Is that a treatment program? Examining the physical landscape of opioid treatment programs in Los Angeles.

INTRODUCTION: Little attention has been paid to the built environment of outpatient opioid treatment programs, despite the need to increase access to medications for opioid use disorder, particularly among people of color. The aims of this study were to rate the attractiveness of publicly-funded opioid treatment programs (OTPs) in Los Angeles County and explore whether less attractive OTPs are found in disadvantaged neighborhoods. METHODS: We conducted observations of the exteriors of all OTPs located in specialty substance use disorder treatment clinics in Los Angeles County in 2021 (N = 44). We created an attractiveness index based on attractiveness of the building exteriors and the surrounding grounds, the presence of disorder such as garbage and graffiti, and the presence of bars on the windows. We tested whether less attractive facilities were more likely to be situated in disadvantaged neighborhoods with high concentrations of racial/ethnic minorities. RESULTS: Most building exteriors were found to have an ordinary level of attractiveness or rated as unattractive. The grounds were largely unattractive. We found a significant negative association between attractiveness and neighborhood disadvantage. CONCLUSION: This project was a preliminary study of the physical conditions of OTPs in Los Angeles. We found was that the physical conditions of OTPs in LA County were generally poor. Research has identified many individual and structural barriers to treatment for people with opioid use disorders. Future research should empirically test the association between the built environment of treatment clinics and access to treatment, particularly in communities of color.

Development of a Health Behavior Screening Tool for Deaf College Students.

Young adults who are Deaf or Hard-of-Hearing (D/HH) face behavioral health risks similar to hearing adults. Despite the emphasis on health behavior screening in health care settings, a brief screening tool in American Sign Language (ASL) does not exist. This manuscript describes the development and pilot testing of an online survey in ASL called the Deaf Health Behavior Report. The Deaf Health Behavior Report includes standardized questions for general health, health behaviors, and psychosocial topics. We invited all D/HH students at a university in Southern California to complete the Deaf Health Behavior Report. A total of 31 D/HH students completed the survey. The most prevalent health risks were related to nutrition, stress, and binge drinking. The Deaf Health Behavior Report is a useful tool for health promotion efforts on college campuses and in general health settings.

Association of masking policies with mask adherence and distancing during the SARS-COV-2 pandemic.

BACKGROUND: Quantification of the impact of local masking policies may help guide future policy interventions to reduce SARS-COV-2 disease transmission. This study's objective was to identify factors associated with adherence to masking and social distancing guidelines. METHODS: Faculty from 16 U.S. colleges and universities trained 231 students in systematic direct observation. They assessed correct mask use and distancing in public settings in 126 US cities from September 2020 through August 2021. RESULTS: Of 109,999 individuals observed in 126 US cities, 48% wore masks correctly with highest adherence among females, teens and seniors and lowest among non-Hispanic whites, those in vigorous physical activity, and in larger groups (P < .0001). Having a local mask mandate increased the odds of wearing a mask by nearly 3-fold (OR = 2.99, P = .0003) compared to no recommendation. People observed in non-commercial areas were least likely to wear masks. Correct mask use was greatest in December 2020 and remained high until June 2021 (P < .0001). Masking policy requirements were not associated with distancing. DISCUSSION: The strong association between mask mandates and correct mask use suggests that public policy has a powerful influence on individual behavior. CONCLUSIONS: Mask mandates should be considered in future pandemics to increase adherence.

Effect of screening, brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: a randomized controlled trial.

AIMS: To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. DESIGN AND SETTING: A multi-centre, longitudinal, two-group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. PARTICIPANTS: A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days. INTERVENTION AND COMPARATOR: A motivation-based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364). MEASUREMENTS: Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end-point 3 months post-baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12-month follow-up and the use of addiction treatment services. FINDINGS: Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48-0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50-0.66) at the 3-month follow-up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3-month follow-up (OR = 0.93; 95% CrI = 0.85-1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. CONCLUSIONS: Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use.

Measurement of sustainment of prevention programs and initiatives: the sustainment measurement system scale.

