"Everything is kind of the same except my mind is with me": exploring cannabis substitution in a sample of adults in early recovery from an opioid or stimulant addiction.

BACKGROUND: Recovery from addiction is frequently equated with abstinence. However, some individuals who resolve an addiction continue to use substances, including via substitution (i.e., increased use of one substance after eliminating/ reducing another). Substitution may play a distinct role during early recovery (≤ 1 year), as this period is marked by dramatic change and adjustment. Cannabis is one of the most used substances and is legal for medical and recreational use in an increasing number of states. Consequently, cannabis an increasingly accessible substitute for substances, like fentanyl, heroin, cocaine and methamphetamine, with higher risk profiles (e.g., associated with risk for withdrawal, overdose, and incarceration). METHODS: Fourteen participants reported that they had resolved a primary opioid or stimulant addiction and subsequently increased their cannabis use within the previous 12 months. Using grounded theory, the interviewer explored their experiences of cannabis use during early recovery. Data were analyzed in three stages: line by line coding for all text related to cannabis use and recovery, focused coding, and axial coding to generate a theory about recovery with cannabis substitution. The motivational model of substance use provided sensitizing concepts. RESULTS & DISCUSSION: The final sample included eight men and six women ranging in age from 20 to 50 years old. Three participants resolved an addiction to methamphetamine and the remaining 11, an addiction to opioids. Participants explained that cannabis was appealing because of its less harmful profile (e.g., no overdose risk, safe supply, few side effects). Participants' primary motives for cannabis use included mitigation of psychiatric symptoms, withdrawal/ cravings, and boredom. While cannabis was effective toward these ends, participants also reported some negative side effects (e.g., decreased productivity, social anxiety). All participants described typical benefits of recovery (e.g., improved self-concept, better relationships) while continuing to use cannabis. Their experiences with and beliefs about substitution suggest it can be an effective strategy for some individuals during early recovery. CONCLUSIONS: Cannabis use may benefit some adults who are reducing their opioid or stimulant use, especially during early recovery. The addiction field's focus on abstinence has limited our knowledge about non-abstinent recovery. Longitudinal studies are needed to understand the nature of substitution and its impact on recovery over time.

Faculty education in addiction training (FEAT): Evaluating an online training program for multidisciplinary health professions educators.

Background: Many health professionals lack adequate training needed to effectively address alcohol and other drug (AOD)-related problems. Building upon our previously successful in-person faculty training programs, we designed and pilot tested the brief online Faculty Education in Addiction Training (FEAT) Program for social work and internal medicine residency faculty. The present study examines baseline and post-FEAT Program AOD knowledge and teaching confidence and preparedness among faculty participants. Methods: The FEAT Program curriculum included didactic videos, online engagement with content experts, recommended readings, and a live virtual classroom experience. Participants completed self-assessments of knowledge and teaching confidence and preparedness pre- and post-FEAT program. Results: In this pilot test, thirty faculty completed the FEAT program: 15 social work and 15 internal medical residency program faculty. Both groups showed significant improvement (p < 0.001) in overall AOD-related knowledge with medium-to-large effects (Cohen's d = 1.83 [social work], 0.72 [medicine]). Both groups showed significant increases in teaching confidence (p < 0.001) for all items with large effects (Cohen's d values range from 1.08 to 1.92) and significant increases and large effects for all teaching preparedness items for social work (at least p < 0.01 | Cohen's d range = 1.03-1.56) and internal medical residency faculty (p < 0.001 | Cohen's d range = 1.08-1.69). Conclusions: Multidisciplinary health professions educators' AOD knowledge and teaching confidence and preparedness can be improved by participation in a brief online program designed to circumvent the logistical and fiscal challenges presented by in-person programs.

Trends and drug-related correlates in residential mobility among young adults in the United States, 2003-2016.

INTRODUCTION: Young adulthood, typically conceptualized as stretching from the late teens to the mid-twenties, is a period of elevated risk for residential mobility (i.e., moving or changing residences frequently) and drug involvement. However, our understanding of the trends and drug-related correlates of residential mobility among young adults remains limited. METHODS: We analyzed national trend data from the National Survey on Drug Use and Health (2003-2016) on residential mobility and drug involvement among young adults (N = 230,790) in the United States. For tests of trend, we conducted logistic regression analyses with survey year specified as a continuous independent variable and residential mobility as the dependent variable (no/yes), controlling for sociodemographic factors. RESULTS: The prevalence of residential mobility was stable among females, but decreased significantly-a 20% reduction in the relative proportion of respondents-among males during the study period (AOR = 0.98, 95% CI = 0.97-0.99). Male and female young adults reporting residential mobility were significantly more likely to report involvement in all drug-related outcomes examined, but effects were larger among females for drug selling and drug-related arrests. DISCUSSION: Study findings show that a substantial minority of young adults experience residential mobility and that, while rates are declining among young men, the experience of mobility is connected with risk for drug involvement, particularly among females. Mobility may be an important target for drug prevention/intervention efforts, but further research is needed to provide insight into how mobility and drug involvement are connected in the lives of young adults.

Trends and correlates of perceived access to heroin among young adults in the United States, 2002-2016.

BACKGROUND: We are at a unique moment in United States (US) history as heroin overdose rates are higher than at any time in recent memory. Based on prior research and the developmental risks faced by young adults (ages 18-25), we examine the trends and correlates of perceived access to heroin among this group over a 15-year period. METHODS: We analyzed national trend data from the National Survey on Drug Use and Health (2002-2016) on young adults' (N = 247,679; ages 18-25) perceived access to heroin. We conducted logistic regression analyses with survey year specified as an independent variable and heroin access specified as the dependent variable while controlling for sociodemographic factors. RESULTS: A majority of respondents reported that it would be difficult or impossible to obtain heroin, if desired. Young adult reports that it would be "probably impossible" to access heroin increased significantly from 31% in 2002 to 41% in 2016. The upward trend in the perceived lack of access was most robust among African Americans and Hispanics as well as those reporting no past-year substance use or drug/criminal justice system involvement. CONCLUSIONS: In the midst of a very serious opioid epidemic, the present study found that most young adults in the US consider that it would be "probably impossible" to obtain heroin. This trend was observed across young adulthood and across gender, racial/ethnic, and family income differences. However, we found that these trends are largely driven by those at relatively low risk of drug misuse and deviant behaviors generally.

Advancing Alcohol and Other Drug Education among Social Work Faculty: An Evaluation of Social Work Faculty Immersion Training.

This study is an educational evaluation of participants (N = 50) in a four-day immersion training program funded by the National Institute of Alcohol Abuse and Alcoholism. Using a pretest-posttest design, clinical social work faculty participants showed statistically significant (p < .001) improvement in overall alcohol and other drug-related knowledge (Baseline: Mean[SD] = 8.75 [2.44]; Post-Intervention: Mean[SD] = 13.88[1.96], Cohen's d = -2.16) in the domains of screening/assessment, brief intervention, medication-assisted treatment, and recovery and relapse prevention. Corresponding increases were also observed for faculty confidence in teaching clinical skills related to alcohol and other drug screening, assessment, and treatment.

Introduction to the Special Issue: Educating Social Workers about Alcohol and Other Drug Use Disorders.

This Special Issue of Journal of Social Work Practice in the Addictions focuses on an emerging effort, the Alcohol and Other Drugs Education Program (ADEP), designed to advance social work faculty knowledge and teaching in the area of alcohol and other drug (AOD) use. In June 2017, with grant support from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the inaugural ADEP program provided in-depth, immersion-based training to 50 full-time, clinical faculty from social work programs across the United States. As detailed in this Special Issue, the preliminary results of our program were highly promising and we look forward to training more social work faculty in June 2018, and in years to come. The ADEP program is predicated on the idea that faculty training in evidence-based AOD identification and treatment methods will help faculty to provide higher-quality instruction in AOD and, in turn, that their students will be better prepared to serve clients experiencing AOD-related problems. While this Special Issue focuses primarily on the ADEP program, we do so with the hope that the work presented here reaches far beyond the specifics of our faculty training program to underscore the need to advance AOD-related training and offer a template for social work educators looking adapt their teaching to address the nation's very serious challenges with AOD.

