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BACKGROUND: Drug, alcohol, and tobacco use among adolescents pose significant short- and long-term health consequences and are associated with more severe use as adults. Screening, brief intervention, and referral to treatment in primary care settings has the potential to deliver preventive interventions to a diverse range of adolescents, but optimal implementation of these services needs to be determined. The purpose of this study was to compare implementation of two different SBIRT service delivery models in primary care settings. METHODS: This cluster-randomized trial assigned 7 primary care clinics of a federally qualified health center to implement brief interventions (BI) using a Generalist model (4 sites), in which BIs were delivered by the primary care provider (PCP), or a Specialist model (3 sites), in which BIs were delivered by a behavioral health counselor (BHC) for adolescent patients ages 12–17 years. Implementation was tracked through the clinic’s electronic health record, spanning 9,639 clinic visits over 20 months. Multilevel logistic regression modeling was used to compare Generalist and Specialist strategies on penetration of BI for patients scoring ≥2 on the CRAFFT substance use screen, delivered by the PCP in the Generalist sites, and via warm hand-off to a BHC in the Specialist sites. RESULTS: Approximately 62% of adolescent patient visits were screened with the CRAFFT (with

OBJECTIVE: This study analyzed the marginal service and program costs, and conducted a cost-effectiveness analysis (CEA) of two models of implementation of adolescent substance screening, brief intervention, and referral to treatment (SBIRT). METHOD: SBIRT was implemented at seven clinics in a multisite, cluster-randomized trial, through a Specialist model (behavioral health counselor–delivered brief intervention), and a Generalist model (primary care provider–delivered brief intervention). The CEA calculated marginal costs using an activity-based costing methodology for direct SBIRT services, and effectiveness was measured by the proportion of brief interventions delivered among patients who screened positive for alcohol, tobacco, or other drugs. Site-level program costs comprised start-up and maintenance (training and technical assistance). Costs were estimated in 2017 U.S. dollars. RESULTS: The marginal cost of SBIRT per patient with a positive screen for brief intervention was $6.72 in the Specialist model and $6.05 in the Generalist model. Implementation effectiveness was 7.2% (SE = 2.9%) in the Specialist model and 37.7% (SE = 5.6%) in the Generalist model. The program costs to provide SBIRT for 1 year per site were $13,548 for the Specialist site and $12,081 for the Generalist. CONCLUSIONS: The Generalist model was more effective in implementing brief intervention and less expensive than the Specialist model. Results were robust to sensitivity analysis. Brief intervention delivered by primary care providers rather than by handoff to a behavioral health counselor may ensure greater penetration and a lower cost of these services in primary care settings.

INTRODUCTION Adolescent illicit drug, tobacco, and alcohol use can result in sudden and long-term negative health consequences. Primary care environments present the optimal opportunity for screening and brief interventions that target prevention and curtailing use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a service delivery method that could potentially be well-integrated into primary care settings and used to serve a high volume of adolescents. Methods: This qualitative analysis of clinic staff interviews (N = 20), collected during a large cluster-randomized trial to implement two models of adolescent SBIRT, examined barriers and facilitating factors to overall acceptability of SBIRT. This study was conducted in a large, urban Federally Qualified Health Center (FQHC) at 7 sites throughout Baltimore City, Maryland, USA. Participants from each clinic included a range of various roles and responsibilities including: medical assistants (n = 3), nurses (n = 3), primary care providers (n = 4), behavioral health counselors (n = 4), and administrators (n = 6). Results: Results indicate both barriers and facilitating factors for acceptability of SBIRT in terms of (1) universal screening, (2) provider time demands, (3) behavioral health collaboration, and (4) behavioral health caseloads. Discussion: Universal screening was acceptable to participants across organizational roles, but brief interventions and referrals to treatment were found substantially less acceptable.

OBJECTIVE: Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model. METHOD: SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used. RESULTS: The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement. CONCLUSIONS: The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.

System dynamics (SD) modeling is used to compare and contrast strategies for effective implementation of an evidence-based adolescent behavioral health treatment in primary care settings. With qualitative and quantitative data from an on-going cluster-randomized trial in 7 federally qualified health center sites, two implementation conditions were compared: generalist vs. specialist. In the generalist approach, the primary care provider (PCP) delivered brief intervention (BI) for substance misuse (n = 4 clinics). In the specialist approach, BIs were delivered by behavioral health counselors (BHCs) (n = 3 clinics). The resultant SD model compared ‘basecase’ dynamics to strategic approaches to deploying continuous technical assistance (TA) and performance feedback reporting (PFR). The basecase effectively represented the SBIRT intervention, which reflected actual monthly volume of adolescent primary care visits (N = 9639), screenings (N = 5937), positive screenings (N = 246), and brief interventions (BIs; N = 50) over the 20-month implementation period. Insights gained suggest that implementation outcomes are sensitive to frequency of PFR, with bimonthly events generating the most rapid and sustained screening results. Simulated trends indicated that availability of the BHC directly impacts success of the specialist model. Similarly, understanding PCPs’ perception of severity of need for intervention is key to outcomes in either condition.

