Behavioral factors predicting response to employment-based reinforcement of cocaine abstinence in methadone patients.

We sought to identify behavioral factors associated with response to an employment-based intervention, in which participants had to provide drug-free urine samples to gain access to paid employment. The present secondary analysis included data from a randomized clinical trial. The trial evaluated whether employment-based reinforcement could decrease cocaine use in community methadone patients.

The effects of "The Work" meditation (Byron Katie) on psychological symptoms and quality of life--a pilot clinical study.

Objectives: "The Work" is a meditative technique that enables the identification and investigation of thoughts that cause an individual stress and suffering. Its core is comprised of four questions and turnarounds that enable the participant to experience a different interpretation of reality. We assessed the effect of "The Work" meditation on quality of life and psychological symptoms in a non-clinical sample.

Challenges and outcomes of parallel care for patients with co-occurring psychiatric disorder in methadone maintenance treatment.

Objective: Most opioid users seeking treatment in community-based substance abuse treatment programs have at least one co-occurring psychiatric disorder, and the presence of psychiatric comorbidity in this population is associated with increased psychological distress, poorer quality of life, and reduced response to substance abuse treatment. This observational study describes clinical outcomes of referring patients receiving methadone maintenance with at least one co-occurring psychiatric disorder to a community psychiatry program located on the same hospital campus.

Methods: Participants (n = 156) were offered priority referrals to a community psychiatry program that included regularly scheduled psychiatrist appointments, individual and group therapy, and enhanced access to psychiatric medications for 1 year.

A randomized trial of Web-based videoconferencing for substance abuse counseling.

Web-based videoconferencing can improve access to substance abuse treatment by allowing patients to receive counseling services in their homes. This randomized clinical trial evaluates the feasibility and acceptability of Web-based videoconferencing in community opioid treatment program (OTP) participants. Participants that reported computer and Internet access (n=85) were randomly assigned to receive 12weeks of weekly individual counseling in-person or via eGetgoing, a Web-based videoconferencing platform.

Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

Background And Aims: Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.

Design: Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n = 160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n = 156), and observed for 1 year.

An observation of lower rates of drug use over time in community syringe exchangers.

Background And Objectives: The present study evaluated changes in rates of self-reported heroin and cocaine use in opioid-dependent individuals newly registered to a syringe exchange program (SEP), and examined the effects of recovery-oriented longitudinal variables (i.e., substance abuse treatment, self-help group participation, employment) on changes in drug use.

Prospective effects of traumatic event re-exposure and post-traumatic stress disorder in syringe exchange participants.

Aim: Determine the effect of traumatic event re-exposure and post-traumatic stress disorder (PTSD) symptom severity on proximal drug use and drug abuse treatment-seeking in syringe exchange participants.

Design: Prospective longitudinal 16-month cohort study of new syringe exchange registrants enrolled in a parent study of methods to improve treatment engagement.

Setting: Data were collected in a research van next to mobile syringe exchange distribution sites in Baltimore, Maryland.

Improving treatment enrollment and re-enrollment rates of syringe exchangers: 12-month outcomes.

Background: Developing bridges between community syringe exchange programs (SEPs) and substance abuse treatment could benefit syringe exchangers and the public health. Kidorf et al. (2009) showed that motivational approaches employed at an SEP site improved rates of treatment enrollment and reduced drug use over a 4-month observation window.

Traumatic event re-exposure in injecting drug users.

Drug users have very high rates of lifetime exposure to traumatic events, leading to significant psychiatric complications. In spite of the high rate of lifetime exposure, very little is known about the rate of ongoing re-exposure to new traumatic events in drug users. We investigated the rate of traumatic event re-exposure in male and female injecting drug users using syringe exchange services in Baltimore (N = 197).

A treatment reengagement intervention for syringe exchangers.

Poor sustained treatment engagement limits the effectiveness of all modalities of substance abuse treatment. This study evaluated the efficacy of a novel treatment reengagement intervention for a subset of syringe-exchange program (SEP) participants (N = 113) that had enrolled in treatment as part of a 4-month clinical trial (M. Kidorf et al.

Randomized multi-site trial of the Job Seekers' Workshop in patients with substance use disorders.

Background: Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial was to evaluate the Job Seekers' Workshop (JSW), a three session, manualized program designed to train patients in the skills needed to find and secure a job.

The role of urgency, frequency, and nocturia in defining overactive bladder adaptive behavior.

Aim: To determine the relation between urgency alone, or in combination with frequency and nocturia, and adaptive behavior in overactive bladder (OAB) syndrome.

Methods: We used survey data from the General Longitudinal Overactive Bladder Evaluation (GLOBE) of primary care patients over 40. Participants (n=2,752: 1,557 females; 1,195 males) completed the same survey at two time points, 6 months apart.

Benefits of concurrent syringe exchange and substance abuse treatment participation.

Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n = 127).

Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants.