Addiction treatment staff perceptions of training as a facilitator or barrier to implementing evidence-based practices: a national qualitative research study.

BACKGROUND: This qualitative effort examines training-related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) nationwide that were funded by the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT) to implement EBPs. METHODS: Using qualitative interviews, the authors explored staff (N = 514) descriptions of training as a facilitator or barrier to implementation. Training-related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. RESULTS: Specific characteristics of the training received, such as access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included the amount of training; the training did not fit current staff and/or organizational needs; the training for some EBPs was perceived to be too demanding; and the difficulty accessing training. CONCLUSIONS: Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility, and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally funded resources for training were not always used.

Organizational readiness for change in community-based addiction treatment programs and adherence in implementing evidence-based practices: a national study.

UNLABELLED: Prior studies by the authors identified that clinical staff who reported that their treatment unit had lower levels of organizational readiness to change experienced higher levels of barriers in implementing an evidence-based practice (EBP). The current study examined whether clinical staff perceptions of their treatment unit's organizational readiness to change were also associated with their adherence to EBP protocols during EBP implementation. Adherence was examined through a variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Multivariate regression analyses identified that clinical staff who had five or more years of addiction counseling experience, who rated staff in their organization as having higher levels of influence, who less frequently implemented new counseling interventions and who reported higher levels of barriers when implementing a newly funded EBP also reported that their program made more modifications to the EBP in the implementation process. Finally, staff who implemented MI compared to any other EBP reported lower levels of EBP modifications. IMPLICATIONS: Continued federal funding is needed to enhance treatment unit organizational resources in order to reduce barriers and promote adherence to EBPs. Also, funders of treatment need to continue to provide ongoing technical assistance and training opportunities to promote implementation of EBPs with fidelity.

Facilitating factors in implementing four evidence-based practices: reports from addiction treatment staff.

UNLABELLED: In this Robert Wood Johnson Foundation-funded study (2009-2011), treatment staff (n = 178) from 330 federally funded U.S. addiction treatment programs provided data through semistructured telephone interviews about factors that facilitated their implementation of four evidence-based practices (EBPs). Such studies can assist the addiction field in improving EBP implementation and ultimately, client care. RESEARCH QUESTIONS: What factors were identified as facilitating implementation of the four EBPs? And, Do facilitating factors vary by EBP? Coders classified facilitating factors (n = 518) using a six-category schema. Results showed that although facilitating factors varied by EBP, organization-related factors dominated. Study implications and limitations are described.

Randomized trial of web-based training to promote counselor use of cognitive behavioral therapy skills in client sessions.

BACKGROUND AND METHODS: The authors designed and delivered an innovative Web course on cognitive behavioral therapy (CBT), a specific empirically based treatment, to a diverse group of addiction counselors and supervisors in 54 addiction units across the country, and conducted a randomized controlled trial of its effectiveness with 127 counselors. The primary focus of the trial was to assess "adequate adherence to CBT practice" after training as judged by raters blinded to training condition who listened to audiotapes of actual client sessions. Counselors who passed were judged to satisfy 2 criteria: (a) low pass or greater on at least 1 of 3 "CBT-generic skills" assessing session structure; and (b) low pass or greater on at least 1 of 3 "CBT-specific skills" related to use of functional analysis, cognitive skills practice, or behavioral skills practice. RESULTS: Although the counselors' use of CBT skills in sessions increased after Web course training, it was not statistically significant and not larger than the gain of control-group counselors trained with a written CBT manual.

Barriers to implementation of evidence-based addiction treatment: a national study.

Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff (n = 510) and director (n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change [TCU ORC]-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.

Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.

This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.

Modifications of evidence-based practices in community-based addiction treatment organizations: a qualitative research study.

This qualitative research effort explored implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study describes CBO program director attitudes on: (1) satisfaction with EBPs they were mandated to implement; (2) the extent to which their organization modified the EBPs; (3) reasons for modifications; and, (4) the standards they used for modifications. Findings indicate that program directors were highly positive both about EBPs implemented and the modifications made to those EBPs. A broad range of modifications were identified; most common were adding or deleting intervention sessions in efforts to serve the needs of a specific client population. Given the addiction treatment field's lack of standards for modifying EBPs, it is not surprising that little consistency occurred in modification efforts. As government funders of addiction treatments require that CBOs implement EBPs, standards need to be created for modifying and adapting the EBPs while maintaining their fidelity.

