Sessions from Blending Conferencex - MIPH-ACCBP - home

hushedsnailInternet και Εφαρμογές Web

12 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

535 εμφανίσεις

r
L

Session Descriptions

Day 1, Thursday, April 22, 2010

9:00
-

9:30 a.m.. Introductions and Welcoming Speakers

Timothy P. Condon, Ph.D.

Deputy Director, National Institute on Drug Abuse, National Institutes of Health

Other Dignitaries

9:30
-

11:00 a.m.,

Opening Plenary

Current and Future Directions for Addiction Research:
Addressing Challenges of Diverse Populations and Settings

Nora D. Volkow, M.D.

Recent scientific advances have dramatically increased our understanding of the complex biological,
developmental, and environmental factors involved in drug abuse and addiction. This presentation
will focus on what we know about molecular mechanisms underlying the effects of drugs of abuse;
consequences of acute and chronic drug exposure on epigenetic m
odifications, gene expression,
and cell function; brain circuit disruption in addiction; and factors involved in genetic vulnerability
and resilience for drug abuse. In the coming years, research efforts will focus on answering such
key questions as: What
neurobiological processes mediate the effects of stressors on drug abuse
vulnerability? What genes play a role in brain development, and how
are
they affected by drugs
7

How
can neuroimaging tools for biofeedback be most effectively employed to strengthen n
eural circuits
disrupted by addiction? All of this knowledge will have a profound impact on the development of
increasingly targeted prevention and treatment strategies and on improving clinical outcomes. This
presentation will also highlight some of what
we know about special challenges encountered in
employing evidence
-
based prevention and treatment strategies in diverse populations and settings,
and how this knowledge can help us to better tailor interventions for a variety of specific needs.

Objectives

The participant will be able to

1.

Identify some of the complex brain circuits that play a role in addiction.

2.

Describe the implications of these scientific findings for targeted prevention and treatment

'development and some of the key questions on which futu
re research will focus.

3.

Distinguish some of the unique needs encountered in the prevention and treatment of drug

abuse and addiction in diverse populations and settings.

11:00 a.m.
-

12:00 p.m., Poster Session

Refer to Poster Descriptions and Floor Plan
(Page 85)

Blending Addiction Science and Treatment:

12:00 p.m.
-

1:30 p.m., Luncheon Plenary

Native Americans and Substance Abuse

Donald K. Warne, M.D., M.P.H.

This presentation will discuss health disparities among American Indian (Al) populations using data
from the Indian Health Service published datasets, including Regional Differences in Indian Health.
Research challenges in Al communities will be shared (Wa
rne, 2005, 2006), as well as descriptions of
potential partnerships and of the role for the research community and NIDA in reducing behavioral
health (BH) disparities in Al populations (Warne, 2006).

Objectives

The participant will be able to

1.

Describe heal
th disparities and substance abuse patterns in Al populations.

2.

Explain challenges in conducting research in Al communities.

3.

Describe potential next steps and strategies to address and reduce BH disparities through research

and educational approaches.

Current Research Tells Us

Significant health disparities exist in the Al population, including disparities in BH realms and illicit
drug use. Limited data are available on effective, culturally appropriate interventions to reduce these
disparities.

Conside
rations for Putting Research Into Practice

Expanded partnerships among several key stakeholder groups are necessary to effectively reduce
Al
BH disparities. Stakeholder groups include Tribal Leaders, the Indian Health Service, Tribal Health
Departments, Un
iversities/Tribal Colleges/Research Institutions, and other federal agencies (e.g.
NIDA), among others.

Considerations for Future Research



What are the most effective approaches to reducing disparities in BH among Al populations?



What is the role of
cultural competence in leveraging best practices into diverse communities?

Additional Resources

Warne, D. K. (2005). Genetics research in American Indian communities: Socio
-
cultural considerations
and participatory research.
Jurimetrics Journal,
45, 191
-
20
3.

Warne, D. K. (2006). Research and educational approaches to reducing heatth disparities among
American Indians and Alaska Natives.
Journal of Transcultural Nursing,
17, 266
-
271.

U.S. Department of Health and Human Services, Indian Health Service. (2000
-
2001).
Regional
Differences in Indian Health.
Rockville, MD: Indian Health Service.

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

SESSIO
N 1, 2:00 p.m.
-

3:45 p.m.

Screening, Brief Intervention and Referral to Treatment:
Translating Knowledge to Practice

Judith A. Bernstein, Ph.D., M.S.N., RNC
Edward Bernstein, M.D.

0

The U.S. Preventive Services Task Force (USPSTF) has rated screening and brief intervention (SBI) for
alcohol in primary care with a "B" recommendation (fair evidence that benefits outweigh any harms).
The research on universal alcohol SB! in other
settings is less extensive, and meta
-
analyses of efficacy
are less conclusive. Similarly, few studies have been conducted on
(
dxu3_screernrig,
brief inte
rventions,
^lefmH
o trcotm
oftt
-
t
SBIRT
). For this reason, the USPSTF found insufficient evidence tcTendors
e

drug SBIRT at this time. This presentation will review key research findings on alcohol SBI and their
implications for SBIRT in drug research. This presentation will aiso address SBIRT implementation
issues.
SBIRT
jrn
&lementation in the medical setti
ng involves a knowledge
-
translation process that
isnonlinear. Knowledge uptake is variable and responds to incentives and market pressures, such
as
political/legislative processes (including funding availability and mandates), patient requests, and
drug
co
mpany promotion. There are also many disincentives to the adoption of new knowledge.
Presenters will describe lessons learned over 15 years of implementing an SBIRT model of care in

busy
environment of the emergency department


a collaborative approach that relies on heatth pro
-

/
motion advocates and peer educators trained in motivational style interviewing, who have substance
abuse treatment experience and broad community contacts and involvement.


Objectives

The participant will be able to

1.

Describe findings from SBIRT effectiveness research in a variety of medical settings,
including

primary care, emer
gency, and

i
npat
i
ea
tli^atment settings.

2.

Describe adT
TocJel for knowledge translation/^
)

3.

List three (3) systems barriers and three (3) individual barriers to SBIRT implementation in medical

Current Research Tells Us

\
)0<f
<k
\
tf

Syste
matic reviews
and meta
-
analyses of alcohol SBI have found up to 57
percent
of patients in
car
e
se
ttings^
re drinking risky amounts after intervention, and 69 percent
are
drinking
risky
amounts in control groups. The absolute risk difference is 12 percent, with a decrease of 38
grams
of alcohol (or about two to three drinks) per week. The research for universal SBI for alcohol in
inpa
-
tient settings, trauma, and emergency departments is less extensive, and its efficacy less
conclusive.
Similarly, f
ew studies have

been conducted on S
BiR
T for drug
s. The National Institute on
Drug Abuse
(NIDA) hasTunded a numEeTot studies Ihdl dfe"ajrrently testing the efficacy of drug
SBIRT.

Considerations for Putting Research Into Practice

Recommendations for sustainable SBIRT programs include the
following:



External funding for start
-
up and then reimbursement streams;



Staff acting as champions (early adoptors) to support SBIRT, to resolve territorial
issues,

promote a cultural shift in the treatment of drug and alcohol misuse from stigma to knowle
dge

and practice of the science of addiction;

Sustainability planning from the beginning, involving administrators, billing and information
technology departments, medical records coders, community service providers, and government
agencies; and



/Creation and maintenance of a robust referral network to facilitate patient acceptance and access

\
LJ to substance abuse services with dedicated personnel (extenders) to conduct the referral process.

L .

-

nm

NX

0

TSfci

Considerations for Future Research

An emerging alcohol and drug SBIRT research question is why, in many studies, have control groups
reduced consumption over time to the extent that research procedures may tend to limit intervention
effect sizes
7

Research
procedures to reduce the impact of moderators on control group consump
tion
include: (1) attention to sample size determination and selection; (2) subject blinding to assess
social
desirability; (3) the need to reduce the burden of assessment instruments a
nd their potential to
mimic
interventions; and (4) analytic techniques to decrease the impact of regression to the mean.

Additional Resources

/bernstein, E. and Bernstein, j. (2008). Effectiveness of alcohol screening and brief motivational
/

intervention in the emergency department setting.
Annals of Emergency Medicine,
51, 751
-
754.

Bernstein, E., Bernstein, J., Stein, J., and Saitz, R. (2009). SBIRT in emergency care: Are we ready to
take it to scale?
Academic Emergency Medicine,
16,
1072
-
1077.

Kaner, E. F., Beyer, R, Dickinson, H. O., Pienaar, E., Campbell, F., Schlesinger, C, etal. (2007). Effectiveness
of
brief alcohol interventions in primary care populations.
Cochrane Database of Systematic Reviews,
Issue 2. Art. No.:CD004148. doi
:10.1002/14651858.CD004147.pub3.

Havard, A., Shakeshaft, A., and Sanson
-
Fisher, R. (2008). A systematic review and meta
-
analysis of
strategies targeting alcohol problems in emergency departments: Interventions reduce alcohol
related injuries.
Addiction,
10
3, 368
-
376.

Nilsen, P., Baird, J., Melio, M. J., Nirenberg, T., Woolard, R., Bendtsen, P., et al. (2008). A systematic
review of emergency care brief alcohol interventions for injury patients.
Journal of Substance Abuse
Treatment,
35, 184
-
201.

/Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., and Hingson, R. (2005). Brief
|
motivational intervention at a clinic reduces cocaine and heroin use.
Drug and Alcohol Dependence,
^77, 49
-
59.

Madras, B. K., Compton, W. M., Avula,
D., Stegbauer, T., Stein, J. B., and Clark, H. W. (2009). Screening,
brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare
sites: Comparison at intake and 6 months later.
Drug and Alcohol Dependence,
99,

280
-
295.

Bernstein, E., Shaw, E., Topp, D., Girard, C, Pressman, K., Woolcock, S., et al. (2009). A preliminary
report of knowledge translation: Lessons from taking screening and brief intervention techniques
(SBI) from the research setting into regional systems of care.
Academic Emergency Medicine.
16,
225
-
1233.

SESSION 2, 2:00 p.m.
-

3:45 p.m.

Out
-
Patient Buprenorphine Treatment of
Prt

Roger D. Weiss, M.D.
John J.
McCarthy, M.D.

The Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey on Drug
Use and Health has shown that
nonmedical prescription

jo
pioid use has grown

rapidly
i nt he

past
decade. Data from the NIDA Clinical Trials Network (CTN)~ sugges
t that those aBLMn^pre^crTpfion^
opioids may have some characteristics that differ from those abusing heroin. However, little is known
about optimal treatment strategies for prescription opioid addiction. This presentation will discuss
a
study currently underway to identify optimal treatments for this disorder. One model of care for
out
-
patient management of prescription opiate addiction will be illustrated, and details on staffing,

Evidence
-
Based Treatment and Prevention
in Diverse Populations and Settings

screening, assessment, medication induction, and ongoing monitoring will be provided. Population
demographics, length of treatment, urine drug testing results, and reasons for discharge from over
200 admissions will be r
eviewed. Brief case vignettes will be presented to stimulate discussion of
pseudo
-
addiction and co
-
occurring psychiatric disorders.

Objectives

The participant will be able to

L /Describe the prevalence of prescription opioid dependence in the United States
, the relationship
.
-
between pain and prescription opioid abuse, and differences between those using heroin and
£

prescription opioids.

2.

List at least three (3) components of a compre
hensive office
-
based buprenorphine prog
ram

Jor prescription opioid abus
ers in a priva
te clinic setting, and describe outcome data frorrTthe"

proposed model.

3.

Explain clinical challenges encountered when treating prescription opioid addiction.

Current Research Tells Us

Buprenorphine is an effective tool for treating opiate addiction, but it appears to have differential
effectiveness in different populations. For example, long
-
term heroin addicts from disadvantaged
populations may do better on methadone
[Starting Treatmen
t with Agonist Replacement (START)
Study,
CTN
-
0027). While multiple factors may be involved, dosing strategies during medication in
-
duction and maintenance may be critical factors in determining patient acceptance, with more ag
-
gressive dosing during induc
tion producing better retention. The UCLA START Retention Study will
be discussed.

Considerations for Putting Research Into Practice

Practitioners should understand how to implement a buprenorphine program in their practices,

both Rharmacoio
g
icaity and with appropriate
jD
sychosocial suppor
ts. 3^

Buprenophine may be a more appropriate choice for youth (based on partial agonist properties

and goals of shorter use,of opioid replacement therapy IORT]).

Buprenorphine may also better meet the needs o
f working patients who can afford private care

and desire a more flexible treatment model.

Considerations for Future Research

Patients with chronic pain and opioid addiction may need a specific type of treatment.
Buprenorphine needs to be assessed for its putative psychotropic effects.


Buprenorphine needs to be researched in terms of pain/addiction co
-
morbidity.

Additional Resources

/Center
for Substance Abuse Treatment. (2004). Clinical guidelines for the u
se of buprenorphine in the
(
treatment of opioid addiction.
Treatment improvement Protocol
(TIP) Series 40. DHHS Publication
i
[_^
No. (SMA) 04
-
3939. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Tenore, P. L. (2008). Psychothera
peutic benefits of opioid agonist therapy.
Journal of Addictive
Diseases,
27(3), 49
-
65.


SESSION 3, 2:00 p.m.
-

3:45 p.m.

Employment
-
Based Settings

Eric Goplerud, Ph.D.

Elizabeth Levy Merrick, Ph.D., M.S.W., LICSW

Tamara Cagney, Ed.D., M.A.,
CEAP

The prevalence of alcohol and drug problems in the workplace and the substantial impact on the
cost of doing business has been well established. How this problem is perceived


and what should
be
done about it


varies, depending on the focus of the v
arious players. This workshop will begin by
discussing the prevalence of substance misuse in the workplace overall and by industry, costs of these
problems and other workplace consequences, productivity and the business case, and parity provi
-
sions and imp
lications. Presenters will then provide an overview and definitions of selected workplace
programs (including employee
-
assistance programs, wellness and health promotion, and selected
specific interventions/technologies), as well as the evidence base of an
d opportunities for each type
of
program. Different reactions and goals of workplace constituents, such as unions, employers,
employee
-
assistance programs, and employees, will be presented. It is critical to develop "Workplace
Cultural Competency" to facil
itate translating clinical and research findings into the world of work.

Objectives

The participant will be able to

1.

Describe the prevalence and impact of substance use problems in the workplace, and implications

of parity for addressing this.

2.

Identify and
define several workplace
-
based programs to address substance use problems and

the evidence base for them.

3.

