- Email: [email protected]
Methadone patients in patient-centered treatment: One-year arrest data
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Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
in left IFOF (t = 3.97, P < 0.001) and a trend-level right IFOF group difference (t = 1.85, P = 0.085). Conclusions: AAS users exhibited FA increases in IFOF, the degree of which was associated with lifetime AAS use. This finding is consistent with our prior report of amygdala and visuospatial memory abnormalities in AAS subjects. Future studies are needed to determine the functional significance of the FA increase in the context of network connectivity and visuospatial memory in AAS users. Financial support: NIH grants R01DA029141 (HP, GK, JH), and R01 AG04252 (MK, NM), R01 MH102377 (MK), and the Stuart T. Hauser Clinical Research Training Program (T32) (AL). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.279 Across time and space: Independent component analysis reveals spatial and temporal differences in functional brain networks between cocaine and alcohol users Tonisha Kearney-Ramos ∗ , Logan Thorne Dowdle, Oliver Mithoefer, Chris Mullins, William DeVries, Mark George, Colleen A. Hanlon Medical University of South Carolina, Charleston, SC, United States Aims: While altered functional connectivity (FC) has been linked to craving and cognitive function in substance use disorders (SUDs), it is unclear which patterns of neural disruption are common across SUDs and which are unique to the abused substance (e.g. cocaine vs alcohol). To determine patterns of FC common to or differentiating cocaine and alcohol users, independent component analysis (ICA) was applied to fMRI data from 38 users (19 cocaine, 19 alcohol) during a cue-induced craving task. Methods: ICA identified 75 functional networks based on temporal coherence of activity across brain regions. Spatial maps of several networks were contrasted between groups (thresholded at |t(37)| > 3, cluster size≥32 voxels for FWE p < .05), and temporal profiles of networks were compared via power spectral analysis. Results: There was no significant difference in spatial or temporal profile of default mode or cognitive control networks, but there were significant differences in several salience/attentional bias networks. Spatially, cocaine users had higher striatal network recruitment of visual cortex (ˇ = .31) than alcohol users (ˇ = −.52; t(37) = 5.86, p < .05); and alcohol users had higher right anterior insula recruitment into ventral visual network (ˇ = .88) than cocaine users (ˇ = .12; t(37) = −5.22, p < .05). Temporally, there was no difference for the striatal component, but there were significant differences for multiple components loading on medial and lateral PFC – with cocaine users favoring higher frequencies (e.g. 0.5 Hz vs 0.1 Hz). Conclusions: These data suggest that patterns of network composition and temporal dynamics provide distinct sources of variability that may differentially relate to cognitive and behavioral dysfunction in SUDs. Future work should use these functional markers to enhance treatment selection and outcome prediction. Financial support: R01DA036617 (Hanlon), P50DA015369 (Kalivas), P50AA010761 (Becker), T32DA00728823 (McGinty). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.280
Household smoking rules among pregnant and newly postpartum smokers Diana Renee Keith 1,∗ , Allison Nicole Kurti 1 , Joan M. Skelly 2 , Stephen Higgins 1 1 Psychiatry, University of Vermont, South Burlington, VT, United States 2 Medical Biostatistics, University of Vermont, Burlington, VT, United States
Aims: Cigarette smoking during pregnancy is the leading preventable cause of poor birth outcomes in the U.S. Despite this, even the most efficacious interventions leave the majority of women smoking, leading to further secondhand smoke exposure for their children. Most interventions for pregnant smokers do not aim to reduce environmental tobacco smoke (ETS) exposure. To begin assessing the need for such an intervention, we examined rules about smoking in the home among pregnant and newly postpartum women enrolled in smoking cessation and relapse prevention trials. Methods: Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Participants were followed from the start of prenatal care through 24 weeks postpartum. Participants were asked, “How is cigarette smoking handled in your home?” and could respond 1: No one is allowed to smoke, 2: only special guests are allowed to smoke, 3: People are allowed to smoke only in certain areas, and 4: People are allowed to smoke anywhere. Smoking status was biochemically verified. Results: The majority of women (75%) continued to smoke at 24 weeks postpartum. Approx. half (52%) of those who continued to smoke reported that they allowed smoking somewhere in the home, with 30% reporting that smoking was allowed anywhere. Abstainers were significantly less likely to allow smoking in the home (p < 0.0001), with 28% reporting that they allowed smoking in some areas, and 9% reporting that they allowed smoking anywhere. In addition to smoking status, other significant predictors of smoking in the home included younger age, lower education, being single, fewer quit attempts, and heavier smoking. Conclusions: Lax rules about smoking in the home are highly prevalent, especially in those who are not able to quit. Those providing smoking cessation interventions for pregnant women may want to consider adding ETS avoidance counseling. Financial support: NIGMS P20GM103644, NIDA R01DA14028, NICHD R01HD075669. