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Latino immigrant men are at increased risk for unhealthy alcohol use, yet few interventions have been designed to meet their unique needs. The current study assessed participant satisfaction and acceptability of a culturally adapted brief intervention to reduce unhealthy alcohol use in this population. Adaptations to the brief intervention included delivering it in Spanish by promotores in a community setting. The mixed methods approach included surveys ( N = 73) and in-depth interviews ( N = 20) with participants in a pilot randomized controlled trial. The study drew on Sekhon's theoretical framework of acceptability to asses affective attitude, burden, and perceived effectiveness of the intervention, along with satisfaction with the content, setting, and promotor . Participants' survey responses indicated that they were highly satisfied with the content, setting, and delivery of the brief intervention. In interviews participants noted that the brief intervention helped them reflect on their drinking behaviors, that they perceived promotores to be a trusted source of health information, and that they liked receiving personalized feedback via tablets. Some participants found the feedback did not match their own perceptions of their alcohol use and wanted clearer advice on how to reduce their drinking. Men felt they would benefit from more contact with promotores . These findings suggest that Latino immigrant men in this study were receptive to the culturally adapted brief intervention. Future interventions may be more effective if they include multiple contacts with promotores and more directive guidance on strategies to reduce drinking.

Background: Patients with a substance use disorder (SUD) often present with co-occurring chronic conditions in primary care. Despite the high co-occurrence of chronic medical conditions and SUD, little is known about whether chronic condition outcomes or related service utilization in primary care varies between patients with versus without documented SUDs. This study examined whether having a SUD influenced the use of primary care services and common chronic condition outcomes for patients with diabetes, hypertension, and obesity., Methods: A longitudinal cohort observational study examined electronic health record data from 21 primary care clinics in Washington and Idaho to examine differences in service utilization and clinical outcomes for diabetes, hypertension, and obesity in patients with and without a documented SUD diagnosis. Differences between patients with and without documented SUD diagnoses were compared over a three-year window for clinical outcome measures, including hemoglobin A1c, systolic and diastolic blood pressure, and body mass index, as well as service outcome measures, including number of encounters with primary care and co-located behavioral health providers, and orders for prescription opioids. Adult patients (N = 10,175) diagnosed with diabetes, hypertension, or obesity before the end of 2014, and who had ≥2 visits across a three-year window including at least one visit in 2014 (baseline) and at least one visit occurring 12 months or longer after the 2014 visit (follow-up) were examined., Results: Patients with SUD diagnoses and co-occurring chronic conditions were seen by providers more frequently than patients without SUD diagnoses (p's < 0.05), and patients with SUD diagnoses were more likely to be prescribed opioid medications. Chronic condition outcomes were no different for patients with versus without SUD diagnoses., Discussion: Despite the higher visit rates to providers in primary care, a majority of patients with SUD diagnoses and chronic medical conditions in primary care did not get seen by co-located behavioral health providers, who can potentially provide and support evidence informed care for both SUD and chronic conditions. Patients with chronic medical conditions also were more likely to get prescribed opioids if they had an SUD diagnosis. Care pathway innovations for SUDs that include greater utilization of evidence-informed co-treatment of SUDs and chronic conditions within primary care settings may be necessary for improving care overall for patients with comorbid SUDs and chronic conditions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Community-university teams investigated substance use, abuse, and dependence (SUAD) and related concerns, needs, strengths, and resources in four Washington State Tribal communities. A total of 153 key community members shared their perspectives through 43 semi-structured interviews and 19 semi-structured focus groups. Qualitative data analysis revealed robust themes: prescription medications and alcohol were perceived as most prevalent and concerning; family and peer influences and emotional distress were prominent perceived risk factors; and SUAD intervention resources varied across communities. Findings may guide future research and the development of much needed strength-based, culturally appropriate, and effective SUAD interventions for American Indians, Alaska Natives, and their communities.

Background: Qualitative and quantitative data and participatory research approaches might be most valid and effective for assessing substance use/abuse and related trends in American Indian and Alaska Native (AIAN) communities., Method: Twenty-nine federally recognized AIAN tribes in Washington (WA) State were invited to participate in Health Directors (HD) interviews and State treatment admissions data analyses. Ten Tribal HD (or designees) from across WA participated in 30-60-minute qualitative interviews. State treatment admissions data from 2002 to 2008 were analyzed for those who identified with one of 11 participating AIAN communities to explore admission rates by primary drug compared to non-AIANs. Those who entered treatment and belonged to one of the 11 participating tribes (n = 4851) represented 16% of admissions for those who reported a tribal affiliation., Results: Interviewees reported that prescription drugs, alcohol, and marijuana are primary community concerns, each presenting similar and distinct challenges. Additionally, community health is tied to access to resources, services, and culturally appropriate and effective interventions. Treatment data results were consistent with interviewee-reported substance use/abuse trends, with alcohol as the primary drug for 56% of AIAN adults compared to 46% of non-AIAN, and other opiates as second most common for AIAN adults in 2008 with 15% of admissions., Limitations: Findings are limited to those tribal communities/community members who agreed to participate., Conclusion: Analyses suggest that some diverse AIAN communities in WA State share similar substance use/abuse, treatment, and recovery trends and continuing needs., Scientific Significance: Appropriate and effective research with AIAN communities requires respectful and flexible approaches.

