Author Archive

UW & WSU Symposium on Marijuana Research in Washington

June 5, 2018

On May 18, 2018, the University of Washington’s Alcohol & Drug Abuse Institute hosted its 3rd Symposium on Marijuana Research in Washington, this year in collaboration with colleagues from Washington State University.

The keynote speaker, Washington State Attorney General Bob Ferguson (pictured below), spoke about issues of federal vs. state marijuana laws, and about Washington’s law protecting local jurisdictions’ right to exclude marijuana retail stores even if the product is legal in the state.

FergusonConfslide_credit

Scientists from the UW and WSU presented panels in three focus areas:

  • Marijuana and Vulnerable Populations
  • Cannabinoids: Therapeutic Potential
  • Marijuana Use & Other Substances: Substitution, Combination, or Both?

The event drew approximately 200 researchers, state and local officials, and community partners.

Video, slides, and speaker information  are available at: http://adai.uw.edu/mjsymposium/.

ADAI received funds from Washington’s Marijuana Dedicated Fund to support marijuana research and information dissemination, described in a report covering activities from July 2015-June 2017.

Advertisements

Mary Hatch-Maillette Named Co-Director of the Pacific NW Node

April 27, 2018

The Pacific Northwest Node is delighted to announce that in March 2018, Dr. Mary Hatch-Maillette was named Co-Director of the Pacific Northwest Node. Having joined the University of Washington’s Alcohol & Drug Abuse Institute in 2003 to work on CTN-0018, Safer Sex for Men, she has since held a variety of local and national roles in seven additional CTN protocols and two platform studies, including the BEing Safe in Treatment (BEST) study.  In addition, she maintains a private psychotherapy practice in Seattle. Her primary research interests are in substance use treatment and HIV risk behavior.

Now one of the longest-serving members of the Pacific Northwest Node and a CTN “veteran,” Mary has co-authored 45 papers, posters, and presentations for the CTN.  She is excited to join the CTN leadership and continue the PNW Node’s tradition of blending science and practice in the treatment of substance use disorders.

SAMHSA TIP 63: Medications for Opioid Use Disorders

February 28, 2018

The goal of treatment for opioid addiction or opioid use disorder (OUD) is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

SAMHSA’s new Treatment Improvement Protocol (TIP), “Medications for Opioid Use Disorder (TIP 63),” helps behavioral healthcare professionals broaden their understanding of the three FDA-approved medications—methadone, naltrexone, and buprenorphine—used to help treat Americans with opioid use disorder, as well as the other strategies and services needed to support recovery for people with OUD.

Download the new TIP or order print copies onlinehttp://bit.ly/2ExvUkz

TIP 63 had significant input from researchers, clinicians, and information specialists affiliated with the Pacific NW Node. Ron Jackson, MSW, LISW and Andrew Saxon, MD served on the Expert Panel to help develop the TIP via a consensus-driven, collaborative process that blends evidence-based, best, and promising practices with the panel’s expertise and combined wealth of experience.

In addition, field reviewers for this TIP included Meg Brunner, MLIS from the CTN Dissemination Library and ADAI, Alison Newman, MPH (ADAI) and Mary Catlin, RN, MPH, CIC, (DOH and ADAI). The field review allows people who work in addiction, mental health, and adjacent fields to gauge the TIP’s relevance, utility, accuracy, and accessibility.

CTN Dissemination Library - What's New

The goal of treatment for opioid addiction or opioid use disorder (OUD) is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

SAMHSA’s new Treatment Improvement Protocol (TIP), “Medications for Opioid Use Disorder (TIP 63),” helps behavioral healthcare professionals broaden their understanding of the three FDA-approved medications—methadone, naltrexone, and buprenorphine—used to help treat Americans with opioid use disorder, as well as the other strategies and services needed to support recovery for people with OUD.

Download the new TIP or order print copies onlinehttp://bit.ly/2ExvUkz

View original post

News from the Pacific Northwest Node

December 19, 2017

Grant News: The Alcohol & Drug Abuse Institute at the University of Washington, home of the CTN Pacific Northwest Node, is pleased to join the Addiction Technology Transfer Centers Network as the new Northwest Regional ATTC, serving Alaska, Idaho, Oregon, and Washington.  The work of the NWATTC will encompass information dissemination, training and technical assistance, and systems consultation for SUD and healthcare organizations and their personnel—all intended to increase awareness and implementation of empirically-supported behavioral health treatment and recovery practices.  Read more about the ATTC Network and its new initiatives.