The present study evaluated psychiatric distress as a predictor of treatment enrollment in out-of-treatment injection opioid users newly registered at the Baltimore Needle Exchange Program (BNEP). Study participants (n=281) completed the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), and the Symptom Checklist-90 (SCL-90-R), and were randomly assigned to one of three different conditions for 4 months that evaluated referral strategies designed to promote treatment interest and enrollment. The Global Severity Index (GSI) of the SCL-90 was used as a measure of psychiatric distress.

A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes.

Objectives: To study the feasibility and effectiveness of a discharge planning intervention.

Design: Quasi-experimental pre-post study design.

Setting: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.

Distress and burnout among genetic service providers.

Purpose: To determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals.

Methods: Mailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses.

Results: Two hundred and fourteen providers completed the survey (55% response rate).

Improving substance abuse treatment enrollment in community syringe exchangers.

Aim: The present study evaluated the effectiveness of an intervention combining motivational enhancement and treatment readiness groups, with and without monetary incentives for attendance and treatment enrollment, on enhancing rates of substance abuse treatment entry among new registrants at the Baltimore Needle Exchange Program (BNEP).

Design: Opioid-dependent study participants (n = 281) referred by the BNEP were assigned randomly to one of three referral interventions: (i) eight individual motivational enhancement sessions and 16 treatment readiness group sessions (motivated referral condition--MRC); (ii) the MRC intervention with monetary incentives for attending sessions and enrolling in treatment--MRC+I); or (iii) a standard referral condition which directed participants back to the BNEP for referral (standard referral-SRC). Participants were followed for 4 months.

The role and impact of personal faith and religion among genetic service providers.

This paper describes the impact of genetic service providers' personal faith and religious values on their experiences interacting with colleagues and patients. We surveyed 480 clinical geneticists (MDs), genetic counselors (GCs), and genetic nurses randomly selected from their professional associations, and then interviewed a sample of survey respondents. Outcomes included religiosity, coping with distress through spiritual beliefs, and personal value conflicts (PVCs).

Correlates of stimulant treatment outcome across treatment modalities.

Objective: This study evaluated variables associated with stimulant use outcomes in stimulant users (N = 800) receiving care in community outpatient psychosocial or methadone maintenance treatment clinics as part of a national multi-site clinical trial.

Methods: Results from the full sample were examined first, and then predictors were examined separately in the two treatment modalities.

Results: A cocaine-positive urine sample at study intake was the most robust and consistent correlate of stimulant use outcome in all analyses.

Active bed management by hospitalists and emergency department throughput.

Background: When emergency departments are overcrowded, ambulances are diverted. Interventions focused primarily on emergency departments have had limited success.

Objective: To discover whether an active bed management, quality improvement initiative could reduce ambulance diversion hours and emergency department throughput times.

Clinical characteristics of treatment-seeking adolescents with opioid versus cannabis/alcohol use disorders.

Objectives: To assess the clinical characteristics of adolescents with DSM-IV opioid use disorder (OUD) and compare them to adolescents with cannabis/alcohol use disorders.

Method: 94 adolescents (ages 14-18 years) with a current OUD and 74 adolescents with a current non-OUD cannabis/alcohol use disorders were recruited from admissions, predominantly residential, to a substance abuse treatment program in Baltimore, ML. Participants were assessed cross-sectionally using standardized interviews and self-reports.

Long-term follow-up of a 10-month programme in curriculum development for medical educators: a cohort study.

Context: There is an ongoing need for curriculum development (CD) in medical education. However, only a minority of medical teaching institutions provide faculty development in CD. This study evaluates the long-term impact of a longitudinal programme in curriculum development.

A comparison of 1-year substance abuse treatment outcomes in community syringe exchange participants versus other referrals.

This longitudinal cohort study of 324 consecutive admissions to methadone maintenance treatment between 08/1994 and 09/1997 compared 1-year outcomes of opioid-dependent patients referred from a syringe exchange program (SEP; n=81) versus other sources (n=243). All participants received stepped-based counseling. The Addiction Severity Index was completed upon admission.

What do clinicians derive from partnering with their patients? A reliable and valid measure of "personal meaning in patient care".

Objective: Burnout is high among clinicians and may relate to loss of "meaning" in patient care. We sought to develop and validate a measure of "personal meaning" that practitioners derive from patient care.

Methods: As part of a larger study of well-being among genetics professionals, we conducted three focus groups of clinical genetics professionals: physicians, nurses and genetic counselors (N=29).

Implementing methadone medical maintenance in community-based clinics: disseminating evidence-based treatment.

Methadone medical maintenance (MMM) is an effective intervention that minimizes the demands of opioid agonist treatment without compromising good treatment response. Despite the benefits of MMM to both patients and treatment programs, little information is available to help community-based programs implement MMM and select patients who might benefit from this intervention. This study evaluates the impact of a seven-session seminar presentation combined with optional on-site consultation on subsequent changes in clinical programming and on the opinions of community-based treatment staff (n = 96) in five methadone maintenance treatment clinics regarding both the adoption of an MMM protocol and the use of an adaptive stepped care model to deliver it.