Do Social Service Interventions for Human Trafficking Survivors Work? A Systematic Review and Meta-Analysis.

Human trafficking leaves victims with long-term social, psychological, and health effects. Research in this area is still nascent, and there are limited studies that show the effectiveness of existing services for survivors. This study fills the gaps in knowledge of the effectiveness of existing programs through a comprehensive systematic review and meta-analysis. Inclusion and exclusion criteria retained 15 studies using the preferred reporting items for systematic reviews and meta-analyses method, containing 16 populations. Included studies examined programs and/or interventions providing direct services to human trafficking survivors using quantitative pre- and post-intervention measurements published from January 2010 to June 2022. Outcomes among survivors were grouped into five categories: (a) mental health, (b) physical health, (c) social support or social behavior, (d) personal development, and (e) other. Roughly half (n = 31, 51.66%) of the outcomes across the 15 studies were statistically significant. Most measured constructs showed a moderate effect size (E.S.; n = 31, 51.67%). In all, 21 constructs (27.91%) met high E.S. levels, and eight (13.33%) met the criteria for a low-level effect. Analyzing different intervention types, physical-based interventions represented the smallest subset and the largest mean effect size (n = 5, g = 1.632, 95% CI [0.608, 2.655]) followed by standardized therapy (n = 23, g = 1.111, 95% CI [0.624, 1.599]), wrap-around services (n = 14, g = 0.594, 95% CI [0.241, 0.947]), and peer and support group modalities (n = 18, g = 0.440, 95% CI [0.310, 0.571]). A meta-regression showed that non-U.S.-based interventions were significantly more effective than U.S.-based interventions (z = -2.25, p = 0.025). While only 15 studies contributed to this analysis, the current study ushered in new avenues regarding future research, policies, and practice in services for survivors of human trafficking.

Examining Correlates of Substance Use Treatment Needs for Adults Under Community Supervision.

Substance use among criminal justice-involved adults is a significant concern for the rehabilitation and reintegration into their communities. Few have examined broader associations with substance use among those in probation or parole (community supervision) using an assessment of risks and needs with a representative sample. Using an assessment based on risk-need-responsivity principles, this research applies negative binomial analyses to examine sociodemographic, criminal, and other problem-area correlates of substance use risks and needs among a statewide dataset of adults in community supervision. Results indicated that mental health risk/need was the strongest predictor of substance use risk/need. Other risk areas, including criminal thinking, employment/education, and the presence of delinquent associates (peers/family) were associated with substance use. Implications highlight the ongoing call to develop integrated models of care that treat co-occurring disorders among adults in supervision. Additionally, diversion-oriented efforts that prevent adults with complex treatment needs from reentering the justice system are discussed.

Assessing the Impact of Recreational Cannabis Legalization on Cannabis Use Disorder and Admissions to Treatment in the United States.

Purpose of Review: Policy implications from changes in recreational cannabis laws (RCLs) have raised public health concerns. While numerous studies have examined the impact of RCLs on cannabis use, there is less research on the risk of developing cannabis use disorder (CUD). This review summarizes the latest research on the effects of RCLs on CUD prevalence and cannabis treatment admissions. Recent Findings: Nine studies were published between 2016 - 2022 that examined RCLs and CUD or treatment. Findings generally indicate an increase in CUD prevalence associated with legalization, but effects differ by age group. There was no significant association between legalization and CUD treatment admissions, and CUD admissions decreased overall during the study periods. Summary: To improve policy, prevention, and treatment services, policymakers should monitor RCLs' effects on adverse public health outcomes and researchers should consider the effects on individual and community-level characteristics. We discuss methodological challenges in conducting state-level research and provide suggestions for future studies.

A Review of Prevalence Estimation Methods for Human Trafficking Populations.

Human trafficking has long-lasting implications for the well-being of trafficked people, families, and affected communities. Prevention and intervention efforts, however, have been stymied by a lack of information on the scale and scope of the problem. Because trafficked people are mostly hidden from view, traditional methods of establishing prevalence can be prohibitively expensive in the recruitment, participation, and retention of survey participants. Also, trafficked people are not randomly distributed in the general population. Researchers have therefore begun to apply methods previously used in public health research and other fields on hard-to-reach populations to measure the prevalence of human trafficking. In this topical review, we examine how these prevalence methods used for hard-to-reach populations can be used to measure the prevalence of human trafficking. These methods include network-based approaches, such as respondent-driven sampling and the network scale-up method, and venue-based methods. Respondent-driven sampling is useful, for example, when little information about the trafficked population has been produced and when an adequate sampling frame does not exist. The network scale-up method is unique in that it does not target the hidden population directly. The implications of our work internationally include the need for documenting and validating the various prevalence estimation methods in the United States in a more robust way than was done in existing efforts. In providing this roadmap for estimating the prevalence of human trafficking, our overarching goal is to promote the equitable treatment and overall well-being of the socially disadvantaged populations who disproportionately experience human trafficking.