During the course of our research on the lead optimisation of the NBTI (Novel Bacterial Type II Topoisomerase Inhibitors) class of antibacterials, we discovered a series of tricyclic compounds that showed good Gram-positive and Gram-negative potency. Herein we will discuss the various subunits that were investigated in this series and report advanced studies on compound 1 (GSK945237) which demonstrates good PK and in vivo efficacy properties.

Purpose The American Academy of Pediatrics recommends screening adolescents for substance use at all well-child and appropriate acute-care visits. However, many pediatric practices aim for such screenings annually at well-child visits. Methods As part of a larger study, 7 urban Federally Qualified Health Center clinics implemented universal screening for risky alcohol and drug use using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. The present study compared uptake of screening and screening results at well-child versus acute-care visits. Results Over a period of 13 months for which encounter-level electronic medical records data were available, there were 6,346 clinic visits by 3,475 unique patients aged 12–17 years, at which 76.6% (n = 4,865) of visits had a screening for problematic substance use conducted. Rates of screening were 95.1% (2,750/2,891 involving 2,629 unique adolescents) for well-child visits and 61.2% (2,115/3,455 involving 1,535 unique adolescents) for acute-care visits. Rates of positive screening results were 9.0% (248/2,750 involving 245 unique adolescents) for well-child visits and 7.8% (164/2,115 involving 126 unique adolescents) for acute-care visits. Of the 469 unique adolescents screened only during an acute-care visit during that same period, 40 unique adolescents had positive screening results for a positive screening rate of 8.5%. Conclusions Nearly 10% of adolescent patients screened only at acute-care visits would not have been screened if screening was implemented solely at well-child visits, and 40 adolescents reporting substance use would have been missed. The findings highlight the benefits of screening adolescents at every primary care visit to better detect and intervene in adolescents' substance use.

[Image: see text] RIP2 kinase was recently identified as a therapeutic target for a variety of autoimmune diseases. We have reported previously a selective 4-aminoquinoline-based RIP2 inhibitor GSK583 and demonstrated its effectiveness in blocking downstream NOD2 signaling in cellular models, rodent in vivo models, and human ex vivo disease models. While this tool compound was valuable in validating the biological pathway, it suffered from activity at the hERG ion channel and a poor PK/PD profile thereby limiting progression of this analog. Herein, we detail our efforts to improve both this off-target liability as well as the PK/PD profile of this series of inhibitors through modulation of lipophilicity and strengthening hinge binding ability. These efforts have led to inhibitor 7, which possesses high binding affinity for the ATP pocket of RIP2 (IC(50) = 1 nM) and inhibition of downstream cytokine production in human whole blood (IC(50) = 10 nM) with reduced hERG activity (14 μM).

Purpose The American Academy of Pediatrics recommends substance use screening in adolescent primary care. Many studies of substance use prevalence and screening tool validation are conducted under research protocols that differ from routine clinical screening in context, consequences, and privacy implications. Methods This study is a secondary analysis drawing from two projects focused on adolescent primary care patients, aged 12–17, conducted nearly contemporaneously in a Federally Qualified Health Center system. The first project conducted anonymous research interviews with patients (N = 525), while the other tracked routine clinical screening as part of a larger service implementation project (N = 5,971). Both projects assessed substance use with the CRAFFT screening tool. Results Rates of substance use disclosure and substance use problems were over three and four times higher, respectively, in the anonymous research interview sample compared to rates found in routine clinical screening (p values Conclusions Routine clinical screening may underestimate substance use among adolescents.

Background Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. Methods This study protocol is a multi-site, cluster randomized trial ( N =7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. Discussion The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.

