Aims Opioid pain reliever abuse rates have increased sharply in the United States. This study examines Americans’ personal experience with opioid pain reliever use and abuse, and views about the seriousness of the problem, factors causing it, responsibility for addressing it and support for policies to resolve it. Design Public opinion survey.
Setting and Participants A nationally representative US adult sample (n = 1111).
Measures Experiences with opioid pain relievers and views about the seriousness, causes of and responsibility for addressing the problem, and support for policies to reduce opioid pain reliever abuse. Findings 28.2 per cent of Americans reported using opioid pain relievers in the last 12 months, 69.5% have used them in their life-time and 17.3% reported using these medications when not prescribed to them. Fifty-eight per cent ranked the problem as serious, on a par with other major health concerns. Individual-orientated factors, including a lack of understanding about how easy it is to become addicted (80.0%) and improper storage (65.1%) and disposal (64.1%), ranked highest as causes, and those abusing opioid pain relievers (83.8%) and their physicians (78.0%) were viewed as most responsible for solving the problem. Of the policies recommended to curb the epidemic, 14 of 16 were supported by a majority of Americans. Conclusions Americans view the problem of opioid pain reliever abuse as serious, and support nearly all the policies recommended by medical, law enforcement, disease control and public health experts to curb the epidemic.
Keywords: Addiction; opioid analgesics; policy; public opinion; substance abuse; surveys
RECOVERY, RELAPSE AND PREVENTION 63. Emerging consensus on measuring addiction recovery: Findings from a multi-stakeholder consultation exercise
Joanne Neale, Daria Panebianco, Emily Finch, John Marsden, Luke Mitcheson, Diana Rose, John Strang & Til Wykes Drugs: Education, Prevention and Policy 2016:23(1);31-40 Abstract
Aim To identify indicators that diverse stakeholders believe are important when measuring recovery from addiction. Methods Our previous work with service users had generated 28 indicators of recovery. Using Delphi group methodology (three rounds), we assessed the extent to which stakeholders working in the addictions field agreed that the 28 indicators were important on a scale of 1–10. Participants included 146 individuals with diverse job roles in 124 organisations across the British Isles. Findings Round 1 scores were high. There was evidence of greater scoring consensus in Round 2, but this trend was less certain in Round 3. Participants scored 27/28 indicators ≥7/10 in Round 3, so confirming their importance. The only Round 3 indicator with a mean score <7 was “experiencing cravings”. There were statistical differences between the Round 3 indicator scores of some sub-groups of participants, but absolute differences were small (never more than 1 point for any indicator). Conclusions We have identified 27 recovery indicators that stakeholders working within the addiction field in the British Isles consistently ranked as important. Replicating our methods in other countries, and with additional stakeholder groups, will provide greater clarity on the term “recovery”, its relevance and value, and how it can best be measured.
Keywords: Delphi group; measurement; recovery; service users; stakeholder consultation
64. Personal support networks, social capital, and risk of relapse among individuals treated for substance use issues
Daria Panebianco, Owen Gallupe, Peter J. Carrington, Ivo Colozzi
International Journal of Drug Policy 2016:27;146-153 Abstract
Background The success of treatment for substance use issues varies with personal and social factors, including the composition and structure of the individual's personal support network. This paper describes the personal support networks and social capital of a sample of Italian adults after long-term residential therapeutic treatment for substance use issues, and analyses network correlates of post-treatment substance use (relapse). Methods Using a social network analysis approach, data were obtained from structured interviews (90–120 min long) with 80 former clients of a large non-governmental therapeutic treatment agency in Italy providing voluntary residential treatments and rehabilitation services for substance use issues. Participants had concluded the program at least six months prior. Data were collected on socio-demographic variables, addiction history, current drug use status (drug-free or relapsed), and the composition and structure of personal support networks. Factors related to risk of relapse were assessed using bivariate and multivariate logistic regression models.
Results A main goal of this study was to identify differences between the support network profiles of drug free and relapsed participants. Drug free participants had larger, less dense, more heterogeneous and reciprocal support networks, and more brokerage social capital than relapsed participants. Additionally, a lower risk of relapse was associated with higher socio-economic status, being married/cohabiting, and having network members with higher socio-economic status, who have greater occupational heterogeneity, and reciprocate support.
Conclusions Post-treatment relapse was found to be negatively associated with the socioeconomic status and occupational heterogeneity of ego's support network, reciprocity in the ties between ego and network members, and a support network in which the members are relatively loosely connected with one another (i.e., ego possesses “brokerage social capital”). These findings suggest the incorporation into therapeutic programming of interventions that address those aspects of clients’ personal support networks.