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.281 Methadone patients in patient-centered treatment: One-year arrest data Sharon M. Kelly 1,∗ , K.E. O’Grady 2 , Jan Gryczynski 1 , Shannon Gwin Mitchell 1 , Jerome H. Jaffe 1,3 , Robert P. schwartz 1 1 Friends Research Institute, Baltimore, MD, United States 2 University of MD, College Park, MD, United States 3 University of MD, School of Medicine, Baltimore, MD, United States
Aims: To examine time to arrest for 295 opioid-dependent individuals enrolled in a study of patient-centered methadone treatment in Baltimore, MD. Methods: This is a secondary analysis from a randomized trial comparing patient-centered methadone (PCM) to treatment-asusual (TAU). PCM modified the methadone treatment program’s
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
(MTP) rules (e.g., counseling was optional) and staff roles (e.g., counselors were not enforcers of MTP rules) to increase treatment retention and improve outcomes. Participants were 295 newlyadmitted patients in two Baltimore MTPs randomly assigned to PCM (n = 146) or TAU (n = 149). Arrest data for one year following study enrollment were obtained from the Maryland Judiciary Case Search website. Cox proportional hazards regression was used to examine time to first arrest by study Condition. Results: Of 295 participants (59% male, 58% African American), 103 (34.9%) participants were arrested in the year following study enrollment – 50 (34.2%) PCM participants were arrested 70 times, and 53 (35.6%) TAU participants were arrested 83 times. The mean (SD) number of arrests (range: 0-5) was 0.48 (0.78) for PCM and 0.56 (0.93) for TAU participants (p = 0.44). Cox proportional hazards regression showed no difference in time to arrest between PCM and TAU (OR = .97, 95% CI = .66–1.43, p = .87). Conclusions: Patients required to attend group and individual counseling (TAU) did not have fewer arrests or a greater number of days to their first arrest than patients for whom counseling attendance was optional (PCM). Financial support: 2 R01DA015842. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.282 Who says yes? Sample representativeness in a clinical trial of SBIRT Sydney Shane Kelpin 2,∗ , Steven J. Ondersma 3 , Dace Svikis 1 1 Virginia Commonwealth University, Richmond, VA, United States 2 Psychology, Virginia Commonwealth University, Richmond, VA, United States 3 Wayne State University, Detroit, MI, United States
Aims: The National Institutes of Health (NIH) has made translational research a top priority, beginning with the signing of the NIH Revitalization Act mandating the inclusion of women and minorities in randomized clinical trials (RCT) (Freeman et al., 1995). Despite these efforts, there still may be fundamental differences between consenters and nonconsenters in clinical research, thereby influencing sample representativeness and generalizability of outcomes. The present study examined this issue using data from a large RCT of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Methods: From a database of N = 4552 primary care patients who completed an anonymous, computer-delivered health survey, the present study selected the N = 1338 individuals who met heavy/problem substance use criteria for a 4-arm clinical trial of SBIRT. This sample was further divided into those consenting to the RCT (N = 713; consenters) and those choosing not to participate (N = 625; non-consenters). Consenters and non-consenters were compared on demographics, drug and alcohol use, family history and other psychosocial measures using chi-square for categorical and t-tests for continuous variables. Results: Demographically, consenters and non-consenters did not differ on age, gender, race or education. Consenters, however, were more likely to be unemployed (p < 0.01) and uninsured (p < 0.01) than non-consenters. Consenters were also more likely to live with someone who had a drug problem (p < 0.01); report a family history of drug use (p < .01); and experience an episode of physical violence (past year) (p = 0.02) than non-consenters. Subsequent multivariate analyses will examine these and other correlates of research participation.