People News: The PNW Node says farewell and good luck to Elizabeth Witwer, MPH, relocating to the East Coast for a research position at the Guttmacher Institute, where she had worked previously.  During her time with the PNW Node, Ellie worked with colleagues on the new Practice Based Research Network SIG that aims to  expand the number of NIDA CTN protocols relevant to and engaging primary care practices, and to increase the ability of community-based practices to participate in CTN studies.  Drs. Laura-Mae Baldwin (Pacific Northwest Node) and Rowena Dolor (Mid-Southern Node) are co-chairs. Read more about the PBRN SIG.

In a “Conversation with Michelle Peavy,” CTN researcher and psychologist Michelle Peavy discusses the role of research in improving the delivery of effective treatment to clients at Evergreen Treatment Services, an opioid treatment program in Seattle.  Dr. Peavy is one of the co-authors of the recent primary outcomes article for CTN-0051, the X:BOT study.

Recent publications from the Pacific Northwest Node:

Opioid Treatment Drugs have Similar Outcomes once Patients Initiate Treatment

November 15, 2017

subvivMedication-assisted treatment is superior to placebo and counseling-only treatment for opioid use disorders, according to a new article by CTN researchers.

This study, CTN-0051, (X:BOT) aimed to estimate the difference in opioid relapse-free survival between Buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX).  It was a 24-week, open-label, randomized controlled, comparative effectiveness trial held in 8 U.S. community-based inpatient services, with outpatient follow-up for participants, all of whom were users or heroin or prescription-type opiates.  Evergreen Treatment Services in the PNW Node was one of 8 participating sites.

While both medications are used to treat OUD, they are pharmacologically and conceptually distinct interventions for preventing opioid relapse, and, until now, a study directly comparing them to each other had not been done.

Half of the participants (283) were randomized to receive XR-NTX (Vivitrol), a monthly injection, with the other half (287) assigned to receive BUP-NX (Suboxone), which came as a film patients placed under their tongues (“sublingual”). Participants were followed for 24 weeks of outpatient treatment, with “relapse”  considered to be 4 consecutive weeks of any non-study opioid use as measured by urine toxicology or self-report, or 7 consecutive days of self-reported use.

As expected, patients randomized to XR-NTX had a substantial induction hurdle: XR-NTX can trigger severe withdrawal in patients if they have not detoxed from opioids first, and detox can be extremely difficult for opioid users (treatment with Suboxone can be started sooner, while the patient is still experiencing some withdrawal). As a result, fewer participants successfully initiated treatment with XR-NTX (72%) than with BUP-NX (94%).

Among all participants who were randomly assigned (“intention-to-treat” population, n=570), 24-week relapse events were greater for XR-NTX (65%) than for BUP-NX (57%). However, most or all of this difference (89%) was due to patients in the XR-NTX group dropping out of detox before receiving the medication.

Of the 474 participants who did successfully begin treatment, however, researchers found that:

  • 24-week relapse events were similar for both XR-NTX and BUP-NX (about half of both groups relapsed). In other words, both medications were equally effective.
  • Self-reported opioid craving was initially less with XR-NTX than with BUP-NX, but by week 24, participants reported similar levels of craving.
  • With the exception of mild-to-moderate XR-NTX injection site reactions, treatment-emergent adverse events, including overdose, did not differ between treatment groups.

Conclusions: In this population of opioid users, it was more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse. However, once initiated, both medications were equally safe and effective. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention for both medications.

Related:

Citation: Lee JD, et al. Comparative Effectiveness of Extended-Release Naltrexone Versus Buprenorphine-Naloxone for Opioid Relapse Prevention (X:BOT): A Multicentre, Open-Label, Randomised Controlled Trial. The Lancet 2017 (in press).

ctn_lib


Find it in the CTN Library!

12-Step Sponsorship Associated with Positive Outcomes for Stimulant Users

March 30, 2017

Mutual support groups are free, readily available, and cost-effective resources for supporting long-term recovery from substance use disorders.

