The RoadMAP Relapse Prevention Group Counseling Toolkit™: counselor adherence and competence outcomes.

Training counselors in empirically supported treatments (ESTs) far exceeds the ever decreasing resources of community-based treatment agencies. The purpose of this study was to examine outpatient substance abuse group counselors' (n=19) adherence and competence in communicating and utilizing concepts associated with empirically-supported relapse prevention treatment following a brief multimedia toolkit (RoadMAP Toolkit™) training. Moderate or large baseline to post-training effect sizes for counselor adherence to toolkit content were identified for 13 of 21 targeted behaviors (overall d range=.

Enhanced midbrain response at 6-month follow-up in cocaine addiction, association with reduced drug-related choice.

Drug addiction is characterized by dysregulated dopamine neurotransmission. Although dopamine functioning appears to partially recover with abstinence, the specific regions that recover and potential impact on drug seeking remain to be determined. Here we used functional magnetic resonance imaging (fMRI) to study an ecologically valid sample of 15 treatment-seeking cocaine addicted individuals at baseline and 6-month follow-up.

Developing an evidence-based, multimedia group counseling curriculum toolkit.

Training community-based addiction counselors in empirically supported treatments (ESTs) far exceeds the ever-decreasing resources of publicly funded treatment agencies. This feasibility study describes the development and pilot testing of a group counseling toolkit (an approach adapted from the education field) focused on relapse prevention (RP). When counselors (N = 17) used the RP toolkit after 3 hours of training, their content adherence scores on "coping with craving" and "drug refusal skills" showed significant improvement, as indicated by very large effect sizes (Cohen's d = 1.

United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet.

Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created Treatnet, a network of 20 drug dependence treatment resource centers around the world. Treatnet's primary goal is to promote the use of effective addiction treatment practices.

Barriers to Implementing Individualized Substance Abuse Treatment: Qualitative Findings from the CASPAR Replication Studies.

Problem-to-services matching is critical to patient-centered care. Further, the extent to which substance abuse treatment is individualized to meet specific client needs is a key predictor of success and represents "best practice" in substance abuse treatment. The CASPAR Resource Guide, an electronic database of local free and low-cost services, is an evidence-based tool designed to help counselors easily and quickly provide offsite referrals to services not available in most community treatment programs to increase problem-to-service matching.

Feasibility and effectiveness of computer-based therapy in community treatment.

Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.

Implementing evidence-based practices in community treatment programs: initial feasibility of a counselor "toolkit".

Community substance abuse treatment programs face many barriers to adopting "evidence-based" therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field-developing a resource "toolkit" for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing.

Results of a statewide evaluation of "paperwork burden" in addiction treatment.

This article chronicles three steps taken by research, clinical, and state staff toward assessing, evaluating, and streamlining clinical and administrative paperwork at all public outpatient addiction treatment programs in one state. The first step was an accounting of all paperwork requirements at each program. The second step included the development of time estimates for the paperwork requirements; synthesis of information across sites; providing written evaluation of the need, utility, and redundancy of all forms (paperwork) collected; and suggestions for eliminating unused or unnecessary data collection and streamlining the remaining data collection.

Extending residential care through telephone counseling: initial results from the Betty Ford Center Focused Continuing Care protocol.

There is increasing evidence that a chronic care model may be effective when treating substance use disorders. In 1996, the Betty Ford Center (BFC) began implementing a telephone-based continuing care intervention now called Focused Continuing Care (FCC) to assist and support patients in their transition from residential treatment to longer-term recovery in the "real world". This article reports on patient utilization and outcomes of FCC.

Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample.

Background: Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study's purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more severe psychosocial problems or histories than housed chronic substance users.

Method: Questions assessing homelessness were inserted into the Drug Evaluation Network System-a computer-assisted intake interview (including the Addiction Severity Index) implemented in addiction treatment programs across the U.

Improving public addiction treatment through performance contracting: the Delaware experiment.

In fiscal 2002, Delaware replaced traditional cost-reimbursement contracts with performance-based contracts for all outpatient addiction treatment programs. Incentives included 90% capacity utilization and active patient participation in treatment. One of the programs failed to meet requirements.