Keywords: Substance abuse; Social network; Social support; Social capital; Relapse
65. Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial
Donald S. Shepard, Marilyn C. Daley, Matthew J. Neuman, Aaron P. Blaakman, James R. McKay
Drug and Alcohol Dependence 2016:159;109-116 Abstract
Purpose To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse.Methods Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes.Results The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p < 0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (−$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. Conclusions TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.
Keywords: Alcohol and cocaine dependence; Continuing care alternatives; Telephone-based continuing care; Relapse prevention
66. The effectiveness of compulsory drug treatment: A systematic review
D. Werb, A. Kamarulzaman, M.C. Meacham, C. Rafful, B. Fischer, S.A. Strathdee, E. Wood
International Journal of Drug Policy 2016:28;1-9 Abstract
BackgroundDespite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment.MethodsWe conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism.
Results Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. Conclusion There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.
67. Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?
Elizabeth J. Gifford, Lindsey M. Eldred, Frank A. Sloan & Kelly E. Evans Substance Use and Misuse 2016:51(2);179-192
Background In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied. Objectives To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement.
Methods Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program. Results Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk.
Conclusion/Importance The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.
Keywords:Drug treatment courts, child maltreatment, convictions, substance use
YOUNG PEOPLE AND ALCOHOL 68. Social Goals and Grade as Moderators of Social Normative Influences on Adolescent Alcohol Use
Samuel N. Meisel and Craig R. Colder
Alcoholism: Clinical and Experimental Research 2015:39(12);2455-2462
Background The literature distinguishes 2 types of social normative influences on adolescent alcohol use, descriptive norms (perceived peer alcohol use) and injunctive norms (perceived approval of drinking). Although theoretical formulations suggest variability in the salience and influence of descriptive and injunctive norms, little is understood regarding for whom and when social norms influence adolescent drinking. Strong agentic and communal social goals were hypothesized to moderate the influence of descriptive and injunctive norms on early adolescent alcohol use, respectively. Developmental changes were also expected, such that these moderating effects were expected to get stronger at later grades.
Methods This longitudinal study included 387 adolescents and 4 annual assessments (spanning 6th to 10th grade). Participants completed questionnaire measures of social goals, social norms, and alcohol use at each wave. Results Multilevel logistic regressions were used to test prospective associations. As hypothesized, descriptive norms predicted increases in the probability of alcohol use for adolescents with strong agentic goals, but only in later grades. Injunctive norms were associated with increases in the probability of drinking for adolescents with low communal goals at earlier grades, whereas injunctive norms were associated with an increased probability of drinking for adolescents with either low or high communal goals at later grades. Although not hypothesized, descriptive norms predicted increases in the probability of drinking for adolescents high in communal goals in earlier grades, whereas descriptive norms predicted drinking for adolescents characterized by low communal goals in later grades. Conclusions The current study highlights the importance of social goals when considering social normative influences on alcohol use in early and middle adolescence. These findings have implications for whom and when normative feedback interventions might be most effective during this developmental period.
Keywords: Social Norms; Social Goals; Adolescent Alcohol Use
69. Effectiveness of a Dutch community-based alcohol intervention: Changes in alcohol use of adolescents after 1 and 5 years
Sophia C. Jansen, Annemien Haveman-Nies, Inge Bos-Oude Groeniger, Cobi Izeboud, Carolien de Rover, Pieter van’t Veer
Drug and Alcohol Dependence 2016:159;125-132 Abstract
Background Underage alcohol drinking is a severe public health problem. The aim of this study was to evaluate the short- and long-term effects of a Dutch community-based alcohol intervention on alcohol use of adolescents in the second and fourth grade of high school.
Methods The community intervention integrated health education, regulation, and enforcement in multiple settings, targeting adolescents as well as their environments. In order to evaluate effectiveness, a quasi-experimental pretest posttest design was used based on three independent cross-sectional surveys in 2003, 2007 and 2011, resulting in an analytical sample of approximately 5700 and 3100 adolescents in the intervention and reference region, respectively. For the main analyses, we compared the change in recent alcohol use and binge drinking in the intervention region with the reference region. Linear regression was used to obtain (adjusted) prevalence of alcohol use. Results During the study period, there was an overall decline in the prevalence of alcohol use. After 1 year of intervention, the decline was 11% (P < 0.01) and 6% (P < 0.01) stronger in the intervention region as compared to the reference region, for recent alcohol use and binge drinking respectively. This effect was restricted to the second grade and remained after 5 years of intervention. No clear subgroup effects or confounding were observed for ethnicity, gender or educational level.
Conclusions The Dutch community intervention appears to be effective on the short- and long-term in reducing the prevalence of recent alcohol use and binge drinking of (underage) adolescents in the second grade of high school.