Introduction The Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative seeks an in vitro test to accurately predict clinical Torsades de Pointes (TdP). We developed a cardiotoxicity assay incorporating simultaneous measurement of the action potential (AP) waveform and Ca 2 + transient (CT) in human iPSC-derived cardiomyocytes (CMs). Concurrent optogenetic pacing provided a well-controlled electrophysiological background. Methods We used the Optopatch platform for all-optical electrophysiology (Hochbaum et al., 2014). In a monolayer culture, a subset of cells expressed a genetically encoded, calcium and voltage reporter, CaViar (Hou, Kralj, Douglass, Engert, & Cohen, 2014), while others expressed a channelrhodopsin variant, CheRiff. Optical pacing of CheRiff-expressing cells synchronized the syncytium. We screened 12 compounds (11 acute, 1 chronic) to identify electrophysiological (AP rise time, AP50, AP90, beat rate) and CT effects in spontaneously beating and paced cultures (1 Hz, 2 Hz). Results CaViar reported spontaneous and paced APs and CTs with high signal-to-noise ratio and low phototoxicity. Quinidine, flecainide, E-4031, digoxin and cisapride prolonged APs, while verapamil and nifedipine shortened APs. Early after depolarizations (EADs) were elicited by quinidine, flecainide and cisapride. All but four compounds (amiodarone, chromanol, nifedipine, verapamil) prolonged AP rise time. Nifedipine and verapamil decreased CT amplitude, while digoxin increased CT amplitude. Pentamidine prolonged APs after chronic exposure. Discussion The Optopatch platform provides a robust assay to measure APs and CTs in hiPSC-CMs. This addresses the CiPA mandate and will facilitate comparisons of cell-based assays to human clinical data.

Obtaining data on attitudes toward buprenorphine and methadone of opioid-dependent individuals in the United States may help fashion approaches to increase treatment entry and improve patient outcomes.This secondary analysis study compared attitudes toward methadone and buprenorphine of opioid-dependent adults entering short-term buprenorphine treatment (BT) with opioid-dependent adults who are either entering methadone maintenance treatment or not entering treatment.The 417 participants included 132 individuals entering short-term BT, 191 individuals entering methadone maintenance, and 94 individuals not seeking treatment. Participants were administered an Attitudes toward Methadone scale and its companion Attitudes toward Buprenorphine scale. Demographic characteristics for the three groups were compared using χ(2) tests of independence and one-way analysis of variance. A repeated-measures multivariate analysis of variance with planned contrasts was used to compare mean attitude scores among the groups.Participants entering BT had significantly more positive attitudes toward buprenorphine than toward methadone (p.001) and more positive attitudes toward BT than methadone-treatment (MT) participants and out-of-treatment (OT) participants (p.001). In addition, BT participants had less positive attitudes toward methadone than participants entering MT (p.001).Participants had a clear preference for a particular medication. Offering a choice of medications to OT individuals might enhance their likelihood of entering treatment. Treatment programs should offer a choice of medications when possible to new patients, and future comparative effectiveness research should incorporate patient preferences into clinical trials.These data contribute to our understanding of why people seek or do not seek effective pharmacotherapy for opioid addiction.

Longer tenure in methadone treatment has been associated with positive outcomes such as reductions in drug use and crime, HIV seroconversion, and overdose death.Retention in treatment was examined for 351 opioid-dependent individuals who had been newly admitted to one of six methadone programs in Baltimore, Maryland. Cox proportional hazards regression was used to predict number of days retained in treatment to 90 days from baseline ASI Composite scores and Treatment Motivation scales. A second analysis predicted days in treatment to 365 days using the same baseline variables plus 3-month Motivation scales, Patient Satisfaction scales, and methadone dose in the 248 individuals who had remained in treatment at least 3 months. Analyses held constant gender, race, age, whether participants had a history of regularly smoking cocaine, whether participants were on parole/probation, and program site.Retention at 90 days was predicted by female gender, and greater baseline Treatment Readiness (p=.005) but lower Desire for Help (p=.010). Retention at 365 days was predicted by higher baseline ASI Medical Composite scores (p=.037) and lower Legal Composite scores (p=.039), higher 3-month Treatment Satisfaction scores (p=.008), and higher dose (p=.046).Greater satisfaction with treatment at 3 months was a significant predictor of retention at 12 months, indicating the importance of understanding the role satisfaction plays in determining retention. Greater severity of legal problems was associated with shorter retention, suggesting that program efforts to increase services to criminal justice patients (e.g., legal counseling) may constitute a useful addition to treatment.

