine, Humans, Alcoholism, United States, Service Delivery, Addiction Treatment, Systems, Substance use and misuse, System Evaluation, service Business, Networked Systems, Substance-Related Disorders, Combined Modality Therapy, Delivery of Health Care, and quality assurance in health care
Research Interests: Psychology, Anxiety Disorders, Addiction, Social Problems, Treatment Outcome, and 15 moreMedicine, Comorbidity, Pregnancy, Humans, Alcoholism, Female, Male, Depressive Disorder, Crack Cocaine, Health Status, Adult, Prognosis, Substance-Related Disorders, Severity of Illness Index, and Addiction Severity Index (ASI)
Community substance abuse treatment programs face many barriers to adopting “evidence-based” therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost... more
Community substance abuse treatment programs face many barriers to adopting “evidence-based” therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field—developing a resource “toolkit” for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing. This trial toolkit was comprised of a DVD (televised during group to illustrate the clinical concept), a laminated counselor guide (to provide guidance and talking points for the counselor during group), and some worksheets and wallet cards for patients to retain key points (see Table 1 ). A feasibility trial assessed the acceptability, and sustainability of the “Decisional Balance” concept toolkit among 26 counselors and 210 of their patients, from 6 community-based substance abuse treatment programs. The great majority of patients (97%) and all counselors (100%) reported they were satisfied with the toolkit session; 84% of patients said they would like more groups like the toolkit session. Almost all counselors (96%) were still using at least one component of the toolkit 3 months after their initial exposure with no prompting. The toolkit curriculum–based approach may be a viable and attractive way of translating core concepts from sophisticated evidence-based therapies into use by counselors within contemporary, community-based treatment programs with minimal training.
Research Interests: Psychology, Evidence Based Practice, Medical Education, Treatment, Adolescent, and 15 moreMedicine, Counseling, Curriculum, Motivational Interviewing, Substance Abuse Treatment, Humans, Substance Abuse, Feasibility Studies, Patient Satisfaction, Substance, Adult, Evidence Based, Group, Boolean Satisfiability, and Community Based Mental Health Services
Research Interests: Psychology, Mental Health, Evaluation, Public Health, Medicine, and 15 moreHumans, Female, Male, Drug Addiction, Addiction Treatment, Data Collection, Laptop, Data transfer, Adult, Public health systems and services research, Computer communication networks, Large Scale, Pilot Projects, Information System, and Databases as topic
Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and... more
Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and that family involvement may influence continuation in and completion of treatment for both cocaine and alcohol abusers.A sample of 99 primary cocaine abusers and
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Research Interests: Program Evaluation, Psychology, Assessment, Technology transfer, Medicine, and 15 moreSubstance Abuse Treatment, Software Design, Humans, Human Resources for Health, Female, Male, Philadelphia, Public health systems and services research, Treatment planning, Community Based Mental Health Services, Severity of Illness Index, Multicenter Studies as Topic, Health Resources, Referral and consultation, and Referral
Research Interests: Psychology, Psychiatry, Addiction, Forecasting, Public Health, and 15 moreMedicine, Humans, Alcoholism, Female, Male, Drug Addiction, Mental Disorder, Medical Diagnosis, Alcohol dependence, Adult, Drug Dependence, Area Under Curve, Networked Systems, Psychiatric Status Rating Scales, and Diagnostic and Statistical Manual
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Research Interests: Psychology and Medicina
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Research Interests: Psychology, Multimedia, Evidence Based Practice, Medical Education, Group Psychotherapy, and 14 moreCounseling, Curriculum, Substance Abuse Treatment, Community Health Workers, Humans, Cognitive Therapy, Patient Satisfaction, Substance, Public health systems and services research, Cost Benefit Analysis, SECONDARY PREVENTION, Substance-Related Disorders, Ambulatory Care, and Guideline Adherence
Research Interests: Engineering, Terrorism, Depression, Medicine, Anxiety, and 7 moreHumans, New York City, United States, Female, Alcohol Drinking, Male, and ANXIETY
ABSTRACT
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Research Interests: Psychology, Addiction, Community-Based Mental Health Services, Financial management, Treatment, and 15 moreQuality of Mental Health Care, Public Health, Substance Abuse Treatment, Information Services, Humans, Substance Abuse, Organization, United States, Organisation, Addiction Treatment, Personnel Management, Public health systems and services research, Community Based Mental Health Services, Substance-Related Disorders, and Quality of health care
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This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine... more
This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine the potential of the Addiction Severity Index (ASI) to serve as a screening instrument for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) substance dependence. A significant positive correlation was found between ASI composite scores (CSs) and DSM-IV diagnoses of dependence in both the alcohol (r > .7) and drug (r > .5) domains (p < .01). Receiver operating characteristic analyses were run to predict DSM-IV alcohol and drug dependence diagnoses from the respective ASI CSs. Results showed good to strong prediction; ASI CSs identified dependent clients with approximately 85% sensitivity and 80% specificity. We recommend strategies for using ASI CSs as a diagnostic screening instrument in both research and treatment delivery environments.
