Longitudinal examination of alcohol use motives, item-level protective behavioral strategies, and alcohol-related consequences.

BACKGROUND: Alcohol misuse among college students is a public health concern. Protective behavioral strategies (PBS) can be used before, during, after, or instead of drinking to reduce alcohol use and negative consequences, but findings on their utility at the aggregate level are mixed. Although recent work has provided important information on the performance of individual PBS items, it is limited by research designs that are cross-sectional, do not examine consequences, or do not examine other important correlates, such as drinking motives. This study examines both the association between item-level PBS and alcohol-related negative consequences and the moderating effect of drinking motives longitudinally. METHODS: College students from two universities (n = 200, 62.5% female, Mage = 20.16) completed the Drinking Motives Questionnaire-Revised, Protective Behavioral Strategies Survey, the Rutgers Alcohol Problem Index, and a measure of the quantity of alcohol use at baseline and 3-month follow-up. Generalized linear models were conducted to assess direct effects of item-level PBS on alcohol-related consequences and the moderating effects of drinking motives. RESULTS: Two PBS items were associated with fewer alcohol-related consequences at follow-up, and two items were associated with greater alcohol-related consequences at follow-up. Drinking motives differentially moderated associations between item-level PBS and alcohol-related consequences for a proportion in the sample. Enhancement motives moderated the greatest number of associations, followed by coping, conformity, and social motives. Certain PBS (e.g., drink slowly, rather than gulp or chug) were moderated by several drinking motives, whereas other PBS items were not moderated by any motives. CONCLUSION: Consistent with previous research, some item-level PBS were associated longitudinally with increased negative consequences, and some were associated with decreased negative consequences. Drinking motives, particularly enhancement, moderated several item-level PBS and consequence associations, suggesting that reasons for drinking may be important for understanding the associations between PBS strategies and alcohol-related consequences.

Whose Approval Matters Most? Examining Discrepancies in Self- and Other- Perceptions of Drinking.

BACKGROUND: Research demonstrates that perceptions of others' attitudes toward drinking behaviors (injunctive norms) are strong predictors of alcohol consumption and problems. Personalized normative feedback (PNF) aims to reduce the discrepancy between one's perception of others' attitudes toward drinking and others' actual attitudes toward drinking. An implicit assumption of PNF is that self and (perceived) other attitudes toward drinking are aligned (thus, shifting one's perceptions of others' attitudes shifts one's own attitudes). However, there is minimal research on the extent to which alignment (or discrepancy) in self-other attitudes toward drinking is associated with alcohol-related outcomes. METHODS: College students (N = 1,494; Mage = 20.11, 61.0% female, 66.4% White) who endorsed past-month heavy episodic drinking reported injunctive norms toward drinking on weekends, drinking daily, drinking to black out, and drinking and driving. Participants reported their perceptions of attitudes toward these drinking behaviors for three reference groups: close friends, typical university-affiliated peers, and parents. Outcomes included weekly drinking, alcohol problems, and alcohol-related risk. RESULTS: Response surface analyses indicated that alignment in approval (versus alignment in disapproval) of drinking demonstrated a linear association with alcohol-related outcomes. Discrepancies in self-peer and self-parent attitudes were associated with alcohol-related outcomes and one's own attitudes (versus one's ratings of others' attitudes) of drinking were more strongly associated with outcomes. CONCLUSIONS: Results provide evidence of how self-other discrepancies in attitudes toward drinking are associated with alcohol-related outcomes. Future work is needed to test whether self-other discrepancies in attitudes toward drinking impacts response to norms-based interventions.

Why get high? Coping and enjoyment motives mediate elevated cannabis demand and cannabis-related outcomes.

OBJECTIVE: Cannabis is the most used psychoactive substance among adolescents and is a public health concern. Cannabis demand is a quantifiable measure of the reinforcing value of cannabis and comprises two latent-factors-amplitude (maximum consumption) and persistence (sensitivity to increasing costs). Cannabis demand and cannabis motives are important predictors of adolescent cannabis use and associated problems; however, little is known about how these two facets of motivation are causally related. Cannabis motives are thought to represent the final common pathway to cannabis use and may explain why elevated demand is associated with use and consequences. The present study tested whether internal cannabis motives (coping and enjoyment) mediated longitudinal associations between cannabis demand, use (hours high), and negative consequences. METHOD: Participants aged 15-18 years old (n = 89, Mage = 17.0, SD = 0.9) who reported lifetime cannabis use completed online assessments of cannabis demand, motives, use and negative consequences at baseline, 3-month, and 6-month follow-up. RESULTS: PROCESS mediation models revealed that enjoyment motives mediated the association between amplitude and persistence and use. In addition, coping motives mediated the association between amplitude and negative consequences. CONCLUSIONS: These findings suggest that internal motives, while differentially related to aspects of demand and cannabis outcomes, are important in understanding adolescent cannabis use. Prevention efforts aimed at limiting access to cannabis and increasing access to substance-free activities may be important targets for adolescents. Further, cannabis interventions targeting specific motives for using (e.g., to cope with negative affect) may be important for reducing cannabis demand. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alcohol and marijuana use predicting next-day absenteeism and engagement at school and work: A daily study of young adults.

This study examined effects of alcohol and marijuana use on next-day absenteeism and engagement at work and school among young adults (18-25 years old) who reported past-month alcohol use and simultaneous alcohol and marijuana use. Participants completed twice daily surveys for five, 14-day bursts. The analytic sample was 409 [64 % were enrolled in university (N = 263) and 95 % were employed (N = 387) in at least one burst]. Daily measures included: any alcohol or marijuana use, quantity of alcohol or marijuana use (i.e., number of drinks, number of hours high), attendance at work or school, and engagement (i.e., attentiveness, productivity) at school or work. Multilevel models examined between- and within-person associations between alcohol and marijuana use and next-day absenteeism and engagement at school or work. Between-persons, the proportion of days of alcohol use days was positively associated with next-day absence from school, consuming more drinks was positively associated with next-day absence from work, and the proportion of days of marijuana use was positively associated with next-day engagement at work. At the daily-level, when individuals consumed any alcohol and when they consumed more drinks than average, they reported lower next-day engagement during school and work. When individuals used marijuana and when they were high for more hours than average, they reported lower next-day engagement during school. Findings suggest alcohol and marijuana use consequences include next-day absence and decrements in next-day engagement at school and work, which could be included in interventions aimed at ameliorating harmful impacts of substance use among young adults.

Can I see some ID? Examining validity of the marijuana purchase task among late adolescent cannabis users.

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old (n = 115, Mage = 16.9, SD = 0.9) residing in a state with legalized cannabis use completed online assessments at baseline and 6-month follow-up. Convergent and divergent validity was examined, while principal component analysis was conducted to determine the factor structure and assess predictive validity. Three indices, Omax (i.e., maximum expenditure on cannabis), breakpoint (i.e., price suppressing consumption to zero), and alpha (i.e., degree to which consumption decreases with increasing price) were all significantly associated with cannabis use, consequences, craving, and expenditures and significantly differentiated low-risk users and high-risk users as measured by the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). A two-factor solution reflecting amplitude (intensity, alpha, Omax) and persistence (breakpoint, Pmax) was observed. Both factors were associated with cannabis use and consequences in baseline regression models. At follow-up, persistence was associated with consequences; amplitude was not associated with either outcome. These findings provide initial evidence that the MPT is a valid measure for assessing cannabis demand among adolescents and can be used to understand mechanisms of adolescent cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Repeated Assessment of Alcohol Use and Perceived Norms Among College Students Who Drink: Comparisons to a Minimal Assessment at 12-Month Follow-Up.

OBJECTIVE: Clinical trials assessing efficacy of alcohol use interventions often aim to test differences between treatment and control conditions at several follow-up time points, requiring repeated assessment of outcomes (e.g., weekly number of drinks). There has been concern that repeated assessment may elicit assessment reactivity in which participants, even those who did not receive treatment, reduce their alcohol use, but findings in the literature have been mixed. The current study of assessment reactivity compared two control conditions that were part of a larger randomized controlled trial: (a) repeated assessment that completed surveys at baseline, 3-, 6-, and 12-month follow-ups, and (b) minimal assessment that only completed surveys at baseline and 12-month follow-up. Outcomes assessed at 12-month follow-up included (a) changes in alcohol use behavior and negative consequences, (b) changes in perceived descriptive and injunctive norms, and (c) participant attrition/retention. METHOD: Participants were undergraduate students who reported at least one heavy drinking occasion (4+/5+ drinks for women/men) in the past month (N = 456; 63.3% female; mean age = 20.11 years). RESULTS: Multiple regression models indicated no significant differences between the repeated and minimal assessment control conditions on any indices of alcohol use (p values ranged from .42 to .97), negative consequences (p = .39), or on perceived descriptive/injunctive norms (p = .60 and .23, respectively). Attrition at 12-month follow-up was low in both groups, but significantly higher (p = .006) in the repeated assessment condition (16.49%) than the minimal assessment condition (8.55%). CONCLUSIONS: Repeated assessment did not elicit changes in alcohol use, negative consequences, or perceived norms. A minimal assessment control condition may not be necessary when assessing intervention efficacy across longitudinal follow-ups. However, when attrition at 12-month follow-up is a salient concern, a minimal assessment control may retain more participants than repeated assessment.

Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences.

BACKGROUND: Alcohol and marijuana are commonly used by young adults, and use of both substances, particularly at the same time, is prevalent among this population. Understanding the prevalence, patterns, correlates, and consequences of simultaneous alcohol and marijuana (SAM) use is important to inform interventions. However, this literature is complicated by myriad terms used to describe SAM use, including use with overlapping effects and same-day co-use. OBJECTIVES: This scoping review identifies and describes the peer-reviewed literature focused on SAM use by young adults and distinguishes simultaneous use from same-day co-use of alcohol and marijuana. This review also provides a narrative summary of the prevalence of SAM use, patterns of SAM and other substance use, psychosocial correlates, and consequences of SAM use. ELIGIBILITY CRITERIA: This review is limited to papers written in English and published in peer-reviewed journals between January 2000 and August 2021. It includes papers assessing simultaneous use or same-day co-use of alcohol and marijuana among young adults ages 18 to 30. Review papers, qualitative interviews, experimental lab studies, policy work, toxicology or medical reports, and papers focused on neurological outcomes are excluded. SOURCES OF EVIDENCE: PubMed, PsycINFO, and Web of Science databases were searched. Databases were selected and the search strategy developed in consultation with an information specialist. CHARTING METHODS: A data charting form was utilized to specify which information would be extracted from included papers. Eight categories of data were extracted: (1) research questions and hypotheses; (2) sample characteristics; (3) study procedures; (4) definition of SAM use; (5) prevalence of SAM use; (6) patterns of SAM and other substance use; (7) psychosocial correlates of SAM use; and (8) consequences of SAM use. RESULTS: A total of 1,282 papers were identified through initial search terms. Through double-blind title/abstract screening and full-text review, the review was narrowed to 74 papers that met review inclusion criteria. Review of these papers demonstrated that SAM use was prevalent among young adults, particularly among those who reported heavier quantities and more frequent use of alcohol and marijuana. Enhancement-related motives for use were consistently positively associated with SAM use. SAM use was associated with greater perceived positive and negative consequences of alcohol and/or marijuana use. Inconsistencies in prevalence, patterns, correlates, and consequences were found between studies, which may be due to large variations in measurement of SAM use, populations studied, methodological design (e.g., cross-sectional vs. intensive longitudinal), and the covariates included in models. CONCLUSIONS: The literature on simultaneous use and same-day co-use of alcohol and marijuana has expanded rapidly. Of the 74 included papers (61 on SAM use; 13 on same-day co-use), 60 papers (47 on SAM use; 13 on same-day co-use) were published within the last 5 years. Future research focusing on the ways in which SAM use confers acute risk, above and beyond the risks associated with separate consumption of alcohol and marijuana, is needed for understanding potential targets for intervention.

Effects of within- and between-person assessments of alcohol expectancies and valuations on use and consequences moderated by sex.

BACKGROUND: Alcohol expectancies (AE; beliefs about the likelihood of outcomes) and valuations (beliefs about the desirability of outcomes) may help explain alcohol use by young adults. However, it remains unclear how variability in AE and valuations over time are related to alcohol-related outcomes, and whether these associations are moderated by sex. The current study addressed these gaps in knowledge by examining within-person variability among positive and negative AEs, valuations, and alcohol-related outcomes over a 12-month period. METHODS: Data were collected from 433 college students (Mage  = 20.06; 59.81% women) who completed surveys at 4 timepoints: at baseline and 3-month, 6-month, and 12-month follow-up. RESULTS: We found substantial within-person variability in both AE and valuations (intraclass correlation coefficients ranged from 50% to 66%), and differences in variability by sex, with women showing more variability than men. Multilevel models revealed that weekly drinking was significantly higher at timepoints in which participants held relatively greater AE for sociability, sexuality, and risk/aggression, but lower when participants expected greater effects on self-perception. Weekly drinking was also higher when participants reported more favorable valuation of risk/aggression. Participants experienced significantly more negative consequences at timepoints in which they held relatively greater AE for sexuality and self-perception. No AEs were associated with a reduced likelihood of negative consequences. Participants experienced more negative consequences at timepoints in which they reported more favorable valuation of self-perception No valuations were associated with fewer consequences. Several between- and within-person associations were moderated by sex. CONCLUSIONS: These findings suggest that AE and valuations are dynamic, that young adults' beliefs about the effects of alcohol varied over time, and that both negative and positive AE and valuations may be important correlates of alcohol use and consequences. These findings have implications for interventions designed to challenge expectancies and valuations with the goal of reducing alcohol use and associated consequences.

