Transcript Open poster - CTN Dissemination Library

Baseline Characteristics by Primary Substance of Abuse of Outpatient Clients
in a Web-based Intervention Trial
Aimee N. C. Campbell, Ph.D.1,2,3, Edward V. Nunes, M.D.1,3 , Mei-Chen Hu, Ph.D. 3, Gloria M. Miele, Ph.D.1, Martina Pavlicova, Ph.D. 4
(1) New York State Psychiatric Institute (2) St. Luke’s-Roosevelt Hospital (3) Columbia University College of Physicians & Surgeons, Department of Psychiatry (4) Columbia University Medical Center, Department of Biostatistics
ABSTRACT
The purpose of this study is to compare baseline demographic and clinical
differences across classes of substances among clients recruited into an effectiveness
trial of an efficacious, web-based version of the Community Reinforcement Approach
(CRA; Onken et al., 1997) plus abstinence-contingent incentives (Budney & Higgins,
1998; Higgins et al., 1994), known as the Therapeutic Education System (TES; [Bickel
et al., 2008]). TES was developed to target a range of substance use disorders.
Clients were recruited from 10 outpatient drug treatment programs within NIDA’s
Clinical Trials Network across 10 states from June 2010-August 2011. Participants
completed a brief eligibility screen followed by baseline assessment, and
randomization into 12 weeks of treatment as usual (TAU) or TAU + TES. Follow-up
assessments were conducted 3- and 6-months post treatment. Final 6-month followup data collection will be completed in June 2012.
1,781 participants completed screening; 866 were ineligible, 408 were eligible but
not randomized. The randomized sample (n=507) reported varied primary substances
of abuse (marijuana 23%; alcohol 21%; opioids 21%; cocaine 20%; stimulants 11%;
other 5%). Differences across primary substance were found on age, race/ethnicity,
marital status, 12-step attendance, abstinence at baseline, injection drug use, and the
social/leisure domain of the Social Adjustment ScaleTM (Weissman & Bothwell, 1976).
The study was successful in recruiting a diverse, treatment-seeking sample.
Clinical differences across primary substance have implications for treatment
engagement and planning, as well as overall trial outcomes.
METHODS
Sample: Men and women in participating outpatient substance abuse treatment
programs (N=10) who were 18 or older, in the first 30 days of the current treatment
episode, reported illicit substance use (with or without alcohol use) in the past 30
days, not currently prescribed an opioid replacement medication, and demonstrated
sufficient English literacy for study activities.
Procedures: Potential participants were referred to or approached by research staff,
provided a brief description of the study and, if interested, completed a 10-minute brief
screen (after verbal consent) to assess general eligibility. Eligible and interested
clients were scheduled for a baseline assessment, prior to which they completed a full
study informed consent. Baseline assessment included measures of daily substance
use over the past 90 days (including urine drug and breath alcohol screens),
substance use disorder diagnosis, co-occurring psychiatric problems, physical health,
social functioning, service utilization, and criminal justice involvement. After baseline,
participants were randomized to receive 12 weeks of (1) TAU, or (2) TAU + TES,
whereby TES replaced approximately 2 hours of standard treatment per week.
Data Analysis: Means and standard deviations or percentages were calculated for
each baseline variable. Chi-square tests for categorical variables and F-tests for
continuous variables were used to analyze data. Statistics are reported only for tests
reaching p  .01. SAS 9.1 was used for all analyses.
DISCUSSION
RESULTS
 This innovative, computer-assisted intervention trial attracted and recruited a diverse
Screened Sample: Characteristics and Eligibility
substance using sample in the first few weeks of their treatment episode. The majority
of clients were ineligible due to a lack of illicit substance use in the prior 30 days,
highlighting a common finding of reduced use prior to treatment.
 1,781 participants screened; 866 ineligible (48.6%), 915 eligible (51.4%)
 44% recruited directly by research staff; 42% via program staff; 9% flyer
 37.2% of screened sample were women; mean age = 35.4 years (SD=11.4)
 507 (55.4%) of 915 eligible participants enrolled; 28.5% of total screened sample
 Reasons for ineligibility: 82% no recent illicit substance use; 12% in treatment for > 30 days; 8%


 The fact that the intervention was web-based did not seem to deter clients from
participating, a positive finding for this new technology.
prescribed opioid replacement medication
Of eligible/not interested participants: 49.2% time was an issue, 26.9% did not want to participate in
research, 7.7% not interested in computer-assisted treatment, and 25.4% other reason
Of eligible/interested participants who scheduled but did not attend baseline: 41.2% failed to show,
25.4% no longer interested, and 23.2% no longer enrolled at treatment program
 There were surprisingly few significant differences in demographic or clinical
characteristics by primary substance.
