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In this article, we applied a marginal structural model (MSM) to estimate the effect on later drug use of drug treatments occurring over 10 years following first use of the primary drug. The study was based on the longitudinal data that were collected in three projects among 421 subjects and covered 15 years since first use of their primary drug. The cumulative treatment effect was estimated by the inverse-probability of treatment weighted estimators of MSM as well as the traditional regression analysis. Contrary to the traditional regression analysis, results of the MSM showed that the cumulative treatment occurring over the 10 years significantly increased the likelihood of drug use abstinence in the subsequent 5-year period. From both the statistical and empirical point of view, MSM is a better approach to assessing cumulative treatment effects, considering its advantage of controlling for self-selection bias over time.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2009.01.002 Byline: Kenneth R. Weingardt, Michael A. Cucciare, Christine Bellotti, Wen Pin Lai Keywords: Web-based training; Cognitive-Behavioral therapy; Substance use disorder counselors; Blended learning Abstract: This study compared training outcomes obtained by 147 substance abuse counselors who completed eight self-paced online modules on cognitive-behavioral therapy (CBT) and attended a series of four weekly group supervision sessions using Web conferencing software. Participants were randomly assigned to two conditions that systematically varied the degree to which they explicitly promoted adherence to the CBT protocol and the degree of control that they afforded participants over the sequence and relative emphasis of the training curriculum. Outcomes were assessed at baseline and immediately following training. Counselors in both conditions demonstrated similar improvements in CBT knowledge and self-efficacy. Counselors in the low-fidelity condition demonstrated greater improvement on one of three measures of job-related burnout when compared to the high-fidelity condition. The study concludes that it is feasible to implement a technology-based training intervention with a geographically diverse sample of practitioners, that two training conditions applied to these samples of real-world counselors do not produce statistically or clinically significant differences in knowledge or self-efficacy, and that further research is needed to evaluate how a flexible training model may influence clinician behavior and patient outcomes. Author Affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and, Stanford University School of Medicine, Palo Alto, CA, USA Article History: Received 1 October 2008; Revised 30 December 2008; Accepted 21 January 2009 Article Note: (footnote) The work described in this article was supported by the Health Services Research and Development Service, Department of Veterans Affairs, and by a grant from the National Institute on Drug Abuse (R21DAO07993). The opinions expressed are those of the authors and do not reflect the official positions of the Department of Veterans Affairs nor the National Institute on Drug Abuse.

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents' motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual's average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. Keywords: adolescent, treatment outcome, substance use, motivation to abstain

This pilot study (N = 30) experimentally examines the effects of an adaptive intervention in a misdemeanor drug court. The adaptive algorithm adjusted the frequency of court hearings and case management sessions according to prespecified criteria in response to participants' performance. Results reveal that the adaptive algorithm was acceptable to clients and staff, was feasible to implement with greater than 85% fidelity, and showed promise for eliciting substantial improvements in drug abstinence and graduation rates. Compared to drug court as usual, participants in the adaptive condition were more likely to receive responses from the drug court team for inadequate performance and received those responses after a shorter period. This suggests the adaptive algorithm more readily focused the team's attention on poorly performing individuals, allowing them to address problems before they developed too fully. These preliminary data justify further research evaluating the adaptive algorithm in a fully powered experimental trial. Keywords: drug court; adaptive treatment; criminal justice; antisocial personality disorder

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2008.03.012 Byline: Melissa Nidecker (a)(b), Carlo C. DiClemente (c), Melanie E. Bennett (a)(b), Alan S. Bellack (a)(b) Keywords: Serious mental illness; Substance abuse; Transtheoretical Model; Psychometrics Abstract: People with severe mental illness (SMI) have high rates of substance use disorders. The Transtheoretical Model (TTM) is a framework for understanding behavior change. There are five leading measures associated with the TTM -- University of Rhode Island Change Assessment, Processes of Change Scale, Decisional Balance Scale, Abstinence Self-Efficacy Scale, and Temptation to Use Drugs Scale. While these measures have been found to be reliable and valid in primary substance abusers, it is unknown if these measures are relevant in people with co-occurring SMI and substance use disorders (SUD). We evaluated the psychometric properties of these measures in a sample (n =240) of people with co-occurring disorders. Participants met DSM-IV criteria for schizophrenia/schizoaffective disorder or non-psychotic affective disorder, and current cocaine dependence or cocaine dependence in remission. All subscales showed good reliability and validity in the total sample. Analyses within diagnostic groups showed good reliability and validity in most groups, with some falling off in the affective disorders and remitted cocaine dependence groups. Overall, findings support the use of these measures in people with co-occurring disorders. Author Affiliation: (a) VISN 5 Mental Illness, Research, Education, and Clinical Center, USA (b) University of Maryland School of Medicine, USA (c) Department of Psychology, University of Maryland, Baltimore County, USA

