National Addiction-specific Institutional Infrastructure - fundamental prerequisite for successful implementation of specialized academic degree study programmes: a case study in historical perspective.

OBJECTIVE: Human resources are crucial for addiction treatment and prevention services, as well as for science and research. The aim of this historical case study is to explain and demonstrate the role of specialized university academic degree study programmes in addictions in the context of a national institutional infrastructure. This specific group of very highly specialized academic programmes represents the highest level of professional development and is producing a totally new generation of addiction specialists with a very distinctive professional identity. METHODS: The study protocol is based on a case study research design and the case is defined as the historical development of addiction specialized institutions closely related to self-help, prevention, and treatment activities on the historical territory of the Czech Republic. We identified relevant historical sources related to establishing and/or running activities or institutions according to the categories specified in our concept of the national institutional infrastructure. All the materials and sources that were collected were sorted according to a timeline and categories of institutions and we systematically determined the first recorded activity/institution in each particular category. For this simple sorting system we used open and selected coding according to Grounded Theory. RESULTS: The public health model developed by Thomas Babor recognizes six different structural mechanisms to support university-based programmes in addiction studies: specialized journals, research centres, professional societies, specialized libraries and documentation centres, training and education programmes and institutions, and funding agencies. We attempted to redefine the concept of addiction studies within the broader context of the addiction field and added three additional mechanisms of support: public interest groups, self-help groups, and service providers. Using a historical case study in the Czech Republic, we demonstrate the potential for a broader context and interaction between these support mechanisms and academic institutions hosting academic programmes in addiction studies. CONCLUSION: The process of establishing integrated addiction studies programmes at Charles University in the Czech Republic had its origins in, and support from, various national institutions and professional organizations. This allowed the university to develop academic programmes at the bachelor's, master's, and Ph.D. levels. The availability of career opportunities for advanced-level addiction professionals in the Czech Republic was also a critically important factor in developing sustainable academic programmes in addiction studies. Our experience is that the creation of successful and sustainable academic programmes for addiction professionals is difficult to achieve without broad infrastructure support, national advocacy efforts, and legislative change at the national level.

Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system.

BACKGROUND: Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. OBJECTIVES: To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. METHODS: We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. RESULTS: Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). CONCLUSION: Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

BACKGROUND: This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. METHODS: To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. RESULTS: Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. CONCLUSIONS: Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects.

Co-occurring substance use and mental disorders in the criminal justice system: a new frontier of clinical practice and research.

This editorial introduces this special section of the Psychiatric Rehabilitation Journal, which focuses on justice-involved persons with co-occurring mental and substance use disorders (CODs). It contains seven original articles examining CODs among justice-involved populations that vary by gender, age, setting (e.g., community/ court, jail, prison), environment (urban, rural), geographic region, and nationality. (PsycINFO Database Record

Behavioral health treatment history among persons in the justice system: Findings from the Arrestee Drug Abuse Monitoring II Program.

OBJECTIVE: Despite the high prevalence of substance use disorders, mental disorders, and co-occurring disorders among persons in the justice system, there is a fairly low rate of treatment utilization among this population. This study explored rates of lifetime behavioral health treatment utilization and factors associated with involvement in treatment. METHODS: The study examined data from the Arrestee Drug Abuse Monitoring II program from 2007 to 2010, including over 18,000 arrestees in 10 U.S. metropolitan jails. Logistic regression and χ² analyses were used to explore the relationship between self-reported lifetime treatment history and sociodemographic characteristics, self-reported substance use, and severity of substance use. RESULTS: Over half of arrestees reported no history of behavioral health treatment (62%), and Caucasians were significantly more likely to have received treatment than African Americans and Hispanics. Rates of treatment for substance use disorders or for both substance use and mental disorders were lowest among arrestees reporting marijuana and alcohol use and highest for heroin users. Methamphetamine users were the most likely to have received prior mental health treatment. Severity of alcohol and drug use was the highest among arrestees who had received both substance abuse and mental health treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Considering the high rates of mental and substance use disorders in this population, the overall lack of behavioral health service utilization among offenders is concerning and points to the need to engage offenders in mental health and substance abuse treatment and to expand these services in jails, prisons, diversionary programs, and community corrections settings. (PsycINFO Database Record

The Psychometric Properties of the Simple Screening Instrument for Substance Abuse.

