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Background: Training in interoceptive awareness is a promising behavioral approach for improving substance use disorder (SUD) treatment. This study examined the longitudinal effects of Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's SUD treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation.Methods: Women in intensive outpatient treatment for SUD at three community clinics were recruited and randomly assigned to one of three study conditions Treatment as Usual (TAU) + MABT, TAU + Women's Health Education (WHE), and TAU only. Four assessments were delivered over one year (N = 187) baseline, 3, 6 and 12 months to examine primary outcome of percent days abstinent from substance use, and secondary outcomes of emotion dysregulation, craving, psychological distress, mindfulness and interoceptive awareness. Changes in outcomes across time were assessed using multilevel mixed effects linear regression.Results: Substance use improved significantly for MABT vs. TAU at 6 months and 12 months. Positive longitudinal effects on secondary outcomes for MABT were evident on respiratory sinus arrhythmia (RSA), a physiological index of emotion regulation; on craving; and on interoceptive awareness skills. Analyses based on participants who completed >75% of the intervention sessions revealed additional immediate significant improvements for MABT vs. TAU and WHE on depressive symptoms and emotion regulation difficulties and longitudinal improvement on mindfulness skills.Conclusions: Results show MABT to be efficacious for longitudinal health outcomes to support women's recovery as an adjunct to community-based SUD treatment. [ABSTRACT FROM AUTHOR]

Background: Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.Methods: This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.Results: Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).Conclusions: The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs. [ABSTRACT FROM AUTHOR]

Background: Drug use is an established risk factor for HIV. Brief Interventions (BIs) targeting reductions in both drug use and HIV risk behaviors may help curtail these related epidemics. The present study evaluates the impact of BIs for drug use and HIV risk reduction on sexual HIV risk behaviors among a primarily marijuana-using sample during a 12-month post-intervention follow-up period.Methods: We conducted a randomized controlled trial of 780 adult patients in an Emergency Department (ED) with past 3-month drug use (primarily non-injecting). This study used a 3 × 2 factorial design (3 ED-based conditions: computer-delivered brief intervention [Computer BI], therapist-delivered, computer-guided BI [Therapist BI], or enhanced usual care (EUC-ED) for drug-using adults; 2 follow-up conditions at 3 months: booster or control). This analysis examines the outcomes of the BIs on sexual HIV risk behaviors at 3-, 6-, and 12-months.Results: Compared to the enhanced usual care control, the combined Therapist BI with booster resulted in significant reductions in scores on the sexual risk subscale of the HIV Risk Taking Behaviour Scale over 12-months, when controlling for baseline sexual risk, gender, and drug dependency status. The baseline interventions alone, booster alone, and Computer BI plus booster did not differ from the comparison group (EUC plus control).Conclusions: A therapist-delivered BI for drug use and HIV risk behaviors, combined with a follow-up therapist-delivered booster, shows promise for reducing sexual HIV risk behaviors among a primarily marijuana using, non-injecting sample. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorders (AUDs) are highly prevalent among persons living with HIV (PLH) within the criminal justice system (CJS). Extended-release naltrexone (XR-NTX) has not been previously evaluated among CJS-involved PLH with AUDs.Methods: A randomized, double-blind, placebo-controlled trial was conducted among 100 HIV+ prisoners with AUDs. Participants were randomized 2:1 to receive 6 monthly injections of XR-NTX or placebo starting one week prior to release. Using multiple imputation strategies for data missing completely at random, data were analyzed for the 6-month post-incarceration period. Main outcomes included: time to first heavy drinking day; number of standardized drinks/drinking day; percent of heavy drinking days; pre- to post-incarceration change in average drinks/day; total number of drinking days; and a composite alcohol improvement score comprised of all 5 parameters.Results: There was no statistically significant difference overall between treatment arms for time-to-heavy-drinking day. However, participants aged 20-29 years who received XR-NTX had a longer time to first heavy drinking day compared to the placebo group (24.1 vs. 9.5days; p<0.001). There were no statistically significant differences between groups for other individual drinking outcomes. A sub-analysis, however, found participants who received ≥4 XR-NTX were more likely (p<0.005) to have improved composite alcohol scores than the placebo group. Post-hoc power analysis revealed that despite the study being powered for HIV outcomes, sufficient power (0.94) was available to distinguish the observed differences.Conclusions: Among CJS-involved PLH with AUDs transitioning to the community, XR-NTX lengthens the time to heavy drinking day for younger persons; reduces alcohol consumption when using a composite alcohol consumption score; and is not associated with any serious adverse events. [ABSTRACT FROM AUTHOR]

