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Afghanistan veterans to other service eras
Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
evaluated by randomly assigning parolees to 6 monthly naltrexone injections or treatment as usual (TAU) without medication. Methods: All patients met DSM-IV criteria for opioid dependence. 308 parolees were randomized and 290 are now eligible for 6-month follow up. The naltrexone group received 6 monthly injections of 380 mg and a monthly visit with a nurse. The parolees randomized to TAU received help in joining a community counseling program. Outcomes were measured by urine tests and self-report. Results: Retention rates in treatment at 27, 52, and 78 weeks were 64%, 58% and 54% for the TAU group and 66%, 54% and 52% for the naltrexone group. Urine tests were examined at 27, 52 and 78 weeks and with pooled data from all 5 sites, there were significantly fewer opioid positive urines in the naltrexone group (p < .0001 for the pooled analysis). The rate of positive opioids for TAU was 3.36 times higher than that for naltrexone. No significant difference was found for other drugs. There were 2 opioid overdoses in the TAU group and none in the naltrexone group. There were 4 deaths from all causes in the TAU group and 2 deaths in the naltrexone group unrelated to medication. Conclusions: A monthly injection of depot naltrexone significantly reduced opioid relapse in parolees. Six-month retention was similar in the two groups. Serious adverse events including opioid overdose occurred less often in the group receiving naltrexone (18 naltrexone vs. 43 for TAU). In this interim analysis, depot naltrexone was found to be both safe and effective in reducing the rate of relapse to opioid use. Financial support: This research was supported by collaborative RO-1 grants to the 5 sites involved. The extended release naltrexone in the form of Vivitrol was supplied by Alkermes Inc. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.519 A needs comparison of justice-involved Iraq/Afghanistan veterans to other service eras Kathryn O’Connor 1,2 , Debra A. Pinals 3,1 , David Smelson 1,2 , Leon Sawh 2,4,1 , Carl Fulwiler 1 , Stephanie Singer 1 , William Fisher 4 , Stephanie Hartwell 5 , Gerardo Gonzalez 1 1
University of Massachusetts Medical School, Worcester, MA, United States 2 US Department of Veterans Affairs, Bedford, MA, United States 3 Massachusetts Department of Mental Health, Boston, MA, United States 4 University of Massachusetts, Lowell, Lowell, MA, United States 5 University of Massachusetts, Boston, Boston, MA, United States Aims: To compare the service needs of veterans who served in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) versus other eras upon entry to a jail diversion program. Methods: Ninety veterans enrolled in MISSION DIRECT-VET, a jail diversion program for justice-involved veterans with co-occurring disorders in four Massachusetts courts. Veterans completed the ASI-Lite, BASIS 24, PCL, and NOMS. Results: Nearly 60% of veterans served in OEF/OIF (58%) versus other eras (42%). The average age of OEF/OIF veterans was 31 compared to 51 among non-OEF/OIF veterans (p < 0.01). Veterans were first booked, arrested, and taken into custody at age 22 in both groups. Veterans who served in the OEF/OIF conflicts were more likely to have served in a combat zone compared to non-OEF/OIF
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veterans (78.8% vs. 28.9; p < .01). Despite greater combat exposure, OEF/OIF veterans scored similarly on the BASIS 24 and PCL-C. However, OEF/OIF veterans were more likely to cite that their military service contributed to their medical (p = 0.01) and mental health or emotional problems (p < 0.05) compared to the non-OEF/OIF group. The average age of first contact with mental health services was lower among OEF/OIF veterans (M = 20.4, SD = 7.7) compared to non-OEF/OIF veterans (M = 31.5, SD = 11.1; p < 0.01). OEF/OIF veterans reported earlier contact with substance abuse services (24 years old) compared to age 30 for non-OEF/OIF veterans (p < 0.01). However, the two groups did not differ in their use of cocaine and alcohol in the past month. Conclusions: Findings suggest that veterans with criminal justice issues who served in OEF/OIF have different programmatic needs compared to those who have served in other eras. The current data highlights information key for tailoring treatments for returning justice-involved veterans. Financial support: SAMHSA CMHS 1SM058804-01 and CABHI 1TI023562-01; OJP/BJA 2013-RW-BX-0003. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.520 Neighborhood disorder, HIV treatment access and ARV diversion: A mediation study of drug-involved HIV positive individuals in South Florida Catherine L. O’Grady, Hilary Surratt Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, United States Aims: Recent research has indicated the presence of an illicit market for HIV antiretroviral (ARV) medications in South Florida. We examine possible environmental contributors to ARV diversion among impoverished HIV+ substance abusers. In particular, this analysis focuses on the role of neighborhood disadvantage in impacting access to HIV treatment and subsequent ARV diversion. Methods: Participants were at least 18 years old, confirmed HIV+, and had used cocaine, crack or heroin at least 12 times within the last 3 months. By design, approximately half of participants endorsed recent diversion of ARVs (n = 251). 503 participants completed a one-time face to face structured interview using standardized assessments. Mediation models were tested that examined the effects of neighborhood disorder and HIV treatment access on ARV diversion. Results: Significant correlations were found between neighborhood disorder and ARV diversion (r = 0.09, p < 0.05), neighborhood disorder and HIV treatment access (r = −0.10, p < .03), and HIV treatment access and ARV diversion (r = −0.12, p < 0.01). During mediation analysis, the correlation of neighborhood disorder and diversion became non-significant, leading to the assumption of mediation through the indirect path of HIV treatment access. An increase in neighborhood disorder was associated with a decrease in HIV treatment access; while a reduction in HIV treatment access was correlated with ARV diversion. Conclusions: ARV diversion is problematic for individuals’ quality of life as well as for public health. Our analysis documented significant impact of environmental stressors on ARV diversion among drug-involved HIV+ individuals. Further examination of the role of the community-level influences on diversion behaviors appears warranted.
evaluated by randomly assigning parolees to 6 monthly naltrexone injections or treatment as usual (TAU) without medication. Methods: All patients met DSM-IV criteria for opioid dependence. 308 parolees were randomized and 290 are now eligible for 6-month follow up. The naltrexone group received 6 monthly injections of 380 mg and a monthly visit with a nurse. The parolees randomized to TAU received help in joining a community counseling program. Outcomes were measured by urine tests and self-report. Results: Retention rates in treatment at 27, 52, and 78 weeks were 64%, 58% and 54% for the TAU group and 66%, 54% and 52% for the naltrexone group. Urine tests were examined at 27, 52 and 78 weeks and with pooled data from all 5 sites, there were significantly fewer opioid positive urines in the naltrexone group (p < .0001 for the pooled analysis). The rate of positive opioids for TAU was 3.36 times higher than that for naltrexone. No significant difference was found for other drugs. There were 2 opioid overdoses in the TAU group and none in the naltrexone group. There were 4 deaths from all causes in the TAU group and 2 deaths in the naltrexone group unrelated to medication. Conclusions: A monthly injection of depot naltrexone significantly reduced opioid relapse in parolees. Six-month retention was similar in the two groups. Serious adverse events including opioid overdose occurred less often in the group receiving naltrexone (18 naltrexone vs. 43 for TAU). In this interim analysis, depot naltrexone was found to be both safe and effective in reducing the rate of relapse to opioid use. Financial support: This research was supported by collaborative RO-1 grants to the 5 sites involved. The extended release naltrexone in the form of Vivitrol was supplied by Alkermes Inc. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.519 A needs comparison of justice-involved Iraq/Afghanistan veterans to other service eras Kathryn O’Connor 1,2 , Debra A. Pinals 3,1 , David Smelson 1,2 , Leon Sawh 2,4,1 , Carl Fulwiler 1 , Stephanie Singer 1 , William Fisher 4 , Stephanie Hartwell 5 , Gerardo Gonzalez 1 1
University of Massachusetts Medical School, Worcester, MA, United States 2 US Department of Veterans Affairs, Bedford, MA, United States 3 Massachusetts Department of Mental Health, Boston, MA, United States 4 University of Massachusetts, Lowell, Lowell, MA, United States 5 University of Massachusetts, Boston, Boston, MA, United States Aims: To compare the service needs of veterans who served in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) versus other eras upon entry to a jail diversion program. Methods: Ninety veterans enrolled in MISSION DIRECT-VET, a jail diversion program for justice-involved veterans with co-occurring disorders in four Massachusetts courts. Veterans completed the ASI-Lite, BASIS 24, PCL, and NOMS. Results: Nearly 60% of veterans served in OEF/OIF (58%) versus other eras (42%). The average age of OEF/OIF veterans was 31 compared to 51 among non-OEF/OIF veterans (p < 0.01). Veterans were first booked, arrested, and taken into custody at age 22 in both groups. Veterans who served in the OEF/OIF conflicts were more likely to have served in a combat zone compared to non-OEF/OIF
e55
veterans (78.8% vs. 28.9; p < .01). Despite greater combat exposure, OEF/OIF veterans scored similarly on the BASIS 24 and PCL-C. However, OEF/OIF veterans were more likely to cite that their military service contributed to their medical (p = 0.01) and mental health or emotional problems (p < 0.05) compared to the non-OEF/OIF group. The average age of first contact with mental health services was lower among OEF/OIF veterans (M = 20.4, SD = 7.7) compared to non-OEF/OIF veterans (M = 31.5, SD = 11.1; p < 0.01). OEF/OIF veterans reported earlier contact with substance abuse services (24 years old) compared to age 30 for non-OEF/OIF veterans (p < 0.01). However, the two groups did not differ in their use of cocaine and alcohol in the past month. Conclusions: Findings suggest that veterans with criminal justice issues who served in OEF/OIF have different programmatic needs compared to those who have served in other eras. The current data highlights information key for tailoring treatments for returning justice-involved veterans. Financial support: SAMHSA CMHS 1SM058804-01 and CABHI 1TI023562-01; OJP/BJA 2013-RW-BX-0003. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.520 Neighborhood disorder, HIV treatment access and ARV diversion: A mediation study of drug-involved HIV positive individuals in South Florida Catherine L. O’Grady, Hilary Surratt Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, United States Aims: Recent research has indicated the presence of an illicit market for HIV antiretroviral (ARV) medications in South Florida. We examine possible environmental contributors to ARV diversion among impoverished HIV+ substance abusers. In particular, this analysis focuses on the role of neighborhood disadvantage in impacting access to HIV treatment and subsequent ARV diversion. Methods: Participants were at least 18 years old, confirmed HIV+, and had used cocaine, crack or heroin at least 12 times within the last 3 months. By design, approximately half of participants endorsed recent diversion of ARVs (n = 251). 503 participants completed a one-time face to face structured interview using standardized assessments. Mediation models were tested that examined the effects of neighborhood disorder and HIV treatment access on ARV diversion. Results: Significant correlations were found between neighborhood disorder and ARV diversion (r = 0.09, p < 0.05), neighborhood disorder and HIV treatment access (r = −0.10, p < .03), and HIV treatment access and ARV diversion (r = −0.12, p < 0.01). During mediation analysis, the correlation of neighborhood disorder and diversion became non-significant, leading to the assumption of mediation through the indirect path of HIV treatment access. An increase in neighborhood disorder was associated with a decrease in HIV treatment access; while a reduction in HIV treatment access was correlated with ARV diversion. Conclusions: ARV diversion is problematic for individuals’ quality of life as well as for public health. Our analysis documented significant impact of environmental stressors on ARV diversion among drug-involved HIV+ individuals. Further examination of the role of the community-level influences on diversion behaviors appears warranted.