 Marijuana and opiate users were younger than alcohol, cocaine, and other stimulant
Fig 1. TES Screen Shot
Table 1: Randomized Sample Characteristics by Primary of Substance of Abuse (N=483*)
Variable
Sex (women)
Age (years)
Alcohol
N=105
Cocaine
N=101
Stimulants
N=58
Opiates
N=105
Marijuana
N=114
41.9%
45.5%
36.2%
34.3%
41.2%
37.6(10.7)a
40.4(10.0) a
37.3(10.1) a
31.8(10.2)b
29.9(10.2)b
Race/Ethnicity
White
African American
Hispanic/Latino
Multi-racial/Other
56.2%
21.0%
15.2%
7.6%
40.6%
44.6%
7.9%
6.9%
32.8%
5.2%
10.3%
51.7%
81.9%
5.7%
7.6%
4.8%
36.8%
29.8%
14.0%
19.3%
Less than H.S. Education (yes)
20.0%
27.7%
22.4%
27.6%
20.2%
 There were high rates of 12-step attendance, especially for clients newly enrolled in
X2/F-test
19.24
149.61
29.99
57.1%
10.5%
32.4%
52.5%
14.9%
32.7%
41.4%
17.2%
41.4%
65.7%
17.1%
17.1%
73.7%
13.2%
13.2%
Employed (yes)
37.1%
36.7%
36.2%
47.6%
47.4%
Admission CJS Prompted/Mandated (yes)
34.3%
28.7%
39.7%
24.8%
45.6%
Nicotine Use (yes)
77.1%
81.2%
69.0%
84.8%
71.9%
12-Step Attendance-90 days (yes)
58.1%a
63.4%a
74.1%a
74.3%a
21.2%b
69.21
Abstinent (all illicit substances)
57.1%a
56.4%a
73.7%a
63.8%a
31.3%b
36.97
Injection Drug Use-90 days (yes)
3.8%a
4.0%a
0%
43.8%b
0%
145.27
71.9(21.2)
71.8(21.0)
77.8(17.8)
74.4(17.5)
73.3(19.7)
Depression (probable diagnosis)
62.9%
57.4%
50.0%
61.9%
45.6%
Generalized Anxiety (probable diagnosis)
25.7%
20.8%
31.0%
33.3%
28.1%
Posttraumatic Stress (probable diagnosis)
22.9%
26.8%
22.8%
13.5%
22.7%
Sexually active-30 days (yes)
62.9%
68.3%
72.4%
64.8%
76.3%
> 1 Sexual Partner-30 days (yes)
20.0%
14.9%
8.6%
16.2%
14.9%
# Unprotected Vaginal/Anal Sex Acts-30 days
7.4(14.7)
9.5(15.3)
9.6(16.0)
11.3(17.6)
9.4(16.0)
Social Adjustment (range=0-5; higher=poorer)
Work Role
Social/Leisure
Primary Relationship
1.8(0.7)
2.5(0.7)ab
2.0(0.6)
1.7(0.6)
2.7(0.7)a
2.3(0.5)
1.6(0.4)
2.5(0.6)ab
2.0(0.5)
1.7(0.5)
2.4(0.6)ab
2.0(0.7)
1.7(0.7)
2.3(0.6)b
2.0(0.6)
* ‘other’ category of primary substance not included in statistical tests (n=24)
Note. X2/F-test values shown only for variables significant at p < .01; superscripts indicate significant differences between primary substance categories
treatment; the exception being lower rates among marijuana users. Marijuana users
may require alternative ancillary support services.
 Participants also had relatively high rates of depressive symptoms and nicotine use,
though these did not differ by primary substance.
 Of note, sexual risk (both unprotected sex acts and proportion of sex acts that were
unprotected-findings not reported in the table) was not significantly different by primary
substance; relatively high rates of risk in the prior 30 days points to continued need for
HIV prevention services in outpatient substance abuse treatment.
Marital Status
Never Married
Married
Divorced/Separated/Widowed
Physical Health (range=0-100; higher=better)
users. The opiate finding is likely fueled by prescription opiate abuse. Further, the vast
majority of opiate users identified as White, while the majority of cocaine users
identified as African American.
REFERENCES
Bickel WK, Marsch LA, Buchhalter A, Badger G. (2008). Computerized behavior therapy for opioid
dependent outpatients: A randomized, controlled trial. Experimental and Clinical Psychopharmacology,
16, 132-143.
Budney A, Higgins S. (1998). Therapy manuals for drug addiction, a community reinforcement plus
vouchers approach: Treating cocaine addiction. Rockville, MD: National Institute on Drug Abuse.
Higgins ST, Budney A J, Bickel WK, Foerg FE, Donham R, Badger GJ. (1994). Incentives improve outcome
in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51, 568-576.
Onken LS, Blaine JD, Boren JJ. (Eds.) (1997). Beyond the Therapeutic Alliance: Keeping the Drugdependent Individual in Treatment. NIDA Research Monograph, 165. Rockville, MD: National Institute
on Drug Abuse, NIH Publication: 97-4142.
Weissman J, Bothwell S. (1976). Assessment of social adjustment by patient self-report. Archives of
General Psychiatry, 33, 1111-1115.
ACKNOWLEDGMENTS
5.84
This research was supported by grants from the National Institute on Drug Abuse (NIDA) National
Drug Abuse Treatment Clinical Trials Network (CTN), U10 DA13035 (EV Nunes & J Rotrosen, Co-PIs)
and NIDA K24 DA022412 (EV Nunes). In the preceding 24 months, Dr. Nunes has served on the Lilly
advisory board and has received medication from Alkermes/Cephalon, Inc. for research study
purposes.
We acknowledge and thank the effort of research staff at participating treatment programs, and
participants who took part in the study.
Inquiries should be directed to the lead author:
Aimee Campbell, Ph.D. | Email: [email protected]