BACKGROUND: Enhancing the sustainability of evidence-based prevention programs for mental and behavioral health requires tools for measuring both sustainability determinants and sustainment outcomes. The aim of this study was to develop the Sustainment Measurement System Scale (SMSS) and to assess its reliability and construct validity for measuring both determinants and outcomes of efforts to sustain prevention programs and initiatives. METHODS: A 42-item scale comprised of items identified from qualitative data collected from 45 representatives of 10 programs and 8 SAMHSA program officers was administered to 186 representatives of 145 programs funded by 7 SAMHSA prevention grant initiatives. Cronbach's alphas were used to determine inter-item reliability. Convergent validity was assessed by comparisons of a global measure of sustainment with current SAMHSA-funding status and continued operation in the same form. Discriminant validity was assessed by comparisons of sustainability determinants with whether or not the program had undergone adaptations. RESULTS: Confirmatory factor analysis provided support for a 35-item model fit to the data. Cronbach's alpha was .84 for the sustainment outcome construct and ranged from .70 to .93 for the sustainability determinant constructs. All of the determinant constructs were significantly associated with sustainment outcome individual and global measures for the entire sample (p < 0.01 to 0.001) and for community-based programs and programs with a substance abuse focus (p < 0.05 to 0.001). Convergent validity was supported by significant associations between the global sustainment measure and current SAMHSA funding status and continued operation in the same form (p < 0.001). Four of the sustainability determinant constructs (responsive to community needs; coalitions, partnerships, and networks; organizational staff capability; and evaluation, feedback, and program outcomes) were also significantly associated with current SAMHSA funding status (p < 0.5 to 0.01). With the exception of organizational staff capability, all sustainability determinants were unrelated to program adaptation as predicted. CONCLUSIONS: The SMSS demonstrated good reliability and convergent and discriminant validity in assessing likelihood of sustainment of SAMHSA funded prevention programs and initiatives. The measure demonstrates potential in identifying predictors of program sustainment and as a tool for enhancing the likelihood of successful sustainment through ongoing evaluation and feedback.

Conceptualizing and measuring sustainability of prevention programs, policies, and practices.

A large knowledge gap exists regarding the measurement of sustainability of evidence-based prevention programs for mental and behavioral health. We interviewed 45 representatives of 10 grantees and 9 program officers within 4 Substance Abuse and Mental Health Services Administration prevention grant initiatives to identify experiences with implementation and sustainability barriers and facilitators; what "sustainability" means and what it will take to sustain their programs; and which Consolidated Framework for Implementation Research (CFIR) elements are important for sustainability. Lists of sustainability determinants and outcomes were then compiled from each data set and compared with one another. Analysis of themes from interviews and free lists revealed considerable overlap between sustainability determinants and outcomes. Four sustainability elements were identified by all three data sets (ongoing coalitions, collaborations, and networks and partnerships; infrastructure and capacity to support sustainability; community need for program; and ongoing evaluation of performance and outcomes), and 11 elements were identified by two of three data sets (availability of funding; consistency with organizational culture; evidence of positive outcomes; development of a plan for implementation and sustainment; presence of a champion; institutionalization and integration of program; institutional support and commitment; community buy-in and support; program continuity; supportive leadership; and opportunities for staff training). All but one of the CFIR domain elements (pressure from other states, tribes, or communities) were endorsed as important to sustainability by 50% or more of participants. It may be more important to implement a standardized process of eliciting determinants and outcomes of sustainability than to implement a single standardized instrument.

Measuring sustainment of prevention programs and initiatives: a study protocol.

BACKGROUND: Sustaining prevention efforts directed at substance use and mental health problems is one of the greatest, yet least understood, challenges in the field of implementation science. A large knowledge gap exists regarding the meaning of the term "sustainment" and what factors predict or even measure sustainability of effective prevention programs and support systems. METHODS/DESIGN: The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) supports a diverse portfolio of prevention and treatment grant programs that aim to improve population and individual level behavioral health. This study focuses on four SAMHSA prevention grant programs, two of which target substance abuse prevention at the state or single community level, one targets suicide prevention, and one targets prevention of aggressive/disruptive behavior in elementary schools. An examination of all four grant programs simultaneously provides an opportunity to determine what is meant by the term sustainment and identify and support both the unique requirements for improving sustainability for each program as well as for developing a generalizable framework comprised of core components of sustainment across diverse prevention approaches. Based on an analysis of qualitative and quantitative data of 10 grantees supported by these four programs, we will develop a flexible measurement system, with both general and specific components, that can bring precision to monitoring sustainment of infrastructure, activities, and outcomes for each prevention approach. We will then transform this system for use in evaluating and improving the likelihood of achieving prevention effort sustainment. To achieve these goals, we will (1) identify core components of sustainment of prevention programs and their support infrastructures; (2) design a measurement system for monitoring and providing feedback regarding sustainment within the four SAMHSA's prevention-related grant programs; and (3) pilot test the predictability of this multilevel measurement system across these programs and the feasibility and acceptability of a measurement system to evaluate and improve the likelihood of sustainment. DISCUSSION: This project is intended to improve sustainment of the supporting prevention infrastructure, activities, and outcomes that are funded by federal, state, community, and foundation sources.

Feasibility and acceptability of an audio computer-assisted self-interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients.

