The mixed message behind "Medication-Assisted Treatment" for substance use disorder.

The gap between treatment utilization and treatment need for substance use disorders (SUDs) remains a significant concern in our field. While the growing call to bridge this gap often takes the form of more treatment services and/or better integration of existing services, this perspective proposes that more effective labels for and transparent descriptions of existing services would also have a meaningful impact. Adopting the perspective of a consumer-based health-care model (wherein treatments and services are products and patients are consumers) allows us to consider how labels like Addiction-focused Medical Management, Medication-Assisted Treatment, Medication-Assisted Therapy, and others may actually be contributing to the underutilization problem rather than alleviating it. In this perspective, "Medication-Assisted Therapy" for opioid-use disorder (OUD) is singled out and discussed as inherently confusing, providing the message that pharmacotherapy for this disorder is a secondary treatment to other services which are generally regarded, in practice, as ancillary. That this mixed message is occurring amidst a nationwide "opioid epidemic" is a potential cause for concern and may actually serve to reinforce the longstanding, documented stigma against OUD pharmacotherapy. We recommend that referring to pharmacotherapy for SUD as simply "medication," as we do for other chronic medical disorders, will bring both clarity and precision to this effective treatment approach.

Preventing alcohol-exposed pregnancies among Hispanic women.

Project Healthy CHOICES, a self-administered, mail-based prevention intervention, was developed for women at risk of an alcohol-exposed pregnancy (AEP). Participants were sent their assessment and study materials through the United States Postal Service. This article uses data from a larger study (N = 354) and focuses on the 89 women who identified as Hispanic. Potential participants who called in response to English and Spanish ads and who said they could read and write Spanish were given a choice of receiving the intervention materials in English or Spanish. The main objective of the present study was to evaluate differences in outcomes as a function of (a) the language in which the intervention materials were received, and (b) the participants' acculturation levels. Prior to the study, all women were at risk of an AEP. At the 6-month follow-up, two thirds (66%) of all Hispanic women had reduced their overall risk of an AEP, primarily by practicing effective birth control. These outcomes are similar to those reported for previous Project CHOICES studies. Significantly more women who requested the intervention materials in English (75%) compared to Spanish (41%) reduced their overall risk of an AEP. Women with high English cultural domain scores were at significantly less risk of an AEP due to effective contraception and a reduced overall risk of an AEP. Compared to other Project CHOICES studies, Project Healthy CHOICES is less intensive; it is self-administered, freely available, and can be completed without visiting a health care practitioner or clinic.

"Alcoholic" or "Person with alcohol use disorder"? Applying person-first diagnostic terminology in the clinical domain.

A recent publication by Broyles et al. has recommended extending the use of diagnostically accurate, person-first language (e.g., "person with alcohol use disorder") as an alternative to non-diagnostic, idiosyncratic terms (e.g., "addict", "alcoholic") when describing individuals with substance use disorders (SUDs) in academic publications. Given the high levels of stigma towards individuals with SUDs in both the public and professional community alike, however, the present commentary advocates for extending the use of appropriate terminology in the description of individuals with SUDs beyond the academic arena- i.e., clinical charting. The use of potentially stigmatizing idiomatic terms and descriptions (e.g., "clean", "dirty") in clinical charting is discussed with respect to: a) the lingering problem of the treatment utilization gap, b) modern conceptualizations of stigma and labelling among individuals with SUDs, as well as c) the emerging concept of structural stigma and how institutional standards (or lack thereof) may inadvertently contribute to the perpetuation of providers' negative attitudes and beliefs. The negative implications of SUD-related stigma on quality of patient care are also discussed, and possible barriers to the successful adoption of the above approach are considered. A number of possible benefits from the successful adoption of person-first, patient-centered, diagnostically appropriate labelling standards within clinical notes are hypothesized, including improved alignment with patient-centered care models, institutional values, and professional ethics, as well as reductions in institutional stigma. A number of recommendations to facilitate adoption of are offered.

The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations.

This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

Reliability of the Timeline Followback for cocaine, cannabis, and cigarette use.

The Timeline Followback (TLFB), a retrospective calendar-based measure of daily substance use, was initially developed to obtain self-reports of alcohol use. Since its inception it has undergone extensive evaluation across diverse populations and is considered the most psychometrically sound self-report measure of drinking. Although the TLFB has been extended to other behaviors, its psychometric evaluation with other addictive behaviors has not been as extensive as for alcohol use. The present study evaluated the test-retest reliability of the TLFB for cocaine, cannabis, and cigarette use for participants recruited from outpatient alcohol and drug treatment programs and the general community across intervals ranging from 30 to 360 days prior to the interview. The dependent measure for cigarette smokers and cannabis users was daily use of cigarettes and joints, respectively, and for cocaine users it was a "Yes" or "No" regarding cocaine use for each day. The TLFB was administered in different formats for different drug types. Different interviewers conducted the two interviews. The TLFB collected highly reliable information about participants' daily use of cocaine, cannabis, and cigarettes from 30, 90, to 360 days prior to the interview. Findings from this study not only suggest that shorter time intervals (e.g., 90 days) can be used with little loss of accuracy, but also add to the growing literature that the TLFB can be used with confidence to collect psychometrically sound information about substance use (i.e., cocaine, cannabis, cigarettes) other than alcohol in treatment- and nontreatment-seeking populations for intervals from ranging up to 12 months prior to the interview.

Alcohol and drug treatment outcome studies: new methodological review (2005-2010) and comparison with past reviews.

OBJECTIVE: Several methodological reviews of alcohol treatment outcome studies and one review of drug studies have been published over the past 40 years. Although past reviews demonstrated methodological improvements in alcohol studies, they also found continued deficiencies. The current review allows for an updated evaluation of the methodological rigor of alcohol and drug studies and, by utilizing inclusion criteria similar to previous reviews, it allows for a comparative review over time. In addition, this is the first review that compares the methodology of alcohol and drug treatment outcome studies published during the same time period. METHOD: The methodology for 25 alcohol and 11 drug treatment outcome studies published from 2005 through 2010 that met the review's inclusion criteria was evaluated. The majority of variables evaluated were used in prior reviews. RESULTS: The current review found that more alcohol and drug treatment outcome studies are now using continuous substance use measures and assessing problem severity. Although there have been methodological improvements over time, the current reviews differed little from their most recent past counterpart. Despite this finding, some areas, particularly the continued low reporting of demographic data, needs strengthening. CONCLUSIONS: Improvement in the methodological rigor of alcohol and drug treatment outcome studies has occurred over time. The current review found few differences between alcohol and drug study methodologies as well as few differences between the current review and the most recent past alcohol and drug reviews.

Statistical methods applied to gamma-ray spectroscopy algorithms in nuclear security missions.

Gamma-ray spectroscopy is a critical research and development priority to a range of nuclear security missions, specifically the interdiction of special nuclear material involving the detection and identification of gamma-ray sources. We categorize existing methods by the statistical methods on which they rely and identify methods that have yet to be considered. Current methods estimate the effect of counting uncertainty but in many cases do not address larger sources of decision uncertainty, which may be significantly more complex. Thus, significantly improving algorithm performance may require greater coupling between the problem physics that drives data acquisition and statistical methods that analyze such data. Untapped statistical methods, such as Bayes Modeling Averaging and hierarchical and empirical Bayes methods, could reduce decision uncertainty by rigorously and comprehensively incorporating all sources of uncertainty. Application of such methods should further meet the needs of nuclear security missions by improving upon the existing numerical infrastructure for which these analyses have not been conducted.