Despite findings that opioid detoxification serves little more than a palliative function, few patients who enter detoxification subsequently transition to long-term treatment. The current study evaluated intensive role induction (IRI), a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment. IRI was delivered either alone or combined with case management (IRI+CM) to determine the capacity of each condition to enhance transition and engagement in long-term treatment of detoxification patients. Study participants were 240 individuals admitted to a 30-day buprenorphine detoxification delivered at a publicly-funded outpatient drug treatment clinic. Following clinic intake, participants were randomly assigned to IRI, IRI+CM, or standard clinic treatment (ST). Outcomes were assessed in terms of adherence and satisfaction with the detoxification program, detoxification completion, and transition and retention in treatment following detoxification. Participants who received IRI and IRI+CM attended more counseling sessions during detoxification than those who received ST (both p’s < .001). IRI, but not IRI+CM participants, were more likely to complete detoxification (p = .017), rated their counselors more favorably (p = .01), and were retained in long-term treatment for more days following detoxification (p = .005), than ST participants. The current study demonstrates that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.

The concern that addiction treatment be grounded in science has been recognized and enthusiastically endorsed in both the clinical and research communities. With recognition of the gap between knowledge development and application, there has been a recent emphasis on developing strategies for more effective application, i.e., for the incorporation of evidence-based practice in routine clinical programming. This has translated to a need to develop strategies designed to achieve organizational change and a field of study whose objective is to better understand how to expedite change in treatment organizations and their clinical practices. This paper focuses on the roles and responsibilities of researchers, practitioners, and the federal government in achieving changed practice and applying new knowledge to improve treatment. Even though great strides have been made to shift the emphasis from dissemination of knowledge to its application, much still remains to be done in the development and testing of additional application strategies specific to the substance abuse treatment field. Future considerations for implementation research are discussed.

The majority of opioid-dependent individuals in the US in need of drug treatment are not receiving it. It would be useful to understand the characteristics of individuals entering and failing to enter methadone treatment.Participants were opioid-dependent adults in Baltimore Maryland recruited from new admissions to one of six methadone treatment programs (n=351) and from the streets from among non-treatment seekers (n=164). At study enrollment, participants were administered the Addiction Severity Index, AIDS Risk Assessment, Community Assessment Inventory, Attitudes toward Methadone Scale, Motivation for Treatment Scale and a urine drug test. A series of logistic regression analyses were conducted to determine the best model to predict treatment entry.The final logistic regression analysis showed that predictors of treatment entry included: being African-American, being on parole or probation, having lower rates of self-reported cocaine use and criminal activity, higher employment functioning, and greater perceptions of support from family and community for behavioral change. In addition, in-treatment participants were more likely to have a more extensive prior history of drug abuse treatment, greater desire to seek help in coping with their drug problem, and more positive view of methadone.The distinctions between those entering and those not pursuing MTP entry have significance for the structure of outreach programs and reaffirm the need to supplement the current practices of voluntary and coerced treatment entry with one of encouraged treatment entry through outreach.

Patient satisfaction surveys, widely used in health care delivery systems, may provide useful data for improving patient retention and outcomes.This study examined the relationship between methadone patients' treatment satisfaction at three months post-admission and their 3-month treatment outcomes and 12-month treatment retention.New methadone treatment admissions (N = 283) were assessed at 3 months post-admission for satisfaction with their counselors and programs. Correlations examined the relationship between 3-month satisfaction and Addiction Severity Index (ASI) scores. Regression analysis assessed the relationship between satisfaction and drug testing at 3 months and was used to predict whether participants were retained in treatment at 12 months.Participants who were more satisfied with their counselors and programs had lower Drug and Legal ASI composite scores at 3 months. Participants who were more satisfied with their programs remained in treatment for at least 12 months.Treatment programs should consider administering the CEF to their patients at 3 months post-admission to identify patients with low satisfaction scores who may be at risk for prematurely leaving treatment.Measuring patient satisfaction during treatment may help programs meet patients' needs and improve retention.

The synthesis and evaluation of tetrasubstituted aminopyridines, bearing novel azaindazole hinge binders, as potent AKT inhibitors are described. Compound 14c was identified as a potent AKT inhibitor that demonstrated reduced CYP450 inhibition and an improved developability profile compared to those of previously described trisubstituted pyridines. It also displayed dose-dependent inhibition of both phosphorylation of GSK3beta and tumor growth in a BT474 tumor xenograft model in mice.