Identify the multiple constituents in the workplace and explore where their goals vary and overlap

in addressing substance abuse in the workplace sett
ing.

Current Research Tells Us

Substance use problems in the workplace are substantial in prevalence and effects. Parity law will
affect the landscape for potential ways to impact this. Research indicates that several programs
are commonly found in workplaces, with varying evidence bases in relation to substance abuse.
implementation issues are key.

Considerations for Putting Research Into Practice



Consider the array of programs available to clients.



Understand the workplace
-
ori
ented perspective on treatment and outcomes.

Considerations for Future Research



What are the employee
-
assistance programs and other workplace
-
based programs delivering in

terms of specific content and methods, nationally (and internationally)?



What are the

"active ingredients" in employee
-
assistance programs and related services
7

Additional Resources

Substance Abuse and Mental Health Services Administration. (2009).
Results from the 2008 National
Survey on Drug Use and Health: National findings.
NSDUH
Series H
-
36, HHS Publication No. SMA
09
-
4434. Office of Applied Studies, SAMHSA: Rockville, MD.
http://www.Qas.Samhsa.gQv/NsduhLatest.
htm

Merrick, E. S., Volpe
-
Vartanian, J., Horgan, C. M., and McCann, B. (2007). Alcohol and drug abuse:
Revisiting employ
ee assistance programs and substance use problems in the workplace: Key issues
and a research agenda.
Psychiatric Services,
58(10), 1262
-
1264.

Evidence
-
Based Treatment an*

George Washington University Medical Center. (2008). Workplace screeni
ng and brief intervention:
What employers can and should do about excessive alcohol use. Ensuring solutions to alcohol
problems.
http://www.EnsuringsolutiQns.orq/Usr_Doc/Workplace_SBI_Report_Final.pdf

Finch, R. A., and Phillips, K. (2005).
An employer's gu
ide to behavioral health services: A roadmap
and recommendations for evaluating, designing and implementing behavioral health services.
Washington, DC: Center for Prevention and Health Services, National Business Group on Health.

SESSION 4, 2:00 p.m.
-

3:45 p.m.

Smoking Prevention and Early Intervention

Scott J. Leischow, Ph.D.

Myra L. Muramoto, M.D., M.P.H.

Raymond Niaura, Ph.D.

This presentation will describe Federal (e.g., Centers for Medicare/^nd Medicaid Services, Food and
Drug Administration), State (Arizona, etc.), and other regulatory/policies (e.g., Joint Commission on
the Accreditation of Healthcare Organizations), as well as the implications of those policies. Data
needed to improve policy decisions will be presented i
n tKe context of a discovery, development,
and
delivery systems model. There are a variety of models for delivering tobacco cessation services
(e.g.,
telephone
-
based counseling, cessation clinics, web
-
based programs) and tobacco dependence
treatment traini
ng (such as brief intervention training, cessation specialist training, workshops,
web
-
based training). This presentation will discuss some of the different challenges that
are
associated
with
the implementation and sustainability of different delivery mod
els, as well as innovations to
address
these challenges. The Public Health Service's
Smoking Cessation Guidelines
publication
provides a framework for content and delivery of smoking cessation services by health care providers.
However,
implementation and
dissemination of the guidelines in health care settings have received
limited at
tention and limited systematic research. Studies that have evaluated implementation efforts,
gaps in
knowledge will be identified, and strategies for moving forward will be id
entified.

Objectives

The participant will be able to

1. Describe existing and planned Federal and other regulatory policies that impact treatment of
tobacco dependence, and describe a model for how those activities are related and can be
assessed.

Explain some of the challenges and innovations related to tobacco cessation treatment and
cessation training.

Describe existing and planned research studies to evaluate the impact of implementing
smoking
cessation guidelines in health care settings.

/t.
C
Current Research Tells Us

The Public Health Service's
Clinical Practice Guidelines on Treating Tobacco Us4and Dependence,

Cpchrane Reviews on tobacco treatment, and other reviews indicate that increasing tobacco

/r n e n t

will prevent premature deaths, but
many people do not have access to the most effective treat
-

( mer i t.

Policy changes are needed to maximize access to effective treatments.
m

___________


Considerations for Putting Research Into Practice

Encourage policy
-
making officials to increase funding for
effective tobacco treatment.

Considerations for Future Research

What economic or other research is needed to increase implementation of policies to help tobacco
users quit?

2.
3.

iicnc
v

i
science ana i reaimeni

Additional Resources

Fiore, M. C Jaen, C. R., Baker, T. B., Bailey, W. C, Benowitz, N. L, Curry, S. J., et al. (2008). Treating
tobacco use and dependence; 2008 Update. Clinical Practice Guideline. Rockvitte, MD; Public
Health Service, U.S. Department of Health and Human Servi
ces,
http://www.surgeongeneral.gov/
tobacco/#clinician

Leischow, S. J. (2009). Setting the national tobacco control agenda.
Journal of the American Medical
Association,
301(10), 1058
-
1060.

Fiore, M. C, Croyle, R. T., Curry, S. J., Cutler, C. M., Davis, R. M., Gordon, C, et al. (2004). Preventing
3
million premature deaths and helping 5 million smokers quit: a national action plan for tobacco
cessation.
American Journal of Public Health,
94(2
), 205
-
210.

SESSION 5, 2:00 p.m.
-

3:45 p.m.

Fetal Alcohol Spectrum Disorders

Philip A. May, Ph.D.

Wendy O. Kalberg, M.A., LED

This workshop will present the revised Institute of Medicine criteria for the diagnosis of fetal alcohol
syndrome (FAS), partial
FAS, and alcohol
-
related neurodevelopmental disorders to describe the char
-
acteristics of children affected with these disorders and the cause of particular features noted. The
prevalence of fetal alcohol spectrum disorders (FASD) in children of American I
ndians of the Plains,
South Africans, and Italians will be identified, with an emphasis on the interdisciplinary methods and
findings in each of these three populations. The extant literature in this area of FASD research will be
reviewed and critiqued wit
h recommendations for future research needs and opportunities for drug
and alcohol researchers. Neurocognitive and behavioral challenges of children affected with an FASD
will be briefly discussed, followed by a review of the empirical research that has be
en shown to be
effective in supporting deficits in these children.

Objectives

The participant will be able to

1.

Define FASD and name the specific characteristics of children with FASD.

2.

Describe and analyze the etiology and prevalence of severe FASD in three
populations of children

(American Indians of the Plains, South Africans, and Italians).

3.

List at least two (2) behavioral interventions that have been researched to help ameliorate the

effects of prenatal alcohol exposure.

Current Research Tells Us

The pres
enters have carried out FASD research in all of the populations to be discussed and have pub
-
lished eight papers on FASD in South Africa, three papers in Italy, and multiple papers on FASD among
American Indians. They have been, and are currently, funded f
or this research by the National Institute

on Alcohol Abuse and Alcoholism (NIAAA).

Considerations for Putting Research Into Practice

What are the characteristic traits of children with FASD? What are common
etiological factors (e.g., maternal risk traits) for FASD?


How can FASD be
prevented?

What types of educational interventions can be used to improve the lives of children with
FASD?

Considerations for Future Research

What are promising avenues in clinical research to prevent FASD via standard clinical treatment?
How can the prevalence of drinking and co
-
morbid drug use be effectively addressed among
pregnant women
and women of child
-
bearing age?

Additional Resources

May, P. A., Fiorentino, D., Gossage, J. P., Kalberg, W. O., Hoyme, H. E., Robinson, L. K., et al. (2006).
Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a rand
om
sample of schools.
Alcoholism: Clinical and Experimental Research,
30(9), 1562
-
1575.

May, P. A., Gossage, J. P., Marais, A. S., Hendricks, L. S, Snelt, C. L, Tabachnick, B. G., et al. (2008).
Maternal risk factors for fetal alcohot syndrome and partial
fetal alcohol syndrome in South Africa: A
third study.
Alcoholism: Clinical and Experimental Research,
32(5), 738
-
753.

May, P. A., Gossage, J. P., Marais, A. S, Adnams, C. M., Hoyme, H. E., Jones, K. L, et al. (2007). The
epidemiology of fetal alcohol synd
rome and partial FAS in a South African community.
Drug and
Alcohol Dependence,
88(2
-
3), 259
-
271.

Adnams, C. M., Sorour, P, Kalberg, W. O, Kodituwakku, P., Perold, M. D, Kotze, A., et al. (2007).
Language and literacy outcomes from a pilot intervention study for children with fetal alcohol
spectrum disorders in South Africa.
Alcohol,
41(6), 403
-
414.

Kalberg, W. O., Provost, B., Tollison, S. J., Tabachnick, B. G., Robinson, L. K., Hoyme, H. E., et a
l. (2006).
Comparison of motor delays in young children with fetal alcohol syndrome to those with prenatal
alcohol exposure and with no prenatal alcohol exposure.
Alcoholism: Clinical and Experimental
Research,
30(12), 2037
-
2045.

Kalberg, W. O., and Buckle
y, D. (2007). FASD: What types of intervention and rehabilitation are useful?
Neuroscience and Biobehavioral Review,
31(2), 278
-
285.

SESSION 6, 2:00 p.m.
-

3:45 p.m.

Evidence
-
Based
Treatmehtj Interventions for
African Americans

A. Kathleen
Burlew, Ph.D.

Cheryl Grills, Ph.D.

~

This presentation wilt provide genefa
\

information on outcomes (ex)., reduction in substance use,
engagement, and retention) for Afncan Americans in substance abuse treatment, and describe treat
-
ments with demonstrated
efficacy for African Americans. The implications of unique risk and resil
-
ience factors for designing interventions will be discussed, as well as some of the unique challenges
of
providing services to African Americans. The presentation will outline altern
ative models for evalu
ating
the cultural appropriateness of a treatment, and methods for designing a treatment to be more
appropriate for African Americans. Finally, the presentation will describe the implementation of sev
eral
treatment programs actually

developed for African American substance abusers in community
settings.

Objectives

The participant will be able to

Describe findings on substance abuse outcomes for African American adults and adolescents,
and recognize evidence
-
based
treatments for this population.

Identify unique predictors and correlates of treatment engagement with African Americans,
describe the research on the utility of culturally adapted interventions, and ex
plain the model
s for
interventio
n to be more cultur
ally appropriate.

3. Plan model programs for treating African American substance abusers in community settings.

L


1.

2.

Blending Addiction Science and Treatment:

Current Research Tells Us

fj
The research on treatment outcomes for African Americans reveals several significant shortcomings.
j^JC
r^rirst, the evidence suggests that the overwhelming majority of African Americans who need drug
^^i
treatment do not receive it (SAMHSA, 2008). Second,

studies that evaluate the efficacy of treatment
"modalities specifically for African Americans are limited (Strada, Donohue and Lefforge, 2006). To
date,
only one treatment has demonstrated efficacy in reducing drug use with African American ado
lescents
(Szapocznik, Prado, Burlew, Williams, and Santisteban, 2007). Moreover, our recent review
revealed only three
treatment interventions with demonstrated efficacy for African American adults.
These include an a
dapted
version of motivational intervie
wing (Mi; Longshore and

Grills, 2000), a modified CBTIntervention (Richard et
aL, 1995), and a therapeutic community intervention (bieiber'g
et at., 1994). Third, the available evidence
suggests that treatment outcomes for African Americans are less favora
ble than treatment outcomes for their
white counterparts. Specifically, African Americans are
less likely to become engaged in treatment
(Jackson
-
Gilfort, Liddle, Tejeda and Dakof, 2001; Perrino, Coatsworth, Briones, Pantin, and Szapocznik,
2001), less lik
ely to complete treatment (Campbell,
Weisner, and Sterling, 2006; Milligan, Celeste, Nich and
Carroll, 2004; Treatment Episode Data Set, more likely to have a negative termination from treatment
(Shillington and Clapp, 2003), less likely to
describe their
treatment as helpful (Longshore, Grills, and Annon,
1999), and less likely to participate
in the treatment research essential for improving future treatment (Yancey,
Ortega, and Kurmanyika,
2006). These outcomes may reflect several important differences be
tween African
Americans and
whites that are potentially related to
the fit between many existing treatment modalities and
African American clients^

These may include, but
are
not limited to,
differences in drug his
tories, route to
treatment, and unique cul
tural risk and protective factors.

These facts all point to the need for more
attention
specifically on the development of effective treatments for African Americans. The focus of
this session will be
on evidence
-
based treatment for African American substa
nce abusers.

Considerations for Putting Research Into Practice



Identify interventions that have demonstrated efficacy with African American substance users.



Become familiar with approaches to developing targeted interventions for African Amer
icans, or

culturally adapting generic interventions.

Considerations for Future Research

1.

Do culturally adapted versions of treatments improve outcomes for African Americans in substance

abuse treatment
7

2.

What are the characteristics of African Americans who

respond more favorably to culturally

tailored, rather than generic, interventions?

3.

Do "deep structural" approaches to culturally tailored interventions yield more favorable outcomes

than "surface" approaches?

Additional Resources

Longshore, D. and Grills,

C. (2000). Motivating illegal drug use recovery: Evidence for a culturally
congruent intervention.
Journal of Black Psychology,
26(3), 288
-
301.

Grills, C. T (2003). Substance abuse and African Americans: The need for Africentric
-
based substance
abuse trea
tment models. In D. j. Gilbert and E. M. Wright (Eds.),
African American Women and HIV/
AlDs: Critical Responses
(pp. 55
-
72). Westport, CT: Praeger Publishers.

Burlew, A. K., Johnson, C. S., Flowers, A. M., Peteet, B. J., Griffith
-
Henry, K. D., and Buchana
n, N.
D.
(2009). Neighborhood risk, parental supervision and the onset of substance use among African
American adolescents.
Journal of Child and Family Studies,
18(6), 680
-
689.

Burlew, A. K., Feaster, D., Brecht, M. L, and Hubbard, R. (2009). Measurement a
nd data analysis in
research addressing health disparities in substance abuse.
Journal of Substance Abuse Treatment,
36(1), 25
-
43.

TsnSF

SESSION 7, 4:00 p.m.
-

5:30 p.m.