Prescription OxyContin abuse among patients entering addiction treatment.

Objective: OxyContin and other pharmaceutical opioids have been given special attention in the media, who frequently describe problematic users of the drug as previously drug-naive individuals who become addicted following legitimate prescriptions for medical reasons. The purpose of this study was to characterize the nature and origins of pharmaceutical opioid addiction among patients presenting at substance abuse treatment programs.

Method: The authors evaluated the prevalence and correlates of OxyContin use and abuse among a population of 27,816 subjects admitted to 157 addiction treatment programs in the United States from 2001-2004.

Predicting DSM-IV dependence diagnoses from Addiction Severity Index composite scores.

This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine the potential of the Addiction Severity Index (ASI) to serve as a screening instrument for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) substance dependence. A significant positive correlation was found between ASI composite scores (CSs) and DSM-IV diagnoses of dependence in both the alcohol (r > .7) and drug (r > .

The Addiction Severity Index at 25: origins, contributions and transitions.

The Addiction Severity Index (ASI) is a multi-dimensional interview used to measure the substance use, health, and social problems of those with alcohol and other drug problems, both at admission to treatment and subsequently at follow-up contacts. This article first discusses the conceptual and practical importance of the ASI's multi-dimensional approach to measuring addiction severity, as illustrated by two case presentations. The second section of the paper reviews how this measurement approach has led to some important findings regarding the prediction and measurement of addiction treatment effectiveness.

Telescoping of drinking-related behaviors: gender, racial/ethnic, and age comparisons.

Objective: To examine demographic differences in alcohol telescoping-the rate of self-reported movement from regular alcohol consumption to the onset of regular heavy drinking-as well as differences in ages of initiation of regular alcohol use and alcohol use to intoxication.

Method: The present study compared the retrospective reports of 2037 clients (1252 males, 785 females) enrolled in substance user treatment facilities around the country in 1998 and 1999.

Results: Overall, the findings support previous research, indicating that women generally move more rapidly than men from initiation of regular alcohol use to problem use (telescoping).

Identifying United States substance abuse treatment programs: a test in one mid-sized city.

An accurate national listing of substance abuse treatment programs is essential for reporting data about the nation's treatment system and the clients entering that system. The National Survey of Substance Abuse Treatment Services (NSSATS) is thought to provide the most comprehensive list of treatment providers. Therefore, we report a partial test of the concurrent validity of the NSSATS in a single mid-sized city.

Getting patients the services they need using a computer-assisted system for patient assessment and referral--CASPAR.

The two goals of this technology transfer study were to: (1) increase the number and appropriateness of services received by substance abuse patients, and thereby (2) give clinical meaning and value to research-based assessment information. A software-based Resource Guide was developed to allow counselors to easily identify local resources for referral of their patients to additional clinical and social services. Two hours of training were provided on the use of the guide.

Developing CASPAR: a computer-assisted system for patient assessment and referral.

A study was completed on the use of a computer-based system that provided counselors with resources for client referrals to free or low-cost services within the community based on problems identified with an Addiction Severity Index (ASI) assessment. That study, completed in Philadelphia, found that in comparison with clients whose counselors received a standard ASI assessment training, clients whose counselors also received brief training on the simple, easy-to-use computer-based resource guide (RG) had treatment plans that were substantially better-matched to their presenting problems and received significantly more and better-matched services. Because of these favorable results, the current article presents further data on counselor use of the RG and, to facilitate the implementation of these procedures by others, we provide access to the original RG database, describe the steps necessary to develop, and maintain an RG, and provide training suggestions.

A successful researcher-practitioner collaboration in substance abuse treatment.

The best efforts to improve substance abuse treatment come from the integration of practice and research. The purpose of this article is to discuss factors that contribute to fruitful research-practice collaborations using the example of our recent successful partnership between a group of treatment researchers and a group of substance abuse recovery houses operated by Fresh Start. The research effort was the Drug Evaluation Network System, a computer assisted method of integrating clinical research and policy relevant information into a standard admission interview.