Research Interests: Psychology, Forecasting, Public Health, Substance Abuse Treatment, Software, and 15 moreHumans, Alcoholism, Female, Male, Drug Addiction, Substance Dependence, Substance, Mental Disorder, Adult, Public health systems and services research, Drug Dependence, Area Under Curve, Networked Systems, Psychiatric Status Rating Scales, and Diagnostic and Statistical Manual
This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine... more
This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine the potential of the Addiction Severity Index (ASI) to serve as a screening instrument for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) substance dependence. A significant positive correlation was found between ASI composite scores (CSs) and DSM-IV diagnoses of dependence in both the alcohol (r > .7) and drug (r > .5) domains (p < .01). Receiver operating characteristic analyses were run to predict DSM-IV alcohol and drug dependence diagnoses from the respective ASI CSs. Results showed good to strong prediction; ASI CSs identified dependent clients with approximately 85% sensitivity and 80% specificity. We recommend strategies for using ASI CSs as a diagnostic screening instrument in both research and treatment delivery environments.
Research Interests: Psychology, Forecasting, Public Health, Substance Abuse Treatment, Software, and 15 moreHumans, Alcoholism, Female, Male, Drug Addiction, Substance Dependence, Substance, Mental Disorder, Adult, Public health systems and services research, Drug Dependence, Area Under Curve, Networked Systems, Psychiatric Status Rating Scales, and Diagnostic and Statistical Manual
Drug addiction is characterized by dysregulated dopamine neurotransmission. Although dopamine functioning appears to partially recover with abstinence, the specific regions that recover and potential impact on drug seeking remain to be... more
Drug addiction is characterized by dysregulated dopamine neurotransmission. Although dopamine functioning appears to partially recover with abstinence, the specific regions that recover and potential impact on drug seeking remain to be determined. Here we used functional magnetic resonance imaging (fMRI) to study an ecologically valid sample of 15 treatment-seeking cocaine addicted individuals at baseline and 6-month follow-up. At both study sessions, we collected fMRI scans during performance of a drug Stroop task, clinical self-report measures of addiction severity and behavioral measures of cocaine seeking (simulated cocaine choice); actual drug use in between the two study sessions was also monitored. At 6-month follow-up (compared with baseline), we predicted functional enhancement of dopaminergically innervated brain regions, relevant to the behavioral responsiveness toward salient stimuli. Consistent with predictions, whole-brain analyses revealed responses in the midbrain (encompassing the ventral tegmental area/substantia nigra complex) and thalamus (encompassing the mediodorsal nucleus) that were higher (and more positively correlated) at follow-up than baseline. Increased midbrain activity from baseline to follow-up correlated with reduced simulated cocaine choice, indicating that heightened midbrain activations in this context may be marking lower approach motivation for cocaine. Normalization of midbrain function at follow-up was also suggested by exploratory comparisons with active cocaine users and healthy controls (who were assessed only at baseline). Enhanced self-control at follow-up was suggested by a trend for the commonly hypoactive dorsal anterior cingulate cortex to increase response during a drug-related context. Together, these results suggest that fMRI could be useful in sensitively tracking follow-up outcomes in drug addiction.
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ABSTRACT Community recovery centers (CRCs) have the potential to be an important component in the substance abuse continuum of care, yet we lack data on their effectiveness. This study examines the 6-month outcomes of 260 clients... more
ABSTRACT Community recovery centers (CRCs) have the potential to be an important component in the substance abuse continuum of care, yet we lack data on their effectiveness. This study examines the 6-month outcomes of 260 clients participating in the Phoenix House Bronx Community recovery Center (BCRC). At follow-up, clients were significantly less likely to report substance use (odds ratio [OR] = 0.4, p = 0.002) and showed improvements on a variety of other psychosocial domains as well. Fewer clients were also using formal inpatient (OR = 0.3, p < 0.001) and outpatient substance abuse treatment services at follow-up (OR = 0.5, p = 0.011). These data provide preliminary evidence for the effectiveness of recovery centers to sustain abstinence, enhance recovery capital, and curtail the use of formal, more expensive substance abuse treatment. Additional studies documenting the type and amount of services received in recovery centers, randomized trials of referrals to recovery centers and referral as usual, and studies of cost-effectiveness are needed.