Co
-
Occurring Disorders

Joan E. Zweben, Ph.D.
KimT. Mueser, Ph.D.

individuals in treatment for substance use disorders are likely to have other co
-
occurring disorders
(COD) that affect recovery. This presentation will focus on clinical and programmatic issues that
may improve treatment outcomes for these individuals. Key

program components will be discussed,
including: (1) treatment at a single site
(if

possible) by cross
-
trained clinicians; otherwise, stellar col
-
laboration between sites; (2) clarity about whether the program is COD
-
capable or COD
-
enhanced;
(3) use of me
dications being supported and monitored when possible; and (4) education about ad
-
diction and mental disorders, and treatment/recovery from both. Further, there should be appropriate
adaptations for serious mental illness (e.g., emphasis on reduction of ha
rm, lowering anxiety, appro
-
priate pacing, self
-
help offered but not mandated). It is also important to enhance clinical abilities to
differentiate between substance
-
induced symptoms versus independent disorders (e.g., screen for
COD; refer for formal diag
nostic assessment; form a preliminary diagnostic impression to be verified by
a trained professional, preliminary screening of danger to self or others; de
-
escalate client who is
agitated, anxious, angry, or otherwise vulnerable; or wait until withdrawal p
henomena have subsided).
Other diagnostic tools include physical exam, toxicology screens, history from significant others, lon
-
gitudinal observations over time, and constructing timelines and inquiring about quality of life during
drug
-
free periods. The p
resentation will also cover (1) stage
-
wise case management, Motivational
Interviewing (MO, and Cognitive Behavioral Therapy (CBT), (2) how to address attitudes and feelings
about medications and teamwork with physicians; (3) group dynamics, such as persuas
ion groups,
social
-
skills training groups, and self
-
help participation; and (4) working with families.

Objectives

Participants will be able to

1.

Identify at least three (3) key elements in the treatment of people with the full spectrum of COD,

including what

is distinctive for people with psychotic conditions.

2.

Explain the principles for distinguishing between substance
-
induced symptoms and independent

disorders.

3.

Identify psychosocial issues (e.g., coping strategies and stigma), medication
is
sues, and

collaborations required to integrate care.

Current Research Tells Us

Making relevant services easily available through integrated treatment results in better treatment
outcomes.



Specific interventions can be adapted to a range of COD populati
ons.

Considerations for Putting Research Into Practice



Support at the organizational level (Federal, State, county, and program) is essential for upgrading

services.

Many resources for systems change are now available (e.g., NIATx, and examples from Mink
off
and Cline).



Clinical training must go beyond dissemination of information and include clinical supervision,

skill practice with feedback, and a supportive program environment.

Considerations for Future Research

1.
In an era of limited resources, what system and program changes are most likely to improve
outcomes?

Blending Addiction Science and Treatment:

2.

For specific treatment interventions (Ml, CBT, etc.), which adaptations are needed for various COD

populations?

3.

Given rapid workforce turnover, what is the most efficient way to train clinicians to address COD?

Additional Resources

Mueser, K. T., Noordsy, D. L, Drake, R. E., and Fox, L. (2003).
Integrated treatment for dual disorders:
A
guide to effective practice.
New York; Guilford Press.

Center for Substance Abuse Treatment. (2005).
Substance abuse treatment for persons with
co
-
occurring disorders.
Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA)
05
-
3922. Ro
ckville, MD: Substance Abuse and Mental Health Services Administration.

SESSION 8, 4:00 p.m.
-

5:30 p.m.

Buprenorphine/Methadone in the
Treatment of Adolescents and Young Adults

Geetha Subramaniam, M.D.

Shannon Garrett, M.S.W., LGSW, CSC
-
AD

In the United States, problem opioid use has remained high among adolescents and
young adults. The emergence of increased opioid dependence among this popula
tion
over the past decade has motivated the research for pharmacological treatments.
Evidence for

effectively treating adolescents and young adults is only now emerging.

. . This presentation will (1) describe community and clinical trends in problems
with opioid

blendinq initiative

7
-
>
\



!

i ■

t
-
7
\

■■ ui ■

NI DA
-
SAMHSA

use; (2) provide
information on treatment
-
seeking populations; (3) review available phar
-
macological/combined treatments for opioid dependence (methadone, buprenorphine,
and
naltrexone); and (4) provide current evidence for the efficacy of those treatments for youth with
o
pioid
dependence. The presentation will also discuss attitudes in the clinical field about medically
assisted
recovery and the need to apply clinical models that work in collaboration with pharmacologi
cal
treatments. Clinical cases and medically assisted recovery models will be discussed to assist in the
development of collaborative care.

Objectives

The participant will be able to

1.

Describe the scientific evidence for the use of methadone, buprenorphine,

and nattrexone in the

treatment of adolescents and young adults.

2.

Describe clinical issues pertaining to engaging youth with opioid use disorders in psychosocial

treatments combined with medications to improve treatment outcomes.

Current Research Tells Us

Rising rates of opioid use among teenagers and young adults is a public health concern. Despite
short durations of opioid use compared to adults, youth with opioid dependence have a host of
co
-
occurring conditions, such as polysubstance abuse, psychiatric
disorders, Hepatitis C infection, HIV
risk, high
-
risk sexual behaviors, and criminal behaviors. Typically, opioid
-
dependent youth are offered
outpatient/residential treatment with brief detoxification, but one study has shown that heroin users
fare worse f
ollowing residential treatment. While there is abundant research supporting the use of
medication
-
assisted treatments for opioid
-
dependent adults, research is only recently emerging for
youth. In any event, buprenorphine, a partial opioid agonist, has been

shown to be safe and effective
in
improving abstinence from opioids in two controlled clinical trials.


Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Considerations for Putting Research Into Practice

Clinical mo
dels for adolescent and young adult group and individual counseling for opioid depen
-
dence can be found in the following studies:



"Individual Drug Counseling for Treatment of Opioid Dependence for Adolescents and Young

Adults." (Delinda E. Mercer, Ph.D.,

and George Woody, M.D., University of Pennsylvania/Philadelphia

Veterans' Affairs Medical Center.)

"Group Drug Counseling for Adolescents and Young Adults in Recovery for Opiate Dependence."
(Delinda E. Mercer, Ph.D., and Dennis C. Daley, Ph.D.)

Considera
tions for Future Research



Conduct additional research on treatments that specifically target youth with opioid dependence.

Evaluate opioid antagonists, including injectable preparations.

Assess integrating treatments for co
-
occurring conditions,
psychiatric disorders, HIV risk, and

Hepatitis C infection.

Determine adequate durations of combined pharmacological and psychosocial treatments.


'Woody, G. E., Poole, S. A., Subramaniam, G., Dugosh, K., Bogenschutz, M
., Abbott, P., et
al. (2008).
Extended vs short
-
term buprenorphine
-
naioxone for treatment of
opioid
-
addicted youth: A
randomized trial.
Journal of the American Medical Association,
300(17),
2003
-
2011.

Subramaniam, G. A., Stitzer, M. A, Woody, G. E., Fishman, M. J., and Kolodner, K. (2009). Clinical
characteristics of treatment
-
seeking adolescents with opioid versus cannabis/alcohol use disorders.
Drug and Alcohol Dependence,
99(1
-
3), 141
-
149.

Subramania
m, G. A. and Stitzer, M. A. (2009). Clinical characteristics of treatment
-
seeking prescription
opioid vs. heroin
-
using adolescents with opioid use disorder.
Drug and Alcohol Dependence,
101(1
-
2),
13
-
19.

Subramaniam, G. A., Ives, M., Stitzer, M. L, and Denn
is, M. (2010). The added risk of opioid problem
use among treatment
-
seeking youth with marijuana and/or alcohol problem use.
Addiction
105(4),
686
-
698.

SESSION 9, 4:00 p.m.
-

5:30 p.m.

Working With the Family Members of Treatment Refusers:

CRAFT

Robert J. Meyers, Ph.D.
Jane
Ellen Smith, Ph.D., LCP

Community Reinforcement and Family Training (CRAFT) is a treatment that was developed to work
with concerned significant others (CSOs) of treatment
-
refusing, substance abusing individuals. The
goals of CRAFT are to (1) get the substance using individual to

enter treatment, (2) decrease the
drinking or drug use in the meantime, and (3) improve the CSO's psychological functioning regard
less
of treatment status. CRAFT has been shown to be effective at engaging treatment refusers into
treatment anywhere from 6
4 percent to 86 percent of the time. These successfully engaged former
treatment refusers represent different types of substance use (e.g., alcohol and illicit drugs), and many
different relationships with the CSOs (e.g., their spouses, partners, parents,
or children). CRAFT proce
-
dures include: (1) communication training, (2) a roadmap (functional analysis) of the loved one's use,
(3) positive reinforcement of non
-
using behavior, (4) withdrawal of reinforcement for using behavior,
(5) allowing for the natu
ral consequences of substance use, (6) enhancing the CSO's own happiness,
and (7) inviting the loved one to enter treatment.

Additional Resources

Blending Addiction Science and Treatment:

Objectives

The participant will be able to

1.

Describe the purpose of the CRA
FT program, including several of its main goals.

2.

Summarize the research findings with regard to how effective CRAFT is at treatment engagement,

and with whom it is effective (e.g., type of drugs, or type of relationship with the CSO).

3.

List or describe at
least two (2) specific CRAFT procedures taught to CSOs.

Current Research Tells Us

CRAFT is a scientifically supported treatment designed to work with the CSOs of treatment
-
refusing
substance abusers. These CSOs
are
taught how to interact differently with their loved ones so that
clean/sober behavior is rewarded (reinforced) and the rewards are withdrawn when drinking or drug
use occurs. A series of controlled studies have shown that CRAFT
-
trained CSOs can successfull
y en
-
gage their loves ones into treatment in anywhere from 64 percent to 86 percent of the cases. These
outcomes are in stark contrast to the low percentages reported for other programs (e.g., Al
-
Anon, or
Johnson Institute Intervention). Furthermore, these

CRAFT
-
trained CSOs typically engage their loved
one after only five sessions, on average. The CSOs in these studies have been in many different types
of
relationships with the substance users (e.g., spouses, partners, parents, siblings), and the substance

using individuals have used many different types of drugs (alcohol, marijuana, opiates, etc.). CRAFT
has been successful with various ethnic groups as well.

Considerations for Putting Research Into Practice

Begin incorporating evidence
-
based CRAFT procedu
res into practice using available resources:

Training in CRAFT is recommended (see Robert J. Meyers's website below, or the University of
New Mexico CASAA website)

A CRAFT therapist manual by Smith and Meyers (2004) is available, and a self
-
help (consumer)

manual is available by Meyers and Wolfe (2004) (see both below).

Considerations for Future Research

There is some interest in applying CRAFT to other diagnostic groups (e.g., compulsive gambling, or
eating disorders).


Resources

Sisson, R. W. and Azrin, N. H. (1986). Family
-
member involvement to initiate and promote
treatment
of problem drinkers.
Behavior Therapy and Experimental Psychiatry,
17, 15
-
21.

Smith, J. E. and Meyers, R. J. (2004).
Motivating substance abusers to enter treatment: Working with
family members.
New York: Guitford Press.

Meyers, R. J. and Wolfe, B. L. (2004).
Get your loved one sober: Alternatives to nagging, pleading, and
threatening.
Center City, MN: Hazelden Press.

Ro
bert J. Meyers:
www.robertjmeyersphd.com

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

SESSION 10,4:00 p.m.
-

5:30 p.m.

HIV Testing and Counseling

Lisa R. Metsch, Ph.D.
Tim
M. Matheson, Ph.D.

In an attempt to reduce seroconversion rates within the United States, guidelines for HIV testing have
shifted. With the goal of having more people aware of their HIV status, efforts have been made to
reduce potential barriers to HIV testing. Current trend
s in HIV testing, including the "test and treat"
model, will be presented. With regard to counseling, Respect 2 will be described. Respect 2, a
client
-
tailored, counselor
-
directed mode of risk reduction counseling, provides a framework within
which
the HIV testing counselor guides the client through a personalized risk assessment and
risk
-
reduction
plan. Each section provides a natural building block to the next section's material.
Implementing HIV testing and counseling in substance use treatment fa
cilities requires serious
consideration in a num
ber of areas, including finances, staffing, and space considerations. Lessons
learned from implement
ing a 12
-
site randomized clinical trial of HIV testing and counseling will be
discussed and provided.

Obje
ctives

The participant will be able to

1.

identify the latest HIV testing strategies in the United States.

2.

Describe components of Respect 2 counseling, and explain counseling issues that may arise in

conducting risk
-
reduction counseling.

3.

Explain the current i
ntent and actual efforts to implement HIV testing and counseling within the

Clinical Trials Network (CTN) substance use treatment sites.

Current Research Tells Us

CTN 0032 is a randomized controlled clinical trial in which 1,281 individuals receiving drug abuse
treatment from 12 community treatment programs (CTPs) throughout the United States were en
-
rolled to participate in a multicenter HIV testing and counseling
study. At 1 month, follow
-
up reten
tion
rates reached 98 percent, and 6 month retention rates were 93 percent. The trial will assess the
relative
effectiveness of three HIV testing strategies on increasing receipt of test results: (1) on
-
site HIV
rapid
tes
ting with brief, participant
-
tailored prevention counseling; (2) on
-
site HIV rapid testing with
information only; and (3) referral for off
-
site HIV testing. The study will also assess the effectiveness
of
the three testing strategies in reducing HIV sexual

risk behaviors. Because the study will be con
ducted
among drug abuse treatment clients, drug use (including injection drug risk behavior) will be a
secondary outcome.

Considerations for Putting Research Into Practice



Secure stable funding for HIV test
kits.

Identify HIV test processing location and comply with state and local requirements.



Select and
train

appropriate staff to conduct HiV testing and Respect 2 counseling.



Secure private space for counseling.



Devise guidelines on who will need/benefit
from counseling versus information only and HIV

testing.

Considerations for Future Research

With a trend towards a "test and treat" model, what role can substance abuse treatment centers
play in assisting clients to get tested for HIV, and accessing and
maintaining HIV treatment
7



How might the intake process and/or substance use counseling services be utilized in this

endeavor?

ucnon science ana i reaimeni

Additional Resources

Branson, B. M, Handfield, H. H.
(

Lampe, M. A, Janssen, R. S., Taylor, A. W., Lyss, S. B., et al. (2006).
Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health
-
care
settings.
Morbidity and Mortality Weekly Report. Recommendation and Reports,
55(RR
-
14
), 1
-
17; quiz
CE1
-
4.

Metcalf, C. A., Douglas, J. M.
f

Malotte, C. K., Cross, H., Dillon, B. A., Paul, S. M.
f

et al. (for the RESPECT
2
Study Group). (2005). Relative efficacy of prevention counseling with rapid and standard HIV testing:
A
randomized, contro
lled trial (RESPECT
-
2).
Sexually Transmitted Diseases,
32(2), 130
-
138.

