This webinar was developed for the NIDA Clinical Trials Network research staff of the START Follow-up Study (PI: Hser). The training presents key tracking and locating strategies to prepare staff for the process of re-contacting 1,269 participants treated in the original START clinical study (CTN-0027). This presentation has been posted on the Clinical Trials Network training website and on the CALDAR website to serve as a resource for disseminating CALDAR’s expertise on tracking and locating strategies to a broader audience of substance abuse researchers and treatment providers.
This webinar was developed for the NIDA Clinical Trials Network research staff of the multi-site START Follow-up Study (PI: Hser). The TLFB is an abbreviated version of the Natural History Interview protocol that has been adapted for the purposes of this study. The presentation provides training on administering the TLFB, outlines TLFB coding rules, enables participants to practice coding, and provides feedback to participants with the goal of increasing coding consistency across the eight participating CTN sites. This presentation has been posted on both the Clinical Trials Network training website and the CALDAR website to disseminate CALDAR’s expertise on coding the TLFB to others conducting substance abuse research.
Amphetamine-type stimulants (ATS) constitute the 2nd most widely used illicit drug category in the world, following cannabis. Globally, the biggest impact from ATS use (amphetamine, methamphetamine, and captagon) has been identified in the Middle East, Southeast Asia, and North America.
ATS affects the mesolimbic reward system in the brain causing increased levels of dopamine. Although initial use results in positive physical and psychological reactions (increased confidence, alertness and energy, enhanced mood and sex drive), a variety of negative and damaging consequences occur after prolonged use (cardiovascular disease, pulmonary and neurologic problems, skin infections and dental decay). In addition, other chronic diseases highly associated with ATS use include hepatitis C and HIV. Specific clinical challenges and special populations are reviewed when treating ATS users. Psychological and behavioral treatments currently have best evidence of efficacy, but ongoing research is being done to identify effective pharmacological treatment strategies.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice and set of procedures that can be used to help patients with problematic substance use and provide early intervention to avoid consequences from a full blown addiction disorder.
SBIRT has been identified as one of the public health solutions to address the many harmful effects of those using and abusing substances at risky levels. In addition, it is a set of procedures that can be implemented in many settings (hospitals, emergency rooms, primary care settings, mental health settings, criminal justice settings, schools, for example). Research has shown that SBIRT is clinically effective and cost effective. Dr. Freese reviews and discusses validated screening assessments, techniques of brief interventions, and strategies for successful referrals to treatment.
The problem of opioid dependence is on the rise; prescription opioid misuse is of particular concern, not only in adults but in adolescents as well.
The scientific community views addiction as a chronic relapsing brain disease characterized by compulsive use despite harmful consequences, and medications may be used to treat opioid use disorder in conjunction with psychosocial strategies to target relapse prevention skills and behavioral change. When treating opioid dependence, opioid- and non-opioid-based medications may be used during detoxification to treat early and late withdrawal symptoms. Maintenance medications including buprenorphine, methadone, oral naltrexone, and sustained-release intramuscular naltrexone may also be used to prevent relapse to opioid use. Dr. Mooney reviews specific dosing and administration procedures when prescribing buprenorphine, methadone, and naltrexone to treat opioid dependence. In addition, she reviews how naloxone rescue kits are being incorporated as a community-based strategy to reduce opiate overdose.
In the US and in many countries, the prevalence of drug use among convicted offenders is often so high that the criminal justice system can be the largest single provider of addiction and mental health services, with many never having participated in previous treatment.
This presentation begins with general prevalence statistics and an overview of the complex relationship between drug use and crime, including the apparent causal link between stimulant use and violence. Use of drugs in prisons appears to be less frequent than in the community, but the risk of infectious disease transfer is high among injectors given the scarcity of clean syringes. Strategies to reduce drug use within prison settings (e.g., provision of methadone, random drug tests) are discussed, followed by a review of strategies to assess and treat drug-involved offenders under community supervision. These strategies include drug courts, frequent and random drug testing coupled with mild sanctions, and the use of pharmacotherapies for those with opioid dependence.
As technology use (e.g. desktop computer, Internet and mobile phones) continues to increase globally, the use of technology offers a great promise in the assessment, prevention and treatment of substance use disorders and related conditions.
In both assessment and treatment, technology-based delivery methods can optimize standardization and fidelity, respectively, with which evidence-based practices are implemented. Additionally, the capability to disseminate evidence-based practices via technology can extend the reach of these approaches to care outside of formal health care settings. In addition to alcohol and drug treatment, technology-based interventions have been utilized and studied in other chronic disease areas such as smoking cessation, psychiatric conditions (mood, anxiety, and thought disorders), diabetes, hypertension, obesity, and HIV. Preliminary studies in the addictions area suggest both promising clinical outcomes and evidence of cost savings associated with the use of technology-assisted interventions. Dr. Glasner-Edwards reviews selected web/computer-based interventions and mobile technology advancements in addiction treatment, discussing both the positive outcomes and the challenges and limitations. She concludes with a description of a current study underway testing the use of text messaging targeting medication adherence and relapse prevention for HIV+ substance users.