A Data Management System Integrating Web-based Training and Randomized Trials: Requirements, Experiences and Recommendations.

This article describes a data management system (DMS) developed to support a large-scale randomized study of an innovative web-course that was designed to improve substance abuse counselors' knowledge and skills in applying a substance abuse treatment method (i.e., cognitive behavioral therapy; CBT). The randomized trial compared the performance of web-course-trained participants (intervention group) and printed-manual-trained participants (comparison group) to determine the effectiveness of the web-course in teaching CBT skills. A single DMS was needed to support all aspects of the study: web-course delivery and management, as well as randomized trial management. The authors briefly reviewed several other systems that were described as built either to handle randomized trials or to deliver and evaluate web-based training. However it was clear that these systems fell short of meeting our needs for simultaneous, coordinated management of the web-course and the randomized trial. New England Research Institute's (NERI) proprietary Advanced Data Entry and Protocol Tracking (ADEPT) system was coupled with the web-programmed course and customized for our purposes. This article highlights the requirements for a DMS that operates at the intersection of web-based course management systems and randomized clinical trial systems, and the extent to which the coupled, customized ADEPT satisfied those requirements. Recommendations are included for institutions and individuals considering conducting randomized trials and web-based training programs, and seeking a DMS that can meet similar requirements.

Predicting long-term outcomes for women physically abused in childhood: contribution of abuse severity versus family environment.

OBJECTIVE: Child physical abuse (CPA) has been associated with adverse adult psychosocial outcomes, although some reports describe minimal long-term effects. The search for the explanation for heterogeneous outcomes in women with CPA has led to an examination of a range of CPA-related factors, from the severity of CPA incidents to the childhood family environment. This study compares several models for predicting adult outcomes: a multidimensional CPA severity scale, the presence or absence of CPA, family environment, and childhood stresses. METHODS: The effect of CPA on adult outcomes was examined among 290 community-dwelling women raised in 2-parent families. Standardized measures and a focused interview were used to collect data, with siblings as collateral informants. RESULTS: Comparison of a multidimensional CPA severity scale to a dichotomous measure of the presence or absence of CPA showed that the severity scale did not have greater predictive value for adult outcomes than the dichotomous measure. Childhood family environment scales considerably attenuated the predictive value of the dichotomous measure of CPA, exerting a greater mediating effect on outcomes than did childhood stresses. CONCLUSIONS: The specific characteristics of a CPA experience may be less important than the occurrence of CPA and the woman's childhood family environment for predicting long-term psychosocial outcomes. PRACTICE IMPLICATIONS: The presence of child physical abuse is substantial and continues to increase, but the clinical significance of abuse on adult outcomes is unclear. The findings of the current study lend credence to the idea that family stresses and resources other than CPA may be crucial in understanding long-term effects in women. Hence treatment and support for victims of CPA might benefit from clinicians' exploration of the family environment.

Moving empirically supported practices to addiction treatment programs: recruiting supervisors to help in technology transfer.

Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, 2001 ; Roman and Johnson, 2002 ; Willenbring et al., 2004 ). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors' perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.

Sibling agreement on retrospective reports of parental alcoholism and other childhood events.

UNLABELLED: Studies have used siblings to verify subject reports of retrospective data and examined variables influencing subject-sibling agreement, but questions remain. From 1998 to 2000, we examined a community sample of women (N = 143) in a metropolitan area, aged 21-60, balanced by race, parental alcoholism, and social class, as well as their siblings, using standardized, self-administered questionnaires and an interview. RESEARCH QUESTIONS: Do subject and sibling reports agree? Do reports vary by subject characteristics, or the type of childhood experience? Descriptive statistics showed that agreement was strong for measures of parental alcoholism and psychiatric problems, weaker for family environment, and varied little by subject characteristics. Study limitations and implications are noted, and future research suggested.