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The appalachian tri-state node experiences Three cost-effectiveness studies including the above CM

study determined that CM is more effective for patients providing alcohol, opioid, and stimulant-free urines and remaining abstinent from these drugs, compared to treat- ment without CM.3335 These cost-effectiveness studies included incremental cost-effectiveness analyses that could help policy makers determine acceptable (societal) costs for CM programs. One important finding, as might be expected, is that the treatment programs varied widely as to cost and effectiveness of the CM programs. Costs varied by a factor of 4.6 while effectiveness varied by a factor of 8, suggesting that more research is needed on site-related variables that affect outcomes.

Study of Adoption of Evidence-Based Practices

Pinto and colleagues36 conducted a study of 571 substance abuse treatment providers from CTN Community Treatment Programs regarding their willingness to use research findings in their practice. The investigators found that providers who were involved in research, those who had positive attitudes toward evidence-based practices, and those who perceived their agencies as supportive of their professional growth were more likely to adopt research findings in their practice. The investigator found that Latino providers were somewhat less willing to adopt research findings but note that their sample may not be representative of the population of Latino treatment providers. They conclude that conducting Commu- nity-Based Participatory Research is an effective way for disseminating evidence-based practices.

The CTN was conceived to bring addiction research to the

sites where treatment is being conducted and, thereby, makes research findings more relevant to real worlds practice. However, some recent findings from CTN studies find that evidence-based practices are not readily accepted by clin- icians. Guydish and colleagues37 investigated adoption of motivational interviewing (MI) in five clinics where CTN studies were conducted and found that only one of the clinics formally adopted MI and one ‘‘partially’’ adopted it. While some individual counselors adopted MI in another clinic, two of the clinics did not adopt it, despite the robust evidence of its effectiveness in addiction treatment.

Descriptive/Predictive Studies

Campbell and colleagues38 found that over 56% of 632 patients who were treated for detoxification following use of injected drugs failed to attend outpatient treatment. However, they also found that having a higher staff to patient ratio, higher levels of training of staff, and communities that have more outpatient clinics and those that are closer to the inpatient program from which the patient was referred increased the likelihood of the patient following through with treatment.

McCarty and colleagues39 surveyed the corporations that contain the CTPs and 106 (95%) of them and 348 (91%) of their treatment programs participated. The investigators found that 6% were private for profit, 27% were government facilities, and 72% were not-for-profit corporations. Fifty- 61

three percent of the programs were free-standing alcohol and drug treatment facilities, 12% were mental health clinics, and 25% were health care facilities. Many of the CTPs were part of hospital-based programs.

The model of treatment ascribed to by most CTP aligned

more with the medical model of care that emphasizes addiction as a progressive disease that requires medical intervention including pharmacotherapy. The social model, which emphasizes that addiction is, primarily, the product of the social environment and that recovery should focus on experiential learning, self-help, group therapy, and sobriety as the goal of treatment, was much less operative. No program was found to be primarily based on the social model but more social model influences were found in residential programs and fewer in outpatient or ambulatory programs. The overall findings suggest that social model philosophies are generally decreasing in the treatment of addiction.

Tross and colleagues40 found that women who were

diagnosed with cocaine abuse or dependence engage in higher frequencies of high-risk sexual behaviors, including having sex with multiple partners, trading sex for drugs, and anal sex. They note that cocaine use alone was not associated with risky sexual activities, rather it is problematic use as defined by having a disorder that was associated with these behaviors. They also found a relationship between use of alcohol and having multiple partners and using drugs or alcohol during sex.

Hartzler and colleagues41 conducted a secondary analysis of

10 trials of treatment effects among 1396 opioid addicts. This analysis investigated the sample with regard to the prevalence of alcohol use disorders among opioid addicts. The investi- gators found that 38% of the sample met criteria for an alcohol use disorder (AUD) but note that missing data may have had an impact on the validity of the findings. Participants with AUD had a greater degree of psychiatric severity including hallucinations, anxiety, and suicidal idea- tion and opioid dependent participants with AUD were also more likely to report violent behaviors.

One study of ethnicity and gender differences found that Caucasians with opioid addiction had more severe withdrawal symptoms and cravings at treatment inception compared to Hispanics and African Americans but that these differences disappeared following treatment with buprenorphine.42 An- other study of sexual risk-taking among 1429 CTN partici- pants found that women engaged in higher risk sexual behaviors and that alcohol and severity of psychiatric disorder were associated with sexual behaviors. Impaired social relations were associated with lower sexual risk-taking among men.43

In an ancillary study of gender differences for HIV risk behaviors among the Meade and colleagues sample, injection drug use decreased during both buprenorphine and detox- ification treatments with patients in the buprenorphine arm decreasing more. Women had higher rates of injection risk behavior at baseline compared to men but women in the

M&B 2011; 2:(1). July 2011

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