Evaluation of the psychometric properties of the cannabis use disorders identification test - revised among college students.

OBJECTIVE: Cannabis use is common among college students and is associated with a variety of negative consequences. The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is an 8-item screening instrument designed to identify potentially problematic or harmful recent cannabis use. The purpose of the current study was to evaluate the internal consistency and validity of the CUDIT-R in a sample of college students who reported recent cannabis use (past 30 day). METHODS: Participants (n = 229) completed the CUDIT-R and measures of smoking behavior (Daily Smoking Questionnaire; DSQ), cannabis related consequences (Marijuana Problem Index; MPI), and problematic cannabis use (self-reported DSM-5 Cannabis Use Disorder Criteria). RESULTS: The CUDIT-R showed good internal consistency and concurrent validity with cannabis related outcome measures including; frequency of use, cannabis related consequences, and total DSM-5 criteria endorsed. The CUDIT-R also showed evidence of discriminant validity across DSM-5 severity classifications, achieved high levels of sensitivity (0.929) and specificity (0.704), and excellent area under the receiver operating characteristics curve when using a cutoff score of six. All items displayed high levels of discrimination and varied in terms of difficulty and information provided. CONCLUSIONS: Overall, the CUDIT-R appears to be a reliable and valid screening measure when used to identify college students at risk for cannabis related problems. Future research should further evaluate the sensitivity and specificity of the CUDIT-R threshold scores with more rigorously established DSM-5 diagnoses, and across a range of populations. Research on the utility of using the CUDIT-R for measuring treatment outcomes is also warranted.

Differential Role of Cannabis Use Motives in Predicting Impairment Across Three Measures.

OBJECTIVE: Previous research has demonstrated the utility of motivational models of cannabis use to predict the frequency of use and associated negative consequences. However, few existing studies have simultaneously investigated a range of motives across different measures of use-related problems, which limit the ability to assess the differential role various motives play. The purpose of the current study was to examine cannabis use motives as predictors of three measures of cannabis use risk. METHOD: Participants (N = 229) who reported cannabis use within the past 30 days completed the Marijuana Motives Measures, as well as measures of typical smoking behavior and risk: Cannabis Use Disorders Identification Test-R (CUDIT-R; screening measure of hazardous cannabis use), Marijuana Problem Index (MPI; measure of broad psychosocial problems), and cannabis use disorder according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). RESULTS: Cannabis use motives-particularly coping, enhancement, and conformity-contributed to the prediction of cannabis-related impairment beyond gender and the frequency of recent use. Among the motives scales, coping emerged as the most robust predictor across the three impairment measures and was the only motive to add unique variance to predictions of DSM-5 symptoms. Enhancement and conformity motives were predictive of the screening measure (CUDIT-R scores), and enhancement motives was also predictive of a measure of broad psychosocial problems related to cannabis use (MPI scores). CONCLUSIONS: The results highlight the differential role various marijuana use motives play across related but distinct measures of impairment.

Pour Convergence: College Students' Definitions and Free-Poured Volumes of Standard Alcohol Servings.

We examined the correspondence between college students' ( N = 192, 71% women) definitions of free-pours and their free-poured volumes of beer, wine, and liquor. Participants' mean beer definitions and free-pours were positively correlated; participants' mean wine and liquor definitions were larger than their free-pours, which were fairly accurate. Contrary to what the aggregate mean values indicated, fewer than half of the participants accurately free-poured a standard volume of beer, wine, or liquor (37.4%, 35.1%, and 22.2%, respectively) or provided an accurate definition of beer (45.8%); similar to the aggregate data, few participants provided accurate definitions of standard serving of wine (12.2%) or liquor (12.8%) Instead, a majority of participants' definitions and free-pours were well over or under a standard serving. For all three types of alcohol, there was little correspondence between each individual participant's definitions and his or her free-poured volumes. These data suggest analyses of individual data points may provide information important for data collection, prevention, and intervention strategies.

Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users.

There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.

A systematic review of the free-pour assessment: Implications for research, assessment and intervention.

Excessive alcohol consumption is a major concern. Alcohol consumption data are typically collected via self-report questionnaires. However, research has suggested that individuals are unable to identify a standard drink size and that their self-report may be influenced by certain environmental conditions, calling into question the reliability and validity of self-report. The free-pour is an objective measure that may provide a clearer picture of current alcohol consumption trends, individuals' knowledge of standard drink sizes, and accuracy of self-report. This systematic review of existing free-pour assessment methods suggests that individuals are unable to identify and pour standard drink sizes, with the largest discrepancies occurring for liquor and wine pours and pours into larger and wider glasses. Additional variables that appear to influence pouring behavior are gender, pouring location (e.g., home or laboratory), pouring task (e.g., selecting a line or physically pouring), and drinking history; however, additional research is necessary to better understand the effects of these variables on pouring behavior. These findings have important implications for the accuracy of self-report measures, as well as clinical implications for alcohol use screenings, alcohol education courses, and brief interventions for alcohol use. The systematic review concludes with recommendations for practical applications and future research of the free-pour assessment. (PsycINFO Database Record

Diversion of prescription stimulants among college students: An initial investigation of injunctive norms.

Nonmedical use of prescription stimulants (NMUPS) is an increasing problem among the college student population. Despite recent increases in stimulant prescriptions, little research has examined diversion of prescription stimulants among college students. The purpose of the current exploratory study was to compare normative beliefs about the frequency and motives of NMUPS among a college student sample. Participants were 121 college students who reported having a current prescription for a prescription stimulant. Participants completed online surveys and reported occasions of diversion behavior along with ratings of perceived approval for NMUPS and associated motives. Participants with a history of diversion were more likely to rate their close friends as more approving of more frequent NMUPS, and more approving of various motives for NMUPS. Perceived approval of NMUPS and NMUPS motives among parents and typical university students was similar across diversion groups, with parents and university students being rated as more approving of NMUPS for educational purposes. These findings extend the use of social norms theory to a new behavior while adding to our understanding how those who divert their medication differ from those who do not. Future studies should seek to establish a causal relationship between perceived approval for NMUPS and diversion behaviors. These findings also suggest that future research should focus on the feasibility and impact of social norms intervention for NMUPS and medication diversion.

Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers.

Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.

Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives.

BACKGROUND: Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. OBJECTIVES: The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. METHODS: Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. RESULTS: Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. CONCLUSIONS/IMPORTANCE: To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.

Dually Diagnosed Patients with Arrests for Violent and Nonviolent Offenses: Two-Year Treatment Outcomes.

The purpose of this study was to examine the history of arrests among dually diagnosed patients entering treatment, compare groups with different histories on use of treatment and mutual-help groups and functioning, at intake to treatment and six-month, one-year, and two-year follow-ups, and examine correlates and predictors of legal functioning at the study endpoint. At treatment intake, 9.2% of patients had no arrest history, 56.3% had been arrested for nonviolent offenses only, and 34.5% had been arrested for violent offenses. At baseline, the violent group had used the most outpatient psychiatric treatment and reported poorer functioning (psychiatric, alcohol, drug, employment, and family/social). Both arrest groups had used more inpatient/residential treatment and had more mutual-help group participation than the no-arrest group. The arrest groups had higher likelihood of substance use disorder treatment or mutual-help group participation at follow-ups. Generally, all groups were comparable on functioning at follow-ups (with baseline functioning controlled). With baseline arrest status controlled, earlier predictors of more severe legal problems at the two-year follow-up were more severe psychological, family/social, and drug problems. Findings suggest that dually diagnosed patients with a history of arrests for violent offenses may achieve comparable treatment outcomes to those of patients with milder criminal histories.

Retention in medication-assisted treatment for opiate dependence: A systematic review.

Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010-2014) found wide variability in retention rates (i.e., 19%-94% at 3-month, 46%-92% at 4-month, 3%-88% at 6-month, and 37%-91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.

Criminal typology of veterans entering substance abuse treatment.

Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild-(78.9%), moderate (13.6%), and severe (7.5%)-distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.

Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review.

Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes.