Substance use-related continuing education course objectives: Alignment with professional competencies.

: Novel educational efforts are needed to prepare the current and future interprofessional health care workforce to address the range of substance use-related health problems. A 6-module massive open online course (MOOC) was developed to provide education to health professionals of various disciplines on the fundamentals of substance use-related treatment. The purpose of this project was to match course objectives to substance use-related competencies for 5 disciplines: nurses, pharmacists, physicians, physician assistants (PA), and social workers.

The effect of varenicline on smoking and drinking outcomes among Black and White adults with alcohol use disorder and co-occurring cigarette smoking: A secondary analysis of two clinical trials.

Introduction: Varenicline is an FDA-approved medication for smoking cessation and has demonstrated promise in reducing alcohol use. This study sought to compare the efficacy of varenicline in reducing smoking and drinking among Black and White people seeking alcohol treatment.

Methods: Linear mixed modeling was conducted using data from two multi-site placebo-controlled randomized clinical trials examining the effects of varenicline for treatment of Alcohol Use Disorder (AUD; O'Malley et al.

PTSD / substance use disorder comorbidity: Treatment options and public health needs.

Purpose Of Review: Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings.

Longitudinal Findings from a Randomized Clinical Trial of Varenicline for Alcohol Use Disorder with Comorbid Cigarette Smoking.

Background: This study is the first to examine longitudinal posttreatment outcomes of a placebo-controlled trial of varenicline for alcohol use disorder (AUD) with comorbid cigarette smoking.

Methods: Participants were 131 adults (n = 39 female) seeking alcohol treatment in a randomized, double-blind, parallel group, placebo-controlled, 16-week multisite trial of varenicline combined with medical management (MM). Timeline follow-back assessments of alcohol and smoking behavior were conducted at the end of treatment (4 months), with follow-ups at 6, 9, and 12 months.

Effect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking: A Randomized Clinical Trial.

Importance: Individuals with alcohol use disorder have high rates of cigarette smoking. Varenicline tartrate, an approved treatment for smoking cessation, may reduce both drinking and smoking.

Objectives: To test the efficacy of varenicline with medical management for patients with alcohol use disorder and comorbid smoking seeking alcohol treatment, and to evaluate the secondary effects on smoking abstinence.

The clinical utility of the Medication Adherence Questionnaire (MAQ) in an alcohol pharmacotherapy trial.

Background: Medication nonadherence is a ubiquitous problem in pharmacology treatment for alcohol use disorders. Unintentional and purposeful nonadherence as measured by the Medication Adherence Questionnaire (MAQ) has been shown to predict problems with medication adherence; however, feedback from the MAQ has never been incorporated into a behavioral intervention to facilitate medication adherence. We assessed the integration of the MAQ into medical management (MM), a counseling approach frequently employed in conjunction with alcohol pharmacotherapy, to determine whether prior patterns of nonadherence could be addressed effectively to promote medication adherence.

Commentary on the adding individual psychotherapy after relapse in a pharmacotherapy trial: commentary on the PREDICT study.

Background: With few exceptions there has been a dearth of research evaluating the independent and combined effects of a promising medication and an effective behavioral intervention for alcohol problems. Few studies have incorporated both theory and empirical findings to ascertain how the combination of medication and behavioral intervention interact or work synergistically to produce better outcomes or why a particular combination of pharmacological and behavioral treatment works better than another combination or either of the interventions employed alone.

Methods: The PREDICT Study is one of the few pharmacotherapy trials that has utilized a behavioral intervention to reduce/delay relapse to heavy drinking.

Sustaining motivational interviewing: a meta-analysis of training studies.

Background And Aims: Previous research indicates that motivational interviewing (MI) skills decline over time among participants in training workshops when post-workshop feedback and coaching are not provided. This study explored moderators of skill retention among trainees learning MI mainly for substance use disorder treatment in real-world treatment settings, including workshop enhancements and type and dose of post-workshop feedback and coaching.

Methods: A meta-analysis of training studies was conducted with studies that reported MI skills using observational measures and that included trainees from real-world agency settings.

Does session attendance by a supportive significant other predict outcomes in individual treatment for alcohol use disorders?

Background: A significant amount of research has supported the efficacy of couple versus individual treatment for alcohol use disorders, yet little is known about whether involving a significant other during the course of individual treatment can improve outcomes. Likewise, several barriers to couple treatment exist and a more flexible approach to significant other involvement may be warranted.

Methods: This study constituted secondary analyses of the COMBINE data, a randomized clinical trial that combined pharmacotherapy and behavioral intervention for alcohol dependence.

Effective Strategies for Maintaining Research Participation in Clinical Trials.

Achieving high protocol adherence is essential for ensuring the overall success and scientific merit of clinical trials. Strategies for maximizing recruitment and treatment adherence have been previously explored in the literature. There has been less focus, however, on effective methods for maintaining participants in research follow-up.

Alcohol treatment effects on secondary nondrinking outcomes and quality of life: the COMBINE study.

Objective: To evaluate the full range of alcohol treatment effectiveness, it is important to assess secondary nondrinking outcome dimensions in addition to primary alcohol consumption outcomes.

Method: We used a large sample (n=1,226) of alcohol-dependent participants entering the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study, a multisite clinical trial of pharmacological (naltrexone [ReVia] and acamprosate [Campral]) and behavioral interventions, to examine the effects of specific treatment combinations on nondrinking functional outcomes. We assessed the outcomes at baseline and at the end of 16 weeks of alcohol treatment and again at the 26-week and/or 52-week postrandomization follow-ups.

Relationship between medication adherence and treatment outcomes: the COMBINE study.

Background: Within the alcoholism field, there is mounting evidence supporting an important relationship between medication adherence and drinking outcomes. Little is known however, about the complex relationships between medication and treatment variables and drinking outcomes. The present paper reports on the differential impact of medication adherence and treatment factors on drinking outcomes.

Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial.

Context: Alcohol dependence treatment may include medications, behavioral therapies, or both. It is unknown how combining these treatments may impact their effectiveness, especially in the context of primary care and other nonspecialty settings.

Objectives: To evaluate the efficacy of medication, behavioral therapies, and their combinations for treatment of alcohol dependence and to evaluate placebo effect on overall outcome.

Addressing substance abuse in health care settings.

This article summarizes the proceedings of a roundtable discussion at the 2005 annual meeting of the Research Society on Alcoholism in Santa Barbara, California. The chair was William R. Miller.

Applying clinical significance methodology to alcoholism treatment trials: determining recovery outcome status with individual- and population-based measures.

Background: The current analysis applies clinical significance methodology to alcoholism treatment outcome research using data available from Project MATCH. Because of its high internal validity and its inclusion of multiple measures assessing multiple outcome dimensions, MATCH was considered an ideal study to explore the utility of this methodology.

Methods: Data reported here are from a total of 1,726 participants enrolled in either aftercare (n = 774) or outpatient (n = 952) arms of the study.

Origins, issues and options in the development of the combined behavioral intervention.

Objective: The aim of the investigators was to develop a moderate intensity comprehensive behavioral treatment based on the principles of motivational interviewing and Cognitive Behavioral Therapy that, within the confines of a standardized abstinence-oriented treatment, would provide a broad spectrum of modules to assist those seeking treatment to achieve reduction of problematic drinking.

Method: The core issue of how to deliver a flexible therapy tailored to the needs of individual clients while at the same time providing a standardized treatment protocol for a randomized clinical trial provided the dilemma out of which this unique standardized protocol arose. By using a single decision tree, client choice, combined with limited options, we were able to reconcile these conflicting demands.

Quality of life as an outcome measure in alcoholism treatment research.

Objective: The present article reviews the literature to date dealing with quality of life (QoL) as it relates to drinking behavior, alcohol use disorders and treatment outcome.