The Simple Screening Instrument for Substance Abuse (SSI-SA) is gaining widespread use as a self-report measure of substance abuse; yet, little information exists regarding the instrument's psychometric properties. This study examined the SSI's psychometric properties within a population of 6,664 adult Medicaid enrollees in Florida, who responded to a survey conducted as part of a statewide evaluation of Medicaid services. The SSI-SA had excellent internal consistency (.85). Evidence of the SSI's validity was strong; SSI-SA scores distinguished among individuals with and without substance abuse needs and were significantly correlated with a measure of functioning in daily living. Using the recommended SSI-SA cutoff score of 4 or higher to indicate the presence of a substance abuse problem, the SSI-SA had respectable sensitivity (.82) and specificity (.90).

Medication-assisted treatment for opioid use disorders in correctional settings: an ethics review.

Opioid use disorders are a pressing health concern that disproportionately impacts the United States (U.S.) correctional population. Medication-assisted treatment (MAT) is an evidence-based standard of care for opioid use disorders. Despite its availability in the community, MAT and MAT medications (buprenorphine and methadone) are largely unavailable and/or inaccessible for the treatment of opioid use disorders in U.S. prisons and jails. Given that the ethical principles have served as justification for limiting access to MAT on "moral" grounds, this article examines the implications of current correctional policies through the ethical principles of: (1) beneficence/non-maleficence; (2) distributive justice (equivalence-of-care); and (3) autonomy (informed consent). Special attention is paid to the five components of informed consent (capacity, disclosure, understanding, voluntariness, and access), as this facet has been used most often to justify policies that limit access to MAT in the past. Findings highlight that these core ethical principles support the adoption of correctional policies that include MAT. Furthermore, our findings demonstrate that autonomy is maximized during the informed consent process when MAT is available as a treatment option.

A clustering method to identify who benefits most from the treatment group in clinical trials.

In randomized controlled trials (RCTs), the most compelling need is to determine whether the treatment condition was more effective than control. However, it is generally recognized that not all participants in the treatment group of most clinical trials benefit equally. While subgroup analyses are often used to compare treatment effectiveness across pre-determined subgroups categorized by patient characteristics, methods to empirically identify naturally occurring clusters of persons who benefit most from the treatment group have rarely been implemented. This article provides a modeling framework to accomplish this important task. Utilizing information about individuals from the treatment group who had poor outcomes, the present study proposes an a priori clustering strategy that classifies the individuals with initially good outcomes in the treatment group into: (a) group GE (good outcome, effective), the latent subgroup of individuals for whom the treatment is likely to be effective and (b) group GI (good outcome, ineffective), the latent subgroup of individuals for whom the treatment is not likely to be effective. The method is illustrated through a re-analysis of a publically available data set from the National Institute on Drug Abuse. The RCT examines the effectiveness of motivational enhancement therapy from 461 outpatients with substance abuse problems. The proposed method identified latent subgroups GE and GI, and the comparison between the two groups revealed several significantly different and informative characteristics even though both subgroups had good outcomes during the immediate post-therapy period. As a diagnostic means utilizing out-of-sample forecasting performance, the present study compared the relapse rates during the long-term follow-up period for the two subgroups. As expected, group GI, composed of individuals for whom the treatment was hypothesized to be ineffective, had a significantly higher relapse rate than group GE (63% vs. 27%; χ2 = 9.99, p-value = .002).

Co-occurring disorders in treatment-based courts: results of a national survey.

Drug courts and mental health courts have expanded rapidly in the past several decades to provide more efficient coordination of treatment and supervision of offenders with behavioral health problems. A significant number of offenders in these court-based programs have co-occurring mental and substance use disorders, which predict early termination, relapse, rearrest, and other negative outcomes. A web-based national survey examined programmatic adaptations for co-occurring disorders (CODs) among 54 drug courts, mental health courts, and freestanding COD dockets. COD dockets were smaller and of longer duration, and provided more intensive services than programs situated in drug courts or in mental health courts. However, more similarities than differences were noted across the different types of court-based program. Key adaptations for CODs included extended program duration, highly intensive and integrated treatment, smaller, less formal, and more frequent hearings, and use of specialized supervision teams and dually credentialed staff.

Further validation of the psychological injury risk indicator scale.

OBJECTIVE: Confirm the Psychological Injury Risk Indicator (PIRI) scale capacity to facilitate routine assessment of psychological health of workers in high-stress environments. METHOD: A cross-sectional study compared the PIRI scale scores with two experienced clinical psychologists' assessment of defined psychological injury in 93 participants. A second, longitudinal, study assessed PIRI predictive capacity for emotional exhaustion, physical health, and work engagement in 420 participants over 14 months. RESULTS: The PIRI scale was shown to (a) determine the degree of psychological injury in participants with high correspondence to a specialist clinical interview; and (b) predict future emotional exhaustion, physical health, and work engagement to a significantly better degree than the 12-item General Health Questionnaire and Kessler-10 measures. CONCLUSIONS: The PIRI scale shows a valuable capacity to provide accurate routine psychological health assessment for at-risk workers in high-strain work environments.

A community planning process for the implementation of evidence-based practice.

Over the past 10 years, increasing attention has been paid to the development and implementation of 'evidence-based' practices or EBPs. In 1998, the National Academy of Sciences' Institute of Medicine began drawing attention to the discrepancy between research findings and practice patterns in the treatment of substance abuse. The community coalition described in this study was developed to create a partnership between substance abuse treatment providers, policy makers, university-based researchers, and consumers to examine treatment advances and evaluate their possible application in local community settings. In the first year the community coalition conducted a needs assessment, with the goal of prioritizing areas for practice change. The needs assessment process included focus groups, key informant interviews, and a survey of substance abuse treatment providers. The questions addressed at each stage of the assessment varied, but collectively all methods formed the basis for consensus-building for a change in practice in substance abuse treatment. The results of the needs assessment were further refined and influenced the development and implementation of two evidence-based practices (EBPs) within multiple agencies. Implications for using a community needs assessment to highlight coalition building and identify and adopting EBPs are discussed.

Identification and measurement of work-related psychological injury: piloting the psychological injury risk indicator among frontline police.

OBJECTIVE: To develop a self-report measure of work-related psychological injury, the Psychological Injury Risk Indicator (PIRI), with a comparable level of accuracy and reliability to individual clinical assessment by a skilled clinical psychologist. METHOD: Two pilot studies investigated the responses of a) 34 frontline police officers completing the PIRI measure who were also examined by a highly experienced clinical psychologist and b) 217 officers who completed the PIRI measure and also the General Health Questionnaire 12 measure. RESULTS: The PIRI scale identified both the presence and the level of psychological injury in the clinical group with a remarkably high level of correspondence to concurrent clinical assessment (r = 0.80). SIGNIFICANCE: The PIRI scale can be used both for the individual assessment of psychological injury and as a potential online screening tool. Its latter use is that it could enable the early identification of evolving psychological injury among workers, facilitating timely and career-preserving intervention.

Polychlorinated biphenyl concentrations in adult chinook salmon (Oncorhynchus tshawytscha) returning to coastal and Puget Sound hatcheries of Washington State.

Identifying the source of polychlorinated biphenyls (PCBs) is the first step to eliminating contamination within anadromous salmonids and other aquatic species. We evaluated PCB concentrations in the muscle tissue of 4-year old Puget Sound and coastal hatchery Chinook salmon in an effortto identify potential locations where contamination occurs. Ten muscle samples were taken from each of two Puget Sound hatcheries and two coastal hatcheries in Washington State to determine PCB concentrations. Two technical mixtures of PCBs, Aroclor 1254 and Aroclor 1260, were measured in the tissue samples collected. Aroclor 1254 was detected in all samples, while Aroclor 1260 was detected in 16 of 40 samples. Generalized linear modeling (GLM) was used to evaluate the influence of region (Puget Sound and coast), hatchery, sex, fish length, and percent lipids on PCB concentrations. Twenty different GLMs representing multiple null hypotheses were ranked using Akaike Information Criterion (AIC). Six of the 20 models evaluated had substantial support for being the best model to describe PCB concentrations in Chinook salmon. The six models with substantial support were region and lipids; region; hatchery and lipid; region and sex; region, sex, and lipids; and region and length. Region appears to be the most influential variable explaining the variation in PCB concentrations in Chinook salmon in the Pacific Northwest. PCB concentrations in Chinook salmon muscle tissue from Puget Sound hatcheries were significantly greater (mean 49.26 microg/kg wet weight and standard deviation 40.55 microg/kg) than those from coastal hatcheries (mean 17.41 microg/kg wet weight and standard deviation 6.8 microg/kg). Our results suggest that some contamination likely occurs in the Pacific Ocean. However, a larger source likely exists within Puget Sound or along the migratory route of Puget Sound Chinook salmon. The observation of PCBs in Chinook salmon also has important implications for human health and salmon carcass supplementation.

Challenges in implementing evidence-based treatment practices for co-occurring disorders in the criminal justice system.

The presence of adults with mental health and substance abuse disorders within the criminal justice system has become increasingly evident over the past decade. Interventions and treatment services have been designed and research conducted in an effort to establish evidence-based practices that effectively address the complex needs of this population. However, adopting and implementing these evidence-based interventions and practices within the real-world setting of criminal justice environments is challenging. This article reviews the research literature related to evidence-based treatment practices for offenders with co-occurring mental health and substance abuse disorders and explores the inherent challenges of fitting these interventions and services within criminal justice settings.

Correctional treatment for co-occurring disorders: results of a national survey.

The significant expansion of correctional populations in the last decade, coupled with the gradual erosion of community treatment infrastructure and health insurance, have brought greater attention to the needs of offenders who have co-occurring mental health and substance use disorders. Individuals with co-occurring disorders frequently cycle through acute care facilities in the community and increasingly are placed in jails or prisons. Approximately 16% of inmates in correctional facilities have major mental health disorders (Bureau of Justice Statistics, 1999), and a large majority of these inmates have co-occurring substance use disorders. Few studies have examined the effectiveness of correctional treatment for co-occurring disorders, and there is little information available regarding clinical and programmatic approaches used with this population. The current study provides findings from a comprehensive national survey of co-occurring disorder treatment programs in correctional settings. A total of 20 co-occurring disorder treatment programs from 13 state correctional systems were identified and surveyed. Many of the programs featured modified therapeutic communities, but there was significant diversity in the duration of treatment and type of services provided. Several unique structural and clinical modifications to treatment have been developed in these settings. Implementation of co-occurring disorder treatment programs has led to enhanced collaboration with prison health services and community supervision and treatment agencies, and greater use of interdisciplinary staff to provide outreach and case management services. Research is now being conducted to examine outcomes in several of these correctional treatment programs.

Characteristics of opinion leaders in substance abuse treatment agencies.

OBJECTIVE: This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence-based treatment of co-occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of "opinion leaders" as technology transfer agents. METHOD: A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co-occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co-occurring disorders. RESULTS: The analyses demonstrate that opinion leaders differed from other counselors in competency-related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co-occurring disorders as well as a greater willingness and confidence in working with such clients. CONCLUSION: These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence-based treatment practices in community treatment settings.

Commentary on why national epidemiological estimates of substance abuse by race should not be used to estimate prevalence and need for substance abuse services at community and local levels.

Large-scale epidemiological studies suggest substantially lower prevalence rates of substance abuse disorders in Black Americans than in White Americans. This is counterintuitive since indicators of socioeconomic status, which on an average are lower in Blacks than Whites, are inversely associated with the prevalence of psychiatric disorders. Herein, we recommend against the use of race-specific national epidemiological data to estimate prevalence of substance abuse disorders and need for services at community/local levels. This is important so that catchment areas with high proportions of minorities receive equitable levels of substance abuse prevention and treatment resources. We illustrate our recommendation through observations and potential biases (e.g., reporting bias) identified from large-scale epidemiological studies of the prevalence of substance use disorders between Black and White Americans.