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Contingency management intervention tailored for juveniles in drug court: Preliminary short-term substance use outcomes of a randomized controlled trial
Abstracts / Drug and Alcohol Dependence 140 (2014) e86–e168
and race. ANOVA test was used to compare adjusted mean BMI. Cigarette smoking status was also adjusted for in a subset of participants with available data. Results: CTN participants had lower BMI (N = 2017, mean = 26.6 kg/m2 ) than NHANES participants (N = 10,966, mean = 28.6 kg/m2 , p < 0.0001). Crude obesity prevalence was 23% and 37% in CTN and NHANES participants, respectively. Adjusted obesity prevalence in CTN participants was 32% lower than NHANES (SPR = 0.68, 95% CI: 0.62–0.74). Obesity prevalence in NHANES participants was 2.75 times that in CTN opiate users (N = 908, SPR = 2.75, 95% CI: 2.27–3.38), but only 1.21 times that in CTN stimulant users (N = 1109, SPR = 1.21, 95% CI: 1.09–1.34). After further adjusting for smoking, obesity prevalence in CTN stimulant users was not different from NHANES participants (SPR = 0.99, 95% CI: 0.90–1.10). BMI for CTN opiate users (mean = 25.1 kg/m2 ) was lower than for stimulant users (mean = 28.2 kg/m2 , p < 0.001), while obesity prevalence in stimulant users was 2.54 times that in opiate users (SPR = 2.54, 95% CI: 2.29–2.81). Conclusions: Obesity prevalence was significantly lower in substance abusers from CTN trials than in a matched sample of general population. The difference was driven by significantly lower BMI and obesity prevalence in opiate than stimulant users, suggesting substance-specific effects on energy homeostasis and weight regulation. Our results warrant further research on relationships between substance use, diet and weight. Financial support: Supported by NIH contract HHSN271200900034C. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.388 Contingency management intervention tailored for juveniles in drug court: Preliminary short-term substance use outcomes of a randomized controlled trial Pia M. Mauro 1 , E.J. Letourneau 1 , M.R. McCart 2 , A.J. Sheidow 2 1
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Medical University of South Carolina, Charleston, SC, United States Aims: The aim of this study was to assess short-term substance use outcomes of an ongoing randomized controlled trial (RCT) of a contingency management (CM) and sexual risk reduction intervention for juveniles in drug court. We hypothesized that abstinence, defined as having all negative urine drug screens (UDS) during the 6-month intervention period, would be higher in the CM arm than usual services (US). Methods: Participants were recruited from two drug courts with parental and youth informed consent. The present study included 72 youth who completed at least 6 months of the RCT (CM = 32, US = 40). UDS were collected at baseline (BL), 3-months, and 6-months; missed UDS were considered positive (5.5%). Chisquared tests were used to detect BL between-group differences. Multivariable logistic regression was used to calculate the relative odds of abstinence (no positive UDS) by 6 months post-BL comparing CM to US, adjusting for BL number of substances ever used. Results: Participants had a mean age of 15.1 (SD = 0.15); 85% were male, 50% white, 36% black, and 35% Hispanic. There were no demographic group differences; 40.6% of CM and 27.5% of US had a positive UDS at BL (2 = 1.38, p = 0.24). The adjusted odds of abstinence by 6 months post-BL for CM youth was 2.37 times that of US, though not statistically significant (95% CI = 0.59–9.88, p = 0.24).
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With each additional substance ever used at BL, there was a significant 31% reduction in odds of abstinence (95% CI = 0.51–0.93, p = 0.016). Conclusions: Although there was a trend of positive intervention effects, there was no statistical difference in abstinence comparing CM to US by 6 months post-BL. Given the limited sample and short follow-up, additional research is planned to assess the long-term outcomes of the intervention. Financial support: This study was supported by grants R01DA025880 and T32DA007292 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.389 Cannabis and alcohol: Is there a relationship for drivers? Jane C. Maxwell Addiction Research Institute, The University of Texas at Austin, Austin, TX, United States Aims: The 2007 National Roadside Survey identified cannabis as the most frequently identified drug found in the drivers, and of those individuals who entered Texas publicly-funded programs with at least one past-year DUI, 66% (22,666) had a primary problem with alcohol and 13% (4438) had a primary problem with cannabis. The aim of this paper is to examine the characteristics of these drivers at treatment admission who were primarily cannabis users as compared to those using cannabis and alcohol and those with a primary problem with alcohol. Methods: A database of 56,717 treatment admissions of DUI drivers was examined using correlation and significance tests to determine differences in these individuals and to assess their risks for abstinence after completing treatment. Results: Individuals with a problem with cannabis but no alcohol problems were younger had used their primary drug fewer years, were less likely to complete treatment, had lower income, had fewer substance abuse problems, and were more likely to be homeless, as well as more likely to be Hispanic. Those who only had problems with alcohol were older, had been in treatment more times, had used more years, had more severe levels of impairment, but completed treatment and had higher incomes. Between these two extremes were those who had primary problems with cannabis and secondary with alcohol and those who had primary problems with alcohol and secondary with cannabis. As their problems with alcohol grew and problems with cannabis decreased, their severity increased in terms of ASI problems, employment, need for medications, emergency room visits, and non-DUI arrests. Conclusions: Impaired drivers who first develop problems with cannabis appear to move along a continuum that includes adding alcohol as the second problem, then developing more problems with alcohol and less with cannabis, and finally having serious problems with alcohol. Use of these two drugs in various combinations of intensity is a factor that should be to lessen driving under the influence. Financial support: None. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.390