BACKGROUND: This study explores the feasibility and acceptability of a computer self-administered approach to substance use screening from the perspective of primary care patients. METHODS: Forty-eight patients from a large safety net hospital in New York City completed an audio computer-assisted self-interview (ACASI) version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and a qualitative interview to assess feasibility and acceptability, comprehension, comfort with screening questions, and preferences for screening mode (interviewer or computer). Qualitative data analysis organized the participants' feedback into major themes. RESULTS: Participants overwhelmingly reported being comfortable with the ACASI ASSIST. Mean administration time was 5.2 minutes (range: 1.6-14.8 minutes). The major themes from the qualitative interviews were (1) ACASI ASSIST is feasible and acceptable to patients, (2) Social stigma around substance use is a barrier to patient disclosure, and (3) ACASI screening should not preclude personal interaction with providers. CONCLUSIONS: The ACASI ASSIST is an appropriate and feasible approach to substance use screening in primary care. Because of the highly sensitive nature of substance use, screening tools must explain the purpose of screening, assure patients that their privacy is protected, and inform patients of the opportunity to discuss their screening results with their provider.

Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment.

We examined feasibility, acceptability, and benefits of a mindfulness-based relapse prevention (MBRP) intervention in a racially and ethnically diverse sample of 318 low-income women in substance use disorder treatment (2003-2006). The study used a single group, repeated measures design. Participant satisfaction was high (M = 3.4, SD = .3), but completion was modest (36%). Linear regressions examining change in addiction severity and psychological functioning by dosage showed that higher dosage was associated with reduced alcohol (ß = -.07, p < .05), drug severity (ß = -.04, p < .05), and perceived stress (ß = -2.29, p < .05) at 12 months. Further research on MBRP efficacy for this population is warranted. The study's limitations are noted.

Reducing readmissions to detoxification: an interorganizational network perspective.

BACKGROUND: The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients' odds of readmission to detox within 1 year. METHODS: Administrative data from 32 counties in California in 2008-2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N=18,278). RESULTS: After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission. CONCLUSION: The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed.

Determinants of successful treatment outcomes among a sample of urban American Indians/Alaska Natives: the role of social environments.

Very few studies have analyzed the role of social environments on substance abuse treatment outcomes among urban American Indians/Alaska Natives (AI/ANs). This study examined a measure of positive treatment response-abstinence from substance use at treatment discharge-among urban AI/ANs in Los Angeles County. The sample included all AI/ANs in outpatient drug-free (e.g., no methadone) treatment and residential treatment from 2004 to 2008 (N = 811). Predictors of abstinence at discharge were (a) having recovery-oriented social support and (b) not having a difficult living situation (i.e., experiencing family conflict and/or living with someone who uses alcohol and/or drugs). Higher levels of recovery-oriented social support in the past 30 days predicted abstinence during outpatient treatment. In residential treatment, retention of 90 days or more, high recovery-oriented social support, and not experiencing difficult living situations predicted abstinence. Suggestions for optimizing treatment outcomes among AI/ANs and areas of further research are provided.

Routine use of screening and brief intervention for college students in a university counseling center.

This study provides preliminary evidence of the effectiveness of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and ASSIST-linked brief intervention in a college mental health clinic. Data are from a single group, pre-post evaluation study (2006-2009) at a university counseling center. Students deemed to be at risk for substance use problems were offered the ASSIST and the ASSIST-linked brief intervention. Staff therapists administered the ASSIST and intervention as part of routine care; 453 students (ages 18-24) participated in the evaluation and completed baseline and six-month follow-up interviews. Changes in alcohol and marijuana use were examined by McNemar's test of proportions and by paired t-tests for means. Slight reductions in the rates and number of days (in the prior 30 days) of binge drinking and marijuana use were found. Routine screening and brief intervention procedures in a mental health setting may reduce problematic substance use among college students.

Intercepting binge drinkers in medical settings: a view from California.

The argument for universal alcohol screening in primary care is based on the assumption that most heavy drinkers routinely visit a doctor. This study examines whether drinking status is associated with higher or lower odds of visiting a doctor in the past year among California adults. As a point of comparison, the study also examines whether drinking status is associated with the odds of visiting an emergency room. Data came from the 2007 California Health Interview Survey. Multivariate logistic regression was used to examine the odds of visiting a doctor and an emergency room for abstainers, moderate drinkers, monthly binge drinkers, and weekly binge drinkers. After controlling for demographics, health coverage, and health status, binge drinkers had the same odds of visiting a doctor and the emergency room as moderate drinkers. Among binge drinkers, female gender, health coverage, and high blood pressure were associated with visiting a primary care doctor.

American indians/alaska natives and substance abuse treatment outcomes: positive signs and continuing challenges.

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Another Way of Talking About Substance Abuse: Substance Abuse Screening and Brief Intervention in a Mental Health Clinic.

This article provides experiential evidence on the transportability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) screening tool and brief intervention in a mental health clinic. There is very little published information on implementing screening and brief intervention (SBI) in a mental health setting. Moreover, few SBI projects have reported on clinicians' experiences using the ASSIST. The article documents a successful attempt at implementing the ASSIST and discusses the benefits and challenges of doing SBI in a mental health setting.