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Conclusions: The computer-based primary care survey afforded a unique opportunity to compare RCT participants and nonparticipants across a wide array of variables. Group differences were found and affirm the need for caution and consideration of sample representativeness. Financial support: Research supported by R01 DA026091 (Svikis PI). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.283 Husband/partner intoxication and intimate partner violence against women in the Philippines Bradley Townsend Kerridge Epidemiology, Columbia University, Gaithersburg, MD, United States Aims: This study examined husband/partner intoxication and experience with physical, sexual and emotional intimate partner violence against women (IPVAW) using data derived from a nationally representative survey conducted in the Philippines in 2013. Methods: Multivariate logistic regression analyses were used to examine the association between intoxication and three different types of intimate partner violence against women, adjusted for sociodemographic and behavioral covariates. Multinomial logistic regression was used to examine intoxication and co-experienced forms of violence. Results: In this sample, 29% of women reported experiencing any form of intimate partner violence and 83% of women reported their partner being intoxicated at least sometimes. Frequent intoxication was significantly associated with all three types of intimate partner violence: physical (adjusted odds ratio (AOR) = 9.8, 95% confidence interval (95% CI) = 4.82–14.38); sexual (AOR = 17.2, 95% CI = 5.37–33.17); and emotional (AOR = 4.1, 95% CI = 2.83-6.04). The odds of experiencing one form of IPVAW vs. no form of IPVAW and two forms of IPVAW vs. one form of IPVAW was greater among women reporting frequency of husband/partner intoxication as often. Conclusions: Husband/partner intoxication was a significant predictor of physical, sexual and emotional intimate partner violence and IPVAW severity in the Philippines. Findings suggest that prevention and intervention strategies to reduce intimate partner violence target men and should include alcohol reduction components. Longitudinal studies linking intoxication and intimate partner violence against women are warranted. Financial support: This research was supported, by the National Institute on Drug Abuse, National Institutes of Health (5F32DA0364431). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.284
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
in left IFOF (t = 3.97, P < 0.001) and a trend-level right IFOF group difference (t = 1.85, P = 0.085). Conclusions: AAS users exhibited FA increases in IFOF, the degree of which was associated with lifetime AAS use. This finding is consistent with our prior report of amygdala and visuospatial memory abnormalities in AAS subjects. Future studies are needed to determine the functional significance of the FA increase in the context of network connectivity and visuospatial memory in AAS users. Financial support: NIH grants R01DA029141 (HP, GK, JH), and R01 AG04252 (MK, NM), R01 MH102377 (MK), and the Stuart T. Hauser Clinical Research Training Program (T32) (AL). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.279 Across time and space: Independent component analysis reveals spatial and temporal differences in functional brain networks between cocaine and alcohol users Tonisha Kearney-Ramos ∗ , Logan Thorne Dowdle, Oliver Mithoefer, Chris Mullins, William DeVries, Mark George, Colleen A. Hanlon Medical University of South Carolina, Charleston, SC, United States Aims: While altered functional connectivity (FC) has been linked to craving and cognitive function in substance use disorders (SUDs), it is unclear which patterns of neural disruption are common across SUDs and which are unique to the abused substance (e.g. cocaine vs alcohol). To determine patterns of FC common to or differentiating cocaine and alcohol users, independent component analysis (ICA) was applied to fMRI data from 38 users (19 cocaine, 19 alcohol) during a cue-induced craving task. Methods: ICA identified 75 functional networks based on temporal coherence of activity across brain regions. Spatial maps of several networks were contrasted between groups (thresholded at |t(37)| > 3, cluster size≥32 voxels for FWE p < .05), and temporal profiles of networks were compared via power spectral analysis. Results: There was no significant difference in spatial or temporal profile of default mode or cognitive control networks, but there were significant differences in several salience/attentional bias networks. Spatially, cocaine users had higher striatal network recruitment of visual cortex (ˇ = .31) than alcohol users (ˇ = −.52; t(37) = 5.86, p < .05); and alcohol users had higher right anterior insula recruitment into ventral visual network (ˇ = .88) than cocaine users (ˇ = .12; t(37) = −5.22, p < .05). Temporally, there was no difference for the striatal component, but there were significant differences for multiple components loading on medial and lateral PFC – with cocaine users favoring higher frequencies (e.g. 0.5 Hz vs 0.1 Hz). Conclusions: These data suggest that patterns of network composition and temporal dynamics provide distinct sources of variability that may differentially relate to cognitive and behavioral dysfunction in SUDs. Future work should use these functional markers to enhance treatment selection and outcome prediction. Financial support: R01DA036617 (Hanlon), P50DA015369 (Kalivas), P50AA010761 (Becker), T32DA00728823 (McGinty). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.280
Household smoking rules among pregnant and newly postpartum smokers Diana Renee Keith 1,∗ , Allison Nicole Kurti 1 , Joan M. Skelly 2 , Stephen Higgins 1 1 Psychiatry, University of Vermont, South Burlington, VT, United States 2 Medical Biostatistics, University of Vermont, Burlington, VT, United States
Aims: Cigarette smoking during pregnancy is the leading preventable cause of poor birth outcomes in the U.S. Despite this, even the most efficacious interventions leave the majority of women smoking, leading to further secondhand smoke exposure for their children. Most interventions for pregnant smokers do not aim to reduce environmental tobacco smoke (ETS) exposure. To begin assessing the need for such an intervention, we examined rules about smoking in the home among pregnant and newly postpartum women enrolled in smoking cessation and relapse prevention trials. Methods: Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Participants were followed from the start of prenatal care through 24 weeks postpartum. Participants were asked, “How is cigarette smoking handled in your home?” and could respond 1: No one is allowed to smoke, 2: only special guests are allowed to smoke, 3: People are allowed to smoke only in certain areas, and 4: People are allowed to smoke anywhere. Smoking status was biochemically verified. Results: The majority of women (75%) continued to smoke at 24 weeks postpartum. Approx. half (52%) of those who continued to smoke reported that they allowed smoking somewhere in the home, with 30% reporting that smoking was allowed anywhere. Abstainers were significantly less likely to allow smoking in the home (p < 0.0001), with 28% reporting that they allowed smoking in some areas, and 9% reporting that they allowed smoking anywhere. In addition to smoking status, other significant predictors of smoking in the home included younger age, lower education, being single, fewer quit attempts, and heavier smoking. Conclusions: Lax rules about smoking in the home are highly prevalent, especially in those who are not able to quit. Those providing smoking cessation interventions for pregnant women may want to consider adding ETS avoidance counseling. Financial support: NIGMS P20GM103644, NIDA R01DA14028, NICHD R01HD075669. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.281 Methadone patients in patient-centered treatment: One-year arrest data Sharon M. Kelly 1,∗ , K.E. O’Grady 2 , Jan Gryczynski 1 , Shannon Gwin Mitchell 1 , Jerome H. Jaffe 1,3 , Robert P. schwartz 1 1 Friends Research Institute, Baltimore, MD, United States 2 University of MD, College Park, MD, United States 3 University of MD, School of Medicine, Baltimore, MD, United States
Aims: To examine time to arrest for 295 opioid-dependent individuals enrolled in a study of patient-centered methadone treatment in Baltimore, MD. Methods: This is a secondary analysis from a randomized trial comparing patient-centered methadone (PCM) to treatment-asusual (TAU). PCM modified the methadone treatment program’s
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
(MTP) rules (e.g., counseling was optional) and staff roles (e.g., counselors were not enforcers of MTP rules) to increase treatment retention and improve outcomes. Participants were 295 newlyadmitted patients in two Baltimore MTPs randomly assigned to PCM (n = 146) or TAU (n = 149). Arrest data for one year following study enrollment were obtained from the Maryland Judiciary Case Search website. Cox proportional hazards regression was used to examine time to first arrest by study Condition. Results: Of 295 participants (59% male, 58% African American), 103 (34.9%) participants were arrested in the year following study enrollment – 50 (34.2%) PCM participants were arrested 70 times, and 53 (35.6%) TAU participants were arrested 83 times. The mean (SD) number of arrests (range: 0-5) was 0.48 (0.78) for PCM and 0.56 (0.93) for TAU participants (p = 0.44). Cox proportional hazards regression showed no difference in time to arrest between PCM and TAU (OR = .97, 95% CI = .66–1.43, p = .87). Conclusions: Patients required to attend group and individual counseling (TAU) did not have fewer arrests or a greater number of days to their first arrest than patients for whom counseling attendance was optional (PCM). Financial support: 2 R01DA015842. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.282 Who says yes? Sample representativeness in a clinical trial of SBIRT Sydney Shane Kelpin 2,∗ , Steven J. Ondersma 3 , Dace Svikis 1 1 Virginia Commonwealth University, Richmond, VA, United States 2 Psychology, Virginia Commonwealth University, Richmond, VA, United States 3 Wayne State University, Detroit, MI, United States