Louise Haynes, M.S.W., and staff of the Southern Consortium Node involved in implementation of
(non
-
research related) HIV testing and counseling in a community treatment program. (For m
ore
information, see
http://ctndisseminationlibrary.org/nodes/scnode.htm
.)

SESSION 11, 4:00 p.m.
-

5:30 p.m.

Native American Track
History and Policy

Karina L. Walters, Ph.D., M.S.W.
Alvin H. Warren

In Native communities, historical trauma, discrimination
(a.k.a. micro
-
aggression), and the correspond
ing
traumatic response processes have been identified as significant factors related to substance use,
engagement in HIV risk behaviors, and poor mental health outcomes. Until recently, much of these
relationsh
ip links were hypothetical or based on case or anecdotal examples observed in clinical and
indigenous community settings. This presentation will highlight: (1) empirical findings on the associa
-
tions among historical trauma, discrimination, and health risk

behaviors and outcomes; (2) the devel
-
opment of innovative culture
-
based measures through community
-
based participatory methods, as
well as preliminary findings regarding the reliability and cultural validity of these new measures; (3) fu
ture
directions
for culturally meaningful methodological and practice
-
based innovations in substance
abuse
treatment and prevention, utilizing a culturally based indigenous stress
-
coping model; and
(4) policy
innovations made by the State of New Mexico through its Behavio
ral Health Collaborative process and
the State
-
Tribal Collaboration Act, both of which created a more culturally inclusive and innovative
environment for behavioral health policy with respect to substance abuse prevention and
treatment for
Native Americans
. Finally, examples of specific projects and policy accomplishments
that are
positively impacting the delivery of substance abuse prevention and treatment for Native
American
tribes in New Mexico will be highlighted.

Objectives

The participant will be able

to

1.

Identify the role of and relevant research on historical trauma and micro
-
aggression distress in

relation to health risk behaviors, alcohol and substance abuse, and health outcomes among

American Indians and Alaska Natives.

2.

Explain the framework for cu
lturally based practice and intervention development.

3.

Describe the policy environment and alternatives currently being pursued and implemented in

New Mexico to acknowledge and support the cultural and traditional needs of Native Americans

in substance and
alcohol prevention and treatment.

Current Research Tells Us

Empirical findings have identified historical trauma, discrimination, and the corresponding traumatic
response processes as significant factors related to substance use, engagement in HIV risk behaviors,
and poor mental health outcomes in Native communities.

I


Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Consi
derations for Putting Research Into Practice

Decolonizing strategies include



Renaming and refraining learned behaviors from a historical trauma perspective.

Developing and utilizing cultural genograms and soul
-
wound timelines related specifically to

subs
tance abuse.

Identifying culturally protective factors, such as identity, family, and culture.

Considerations for Future Research



What are the mechanisms by which historical trauma, or intergenerational trauma, are transmitted

to future generations?

Additional Resources

Chae, D. and Walters, K. L. (2009). Racial discrimination and racial identity attitudes in relation to
self
-
rated health and physician pain and impairment among Two
-
Spirit American Indians/Alaska
Natives.
American Journal of Public Hea
lth,
99(Suppl 1), S144
-
S151.

Walters, K. L, Simoni, J. M., and Evans
-
Campbell, T. (2002). Substance use among American Indians
and Alaska Natives: Incorporating culture in an "indigenist" stress
-
coping paradigm.
Public Health
Reports,
117(Suppl 1), S104
-
S1
17 "

Lehavot, K., Walters, K. L, and Simoni, J. M. (2009). Abuse, mastery, and health among lesbian,
bisexual, and Two
-
Spirit American Indian and Alaska Native women.
Cultural Diversity and Ethnic
Minority Psychology
15(3), 275
-
284.

Walters, K. L.

and Simoni, J. M. (2009). Decolonizing strategies for mentoring American Indians and Alaska Natives
in
HIV and mental health
research. American Journal of Public Health,
99(Suppl 1), S71
-
S76.

SESSION 12, 4:00 p.m.
-

5:30 p.m.

Benzodiazepine Use and Misuse in
Addiction Treatment Settings

Peter Roy
-
Byrne, M.D.
Patrick J.Abbott M.D.

Benzodiazepines (Bzs) have Food and Drug Administration (FDA) approval and demonstrated efficacy
for the treatment of panic, generalized, and social a
nxiety disorders, but are not effective for obses
sive
compulsive disorder and may be detrimental in posttraumatic stress disorder (PTSD). Although
not
approved by the FDA, Bzs also have demonstrated efficacy as an adjunctive agent in treating major
depres
sion among patients showing incomplete response to antidepressants, and are more
commonly used as an adjunct to selective serotonin reuptake inhibitors (SSRIs) rather than as
mono
-
therapy. Cognitive behavioral therapies (CBT) are comparable in efficacy to
medications, but
are dramatically underutilized because of the limited availability of trained experts. Often, clinicians de
-
liver CBT but may not be delivering anxiety disorder
-
specific CBT packages that are known to work
effectively. Thus, not all patien
ts need treatment with Bzs, but some may require them for complete
remission of anxiety or depression. Studies show high rates of substance use disorders (SUDs) among
those with anxiety disorders (17 percent), with the relationship more common in drug (odd
s ratio 2.8)
than in alcohol use (odds ratio 1.7) disorders. Rates of anxiety and depression in clinical substance
abuse populations have been estimated at as high as 80 percent. When necessary, clinicians can
treat patients without a substance abuse probl
em, or history with Bzs, without major risks. Treating
patients with a substance abuse problem or history, however, requires more complex decisionmak
-

Blending Addiction Science and Treatment:

ing. Although there is some evidence that
untreated anxiety may be detrimental to recovery from
substance abuse, there is little evidence
-
based guidance as to whether, when, and how to use Bzs in
individuals struggling with both addiction and anxiety.

Objectives

The participant will be able to

1.

Explain the role of benzodiazepines (Bzs) in the treatment of anxiety disorders.

2.

Describe rates of anxiety disorders in substance
-
abusing populations and the impact of untreated

anxiety on these individuals.

3.

Recall what the literature shows about the impac
t of Bzs use in substance
-
abusing populations.

Current Research Tells Us

Research clearly outlines the role of Bzs in the treatment of anxiety, identifies that anxiety disorders
occur at a rate greater than chance in substance
-
abusing populations, and prov
ides some evidence
that untreated anxiety may have an adverse effect on the course and outcome of SUDs. Evidence
outlining the risks and benefits of judiciously used Bzs in anxious individuals with SUDs is still meager,
and an imperfect guide for clinical
practice.

Considerations for Putting Research Into Practice



Bzs have a place in the treatment of anxiety; this is not a first
-
tine place, but there ARE patients

who will require these medications to get relief from anxiety.



Anxiety is common in
substance
-
abusing populations, and failure to address this or see it as

merely a manifestation of addiction could hinder recovery.



Current research poorly informs decision
-
making about when to use Bzs; what research there is

suggests that use of Bzs is not

uniformly harmful and is safe in some patients.

Considerations for Future Research

Studies are needed to define the risks and benefits of Bzs use in anxious individuals with SUDs who
fail to respond to first
-

and second
-
line anxiety treatments, and more s
pecifically, to determine the in
-
dividual characteristics (type of substance, severity
of
disorder, duration of disorder, other psychiatric
co
-
morbidity) that predict beneficial or adverse outcomes with Bzs treatment.

Additional Resources

Roy
-
Byrne, P., Ve
itengruber, J. P., Bystritsky, A., Edlund, M. J, Sullivan, G., Craske, M. G., et al. (2009).
Brief intervention for anxiety in primary care patients.
Journal of the American Board of Family
Medicine,
22, 175
-
186.

Compton, W. M., Thomas, Y. R, Stinson, F. S., and Grant, B. R (2007). Prevalence, correlates, disability
and comorbidity of DSM
-
IV drug abuse and dependence in the United States: Results from the
National Epidemiologic Survey on Alcohol and Related Conditi
ons.
Archives of General Psychiatry
64(5), 566
-
576.

Hasin, D. S., Stinson, F. S., Ogburn, E., and Grant, B. R (2007). Prevalence, correlates, disability and
comorbidity of DSM
-
IV alcohol abuse and dependence in the United States: Results from the National
Epidemioiogic Survey on Alcohol and Related Conditions.
Archives of General Psychiatry
64(7),
830
-
842.

Book, S. W., Thomas, S. E, Dempsey, J. P., Randall, P. K, and Randall, C. L. (2009). Social anxiety
impacts willingness to participate in addiction treat
ment.
Addictive Behaviors,
34(5), 474
-
476.

Brunette, M. R, Noordsy, D. L, Xie, H., Drake, R. E. (2003). Benzodiazepine use and abuse among
patients with severe mental illness and co
-
occurring substance use disorders.
Psychiatric Services,
54(10), 1395
-
1401
.

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Session Descriptions

Day 2, Friday, April 23, 2010

8:45 a.m.
-

9:45 a.m., Morning Plenary

Evidence
-
Based Treatments for Women

Barbara S. McCrady, Ph.D.

The overall prevalence of substance use disorders (SUDs) is lower in women than in men. Pathways
into drug dependence and patterns of use differ as well. Nevertheless, women are more likely than
men to have a co
-
occurring psychiatric disorder, and are more

likely to present with a trauma history,
post
-
traumatic stress disorder (PTSD), other anxiety disorder, or depression. Women experience sev
eral
complicating conditions that affect access to treatment and treatment retention, including preg
nancy,
primary

or sole child care responsibilities, domestic violence, or a drug
-
using intimate partner.
Evidence
that women and men have differential responses to standard treatments is limited. However,
efficacious
treatments typically address co
-
morbidity and wrap
-
ar
ound service needs for women.

Objectives

The participant will be able to

1.

Describe the prevalence of SUDs in women and patterns of use.

2.

List co
-
occurring disorders and complicating conditions that affect access to treatment and

treatment retention in women.

3.

Describe and appraise evidence
-
based treatments and service
-
delivery systems tailored for

women with SUDs.

Current Research Tells Us

Randomized clinical trials, single group evaluation studies, surveys of treatment delivery systems, and
diagnostic studies will be discussed that support the efficacy of treatments designed to address the
specific needs of women with SUDs.

Considerations for Putting Research Into Practice

Assess service needs of women entering treatment.
Assess for co
-
morbid

disorders.

Develop comprehensive treatment plans that address "wrap
-
around" service needs.
Make provisions for children.


include the intimate partner in treatment when
possible.

Design treatment systems that attempt to minimize barriers to treatment

entry.

Considerations for Future Research

What is the impact on women's treatment outcomes of including brief family
-
involved treatment

in all
SUD treatment?

What is the impact of changes in women's substance use on outcomes for their child(ren)?

Addition
al Resources

McCabe, S. E., Cranford, J. A., and West, B. T. (2008). Trends in prescription drug abuse and
dependence, co
-
occurrence with other substance use disorders, and treatment utitization: Results
from two national surveys.
Addictive Behaviors,
33,
1297
-
1305.

* 41 *

Mangrum, L. R, Spence, R. T., and Steinley
-
Bumgarner, M. D. (2006). Gender differences in
substance
-
abuse treatment clients with co
-
occurring psychiatric and substance
-
use disorders.
Brief
Treatment
and Crisis intervention,
6, 255
-
267.

Morgenstern, J.
(

Blanchard, K. A., McCrady, B. S., McVeigh, K. H., Morgan, T. J., and Pandina, R. J.
(2006). Effectiveness of intensive case management for substance
-
dependent women receiving
temporary assistance for ne
edy families (TANF).
American Journal of Public Health,
96, 2016
-
2023.

Brady, K.T., Back, S, E., and Greenfield, S. F. (2009).
Women and addiction: A comprehensive handbook.
New York, NY: Guilford Press.

10:00 a.m.
-

11:00 a.m., Morning Plenary

Evidence
-
Ba
sed Practices in Adolescent Treatment

Scott W. Henggeler, Ph.D.

This plenary session will present various criteria for determining whether a treatment is
"evidence
-
based" and will note the advantages of the most rigorous criteria. Based on well
-
respected
literature
reviews on adolescent substance abuse treatments, seve
ral intervention models have been
identified
as evidence
-
based, and these will be briefly summarized. The bases of the success of
evidence
-
based
treatments will be discussed. These include attenuating known risk factors, building
protective fac
tors, provi
ding services with ecological validity, using behavioral strategies, and
assuring the fidelity
of services.

Objectives

The participant will be able to

1.

List the criteria for evidence
-
based treatment.

2.

Identify at least two (2)1 treatments for adolescent
substance abuse that have a strong evidence

base.

3.

Describe the likely underlying bases of the effectiveness of these evidence
-
based treatments for

adolescent substance abuse.

Current Research Tells Us

Current treatment outcome research in the area of adole
scent substance abuse will be reviewed.

Considerations for Putting Research Into Practice

Practitioners should examine and consider for adoption the interventions that will be described.

Considerations for Future Research

Additional research is needed on practices that are thought to
f
e promising, but have not undergone

rigorous evaluations.

ti,

JJ. I , /j

Additional Resources ^
\
)
*
\
/T
(jA^ fj
\
\
,
^

Waldron, H. B., and Turner, C. W. (2008). Evidence
-
based psychosocial treatments for adolescent
substance abuse.
Journal of Clinical Child and Adolescent Psychology,
37, 238
-
261.

National Institute on Drug Abuse. (2009).
Principles of drug addiction treatm
ent: A research
-
based
guide.
NIH Publication No. 09
-
4180. Bethesda, MD: National Institute on Drug Abuse.

Sheidow, A. J., and Henggeler, S. W. (2008). Multisystemic therapy with substance using adolescents:
A
synthesis of research. In A. Stevens (Ed.),
Cro
ssing frontiers: international developments in the
treatment of drug dependence
(pp. 11
-
33). Brighton, England: Pavilion Publishing.

11:00 a.m.
-

12:00 p.m.. Poster Session

Refer to Poster Descriptions and Floor Plan

12:00 p.m.
-

1:30 prn.,
Eileen Pencer Memorial Lecture

William R. Miller, Ph.D. J^
\

'

This plenary session will begiWwith a brief narrative summary of 50 years of scientific research
documenting therapist effects on retention, adherence, and outcome. Working in pairs, participants
will practice and experience two contrasting styles of helping


a direct
-
teach style and a
motivational
-
interviewing style


in exploring a personal change
topic. The session wilt conclude with
an open
question and answer discussion period, with an invitation to consider the implications of
this
knowledge for the participant's program setting.

Objectives

The participant will be able to

1.

Describe how the client
-
clinician relationship impacts addiction treatment outcomes.

2.