The rise in methamphetamine use among American Indians in Los Angeles County.

A preliminary review of substance abuse treatment admission data from 2001-2005 was conducted to explore the use of methamphetamine among American Indians in treatment programs funded by Los Angeles County. Comparisons were made between primary methamphetamine users and users whose primary drug was a substance other than methamphetamine. In that period, the number of American Indians reporting methamphetamine as their primary drug in Los Angeles County significantly increased, particularly among females.

Severity of heroin use in Israel: comparisons between native Israelis and former Soviet Union immigrants.

AIMS: This study examined drug use patterns and severity among native-Israeli and former Soviet Union (FSU) immigrants in Israel who reported heroin use. DESIGN, SETTING AND PARTICIPANTS: a total of 272 native Israelis and 300 FSU heroin users were interviewed from 2002 to 2006 as part of a large drug use surveillance study in Israel. Individuals were sampled at an intake centre, a methadone clinic and a day-treatment facility in the Negev region of Israel. Participants were assessed using the Addiction Severity Index, fifth edition. Native Israeli and FSU users were compared within two groups: those interviewed at intake and those interviewed in treatment. FINDINGS: Overall, ASI composite scores suggested generally comparable levels of addiction severity between the two ethnic groups. Native-born Israelis reported more years of heroin use; however, the FSU immigrants reported longer use of other opiates. The FSU reported significantly more heroin use by injection, and a significantly higher rate of hepatitis C and other chronic medical problems. Comparisons by gender within each group revealed higher drug severity scores for females (native-born Israeli and FSU combined). Females in the intake group had significantly higher severity scores in the areas of employment and psychiatric status when compared to individuals who had been in treatment for some time. CONCLUSIONS: Except for higher levels of alcohol use, the FSU did not have more severe drug problems than the native Israelis as measured by ASI severity scores. Injection use among FSU, however, is a critical public health problem, especially given the well-established link between injection drug use, hepatitis C and HIV/AIDS.

Outcomes of drug and alcohol treatment programs among American Indians in California.

OBJECTIVES: We examined differences in substance abuse treatment outcomes between American Indians and their non-American Indian counterparts in California, during 2000 to 2002. METHODS: A total of 368 American Indians and a matched sample of 368 non-American Indians from 39 substance abuse treatment programs in 13 California counties were assessed at multiple time points. Records on arrests, driving while under the influence of alcohol or drugs, and mental health care were obtained 1 year before and 1 year after treatment entry. Differences in pretreatment characteristics, services received, treatment satisfaction, treatment completion and retention, and outcomes were examined. RESULTS: Pretreatment problems were similarly severe among American Indians and non-American Indians. About half in both groups either completed treatment or stayed in treatment more than 90 days; American Indians in residential care had significantly shorter treatment retention. American Indians received fewer individual sessions and out-of-program services, especially for alcohol abuse, but were nevertheless generally satisfied with their treatment. Both groups improved after treatment, with American Indians demonstrating greater reductions in arrests than non-American Indians. CONCLUSION: American Indians benefit from substance abuse treatment programs, although the type and intensity of services offered could be improved.

"Painting a picture of the client": implementing the Addiction Severity Index in community treatment programs.

This article discusses the implementation of the Drug Evaluation Network System (DENS) version of the Addiction Severity Index (ASI) among substance abuse treatment providers in Los Angeles County. Thirty-two trained and certified treatment professionals from 14 programs participated in focus group interviews about their use of and experiences with the ASI. All 14 programs were currently administering the ASI at the time of the study. Qualitative interviews revealed variation among the programs in terms of when staff administered the ASI and how they used it in clinical care. Although the ASI creates a comprehensive picture of substance-abusing patients and their functioning, the timing of its administration seems to significantly affect the usefulness of the information. The findings illustrate the importance of practicality, flexibility, and ongoing training for the successful implementation of evidence-based practices.

Prevalence of substance use among white and American Indian young adolescents in a Northern Plains state.

This article documents the prevalence of self-reported substance use among White and American Indian adolescents enrolled in seventh grade (ages 12 through 13) in 1997 in a Northern Plains state. Data were collected by self-administered questionnaire preceding adolescents' participation in a randomized field trial of Project Alert, a seventh and eighth grade substance use prevention curriculum. Rates of lifetime and past-month use of cigarettes and marijuana were higher among American Indians than among Whites of the same gender. American Indian girls exceeded American Indian boys as well as White girls and White boys on lifetime and past-month use of cigarettes and marijuana as well as alcohol and inhalants; differences on cigarette and inhalant use reached statistical significance. These findings add to the sparse literature on substance use among adolescents as young as 12 through 13 years old and underscore the importance of examining gender-specific substance use patterns early in adolescence.