and race. ANOVA test was used to compare adjusted mean BMI. Cigarette smoking status was also adjusted for in a subset of participants with available data. Results: CTN participants had lower BMI (N = 2017, mean = 26.6 kg/m2 ) than NHANES participants (N = 10,966, mean = 28.6 kg/m2 , p < 0.0001). Crude obesity prevalence was 23% and 37% in CTN and NHANES participants, respectively. Adjusted obesity prevalence in CTN participants was 32% lower than NHANES (SPR = 0.68, 95% CI: 0.62–0.74). Obesity prevalence in NHANES participants was 2.75 times that in CTN opiate users (N = 908, SPR = 2.75, 95% CI: 2.27–3.38), but only 1.21 times that in CTN stimulant users (N = 1109, SPR = 1.21, 95% CI: 1.09–1.34). After further adjusting for smoking, obesity prevalence in CTN stimulant users was not different from NHANES participants (SPR = 0.99, 95% CI: 0.90–1.10). BMI for CTN opiate users (mean = 25.1 kg/m2 ) was lower than for stimulant users (mean = 28.2 kg/m2 , p < 0.001), while obesity prevalence in stimulant users was 2.54 times that in opiate users (SPR = 2.54, 95% CI: 2.29–2.81). Conclusions: Obesity prevalence was significantly lower in substance abusers from CTN trials than in a matched sample of general population. The difference was driven by significantly lower BMI and obesity prevalence in opiate than stimulant users, suggesting substance-specific effects on energy homeostasis and weight regulation. Our results warrant further research on relationships between substance use, diet and weight. Financial support: Supported by NIH contract HHSN271200900034C. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.388 Contingency management intervention tailored for juveniles in drug court: Preliminary short-term substance use outcomes of a randomized controlled trial Pia M. Mauro 1 , E.J. Letourneau 1 , M.R. McCart 2 , A.J. Sheidow 2 1
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Medical University of South Carolina, Charleston, SC, United States Aims: The aim of this study was to assess short-term substance use outcomes of an ongoing randomized controlled trial (RCT) of a contingency management (CM) and sexual risk reduction intervention for juveniles in drug court. We hypothesized that abstinence, defined as having all negative urine drug screens (UDS) during the 6-month intervention period, would be higher in the CM arm than usual services (US). Methods: Participants were recruited from two drug courts with parental and youth informed consent. The present study included 72 youth who completed at least 6 months of the RCT (CM = 32, US = 40). UDS were collected at baseline (BL), 3-months, and 6-months; missed UDS were considered positive (5.5%). Chisquared tests were used to detect BL between-group differences. Multivariable logistic regression was used to calculate the relative odds of abstinence (no positive UDS) by 6 months post-BL comparing CM to US, adjusting for BL number of substances ever used. Results: Participants had a mean age of 15.1 (SD = 0.15); 85% were male, 50% white, 36% black, and 35% Hispanic. There were no demographic group differences; 40.6% of CM and 27.5% of US had a positive UDS at BL (2 = 1.38, p = 0.24). The adjusted odds of abstinence by 6 months post-BL for CM youth was 2.37 times that of US, though not statistically significant (95% CI = 0.59–9.88, p = 0.24).
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With each additional substance ever used at BL, there was a significant 31% reduction in odds of abstinence (95% CI = 0.51–0.93, p = 0.016). Conclusions: Although there was a trend of positive intervention effects, there was no statistical difference in abstinence comparing CM to US by 6 months post-BL. Given the limited sample and short follow-up, additional research is planned to assess the long-term outcomes of the intervention. Financial support: This study was supported by grants R01DA025880 and T32DA007292 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.389 Cannabis and alcohol: Is there a relationship for drivers? Jane C. Maxwell Addiction Research Institute, The University of Texas at Austin, Austin, TX, United States Aims: The 2007 National Roadside Survey identified cannabis as the most frequently identified drug found in the drivers, and of those individuals who entered Texas publicly-funded programs with at least one past-year DUI, 66% (22,666) had a primary problem with alcohol and 13% (4438) had a primary problem with cannabis. The aim of this paper is to examine the characteristics of these drivers at treatment admission who were primarily cannabis users as compared to those using cannabis and alcohol and those with a primary problem with alcohol. Methods: A database of 56,717 treatment admissions of DUI drivers was examined using correlation and significance tests to determine differences in these individuals and to assess their risks for abstinence after completing treatment. Results: Individuals with a problem with cannabis but no alcohol problems were younger had used their primary drug fewer years, were less likely to complete treatment, had lower income, had fewer substance abuse problems, and were more likely to be homeless, as well as more likely to be Hispanic. Those who only had problems with alcohol were older, had been in treatment more times, had used more years, had more severe levels of impairment, but completed treatment and had higher incomes. Between these two extremes were those who had primary problems with cannabis and secondary with alcohol and those who had primary problems with alcohol and secondary with cannabis. As their problems with alcohol grew and problems with cannabis decreased, their severity increased in terms of ASI problems, employment, need for medications, emergency room visits, and non-DUI arrests. Conclusions: Impaired drivers who first develop problems with cannabis appear to move along a continuum that includes adding alcohol as the second problem, then developing more problems with alcohol and less with cannabis, and finally having serious problems with alcohol. Use of these two drugs in various combinations of intensity is a factor that should be to lessen driving under the influence. Financial support: None. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.390