Explain how clinician style directly impacts client resistance versus motivation for change.

3.

Describe how the knowledge of clinician relationship effects presented In this session apply to

the
participant's own work setting.

Current Research Tells Us

Fifty years of clinical research indicate that one of the strongest determinants of addiction treatment
outcome is the counselor with whom the client works. Regardless of treatment method, counselor

attributes, attitudes, and particularly in
-
session response style significantly influence client treatment
entry, retention, adherence, and outcome. The learnable therapeutic skill of accurate empathy
appears to be one of the more robust predictors of suc
cessful outcomes. Complex therapeutic skills,
such as accurate empathy and motivational interviewing, are learned not by reading or attending a
workshop, but through feedback and coaching based on observed practice.

Considerations for Putting Research Into

Practice

Make it a norm in your program that practice is observed (e.g., recorded) as a basis for supervision,
feedback, and coaching. This provides a solid basis for supervision and quality assurance.
Use what
we know about the attributes of successful c
ounselors in your hiring practices. For
example,
obtain a sample of the applicant's best reflective listening skills during the interview process, and
hire people who already have good skills in this area. Use evidence
-
based practice
in hiring!



Establish

and publicize clear expectations about how clients in your care are to be treated,
and
consider what changes could be made in program procedures to be consistent with your
philosophy.

Considerations for Future Research

Rather than debating what is more important


treatment method or counselor style


design

research to examine the relative simultaneous contributions of these factors.

Do not treat therapist and site effects as nuisance variances, but as important sources

of

information about the transition from efficacy to effectiveness.

Design studies with the clinician (rather than, or in addition to, the treatment method) as the level


Relationships That Heal

action science ana i reatmen

of analysis. What influences a clinician'
s success in client engagement, retention, therapeutic
alliance, and treatment outcome
7

Additional Resources

Project MATCH Research Group (1998). Therapist effects in three treatments for alcohol problems.
Psychotherapy Research,
8, 455
-
474,

Najavits, L. M
. and Weiss, R. D. (1994). Variations in therapist effectiveness in the treatment of patients
with substance use disorders: An empirical review.
Addiction,
89, 679
-
688.

McLellan, A. T, Woody, G. E., Luborsky, L, and Goehl, L. (1988). Is the counselor an "active ingredient"
in
substance abuse rehabilitation? An examination of treatment success among four counselors.
Journal of Nervous and Mental Disease, 176,
423
-
430.

For more information:
www.motivationalinterview.org

and
www.williamrmiller.net
.

SESSION 13, 2:00 p.m.
-

3:45 p.m.

Providing Culturally Competent Service to Lesbian, Gay,
Bisexual, and Transgender Clients

Thomas E. Freese, Ph.D.
JoAnne G. Keatley, M.S.W.

Th
ere are many misunderstandings about the terms used to discuss and interact with lesbian, gay,
bisexual, and transgender (LGBT) clients. Terms such as gay, lesbian, transgender, sex, and gender will
be detailed and discussed, in order for a program to be r
esponsive and sensitive to the needs of LGBT
clients, organizational characteristics (e.g., room assignment), programming (group versus individual
treatment), and assessment issues must be evaluated. Specific elements will be described in detail
and discus
sed. Interactive discussion and case materials will be used to elucidate the specific clinical
issues that LGBT clients bring to treatment. Each population will be addressed separately to clarify
myths and define specific clinical issues.

Objectives

The
participant wilt be able to

1.

Define key terms relevant to the LGBT population and describe the difference between the terms.

2.

Identify strategies for ensuring that program staff and services are responsive to the needs of

LGBT clients.

3.

Demonstrate the
ability to define specific clinical issues faced by each subpopulation in the LGBT

community in search of treatment services for alcohol and/or other drugs.

Current Research Tells Us

Research about the LGBT population suggests that its members are more lik
ely than those in the
general population to use alcohol and drugs, have higher rates of substance abuse, and to continue
use into later life, it is likely that all substance abuse treatment programs have LGBT clients, but unless
staff are sensitized to the
se issues, they may not conduct appropriate assessments and are unlikely to
be responsive to client needs. Most treatment programs do not ask about sexual orientation, and many
LGBT individuals are afraid to speak openly about their sexual orientation or i
dentity.

Considerations for Putting Research Into Practice

Due to homophobia and discrimination against LGBT individuals, some may find it difficult or
uncomfortable to access treatment services. Substance abuse treatment programs
are
often not
equipped to

meet the needs of this population. Sensitizing providers to unique issues faced by LGBT
clients may result in more effective treatment and improved treatment outcomes.

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settin
gs

Considerations for Future Research

Additional research is needed in order to determine methodologies for providing LGBT
-
responsive
services in a mainstream treatment environment. Research about the relative efficacy of culturally
specific versus mainstream treatment is also needed. Finally, questions about sexual orientation and
gender should be included in national survey data to allow for a more accurate estimate of the
population.

Additional Resources

Center for Substance Abuse Treatment. (2001). A provider's introduction to substance abuse treatment
for lesbian, gay, bisexual, and transgender individuals. DHHS Publication No. (SMA) 01
-
3498. Rockville,
MD: Substance Abuse and Mental Health Services Admi
nistration.

Eliason, M.J. (2000). Substance abuse counselor's attitudes regarding lesbian, gay, bisexual, and
transgendered clients. Journal of Substance Abuse, 12, 311
-
328.

Shoptaw, S., Reback, C. J., Peck, J. A, Yang, X., Rotherum
-
Fuller, E., Larkins, S.
, et al. (2005). Behavioral
treatment approaches for methamphetamine dependence and HiV
-
related sexual risk behaviors
among urban gay and bisexual men. Drug and Alcohol Dependence, 78(2), 125
-
134.

Center for Excellence for Transgender HIV Prevention.
http:
//transhealth.ucsf.edu/trans
?
paae^home
-
QO
-
00

SESSION 14, 2:00 p.m.
-

3:45 p.m.

Treatment Through the Criminal Justice System

Faye S. Taxman, Ph.D.
Yvonne
Lutter, Psy.D., M.S.W.

Using results from the National Criminal Justice Treatment Practices Survey, this presentation will
highlight (1) the most frequently used evidence
-
based practices and treatments for drug
-
involved
offenders in prison, jail, probation/parole, and drug treat
ment courts; (2) the type of service integration
issues that improve the delivery of services; and (3) the factors that affect adoption of evidence
-
based
practices. The emphasis will be on learning how to use the "seamless" service system to improve the
de
livery of evidence
-
based treatment services. Using a case study of two systems, we will examine
how the seamless system of care model can be applied to improve services for offenders by drug
treatment and correctional agencies. The seamless model will be p
resented, and then several systems
will be assessed to see how the model can be used in everyday practices.

Objectives

The participant will be able to

1.

Identify at least two (2) core components of evidence
-
based practices in treatment systems that

serve dru
g
-
involved offenders.

2.

Describe at least two (2) core components of a seamless service delivery system for offenders

that is consistent with the evidence
-
based practices and treatment literature.

Current Research Tells Us.

Correctional agencies adopt an ave
rage of one third of the recommended evidence
-
based practices
and treatments that are recommended. An important factor involved in improving the adoption of
evidence
-
based practices is the integration of services across service agencies. The integration fa
ctors
are as follows: (1) we share information on offender needs for treatment services; (2) our organizations
have agreed to use similar requirements for program eligibility; (3) we have written agreements
providing space for substance abuse services; (4)

we hold joint staffing/case reporting consultation;

iction science ana i reatmeni

(5) we have developed joint policy and procedure manuals; (6) our organization has pooled funding for
offender substance abuse services; (7) we have modified the program/service protocols to meet
the
needs of each agency; (8) we share operational oversight

of treatment program/services; (9)
our
organizations cross
-
train staff on substance abuse issues; and (10) we have written protocols
for
sharing offender information. Agencies that have higher scores on integration with treatment
agencies
are more likely
to adopt evidence
-
based practices, and to use evidence
-
based treatment.
Further, the
research finds that integration contributes to more attention being paid to creating a
clinical
environment for delivering the services.

Considerations for Putting
Research Into Practice

Develop a memorandum of understanding that addresses the system integration points.
Develop integrated programs that serve specific target populations.



Focus on creating a therapeutic milieu for correctional clients.

Improve the deli
very of treatment for drug
-
involved clients.



Use the seamless system model to develop an open culture to test out new ideas.

Considerations for Future Research

Assess how organizational learning environments can be used to facilitate treatment outcomes.



Develop new models of how to address competing values among organizations responsible for

the care and treatment of drug
-
involved offenders.

Examine how to train administrators to improve the quality of programs delivered to offenders.

Additional Resources

Taxman, F. S., Shepherdson, E., and Byrne, J. M. (2004). Tools of the trade; A guide to implementing
science into practice (with A. Gelb and M. Gornik). Washington, DC: National Institute of Corrections.
http://www.nicic.org/Library/020095

Henderson, C. E
., and Taxman, F. S. (2009). Competing values among criminal justice administrators:
The importance of substance abuse treatment. Drug and Alcohol Dependence, 103(Suppl 1), S7
-
S16.
doi:10.1016/j.drugalcdep.2008.10.001

Taxman, F. S. (2008). No illusions: Of
fender and organizational change in Maryland's proactive
community supervision efforts.
Criminology and Public Policy,
7(2), 275
-
302.
doi:10.1111/j.l745
-
9133.2008.00508.

Fletcher, B. W., Lehman, W. E., Wexler, H. K., Melnick, G, Taxman, F. S., and Young, D
. W. (2009).
Measuring collaboration and integration activities in criminal justice and substance abuse treatment
agencies.
Drug and Alcohol Dependence,
101(3), 191
-
201.

SESSION 15, 2:00 p.m.
-

3:45 p.m.

Veterans Issues and Substance Use Disorders

Andrew
J. Saxon, M.D.

Peter Banys, M.D., M.Sc.

Susan A. Storti, Ph.D., R.N., CARN
-
AP

The large number of National Guard and Reserve personnel who have been activated and deployed to
Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) raises significa
nt complex
ity in
the provision of behavioral health care. National Guard and Reservists and their families often
reside in
the community and do not have built
-
in support systems that come from living in or around
a military
base. This presentation will (1
) provide a review of the emotional cycles of deployment and
changes in
family structure; (2) describe common responses of family members and veterans to de
-

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

pioyment

and homecoming; (3) discuss the impact of combat stress and substance abuse on family
functioning; and (4) discuss how to engage OIF/OEF veterans and/or their families in treatment. Two
videotaped case interviews of !raq combat veterans with substance use

problems and trauma
-
related
symptoms will be presented and discussed. Veterans suffering from PTSD and co
-
morbid alcohol,
marijuana, or other drug abuse regularly rationalize the drug use as a form of self
-
medication, par
-
ticularly for sleep disorders and

hyperarousal states. This presenting posture creates clinical problems
for
providers who must sort out (1) sequencing of PTSD
-
oriented interventions (such as prolonged
exposure therapies), (2) the role of adjunctive sleep medications (such as trazodone),
and (3) whether
dual
-
diagnosis interventions should be simultaneous or in sequence, after sobriety.

Objectives

The participant will be able to

1.

Describe the impact of combat
-
related psychological trauma in veterans, and the interplay

between the trauma and
problematic substance use.

2.

Identify the challenges associated with multiple deployments, reintegration, and the provision of

care, particularly as it pertains to members of the National Guard and Reserve components and/

or their families.

3.

Explain the self
-
medication hypothesis as applied to co
-
morbid PTSD, sleep disturbances, and

excessive alcohol or drug use.

Current Research Tells Us

The enormously stressful conditions faced by our military while in combat can be difficult to overcome,
even after they hav
e returned from their tours of duty. Ample clinical data confirms that increasing
exposure to combat leads, inevitably, to increasing risks of subsequent mental health disorders and
substance abuse.

Considerations for Putting Research Into Practice



Learn

the nature of combat stress and its impact on individuals, families, communities, and

organizations.

Recognize physical and psychological reactions that may be exhibited in response to stress.



Identify appropriate resources within the community.

Considerations for Future Research

Further research is needed to examine (1) the psychological impact of deployment on military personnel
and their families during the various phases of deployment, and (2) stress/anxiety/depression among
children/spouses of active
-
duty military members compared with children/spouses of Reserve/
National Guard members, etc.

Additional Resources

National Center for Post
-
Traumatic Stress Disorder. (2004). Iraq war clinician guide (2nd ed.).
Washington, DC: U.
S. Department of Veterans Affairs,
http://www.ptsd.va.gov/professional/manuals/
iraq
-
war
-
clinician
-
guide.asp

Jacobson, I. G., Ryan, M. A., Hooper, T I., Smith, T C, Amoroso. P. J., Boyko, E. J, et al. (2008).
Alcohol use and alcohol
-
related problems before

and after military combat deployment.
Journal of
the American Medical Association,
300(6), 663
-
675.

Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., Marmar, C. R. (2009). Trends and
risk
factors for mental health diagnoses among Iraq
and Afghanistan veterans using Department of
Veterans Affairs health care, 2002
-
2008.
American Journal of Public Health,
99(9), 1651
-
1658.

U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder.
http://www.
ptsd.va.qov/index
.asp

iciion science ana i reaimeni

SESSION 16, 2:00 p.m.
-

3:45 p.m.

Addiction
-
Related Self
-
Help/Mutual Aid Croups

Lee Ann Kaskutas, Dr.P.H., M.P.H.
J.
Scott Tonigan, Ph.D.
Michael P.
Bogenschutz, M.D.

This presentation will discuss several meta
-
analytic reviews of the extant 12
-
step literature, noting the
averaged weight correlations, their sampling error, and the populations of interest, as well as findings
of
four meta
-
analytic reviews on Alcoholics A
nonymous (AA) affiliation. Substance use patterns will
be
examined that take into account alcohol, illicit drugs, and quality
-
of
-
life measures among
12
-
step
-
exposed adults, and the literature on abstinence self
-
efficacy and social support for
abstinence wi
ll
be described. The content of manualized 12
-
step facilitation interventions that have
been studied
in clinical trials will be presented in a way that makes it clear how these differ from
12
-
step
-
based
treatment per se. Interventions will be classified in
to one of three categories, which will
help the
participants to have a framework for judging the results of the trials of these interventions. Results
from
published clinical trials of 12
-
step facilitation interventions will be presented, overall, and in
i
mportant
client groupings. The consistency/inconsistency of results across studies will be
summarized, and
reasons for these different findings will be put forward for consideration. The
presentation will review
what is known about individual factors that
moderate the effects of 12
-
step
program involvement and 12
-
step
-
oriented treatment. The discussion will then deal in greater depth
with issues relating to co
-
occurring mental illness.

