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This trial assessed whether behavioral treatment improves outcome during a 26-week outpatient opioid detoxification. Thirty-nine opioid-dependent adults were assigned randomly to a buprenorphine dose-taper combined with either behavioral or standard treatment. Behavioral treatment included (a) a voucher incentive program for providing opioid-free urine samples and engaging in verifiable therapeutic activities and (b) the community reinforcement approach, a multicomponent behavioral treatment. Standard treatment included lifestyle counseling. Fifty-three percent of the patients receiving behavioral treatment completed treatment, versus 20% receiving standard treatment. The percentage of patients achieving 4, 8, 12, and 16 weeks of continuous opioid abstinence were 68, 47, 26, and 11 for the behavioral group and 55, 15, 5, and 0 for the standard group, respectively. Behavioral treatment improved outcomes during outpatient detoxification.

This study evaluated preferences for various clinic privileges, retail items, and social activities for use in an outpatient opioid dependence treatment program. Fifty-three opioid-dependent patients who received treatment with buprenorphine for at least 30 days rank ordered 11 clinic privileges, 19 retail items, and 8 social activities from the most desirable (a rank of 1) to the least desirable (a rank equal to the number of items in that category). Additional questions determined preference for counseling frequency and dosing levels. The top three mean rankings for clinic privileges were $50 cash for opioid-negative urines (2.8), take-home doses of buprenorphine (3.6), and voucher points for opioid-negative urines (4.7). The top three mean rankings for retail items were restaurant gift certificates (4.1), movie passes (4.9), and videotape movie and player rentals (6.8). The top three mean rankings for social activities were movies (2.4), barbecues (3.8), and hiking trips (4.3). There was no preference reported for increases or decreases in counseling frequency. Seventy-four percent of subjects preferred to increase their buprenorphine dose by an average of 60.84% independent of their present dose. Consistent with previous findings from methadone treatment, cash payments for opioid-negative urines and take-home medication were the highest ranked clinic privileges. These results suggest that various retail items and social activities may also be useful for reinforcing positive treatment outcomes during outpatient opioid treatment. Keywords - contingency management; buprenorphine; human; opiod dependence; reinforcer.

Patients with transthyretin amyloid polyneuropathy (ATTR‐PN) show decreased motor and sensory nerve amplitudes and conduction. Electrophysiological changes over time may be sensitive indicators of progression. This analysis from the Transthyretin Amyloidosis Outcomes Survey (THAOS) assessed longitudinal changes in nerve conduction as signals of neurologic disease progression in patients with hereditary ATTR (ATTRv) amyloidosis. Patients with ATTRv in THAOS with recorded nerve conduction values were included (data cut‐off: January 6, 2020); changes in nerve amplitude and velocity over time were assessed. Patients (n = 1389) were 45.0% male; 80.4% were the Val30Met (p.Val50Met) genotype. Mean (SD) age at enrollment was 43.6 (14.5) years; duration of symptoms was 9.3 (6.4) years. Median (10th, 90th percentile) sural nerve amplitude and velocity was 18.0 (4.9, 35.0) μV and 50.7 (41.0, 57.9) m/s; peroneal conduction was 13.0 (4.4, 27.0) μV and 51.0 (41.7, 59.7) m/s, respectively. Median (10th, 90th percentile) percentage change from baseline in sural nerve amplitude was variable, but generally decreased over time from −7.4 (−43.2, 52.4) at year 1 to −14.4 (−76.9, 46.7) at year 8. Percent change from baseline in sural nerve velocity declined similarly: −0.1 (−14.5, 15.3) at year 1 and − 6.4 (−21.3, 10.5) at year 8. The decline was more pronounced in patients with greater disability at baseline. Similar patterns were observed for the peroneal nerve. These data show an association between nerve amplitudes and velocities and disease severity, suggesting progressive deterioration in nerve conduction may be an indicator of ATTRv amyloidosis disease progression. [ABSTRACT FROM AUTHOR]

Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in a public clinic., Distribution location is an important factor in promoting the taking of condoms in a public clinic, according to a study at the University of Vermont's Substance Abuse Treatment Center. Drug abuse treatment programs can help lower high-risk sexual behavior in drug users through the promotion of condom use. The influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic were examined by this study. During a period of 6 months, condoms were made available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not influence the taking of condoms.

Background: Impulsivity is associated with substance use; however, to date, impulsivity has not been characterized among a sample of homeless, non-treatment seeking, substance-dependent men who have sex with men (MSM). Objectives: The aim of this study was to utilize the delay-discounting instrument to assess impulsive behaviors among a subsample of homeless, non-treatment seeking, substance-dependent men who have sex with men (S-D MSM) enrolled in a randomized, controlled, contingency management (CM) trial. Methods: Twenty S-D MSM participants from the CM parent study were matched on age and ethnicity to 20 non-substance-dependent, non-homeless control participants using propensity scores ( N == 40) and were administered the delay-discounting procedure. Results: Although discounting values decreased rapidly with time in both groups, the S-D MSM participants consistently discounted rewards more steeply than controls ( p == .05), particularly at all intermediate measured timeframes. The S-D MSM participants also presented greater median discounting rates ( k values) compared with the control group (mS-D MSM == 2.39 (SD == 3.72) vs. mctrl == 1.27 (SD == 3.71), p ≤≤ .01). Conclusion: This work extends existing findings of increased delay-discounting among substance-dependent individuals to homeless, substance-dependent, non-treatment seeking MSM. Scientific Significance: A better understanding of the prevalence of delay-discounting type behaviors among homeless, substance-dependent MSM can be used to inform the development of tailored substance abuse interventions for this high-risk population. [ABSTRACT FROM AUTHOR]

Eight opioid-dependent individuals were maintained on daily sublingual buprenorphine (8 mg) for 28 days and assigned randomly to one of two outpatient detoxification schedules under double-blind, double-dummy conditions. The two detoxification schedules were buprenorphine gradual (36 days; N = 3) or buprenorphine rapid (12 days; N = 5). Outcome variables were subject- and observer-ratings of opioid withdrawal, treatment retention and illicitopioid use. Outcome measures were similar for the two groups during buprenorphine maintenance. Increases in subject-rated opioid withdrawal and illicit-opioid use, and a drop in treatment retention occurred during rapid detoxification. Stable subject-rated opioid withdrawal and treatment retention, and less illicit-opioid use occurred during gradual detoxification. These data suggest that gradual reduction in buprenorphine dose is likely to produce superior treatment outcomes than more rapid buprenorphine detoxification. [ABSTRACT FROM PUBLISHER]