Activator of G protein signaling 3 (AGS3), originally identified in a functional screen for mammalian proteins that activate heterotrimeric G protein signaling, is known to be involved in drug-seeking behavior and is up-regulated during cocaine withdrawal in animal models. These observations indicate a potential role for AGS3 in the formation or maintenance of neural plasticity. We have found that the overexpression of AGS3 alters the surface-to-total ratios of a subset of heterologously expressed plasma membrane receptors and channels. Further analysis of the endocytic trafficking of one such protein by a biotin-based internalization assay suggests that overexpression of AGS3 moderately affects the internalization or recycling of surface proteins. Moreover, AGS3 overexpression and siRNA-mediated knockdown of AGS3 both result in the dispersal of two endogenously expressed trans-Golgi network (TGN)-associated cargo proteins without influencing those in the cis- or medial-Golgi compartments. Finally, adding a TGN-localization signal to a CD4-derived reporter renders the trafficking of fusion protein sensitive to AGS3. Taken together, our data support a model wherein AGS3 modulates the protein trafficking along the TGN/plasma membrane/endosome loop. drug addiction | Golgi apparatus | membrane trafficking | receptors and channels

The goals of the National Institute on Drug Abuse Clinical Trials Network (CTN) are to test promising drug abuse treatment models in multisite clinical trials and to support the adoption of new interventions into clinical practice. Using qualitative research methods, we studied adoption in the context of two multisite trials, one outside the CTN and another within the CTN. Seventy-one participants representing eight organizational roles ranging from clinic staff to clinical trial leaders were interviewed about their role in the clinical trial, the trial's interactions with clinics, and intervention adoption. Drawing on the conceptual themes identified in these interviews, we report on strategies that could be applied in the planning, development, and implementation of multisite studies to better support the adoption of tested interventions in study clinics after trials had ended. Planning for adoption in the early stages of protocol development will enhance the integration of new interventions into practice. Keywords: Drug abuse treatment; Clinical trials; Dissemination; Adoption

Methadone medical maintenance (MMM) reduces the reporting schedule for stable and well-functioning methadone maintenance patients to once a month, with counseling provided by medical staff. We report on the 12-month outcomes of 92 highly stable methadone maintenance patients randomly assigned to one of three study conditions: routine care, MMM at the methadone maintenance program, and MMM at a physician's office. Methadone medical maintenance patients received a 28-day supply of methadone, whereas routine care patients received five or six take-home methadone doses each week. All patients performed a medication recall once a month and submitted two urine samples each month. An adaptive stepped-care system of treatment intensification was used for patients who failed recall or who had drug-positive urine specimens. Seventy-seven patients completed the 12-month study period. Dropout was caused primarily by problems with handling methadone and disliking the recall frequency. There were low rates of drug use or failed medication recall. Treatment satisfaction was high in all groups, but the MMM patients initiated more new employment or family/social activities than did routine care patients over the study period. The stepped-care approach was well tolerated and matched patients to an appropriate step of service within a continuum of treatment intensity. Keywords: Methadone; Medical maintenance; Stepped care; Adaptive treatment

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2004.09.007 Byline: A. Agrawal (a), M.C. Neale (a)(b), K.C. Jacobson (b), C.A. Prescott (b), K.S. Kendler (a)(b) Abstract: Drug use and abuse/dependence are stages of a complex drug habit. Most genetically informative models that are fit to twin data examine drug use and abuse/dependence independent of each other. This poses an interesting question: for a multistage process, how can we partition the factors influencing each stage specifically from the factors that are common to both stages? We used a causal-common-contingent (CCC) model to partition the common and specific influences on drug use and abuse/dependence. Data on use and abuse/dependence of cannabis, cocaine, sedatives, stimulants and any illicit drug was obtained from male and female twin pairs. CCC models were tested individually for each sex and in a sex-equal model. Our results suggest that there is evidence for additive genetic, shared environmental and unique environmental influences that are common to illicit drug use and abuse/dependence. Furthermore, we found substantial evidence for factors that were specific to abuse/dependence. Finally, sexes could be equated for all illicit drugs. The findings of this study emphasize the need for models that can partition the sources of individual differences into common and stage-specific influences. Author Affiliation: (a) Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box# 980003 Suite 1-154, Richmond, VA 23298-0003, United States (b) Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Department of Psychiatry, United States

An economic model indicates that tougher drug policies lead to increased drug purchasing and consumption.

The purpose of the study was to identify a stable model of psychosocial variables related to cocaine use among college students. Development and validation of this model could contribute to a useful cocaine abuse risk profile for college students. Of the 683 students who participated in the study, 179 reported using cocaine at least once in their life on an anonymous survey. The relationship between an index of cocaine use (coef. alpha = .79) and eight psychosocial variables was examined using a multiple regression procedure. The results indicated that two variables, perceived academic ability and interest in school, were significantly associated with scores on the cocaine index. Cross-validation procedures, including Tukey's Jackknife method, were conducted to ascertain the stability of the multiple regression model based on changes in the R-Squared value. The implications for future research and prevention programming efforts are discussed.

The EuroConference/Neurochemistry Winter Conference on Modeling Addiction, held on 6-11 April 2002 in Soelden, Austria * explored the question of how various experimental approaches, ranging from those at the level of molecular biology to human behavior, reflect human patterns of drug abuse and dependence and whether these various approaches constitute suitable predictive or homologous models to test novel pharmacotherapies.

Heyman's target article seeks to resolve the apparent paradox surrounding the issue of control in relation to addictive behaviour. The present commentary argues that addiction is in fact less paradoxical and more easily understandable than Heyman supposes. A fully satisfactory model of addiction, however, requires a more multifaceted approach than that provided by the type of behavioural choice theory favoured by Heyman.

For use in applied settings, the melioration model will need to incorporate changes in the shapes of local value functions over time, treat current value as a continuous function of time since previous choices, and take into account discounting of the effects of current behavior on future value. The policy implications of the model for regulating drugs are limited.