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Hunter S.B.,RAND Health | Schwartz R.P.,Friends Research Institute | Friedmann P.D.,Baystate Health
Journal of Substance Abuse Treatment | Year: 2016

National efforts are underway to integrate medical care and behavioral health treatment. This special issue of the Journal of Substance Abuse Treatment presents 13 papers that examine the integration of substance use interventions and medical care. In this introduction, the guest editors first describe the need to examine the integration of substance use treatment into medical care settings. Next, an overview of the emerging field of implementation science and its applicability to substance use intervention integration is presented. Preview summaries of each of the articles included in this special issue are given. Articles include empirical studies of various integration models, study protocol papers that describe currently funded implementation research, and one review/commentary piece that discusses federal research priorities, integration support activities and remaining research gaps. These articles provide important information about how to guide future health system integration efforts to treat the millions of medical patients with substance use problems. © 2015 Elsevier Inc. Source

Gryczynski J.,Friends Research Institute | Ward B.W.,University of Maryland University College
Health Education and Behavior | Year: 2012

Previous research has found that religiosity may protect against risky alcohol and drug use behaviors among adolescents, but the social mechanics underpinning the relationship are not well understood. This study examined the relationship between religiosity, heavy drinking, and social norms among U.S. adolescents aged 12 to 17 years, using the 2007 National Survey on Drug Use and Health (n = 14,556). Based on a vicarious learning networks theoretical perspective, the effect of religiosity on heavy drinking behavior was hypothesized to be exerted indirectly through the norms of key reference groups in the social network (close friends and parents). Support was found for reference group norms as one underlying mechanism of the religiosity-alcohol relationship. Religiosity and nonpermissive drinking norms of parents, close friends, and peers maintained a strong protective association with adolescent heavy drinking. Supplementary analyses elaborated on the role of competing and complementary normative orientations among reference groups in the social network. © 2012 Society for Public Health Education. Source

Lee J.D.,New York University | Vocci F.,Friends Research Institute | Fiellin D.A.,Yale University
Journal of Addiction Medicine | Year: 2014

Background: Unobserved, or "home" buprenorphine induction is common in some clinical practices. Patients take the initial and subsequent doses of buprenorphine after, rather than during, an office visit. This review summarizes the literature on the feasibility and acceptability, safety, effectiveness, and prevalence of unobserved induction. Methods: We searched the English language literature for studies describing unobserved buprenorphine induction and associated outcomes. Clinical studies were assessed by strength of design, bias, and internal and external validity. Surveys of provider practices and unobserved induction adoption were reviewed for prevalence data and key findings.We also examined previous review papers and international buprenorphine treatment guidelines. Results: N = 10 clinical studies describing unobserved induction were identified: 1 randomized controlled trial, 3 prospective cohort studies, and 6 retrospective cohort studies. The evidence supports the feasibility of unobserved induction, particularly in office-based primary care practices. Evidence is weak to moderate in support of no differences in adverse event rates between unobserved and observed inductions. There is insufficient orweak evidence in terms of any or no differences in overall effectiveness (treatment retention, medication adherence, illicit opioid abstinence, other drug use). N = 9 provider surveys assessed unobserved induction: observed induction logistics are seen as barriers to buprenorphine prescribing; unobserved induction appearswidespread in specific locations. International guidelines reviewed emphasize clinician or pharmacist observed induction (the United States, the United Kingdom, France, Australia); only one (Denmark) explicitly endorses unobserved induction. Conclusions: There is insufficient evidence supporting unobserved induction as more, less, or as effective as observed induction. However, the predominantly observational and naturalistic studies of unobserved induction reviewed, all of which have significant sources of bias and limited external validity, document feasibility and low rates of adverse events. Unobserved induction seems to be widely adopted in US and French regional provider surveys. Prescribers, policy makers, and patients should balance the benefits of observed induction such as maximum clinical supervision with the ease-of-use and comparable safety profile of unobserved induction. Copyright © 2014 American Society of Addiction Medicine. Source

Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase I | Award Amount: 114.67K | Year: 2011

DESCRIPTION (provided by applicant): Alcohol misuse continues to be a major public health problem in the United States, contributing substantially to morbidity, mortality, and social costs. There is a solid body of evidence supporting screening and brief intervention (SBI) for alcohol misuse on both public health and cost-effectiveness grounds, and the practice is endorsed by the U.S. Preventive Health Services Task Force. However, efforts to incorporate SBI into mainstream medical practice have faced barriers due to severe constraints on time and personnel that characterize many modern healthcare delivery settings. Novel methods for seamlessly integrating SBI into mainstream medical practice are needed. The proposed Phase 1 STTR project seeks to establish the feasibility of designing key components of an innovative computerized SBI program that would be appropriate for use within a variety of healthcare settings. The formative research in the Phase 1 STTR will provide critical information to guide the designof a computerized micro-targeted personalized normative feedback product that could ultimately facilitate more rapid diffusion of alcohol SBI into the healthcare system. PUBLIC HEALTH RELEVANCE: The envisioned SBI product will be designed for use on headphone-equipped touch screen tablet computers. The entire screening and intervention session will take approximately 15 minutes so that a patient can complete the program while waiting to see their healthcare provider. The proposed brief interventionwill be informed by established social-behavioral theories and will use promising micro-targeted normative feedback and norms misperception correction strategies. These techniques will compare the patient's reported behaviors and perceived norms to the actual estimated population norm for individuals that are similar to the patient in age, race, and sex. Normative comparison data will be obtained from ongoing, national-level epidemiological surveillance systems, analyzed for specific subpopulation-behaviorcombinations, and embedded within a special database in the software. The targeting of the reference group for behavioral norms feedback to match the patient on age, race, and sex is designed to increase the resonance of the normative comparison for the patient, and represents an unprecedented level of micro-targeting for a normative feedback intervention that can be readily scaled up for use in a variety of medical contexts across the country. Key system components will be pilot tested by a sample of participants recruited from a local community-based health center (a typical consumer of the finished product). Participants' experiences with the technology will be explored via in-depth qualitative interviews, and the presentation refined based on user feedback.

Kelly S.M.,Friends Research Institute | Gryczynski J.,Friends Research Institute | Mitchell S.G.,Friends Research Institute | Kirk A.,Total Health Care | And 2 more authors.
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad. METHODS: Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs. RESULTS: One hundred fifty-nine (30.3%) adolescents reported pastyear use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001). CONCLUSIONS: The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention. Copyright © 2014 by the American Academy of Pediatrics. Source

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