Archive for June, 2014

Higher Exposure to STAGE-12 Sessions Resulted in Improved Outcomes for Stimulant Use

June 19, 2014

Psychotherapie - Die Selbsthilfegruppe blau schwarzThis ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (“Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)“), by Pacific Northwest Node members Elizabeth Wells, Dennis Donovan, Suzanne Doyle, Sharon Garrett, Michelle Ingalsbe, Mary Hatch-Maillette, and colleagues examined whether level of exposure to the STAGE-12 intervention, a 12-step facilitative therapy, is related to treatment outcome.

The original study compared STAGE-12 combined with treatment-as-usual (TAU) to TAU alone; however, these analyses include only those randomized to STAGE-12 (n=234).

“High-exposure” patients (n=158; attended at least 2 of 3 individual and 3 of 5 group sessions in the STAGE-12 intervention), compared to those with less exposure, demonstrated:

  1. Higher odds of self-reported abstinence from, and lower rates of, stimulant and non-stimulant drug use;
  2. Lower probabilities of stimulant-positive urine screens;
  3. More days of attending and lower odds of not attending 12-Step meetings;
  4. Greater likelihood of reporting no drug problems;
  5. More days of duties at meetings;
  6. More types of 12-Step activities.

Many of these differences declined over time, but several were still significant by the last follow-up (180 days following randomization).

Conclusions:  Although outpatient substance use disorder treatment is thought to be characterized by high drop-out rates and low rates of treatment completion, exposure to STAGE-12 was relatively high for this 8-session intervention.  Those achieving high exposure to STAGE-12 demonstrated more positive outcomes, though the design of this secondary analysis cannot demonstrate a causal relationship there. However, it does demonstrate that it is feasible to interest people entering intensive outpatient treatment in a 12-Step oriented intervention and that individuals who agree to participate can be retained at relatively high rates.

Citation: Wells EA, Donovan DM, Daley DC, et al. Is Level of Exposure to a 12-Step Facilitation Therapy Associated with Treatment Outcome? Journal of Substance Abuse Treatment 2014 (in press).


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Raters Unaffiliated with the Tested Treatment May Have Most Objective Fidelity Feedback

June 18, 2014

HAQThis ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (“Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)“), by Pacific Northwest Node members Michelle Peavy and Sharon Garrett, as well as Joseph Guydish, Jennifer Knapp Manuel, and colleagues, investigated the correspondence among four groups of raters on adherence to STAGE-12, a manualized 12-step facilitation (TSF) group and individual treatment targeting stimulant abuse.

The four rater groups compared included the study therapists, their supervisors, study-related (“TSF expert”) raters, and non-project-related (“external”) raters.

Results indicated that external raters rated most critically Mean Adherence — the mean of all the adherence items — and global performance. External raters also demonstrated the highest degree of reliability with the designated expert. Therapists rated their own adherence lower, on average, than did supervisors and TSF expert raters, but therapist ratings also had the poorest reliability.

Conclusions:  Findings highlight the challenge in developing practical, but effective methods of fidelity monitoring for evidence-based practice in clinical settings. While funding and licensing agencies increasingly call for use of evidence-based treatments, community-based organizations implementing them will seek the simplest, most reliable and cost-effective ways of monitoring their delivery.

These results suggest that there may be a role for on-site therapists or supervisors rating adherence, and that raters unaffiliated with the treatment being tested may provide the most objective ratings.

Citation: Peavy KM, Guydish JR, Manuel JK,et al. Treatment Adherence and Competency Ratings Among Therapists, Supervisors, Study-Related Raters and External Raters in a Clinical Trial of 12-Step Facilitation for Stimulant Users. Journal of Substance Abuse Treatment 2014 (in press).


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