Objectives

The participant will be able to

1.

Identify predictors of
12
-
step affiliation, the magnitude and nature of 12
-
step related benefit, and

two robust mechanisms accounting for AA
-
related benefit.

2.

Synthesize and summarize the results of clinical trials of 12
-
step facilitation treatment, and

summarize what explains th
ese results.

3.

Explain whether individual characteristics, such as psychiatric co
-
morbidity, moderate the benefits

associated with 12
-
step program involvement and 12
-
step facilitation therapies, and describe

ways in which 12
-
step approaches have been modifie
d with the intention of maximizing benefit

to special populations, such as the dually diagnosed.

Current Research Tells Us



The magnitude of 12
-
step
-
related benefit is about r=.31 in meta
-
analytic reviews and prospective

studies. The strongest support for A
A
-
related benefit is found on abstinence
-
based measures,

while little, if any, evidence suggests that quality of life improves with 12
-
step exposure. In general,

problem severity is the strongest predictor of 12
-
step affiliation, and predictors thought to
be

important (e.g., gender) are relatively unimportant. Finally, 12
-
step participation is associated with

increased self
-
efficacy to remain abstinent and increased social support for abstinence.



While 12
-
step facilitation interventions have led to better o
utcomes than usual care in a number of

studies, some trials have reported null results. Interesting subgroup differences have been found

across the various trials, suggesting that particular approaches to 12
-
step facilitation may be more

appropriate for pa
rticular clients, and less so for others.

Considerations for Putting Research Into Practice



Strongly encourage individuals to attend 12
-
step programs, especially during treatment.

Recognize the need for adjunct treatment to address quality of life and
other, broader measures

of life functioning.



Recognize when 12
-
step referral may and may not be considered.



Think about whether the interventions woutd be possible to implement in your program.

Evidence
-
Based Treatment and Prevention in Diver
se Populations and Settings



Think about whether you treat clients with the characteristics that have been found to correspond

to individuals who have had superior outcomes in 12
-
step facilitation interventions.

Considerations for Future Research



How, if
at all, do 12
-
step programs differ from one another?



How do 12
-
step meetings differ, and do these differences predict differential outcomes
7



What are the long
-
term trajectories of AA
-
exposed adults
7

What explains differential results across studies
7

Some studies have scratched the surface of this
question, but more research is needed to really understand why some 12
-
step interventions are
achieving their effects in particular client groups.

Additional Resources

Emrick, C. D., Tonigan, J. S., Montgomery, H. A., and Little, L. (1993). Alcoholics Anonymous: What
is
currently known? In B. S. McCrady and W. R. Miller (Eds.),
Research on Alcoholics Anonymous:
Opportunities and alternatives
(pp. 41
-
76). Piscataway, NJ:
Rutgers Center for Alcohol Studies.

McCrady, B. S., and Tonigan, J. S. (2009). Recent research on twelve step programs. In R. K. Ries,
D.
A, Fiellin, S. C. Miller, and R. Saitz, (Eds.),
Principles of addiction medicine
(4th ed., pp. 923
-
938).
Philadelphia,

PA: Lippincott Williams and Wilkins.

Forcehimes, A. A., and Tonigan, J. S. (2008). Self
-
efficacy as a factor in abstinence from alcohol/other
drug abuse: A meta
-
analysis.
Alcoholism Treatment Quarterly,
26(4), 480
-
489.

Tonigan, J. S., Bogenschutz, M. P.,
Miller, W. R. (2006). Is alcoholism typology a predictor of Alcoholics
Anonymous affiliation and disaffiliation after treatment?
Journal of Substance Abuse Treatment,
30(4),
323
-
330.

Huebner, R. B., and Tonigan, J. S. (2007). The search for mechanisms of
behavior change in
evidence
-
based behavioral treatment for alcohol use disorders: Overview.
Alcoholism: Clinical and
Experimental
Research,
31(10 Suppl), ls
-
3s.

Kaskutas, L. A. (2009). Alcoholics Anonymous effectiveness: Faith meets science.
Journal of Add
ictive
Diseases,
28, 145457.

Kaskutas, L. A., and Subbaraman, M. (in press). Enhancing 12
-
step participation, in J. Kelly and W. White
(Eds.), Addiction recovery management: Theory, research, and practice.
Current Clinical Psychiatry
Series.
New York, NY:
Springer.

Kaskutas, L. A., Subbaraman, M. S., Witbrodt, J., and Zemore, S. E. (2009). Effectiveness of making
Alcoholics Anonymous easier: A group format 12
-
step facilitation approach. Journal of Substance
Abuse Treatment, 37, 228
-
239.

Bogenschutz, M. P. (2008). Individual and contextual factors that influence AA affiliation and outcomes. In
M. Galanter and L. A. Kaskutas (Eds.), Recent developments in alcoholism, Volume 18: Research on
Alcoholics Anonymous and spirituality in addiction
recovery (pp. 413
-
433). New York, NY: Springer.

Bogenschutz, M. P. (2007). 12
-
step approaches for the dually diagnosed: Mechanisms of change.
Alcoholism: Clinical and Experimental Research, 31(10 Suppl), 64s
-
66s.

Bogenschutz, M. P., Tonigan, J. S., and Mil
ler, W. R. (2006). Examining the effects of alcoholism
typology and AA attendance on self
-
efficacy as a mechanism of change. Journal of Studies on
Alcohol, 67 562
-
567.

Bogenschutz, M. P., Geppert, C. M. A., and George, J. (2006). The role of twelve
-
step ap
proaches in
dual diagnosis treatment and recovery. American Journal on Addictions, 15(1), 50
-
60.

Bogenschutz, M. P. (2005). Specialized 12
-
step programs and 12
-
step facilitation for the dually
diagnosed. Community Mental Health Journal, 41(1), 7
-
20.

icnon science ana i reatment

SESSION 17, 2:00 p.m.
-

3:45 p.m. (Combined with SESSION # 24)

Native American Track
Treatment and
Recovery: Adapting Interventions

Kamilla L. Venner, Ph.D., LP

Ed Parsells, CCDCIII

Frank Zavadil, M.A., CCDC III

American Indian/Alaska Native (AI/AN) people have modes of healing that date back to their origins.
The challenge is to decide whether to support culturally based healing traditions only, Western ap
-
proaches only, a blend of the two, or to develop new inte
rventions. This presentation highlights
an
example of adapting a Western approach by acknowledging the commonalities and differences
between the Western and Native traditions. Also discussed will be caveats in using evidence
-
based
treatments (EBTs) and in
making adaptations that will still help AI/AN people with substance use dif
-
ficulties. Due to limited Tribal treatment programs and the number of available beds in South Dakota,
many Native Americans are treated off reservation in non
-
Tribal state
-
accredit
ed substance abuse
treatment programs, where counseling staff have limited awareness and resources available regard
ing
the Native American culture. To address this area of deficiency in cultural awareness among non
-
Tribal
programs, Dr. Duane Mackey develo
ped an introductory curriculum on the Dakota, Lakota,
and
Nakota culture, with assistance from both Tribal and non
-
Tribal consultants. This presentation
highlights the curriculum development, intended outcomes, and potential opportunities for expand
ing
th
e curriculum to other regions in the country.

Listening skills that will prepare non
-
Native counselors to improve effectiveness in working with Native
American clients are highlighted in this composite module, which is based on three modules from
the Native American Curriculum for Non
-
Tribal Substance Abuse Counselors. The presentation will
include essential elements of the following three modules: (1) The History of Alcohol and Drug Abuse
Among Native American Populations, (2) Counseling Strategie
s for Native American Populations in
Substance Abuse Treatment Programs, and (3) Substance Abuse Intake, Treatment and Aftercare
Goals for L/N/Dakota Populations. Participants will be challenged to look outside of Western culture
and into the continuum of
Traditional to Assimilated Native American culture.

Objectives

The participant will be able to

1.

Identify the pros and cons of cultural adaptations of evidence
-
based substance abuse treatment,

and select the best course of action for their community programs

and people.

2.

Distinguish the need for the Native American Curriculum for State Accredited, Non
-
Tribal

Substance Abuse Programs in South Dakota, and recall the development process, curriculum

goals, and implementation requirements.

3.

Explain the impact of l
inear and circular thought processes in counseling among Native American

populations as demonstrated through samples of the curriculum.

Current Research Tells Us



EBTs are not often available in community substance abuse treatment programs.



Cultural
adaptations of EBTs can increase recruitment and retention of ethnic minority people.

Considerations for Putting Research Into Practice

Read manuals that have already adapted an EBT, or were created for an ethnic minority group (see
below for an example).



Find experts in the EBT program and experts in the cultural group to work together, so that the

treatment remains effective and recognizable, and the cultural sensitivity and acceptability
are

high.

Evidence
-
Based Treatment and Prevention i
n Diverse Populations and Settings

Considerations for Future Research

Test the effectiveness or efficacy of culturally adapted EBTs using the best research methodology
acceptable to the particular community.

Test methodologies to highlight Al/AN traditiona
l healing methods that appear in EBTs (such
as
behavioral modification or other training methods), and identify ways to incorporate Al/AN
spirituality in appropriate ways.

Additional Resources

www.motivationalinterview.org

for training schedules, a list of trainers, and more information.

Miller, W. R., Sorensen, J. L, Selzer, J. A., and Brigham, G. S. (2006). Disseminating evidence
-
based
practices in substance abuse treatment: A review with suggestions.
Journal of Substance

Abuse
Treatment,
31, 25
-
39.

Venner, K. L, Feldstein, S. W., and Tafoya, N. (2008). Helping clients feel welcome: Principles of
adapting treatment cross
-
culturally.
Alcoholism Treatment Quarterly,
25(4), 11
-
30.

SESSION 18, 2:00 p.m.
-

3:45 p.m.

Adolescent
Drug/Smoking Prevention in Primary and

Secondary Schools

Anthony Biglan, Ph.D.
Dalene Dutton, M.S.

This presentation will describe the results of the Institute of Medicine review of school
-
based
interventions to prevent adolescent problem behaviors, drawing
on
the Institute report on
prevention and using PowerPoint slides originally developed by the Institute that have been used
to
brief numerous policymakers around the country. The concept of ker
nels


simple, evidence
-
based
behavior
-
influence techniques that are useful for teachers, parents, and adolescents


will be
presented. At least five kernels will be described with illustrations of how they can be used to motivate
prosocial behavior among
teens. After a brief discussion of the problem of stress among teachers and
others working in human services, we will review the basic principles of acceptance and commitment
training, and describe how they are valuable for helping people to cope with stre
ss and lead more
value
-
filled lives. The presentation will include metaphors and experiential exercises to explicate the
concept of psychological flexibility, which involves mindfully acting in the service of one's values. The
session will conclude with a
summary of the value of this approach to human wellbeing for dealing
with
problems as disparate as drug abuse, job stress, innovation, and prejudice.

Objectives

The participants will be able to

1.

Identify and describe at least five (5) evidence
-
based school
programs that are useful for preventing

substance use.

2.

Describe five (5) evidence
-
based kernels that are useful in influencing student behaviors (a kernel

can be a simple behavior
-
influence technique, such as a prize bowl).

3.

Explain the principles of
psychological flexibility and describe how they could be relevant to

teacher wellbeing, as well as their own wellbeing.

Current Research Tells Us

In the last decade, social scientists have reached the same conclusion: There are connections
among all the mo
st prevalent problems of adolescents and, in order to mitigate those problems.

action bcience and Treatment:

we must create nurturing environments, not only for those adolescents, but also for their families,
their friends, their schools, and their communities. Only in recognizing the importance of nurturance
can we even begin to improve the lives of these teens, now and in the future. A group of scientists
who
worked together at Stanford University in 2003 wro
te a book describing the growing crisis of
adolescents with multiple problems (Biglan et al, 2004). Since then, numerous researchers have
studied the problem (e.g., Biglan, Hayes, and Pistorello, 2008; Wilson and Csikszentmihalyi, 2007;
Wilson and O'Brien,

2008). Last year, the National Research Council and the Institute of Medicine
released their comprehensive report,
Preventing Mental, Emotional, and Behavioral Disorders Among
Young People: Progress and Possibilities.
Now, with the funding that the Obama
Administration has
given to the National Institutes of Health, there is reason to believe that decades of scientific study will
provide important founts of knowledge in programs across the country with one goal in mind


to
make the country and the world a better place for today's young people.

Considerations for Putting Research Into Practice



Kernels provide everyone with the opportunity to take small, simple steps to improve the wellbeing

of those around them, as well a
s their own.



Consumers anywhere can go to a website and find practical, proven recipes for prevention of

most behavior problems. Once selected, an individual consumer could retrieve an effective

technique and receive social support for using it, all for th
e cost of a music CD.



Businesses and organizations trying to reduce healthcare costs through prevention can distribute

Gift Cards that allow members, citizens, employees, or consumers to go to a website and access

practical toots proven to prevent costly p
roblems. People and/or groups could purchase and

distribute the Gift Cards in bulk.



The initial success of such an effort would stimulate behavioral scientists and entrepreneurs to

create additional kernels that could benefit wellbeing.

Considerations for
Future Research

NIDA recently funded the national Promise Neighborhood Research Consortium (PNRC) to assist
high
-
poverty neighborhoods in translating existing knowledge into widespread, multiple improvements
in weltbeing. Neighborhoods of concentrated pove
rty often have high levels of drug abuse, antisocial
behavior, depression, academic failure, and intergenerational poverty. Recent research shows that
substantial reductions in the prevalence of all of these problems are achievable (National Research
Council and institute of Medicine, 2009). Thus, it is important to provide neighborhoods and
communities with the best available prevention and treatment interventions.

The Consortium is building a network of neighborhood and community leaders as well as behavioral
scientists who can work together to improve wellbeing in high
-
poverty neighborhoods. It will indentify
evidence
-
based prevention and treatment interventions (s
trategies, practices, programs, and policies)
that communities can adopt and implement. It will also define and help communities implement
measures of wellbeing and of risk, and protective factors fundamental to knowing whether prevention
and treatment int
erventions are achieving their intended benefits.

The PNRC is developing community
-
based research initiatives on the impact of evidence
-
based
policies, programs, and practices when implemented in high
-
poverty communities. At the same time,
it
will develop
the capacity of early
-
career and local community prevention scientists to conduct
research and support evidence
-
based practices.

Additional Resources

Biglan, A., Brennan, P. A., Foster, S. L, and Holder, H. D. (2004).
Helping adolescents at risk: Preventio
n
of
multiple problem behaviors.
New York, NY: Guilford Press.

