Research Findings - CTN-Related Research
Methods of Recruiting Adolescents With Psychiatric and Substance Use Disorders For A Clinical Trial
The present article reports on recruiting strategies in a 16-week, multi-site trial of osmotic-release methylphenidate combined with cognitive-behavioral therapy in adolescents with co-occurring attention deficit hyperactivity disorder and substance use disorder. A multifaceted recruiting strategy was employed that targeted multiple referral sources, used incentives, involved numerous staff members, emphasized the therapeutic alliance during prescreening, and utilized data to modify strategies based on results. Overall, 303 adolescents were randomized from 1,333 total referrals across 11 participating sites. Overall, existing treatment program sources, including treatment program staff, social services, the juvenile justice system, and mental health clinics provided a majority of referrals for pre-screening and randomization. These results support the feasibility of recruiting dually-diagnosed adolescents utilizing a multifaceted approach involving the entire study team. Jaffee WB, Bailey GL, Lohman M, Riggs P, McDonald L, Weiss RD. The American Journal of Drug and Alcohol Abuse. 2009 Sept; 35(5):381-384.
Predictors of Condom Use Among Men Enrolled In Drug Treatment Programs
This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses, reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed that taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions. Song YS, Calsyn DA, Doyle SR, Dierst-Davies R, Chen T, Sorensen JL. AIDS Educ Prev. 2009 Oct;21(5):460-473.
A Multisite Randomized Effectiveness Trial of Motivational Enhancement Therapy For Spanish-Speaking Substance Users
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. This multisite randomized trial compared 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. Sixty-six percent of participants completed 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. (PsycINFO Database Record (c) 2009 APA, all rights reserved). Carroll KM, Martino S, Ball SA, et al. J Consult Clin Psychol. 2009 Oct;77(5):993-999.
Methodological Innovation To Increase the Utility and Efficiency of Psychotherapy Research For Patients With Co-Occurring Mental Health and Substance Use Disorders
Psychotherapy research with chronic and difficult-to-treat populations, such as those with co-occurring mental health and addictive disorders, can employ flexible research designs, which allow for a systematic yet nonlinear relationship between efficacy and effectiveness designs. Outcomes research can bypass the efficacy-effectiveness dichotomy through use of a hybrid model conducted in the context of community treatment settings. This approach was used as a means of advancing psychotherapy research and practice, while translating and disseminating empirically supported treatments with more efficiency. The study entitled "Women's Treatment for Trauma and Substance Use Disorder" was conducted within the National Institute on Drug Abuse's Clinical Trials Network as. Hien DA, Cohen LR, Campbell AN. Professional Psychology: Research and Practice. 2009 Oct:40(5):502-509.
External Pressure, Motivation, and Treatment Outcome Among Pregnant Substance-Using Women
The weight of evidence suggests that legal pressure to enter treatment facilitates retention. However, the extent to which such mandates (a) influence actual levels of substance use, or (b) also facilitate retention among pregnant women, is unclear. Associations between external pressure-defined as self-reported pressure to attend treatment under threat of incarceration, loss of child custody, and/or loss of subsidized housing-and the key outcomes of retention and substance use were therefore examined in a sample of 200 pregnant women receiving community-based substance abuse treatment. The role of external pressure was examined in a series of Cox and GEE regressions, which suggested that external pressure as measured at baseline was associated with decreased risk of dropout (Hazard Ratio=.47, p=.001) and fewer drug-positive urine tests throughout treatment and 12-week follow-up (OR=.48, p=.03). These differences did not appear to be the result of baseline differences between coerced and non-coerced participants in education, legal history, the presence or absence of a substance use disorder, employment, or motivation. The present findings extend the larger literature on external pressure by demonstrating effects on drug use as well as on retention, and among pregnant women. Ondersma SJ, Winhusen T, Lewis DF. Drug Alc Depend. 2009 Nov 16. [Epub ahead of print].
Do Treatment Improvements In PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From A Randomized Clinical Trial In NIDA's Clinical Trials Network
The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. Three hundred and fifty three women were randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement among those who were heavy substance users at baseline and had achieved significant PTSD reductions. PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms. Hien DA, Jiang H, Campbell AN, et al. Am J Psychiatry. 2009 Nov 16. [Epub ahead of print].
Relationship Power and Sexual Risk Among Women In Community-Based Substance Abuse Treatment
Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a NIDA Clinical Trials Network multisite trial of a women's HIV prevention intervention in community-based drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Campbell AN, Tross S, Dworkin SL, Hu MC, Manuel J, Pavlicova M, Nunes EV. J Urban Health. 2009 Nov 18. [Epub ahead of print].
Predictors Of Buprenorphine-Naloxone Dosing In A 12-Week Treatment Trial For Opioid-Dependent Youth: Secondary Analyses From A NIDA Clinical Trials Network Study
The present investigation examines baseline patient characteristics to predict dosing of buprenorphine-naloxone, a promising treatment for opioid addiction in youths. This study of 69 opioid-dependent youths is a secondary analysis of data collected during a NIDA Clinical Trials Network study. Outpatients aged 15-21 were randomized to a 12-week buprenorphine-naloxone dosing condition (including 4 weeks of taper). Predictors of dosing included sociodemographic characteristics (gender, race, age, and education), substance use (alcohol, cannabis, cocaine, and nicotine use), and clinical characteristics (pain and withdrawal severity). Most (75.4%) reported having either "some" (n=40, 58.0%) or "extreme" (n=12, 17.4%) pain on enrollment. Maximum daily dose of buprenorphine-naloxone (19.7 mg) received by patients reporting "extreme" pain at baseline was significantly higher than the dose received by patients reporting "some" pain (15.0 mg) and those without pain (12.8 mg). In the adjusted analysis, only severity of pain and withdrawal significantly predicted dose. During the dosing period, there were no significant differences in opioid use, as measured by urinalysis, by level of pain. These data suggest that the presence of pain predicts buprenorphine-naloxone dose levels in opioid-dependent youth, and that patients with pain have comparable opioid use outcomes to those without pain, but require higher buprenorphine-naloxone doses. Chakrabarti A, Woody GE, Griffin ML, Subramaniam G, Weiss RD. Drug Alcohol Depend. 2009 Nov 28. [Epub ahead of print].
Reducing Sex Under the Influence Of Drugs Or Alcohol For Patients In Substance Abuse Treatment
The effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was previously reported. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. The participants were assigned randomly to either REMAS (five sessions containing information, motivational exercises and skills training, including one session targeting reducing SUI) or HIV education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome. Men assigned to REMAS reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to an increase from 36.9% to 38.3% in the HIV-Ed condition (tintervention = -2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up. Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Addiction. 2010; 105(1):100-108.