In particular, 12-step programs like Alcoholics Anonymous, are popular and generally seen as an integral part of an international shift toward a chronic-care model of addiction treatment and recovery.

One frequently theorized mechanism for the efficacy of 12-step groups is social support, or the “fellowship” aspect, particularly “sponsorship,” in which a 12-step participating in long-term, stable recovery voluntarily serves as a role model and supportive guide to a fellow participant in earlier recovery.

Previous studies on 12-step sponsorship have focused almost exclusively on Alcoholics Anonymous and individuals with alcohol use disorders. This secondary data analysis by Dennis Wendt and others from the Pacific Northwest Node, however, explored predictors and outcomes of having a 12-step sponsor among individuals receiving treatment for stimulant use disorders, inclusive of four types of 12-step groups (Narcotics Anonymous, Alcoholics Anonymous, Cocaine Anonymous, and Crystal Meth Anonymous).

The analysis used data from the CTN Stimulant Abuse Groups to Engage in 12-Step (STAGE-12) protocol (CTN-0031), a multisite randomized trial in which participants receiving treatment for stimulant use disorder (N=471, 59% women) were randomized into treatment as usual (TAU) or a 12-step facilitation (TSF) intervention (STAGE-12).

Logistic regression analyses explored the extent to which participants obtained sponsors, including the extent to which treatment condition and other predictors (12-step experiences, expectations, and beliefs) were associated with having a sponsor.

The relationship between end-of-treatment sponsorship and follow-up substance use outcomes was also tested.

Results found that participants were more likely to have a sponsor at the end of treatment and 3-month follow-up, with the STAGE-12 condition having higher sponsorship rates.

Twelve-step meeting attendance and literature reading during the treatment period predicted having a sponsor at the end of treatment. Sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant user and having no drug-related problems at follow-up.

Conclusions: This study extends previous research on sponsorship, which has mostly focused on alcohol use disorders, by indicating that sponsorship is associated with positive outcomes for those seeking treatment from stimulant use disorders. It also suggests that sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF intervention.

Citation: Wendt DC, et al. Predictors and Outcomes of Twelve-Step Sponsorship of Stimulant Users: Secondary Analyses of a Multisite Randomized Clinical Trials. Journal of Studies on Alcohol and Drugs 2017;78:287-295.


Find it in the CTN Dissemination Library!

Congratulations to Molly Carney, Director of ETS!

March 21, 2017

Molly Carney, PhD, MBA of Evergreen Treatment Services

The Pacific Northwest Node is excited to announce that one of our CTP directors, Molly Carney, of Evergreen Treatment Services, will be receiving the Excellence in Advocacy – Individual Achievement award at the National Council for Behavioral Health meeting this April in Seattle!

The National Council for Behavioral Health is the unifying voice of America’s mental health and addictions treatment organizations. Its annual Awards of Excellence honor the advocates and leaders advancing public policies that support improved quality of and access to care, organizations that promote excellence and build health communities, and the achievements of individuals with mental illnesses and addictions, their family members, and the professionals who care for them.

Molly Carney, PhD, MBA, is trained as a clinical psychologist and has worked in substance use disorder treatment since 1986, most recently as director of Evergreen Treatment Services, a private, nonprofit agency offering medication-assisted treatment for adults with opioid use disoders since 1973.

The Pacific Northwest Node says “Congratulations and thank you for your outstanding service!” to Dr. Carney!

Measures of Clinicians’ Skills Post-CM-Training Predict Subsequent Client Outcomes

January 9, 2017

counselor client_138711347The implementation of evidence-based behavior therapies for routine use in addiction care settings remains a challenge.  A prominent issue involves fidelity, or clinician capability to skillfully deliver an intervention as intended and thereby offer therapy-exposed clientele an opportunity to approximate the therapeutic outcomes reported in corresponding efficacy trials.  If an evidence-based intervention is not delivered correctly, it may not be as effective for clients as it was in the studies that make up its evidence base in the first place.

One widely studied behavior therapy for substance use disorders is contingency management (CM), which involves the use of tangible reinforcers to encourage clients to demonstrate identified behaviors such as session attendance or medication adherence.

