- Email: [email protected]
Patient pre-treatment expectations and substance use treatment outcomes
Abstract / Drug and Alcohol Dependence 156 (2015) e183–e245
conducted utilizing a subset of the NSCAW II in which the children remained in the home following a CPS investigation. A random half sample was drawn (n = 1087) to conduct two separate models for female and male caregivers. Results were confirmed on the second half of the sample. PDU was measured continuously with the 20-item Drug Abuse Screening Test. Caregiver depression was measured with the Composite International Diagnostic Interview-Short Form. CIB was measured continuously with the internalizing subscale of the Child Behavior Checklist. Control variables were child age, child gender, and family poverty. Analyses accounting for stratification, clustering, and weighting were conducted with Mplus 7.0. Standardized estimates and asymmetrical confidence intervals are reported. Results: Female caregivers’ depression was found to fully mediate the relationship from PDU to CIB ( = .048, ⌠ = .015, 95% CI .021–.081). Among male caregivers, depression was not a significant mediator in the relationship from PDU to CIB ( = .007, ⌠ = .039, 95% CI −.068 to .099). Fit for the female caregiver model was strong (RMSEA = .000, p = .99; CFI = 1.00). Conclusions: Among families reported to CPS where a female caregiver is engaged in PDU, the presence of comorbid depression is an important indicator of need for intervention. Addressing these comorbid disorders may lead to decreases in CIB. Unavailable in this dataset, future research should examine anxiety as another potential mediator. Financial support: F31DA034442; T32DA015035; Doris Duke Fellow; Fahs-Beck Scholar. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.540 Patient pre-treatment expectations and substance use treatment outcomes Kelly Serafini 2,∗ , Suzanne Decker 2,3 , Brian D. Kiluk 1 , Luis Anez 2 , Manuel Paris 2 , Tami Frankforter 2 , Kathleen M. Carroll 2 1
Psychiatry, Yale School of Medicine, West Haven, CT, United States 2 Department of Psychiatry, Yale University School of Medicine, West Haven, CT, United States 3 West Haven VA, West Haven, CT, United States
Aims: To determine if expectations at pre-treatment are associated with substance use treatment outcomes. Methods: Treatment expectations were examined in two randomized controlled trials (RCTs) utilizing Motivational Enhancement Therapy (MET) for the treatment of substance use conducted in the CTN. One RCT was delivered in English (MET-E) and one was delivered in Spanish (MET-S). There were 461 participants MET-E sample and 405 participants MET-S. Participants responded to the following item at pre-treatment: “Do you think you will reduce or stop your use of drugs or alcohol as a result of this treatment?” ANOVAs and chi-square tests were used to examine the relationship between treatment expectations and treatment outcomes in the two samples. Results: Treatment expectations were not associated with any of the treatment outcomes in MET-E. However, in MET-S, expectations were significantly associated with most of the post-treatment outcomes. Among these, treatment expectations were significantly associated with the percentage of drug positive urines within the treatment period, F (1, 1,163) = 18.83, p = .000, and the percentage of days abstinent from primary drug use while in treatment and through follow-up, F (1, 1,364) = 23.78, p = .000. Conclusions: There are several possible interpretations to the divergent findings between samples. The first is that the MET-S
e201
sample had fewer previous treatments, and that when a treatment is novel, expectations may have more of an influence. The second interpretation is that there may be cultural components that may affect how an individual relates to the treatment process. These findings are preliminary and future research should examine treatment expectations across cultures. Financial support: This research was supported in part through a National Institute on Drug Abuse (NIDA) T-32 grant, 5T32DA007238-23 (Petrakis), and used data from studies that were funded by the Clinical Trials Network. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.541 Does craving intensity influence cue exposure reports? An ecological momentary assessment study in patients with alcohol, tobacco, cannabis and heroin use disorder F. Serre 1,∗ , M. Fatseas 1 , J. Swendsen 2 , Marc Auriacombe 1 1 Addiction Psychiatry (CNRS USR 3413), Universite Bordeaux, Bordeaux, France 2 CNRS UMR 5284 INCIA University Bordeaux, Bordeaux, France
Aims: Although it is now well established that exposure to substance-related cues could induce craving, less studies have examined if individuals experiencing higher levels of craving are more likely to report exposure to cues. Here, we aimed to examine the influence of craving intensity in the prediction of cue exposure reported in daily life. Methods: A total of 132 participants were recruited from an outpatient addiction clinic and completed 2 weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). The main substance of dependence was alcohol (n = 39), opiates (n = 32), tobacco (n = 32), or cannabis (n = 29). Patients described in real-time craving intensity and exposure to cues. Data were analyzed using hierarchical linear models (HLM) to examine the influence of craving intensity (T0) on later reports of cues (T1: 4 h later). Results: Craving intensity at T0 strongly predicted number of cues ( = 0.104, p < 0.001) reported at T1. As craving intensity also predicted later substance use and as substance use was associated with same time cue reports, we ran an additional model controlling for substance use at T1. Craving intensity remained a good predictor of later reports of cues ( = 0.072, p < 0.01). Conclusions: In this study individuals who are experiencing higher levels of craving were more likely to report exposure to cues at the next assessment, even after controlling on substance use at T1. We hypothesize that craving increases the consciousness of cues and that individuals who are experiencing higher levels of craving are more likely to notice cues. Further studies are needed to explore this hypothesis. Financial support: PHRC 2006, MILDT 2010, CRA 2009, PRACNRS- CHU 2008, CNRS ATIP. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.542