The use of off-label medications in substance abuse treatment programs.

Background: Substance use disorder (SUD) treatment centers serve a population of clients who have diverse needs, and may desire or require access to varied treatments while seeking care for their SUDs. While pharmacotherapies have increased in popularity for the treatment of SUDs, adoption rates do remain quite low. But a wider array of pharmacotherapies has become available in recent years which may shift the trend. This article helps shed light on how variations in SUD treatment centers develop and persist with regard to the adoption and delivery of off-label medications. Methods: We use a nationally representative and longitudinal sample of SUD treatment centers in the US (N = 196). We use a logistic regression to analyze the relationship between organizational characteristics and offering any medications, off-label. We also use a negative binomial regression to analyze the relationship between organizational characteristics and the number of medications that were used off-label. Results: Our findings reveal that older centers, accredited centers, and centers that offer mental health screenings are all positively associated with the provision of off-label medication in SUD treatment. We also find a positive relationship between private funding and offering a greater number of off-label medications. Conclusions: Our results suggest that SUD clients who seek treatment from centers that offer medications off-label, may have access to a greater number of medication-assisted treatment options.

Insurance Receipt and Readiness for Opportunities under the Affordable Care Act: A National Survey of Treatment Providers for Substance Use Disorders.

This study measures the readiness of substance use disorder (SUD) treatment to use opportunities under the Affordable Care Act by examining Medicaid and private insurance acceptance between 2011 and 2013, as well as center characteristics associated with acceptance. Data for this study were from a random sample of SUD treatment centers in the United States. Interviews were conducted on site and face to face, with administrative and clinical directors. We employed logistic regression analyses to examine Medicaid acceptance and private insurance acceptance. We found that 59% of centers accepted Medicaid and 55% accepted private insurance. Accredited centers were more likely to accept Medicaid. A 12-step orientation and greater reliance on female clients were negatively associated with Medicaid acceptance. Larger centers and centers with a greater percentage of counselors with advanced degrees had greater odds of accepting private insurance. Centers that offered residential treatment had lower odds of accepting either Medicaid or private insurance. For private insurance acceptance, having a specific track for homeless patients lowered the odds of acceptance, as did having a greater percentage of Hispanic clients. Newly insured individuals under the ACA may have difficulty finding a program that accepts insurance. Future research should examine effects of Medicaid expansion on SUD treatment delivery.

Integration of Care in the Implementation of the Affordable Care Act: Changes in Treatment Services in a National Sample of Centers Treating Substance Use Disorders.

This study examined patterns of medicalization in substance use disorder (SUD) that are aligned with the goals of the Affordable Care Act (ACA). Using a nationally representative sample of SUD treatment programs, we examined changes in several treatment domains. While observed changes were modest, they were in directions that support the thrust of the ACA. Specifically, we found an increase in the percentage of treatment referrals from other health care providers. We found an increase in the number of physicians for programs that did have a physician on staff, and an increase in counselors certified in treating alcohol and drug addiction. There was significant growth in the availability of oral and injectable naltrexone but not of other pharmacotherapies. There was a decrease in support for the 12-step model and an increase on the emphasis of a medicalized treatment model. Finally, we found a shift away from federal block grants and other public funding, consistent with the expectations of the ACA. These data indicate that, while progress is slow, the environment of the recent past has been supportive of the goal of SUD treatment's integration into mainstream medical care.

The United States' Federal Parity Act and treatment of substance use disorders: Administrators' familiarity and perceptions of impact.