Aims: The National Institutes of Health (NIH) has made translational research a top priority, beginning with the signing of the NIH Revitalization Act mandating the inclusion of women and minorities in randomized clinical trials (RCT) (Freeman et al., 1995). Despite these efforts, there still may be fundamental differences between consenters and nonconsenters in clinical research, thereby influencing sample representativeness and generalizability of outcomes. The present study examined this issue using data from a large RCT of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Methods: From a database of N = 4552 primary care patients who completed an anonymous, computer-delivered health survey, the present study selected the N = 1338 individuals who met heavy/problem substance use criteria for a 4-arm clinical trial of SBIRT. This sample was further divided into those consenting to the RCT (N = 713; consenters) and those choosing not to participate (N = 625; non-consenters). Consenters and non-consenters were compared on demographics, drug and alcohol use, family history and other psychosocial measures using chi-square for categorical and t-tests for continuous variables. Results: Demographically, consenters and non-consenters did not differ on age, gender, race or education. Consenters, however, were more likely to be unemployed (p < 0.01) and uninsured (p < 0.01) than non-consenters. Consenters were also more likely to live with someone who had a drug problem (p < 0.01); report a family history of drug use (p < .01); and experience an episode of physical violence (past year) (p = 0.02) than non-consenters. Subsequent multivariate analyses will examine these and other correlates of research participation.
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Conclusions: The computer-based primary care survey afforded a unique opportunity to compare RCT participants and nonparticipants across a wide array of variables. Group differences were found and affirm the need for caution and consideration of sample representativeness. Financial support: Research supported by R01 DA026091 (Svikis PI). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.283 Husband/partner intoxication and intimate partner violence against women in the Philippines Bradley Townsend Kerridge Epidemiology, Columbia University, Gaithersburg, MD, United States Aims: This study examined husband/partner intoxication and experience with physical, sexual and emotional intimate partner violence against women (IPVAW) using data derived from a nationally representative survey conducted in the Philippines in 2013. Methods: Multivariate logistic regression analyses were used to examine the association between intoxication and three different types of intimate partner violence against women, adjusted for sociodemographic and behavioral covariates. Multinomial logistic regression was used to examine intoxication and co-experienced forms of violence. Results: In this sample, 29% of women reported experiencing any form of intimate partner violence and 83% of women reported their partner being intoxicated at least sometimes. Frequent intoxication was significantly associated with all three types of intimate partner violence: physical (adjusted odds ratio (AOR) = 9.8, 95% confidence interval (95% CI) = 4.82–14.38); sexual (AOR = 17.2, 95% CI = 5.37–33.17); and emotional (AOR = 4.1, 95% CI = 2.83-6.04). The odds of experiencing one form of IPVAW vs. no form of IPVAW and two forms of IPVAW vs. one form of IPVAW was greater among women reporting frequency of husband/partner intoxication as often. Conclusions: Husband/partner intoxication was a significant predictor of physical, sexual and emotional intimate partner violence and IPVAW severity in the Philippines. Findings suggest that prevention and intervention strategies to reduce intimate partner violence target men and should include alcohol reduction components. Longitudinal studies linking intoxication and intimate partner violence against women are warranted. Financial support: This research was supported, by the National Institute on Drug Abuse, National Institutes of Health (5F32DA0364431). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.284