Publications by authors named "Jan Gryczynski"

92 Publications

Integration of Transcendental Meditation® (TM) into alcohol use disorder (AUD) treatment.

J Subst Abuse Treat 2018 04 16;87:23-30. Epub 2018 Jan 16.

University of Maryland, College Park, MD, USA.

Aims: Maladaptive responses to stress are thought to play a role in addiction and relapse. Transcendental Meditation (TM) is a popular meditation technique with promising clinical applications. This study sought to: (a) examine the feasibility of providing TM during AUD treatment; (b) compare outcomes for TM vs. treatment as usual (TAU); and (c) investigate the relationship between TM practice and outcomes.

Methods: Meditation-naïve adults with primary AUD (N = 60; 35% female, 60% white) newly admitted to inpatient treatment were recruited in sequential cohorts (30 receiving TAU and 30 receiving TM training). Assessments were conducted at baseline and 3-months post-discharge.

Results: Integrating TM into inpatient AUD treatment was feasible. Uptake of TM was high (85% meditating on most of the past 30 days at follow-up; 61% closely adherent to recommended practice of twice-daily TM). Participants reported high satisfaction with TM. The sample as a whole improved on multiple measures after AUD treatment, but there were no significant differences between TM and TAU cohorts. However, those practicing TM twice-daily as recommended were less likely than the rest of the sample to return to any drinking (25% vs. 59%; p = .02) or heavy drinking post-discharge (0% vs. 47%, p < .001). Greater regularity of TM practice was inversely correlated with stress, psychological distress, craving, and alcohol use at follow-up.

Conclusions: This study established the feasibility and acceptability of using TM during AUD treatment. Consistently practicing TM (but not just learning it) was associated with better outcomes. These promising findings warrant further investigation in larger, controlled studies.
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http://dx.doi.org/10.1016/j.jsat.2018.01.009DOI Listing
April 2018

Gender and ethnic differences in primary care patients' response to computerized vs. in-person brief intervention for illicit drug misuse.

J Subst Abuse Treat 2018 01 7;84:50-56. Epub 2017 Nov 7.

Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States.

This study is a secondary analysis from a randomized clinical trial of computerized vs. in-person brief intervention (BI) for illicit drug misuse among adult primary care patients (N=359; 45% Female; 47% Hispanic) with moderate-risk illicit drug misuse as measured by the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This study examined differences in response to the two brief intervention strategies (both based on motivational interviewing) on the basis of gender and ethnicity, comparing non-Hispanic males, non-Hispanic females, Hispanic males, and Hispanic females. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up with the ASSIST. Trajectories in Global Continuum of Illicit Drug Risk Scores were examined using a generalized linear mixed model. There were significant differences in response to computerized vs. in-person BI over time on the basis of gender-ethnic subgroups (Gender×Ethnicity×Condition×Time interaction; p=0.03), with Hispanic males tending to respond more favorably to the computerized BI and Hispanic females tending to respond more favorably to the in-person BI. There was no clear differentiation in response to the two BIs among non-Hispanic males, while among non-Hispanic females the pattern of change converged following baseline differences. Consideration of gender and ethnic differences in future studies of BI is warranted.
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http://dx.doi.org/10.1016/j.jsat.2017.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731246PMC
January 2018

When does methadone treatment reduce arrest and severity of arrest charges? An analysis of arrest records.

Drug Alcohol Depend 2017 11 14;180:385-390. Epub 2017 Sep 14.

Friends Research Institute, Baltimore, MD, USA; University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD, USA.

This is an analysis of the odds of arrest, severity of charges, and factors predicting these outcomes in the year after methadone treatment entry using arrest records of patients (N=289) participating in two opioid treatment programs (OTPs) in Baltimore, MD as part of a previously-reported study. Baseline Addiction Severity Index data were examined along with publicly-available dates of arrest and arrest charges from the year before and after OTP entry. Severity of charges was rated independently by three researchers using a 1-7 point scale. Data were analyzed using Generalized Estimating Equations and Multiple Regression. The majority of the patients had no arrests over both time periods (61.6% and 65.7%, respectively). Of those arrested, the majority of the sample were charged with non-severe crimes in the year before and after OTP entry (82.9% and 73.7%, respectively). There were no significant differences in the odds of arrest or severity of charges in the year before versus the year after OTP admission (both ps>0.05). Predictors of arrest following admission included an arrest in the year prior to admission (p<0.001), younger age (p<0.001), and more lifetime months of incarceration (p=0.045). Predictors of the higher severity of charges included younger age (p<0.001), African-American race (p=0.032), and more lifetime months of incarceration (p=0.018). While in this population, the odds of arrest and severity of charges did not decrease significantly in the year following OTP entry, we discuss the need to avoid generalizing findings without considering those factors that may influence the likelihood of post-OTP entry arrest.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.08.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667939PMC
November 2017

The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center.

