Archive for September, 2012

Frontal Systems Dysfunction in Stimulant Abusers – Results from CTN-0031-A-1

September 12, 2012

Currently in-press at Drug and Alcohol Dependence, and written by Theresa Winhusen, Eugene Somoza, Daniel Lewis, and colleagues, this article reports on the ancillary protocol CTN-0031-A-1, “An Evaluation of Neurocognitive Function, Oxidative Damage, and Their Association with Treatment Outcomes in Methamphetamine and Cocaine Abusers.”  Recovery Centers of King County, part of the Pacific Northwest Node, participated in this study.

Frontal systems dysfunction is present in stimulant-dependent patients. However, it is unclear whether this dysfunction is a pre-morbid risk factor or stimulant-induced, is severe enough to be clinically relevant, and if it is relevant to treatment response. These questions were addressed using the Frontal Systems Behavior Scale (FrSBe), a reliable and valid self-report assessment of three neurobehavioral domains associated with frontal systems functioning (Apathy, Disinhibition, and Executive Dysfunction, summed for a Total), that assesses both pre- and post-morbid functioning, and has a specific cutoff for defining clinically significant abnormalities.

Analysis of results revealed that stimulant-dependent patients evidence frontal systems dysfunction as measured by the FrSBe, that frontal systems dysfunction was present prior to the initiation of stimulant abuse based on retrospective ratings, that stimulant use was associated with significant worsening of frontal systems function, and that clinically significant Disinhibition was associated with poorer treatment response.

Citation: Winhusen TM, Somoza EC, Lewis DF, et al. Frontal Systems Deficits in Stimulant-Dependent Patients: Evidence of Pre-Illness Dysfunction and Relationship to Treatment Response. Drug and Alcohol Dependence 2012 (in press).


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Evaluation of the Twelve-Step Facilitation Adherence Competence Empathy Scale (TSF ACES)

September 6, 2012

This article, in press at Journal of Substance Abuse Treatment and written by Barbara Campbell, Jennifer Knapp Manuel, Sarah Turcotte Manser, K. Michelle Peavy (of the Pacific Northwest Node), and colleages, describes the development, reliability, and concurrent validity of the Twelve-Step Facilitation Adherence Competence Empathy Scale (TSF ACES).

The TSF ACES is a comprehensive fidelity rating scale for group and individual TSF treatment developed for the CTN ancillary study “Organizational and Practitioner Influences on Implementation of STAGE-12” (protocol CTN-0031-A-3).

For the evaluation of the instrument’s psychometrics, independent raters used the TSF ACES to rate treatment delivery fidelity for 966 TSF group and individual sessions. TSF ACES summary measures assessed therapist adherence, competence, proscribed behaviors, empathy, and overall session performance.

Analysis of the TSF ACES found it reliable, with variable internal consistency. Relationships of the TSF ACES summary measures with each other, as well as relationships of the summary measures with a measure of therapeutic alliance, provided support for concurrent and convergent validity. Fidelity instruments such as the TSF ACES can be used in clinical implementation to train and supervise counselor adherence and skill.

The TSF ACES administration manual, which includes a copy of the measure itself, can be found in the CTN Dissemination Library: http://ctndisseminationlibrary.org/PDF/795_TSFACES.pdf

Citation: Campbell BK, Manuel JK, Manser ST, Peavy KM, et al. Assessing Fidelity of Treatment Delivery in Group and Individual 12-Step Facilitation. Journal of Substance Abuse Treatment 2012 (in press).


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Potential Role of Assessment Reactivity in SMART-ED Protocol (CTN-0047)

September 4, 2012

Screening, brief intervention, and referral to treatment (SBIRT) approaches to reducing hazardous alcohol and illicit drug use have been assessed in a variety of health care settings, including primary care, trauma centers, and emergency departments. A major methodological concern in these trials, however, is “assessment reactivity,” the hypothesized impact of intensive research assessments to reduce alcohol and drug use and thus mask the purported efficacy of the interventions under scrutiny.

Assessment reactivity is a potential source of bias that may reduce and/or lead to an underestimation of the purported effectiveness of brief interventions. From a methodological perspective, it needs to be accounted for in research design. This article in Addiction Science & Clinical Practice, by Pacific Northwest Node PI Dennis Donovan and colleagues, describes the design of the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol, “Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments” (SMART-ED, CTN-0047), which addresses the potential bias of assessment reactivity using a 3-arm design.

The SMART-ED design offers an approach to minimize assessment reactivity as a potential source of bias. Elucidating the role of assessment reactivity may offer insights into the mechanisms underlying SBIRT as well as suggest clinical options incorporating assessment reactivity as a treatment adjunct.

Citation: Donovan DM, Bogenschutz MP, Perl HI, et al. Study Design to Examine the Potential Role of Assessment Reactivity in Screening, Motivational Assessment, Referral and Treatment in Emergency Departments (SMART-ED) Protocol. Addiction Science & Clinical Practice 2012;7:16.


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