BACKGROUND: The 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) aims to secure parity in private insurance coverage between behavioral and other medical disorders in the United States (U.S.). This legislation represents an important change in the operating field of substance use disorder treatment, but to date, its impact on treatment centers has not been widely examined. The current study measured the extent of center leaders' familiarity with the MHPAEA and their perceptions of its overall impact on their centers. METHODS: Using a nationally representative sample of treatment centers in the U.S., we examined the extent of MHPAEA familiarity and its perceived impact as reported by treatment center leaders. We further employed logistic and ordered logistic regressions to determine personal and organizational characteristics associated with their reported familiarity and experienced impacts, including changes in the number of privately-insured clients seeking treatment and in the treatment coverage of those clients. RESULTS: We found that dissemination of parity information was low. Only 36% of administrators reported high levels of familiarity and 16% used professional sources of information. The majority of administrators (71%) reported no impact of the legislation on their organization, but those that reported any impact were more likely to state positive impact. Greater parity knowledge and perceived positive impacts were associated with administrator and organizational characteristics indicative of greater access to industry-specific knowledge, a medical model orientation, and reliance on private insurance revenue. CONCLUSION: This study demonstrates that dissemination of parity information is lacking and that the majority of leaders have yet to experience an impact of the MHPAEA. Leaders of centers with more sophisticated structures are most likely to be familiar with the legislation and perceive a positive impact. Research concerning the effective management of treatment centers, including environmental scanning techniques, continues to be needed.

The Relationship Between Client Characteristics and Wraparound Services in Substance Use Disorder Treatment Centers.

OBJECTIVE: The National Institute on Drug Abuse (NIDA) recommends a comprehensive treatment program for individuals with substance use disorder (SUD) in order to treat needs they often have in addition to their SUD. Specifically, NIDA suggests providing services related to the following issues: medical care, mental health care, HIV/AIDS, child care, educational, vocational, family counseling, housing, transportation, financial, and legal. By providing a comprehensive model that combines core and wraparound services, treatment centers can deliver a higher quality of treatment. In this article, we assessed the relationship between client characteristics and the availability of wraparound services in SUD treatment centers. METHOD: We combined two nationally representative samples of treatment centers and used a negative binomial regression and a series of logistic regressions to analyze the relationship between client characteristics and wraparound services. RESULTS: On average, centers offered fewer than half of the wraparound services endorsed by NIDA. Our results indicated that client characteristics were significantly related to the provision of wraparound services. Most notably, the proportion of adolescent clients was positively related to educational services, the proportion of female clients was positively related to child care, but the proportion of clients referred from the criminal justice system was negatively associated with the provision of multiple wraparound services. CONCLUSIONS: Our findings have important implications for SUD clients and suggest that, although centers are somewhat responsive to their clients' ancillary needs, most centers do not offer the majority of wraparound services.

Counselor training and attitudes toward pharmacotherapies for opioid use disorder.

BACKGROUND: Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine's association with fewer withdrawal symptoms and lessened risk of abuse, compared with methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance. METHODS: Informed by diffusion theory, the current study examined perceptions of buprenorphine's and methadone's acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted 2 ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone. RESULTS: Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared with methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability. CONCLUSIONS: Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine's or methadone's effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors, and patients about the use of opioid agonist therapy.

Rural substance use treatment centers in the United States: an assessment of treatment quality by location.

BACKGROUND: While previous research has added to the understanding of rural residents' unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers. OBJECTIVE: To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers' structural resources. METHODS: Utilizing combined data from two representative samples of SUD treatment centers (n = 591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators. RESULTS: We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be non-profit and dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services. CONCLUSION: Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.

Treatment strategy profiles in substance use disorder treatment programs: A latent class analysis.

BACKGROUND: Modern treatment options for substance use disorder are diverse. While studies have analyzed the adoption of individual evidence-based practices in treatment centers, little is known about the specific make-up of treatment strategy profiles in treatment centers throughout the United States. The current study used latent class analysis to profile underlying treatment strategies and to evaluate philosophical and structural supports associated with each profile. METHODS: Utilizing three aggregated and secondary datasets of nationally representative samples of substance use disorder treatment centers (N=775), we employed latent class analysis to determine treatment strategy profiles. Using multinomial logistic regression, we then examined organizational characteristics associated with each profile. RESULTS: We found three distinct treatment strategy profiles: centers that primarily relied on motivational interviewing and motivational enhancement therapy, centers that utilized psychosocial and alternative therapies, and centers that employed comprehensive treatments including pharmacotherapy. The multinomial logistic regression revealed that philosophical and structural center characteristics were associated with membership in the comprehensive class. Centers with philosophical orientations conducive to holistic care and pharmacotherapy-acceptance, resource-rich infrastructures, and an entrepreneurial reliance on insured clients were more likely to offer diverse interventions. All associations were significant at the .05 level. PRINCIPLE CONCLUSION: The findings from this study help us understand the general strategies of treatment centers. From a practical perspective, practitioners and clients should be aware of the variation in treatment center practices where they may offer or receive treatment.