This study examined the links between post-training assessment of clinician skills in delivering CM and outcomes for their CM-exposed clients.

Nineteen direct-care clinicians affiliated with one of the community treatment programs in the Pacific Northwest Node of the NIDA Clinical Trials Network were examined, comparing post-training implementation domains (assessed using standardized patients) to a targeted outcome of subsequently CM-exposed clients.

Clinicians’ skillfulness, a behavioral measure of their capability to skillfully deliver the intended CM intervention, was found to be a robust and specific predictor of their subsequent client outcomes.

Analyses also revealed CM skillfulness to:

  1. fully mediate an association between a general therapeutic effectiveness and client outcome,
  2. partially mediate an association of in-training exposure to CM and client outcomes, and
  3. be composed of six component clinical practice behaviors that each contributed meaningfully to this behavior fidelity index.

Conclusions: Study findings offer preliminary evidence of the predictive validity of post-training CM skillfulness for subsequent client outcomes. This suggests an apparent value in providing skills-focused training in CM, and perhaps other empirically-supported behavior therapies.

Skills-focused training does not necessarily preclude trainer use of didactic and discussion elements in CM training curricula, presumably for purposes of enhancing clinician knowledge of core operant conditions principles and practices, as well as to dispel myths and misconceptions that deter adoption readiness. However, current findings provide preliminary evidence to suggest such passive learning strategies are insufficient if the goal of behavior therapy training is to prepare a workforce to effectively implement a new approach.

Citation: Hartzler B, et al. Predictive Validity of Addiction Treatment Clinicians’ Post-Training Contingency Management Skills for Subsequent Clinical Outcomes. Journal of Substance Abuse Treatment 2017;72:126-133.


Find it in the CTN Dissemination Library!

 

Congratulations to PN Node Researcher Kari Stephens!

October 17, 2016

kariThe Pacific Northwest Node is proud to announce that one of its members, Kari Stephens, PhD, was just featured as one of nine “rising stars” in the American Psychological Association’s Monitor on Psychology journal (v. 47(9), p. 46). The piece features a “group of early career psychologists who confronted problems and found unique ways to solve them.”

Dr. Stephens, an assistant professor in the University of Washington’s Psychiatry and Behavioral Science department, is recognized for her work on extracting elusive health data” by leading a groundbreaking project that aims to help community health clinics gather research data using electronic health records.

That project, Data QUEST, is capable of harmonizing EHR data from multiple clinics using different platforms across the 5-state WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region. Both the CDC and NIDA are already using the system in their research, and the data have also been used by UW researchers studying wellness counseling for Native American women.

Read the article here: http://www.apa.org/monitor/2016/10/cover-rising-stars.aspx

Congratulations and keep up the great work, Dr. Stephens!

 

Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders

July 18, 2016

group therapy orientation_174164939 - CopyFew studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs).

The NIDA Clinical Trials Network study, STAGE-12, was a clinical trial of 12-step facilitation lead by the Pacific Northwest Node (N=471) focusing on individuals with cocaine or methamphetamine use disorders. It allowed for examination of four questions:

  1. To what extent do treatment-seeking stimulant users use 12-step programs and which ones?
  2. Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users?
  3. What specific baseline “12-step readiness” factors predict subsequent 12-step participation and attendance?
  4. Does stimulant drug of choice differentially predict 12-step participation and attendance?

The four outcome variables, attendance, speaking, duties and 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity.

Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3-, and 6-month follow-ups than did methamphetamine users.

Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment self-help activities at end-of-treatment and 3-month follow-up. Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all times points by pre-randomization in self-help actitivies.

Conclusions: The primary finding of this study is one of continuity: both readiness to engage in 12-step content and specific prior attendance and active participation (defined as speaking, having duties at, or engaging in related activities) with 12-step programs were the main signs pointing to future involvement in these same areas. Based on these findings, there may be little value in continuing to explore demographic characteristics as predictors of 12-step involvement, and instead future research should focus on measures of perceptions and behaviors that are 12-step specific.

Citation: Hatch-Maillette MA, et al. Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders.  Journal of Substance Abuse Treatment 2016;68:74-82.


Find it in the CTN Dissemination Library!