Biglan, A., and Hayes, S.C. (1996). Should the behavioral sciences become more pragmatic? The case
for functional contextualism in research on human behavior.
Applied and Preventive Psychology,

5(1),
47
-
57.

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Biglan, A., Hayes, S. C, and Pistorello, J. (2008). Acceptance and commitment: Implications for
prevention science.
Prevention Science,
9(3), 139
-
152.

National Research Council and Institute of Medicine (2009). Preventing mental, emotional, and
behavioral disorders among young people: Progress and possibilities.
Committee on the Prevention
of
Mental Disorders and Substance Abuse Among Children, Youth, an
d Young Adults: Research
advances and promising interventions.
M. E. O'Connell, T. Boat, and K. E. Warner (Eds.). Board on
Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington,
DC: The National Academies Press
.

Wilson, D. S., and Csikszentmihalyi, M. (2007). Health and the ecology of altruism. In S. G. Post (Ed.),
The
science of altruism and health
(pp. 314
-
331). Oxford, England: Oxford University Press.

SESSION 19, 2:00 p.m.
-

3:45 p.m.

Promising New Treatment
s Including Vaccines

Thomas Kosten, M.D.
Claire Wilcox, M.D.
Raafat Fahim, Ph.D.

This workshop will review how a vaccine is made from a cholera toxin linked to cocaine, and how the
vaccine makes antibodies that block entry of cocaine into the brain, thereb
y preventing the "high" and
blocking continued abuse of cocaine. Organizational predictors of and barriers to adoption of
phar
-
macotherapies for addiction will be discussed. Special issues related to dissemination of cocaine
and
nicotine vaccines (adherenc
e to vaccination schedule, safety issues, individual variation in
antidrug
antibody levels) will be presented. Finally, the nicotine addiction challenge will be reviewed,
including
how a nicotine vaccine is made to counter these challenges and break the ad
diction cycle.

Objectives

The participant will be able to

1.

Describe how a cocaine vaccine works for addiction treatment.

2.

Identify issues related to dissemination of vaccines for addiction treatment.

3.

Describe the mechanism of action of a nicotine vaccine for

the treatment of nicotine addiction.

Current Research Tells Us

The cocaine vaccine works to produce antibodies; the antibodies block cocaine effects in the human
laboratory setting, and significantly reduce cocaine use in outpatients.

Considerations for P
utting Research Into Practice

The next study will take place in six sites in the United States, and the vaccine may become commercially
available in several years.

Considerations for Future Research

Current research is focusing on making better vaccines in animals that produce higher antibody levels,
at
a faster rate (1 month instead of 3), and with a longer duration of action (3 months instead of 2).

Additional Resources

Martell, B. A., Orson, F. M.,

Poling, J., Mitchell, E., Rossen, R. D., Gardner, T, et al. (2009). Cocaine
vaccine for the treatment of cocaine dependence in rnethadone
-
maintained patients: A randomized,
double
-
blinded, placebo
-
controlled efficacy trial.
Archives of General Psychiatry,

66(10), 1116
-
1123.

ucnon science and Treatment:

Cornuz, J., Zwahlen, S., Jungi, W. F., Osterwalder, J., Klingler, K., van Metle, G., et al. (2008). A vaccine
against nicotine for smoking cessation: A randomized controlled trial.
PLoS One,
3(6), e2547.

Ducharme, L. J., Knudsen, H. K., and Roman, P. M. (2006). Trends in the adoption of medications
alcohol dependence.
Journal of Clinical Psychopharmacotogy,
26(Sup
pl 1), S13
-
S19.

SESSION 20, 4:00 p.m.
-

5:30 p.m.

Substance Use Among High
-
Risk Adolescents:
Related Risks and Treatment Challenges

Angela Bryan, Ph.D.
Jerald Belitz, Ph.D.

Adolescents involved with the criminal justice system represent a high
-
risk population that engages in
extremely high rates of alcohol/marijuana use and abuse, as well as risky sexual behavior, as compared
to
general adolescents. Moreover, there is evidenc
e that alcohol/marijuana use and abuse are related
to
risky sexual behavior. Increasing numbers of young women being processed through the juvenile
justice system. Other evidence suggests that marijuana may be associated with different facets of
risky sexu
al behavior for males versus females.

Objectives

The participant will be able to

1.

Identify youth at high risk for substance use and related risky behavior.

2.

Describe longitudinal relationships among substance use, related risk behavior, and individual

differences that moderate those relationships.

3.

Define the challenges of treating high
-
risk, substance
-
using youth, including lack of family support,

economic disadvantage, co
-
morbidity, lack of treatment availability, and rarity of self
-
referral.

Current R
esearch Tells Us

Research indicates that adolescence is a time of exploration and risk, when many young people
engage in increasingly "adult" behaviors. While much of this development in normative, some adoles
-
cents engage in high levels of risky behaviors. Specifically, adolescents in the criminal justice system
evidence extremely high levels of substance use, such that between 47 percent and 62 percent of
them meet lifetime criteria for at least one SUD. Treat
ing adolescents poses particular challenges;
however, the vast majority of SUD treatment research is conducted with adults, meaning that we do
not
have strong notions about what the most effective prevention and treatment strategies are for
high
-
risk adole
scents.

Considerations for Putting Research Into Practice



High
-
risk adolescents tend to be extremely transient with unstable home lives, so long
-
term

outpatient treatment, particularly involving families/caretakers, is difficult.



Substance use among adoles
cents serves a highly social function. Physiological dependence

is less common than with adults; therefore, treatment modalities that focus on craving and

withdrawal (which are successful with adults) are (ess likely to have success with adolescents, in

addition, social factors and future goats/motivations must be addressed.



Substance use among adolescents is highly co
-
morbid, both with other risk behaviors (e.g., sexual

risk, violence) as well as psychopathology (e.g., ADHD, depression), and should there
fore be

treated as a system of disorders.

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Considerations for Future Research

More research needs to be conducted regarding both the mechanisms by which some adolesce
nts
can engage in increasingly adult behaviors and "age out" successfully, versus others who develop
abuse and dependence. There is enormous interest in neurocognitive development as a mechanism
by
which exposure to substances translates into risky behavio
r. Further, there is interest in underlying
genetic vulnerability, as well as gene X environment interactions, that result in high risk for the transition
from use to abuse and dependence. Finally, there needs to be extensive research done on treatment
wit
h adolescents in terms of longer term outcomes and the targeting of different types of treatment to
the adolescent, based on their co
-
morbidity, neurocognitive, and (potentially) genetic profile.

Additional Resources

Bryan, A., Ray, L. A., and Cooper, M. L. (2007). Alcohol use and protective sexual behaviors among
high
-
risk adolescents.
Journal of Studies on Alcohol and Drugs,
68(3), 327
-
335.

Kingree, J. B.. and Betz, H. (2003). Risky sexual behavior in relation to marijuana and alcohol use
among African
-
American, male adolescent detainees and their female partners.
Drug and Alcohol
Dependence,
72(2), 197
-
203.

Bryan, A. D., Schmiege, S. J., and

Broaddus, M. R. (2009). HIV risk reduction among detained
adolescents: A randomized, controlled trial.
Pediatrics,
142: ell80
-
ell88.

SESSION 21, 4:00 p.m.
-

5:30 p.m.

Identification of and Treatment for Prenatal Substance Use:

From Research to Practice

Wi
lliam F. Raybura M.D., M.B.A.
DaceS. Svikis, Ph.D.

The clinical and treatment profiles of prenatal substance use are complex, difficult to characterize,
and vary considerably because they are highly dependent on the different type(s) and combinations
of
dr
ugs used. Not only do maternal and fetal/infant consequences of prenatal substance use vary by
type
of drug as well as quantity and frequency of use, but the majority of women use more than one
substance, making it difficult to determine consequences of si
ngle drug use (particularly if alcohol
and tobacco are taken into consideration). Prevalence rates of drug use during pregnancy can also
vary depending on the epidemiological methods used. Finally, the most effective pharmacological
and psychosociat
treatments vary by the drug(s) of abuse (e.g., methadone is an alternative for
opiate
-
dependent pregnant women). Identification of substance use during pregnancy can be
accomplished
through a variety of standardized questionnaire or interview methods. Some

are
specific to alcohol
(T
-
ACE, TWEAK), while others can be used to evaluate risk for other drugs (Drug
CAGE). Objective
measures can be used (e.g., urine screens, hair analysis), but may be more difficult
to implement or limited in detection (e.g., depen
dent on recency and chronicity of use). Barriers to
translating these
methods to "real life" practice include limited time, discomfort with questions about
substance use
(fear it will negatively impact the relationship with the practitioner), and inadequat
e
training in "best practices." Similar barriers can be found for different intervention and treatment
strategies, including pharmacotherapies and psychosocial interventions (time, training, fidelity
monitoring). Various meth
ods have been studied for movi
ng from research to practice, including
computer
-
directed methods
for screening (to minimize practitioner time/effort and reduce limitations
based on training, staff turn
over, and discomfort with subject matter). These show promise for moving
from researc
h to practice.
Reimbursement of practitioners for time spent in screening and brief
intervention is now available in
approximately 10 States, and the results to date have been mixed,
suggesting it may be necessary but
not sufficient. Other strategies (e.g.
, risk factors that predict
women most at risk for substance use

Blending Addiction Science and Treatment:

during pregnancy) can help to reduce the time and effort needed. Indirect methods for identifying
women at risk for using drugs during
pregnancy also show promise.

Objectives

The participant will be able to

1.

Describe prevalence estimates, maternal and fetal/infant consequences, and most frequent co

morbid conditions associated with the different types of substance use, abuse, or dependence

during pregnancy.

2.

Compare and contrast the most effective methods for screening, assessment, and intervention as

found in empirical research with those typically employed in routine treatment settings.

3.

Explain the primary barriers to translating research
into practice in the treatment of perinatal drug

use, abuse, and dependence, and identify one or more strategies that may facilitate translation of

standardized methods from the research setting to substance abuse treatment or other clinical

care settings.

Current Research Tells Us



Current research has consistently found that prenatal use of both licit (alcohol, tobacco) and illicit

(cocaine, methamphetamine, heroin) drugs increases the risks for negative maternal and fetal/

infant consequences.
Unfortunately, because polydrug use is normative, it is difficult to do drug
-

specific research in many cases, and other social/environmental factors must be considered (e.g.,

poor nutrition,
or
-

co
-
morbid psychiatric and medical conditions).



Methods for i
dentifying pregnant women at
risk

for use/abuse of alcohol and other drugs are

available; however, their accuracy rates vary (e.g., urine assays will only detect recent substance

use, while paper and pencil measures are limited by accuracy of self
-
report).



For some women, education is sufficient to prompt discontinuation of use. For others, additional

steps may be needed, and research has identified several effective interventions (both psychosocial

and pharmacological). Their effectiveness varies based on
patient motivation, type(s) of drugs

being used, and severity of use, as well as other factors.

Considerations for Putting Research Into Practice



With respect to screening and identification, while policies vary from State to State, pregnant

women generall
y face greater social and often legal risks when they admit to using drugs during

the prenatal period.



tn some settings (primary or specialty care), baseline rates of drug use may be sufficiently low

such that the economic burden on clinic practitioners (t
ime, monies for urine drug assays) to

implement routine screening becomes prohibitive. Even in other settings, where base rates may

be higher, practical (time, lack of community treatment resources) and attitudinal (discomfort

asking about substance use) f
actors make implementation difficult. Staff turnover as well as

management of ongoing training needs and fidelity "boosters" also contribute to the "disconnect"

between research and practice.



In some States, specialized programs have been created for pregn
ant drug
-
dependent women,

with a therapeutic milieu that specifically targets the unique needs of pregnant drug
-
abusing/

dependent women. In other cases, pregnant women receive treatment in settings where the

majority of patients are not pregnant and, in m
any cases, may not be women. Methods for using

evidence
-
based practices (pharmacological and/or psychosocial) with pregnant women present

unique issues, as medical or clinical staff may lack adequate information/training in evidence
-

based practices, and t
hey are also concerned about ethical and legal liabilities.

Considerations for Future Research

In the past 16 months, a number of States have passed legislation that provides reimbursement
to
practitioners who utilize SBIRT. While the goal was to address one of the barriers noted above
(lack
of monetary compensation), in some cases the mechanism for reimbursement does not

Evidence
-
Based Treatment and Prevention in Diverse
Populations and Settings

seem, in and of itself, to be sufficient to motivate change in practitioner behavior. Future research is
needed to identify strategies to further educate and encourage practitioners in these States to
make use of this mechanism and

implement evidence
-
based SBIRT methods. Alternatives to
practitioner
-
administered screening and assessment tools have been developed with
computer
-
based programs. A number of studies have found that such methods yield higher
rates of
patient self
-
disclosu
re. They also, in theory, can address many of the barriers noted above,
and
constitute a novel new direction for future research and clinician
-
research collaboration.
Some of
the computer programs include computer
-
directed motivational interventions that
e
xamine the
pros and cons of continued use and benefits for making a positive change in behavior.
To date, the
findings suggest they yield outcomes similar to those found with counselor
-

or
practitioner
-
delivered brief interventions. Again, this is a promis
ing area for future research.
Ongoing studies are exploring strategies for identifying pregnant women at risk for substance
use/abuse during pregnancy through indirect measures. This approach minimizes the risk of
social/legal sanctions and practitioner di
scomfort with the subject matter. Interventions for
women who screen "at risk" can focus on more general topics that may include substance use,
but
do not specifically target such behavior. This approach also warrants further consideration by
practitioners

and researchers.



Given the limited success to date in making evidence
-
based screening, assessment, and
intervention practices a part of routine clinical practice, more opportunities for practitioner/
counselor and clinician interactions with researchers

to specifically identify and discuss barriers to
implementation are warranted, and are likely to
generate
promising directions for future
collaborative research.

Additional Resources

Rayburn, W. F. (2007). Maternal and fetal effects from substance use.
Clinics in Perinatology,
34(4),
559
-
571.

Svikis, D. S., and Reid
-
Quinones, K. (2003). Screening and prevention of alcohol and drug use disorders
in
women.
Obstetrics and Gynecology Clinics of North America,
30(3), 447
-
468.

Lui, S., Terplan, M., and Smith,
E. J. (2008). Psychosocial interventions for women enrolled in alcohol
treatment during pregnancy.
Cochrane Database Syst Rev,
2008 Jul 16;(3), CD006753.

Jones, H., Tuten, M., Keyser
-
Marcus, L, and Svikis, D. S. (2005). Specialty treatment for women. In E.

C.
Strain and M. L. Stitzer (Eds.),
The treatment of opioid dependence
(pp. 455
-
484). Baltimore, MD:
Johns Hopkins University Press.

Babor, T. F., McRee, B. G., Kassebaum, P. A., Gnmaldi, P. L, Ahmed, K., and Bray, J. (2007). Screening, brief
intervention and referral to treatment (SBIRT): Toward a public health approach to the management of
substance abuse.
Substance Abuse,
28(3), 7
-
30.

Ondersma, S. J., Svikis, D. S., and Schuster, C. R. (2007). Computer
-
based brief intervention: A
randomized
trial with postpartum women.
American Journal of Preventive Medicine,
32(3), 231
-
238.

SESSION 22, 4:00 p.m.
-

5:30 p.m.

Rural Treatment and Telehealth

John M. Roll, Ph.D.

Sanjeev Arora, M.D., FACP, FACG

This presentation will summarize the wide
-
ranging literature that touches on physical and social
barriers to receipt of care for substance use in rural areas, including provider
-
based and
consumer
-
based perceptions. Material will be presented documenting t
he factors that negatively impact
the use
of many evidence
-
based treatments with high degrees of fidelity in rural areas, suggesting the
need
to develop new or modify existing
treatments.
The Extension for Community Healthcare
Outcomes

Blendi
ng Addiction Science and Treatment:

(ECHO) project enhances both quality of care and access to care for substance use disorders. ECHO
will be described, and a detailed case study of implementation and outcomes in New Mexico will be
presented.

Objectives

The participant will be able to

1.

Describe the unique challenges related to the delivery of substance abuse and mental health

treatment in rural communities.

2.

Explain why many existing evidence
-
based treatments are not suitable, as designed, for use in

rural
areas.

3.

Describe and implement the ECHO model in their community, a new model of care that enhances

access to care for patients with addiction.

Current Research Tells Us

Management of chronic diseases in rural areas is often difficult because of a shortage
of specialty
providers. Our research demonstrates that by using the ECHO model, we can enhance both quality
of
care and access to care for underserved populations.

Considerations for Putting Research Into Practice

By using technology to build "Knowledge Networks," rural providers can be linked to university
specialists. These Knowledge Networks build capacity for care in rural areas.

Considerations for Future Research

Development of new and refinement of existing ev
idence
-
based treatment protocols for use in rural
communities needs to continue. A special emphasis on implementing sustainable practices needs to
be taken into consideration.

Additional Resources

Arora, S., Thornton, K., Jenkusky, S. M., Parish, B., and S
caletti, J. V. (2007). Project ECHO: Linking
university specialists with rural and prison
-
based clinicians to improve care for people with chronic
hepatitis C in New Mexico.
Public Health Reports,
122(Suppl 2), 74
-
77.

Arora, S., Geppert, C. M., Kalishman, S., Dion, D., Pullara, R, Bjeletich, B, et al. (2007). Academic health
center management of chronic diseases through knowledge networks: Project ECHO.
Academic
Medicine,
82(2), 154
-
160.

SESSION 23, 4:00 p.m.
-

5:30 p.m
.

Southwestern Hispanic Concerns in Drug Abuse

Andrea Romero, Ph.D.

Felipe Gonzalez Castro, Ph.D., M.S.W.

Health disparities among ethnic minority groups are more than ethnic
-
label deep, and involve multiple
dimensions of culture, including language, values, attitudes, beliefs, and traditions. A Community
Readiness Model was used as a guide to integrate community
-
based organizations and community
leaders over multiple years. The Ethnic identity Development The
ory was integrated with Social
Cognitive Theory to create a culture
-
based health promotion curriculum. Results from a pretest/
posttest/6
-
month follow
-
up evaluation of this model will be presented. Considerations in the design and
development of culturally

relevant prevention and treatment interventions will be discussed, including

Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

known efficacious components of prevention and treatment interventions, as well as adapt
ations to
the unique needs and preferences of specific subpopulations of Latinos, ranging from youths at
risk
to
adults dependent on illegal drugs. The session will conclude with a brief but integrative Question
and
Answer discussion of clinical and cultural issues and their nuances, as relevant for working with various
Latino/Hispanic populations, ranging in ages from children at
risk

of drug use to middle
-
aged
adults who
are dependent on illegal drugs. This inte
grative discussion will examine prevention and
treatment
issues. Prevention issues might include (1) major risk and protective factors in drug use prevention, and
(2) an analysis of cultural variables (e.g., acculturation, traditionalism, ethnic identity)
that influence the
development of Latino youth development. Treatment issues may include (1) major
factors associated
with effective recovery for adult Latino men and women, (2) major challenges to
full recovery and
relapse avoidance, and (3) the rote of c
ertain cultural factors (e.g., cultural identity
development,
spirituality) that can contribute to more effective recovery and prevention of relapse.

Objectives

The participant will be able to

1.

Define culture and influences on health, and describe and apply

a community readiness approach

to community integration with teen health promotion.

2.

Explain how the Ethnic Identity Development Theory can be integrated into substance use

prevention for Mexican
-
American youth.

3.

Describe model approaches for efficacious an
d culturally informed prevention and treatment

interventions for Latino/Hispanic adolescent and adult populations affected by drug abuse and

dependence.

Current Research Tells Us

Latino adolescents have an earlier age of substance use onset and are less li
kely to have prevention
programs through their schools, yet there
are
very few evidence
-
based research programs available
for this population. Epidemiological research indicates that, in order to change health disparities,
we
need to address cultural issues beyond the ethnic label. Ethnic identity development is a core
element
of positive youth development for ethnic minority adolescents, and acknowledges critical aspects of
their ecology that impacts their likelihood to eng
age in risk behaviors. Social Cognitive
Theory has
been demonstrated to be effective in changing behavior. However, previous studies have
not integrated
ethnic identity development with Social Cognitive Theory. For issues of prevention
intervention
efficac
y, research has examined the effects of normative information and refusal skills to
avoid high
-
risk
situations along with personal skills to resist offers to use drugs. For the treatment of
drug dependence,
major approaches involve understanding personal a
nd interpersonal risk conditions
(triggers), as well as
building personal competencies, to avoid high
-
risk situations and to develop a
commitment to a
drug
-
free lifestyle.

Considerations for Putting Research Into Practice

Community Readiness Models can eas
ily be applied to research within Latino communities.



Integrating community leaders can be essential to the success and sustainabiiity of health
-

promotion programs with Latino teens.



Positive ethnic identity development through teaching history, music,
and art is a protective factor

for Latino teens.

Prevention of drug use among youths involves a combined approach that includes parental
monitoring and support, as well as youth refusal skills building.

Effective recovery from drug dependence involves avoi
ding risk situations, personal commitments
to sobriety, and a network of social supports for a drug
-
free lifestyle.



The Latino population is heterogeneous, and cultural tailoring involves matching subpopulation

needs with evidence
-
based efficacious inter
ventions in addition to addressing culturally relevant

issues.

iction Science and Ireatment:

Considerations for
Future Research



How do stereotypes about minority adolescents and crime, drugs, and sex impact their health

behaviors?

What other sources of resiliency do minority adolescents find within their ecologies of
neighborhoods, families, and ethnic communities
7



What remains unknown in the design and implementation of more efficacious interventions for

various Latino

populations?



How can service providers best integrate intervention issues to tailor intervention activities in

accordance with the individual and qultqral
nqeds of various
Latiop,clients?

Additional Resources

Phinney, j. S. (2005). Ethnic identity in late modern ^imes: A response to Rattansi and Phoenix.
Identity:
An international Journal of Theory and Research,
5(2), 187
-
194.

Romero, A. J., Martinez, D., and Carvajal, S. C. (2007). Bicultural stress and adoles
cent risk behaviors
in
a community sample of Latinos and non
-
Latino European Americans.
Ethnicity and Health,
12(5),
443
-
463.

Oetting, E. R., Donnermeyer, J. R. Ptested, B. A., Edwards, R. W., Kelly, K., and Beauvais, F. (1995).
Assessing community readine
ss for prevention.
International Journal of Addictions,
30(6), 659
-
683.

Castro, F. G., Stein, J. A., and Bentler, P. M. (2009). Ethnic pride, traditionalfamily values, and acculturation
in
early cigarette and alcohol use among Latino adolescents.
Journal of Primary Prevention,
30(3
-
4),
265
-
292.

Castro, F. G., Barrera, M., and Holleran Steiker, L.K. (in press). Issues and challenges in the design of
culturally
-
adapted evidence
-
based interventions. Annual Review of Clinical Psychology.

Witkiewitz, K.
, and Marlatt, G. A. (2007). High
-
risk situations: Relapse as a dynamic process. In K.
Witkiewitz and G. A. Marlatt (Eds.),
Therapist's guide to evidence
-
based relapse prevention
(pp. 19
-
33).
Boston, MA: Academic Press.

SESSION 24, 4:00 p.m.
-

5:30 p.m.
(Combined with SESSION #17)

Native American Track

Recovery Among American Indians/Alaska Natives
~

Adapting Interventions

Raymond Daw, MA
Dennis Donovan, Ph.D.
Laura Price
Albie
Lawrence

Use of two evidence
-
based practices


Motivational Interviewing (Ml) and the Community
Reinforcement Approach (CRA)


with Native American (NA) populations is relatively new, and there is
little documentation of the efficacy and effectiveness of these practices when used with this diverse
population. At an outpatient program that is 85 percent staffed by American Indians, and with a
population that is 95 percent American Indian, Ml and CRA have been practiced for 3 years. This
presentation will compare and contrast Ml and CRA with indigenou
s interventions to describe how
these practices intersect and blend.



Evidence
-
Based Treatment and Prevention in Diverse Populations and Settings

Objectives

The participant will be able to

1.

Explain how to adapt Ml and CRA, and interweave tradi
tional NA healing with Eurocentric models

of treatment.

2.

Describe the Canoe Journey and interweave traditional NA healing with Eurocentric models of

treatment.

Current Research Tells Us

As evidence
-
based practices, both Ml and CRA have been shown to improve treatment motivation
and completion by providing practitioners with skills that display empathy and enhance client
engagement.

Considerations for Putting Research Into Practice

Have Ml

and CRA trainers who are culturally relevant and sensitive.



Have clinical supervision that motivates an approach to support and encourage learning.



Provide appropriate resources that are based on continuous evaluation.

Considerations for Future Research

Cross
-
site effectiveness studies of Ml and CRA should be conducted.

Additional Resources

Venner, K. L, Feldstein, 5. W., andTafoya, N. (2006).
Native American motivational interviewing: Weaving
Native American and western practices. A manual for counselors

in Native American communities.
Albuquerque, NM: The University of New Mexico.

Center for Substance Abuse Treatment. (2009). Enhancing motivation for change in substance abuse
treatment.
Treatment Improvement Protocol (TIP) Series 35.
DHHS Publication No.

(SMA) 99
-
3354.
Rockville, MD: Substance Abuse and Mental Health Services Administration.

SESSION 25, 4:00 p.m.
-

5:30 p.m.

Drug Courts Today and the Promise for Tomorrow

Marie A. Baca, J.D.

Douglas B. Marlowe, Ph.D., J.D.

Traditionally, the criminal justice system has focused largely on a punishment model as opposed to
a rehabilitative approach. Alternatively, drug courts focus on both public health and public safety,
and emphasize the personal responsibility of the partici
pant in his or her own recovery. The foci
of
drug courts are on improved utilization of community resources and improved functioning of
individuals. Drug courts must have clearly stated, realistic end results, and quantifiable and measurable
outcomes, as w
ell as be responsive to the participants and the community. New Mexico recently
completed several countywide evaluations of drug courts and driving while impaired (DWi) courts. The
findings are important for establishing the effectiveness of these programs

and pointing to directions
for improvement. Further, several meta
-
analyses and systematic reviews have demonstrated the
effectiveness and cost
-
effectiveness of drug courts. Additional studies on best practices have pointed
to
specific treatment and superv
ision strategies that are associated with better outcomes in drug
courts,
and have identified the optimal target population for drug courts. Results of these studies will be
summarized in understandable terminology for practitioners, researchers, and polic
ymakers.

Blending Addiction Science and Treatment:

Objectives

The participant will be able to

1.

Describe drug courts and their role in the rehabilitation of the substance
-
abusing or
-
addicted

criminal offender within the judicial process.

2.

Summarize New Mexico's experience with drug courts and DWI courts, and interpret the most

recent findings from the evaluations of these programs.

3.

Describe national findings on the effects of drug courts, including best practices and evidence
-

based practic
es that have been proven to optimize outcomes in these programs.

Current Research Tells Us

Adult drug courts reduce crime, on average, by 8 percent to 26 percent, and return an average of $2.21
in
measurable benefits for every $1 invested in these programs. The optimal target population for drug
courts comprises both high
-
risk and high
-
need clients, meaning they are seriously addicted to drugs
or
alcohol and have other risk factors for failure in

standard treatment or supervision regimens. Finally,
the
best outcomes are elicited when participants
are
drug tested frequently, required to appear in
court for
hearings before the judge on a routine basis, and receive evidence
-
based treatment services.

Considerations for Putting Research Into Practice



Conduct urine drug testing twice per week on a random basis.



Hold court hearings every 2 weeks for the first several months.



Administer standardized behavioral and cognitive
-
behavioral treatment
interventions.



Administer gradually escalating rewards for accomplishments, and sanctions for infractions.



Engage community corrections officers to conduct random home visits and employment checks,

and enforce compliance with site and area restrictions.

Co
nsiderations for Future Research

Comparable research is now needed for other types of problem
-
solving courts, such as DWI courts,
juvenile drug courts, and family dependency treatment courts.

Additional Resources

Hardm, C, and Kushner, J. N. (Eds.). (2008)
. Quality improvement for drug courts: Evidence
-
based
practices [Monograph Series No. 9]. Alexandria, VA: National Drug Court Institute. Available at
www.allrise.org

Carey, S. M., Finigan, M. W., and Pukstas, K. (2008). Exploring the key components of drug

courts: A
comparative study of 18 adult drug courts on practices, outcomes and costs. Portland, OR: NPC
Research. Available at
www.npcresearch.com

Lessenger, J. E., and Roper, G. F. (Eds.)
-

(2007).
Drug courts: A new approach to treatment and
rehabilitation.
New York, NY: Springer.

Marlowe, D. B. (in press). The verdict on drug courts and other problem
-
solving courts. Chapman
Journal of Criminal Justice.