conducted utilizing a subset of the NSCAW II in which the children remained in the home following a CPS investigation. A random half sample was drawn (n = 1087) to conduct two separate models for female and male caregivers. Results were confirmed on the second half of the sample. PDU was measured continuously with the 20-item Drug Abuse Screening Test. Caregiver depression was measured with the Composite International Diagnostic Interview-Short Form. CIB was measured continuously with the internalizing subscale of the Child Behavior Checklist. Control variables were child age, child gender, and family poverty. Analyses accounting for stratification, clustering, and weighting were conducted with Mplus 7.0. Standardized estimates and asymmetrical confidence intervals are reported. Results: Female caregivers’ depression was found to fully mediate the relationship from PDU to CIB ( = .048, ⌠ = .015, 95% CI .021–.081). Among male caregivers, depression was not a significant mediator in the relationship from PDU to CIB ( = .007, ⌠ = .039, 95% CI −.068 to .099). Fit for the female caregiver model was strong (RMSEA = .000, p = .99; CFI = 1.00). Conclusions: Among families reported to CPS where a female caregiver is engaged in PDU, the presence of comorbid depression is an important indicator of need for intervention. Addressing these comorbid disorders may lead to decreases in CIB. Unavailable in this dataset, future research should examine anxiety as another potential mediator. Financial support: F31DA034442; T32DA015035; Doris Duke Fellow; Fahs-Beck Scholar. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.540 Patient pre-treatment expectations and substance use treatment outcomes Kelly Serafini 2,∗ , Suzanne Decker 2,3 , Brian D. Kiluk 1 , Luis Anez 2 , Manuel Paris 2 , Tami Frankforter 2 , Kathleen M. Carroll 2 1
Psychiatry, Yale School of Medicine, West Haven, CT, United States 2 Department of Psychiatry, Yale University School of Medicine, West Haven, CT, United States 3 West Haven VA, West Haven, CT, United States
Aims: To determine if expectations at pre-treatment are associated with substance use treatment outcomes. Methods: Treatment expectations were examined in two randomized controlled trials (RCTs) utilizing Motivational Enhancement Therapy (MET) for the treatment of substance use conducted in the CTN. One RCT was delivered in English (MET-E) and one was delivered in Spanish (MET-S). There were 461 participants MET-E sample and 405 participants MET-S. Participants responded to the following item at pre-treatment: “Do you think you will reduce or stop your use of drugs or alcohol as a result of this treatment?” ANOVAs and chi-square tests were used to examine the relationship between treatment expectations and treatment outcomes in the two samples. Results: Treatment expectations were not associated with any of the treatment outcomes in MET-E. However, in MET-S, expectations were significantly associated with most of the post-treatment outcomes. Among these, treatment expectations were significantly associated with the percentage of drug positive urines within the treatment period, F (1, 1,163) = 18.83, p = .000, and the percentage of days abstinent from primary drug use while in treatment and through follow-up, F (1, 1,364) = 23.78, p = .000. Conclusions: There are several possible interpretations to the divergent findings between samples. The first is that the MET-S
e201
sample had fewer previous treatments, and that when a treatment is novel, expectations may have more of an influence. The second interpretation is that there may be cultural components that may affect how an individual relates to the treatment process. These findings are preliminary and future research should examine treatment expectations across cultures. Financial support: This research was supported in part through a National Institute on Drug Abuse (NIDA) T-32 grant, 5T32DA007238-23 (Petrakis), and used data from studies that were funded by the Clinical Trials Network. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.541 Does craving intensity influence cue exposure reports? An ecological momentary assessment study in patients with alcohol, tobacco, cannabis and heroin use disorder F. Serre 1,∗ , M. Fatseas 1 , J. Swendsen 2 , Marc Auriacombe 1 1 Addiction Psychiatry (CNRS USR 3413), Universite Bordeaux, Bordeaux, France 2 CNRS UMR 5284 INCIA University Bordeaux, Bordeaux, France
Aims: Although it is now well established that exposure to substance-related cues could induce craving, less studies have examined if individuals experiencing higher levels of craving are more likely to report exposure to cues. Here, we aimed to examine the influence of craving intensity in the prediction of cue exposure reported in daily life. Methods: A total of 132 participants were recruited from an outpatient addiction clinic and completed 2 weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). The main substance of dependence was alcohol (n = 39), opiates (n = 32), tobacco (n = 32), or cannabis (n = 29). Patients described in real-time craving intensity and exposure to cues. Data were analyzed using hierarchical linear models (HLM) to examine the influence of craving intensity (T0) on later reports of cues (T1: 4 h later). Results: Craving intensity at T0 strongly predicted number of cues ( = 0.104, p < 0.001) reported at T1. As craving intensity also predicted later substance use and as substance use was associated with same time cue reports, we ran an additional model controlling for substance use at T1. Craving intensity remained a good predictor of later reports of cues ( = 0.072, p < 0.01). Conclusions: In this study individuals who are experiencing higher levels of craving were more likely to report exposure to cues at the next assessment, even after controlling on substance use at T1. We hypothesize that craving increases the consciousness of cues and that individuals who are experiencing higher levels of craving are more likely to notice cues. Further studies are needed to explore this hypothesis. Financial support: PHRC 2006, MILDT 2010, CRA 2009, PRACNRS- CHU 2008, CNRS ATIP. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.542