This study examined the uses of diverted methadone and buprenorphine among opiate-addicted individuals recruited from new admissions to methadone programs and from out-of-treatment individuals recruited from the streets. Self-report data regarding diversion were obtained from surveys and semi-structured qualitative interviews. Approximately 16% (n = 84) of the total sample (N = 515) reported using diverted (street) methadone two-three times per week for six months or more, and for an average of 7.8 days (SD = 10.3) within the past month. The group reporting lifetime use of diverted methadone as compared to the group that did not report such use was less likely to use heroin and cocaine in the 30 days prior to admission (ps.01) and had lower ASI Drug Composite scores (p.05). Participants in our qualitative sub-sample (n = 22) indicated that street methadone was more widely used than street buprenorphine and that both drugs were largely used as self-medication for detoxification and withdrawal symptoms. Participants reported using low dosages and no injection of either medication was reported.

Longer retention in drug abuse treatment is associated with better patient outcomes, and research indicates the first 12 months of methadone treatment are critical to patient success. Nevertheless, large-scale multisite longitudinal studies over the past three decades indicate that the majority of patients drop out during the first year of methadone treatment. Through an examination of 42 qualitative interviews with patients prematurely discharged from six methadone treatment programs in Baltimore, this study highlights factors patients describe as contributing to their reasons for being discharged within the first 12 months of the treatment. The two most consistent themes are program-related factors and incarceration. The former factors are richly described through patients' words and underscore the ways in which patients' perceptions of control exerted by the program and by the medication and misunderstandings of program structure can lead to premature discharge. Patients' reasons for discharge were compared to counselors' reasons as indicated in discharge summary forms. An analysis of the patterns of agreement and disagreement are presented. Patient-centered program and policy implications are discussed.

This study examined whether Motivational Interviewing (MI), found effective with voluntary entrants to drug treatment, would improve intrinsic motivation and treatment retention among drug court probationers. Probationers were randomly assigned to receive either a two-session MI intervention or a two-session Drug Education (DE) intervention preceding drug-free outpatient counseling. Participants who received MI (n = 72) did not differ from participants who received DE (n = 68) nor from participants who did not attend either MI or DE sessions (n = 56) on changes in motivation during the first month of treatment or in treatment retention. Baseline motivation was inversely related to time in treatment; however, motivation after one month of treatment, and change in motivation from baseline to one month, were independently and positively related to treatment retention.

Despite evidence supporting the efficacy of buprenorphine relative to established detoxification agents such as clonidine, little research has examined: 1) how best to implement buprenorphine detoxification in outpatient settings; and 2) whether extending the length of buprenorphine detoxification improves treatment engagement and outcomes.The current study examined the impact on 1) successful detoxification completion; 2) transition to longer-term treatment; and 3) treatment engagement of two different length opioid detoxifications using buprenorphine.The study compared data obtained from two consecutive studies of early treatment engagement strategies. In one study (n = 364), opioid-addicted participants entered treatment through a Brief (5-day) buprenorphine detoxification. In the other study (n = 146), participants entered treatment through an Extended (i.e., 30-day) buprenorphine detoxification.Results indicated a greater likelihood of successful completion and of transition among participants who received the Extended as compared to the Brief detoxification. Extended detoxification participants attended more counseling sessions and submitted fewer drug-positive urine specimens during the first 30 days of treatment, inclusive of detoxification, than did Brief detoxification participants.Results demonstrate that longer periods of detoxification improve participant engagement in treatment and early treatment outcomes.Current findings demonstrate the feasibility of implementing an extended buprenorphine detoxification within a community-based treatment clinic.

The high cost of incarceration and a general confidence in the effectiveness of drug abuse treatment have led many states to adopt community-based drug abuse treatment as part of, or as an alternative to, incarceration. Community re-entry and aftercare have therefore received increasing attention from both practitioners and researchers. This article examines possibilities for encouraging change in both adult and juvenile justice treatment. Four issues are highlighted: (1) relapse and aftercare, (2) co-occurring disorder, (3) juvenile justice programming, and (4) women's treatment. The success of U.S. drug treatment policy depends on a capacity to resolve these and related issues.

The purpose of this project was to identify the relationships between various fitness parameters such as upper body muscular endurance, upper and lower body strength, flexibility, body composition and performance on an ability test (AT) that included simulated firefighting tasks. A second intent was to create a regression model that would predict firefighter performance on the test. Thirty-eight experienced firefighters performed the AT and underwent assessments for the fitness parameters. Multiple regression analyses indicated that variation in the fitness parameters explained a significant, F(6, 36) = 6.31, p.001, proportion (55%) of the variation observed in the AT. The results demonstrated that upper muscular strength and endurance as well as low body composition were significantly related (p.01) to better performances on the simulated firefighting tasks. Variables such as low back and hamstring flexibility, upper and lower body strength, and body composition may contribute significantly to the model's predictive power.