Research Interests:
Research Interests:
Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and... more
Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and that family involvement may influence continuation in and completion of treatment for both cocaine and alcohol abusers.A sample of 99 primary cocaine abusers and
Research Interests:
Research Interests: Terrorism, Depression, Anxiety, Humans, New York City, and 5 moreUnited States, Female, Alcohol Drinking, Male, and ANXIETY
Research Interests: Psychology, Mental Health, Evaluation, Treatment, Public Health, and 20 moreSubstance Abuse Treatment, Humans, United States, Female, Male, Drug Addiction, Service Delivery, Addiction Treatment, Data Collection, Systems, Registries, Data transfer, Adult, Public health systems and services research, Computer communication networks, Large Scale, Pilot Projects, Substance-Related Disorders, Quality of data, and Information System
Research Interests:
Research Interests: Terrorism, Depression, Anxiety, Humans, New York City, and 5 moreUnited States, Female, Alcohol Drinking, Male, and ANXIETY
This paper reviews the current literature on the definition and classification of drug and alcohol user treatment "programs," and provides a rationale for our approach to measuring the treatment programs in the Drug... more
This paper reviews the current literature on the definition and classification of drug and alcohol user treatment "programs," and provides a rationale for our approach to measuring the treatment programs in the Drug Evaluation Network System (DENS). The DENS gathers extensive background and recent status data on patients' drug, alcohol, psychiatric, medical, employment, legal, and family problems as they enter a sample of treatment programs throughout the country. The DENS recognized the need for descriptive information on important structural, organizational, and service delivery aspects of the programs in which those patients were treated. To this end, we present our efforts thus far in characterizing and monitoring "service delivery units" or "programs" that are sampled in the DENS system. Specifically, we present development of the Addiction Treatment Inventory (ATI), a standardized measurement instrument to characterize these service delivery units and their services.
Research Interests:
To examine demographic differences in alcohol telescoping-the rate of self-reported movement from regular alcohol consumption to the onset of regular heavy drinking-as well as differences in ages of initiation of regular alcohol use and... more
To examine demographic differences in alcohol telescoping-the rate of self-reported movement from regular alcohol consumption to the onset of regular heavy drinking-as well as differences in ages of initiation of regular alcohol use and alcohol use to intoxication. The present study compared the retrospective reports of 2037 clients (1252 males, 785 females) enrolled in substance user treatment facilities around the country in 1998 and 1999. Overall, the findings support previous research, indicating that women generally move more rapidly than men from initiation of regular alcohol use to problem use (telescoping). The findings also indicate that African-Americans generally begin regular alcohol use later than their Anglo counterparts and move more rapidly from initiation of regular alcohol use to problem use (telescoping). Examining the sample by older vs. younger age groups demonstrates that gender and racial/ethnic differences in the age of initiation of regular alcohol use and in telescoping may be limited by age group, as these patterns appear in the older but not the younger cohort. These findings suggest that self-reported regular alcohol use, alcohol abuse, and telescoping differences vary dramatically by gender, race/ethnicity, and age cohort. Furthermore, the pattern of findings suggests that these differences are more likely the result of sociocultural than biological differences between the groups under study.
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Community substance abuse treatment programs face many barriers to adopting... more
Community substance abuse treatment programs face many barriers to adopting "evidence-based" therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field-developing a resource "toolkit" for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing. This trial toolkit was comprised of a DVD (televised during group to illustrate the clinical concept), a laminated counselor guide (to provide guidance and talking points for the counselor during group), and some worksheets and wallet cards for patients to retain key points (see Table 1). A feasibility trial assessed the acceptability, and sustainability of the "Decisional Balance" concept toolkit among 26 counselors and 210 of their patients, from 6 community-based substance abuse treatment programs. The great majority of patients (97%) and all counselors (100%) reported they were satisfied with the toolkit session; 84% of patients said they would like more groups like the toolkit session. Almost all counselors (96%) were still using at least one component of the toolkit 3 months after their initial exposure with no prompting. The toolkit curriculum-based approach may be a viable and attractive way of translating core concepts from sophisticated evidence-based therapies into use by counselors within contemporary, community-based treatment programs with minimal training.