Subst Abus 2017 Oct-Dec;38(4):382-388. Epub 2017 Jul 7.

a Friends Research Institute, Inc. , Baltimore , Maryland , USA.

Background: The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses.

Methods: Adolescents (N = 525; 93% African American, 55% female) 12-17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT "yes" responses.

Results: For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79-1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81-0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96-1.00 and 0.79-0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82-0.89 and 0.89-0.96, respectively).

Conclusions: Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in busy pediatric practices.
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http://dx.doi.org/10.1080/08897077.2017.1351413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317511PMC
June 2018

Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics.

J Addict Med 2017 Sep/Oct;11(5):350-356

Friends Research Institute (JG, CDN, SGM, RPS); Johns Hopkins University (KRP); Baltimore City Health Department, Baltimore (LJ); University of Maryland, College Park, MD (KEO).

Background: Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services.

Methods: We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up.

Results: In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01).

Conclusions: SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.
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http://dx.doi.org/10.1097/ADM.0000000000000327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610078PMC
May 2018

Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.

J Gen Intern Med 2017 Sep 26;32(9):990-996. Epub 2017 May 26.

Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Background: The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily.

Objective: To validate the TAPS-1 in primary care patients.

Design: Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD).

Participants: Two thousand adult patients at five primary care sites.

Main Measures: DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use.

Key Results: Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker.

Conclusions: The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy, and may have utility in primary care for rapid triage.
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http://dx.doi.org/10.1007/s11606-017-4079-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570743PMC
September 2017

Update on Barriers to Pharmacotherapy for Opioid Use Disorders.

Curr Psychiatry Rep 2017 Jun;19(6):35

Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Purpose Of Review: The recent heroin and prescription opioid misuse epidemic has led to a sharp increase in the number of opioid overdose deaths in the USA. Notwithstanding the availability of three FDA-approved medications (methadone, buprenorphine, and naltrexone) to treat opioid use disorder, these medications are underutilized. This paper provides an update from the recent peer-reviewed literature on barriers to the use of these medications.

Findings: These barriers are interrelated and can be categorized as financial, regulatory, geographic, attitudinal, and logistic. While financial barriers are common to all three medications, other barriers are medication-specific. The adverse impact of the current opioid epidemic on public health can be reduced by increasing access to effective pharmacotherapy for opioid use disorder.
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http://dx.doi.org/10.1007/s11920-017-0783-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075636PMC
June 2017

Pregnant Women's Current and Intended Cannabis Use in Relation to Their Views Toward Legalization and Knowledge of Potential Harm.

J Addict Med 2017 May/Jun;11(3):211-216

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine (KM, EA); Friends Research Institute (JG, RS); Department of Epidemiology and Public Health, University of Maryland School of Medicine (MT); Behavioral Health System Baltimore, Baltimore MD (MT).

Objectives: The objective of this study was to investigate pregnant women's current use of cannabis and their intended patterns of use with relation to their views on the legalization of cannabis and their knowledge of potential harms.

Methods: A voluntary, anonymous survey regarding patterns of use of cannabis and views on legalization was distributed to a convenience sample of pregnant women presenting for prenatal care at an outpatient university clinic. Chi-square and Fischer's exact tests were used for analysis using STATA.

Results: Of 306 surveys returned, 35% of women reported currently using cannabis at the time of diagnosis of pregnancy and 34% of those women continued to use. Seventy percent of respondents endorsed the belief that cannabis could be harmful to a pregnancy. Fifty-nine percent of respondents believed that cannabis should be legalized in some form and 10% reported that they would use cannabis more during pregnancy if it were legalized. Those who continued to use cannabis during pregnancy were less likely than those who quit to believe that cannabis use could be harmful during pregnancy (26% vs 75%, P < 0.001). The most common motivation for quitting cannabis use in pregnancy was to avoid being a bad example (74%); in comparison, only 27% of respondents listed a doctor's recommendation as a motivation to quit.