Background: Client language is hypothesized to be a mechanism of action in motivational interviewing (MI). Despite the association of change and sustain talk with substance treatment outcomes, it not known whether providers can intentionally influence this language as hypothesized.Objective: This is a randomized controlled trial to investigate whether substance use providers can be trained to influence client language.Methods: Treatment providers specializing in substance use disorders (n=190) were randomly assigned to standard training in MI (MI-AU) or training emphasizing an influence of client language (MI-LEAF). Treatment sessions with actual clients were evaluated 3, 6 and 12 months after training by masked raters. Frequencies of client change and sustain talk were the outcome variables.Results: Sustain talk, but not change talk, was significantly lower in clients whose providers had received the specialized training (b=-0.175, SE=0.087, p=0.046, CI[-0.348 to 0.002], d=-0.325). Mediation analyses supported a causal chain between a) training, b) providers' attempts to minimize sustain talk in treatment sessions via directive reflective listening and c) client sustain talk in the treatment session (κ2=0.0833, bootstrap SE=0.0394, 95% CI [0.0148, 0.1691]).Conclusions: With specialized training, providers can reduce the amount of opposition language their clients offer when considering a change in their substance use. Demonstrating that client language is under partial control of the provider supports the feasibility of clinical trials to investigate the impact of shaping client language on treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Although empirical evidence for the effectiveness of technology-mediated interventions for substance use disorders is rapidly growing, the role of baseline characteristics of patients in predicting treatment outcomes of a technology-based therapy is largely unknown.Method: Participants were randomly assigned to either standard methadone maintenance treatment or reduced standard treatment combined with the computer-based therapeutic education system (TES). An array of demographic and behavioral characteristics of participants (N=160) was measured at baseline. Opioid abstinence and treatment retention were measured weekly for a 52-week intervention period. Generalized linear model and Cox-regression were used to estimate the predictive roles of baseline characteristics in predicting treatment outcomes.Results: We found significant predictors of opioid abstinence and treatment retention within and across conditions. Among 21 baseline characteristics of participants, employment status, anxiety, and ambivalent attitudes toward substance use predicted better opioid abstinence in the reduced-standard-plus-TES condition compared to standard treatment. Participants who had used cocaine/crack in the past 30 days at baseline showed lower dropout rates in standard treatment, whereas those who had not used exhibited lower dropout rates in the reduced-standard-plus-TES condition.Conclusions: This study is the first randomized controlled trial, evaluating over a 12-month period, how various aspects of participant characteristics impact outcomes for treatments that do or do not include technology-based therapy. Compared to standard alone treatment, including TES as part of the care was preferable for patients who were employed, highly anxious, and ambivalent about substance use and did not produce worse outcomes for any subgroups of participants. [ABSTRACT FROM AUTHOR]

Background: School-based programs are the most convenient interventions to tackle substance use among youth. "Unplugged" is a Social Influence universal school curriculum developed and tested in the "EU-Dap" project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of "Unplugged" was evaluated through a cluster randomized controlled trial.Methods: The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use.Results: Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use.Conclusions: Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported. [ABSTRACT FROM AUTHOR]

Background: Few individuals hospitalized with Substance Use Disorder (SUD) complications participate in recovery support services after discharge. Peer recovery coaching represents one potential new method for promoting recovery.Methods: A six-month prospective randomized controlled trial compared outcomes between the standard of care and a physician-initiated recovery coaching intervention. The primary outcome measure was engagement in recovery support services, and the secondary outcome measures were substance use frequency and self-reported physical and mental health using the SF-12 survey. Participants (N = 98) were eligible if they were identified by a healthcare provider as having a SUD and were hospitalized due to SUD complications.Results: Engagement rate over the six-month post-discharge time period was higher for participants in the recovery coaching intervention (84 %, 95 % CI: 78%-91%) compared to the standard of care control condition (34 %, 95 % CI: 25 %-44 %), log OR = 28.59, p < .001. No overall group differences in substance use frequency (p = .80), self-reported physical (p = .69) or mental (p = .89) health were observed.Conclusion: An inpatient linkage to recovery coaching services improves engagement rates and can feasibly be implemented in a single-center inpatient service. This intervention is promising for promoting both short-term and long-term engagement in recovery support services. [ABSTRACT FROM AUTHOR]