Transcript Document

Medication Assisted Treatment: Examining
Criminal Justice Client Outcomes
Kevin Knight, Ph.D.1, Julie Gray, Ph.D. 1,
Amy Cohn, Ph.D. 2, Sarah Desmarais, Ph.D. 3,
Jennifer Pankow, Ph.D. 1, Grace Rowan-Szal Ph.D. 1,
Stephen Doherty, M.Ed. 4, & Pat Flynn, Ph.D. 1
1Texas
Christian University
of South Florida
3 North Carolina State University
4 Gateway Foundation
2 University
CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ
Problem Background
 Persistent skepticism exists within the criminal justice
(CJ) system – including among criminal justice partner
agencies – about the feasibility and impact of promoting
medication‐assisted treatment (MAT).
 Substantial evidence suggests MAT helps patients
reduce opioid and alcohol use (Amato et al., 2005;
Johnson, 2008), criminal behavior and arrest (Schwartz
et al., 2009), and HIV risk behavior and infection
(Metzger et al., 1993).
Specific Aim of This Study
Aim: To identify MAT clinic visit predictors based on
patient self-report the day prior to the visit.
Sub-Aim: Assess relationship of Violence and
Victimization on patient participation in MAT.
Study Design
Recruit a minimum of 75 “MAT eligible” parolees
& probationers participating in a communitybased treatment program in the greater St. Louis
area.
As part of the study, participants call into an
interactive voice response (IVR) survey system
daily over a 2-week period. The survey asks
questions about previous day events, including
stressors, psychological functioning, substance
use, and problems attending treatment.
Data Collection
Baseline
assessment
2 weeks of
daily IVR
assessments
10 weeks of
MAT
treatment as
usual
Follow-up
assessment
 Baseline survey conducted in face-to-face
interview after client is referred to MAT.
 IVR training conducted with clients at baseline.
The expectation for each participant is 2 weeks
of consecutive daily calls (14 total).
 Follow-up survey conducted as face-to-face
interview with each participant after 90 days.
Measures: IVR Daily Interview
 Interactive Voice Response (IVR) Technology
 affordable and easy to use automated survey technology
 uses recorded voice prompts to ask questions that clients
answer by using the touchtone keypad on the telephone or by
speaking open ended responses.
 Software: SmartQ by TeleSage (www.telesage.com/SmartQ.html)
Measures: IVR Daily Interview
For the next several questions, I'm going to ask you about things that you've done
since this time yesterday. Answer each questions using a scale of 0 to 3 where:
0 = no,
1 = yes, but yesterday only
2 = yes, but today only, or
3 = yes, both yesterday & today.
Did you have stress about an argument with someone?
Did you have any stress about work or unemployment?
Did you have any stress about money problems?
Did you have any stress about your health?
Did you have any stress about probation or parole?
Today, please rate how strong is your craving to drink or use drugs?
0 = not at all
1 = slightly
2 = moderately
3 = very
4 = extremely
Measures: Victimization & Violence
In 3 months prior to incarceration,
Victimization
Violence
has anyone…
have you…
1. thrown something at you?
1. thrown something at someone?
2. pushed, grabbed, or shoved you?
2. pushed, grabbed or shoved anyone?
3. slapped you?
3. slapped anyone?
4. kicked, bitten, or choked you?
4. kicked, bitten or choked anyone?
5. hit you with a fist or object or beaten
you up?
5. hit anyone with a fist or object or
beaten up anyone?
6. tried to physically force you to have sex
against your will?
6. tried to physically force anyone to have
sex against their will?
7. threatened you with a knife or gun or
other lethal weapon?
7. threatened anyone with a knife or gun
or other lethal weapon?
8. used a knife or fired a gun at you?
8. used a knife or fired a gun at anyone?
Adapted from MacArthur Community Violence Inventory (Steadman et al., 1998)
Study Sample (n=75)
Demographic Characteristics
 Mean age = 35.5 years (SD = 10.2)
 Range = 20 to 66 years
 Race/ethnicity
 78.4% African American/Black
 18.9% Caucasian/White
 2.7% Other
 Relationship status
 37.3% living with a spouse/partner
 Children
 29.3% have children that live with them
 Education
 22.7% graduated from high school, 37.3% completed GED
Study Sample
Service Use and System Contact
Criminal Justice History
 # of lifetime arrests
 M = 16.2 (SD = 15.1) Range = 1 – 85
 # of arrests while using/seeking drugs
 M = 11.9 (SD = 13.8) Range = 0 – 85
 Age at first arrest
 M = 16.9 years (SD = 3.8) Range = 11 – 32
 # of times in jail, prison or juvenile lockup
 M = 11.3 (SD = 11.7) Range = 1 – 60
Study Sample
Service Use and System Contact
Treatment History
 # of times received treatment for substance use
 M = 3.6 (SD = 4.8) Range = 0 – 30
 Drug of choice
 82% Opiates, 8% Alcohol, 10% poly-drug use, other
 # of times hospitalized for psychiatric problems (Range = 0 – 10)
 n = 68 (91%) never hospitalized for psychiatric problems
 n = 2 (3%) one time
 n = 5 ( 7%) 2 times or more
 # of times hospitalized for other health problems
 M = 2.37 (SD = 3.3) Range 0 – 15
Participant Characteristics:
IVR Responses From Call
Prior to MAT Appointment
Characteristic
Receiving medication for alcohol/drug use
Any alcohol use
Any illegal drug use
Any prescription drug use to get high
Any (other) illegal activities
Kept MAT appointment
N (%) or Mean
35 (47%)
18 (24%)
38 (51%)
18 (24%)
4 (16%)
50 (67%)
Preliminary Findings
Using Alcohol or Drugs to Cope with Stress
100
% Participants
75
Yesterday and Today
Yesterday, but not Today
50
None in the last 2 days
25
0
Alcohol
Illegal Drugs Prescription Drugs
Preliminary Findings (n=75)
Correlates of keeping MAT appointment
Correlates of Appointment Kept
r
Source
Treatment Readiness
.29**
From TCU CEST
Self-Esteem
.04
From TCU CEST
Anxiety
.03
From TCU CEST
Personal Irresponsibility
-.29**
From CTS
Use of drugs for coping with Stress
-.27*
From IVR
Craving for Alcohol, Illegal or Rx Drugs
-.10
From IVR
*p < .05 **p < .01 ***p < .001
Preliminary Findings (n=75)
Correlates of Vivitrol prescription
Correlates of receiving Vivitrol
r
Source
Self-esteem
.28**
From TCU CEST
Anxiety
-.04
From TCU CEST
Expectancy to refrain from drug use - next 90 days
.21*
From TCU CEST
Percentage of daily calls to IVR survey
.33***
From IVR
Craving for Alcohol, Illegal or Rx Drugs
-.20
From IVR
*p < .05 **p < .01 ***p < .001
Preliminary Findings
Keeping Scheduled MAT Appointment
and Previous Day’s Stressors
“Did you have any stress about your health?”
No stress from
Health
Stress about Health
yesterday, today, or both
N (%)
N (%)
Missed
scheduled MAT
Appointment
16 (21%)
9 (12%)
Kept
scheduled MAT
Appointment
41 (55%)
9 (12%)
Preliminary Findings
Keeping scheduled MAT appointment and Use of
illegal Drugs to cope with Stress
“Did you take illegal drugs because of stress”
Did not use of illegal
drugs because of
stress
Used illegal drugs
because of stress
yesterday, today, or
both
N (%)
N (%)
Missed
scheduled MAT
Appointment
9 (12%)
16 (21%)
Kept
scheduled MAT
Appointment
36 (48%)
14 (19%)
X2(1, n=75) = 9.0, p < .01
Preliminary Findings
Associations between previous psychiatric
hospitalizations and keeping MAT
appointment
No previous
psychiatric
hospitalizations
One or more
psychiatric
hospitalizations
N (%)
N (%)
Missed
scheduled MAT
Appointment
23 (31%)
2 (3%)
Kept
scheduled MAT
Appointment
45 (60%)
5 (7%)
Preliminary Findings
Prevalence and Co-occurrence of
Violence & Victimization
Violence &
Victimization,
40%
None, 57.3%
Victimization
only, 6.7% Violence
only, 2.7%
x2(1, n=75) = 18.62, p < .001
Preliminary Findings
Prevalence of violent outcomes reported at
baseline (n = 75) & follow-up (n = 47)
50
40
*
%
30
*
20
10
0
Any Violent
Outcome
*p < .05.
Perpetration
Victimization
Baseline
Follow-Up
Conclusions
 Need to explore impact of MAT on violence and
victimization.
 Will continue to examine measurement of MAT treatment
satisfaction, barriers to MAT treatment, and support for
MAT treatment.
Questions and Comments
The study team gratefully acknowledges the support of the
following organizations:
National Institute on Drug Abuse
Department of Justice
Substance Abuse and Mental Health Services Administration