Conclusions: Cannabis use during pregnancy is relatively common and persistent, despite knowledge of the potential risks of harm. Views toward legalization vary among pregnant women and may impact cannabis use during pregnancy. In a changing legal climate, there is a need for clear messaging on the effects of cannabis use during pregnancy.
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http://dx.doi.org/10.1097/ADM.0000000000000299DOI Listing
January 2018

Patient-centered methadone treatment: a randomized clinical trial.

Addiction 2017 03 10;112(3):454-464. Epub 2016 Nov 10.

Friends Research Institute, Baltimore, MD, USA.

Background And Aims: Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual.

Design: Two-arm open-label randomized trial.

Setting: Two methadone treatment programs (MTPs) in Baltimore, MD, USA.

Participants: Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males.

Intervention: Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151).

Measurements: The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment.

Findings: There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05).

Conclusions: Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.
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http://dx.doi.org/10.1111/add.13622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296234PMC
March 2017

Immediate Versus Delayed Computerized Brief Intervention for Illicit Drug Misuse.

J Addict Med 2016 Sep-Oct;10(5):344-51

Friends Research Institute (JG, SGM, RPS), Baltimore; University of Maryland (KEO), College Park, MD; and Wayne State University (SJO), Detroit, MI.

Objective: Computerized brief interventions are a promising approach for integrating substance use interventions into primary care settings. We sought to examine the effectiveness of a computerized brief intervention for illicit drug misuse, which prior research showed performed no worse than a traditional in-person brief intervention.

Methods: Community health center patients were screened for eligibility using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Participants were adult patients (aged 18-62 years; 53% female) with moderate-risk illicit drug use (N = 80), randomized to receive the computerized brief intervention either immediately or at their 3-month follow-up. Assessments were conducted at baseline, 3, and 6-month follow-up, and included the ASSIST and drug hair testing.

Results: Most participants in the sample (90%) reported moderate-risk marijuana use. Although the sample as a whole reported significant decreases in ASSIST Global Drug Risk scores and ASSIST marijuana-specific scores, no significant differences were detected between "immediate" and "delayed" conditions on either of these measures. Likewise, no significant differences were detected between conditions in drug-positive hair test results at either follow-up.

Conclusions: This study did not find differences between immediate versus delayed computerized brief intervention in reducing drug use or associated risks, suggesting potential regression to the mean or reactivity to the consent, screening, or assessment process. The findings are discussed in light of the study's limitations and directions for future research.
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http://dx.doi.org/10.1097/ADM.0000000000000248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042843PMC
October 2017

Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

Subst Abuse Rehabil 2016 27;7:27-40. Epub 2016 Apr 27.

Friends Research Institute, Baltimore, MD, USA.

Purpose: The World Health Organization recommends the initiation of opioid agonists prior to release from incarceration to prevent relapse or overdose. Many countries in the world employ these strategies. This paper considers the evidence to support these recommendations and the factors that have slowed their adoption in the US.

Methods: We reviewed randomized controlled trials (RCTs) and longitudinal/observational studies that examine participant outcomes associated with the initiation or continuation of opioid agonists (methadone, buprenorphine) or antagonists (naltrexone) during incarceration. Papers were identified through a literature search of PubMed with an examination of their references and were included if they reported outcomes for methadone, buprenorphine, or naltrexone continued during incarceration or initiated prior to release in a correctional institution.

Results: Fourteen studies were identified, including eight RCTs and six observational studies. One RCT found that patients treated with methadone who were continued on versus tapered off methadone during brief incarceration were more likely to return to treatment upon release. A second RCT found that the group starting methadone treatment in prison versus a waiting list was less likely to report using heroin and sharing syringes during incarceration. A third RCT found no differences in postrelease heroin use or reincarceration between individuals initiating treatment with methadone versus those initiating treatment with buprenorphine during relatively brief incarcerations. Findings from four additional RCTs indicate that starting opioid agonist treatment during incarceration versus after release was associated with higher rates of entry into community treatment and reduced heroin use. Finally, one pilot RCT showed that providing extended-release naltrexone prior to discharge resulted in significantly lower rates of opioid relapse compared to no medication.

Conclusion: Reasons why uptake of these pharmacotherapies is limited in the US and relatively widespread in Europe are discussed. Recommendations for future research are outlined.
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http://dx.doi.org/10.2147/SAR.S81602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853155PMC
May 2016

Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.

Internet Interv 2016 May;4(Pt 1):11-16

Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' (=178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss ( = 114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use ( = 108, 60.7%), but nearly a third of these ( = 32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and-when addressing consequences-should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content.
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http://dx.doi.org/10.1016/j.invent.2016.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836054PMC
May 2016

Confirmatory factor analysis of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in community health center patients.

Am J Addict 2016 06 1;25(4):259-63. Epub 2016 Apr 1.

Friends Research Institute, Baltimore, Maryland.

Background And Objectives: To investigate the factor structure of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).

Methods: Secondary analysis on an adult primary care sample (N = 2,599).

Results And Discussion: Factor analysis of the tobacco, alcohol, and cannabis items did not yield an acceptable oblique, three-factor solution, due in part to floor effects and limited variability. A short form comprises three items (past-3-month frequency of use, urge to use, and whether others have expressed concern for use), that showed good psychometrics.

Scientific Significance: Supports the need for further investigation of the ASSIST factor structure and a short form. (Am J Addict 2016;25:259-263).
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http://dx.doi.org/10.1111/ajad.12360DOI Listing
June 2016

Two Models of Integrating Buprenorphine Treatment and Medical Staff within Formerly "Drug-Free" Outpatient Programs.

J Psychoactive Drugs 2016 Apr-Jun;48(2):101-8. Epub 2016 Mar 3.

c Senior Research Scientist, Friends Research Institute , Baltimore , MD , USA.

"Drug-free" outpatient programs deliver treatment to the largest number of patients of all treatment modalities in the U.S., providing a significant opportunity to expand access to medication treatments for substance use disorders. This analysis examined staff perceptions of organizational dynamics associated with the delivery of buprenorphine maintenance within three formerly "drug-free" outpatient treatment programs. Semi-structured interviews (N = 15) were conducted with counseling and medical staff, and respondents were predominantly African American (n = 11) and female (n = 12). Themes and concepts related to medical staff integration emerged through an inductive and iterative coding process using Atlas.ti qualitative analysis software. Two treatment clinics incorporated buprenorphine maintenance into their programs using a co-located model of care. Their staff generally reported greater intra-organizational discord regarding the best ways to combine medication and counseling compared to the clinic using an integrated model of care. Co-located program staff reported less communication between medical and clinical staff, which contributed to some uncertainty about proper dosing and concerns about the potential for medication diversion. Clinics that shift from "drug-free" to incorporating buprenorphine maintenance should consider which model of care they wish to adapt and how to train staff and structure staff communication.
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http://dx.doi.org/10.1080/02791072.2015.1130884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956482PMC
December 2017

Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups.

Health Aff (Millwood) 2016 Jan;35(1):12-9

Jerome H. Jaffe is a senior research scientist at the Friends Research Institute.

Substance use contributes to significant societal burdens, including high-cost health care use. However, these burdens may vary by type of substance and level of involvement. Using the 2009-13 National Surveys on Drug Use and Health, we examined all-cause hospitalizations and estimated costs across substance use profiles for alcohol, marijuana, and other illicit drugs. For each substance, we characterized differences between abstainers, nondiagnostic users (people who used the substance but did not meet diagnostic criteria for substance use disorder), and people with substance use disorders. In a multivariate analysis, we found that the odds of hospitalization were 16 percent lower for nondiagnostic marijuana users and 11 percent lower for nondiagnostic alcohol users, compared to abstainers. Neither alcohol- nor marijuana-specific substance use disorders were associated with hospitalization. In contrast, substance use disorders for other illicit drugs were strongly associated with hospitalization: People with those disorders had 2.2 times higher odds of hospitalization relative to abstainers. A more detailed understanding of health care use in different substance user groups could inform the ongoing expansion of substance use services in the United States.
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http://dx.doi.org/10.1377/hlthaff.2015.0618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936480PMC
January 2016

Reference periods in retrospective behavioral self-report: A qualitative investigation.

Am J Addict 2015 Dec 6;24(8):744-7. Epub 2015 Nov 6.

Friends Research Institute, Baltimore, Maryland.

Background: Self-report questions in substance use research and clinical screening often ask individuals to reflect on behaviors, symptoms, or events over a specified time period. However, there are different ways of phrasing conceptually similar time frames (eg, past year vs. past 12 months).

Methods: We conducted focused, abbreviated cognitive interviews with a sample of community health center patients (N = 50) to learn how they perceived and interpreted questions with alternative phrasing of similar time frames (past year vs. past 12 months; past month vs. past 30 days; past week vs. past 7 days).

Results: Most participants perceived the alternative time frames as identical. However, 28% suggested that the "past year" and "past 12 months" phrasings would elicit different responses by evoking distinct time periods and/or calling for different levels of recall precision. Different start and end dates for "past year" and "past 12 months" were reported by 20% of the sample. There were fewer discrepancies for shorter time frames.

Conclusions: Use of "past 12 months" rather than "past year" as a time frame in self-report questions could yield more precise responses for a substantial minority of adult respondents.

Scientific Significance: Subtle differences in wording of conceptually similar time frames can affect the interpretation of self-report questions and the precision of responses.
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http://dx.doi.org/10.1111/ajad.12305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902154PMC
December 2015

Staff Views of Acceptability and Appropriateness of a Computer-Delivered Brief Intervention for Moderate Drug and Alcohol Use.

J Psychoactive Drugs 2015 Sep-Oct;47(4):301-7. Epub 2015 Sep 16.

d Medical Director/Senior Research Scientist , Friends Research Institute , Baltimore , MD.

The use of computers for identifying and intervening with stigmatized behaviors, such as drug use, offers promise for underserved, rural areas; however, the acceptability and appropriateness of using computerized brief intervention (CBIs) must be taken into consideration. In the present study, 12 staff members representing a range of clinic roles in two rural, federally qualified health centers completed semi-structured interviews in a qualitative investigation of CBI vs. counselor-delivered individual brief intervention (IBI). Thematic content analysis was conducted using a constant comparative method, examining the range of responses within each interview as well as data across interview respondents. Overall, staff found the idea of providing CBIs both acceptable and appropriate for their patient population. Acceptability by clinic staff centered on the ready availability of the CBI. Staff also believed that patients might be more forthcoming in response to a computer program than a personal interview. However, some staff voiced reservations concerning the appropriateness of CBIs for subsets of patients, including older patients, illiterate individuals, or those unfamiliar with computers. Findings support the potential suitability and potential benefits of providing CBIs to patients in rural health centers.
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http://dx.doi.org/10.1080/02791072.2015.1075631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669042PMC
February 2016

SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers.

J Subst Abuse Treat 2016 Jan 26;60:81-90. Epub 2015 Jun 26.

Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA.

Background: Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study.

Methods: This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability.

Discussion: The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
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http://dx.doi.org/10.1016/j.jsat.2015.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548813PMC
January 2016

Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research.

J Addict Dis 2015 ;34(2-3):151-61

a Friends Research Institute Inc. , Baltimore , Maryland , USA.

This article reviews research conducted in Baltimore over the past 15 years, examining the following: (1) What factors differentiate heroin-addicted individuals who enter methadone treatment from those who do not? (2) How difficult is gaining access to methadone treatment? (3) What are effective ways to overcome barriers to treatment entry? (4) Why do so many methadone patients drop out of treatment prematurely? (5) What are the added benefits of counseling when coupled with methadone or buprenorphine treatment? (6) Does increasing access to treatment have an impact on overdose deaths? Specific recommendations are made for policymakers concerned with addressing heroin addiction.
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http://dx.doi.org/10.1080/10550887.2015.1059222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550504PMC
May 2016

Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes.

J Subst Abuse Treat 2015 Oct 12;57:89-95. Epub 2015 May 12.

Friends Research Institute, 1040 Park Ave., Suite 103, Baltimore, MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 110 South Paca St. 4th floor, Baltimore, MD, USA. Electronic address:

This analysis examines patient experiences and outcomes with 12-step recovery group attendance during buprenorphine maintenance treatment (BMT), two approaches with traditionally divergent philosophies regarding opioid medications for treatment of opioid use disorder. Using quantitative (n = 300) and qualitative (n = 20) data collected during a randomized trial of counseling services in buprenorphine treatment, this mixed-methods analysis of African Americans in BMT finds the number of NA meetings attended in the prior 6 months was associated with a higher rate of retention in BMT (p < .001) and heroin/cocaine abstinence at 6 month follow-up (p = .005). However, patients whose counselors required them to attend 12-step meetings did not have better outcomes than patients not required to attend such meetings. Qualitative narratives highlighted patients' strategies for managing dissonant viewpoints on BMT and disclosing BMT status in community 12-step meetings. Twelve-step meeting attendance is associated with better outcomes for BMT patients over the first 6 months of treatment. However, there is no benefit to requiring meeting attendance as a condition of treatment, and clinicians should be aware of potential philosophical conflicts between 12-step and BMT approaches.
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http://dx.doi.org/10.1016/j.jsat.2015.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560966PMC
October 2015

Prior Experience with Non-Prescribed Buprenorphine: Role in Treatment Entry and Retention.

J Subst Abuse Treat 2015 Oct 7;57:57-62. Epub 2015 May 7.

Friends Research Institute, 1040 Park Ave., Suite 103, Baltimore, MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 110 South Paca St. 4th floor, Baltimore, MD, USA. Electronic address:

Buprenorphine availability continues to expand as an effective treatment for opioid dependence, but increases in availability have also been accompanied by increases in non-prescribed use of the medication. Utilizing data from a randomized clinical trial, this mixed-method study examines associations between use of non-prescribed buprenorphine and subsequent treatment entry and retention. Quantitative analyses (N = 300 African American buprenorphine patients) found that patients with prior use of non-prescribed buprenorphine had significantly higher odds of remaining in treatment through 6 months than patients who were naïve to the medication upon treatment entry. Qualitative data, collected from a subsample of participants (n = 20), identified three thematic explanations for this phenomenon: 1) perceived effectiveness of the medication; 2) cost of obtaining prescription buprenorphine compared to purchasing non-prescribed medication; and 3) convenience of obtaining the medication via daily-dosing or by prescription compared to non-prescribed buprenorphine. These findings suggest a dynamic relationship between non-prescribed buprenorphine use and treatment that indicates potential directions for future research into positive and negative consequences of buprenorphine diversion.
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http://dx.doi.org/10.1016/j.jsat.2015.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561018PMC
October 2015

Changes in Quality of Life following Buprenorphine Treatment: Relationship with Treatment Retention and Illicit Opioid Use.

J Psychoactive Drugs 2015 Apr-Jun;47(2):149-57

a Senior Research Scientist , Friends Research Institute , Baltimore , MD.

Studies of substance abuse treatment outcomes that give priority to cessation of all drug use may obscure other tangible benefits of treatment that are important to patients. The aim of this study was to examine the association between changes in quality of life (QoL) and: (1) retention in treatment; and (2) opioid use as measured by self-report and urine testing. Participants were 300 African American men and women starting outpatient buprenorphine treatment. Participants completed assessments at baseline, three and six months consisting of the World Health Organization's Quality of Life brief scale, Addiction Severity Index, and urine testing for opioids. There were statistically significant increases over time across all four QoL domains: physical, psychological, environmental, and social. Self-reported frequency of opioid use was negatively associated with psychological QoL, but opioid urine test results were not significantly associated with any QoL domains. Continued treatment enrollment was significantly associated with higher psychological QoL and environmental QoL. Patients entering buprenorphine treatment experience improvements in QoL, which are amplified for patients who remain in treatment. Point-prevalence opiate urine test results obtained at each assessment were not associated with any of the QoL domains and may not accurately reflect improvements perceived by patients receiving buprenorphine treatment.
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http://dx.doi.org/10.1080/02791072.2015.1014948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425232PMC
October 2015

Potential radiating effects of misusing substances among medical patients receiving brief intervention.

J Subst Abuse Treat 2015 Aug 23;55:39-44. Epub 2015 Feb 23.

Friends Research Institute, Baltimore, MD, USA.

Background: The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired.

Methods: This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range).

Results: 12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01).

Conclusion: This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users.
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http://dx.doi.org/10.1016/j.jsat.2015.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456200PMC
August 2015

Astigmatism and early academic readiness in preschool children.