Aims: To assess retention in methadone maintenance treatment for prescription-type opioid primary (PTOP) users compared to heroin users., Design and Participants: A retrospective cohort study was carried out to examine the association between opiate types used on 12-month retention. The study population consisted of adults admitted to one of 11 not-for-profit methadone maintenance clinics in 2004 and 2005 throughout Washington State (n = 2308). Logistic regression analyses with fixed effects for treatment agencies were conducted., Measurements: Opiate use type in past 30 days: any heroin use or primary prescription opioid without heroin use. Demographics, other drugs used, self-reported medical and psychiatric concerns, social, familial and legal issues, public assistance type and housing stability were documented at intake using a comprehensive biopsychosocial instrument, the Treatment and Assessment Reports Generation Tool., Findings: The odds of being retained in treatment for PTOP compared to heroin users not adjusting for other factors was 1.33 (95% confidence interval [CI], 1.03, 1.71). In the final logistic regression model the odds of retention for PTOP compared to heroin users was 1.25 (95% CI, 0.93, 1.67), indicating that there was no statistically significant difference in treatment retention by opiate type after adjusting for demographics, treatment agencies, other drug use, public assistance type, medical, psychiatric, social, legal and familial factors., Conclusion: The findings of this study suggest that PTOP can be treated at methadone maintenance treatment facilities at least as effectively as heroin users in terms of treatment retention.

Alcohol and drug abuse are major areas of concern for many American Indian=Alaska Native communities. Research on these problems has often been less than successful, in part because many researchers are not sensitive to the culture and traditions of the tribes and communities with which they are working. They alsooften fail to incorporate tribal customs, traditions, and values into the interventions developed to deal with substance abuse. The authors describe the use of community-based participatory research and tribal participatory research approaches to develop a culturally sensitive substance abuse prevention program for Native youth. This project, The Community Pulling Together: Healing of the Canoe, is a collaboration between the Suquamish Tribe and the Alcohol and Drug Abuse Institute at the University of Washington, Seattle, Washington.

The present study was designed to examine putative risk factors of driving anger, traffic citations, and traffic-related injuries as a function of gender. Participants included 785 (65% men) drivers identified by the Washington State Department of Licensing. Just over half of participants (55%) were identified as high-risk drivers based on multiple traffic violations, whereas 45% were recruited from a random sample of drivers. Participants completed a mailed survey assessing indicators of risky driving and risk factors including sensation seeking, stressful events, negative affect, tobacco use, and drinking behavior. Hierarchical regression analysis was used to evaluate risky driving outcomes as a function of theoretically prioritized risk factors and to evaluate gender as a moderator. Overall, men reported more traffic citations and injuries, but did not differ from women in reported driving anger. All putative risk factors were associated with one or more indicators of risky driving. Moderation results revealed that the positive relationship between drinking frequency and driving anger was stronger for women. In contrast, typical number of drinks consumed was negatively associated with driving anger, which was also more evident for women. In addition, the positive association between sensation seeking and number of traffic citations was stronger among women.

This study evaluated gender differences in baseline characteristics and treatment outcomes among 654 treatment seekers referred to state-funded drug treatment. Women were significantly less likely than men to enter treatment following referral, but not significantly less likely to complete treatment, once they entered. After adjustment for treatment dose, gender differences in substance use at followup (3-6 months after leaving the treatment wait list) were nonsignificant. The genders did not differ significantly in rates of psychosocial improvement between referral and followup. Women waited significantly longer than men before leaving the treatment wait list (with or without treatment entry), but wait time was associated with entry rates only among men. The authors discuss system-level and personal characteristics that potentially affect wait times and call for additional study of whether abbreviating waits can increase women's treatment entry rates.

This study of persons referred to publicly funded drug-free substance abuse treatment in Washington State compares 122 primary heroin users (those specifying heroin as a drug of choice) with 532 persons who preferred other substances. Information on treatment entry and completion was obtained through review of client charts at the referral agency. Follow-up interviews with 587 participants provided self-reports of substance use during a 90-day period 3-6 months following removal from the treatment waitlist. Primary heroin users were significantly less likely than others to enter the treatment programs to which they were referred. Among treatment entrants, primary heroin users were somewhat less likely than other users to complete inpatient programs but no less likely to complete outpatient programs. The heroin preference group reported less abstinence and greater frequency of use during the follow-up period than did other users, patterns that almost entirely coincided with the lower treatment compliance in the heroin group. The authors note the importance of investigating methods for increasing treatment entry rates for opiate users who desire drug-free treatment.

This study evaluated the relative effectiveness of two forms of publicly funded substance abuse treatment provided in Washington State: The full continuum (FC), in which clients receive approximately three weeks of inpatient treatment prior to outpatient care, and the partial continuum (PC), in which clients are admitted directly to outpatient treatment. Data on treatment process/proximal outcomes, such as psychological distress and readiness to change, were assessed at 8 weeks post intake, and data on treatment services received were obtained at 2, 4, 8, and 12 weeks. Multidimensional outcomes, including alcohol and drug use as well as a number of psychosocial functioning outcomes, were assessed at 3 and 9 months post intake. Results indicated that clients in the FC had greater alcohol, drug, and legal problem severity at intake than those in the PC, whereas medical and employment problem severity was greater in the PC. Clients in the FC received more treatment services in the first 2 weeks than those in the PC, but there were no differences at subsequent points. Outcome analyses at 3 and 9 months indicated that clients in the FC had greater improvements in alcohol, drug, and psychiatric severity than those in the PC. Matching analyses indicated that clients with greater substance-use severity at baseline improved to a greater degree in the FC as compared to the PC. Matching effects were not obtained with medical or psychiatric severity, or readiness to change.