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Statistical reliability of the Treatment Perceptions Survey (TPS) questionnaire was examined using data from 19 California counties. The 14-item TPS was designed for clients receiving substance use disorder services at publicly funded community-based programs. The TPS is being used for evaluation of the State's 1115 Medicaid Waiver, external quality review of county-based systems of care, and quality improvement efforts. The survey addresses four domains of access to care, quality of care, care coordination, and general satisfaction that each include multiple items, plus a single item focused on self-reported outcome. Reliability test results of the four domains as composite measures were statistically significant. General satisfaction ratings were the best predictor of self-reported outcome in a path analysis model, followed by ratings of care coordination and quality of care. Separate analyses of TPS data from clients receiving specialty mental health services suggest the questionnaire can also be used reliably in mental health settings.

BackgroundApproximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America.MethodsThe study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression.ResultsOf 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p

AimThe aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users.MethodsWe captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v. heroin) on the hazard of transitioning among 5 states: (1) opioid detoxification treatment; (2) opioid agonist treatment (OAT); (3) legal supervision (probation or parole); (4) incarceration (jail or prison); and (5) out-of-treatment. Transitions were conditional on survival, and death was modeled as an absorbing state.ResultsBoth primary PO (n = 11,733) and heroin (n = 19,926) users spent most of their median 2.3 y of observation out of treatment. Primary PO users were significantly younger (median age 30 v. 34 y), and a higher percentage were female (43.1% v. 31.5%; P < 0.001), white (74.6% v. 63.1%; P < 0.001), and had completed high school (31.8% v. 18.9%; P < 0.001). When compared to primary heroin users, PO users had a higher hazard of transitioning from detoxification to OAT (Hazard Ratio (HR), 1.65; 95% CI, 1.54 to 1.77), and had a lower hazard of transitioning from out-of-treatment to either detoxification (0.75 [0.70, 0.81]) or OAT (0.90 [0.85, 0.96]).ConclusionOur findings can be applied directly in state transition modeling to improve the validity of health economic evaluations. Although PO users tended to remain in treatment for longer durations than heroin users, they also tended to remain out of treatment for longer after transitioning to an out-of-treatment state. Despite the proven effectiveness of time-unlimited treatment, individuals with OUD spend most of their time out of treatment.

BackgroundEach year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services.MethodsPrimary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n=18) from these organizations to collect further qualitative information on the barriers and facilitators of integration.ResultsCompared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity.ConclusionsEfforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable.

BackgroundCalifornia treats the largest population of opioid dependent individuals in the USA and is among a small group of states that applies regulations for opioid treatment that are more stringent than existing federal regulations. We aim to characterize changes in patient characteristics and treatment utilization over time, and identify determinants of successful completion of detoxification and MMT retention in repeated attempts.MethodsState-wide administrative data was obtained from California Outcome Measurement System during the period: January 1st, 1991-March 31st, 2012. Short-term detoxification treatment and long-term maintenance treatment, primarily with methadone, was available to study participants. Mixed effects regression models were used to define determinants of successful completion of the detoxification treatment protocol (as classified by treatment staff) and duration of maintenance treatment.ResultsThe study sample consisted of 237,709 unique individuals and 885,971 treatment episodes; 837% were detoxification treatment episodes in 1994, dropping to 40.5% in 2010. Among individuals accessing only detoxification, the adjusted odds of success declined with each successive attempt (vs. 1st attempt: 2nd: OR: 0.679; 95% CI (0.610, 0.755); 3rd: 0.557 (0.484, 0.641); 4th: 0.526 (0.445, 0.622); 5th: 0.407 (0.334, 0.497); ≥6th: 0.339 (0.288, 0.399). For those ever accessing maintenance treatment, later subsequent attempts were longer in duration, and those with two or more prior attempts at detoxification had marginally longer subsequent maintenance episodes (hazard ratio: 0.97; 95% CI: 0.95, 0.99). Finally, only 10.9% of all detoxification episodes were followed by admission into maintenance treatment within 14 days.ConclusionsThis study has revealed high rates of detoxification treatment for opioid dependence in California throughout the study period, and decreasing odds of success in repeated attempts at detoxification.

In 2005, researchers and policymakers gathered in Istanbul, Turkey for a conference, Delivery Systems for Substance Abuse Treatment, to address the internationally shared problem of substance use disorders. The conference included participants from the United States, Israel, and neighboring Middle Eastern countries and territories and was structured to create conditions that behavioral scientists have identified as key factors in facilitating successful intergroup contact. At the conclusion of the meeting, attendees reported being more likely to work with people from other countries or territories in their region as a result of the conference. Five years later, surveyed attendees reported having engaged in cooperative activities that the participants attributed at least in part to the conference. A number of concrete and verifiable examples of joint efforts between participants from the United States, Israel, and other Middle Eastern countries and territories were provided, suggesting the conference had a meaningful and lasting impact. This occurred despite a generally poor and declining environment for cooperation during this same period. These outcomes suggest that psychological principles can be successfully applied to real-world meetings, and that this may be a useful method for reaching participants who would not otherwise be reached by meetings explicitly promoted as peace-related. Limitations of this study include its descriptive nature and lack of a comparison group, which prevents conclusions regarding causality or magnitude of effect. This is a first step; in the future, controlled studies are needed to provide a stronger test of the effect of such structured meetings on outcomes. © 2014 American Psychological Association.

Abstract Background Increasing evidence suggests that culturally and linguistically responsive programs may improve substance abuse treatment outcomes among Latinos. However, little is known about whether individual practices or culturally and linguistically responsive contexts support efforts by first-time Latino clients to successfully complete mandated treatment. Methods We analyzed client and program data from publicly funded treatment programs contracted through the criminal justice system in California. A sample of 5,150 first-time Latino clients nested within 48 treatment programs was analyzed using multilevel logistic regressions. Results Outpatient treatment, homelessness, and a high frequency of drug use at intake were associated with decreased odds of treatment completion among Latinos. Programs that routinely offered a culturally and linguistically responsive practice—namely, Spanish-language translation—were associated with increased odds of completion of mandated treatment. Conclusions These preliminary findings suggest that concrete practices such as offering Spanish translation improve treatment adherence within a population that is at high risk of treatment dropout.

This study seeks to investigate racial dynamics among clients in a female-only residential substance use disorder treatment facility in South Los Angeles and its effects on treatment experiences. Clients were interviewed about their interracial interactions, perceptions of clients of races and ethnicities different from their own and how racial dynamics might affect their experiences in treatment. Nine interviews were conducted and analyzed using thematic analysis. Participants recounted that racial differences do not play a significant role in their treatment experiences, although racial identities shape social group formation. Motivation to recover from addiction and other shared lived experiences facilitate interracial harmony. [ABSTRACT FROM AUTHOR]

Four studies examined processing of in-group and out-group information with stimuli that are more complex than those used in previous crossed categorization studies. A diverse set of predictions is generated by previous theoretical work to account for how participants will integrate information stemming from multiple group memberships. Heuristic, threshold-based processing of information was supported over algebraic processing. Participants appeared to divide stimuli into 'in-grouplike' and 'out-grouplike' metacategories. However, the threshold at which this distinction was made, and whether it was based on in-group favoritism or out-group derogation, was influenced by the nature of the situation and the task participants performed. Advantages of crossed categorization research that moves beyond the traditional two-group model are discussed. Keywords: cross-categorization, intergroup relations, in-group, out-group