Counselor Attitudes Toward Contingency Management for Substance Use Disorder: Effectiveness, Acceptability, and Endorsement of Incentives for Treatment Attendance and Abstinence.

Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client-counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counselors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of "Promoting Awareness of Motivational Incentives" (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the impact of multiple Web-based educational strategies. Given the barriers to CM adoption, identifying predictors of positive attitudes among counselors can help diffuse CM into routine clinical practice.

Provision of onsite HIV Services in Substance Use Disorder Treatment Programs: A Longitudinal Analysis.

The provision of HIV education and testing in substance use disorder (SUD) treatment programs is an important public health strategy for reducing HIV incidence. For many at-risk individuals, SUD treatment represents the primary point of access for testing and receiving HIV-related services. This study uses two waves of nationally representative data of 265 privately-funded SUD treatment programs in the U.S. to examine organizational and patient characteristics associated with offering a dedicated HIV/AIDS treatment track, onsite HIV/AIDS support groups, and onsite HIV testing. Our longitudinal analysis indicated that the majority of treatment programs reported providing education and prevention services, but there was a small, yet significant, decline in the number of programs providing these services. Programs placed more of an emphasis on providing information on the transmission of HIV rather than on acquiring risk-reduction skills. There was a notable and significant increase (from 26.0% to 31.7%) in programs that offered onsite HIV testing, including rapid HIV testing, and an increase in the percentage of patients who received testing in the programs. Larger programs were more likely to offer a dedicated HIV/AIDS treatment track and to offer onsite HIV/AIDS support groups, while accredited programs and programs with a medical infrastructure were more likely to provide HIV testing. The percentage of injection drug users was positively linked to the availability of specialized HIV/AIDS tracks and HIV/AIDS support groups, and the percentage of female clients was associated with the availability of onsite support groups. The odds of offering HIV/AIDS support groups were also greater in programs that had a dedicated LGBT track. The findings suggest that access to hospitals and medical care services is an effective way to facilitate adoption of HIV services and that programs are providing a needed service among a group of patients who have a heightened risk of HIV transmission. Nonetheless, the fact that fewer than one third of programs offered onsite testing, and, of the ones that did, fewer than one third of their patients received testing, raises concern in light of federal guidelines.

Adoption of injectable naltrexone in U.S. substance use disorder treatment programs.

OBJECTIVE: Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption. METHOD: The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone. RESULTS: Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxification services. For-profit status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a significant issue for the majority of adopting organizations. CONCLUSIONS: The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time.

Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment.

BACKGROUND: Adolescent substance abuse remains a significant problem in the United States, yet treatment centers do not always admit adolescent clients. In this paper, we first determine the extent to which treatment is available for adolescents in general and whether or not adolescent-specific (segregated) tracks are offered. Second, we examine the organizational characteristics associated with adolescent treatment. Third, we illuminate how the adolescent caseload in a treatment center is related to offering evidence-based practices (EBPs). METHODS: Drawing upon a nationally representative sample of US treatment programs, we use logistic regression to assess how organizational characteristics are associated with the provision of adolescent treatment. Using ordinal logistic regression, we analyze how the treatment center's adolescent caseload and organizational characteristics affect the extent to which a treatment center offers medication-assisted treatment (MAT) and psychosocial treatment. RESULTS: Half (49.5%) of treatment programs admitted adolescents, and 41.8% offered an adolescent-specific track. Findings from the logistic regression suggested several organizational characteristics that were significantly associated with treating adolescents and/or having an adolescent-only track. Our findings from the ordinal models indicated a negative relationship between the percent of adolescents in a treatment center and the extent of MAT, and a positive relationship between the percent of adolescent clients and the extent of psychosocial treatment offered. CONCLUSIONS: This paper highlights organizational barriers to treatment entry for adolescents, who remain a small proportion of clients in treatment centers. When treatment centers serve adolescents, however, those adolescents are likely to receive care in adolescent-only tracks and/or services and in programs that offer several psychosocial EBPs. Finally, adolescents are less likely to receive treatment in centers that offer a variety of MAT.

The use of art and music therapy in substance abuse treatment programs.

Although the implementation of evidence-based practices in the treatment of substance use disorders has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs' use of Motivational Enhancement Therapy was positively related to offering art therapy, whereas use of contingency management was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents.