Publications by authors named "Michael L Dennis"

95 Publications

The impact of the opioid crisis on U.S. state prison systems.

Health Justice 2021 Jul 24;9(1):17. Epub 2021 Jul 24.

Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD, 20878, USA.

Background: Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD).

Methods: A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance.

Results: MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications.

Conclusion: Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.
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http://dx.doi.org/10.1186/s40352-021-00143-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310396PMC
July 2021

Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centers with SBIRT services.

Subst Abuse Treat Prev Policy 2021 Jul 14;16(1):58. Epub 2021 Jul 14.

Chestnut Health Systems, 221 W Walton St, 60610, Chicago, IL, United States.

Background: Brief treatment (BT) can be an effective, short-term, and low-cost treatment option for many people who misuse alcohol and drugs. However, inconsistent implementation is suggested to result in BT that often looks and potentially costs similar to regular outpatient care. Prior research is also rife with inconsistent operationalizations regarding the measurement of BT received by patients. As such, there is a need to more explicitly identify and document variations in BT practice.

Methods: A qualitative investigation of BT in four Federally Qualified Health Centers (FQHC) was undertaken as a sub study of a larger clinical trial. Researchers interviewed 12 staff (administrators and clinicians) involved in BT oversight, referral, or delivery within the four FQHCs. Data were analyzed following an inductive approach guided by the primary research questions.

Results: Findings demonstrate considerable differences in how BT was conceptualized and implemented within the FQHCs. This included a variety of ways in which BT was presented and described to patients that likely impacts how they perceive the BT they receive, including potentially not understanding they received substance use disorder treatment at all.

Conclusions: The findings raise questions regarding the validity of prior research, demonstrating more objective definitions of BT and fidelity checklists are needed to ensure integrity of results. Future work in this area should seek to understand BT as practiced among a larger sample of providers and the direct experiences and perspectives of patients. There is also a need for more consistent implementation, quality assurance guidelines, and standardized stage of change assessments to aid practitioners.
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http://dx.doi.org/10.1186/s13011-021-00381-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278761PMC
July 2021

Screening for more with less: Validation of the Global Appraisal of Individual Needs Quick v3 (GAIN-Q3) screeners.

J Subst Abuse Treat 2021 Jul 15;126:108414. Epub 2021 Apr 15.

Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, United States of America.

Multi-morbidity is the norm among adolescents and adults with substance use and other mental disorders and warrants a multi-pronged screening approach. However, the time constraints on assessment inherent in clinical practice often temper the desire for a full understanding of multi-morbidity problems. The 15- to 25-minute Global Appraisal of Individual Needs Quick version 3 (GAIN-Q3) includes screeners for 9 common clinical problems that are short (4 to 10 items) and provide dimensional measures of problem severity in each area that are also categorized to guide clinical decision making. The screeners are summed into a total score that represents a 10th screener for multi-morbidity. This paper provides background on the development of the GAIN-Q3 screeners, their psychometric behaviors, efficiency, and predictive power relative to the 1-2 h full GAIN-I. Based on literature showing differential item and scale functioning by age, analyses were conducted separately using data from 10,625 adolescent and 10,167 adult treatment clients. Despite the condensed lengths of the screening measures compared with their longer versions, the reliability estimates are within the good to excellent range (0.7 to 0.9) in terms of internal consistency for 6 of the 10 screeners for adolescents and 7 of the 10 screeners for adults. In addition, the part to whole correlation for all 10 comparisons for both adolescents and adults are excellent (0.82 to 0.96). Moreover, there is strong evidence for the measures' convergent and discriminant validity and efficiency (i.e., maximum information gathered in as few items possible) relative to the full-length scales as well as relative to other scales in the full GAIN-I. Analyses of the interpretive cut-scores provide accurate identification of cases with high sensitivity and specificity, thus supporting the screeners' capacity to triage. PUBLIC SIGNIFICANCE STATEMENT: This study reports on the ability (GAIN-Q3) to efficiently screen for multiple co-occurring substance use, mental health, and associated problems. Multi-problem presentation in the social service sector is the normal expectation, yet time constraints prevent broad assessment of potentially many problematic areas. The GAIN-Q3 showed convergent and discriminant validity relative to the full-length scales as well as other scales assessed in the GAIN-I. The GAIN-Q3 achieves the desired balance between broad coverage and measurement efficiency to provide ample information to identify the best course of action for an individual.
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http://dx.doi.org/10.1016/j.jsat.2021.108414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197776PMC
July 2021

Chronic Reproductive Toxicity Thresholds for Northern Bobwhite Quail (Colinus virginianus) Exposed to Perfluorohexanoic Acid (PFHxA) and a Mixture of Perfluorooctane Sulfonic Acid (PFOS) and PFHxA.

Environ Toxicol Chem 2021 Jun 8. Epub 2021 Jun 8.

Department of Environmental Toxicology, Texas Tech University, Lubbock, Texas, USA.

Terrestrial toxicology data are limited for comprehensive ecotoxicological risk assessment of ecosystems contaminated by per- and polyfluoroalkyl substances (PFAS) partly because of their existence as mixtures in the environment. This complicates logistical dose-response modeling and establishment of a threshold value characterizing the chronic toxicity of PFAS to ecological receptors. We examined reproduction, growth, and survival endpoints using a combination of hypothesis testing and logistical dose-response modeling of northern bobwhite quail (Colinus virginianus) exposed to perfluorohexanoic acid (PFHxA) alone and to PFHxA in a binary mixture with perfluorooctane sulfonic acid (PFOS) via the drinking water. The exposure concentration chronic toxicity value (CTV) representative of the lowest-observable-adverse effect level (LOAEL) threshold for chronic oral PFAS toxicity (based on reduced offspring weight and growth rate) was 0.10 ng/mL for PFHxA and 0.06 ng/mL for a PFOS:PFHxA (2.7:1) mixture. These estimates corresponded to an adult LOAEL average daily intake CTV of 0.0149 and 0.0082 µg × kg body weight  × d , respectively. Neither no-observable-adverse effect level threshold and representative CTVs nor dose-response and predicted effective concentration values could be established for these 2 response variables. The findings indicate that a reaction(s) occurs among the individual PFAS components present in the mixture to alter the potential toxicity, demonstrating that mixture affects avian PFAS toxicity. Thus, chronic oral PFAS toxicity to avian receptors represented as the sum of the individual compound toxicities may not necessarily be the best method for assessing chronic mixture exposure risk at PFAS-contaminated sites. Environ Toxicol Chem 2021;00:1-14. © 2021 SETAC.
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http://dx.doi.org/10.1002/etc.5135DOI Listing
June 2021

The Missing Link(age): Multilevel Contributors to Service Uptake Failure Among Youths on Community Justice Supervision.

Psychiatr Serv 2021 05 26;72(5):546-554. Epub 2021 Mar 26.

Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wasserman, McReynolds, Elkington); Schar School of Policy and Government, George Mason University, Fairfax, Virginia (Taxman); Department of Criminal Justice, Temple University, Philadelphia, (Belenko); Social Science Research Center, Mississippi State University, Starkville (Robertson); Lighthouse Institute, Chestnut Health Systems, Normal, Illinois (Dennis); Department of Psychology, Texas Christian University, Fort Worth (Knight); Department of Behavioral Science, University of Kentucky, Lexington (Knudsen); Department of Criminology, University of South Florida, Tampa (Dembo); Department of Biostatistics and Bioinformatics, George Washington University, Washington, D.C. (Ciarleglio); National Institute on Drug Abuse, Bethesda, Maryland (Wiley).

Objectives: Youths in the juvenile justice system often do not access needed behavioral health services. The behavioral health services cascade model was used to examine rates of substance use screening, identification of substance use treatment needs, and referral to and initiation of treatment among youths undergoing juvenile justice system intake and to identify when treatment access is most challenged. Characteristics associated with identification of behavioral health needs and linkage to community services were also examined.

Methods: Data were drawn from administrative records of 33 community justice agencies in seven states participating in Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System, funded by the National Institute on Drug Abuse (N=8,307 youths). Contributions of youth, staff, agency, and county characteristics to identification of behavioral health needs and linkage to community services were examined.

Results: More than 70% (5,942 of 8,307) of youths were screened for substance use problems, and more than half needed treatment. Among those in need, only about one-fifth were referred to treatment, and among those referred, 67.5% initiated treatment. Overall, <10% of youths with identified needs initiated services. Multivariable multilevel regression analyses revealed several contributors to service-related outcomes, with youths' level of supervision being among the strongest predictors of treatment referral.

Conclusions: Community justice agencies appear to follow an approach that focuses identification and linkage practices on concerns other than youths' behavioral health needs, although such needs contribute to reoffending. Local agencies should coordinate efforts to support interagency communication in the referral and cross-system linkage process.
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http://dx.doi.org/10.1176/appi.ps.202000163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288447PMC
May 2021

A scoping review of factors that influence opioid overdose prevention for justice-involved populations.

Subst Abuse Treat Prev Policy 2021 Feb 22;16(1):19. Epub 2021 Feb 22.

Chestnut Health Systems, 221 W. Walton St, Chicago, IL, 60610, USA.

Background: There is a high risk of death from opioid overdose following release from prison. Efforts to develop and implement overdose prevention programs for justice-involved populations have increased in recent years. An understanding of the gaps in knowledge on prevention interventions is needed to accelerate development, implementation, and dissemination of effective strategies.

Methods: A systematic search process identified 43 published papers addressing opioid overdose prevention in criminal justice settings or among justice-involved populations from 2010 to February 2020. Cross-cutting themes were identified, coded and qualitatively analyzed.

Results: Papers were coded into five categories: acceptability (n = 8), accessibility (n = 4), effectiveness (n = 5), feasibility (n = 7), and participant overdose risk (n = 19). Common themes were: (1) Acceptability of naloxone is associated with injection drug use, overdose history, and perceived risk within the situational context; (2) Accessibility of naloxone is a function of the interface between corrections and community; (3) Evaluations of overdose prevention interventions are few, but generally show increases in knowledge or reductions in opioid overdose; (4) Coordinated efforts are needed to implement prevention interventions, address logistical challenges, and develop linkages between corrections and community providers; (5) Overdose is highest immediately following release from prison or jail, often preceded by service-system interactions, and associated with drug-use severity, injection use, and mental health disorders, as well as risks in the post-release environment.

Conclusion: Study findings can inform the development of overdose prevention interventions that target justice-involved individuals and policies to support their implementation across criminal justice and community-based service systems.
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http://dx.doi.org/10.1186/s13011-021-00346-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898779PMC
February 2021

Improving retention across the OUD service cascade upon reentry from jail using Recovery Management Checkups-Adaptive (RMC-A) experiment.

J Subst Abuse Treat 2020 Dec 11:108245. Epub 2020 Dec 11.

Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, USA. Electronic address:

Incarcerated individuals with opioid use disorders (OUD) should be linked to community-based treatment with medications for opioid use disorder (MOUD) upon their release, as well as to services that provide support for their ongoing recovery. The RMC-A experiment will test an adapted version of the evidence-based Recovery Management Checkups (RMC), which provides treatment linkage, support for retention, and re-linkage as indicated at quarterly checkups. A total of 750 male and female individuals will be recruited from 5 county jails in Illinois and randomly assigned to 1 of 3 groups at release from jail: a) Monitoring and Treatment Referral (MTR); b) quarterly RMC (RMC-Q); or c) RMC-A, which adjusts the frequency and intensity of checkups based on the individual's assessed need for treatment at each checkup. Measurement includes quarterly research follow-up assessments for 2 years, urine tests, and records checks (treatment, mortality, recidivism). The study aims to evaluate: (1) the direct effects of RMC-Q/RMC-A on MOUD treatment initiation, engagement, retention, and re-linkage; (2) the indirect effects of RMC-Q/RMC-A (via months of MOUD) on public health outcomes (days of opioid use, OUD symptoms, quality of life, cost of health care utilization); (3) the indirect effects of RMC-Q/RMC-A (via months of MOUD and public health outcomes) on public safety outcomes (illegal activity, re-arrest, re-incarceration, cost of crime); and (4) the incremental costs and cost-effectiveness of MTR vs. RMC-Q vs. RMC-A on public health and public safety outcomes. This experiment will determine whether the adapted RMC model improves the overall effectiveness and cost-effectiveness of the fixed quarterly RMC.
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http://dx.doi.org/10.1016/j.jsat.2020.108245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192586PMC
December 2020

Species- and Tissue-Specific Avian Chronic Toxicity Values for Perfluorooctane Sulfonate (PFOS) and a Binary Mixture of PFOS and Perfluorohexane Sulfonate.

Environ Toxicol Chem 2021 Mar 27;40(3):899-909. Epub 2021 Jan 27.

Department of Environmental Toxicology, Texas Tech University, Lubbock, Texas, USA.

To further characterize avian toxicity to environmental levels of select per- and poly-fluoroalkyl substances (PFAS), we established species- and tissue-specific PFAS chronic toxicity values (CTVs) associated with a lowest-observable-adverse effect level (LOAEL) threshold previously established for northern bobwhite quail (Colinus virginianus) chronically orally exposed via drinking water to either perfluorooctane sulfonate (PFOS) or a simple PFAS mixture. Aided by advances in analytical techniques, the novel avian oral PFAS CTVs reported in the present study are lower than the previously reported toxicity reference values (TRVs) estimated for birds chronically exposed via feed. Thus, current avian PFOS TRVs may not be fully protective of wild avian populations at PFAS-impacted sites. Also, likely due to differences in bioavailability, bioaccessibility, and toxicokinetics among individual PFAS between oral exposure types, we found higher bioaccumulation factors in all assessed tissues from birds exposed via water versus feed. Thus, we propose that future characterization of chemical toxicity due to ingestion exposure initially include a full examination of all probable sources of oral exposure for the most accurate derivation of TRVs and a more complete picture of ecological risk. The avian PFAS LOAEL CTVs established in the present study can be modified with the use of uncertainty factors to derive site-specific avian TRVs for ecological risk assessment at PFAS-impacted sites. From differences observed in the behavior of PFOS when administered as either a single chemical or part of a binary mixture with perfluorohexane sulfonate (PFHxS), we verified that PFOS was absorbed and distributed differently when coadministered with PFHxS and that PFOS likely interacted with PFHxS differently among tissues, helping to explain the differences observed in avian toxicity between exposures. Environ Toxicol Chem 2021;40:899-909. © 2020 SETAC.
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http://dx.doi.org/10.1002/etc.4937DOI Listing
March 2021

A randomized clinical trial of smartphone self-managed recovery support services.

J Subst Abuse Treat 2020 10 21;117:108089. Epub 2020 Jul 21.

Chestnut Health Systems, 221 W. Walton St., Chicago, IL 60610, United States of America. Electronic address:

This study examines the effectiveness of smartphone-based ecological momentary interventions (EMI) and assessments (EMA), delivered separately and combined, to provide recovery support following substance use disorder (SUD) treatment engagement. We recruited adults (N = 401) from SUD treatment programs in Chicago and, after engagement for at least two sessions, nights, or medication dosages, we randomly assigned them to one of four conditions that lasted 6 months: (1) EMI only, (2) EMA only, (3) both EMI and EMA, and (4) control condition of neither EMI nor EMA. EMIs provided support for recovery through applications on the phone or links to other resources; EMAs were delivered randomly 5 times per day asking participants to indicate recent substance use and situational risk and protective factors. The primary dependent variable was days of abstinence in the 6 months following study intake. Rates of EMI and EMA utilization indicated high compliance, although EMI use decreased over time. There was a small direct effect of time across conditions (F = 4.33, p = .014, Cohen's f = 0.11) and a small direct effect of time-by-EMI use (F = 4.85, p = .009, f = 0.11) on days of abstinence. There was no significant direct effect of time-by-EMAs nor interaction effect of time-by-EMI-by-EMA. However, secondary path model analyses showed a small but significant indirect effect of EMA on abstinence via EMI use. Stepwise modeling identified a simplified model based on the proportion of weeks using ≥1 EMI and the EMI to listen to music, which predicted 7.2% of the variance in days of abstinence (F = 7.56, p < .001). Combined delivery of EMI and EMA shows potential for increasing abstinence above and beyond the effect of SUD treatment engagement and for addressing the limited national capacity for recovery support.
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http://dx.doi.org/10.1016/j.jsat.2020.108089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438609PMC
October 2020

Temporal dynamics of the relationship between change in depressive symptoms and cannabis use in adolescents receiving psychosocial treatment for cannabis use disorder.

J Subst Abuse Treat 2020 10 20;117:108087. Epub 2020 Jul 20.

Chestnut Health Systems, United States of America. Electronic address:

Aims: Cannabis use disorder (CUD) and depression frequently co-occur in youth. How depressive symptoms change over the course of CUD treatment and how they impact substance use treatment outcomes is unknown. In the current study, we examine the temporal relationships between cannabis use and depression in adolescents receiving evidence-based treatments for CUD as part of a multisite clinical trial.

Design: Six hundred adolescents (age 12-18) with a CUD were randomly assigned to substance use treatment from one of five evidence-based psychosocial interventions. We assessed self-reported cannabis use frequency and depressive symptoms at baseline (BL) and again at 3-, 6-, 9, and 12-months. A bivariate latent change model assessed bidirectional effects of baseline levels and time-lagged changes in depressive symptoms and cannabis use on depression and cannabis use outcomes.

Findings: Depressive symptoms (72%) and major depressive disorder (MDD) (18%) were common at BL. Both depression and cannabis use decreased over time and change in cannabis use was significantly associated with change in depressive symptoms (b = 1.22, p = .003). Time-lag analyses showed that within-subject change in depression (from one time point to the next) was predicted by previous depression (b = -0.71, p < .001) but not cannabis use (p = .068), and change (decrease) in cannabis use was predicted by previous (greater) depressive symptoms (b = -1.47, p < .001) but not cannabis use (p = .158), respectively.

Conclusion: These findings indicate an enduring relationship between decreasing cannabis use and decreasing depression among adolescents lasting for 9-months after receiving psychosocial interventions for CUD. The presence of depressive symptoms did not appear to interfere with substance use treatment or attenuate improvements in cannabis use frequency. A decrease in cannabis use was not contingent upon a reduction in depressive symptoms. These findings are limited by the possibility of regression to the mean for both cannabis use and depressive symptoms, and the lack of a nonintervention control group.
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http://dx.doi.org/10.1016/j.jsat.2020.108087DOI Listing
October 2020

HIV/STI Service Delivery Within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth Through the HIV Care Cascade.

AIDS Patient Care STDS 2020 02;34(2):72-80

Department of Social and Behavioral Sciences, New York University, New York, New York.

Justice-involved youth (JIY) are at considerable risk for human immunodeficiency virus (HIV), but are disconnected from treatment and prevention. Juvenile justice agencies providing community supervision (CS) are well positioned to provide HIV prevention, testing, and prompt referral to treatment for JIY. However, we lack an understanding of juvenile CS agency responses to HIV/sexually transmitted infection (STI) needs among JIY. We conducted a nationwide systematic assessment of how juvenile CS agencies identify, refer, and move youth through the HIV care cascade using a nationally representative sample of 195 juvenile CS agencies across 20 states. Two-thirds of CS agencies did not offer any HIV-/STI-related services, and 82% reported no collaboration with health agencies. Screening or referral for HIV risk behaviors was reported by 32% of the CS agencies and 12% for any intervention or prevention for HIV/STI risk behaviors. Between 21% and 30% of agencies were unaware of the location of local HIV/STI services. HIV/STI prevention training was not a priority for directors and was ranked second to last out of 16 training topics. Agencies where staff expressed need for HIV risk training and where specific court programming was available were more likely to provide or refer for HIV/STI screening and/or testing. Agencies were more likely to provide or refer for services if they provided pre-trial/pre-adjudication supervision, parole, or court programming. Considering the low provision of HIV/STI-related services and limited collaboration between health and justice agencies, interventions that promote cross-system collaboration designed to minimize barriers and facilitate identification, referral, and linkage to HIV services for JIY are necessary.
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http://dx.doi.org/10.1089/apc.2019.0157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044763PMC
February 2020

Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment.

J Subst Abuse Treat 2020 01 7;108:65-74. Epub 2019 Aug 7.

Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America. Electronic address:

This pilot study evaluated the feasibility of the Recovery Initiation and Management after Overdose (RIMO) intervention to link individuals to medication-assisted treatment (MAT) following an opioid overdose. The study team worked with the Chicago Fire Department to train Emergency Medical Service (EMS) teams to request permission from individuals after an opioid overdose reversal to release their contact information; individuals were subsequently contacted by the study team for participation. A mixed-methods study design comprised: (1) an experimental pilot study that examined participation at each stage of the intervention and compared the odds of treatment received for individuals who were randomly assigned to either the RIMO intervention (n = 16) or a passive referral control (n = 17); and (2) a focus group that was subsequently conducted with participants in the RIMO group to obtain their feedback on the intervention components. Quantitative data was collected on participant characteristics at study intake and treatment received was based on self-report at a 30-day follow-up. The RIMO group had higher odds of receiving any treatment for opioid use (OR = 7.94) and any MAT (OR = 20.2), and received significantly more days of opioid treatment (Ms=15.2 vs. 3.4) and more days of MAT in the 30 days post-randomization (Ms=11.2 vs. 0.76), relative to the control group (all p < .05). Qualitative data illustrated that participants valued the assertive outreach, engagement, and persistent follow-up components of RIMO, which differed from their prior experiences. The pilot study suggests that the RIMO intervention is able to address the challenges of linking and engaging individuals into MAT after an opioid overdose.
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http://dx.doi.org/10.1016/j.jsat.2019.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893133PMC
January 2020

A community outreach intervention to link individuals with opioid use disorders to medication-assisted treatment.

J Subst Abuse Treat 2020 01 10;108:75-81. Epub 2019 Jul 10.

Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America. Electronic address:

Individuals with opioid use disorders (OUD) face significant barriers to accessing medication-assisted treatment (MAT), yet access to MAT is critical to reducing opioid-related fatality. This study evaluated a peer outreach and treatment linkage intervention in Chicago that is part of the Illinois Opioid State Targeted Response (STR) project to assist individuals with OUD in accessing MAT. The study uses the framework of the Opioid Use Disorder Cascade of Care to track progress through successive stages of the intervention and evaluated covariates of successful transitions across stages. Peer outreach workers contacted individuals in high-risk communities, conducted an eligibility screen, and scheduled eligible individuals to meet with project staff for treatment linkage. Over the 12-month study period (July 2017-June 2018), peer outreach workers conducted approximately 3308 encounters with individuals; 83% (n = 1638) were determined to be eligible for the intervention and agreed to an on-site linkage meeting. A majority of these (59%; n = 972) showed to the linkage meeting; most of these (92%, n = 890) were scheduled for a MAT intake appointment; and 86% (n = 765) of those scheduled showed to the MAT intake appointment. Most (91%; n = 696) of those who showed for treatment intake received a first dose, and 72% (n = 498) of these were in treatment at 30 days after their first dose. Several participant characteristics differentiated individuals that continued at each stage of the cascade model from those that did not. These findings demonstrate that the peer outreach and treatment linkage intervention may be successfully used to engage individuals with OUD into treatment.
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http://dx.doi.org/10.1016/j.jsat.2019.07.001DOI Listing
January 2020

Geographic differences in substance use screening for justice-involved youth.

J Subst Abuse Treat 2019 07 13;102:40-46. Epub 2019 Apr 13.

Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.

Justice-involved youth report high rates of substance use. Community Supervision (CS) agencies are uniquely positioned to impact public health through substance use identification and early intervention. Geographic location (i.e., living in an urban versus rural area) is an understudied factor that can be associated with differences in service and resource availability. A secondary analysis of a nationally representative sample of CS agencies assessed agency and youth characteristics, as well as substance use screening in urban and rural CS agencies. Respondents representing rural agencies reported higher rates of substance use, yet were less likely to report using screeners focused on substance use. Respondents representing urban CS agencies reported a wider variety of screening instruments and were more likely to test for drug use during screening. Differences in the screening process can reflect adaptive and culturally responsive approaches to addressing substance use as well as unique barriers to service provision. System-wide improvement is contingent upon implementation strategies that identify and acknowledge geographic differences to more adequately address the common and unique needs of the justice-involved youth they serve.
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http://dx.doi.org/10.1016/j.jsat.2019.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599716PMC
July 2019

Juvenile justice systems of care: results of a national survey of community supervision agencies and behavioral health providers on services provision and cross-system interactions.

Health Justice 2019 Jun 14;7(1):11. Epub 2019 Jun 14.

Loyola University Chicago, Chicago, USA.

Background: Youth involved in the juvenile justice (JJ) system have high needs for behavioral health services, especially related to substance use and mental disorders. This study aimed to understand the extent to which elements in the cascade model of behavioral health services for JJ-involved youth are provided to youth by Community Supervision (CS) and/or Behavioral Health (BH) providers. In order to understand interactions across CS and BH systems, this study used a multistage probabilistic survey design to sample CS agencies and their primary BH service providers of substance use and mental health treatment in the United States. Parallel surveys were administered to both CS and BH providers regarding: characteristics of youth served, BH services available, whether services were provided directly and/or by referral, use of evidence-based practices (EBPs), and methods of collaboration, referral, and information exchange across CS and BH providers.

Results: The findings from weighted national estimates demonstrate that youth referred from CS to the BH programs represent a more severe sub-group of youth under CS supervision. There are established cross-system relationships for assessment and referral for substance use and mental health treatment, but less so for prevention services. Most CS programs refer youth to BH providers for these services, which typically utilize more highly trained staff to provide EBPs to a majority of the youth served. More intensive substance use and mental health treatment, aftercare, and recovery support services were limited in availability.

Conclusions: The findings suggest that although many elements in a cascade model of BH services for JJ-involved youth have been implemented within local systems of care through collaboration between CS and BH providers, there are several underdeveloped areas and potential for attrition across the service cascade. Greater attention to providing services to youth with higher levels of severity, aftercare services, and recovery support is warranted within a multi-systemic framework.
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http://dx.doi.org/10.1186/s40352-019-0093-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717998PMC
June 2019

Reprint of Using ecological momentary assessments to predict relapse after adult substance use treatment.

Addict Behav 2018 08 7;83:116-122. Epub 2018 Apr 7.

Center for Health Enhancement Systems Studies, Industrial and Systems Engineering, Department, University of Wisconsin-Madison, Madison, WI 53706, USA.

Background: A key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons.

Methods: Data are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM).

Results: The major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of "any" use in the next five completed EMAs from 3% to 82%.

Conclusions: This study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies.
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http://dx.doi.org/10.1016/j.addbeh.2018.04.003DOI Listing
August 2018

Using ecological momentary assessments to predict relapse after adult substance use treatment.

Addict Behav 2018 07 23;82:72-78. Epub 2018 Feb 23.

Center for Health Enhancement Systems Studies, Industrial and Systems Engineering, Department, University of Wisconsin-Madison, Madison, WI 53706, USA.

Background: A key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons.

Methods: Data are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM).

Results: The major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of "any" use in the next five completed EMAs from 3% to 82%.

Conclusions: This study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies.
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http://dx.doi.org/10.1016/j.addbeh.2018.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237687PMC
July 2018

Opioid recovery initiation: Pilot test of a peer outreach and modified Recovery Management Checkup intervention for out-of-treatment opioid users.

J Subst Abuse Treat 2018 03 19;86:30-35. Epub 2017 Dec 19.

Lighthouse Institute, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States. Electronic address:

The recent surge in opioid-related overdoses and related fatalities underscores the need for assertive mechanisms for linking individuals with opioid use disorders (OUD) to medication-assisted treatment (MAT). This pilot study investigated the feasibility of an intervention that used peer outreach workers to identify out-of-treatment individuals with OUD combined with a modified version of the Recovery Management Checkup to link individuals to methadone treatment. The study was conducted in high-risk communities in Chicago over 8weeks; peer outreach workers identified 88 active opioid/heroin users; 72 were screened as eligible, and 70 showed to the study intake/initial linkage meeting. Most participants were male (73%) and African American (94%), with an average age of 52.0 (sd=7.6). Nearly all (67/70, 96%) were admitted to methadone treatment; median time from initial linkage meeting to treatment admission was 2.6days. Most were still in treatment at 30 and 60days post-intake (69% and 70%, respectively). A high-risk sub-group was identified that had ever received naloxone for an opioid overdose; they had one third of the odds of being in treatment at 30days post-intake compared with others. The intervention model holds promise as an assertive method for identifying and engaging individuals with OUD into treatment.
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http://dx.doi.org/10.1016/j.jsat.2017.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808598PMC
March 2018

Judges' Perceptions of Screening, Assessment, Prevention, and Treatment for Substance Use, Mental Health, and HIV among Juveniles on Community Supervision: Results of a National Survey.

Juv Fam Court J 2017 09 1;68(3):5-25. Epub 2017 Sep 1.

Chestnut Health Systems, Chicago & Normal, IL.

Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) National Survey was funded in part to describe the current status of screening, assessment, prevention and treatment for substance use, mental health, and HIV for youth on community supervision within the US juvenile justice system. Surveys were administered to community supervision agencies and their primary behavioral healthcare providers, as well as the juvenile or family court judge with the largest caseload of youth on community supervision. This article presents the findings from the judges' survey. Survey results indicated juvenile and family court judges were open to innovations for improving the court's performance, rated their relationships with collaborators highly, and appreciated the impact of screening, assessment, prevention, and treatment on judicial practices.
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http://dx.doi.org/10.1111/jfcj.12094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734097PMC
September 2017

Linking Individuals with Substance Use Disorders (SUDs) in Primary Care to SUD Treatment: the Recovery Management Checkups-Primary Care (RMC-PC) Pilot Study.

J Behav Health Serv Res 2018 04;45(2):160-173

Lighthouse Institute, Chestnut Health Systems, 221 W. Walton, Chicago, IL, 60610, USA.

Linking individuals in primary care settings with substance use disorders (SUDs) to SUD treatment has proven to be challenging, despite the widespread use of Screening, Brief Intervention, and Referral to Treatment (SBIRT). This paper reports findings from a pilot study that examined the efficacy of the Recovery Management Checkups intervention adapted for primary care settings (RMC-PC), for assertively linking and engaging patients from Federally Qualified Health Centers into SUD treatment. Findings showed that patients in the RMC-PC (n=92) had significantly higher rates of SUD treatment entry and received more days of SUD treatment compared with those who receive the usual SBIRT referral (n=50). Receipt of RMC-PC had both direct and indirect effects, partially mediated through days of SUD treatment, on reducing days of drug use at 6 months post intake. RMC-PC is a promising intervention to address the need for more assertive methods for linking patients in primary care to SUD treatment.
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http://dx.doi.org/10.1007/s11414-017-9576-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871558PMC
April 2018

Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial.

Trials 2017 08 10;18(1):374. Epub 2017 Aug 10.

Center for Health Enhancement Systems Studies, Industrial and Systems Engineering Department, University of Wisconsin-Madison, Madison, WI, 53706, USA.

Background: Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs).

Methods/design: The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors.

Discussion: This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible.

Trial Registration: ClinicalTrials.gov, ID: NCT02132481 . Registered on 5 May 2014.
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http://dx.doi.org/10.1186/s13063-017-2096-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553728PMC
August 2017

The Juvenile Justice Behavioral Health Services Cascade: A new framework for measuring unmet substance use treatment services needs among adolescent offenders.

J Subst Abuse Treat 2017 03 31;74:80-91. Epub 2016 Dec 31.

Emory University, Rollins School of Public Health, 1518 Clifton Road, Room 570, Atlanta, GA 30322, United States. Electronic address:

Overview: Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies.

Methods And Results: This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade ("Cascade"), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse.

Conclusion: As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings. Clinical Trials Registration number - NCT02672150.
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http://dx.doi.org/10.1016/j.jsat.2016.12.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298399PMC
March 2017

Sensitivity and specificity of the gain short-screener for predicting substance use disorders in a large national sample of emerging adults.

Addict Behav 2017 05 6;68:14-17. Epub 2017 Jan 6.

Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61701, USA.

Background And Objectives: Emerging Adults (ages 18-25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener's (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18-25) substance use disorders.

Methods: We analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs.

Results: Analyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p<0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder.

Conclusions: The five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions.
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http://dx.doi.org/10.1016/j.addbeh.2017.01.013DOI Listing
May 2017

iSurvive: An Interpretable, Event-time Prediction Model for mHealth.

Proc Mach Learn Res 2017 ;70:970-979

Georgia Institute of Technology.

An important mobile health (mHealth) task is the use of multimodal data, such as sensor streams and self-report, to construct interpretable time-to-event predictions of, for example, lapse to alcohol or illicit drug use. Interpretability of the prediction model is important for acceptance and adoption by domain scientists, enabling model outputs and parameters to inform theory and guide intervention design. Temporal latent state models are therefore attractive, and so we adopt the continuous time hidden Markov model (CT-HMM) due to its ability to describe irregular arrival times of event data. Standard CT-HMMs, however, are not specialized for predicting the time to a future event, the key variable for mHealth interventions. Also, standard emission models lack a sufficiently rich structure to describe multimodal data and incorporate domain knowledge. We present iSurvive, an extension of classical survival analysis to a CT-HMM. We present a parameter learning method for GLM emissions and survival model fitting, and present promising results on both synthetic data and an mHealth drug use dataset.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430609PMC
January 2017

Synchronization of Clocks Through 12 km of Strongly Turbulent Air Over a City.

Appl Phys Lett 2016 10 11;109(15). Epub 2016 Oct 11.

National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA.

We demonstrate real-time, femtosecond-level clock synchronization across a low-lying, strongly turbulent, 12-km horizontal air path by optical two-way time transfer. For this long horizontal free-space path, the integrated turbulence extends well into the strong turbulence regime corresponding to multiple scattering with a Rytov variance up to 7 and with the number of signal interruptions exceeding 100 per second. Nevertheless, optical two-way time transfer is used to synchronize a remote clock to a master clock with femtosecond-level agreement and with a relative time deviation dropping as low as a few hundred attoseconds. Synchronization is shown for a remote clock based on either an optical or microwave oscillator and using either tip-tilt or adaptive-optics free-space optical terminals. The performance is unaltered from optical two-way time transfer in weak turbulence across short links. These results confirm that the two-way reciprocity of the free-space time-of-flight is maintained both under strong turbulence and with the use of adaptive optics. The demonstrated robustness of optical two-way time transfer against strong turbulence and its compatibility with adaptive optics is encouraging for future femtosecond clock synchronization over very long distance ground-to-air free-space paths.
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http://dx.doi.org/10.1063/1.4963130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769483PMC
October 2016

Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model.

Eval Rev 2015 Aug 14;39(4):395-427. Epub 2015 Aug 14.

Chestnut Health Systems Lighthouse Institute, Normal, IL, USA.

Background: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups.

Methods: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age.

Results: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both.

Conclusions: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.
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http://dx.doi.org/10.1177/0193841X15599645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591028PMC
August 2015

Comorbidity among female detainees in drug treatment: an exploration of internalizing and externalizing disorders.

Psychiatr Rehabil J 2015 Mar;38(1):35-44

College of Arts and Sciences, Loyola University Chicago.

Objective: The current study explored the prevalence and comorbidity of major internalizing and externalizing psychiatric disorders in a sample of female detainees participating in drug treatment programs in the nation's largest single-site jail, the Cook County (Chicago) Department of Corrections.

Methods: A total of 253 women participated in a Needs Inventory. The study incorporated an extensive combination of measures, which captured the women's demographic characteristics and psychological problems as well as their substance use and drug treatment histories and their criminal thinking tendencies. For the purpose of analyses, women were combined into 3 groups: women with substance use problems but no comorbid psychiatric disorders, women with 1 comorbid psychiatric disorder (either internalizing or externalizing), and women with both internalizing and externalizing disorders.

Results: More than 3/4 of the women were comorbid for another psychiatric (an internalizing or externalizing) disorder. Comorbid disorders were related to lower self-esteem, greater drug use severity, and higher levels of criminal thinking. For example, measures of reported histories of criminal activities and trauma exposure increased with comorbidity. The most critical variables in differentiating between female detainees with no and both internalizing and externalizing disorders were criminal thinking and exposure to trauma.

Conclusions: The women in the present investigation and other female detainees in drug treatment programs require interventions that focus on both criminal and psychiatric recidivism. These interventions are most effectively delivered in a person-focused recovery framework that provides integrated modules of services. (PsycINFO Database Record
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http://dx.doi.org/10.1037/prj0000134DOI Listing
March 2015

A Pilot Study to Examine the Feasibility and Potential Effectiveness of Using Smartphones to Provide Recovery Support for Adolescents.

Subst Abus 2015 13;36(4):486-92. Epub 2014 Oct 13.

b Chestnut Health Systems , Chicago , Illinois , USA.

Background: Smartphone applications can potentially provide recovery monitoring and support in real-time, real-life contexts. Study aims included determining feasibility of (a) adolescents completing ecological momentary assessments (EMAs) and utilizing phone-based ecological momentary interventions (EMIs); and (b) using EMA and EMI data to predict substance use in the subsequent week.

Methods: Twenty-nine adolescents were recruited at discharge from residential treatment, regardless of their discharge status or length of stay. During the 6-week pilot, youth were prompted to complete an EMA at 6 random times per day and were provided access to a suite of recovery support EMI. Youth completed 87% of the 5580 EMAs. Based on use in the next 7 days, EMA observations were classified into 3 risk groups: "Current Use" in the past 30 minutes (3% of observations), "Unrecognized Risk" (42%), or "Recognized Risk" (55%). All youth had observations in 2 or more risk groups and 38% in all 3. Youth accessed an EMI on average 162 times each week.

Results: Participants were 31% female, 48% African American, 21% Caucasian, 7% Hispanic, and 24% Mixed/Other; average age was 16.6 years. During the 90 days prior to entering treatment, youth reported using alcohol (38%), marijuana (41%), and other drugs (7%). When compared with the "Recognized Risk" group's use in the following week (31%), both the "Unrecognized Risk" (50%, odds ratio [OR]=2.08) and "Current Use" (96%, OR=50.30) groups reported significantly higher rates of use in the next week. When an EMI was accessed 2 or more times within the hour following an EMA, the rate of using during the next week was significantly lower than when EMIs were not accessed (32% vs. 43%, OR=0.62).

Conclusions: Results demonstrate the feasibility of using smartphones for recovery monitoring and support with adolescents, with potential to reduce use.
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http://dx.doi.org/10.1080/08897077.2014.970323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395503PMC
December 2016

The relationship between recovery and health-related quality of life.

J Subst Abuse Treat 2014 Oct 10;47(4):293-8. Epub 2014 Jun 10.

Chestnut Health Systems, Normal, IL 61761, USA.

Building upon recommendations to broaden the conceptualization of recovery and to assess its relationship with health-related quality of life (HRQoL), this study addressed three primary aims. These included: 1) testing the model fit of a hypothesized latent measure of recovery, 2) examining the extent to which this multidimensional measure of recovery was associated with concurrently measured HRQoL, and 3) examining the extent to which this multidimensional measure of recovery predicted changes in HRQoL during the subsequent year. Data were from 1,008 adults who completed follow-up assessments at 15 and 16 years post-intake. Confirmatory factor analysis indicated a good fit for a hypothesized recovery measure (CFI=.98; RMSEA=.06). Additionally, structural equation modeling suggested that this recovery measure was not only concurrently associated with HRQoL (β=.78, p<.001), but was also a significant predictor of changes in HRQoL during the subsequent year (β=.25, p<.001).
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http://dx.doi.org/10.1016/j.jsat.2014.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138291PMC
October 2014
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