Method: Articles using the term "quality of life" to describe a status or outcome construct for individuals diagnosed with or being treated for alcohol use disorders or that used one or more instruments considered to reflect patients' QoL were identified primarily through Psychological Abstracts, MEDLINE and the National Institute on Alcohol Abuse and Alcoholism's ETOH archival database.

Results: Thirty-six studies, published between 1993 and 2004, met these criteria.

Recruiting and retaining participants in a combined behavioral and pharmacological clinical trial.

Objective: This article focuses on the practical and methodological considerations that went into recruiting and retaining participants in a complex clinical trial. It describes multiple recruitment strategies that were employed to meet stringent eligibility criteria and manage efficiently the flow of participants to fulfill recruitment goals. Both study-wide and site-specific methods that were employed to maximize retention rates are discussed.

Use of a "psychotherapy with no pills" treatment condition as part of a combined pharmacotherapy-psychotherapy research study of alcohol dependence.

Objective: The purpose of this article is to review issues related to the use of placebo medication in a study examining combined pharmacotherapy and psychotherapy for alcohol dependence.

Method: Little is known about the strength of the placebo effect in alcohol-dependent patients. One way to study this is to compare placebo to no pharmacological treatment.

When worlds collide: blending the divergent traditions of pharmacotherapy and-psychotherapy outcome research.

Objective: The multisite COMBINE Study brought together a team of alcoholism investigators who varied in whether their expertise was primarily in pharmacotherapy research or in studying psychotherapy. The process of designing a single trial that tested combinations of psychotherapy and pharmacotherapy highlighted the differences in these two research traditions and necessitated a number of compromises that are the focus of this article.

Method: The COMBINE trial was designed to investigate the efficacy, separately and in combination, of two medications (i.

Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients.

An experimental components analysis of brief HIV risk-reduction counseling based on the information-motivation-behavioral skills (IMB) model was conducted with 432 men and 193 women receiving sexually transmitted infection (STI) clinic services. Following baseline assessments, participants were randomly assigned to 1 of 4 90-min risk-reduction counseling sessions that deconstructed the IMB model within a full factorial design. Participants were followed for 9 months, with STI diagnoses monitored over 12 months.

A multi-site dose ranging study of nalmefene in the treatment of alcohol dependence.

The opiate antagonist nalmefene has been shown in 2 single-site studies to reduce alcohol consumption and relapse drinking in alcohol-dependent individuals. This safety and preliminary multisite efficacy study evaluated 3 doses of nalmefene (5, 20, or 40 mg) in a double-blind comparison to placebo over a 12-week treatment period in 270 recently abstinent outpatient alcohol-dependent individuals. Participants concomitantly received 4 sessions of a motivational enhancement therapy (with a medication compliance component) delivered from trained counselors.

Clinical and methodological utility of a composite outcome measure for alcohol treatment research.

Background: How to capture different response patterns resulting from alcohol treatment has been a troublesome issue for alcohol researchers. A composite measure is one approach to capturing multiple treatment outcomes among diverse client populations. This article provides the rationale, development, and work conducted thus far on the composite outcome index and discusses the clinical utility of the measure.

Sensation seeking, alcohol use and sexual risk behaviors among men receiving services at a clinic for sexually transmitted infections.

Objective: Risk-prone personality dispositions are associated with alcohol use and high-risk sexual behaviors; however, the nature of these associations and their implications for sexual risk reduction interventions are not clear. This study examined a conceptual model of sensation seeking personality and alcohol expectancies as correlates of sex-related alcohol use and sexual risk behaviors.

Method: Men (N = 350) seeking services from an innercity clinic that treats sexually transmitted infections (STI) completed measures of demographic characteristics, sensation seeking, alcohol outcome expectancies, alcohol use in sexual contexts and sexual behaviors, administered onsite at the clinic using audio-computer-assisted interviewing.

Alcoholism treatment and medical care costs from Project MATCH.

Aims: This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality.

Design: Longitudinal study with pre- and post-treatment initiation.

Measurements: The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment.