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Treatment of Substance Abuse and Recovery Support Services
Established in 1984, Amethyst Inc. is a fully integrated alcohol, tobacco and other drug treatment program that provides long-term treatment and permanent supportive housing to over 125 women each year in Columbus, Ohio. Amethyst, Inc. implemented the Integrated Tobacco Treatment Program in 2006, utilizing the intensive clinical intervention recommendations found in the CDC’s Clinical Practice Guideline: Treating Tobacco Use and Dependence. The program provides assessment, pharmacotherapy, and program services for up to one year in a format that combines group and individual services, and extra-treatment social support.
Internal fidelity measures indicate that Amethyst is following the recommendations provided by the CDC’s Clinical Practice Guideline. In 2007, Amethyst provided an intensive intervention – including relapse intervention services - to 68 women. The overall success rate for 2007 based on those remaining in treatment is 47%.
Integrated Treatment Court, 20th Judicial District, Colorado
In 2006, the 20th Judicial District’s Probation Department in Boulder, Colorado determined that over 40% of revocations filed were based on violations relating to substance abuse. It was further determined that many of these individuals ultimately ended up with long jail sentences or in prison. These findings resulted in the formation of the Integrated Treatment Court (ITC), an interagency collaboration that seeks to integrate judicial oversight, probation supervision and intensive treatment in an effort to help participants overcome addiction, thereby reducing recidivism, decreasing incarceration rates, and improving community safety.
The ITC program targets high-risk offenders, and makes every effort to adhere to evidence-based practices. The program maintains extensive data on a variety of factors in order to track client outcomes as well as progress toward program goals. Members of the collaboration include the Probation Department, the District Attorney’s Office, the Public Defender’s Office, Boulder County Public Health, The Mental Health Center Serving Boulder & Broomfield Counties, private treatment providers, and housing programs. The ITC team convenes three times a week to review three separate dockets of participants, two in Boulder and one in Longmont.
The ITC has fostered other creative partnerships in an effort to support clients in their recovery. As a referring agency to three transitional housing programs, ITC has been able to secure alternative living arrangements for those who are homeless or in undesirable situations. ITC has also partnered with Phoenix Multisport, a local non-profit that seeks to build supportive social networks for people in recovery through activities such as hiking, cycling, climbing, running, and triathlon.
After one year of operation, an external evaluation found that jail bed usage had been reduced 92% (or 8,964 days) realizing a cost savings of $544,974 to Boulder County. The evaluator also noted that 89% of participants were enrolled in substance abuse treatment within 10 days of admission. In 2008, the ITC was recognized by the Boulder County Commissioners with a Pinnacle Award, which is given to programs that exemplify excellence in public service.
Maine Office of Substance Abuse
The Maine Office of Substance Abuse (OSA), Maine Department of Corrections (MDOC), and the Judicial Branch worked in collaboration to target reductions in recidivism. This collaboration resulted in development of the Differential Substance Abuse Treatment (DSAT) model – based on Motivational Enhancement and Cognitive-Behavioral treatment - to provide a continuum of comprehensive substance abuse services to adults in all MDOC adult correctional institutions, as well as community settings across six counties in Maine. The personnel selected for program implementation undergo two main training sessions prior to their certification. The first training event is a 5 day Basic Training, the second is an annual 1 day “booster” event. These “hands-on” trainings teach participants how to deliver each of the sessions and further develop and refine skills, ensuring program integrity. Video feedback and role playing are introduced and utilized as a mechanism for supervision and certification as a program facilitator.
Process and outcome evaluations are used to assess the functioning of the programming. The results on the CEST (Client Evaluation Self Test) indicate that clients who participated in the DSAT curriculum experienced a reduction in depression, hostility, and risk-taking behaviors, and an increase in social conformity, and therapeutic involvement. Equally important is that clients have the ability to identify personal progress, develop a good rapport with counselors, and recognize the competence of counselors - such offenders are more likely to make positive changes. DSAT can be effectively delivered through the mechanisms that are employed by OSA, as shown in the evaluation, to include training the counselors, using quality assurance mechanisms, and working with the drug courts on the programming issues to support treatment engagement. The DSAT curriculum engages many of the offenders in the treatment process. They report good rapport with the counselors which is an important predictor of engaging offenders in treatment programming. Fewer drug court participants (17.5%) recidivated during a 12 month post-program follow-up than a comparison group of adult offenders traditionally adjudicated (33.1%).
Maryhaven is Central Ohio’s oldest and most comprehensive behavioral healthcare provider specializing in substance abuse treatment with admissions totaling over 7000 annually. Although Maryhaven admits over 600 opioid dependent patients annually into its detoxification program, it is well established that detoxification alone is not an effective treatment for opiate addiction and therefore all cases which do not result in ongoing treatment can be considered treatment failures. As a community treatment provider participating in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), Maryhaven participated in an inpatient initiated trial evaluating buprenorphine–naloxone short-term taper for medically managed opioid withdrawal. The primary findings were that 77% of patients assigned to buprenorphine achieved the treatment success criterion compared to only 22% of those assigned to clonidine. Upon FDA approval and in consideration of the robust research findings from the NIDA
CTN trial, Maryhaven decided to adopt a short-term buprenorphine taper treatment.
Western Psychiatric Institute & Clinic
Cigarette smoking by pregnant women is a major cause of perinatal illness and death. About 11% of pregnant women in the U.S. smoke, but in Pittsburgh the rate is much higher (24%) and the rate for low income women approaches 50%. The goal of the Pittsburgh STOP (Stop TObacco in Pregnancy) Program is to improve the health of pregnant women and babies through the delivery of an evidence-based, individualized, and motivational intervention among underserved pregnant smokers. Participants are referred by prenatal clinics, drug and alcohol rehab centers and health plan maternity programs. Of over 1000 STOP participants so far: 36% are African American, 59% White, and 5% Other; 90% have Medicaid or are uninsured; 74% are unmarried; 41% did not complete high school; 67% earn less than $10,000 per year; and, 84% are experiencing an unplanned pregnancy.
Evidence-based treatment components include motivational strategies to increase readiness, education about the health benefits of quitting, interventionist support, problem solving, and exploration of family and community social supports for quitting. Routine assessment of exhaled air carbon monoxide is used to increase motivation for quitting. Fidelity evaluation measures compare STOP treatment with that recommended in the Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence, including process measures such as number of sessions/participant, counseling type, and treatment tailoring based on participants’ individual reasons for quitting, among others. Over 5,200 cessation counseling sessions have been completed since 2000 with an 86% retention rate and 30% quit rate. Babies of quitters were more likely to: be born normal weight (88% vs. 80%; p=.04); have longer gestational age (38.4 vs. 37.9 weeks; p=.08); have better Apgar scores (birth: 8.1 vs. 7.8, p=.09; 5 minutes: 8.9 vs. 8.7; p=.04); and be “healthy” versus having “some problem” (82% vs. 71% “healthy”; 18% vs. 29% “some problem”; p=.02). The Pittsburgh STOP Program will continue to be instrumental in helping underserved pregnant women quit smoking during pregnancy, thus improving the health of babies in the Pittsburgh region.
Substance Abuse & Mental Health Services Administration • 1 Choke Cherry Road • Rockville, MD 20857