Optom Vis Sci 2015 Mar;92(3):279-85

*OD, MEd †PhD ‡OD §OD, MS ∥PhD, MA Pennsylvania College of Optometry at Salus University, Philadelphia, Pennsylvania (GO, EC); Wellesley College, Wellesley, Massachusetts (JW); Southern College of Optometry, Memphis, Tennessee (MBT); SUNY College of Optometry, New York, New York (DR); and Friends Research Institute, Baltimore, Maryland (JG).

Purpose: This study investigated the relationship between uncorrected astigmatism and early academic readiness in at-risk preschool-aged children.

Methods: A vision screening and academic records review were performed on 122 three- to five-year-old children enrolled in the Philadelphia Head Start program. Vision screening results were related to two measures of early academic readiness, the teacher-reported Work Sampling System (WSS) and the parent-reported Ages and Stages Questionnaire (ASQ). Both measures assess multiple developmental and skill domains thought to be related to academic readiness. Children with astigmatism (defined as >|-0.25| in either eye) were compared with children who had no astigmatism. Associations between astigmatism and specific subscales of the WSS and ASQ were examined using parametric and nonparametric bivariate statistics and regression analyses controlling for age and spherical refractive error.

Results: Presence of astigmatism was negatively associated with multiple domains of academic readiness. Children with astigmatism had significantly lower mean scores on Personal and Social Development, Language and Literacy, and Physical Development domains of the WSS, and on Personal/Social, Communication, and Fine Motor domains of the ASQ. These differences between children with astigmatism and children with no astigmatism persisted after statistically adjusting for age and magnitude of spherical refractive error. Nonparametric tests corroborated these findings for the Language and Literacy and Physical Health and Development domains of the WSS and the Communication domain of the ASQ.

Conclusions: The presence of astigmatism detected in a screening setting was associated with a pattern of reduced academic readiness in multiple developmental and educational domains among at-risk preschool-aged children. This study may help to establish the role of early vision screenings, comprehensive vision examinations, and the need for refractive correction to improve academic success in preschool children.
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http://dx.doi.org/10.1097/OPX.0000000000000485DOI Listing
March 2015

Racial/ethnic differences in the relationship among cigarette use, religiosity, and social norms for U.S. adolescents.

J Ethn Subst Abuse 2014 ;13(4):337-61

a African American Studies Department , University of Maryland , College Park , Maryland.

This study investigated the racial/ethnic differences in the role of social norms in the protective relationship between religiosity and cigarette smoking. The 2009 National Survey on Drug Use and Health was used to investigate the relationships between smoking, religiosity, and social norms of U.S. adolescents (N = 13,278). Significant indirect effects between religiosity and smoking were found through social norms for non-Hispanic White adolescents. Findings were mixed for non-Hispanic Black adolescents. Mechanisms driving the religiosity-smoking association differ across subpopulations. Smoking prevention efforts and messaging campaigns that include partnerships with religious communities may require consideration of these racial/ethnic differences when planning prevention strategies.
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http://dx.doi.org/10.1080/15332640.2014.958636DOI Listing
July 2015

Treatment Outcomes of African American Buprenorphine Patients by Parole and Probation Status.

J Drug Issues 2014 Jan;44(1):69-82

Friends Research Institute, Baltimore, MD 21201 USA.

This secondary analysis compared outcomes of African-American adults newly-admitted to buprenorphine treatment who were on parole and probation to patients who were not under criminal justice supervision. Buprenorphine patients (N=300) were randomly assigned to receive either Intensive Outpatient Treatment (IOP) or Standard Outpatient Treatment (OP) treatment and were assessed at baseline, 3- and 6-months. There were no differences between groups in treatment retention. Among probationers/parolees, IOP was associated with lower 3-month treatment retention compared to OP, but among participants not on probation/parole the relationship was reversed (=.004). Both conditions showed significant declines in heroin and cocaine use, illegal activity, and in meeting DSM-IV criteria for opioid and cocaine dependence. Probationers/parolees reported lower frequency of illegal activities at 3-months compared to non-probationers/parolees (=.007). Buprenorphine treatment should be made more widely available to individuals on parole/probation as they respond as well to treatment as patients not supervised by the criminal justice system.
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http://dx.doi.org/10.1177/0022042613491106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214068PMC
January 2014

Validation and performance of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among adolescent primary care patients.

Addiction 2015 Feb 20;110(2):240-7. Epub 2014 Nov 20.

Friends Research Institute, Baltimore, MD, USA.

Background And Aims: The World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) has strong support as a clinical screening tool and research instrument, but has only been validated with adults. This study evaluated the ASSIST and ASSIST-Lite in an adolescent population.

Design: Internal consistency, concurrent validity, discriminant validity and diagnostic accuracy were examined for tobacco, alcohol and cannabis ASSIST scores. An abbreviated version (the ASSIST-Lite) was evaluated for cannabis.

Setting: Three community health centers in Baltimore, MD, USA.

Participants: A total of 525 primary care patients, ages 12-17 years.

Measurements: Measures included the ASSIST, the CRAFFT screening tool and items from the Composite International Diagnostic Interview (CIDI) corresponding to substance use disorder criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

Findings: The ASSIST had good internal consistency (α = 0.68-0.88), good concurrent validity with the CRAFFT (r = 0.41-0.76; P < 0.001), and was able to discriminate between gradations of cannabis problem severity. In receiver operating characteristics analysis of optimal clinical cut-points, the ASSIST accurately identified tobacco, alcohol and cannabis use disorders (sensitivities = 95-100%; specificities = 79-93%; area under the curve [AUC] = 0.90-0.94), but did so at minimally low cut-points (indicative of any use in the past 3 months). The ASSIST-Lite performed similarly to the ASSIST in identifying cannabis use disorders (sensitivity = 96%; specificity = 88%; AUC = 0.92), also at a minimally low cut-point. However, confirmatory factor analysis of the ASSIST indicated poor model fit.

Conclusions: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is promising as a research and screening/brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. The ASSIST-Lite is sufficiently informative for rapid clinical screening of adolescents for cannabis use disorders.
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http://dx.doi.org/10.1111/add.12767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301997PMC
February 2015

A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: outcomes through 12 months.

J Subst Abuse Treat 2015 Mar 16;50:3-10. Epub 2014 Sep 16.

Friends Research Institute, Baltimore, MD USA.

This study examined outcomes through 12 months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N=360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p<.001), but there were no significant differences between conditions in overall change across 12 months of follow-up (p=.13). CBI produced greater overall reductions in alcohol (p=.04) and cocaine (p=.02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions.
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http://dx.doi.org/10.1016/j.jsat.2014.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304885PMC
March 2015

The CRAFFT cut-points and DSM-5 criteria for alcohol and other drugs: a reevaluation and reexamination.

Subst Abus 2014 ;35(4):376-80

a Friends Research Institute , Baltimore , Maryland , USA.

Background: The CRAFFT, previously validated against DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnostic criteria, is the most widely used screening instrument for alcohol and other substance misuse in adolescents. The present secondary analysis study sought to compare the CRAFFT with the new DSM-5 diagnostic criteria in order to assess the CRAFFT's psychometric properties and determine the optimal cut-point for identifying adolescents in need of further assessment.

Methods: Participants were primary care patients aged 12-17 (N = 525) who were recruited while waiting for a medical appointment in an urban federally qualified health center in Baltimore, Maryland, USA. Participants were administered the CRAFFT and the Composite International Diagnostic Interview, second edition, modified to include the new DSM-5 craving item. The authors examined the performance of the CRAFFT in identifying any problem use (defined as 1 or more DSM-5 criteria) and any DSM-5 substance use disorder (2 or more DSM-5 criteria) for alcohol or drugs other than tobacco. The authors examined sensitivity, specificity, and receiver operating characteristic areas under the curve (AUC) to determine the optimal CRAFFT cut-point(s) for predicting any problem use and any DSM-5 substance use disorder (SUD).

Results: Examining the CRAFFT as a continuous measure, AUC values were 0.93 for problem use or higher and 0.97 for DSM-5 SUD. Consistent with previously recommended cut-points for the CRAFFT, the cut-point of 2 performed optimally for identifying adolescents both exhibiting problem use of alcohol or drugs and meeting DSM-5 SUD criteria for alcohol or other drugs.

Conclusions: Despite changes in the DSM substance use diagnostic criteria, the CRAFFT continues to demonstrate excellent sensitivity and specificity at its established cut-point of 2. Additional studies examining the CRAFFT in light of the new DSM-5 diagnostic criteria with more diverse populations are warranted.
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http://dx.doi.org/10.1080/08897077.2014.936992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268117PMC
November 2015
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