Locating and recruiting out-of-treatment drug-dependent individuals for inclusion in research studies are important and challenging tasks. Targeted sampling, a technique to reach such populations, has been described in the substance abuse literature. However, this literature has generally lacked a recent detailed account of the procedures for planning and implementing targeted sampling. This article provides a review of the literature of targeted sampling in drug abuse studies and a detailed description of methodology employed in our ongoing study of entry and engagement among opioid-dependent individuals in Baltimore, Maryland. Findings indicate that the out-of-treatment samples recruited from the streets are quite similar to those recruited from new admissions to opioid treatment programs, except for their prior treatment experience. This article indicates that targeted sampling can be useful in an urban setting with pervasive drug use.

Argument is made for the importance of conducting a national treatment evaluation to permit understanding of the nature and effectiveness of typical treatment programming. Only through such study can we hope to learn areas of success and failure of normative programming relative to population characteristics and treatment strategies, and the extent to which research-based initiatives have been adopted by the field. That information is central to efforts to draw up a research agenda appropriate to the needs of clients and the staffs responsible for their treatment, and to clarify and respond to gaps in the application of potentially useful treatment components. In spite of such need, our understanding of typical treatment programming and of its effectiveness is based on data collected from a treatment cohort of 20 years ago, although patterns of drug use, characteristics of clients, and the treatment components available have all undergone substantial change. The responsibility taken to provide such information to the field, once seen as a central task of research, needs to be reasserted to strengthen and support our treatment efforts.

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability.

A measure assessing client views of the community supports available to them was developed and tested with entrants to outpatient drug free treatment. Items for a Community Assessment Inventory (CAI) fell into four areas of potential social support for treatment entry and engagement: (1) partner and/or family with whom living; (2) family living outside the home; (3) friends; and (4) the community itself. Based on 241 study participants, it was found that internal consistency alphas for the four scales ranged between .79 and .88. Both total CAI score and individual scales assessing support from friends and from partner/spouse were found capable of predicting treatment readiness as assessed using the TCU Motivation Scale. Evidence of construct validity was suggested by differences in CAI total score between participants reporting and not reporting involvement in discussions with others regarding crime and regarding drugs. Findings are also provided regarding leisure time activities and social relations of treatment entrants.

Retention in outpatient drug-free treatment is poor, with many clients terminating prior to receiving therapeutic benefit. This randomized clinical trial compared the impact on retention and drug use of an individual role induction session conducted at intake with the standard group orientation offered at the clinic. Results of interim analyses indicated that participants assigned to role induction (n = 180) were retained for more days, more likely to attend at least one postorientation session, and more satisfied with the treatment program than were those assigned to standard treatment (n = 87). Preliminary results suggest that role induction is a brief technique that shows promise for retaining clients through the critical first 3 months of treatment.

This study examined six-month outcomes for 194 criminal justice clients exiting outpatient drug-free treatment and assigned to aftercare or standard treatment. It compared sub-samples of those achieving positive (n=111) and negative outcomes (n=59), as defined by drug and alcohol use and arrests. Psychological variables and attendance at religious services distinguished significantly between groups. Predictor variables developed from that comparison were employed in logistic regression analyses making use of the full sample. Aftercare was found to be particularly significant for reduction in drug use, with optimism/pessimism about one's future and religious observance also significant predictors for substance use.

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed.

Using data collected from cocaine-abusing patients who participated in the Drug Abuse Treatment Outcome Studies (DATOS), we contrasted patients in treatment for the first time and patients having extensive histories of prior treatment to identify factors associated with better outcomes in each group. Compared with first-timers, treatment-experienced patients had less favorable post-treatment outcomes. Indicators of early engagement in DATOS treatment predicted post-treatment abstinence for both groups. Importantly, the interaction of treatment history and several process measures affected post-treatment abstinence. For example, individual counseling and program compliance had greater impacts on abstinence among treatment repeaters in outpatient drug-free programs than for first-timers. Social support and environmental context were significantly related to abstinence. These findings confirm the importance of considering treatment process and aftercare in developing and implementing strategies to optimize treatment for patients with different treatment histories.

The M-current regulates the subthreshold electrical excitability of many neurons, determining their firing properties and responsiveness to synaptic input. To date, however, the genes that encode subunits of this important channel have not been identified. The biophysical properties, sensitivity to pharmacological blockade, and expression pattern of the KCNQ2 and KCNQ3 potassium channels were determined. It is concluded that both these subunits contribute to the native M-current.