Posts Tagged ‘CTN-0031’

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.


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Updates from STAGE-12

August 25, 2014

Two new articles have just been released online in-press at Psychology of Addictive Behaviors, providing the latest information about National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0031, Stimulant Abuser Groups to Engage in 12-Step (STAGE-12).

The first paper, by Suzanne Doyle and Dennis Donovan of the Pacific Northwest Node, the Lead Node for this project, describes the application of an “ensemble classification tree approach” to the prediction of completion from the 12-Step Facilitation intervention used in the study.

The application of an emsemble subsampling regressions tree method utilizes the fact that classification trees are unstable but, on average, produce an improved prediction of the completion of drug abuse treatment.  The results of this analysis support the notion that there are early indicators of treatment completion that may allow for modification of approaches more tailored to fitting the needs of individuals, and potentially provide more successful treatment engagement and improved outcomes.  For example, the number of types of self-help activity involvement prior to treatment was the predominant predictor, with other effective predictors including better coping self-efficacy, more days of prior meeting attendance, greater acceptance of the disease model, higher confidence for not resuming use following discharge, lower ASI Drug and Alcohol composite scores, negative urine screens for cocaine or marijuana, and fewer employment problems.

Citation: Doyle SR, Donovan DM. Applying an Ensemble Classification Tree Approach to the Prediction of Completion of a 12-Step Facilitation Intervention with Stimulant Abusers. Psychology of Addictive Behaviors 2014 (in press).

The second paper, by Barbara Campbell, Joseph Guydish, and colleagues, reports on an examination of associations of therapeutic alliance and treatment delivery fidelity with treatment retention in STAGE-12.  Stronger therapeutic alliance and higher therapist competence in the delivery of TSF intervention were associated with better treatment retention, whereas treatment adherence was not.  Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention.

Notably, this was  the first study to show a relationship between therapeutic alliance and retention in TSF with substance abusers, and to identify a significant fidelity-retention relationship for manual-guided TSF treatment, a finding that has important implications for treatment delivery.

Citation: Campbell BK, Guydish JR, et al. The Relationship of Therapeutic Alliance and Treatment Delivery Fidelity with Treatment Retention in a Multisite Trial of Twelve-Step Facilitation. Psychology of Addictive Behaviors 2014 (in press).


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Cocaine or Methamphetamine Use, Oxidative Damage, and Executive Dysfunction

July 2, 2013

brainIllicit substance use increases oxidative stress and oxidative stress has been found to be associated with deficits in memory, attention, and problem-solving. This type of executive dysfunction, which impairs the ability to learn and apply new, more adaptive behaviors, may serve to increase vulnerability to stimulant use.

This article, in-press at American Journal of Drug and Alcohol Abuse and written by Theresa Winhusen, Jessica Walker, Greg Brigham, and colleagues, reports on an ancillary study of National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)) that aimed to test a model of the association among oxidative DNA damage and stimulant use, executive function, and stimulant-use outcomes.  Recovery Centers of King County, part of the Pacific Northwest Node, participated in this study.

The researchers found that while more recent cocaine use (use within the past 30 days) was associated with greater oxidative DNA damage, the results did not support the hypothesized relationship between oxidative DNA damage, executive dysfunction, and stimulant use outcomes for cocaine-dependent patients.

However, support for the model was found for methamphetamine-dependent patients, with oxidative DNA damage significantly greater in methamphetamine-dependent patients with executive dysfunction and with executive dysfunction being a significant mediator of oxidative DNA damage and stimulant use during active treatment.

Conclusions: The present results suggest that methamphetamine is neurotoxic, as assessed by executive dysfunction, but cocaine is not, which is consistent with research finding that methamphetamine, but not cocaine, is toxic to dopamine and serotonin neurons. These findings provide preliminary support for a model in which oxidative damage resulting from methamphetamine use results in executive dysfunction, which in turn increases vulnerability to future stimulant use.

Citation: Winhusen TM, Walker J, Brigham GS, et al. Preliminary Evaluation of a Model of Stimulant Use, Oxidative Damage and Executive Dysfunction. American Journal of Drug and Alcohol Abuse 2013 (in press).


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From STAGE-12: Impulsivity Associated with Treatment Non-Compliance in Stimulant-Dependent Patients

January 14, 2013

This ancillary investigation of data from the STAGE-12 protocol (CTN-0031), currently in-press in Journal of Substance Abuse Treatment and co-written by Theresa Winhusen, Daniel Lewis, Bryon Adinoff, and colleagues Dennis Donovan and Jessica DiCenzo from the Pacific Northwest Node, among others, evaluated the relationships among impulsivity, stimulant-dependence diagnosis, and treatment completion.

Six sites from CTN-0031 obtained BIS-11 and Stroop Color Word test results from 182 methamphetamine- and/or cocaine-dependent participants. Methamphetamine-dependent, relative to cocaine-dependent, participants evidenced significantly greater BIS-11 non-planning and total scores. Accounting for other factors related to treatment completion, BIS-11 motor score, and assessing the tendency to act without thinking predicted treatment completion for both cocaine-dependent and methamphetamine-dependent patients.

Conclusions: These results suggest that methamphetamine-dependent and cocaine-dependent patients may have different impulsivity profiles but that the BIS-11 may be useful in identifying both methamphetamine-dependent and cocaine-dependent patients who are at risk for treatment non-completion.

Citation: Winhusen TM, Lewis DF, Adinoff BH, et al. Impulsivity is Associated with Treatment Non-Completion in Cocaine- and Methamphetamine-Dependent Patients but Differs in Nature as a Function of Stimulant-Dependence Diagnosis. Journal of Substance Abuse Treatment 2013 (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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Primary Outcomes for STAGE-12 (CTN-0031) Published!

June 5, 2012

This paper, co-written by Pacific Northwest Node Lead Investigator Dennis Donovan, as well as Dennis Daley, Greg Brigham, and colleagues, currently in-press in the Journal of Substance Abuse Treatment, reports on the primary outcomes of National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031.  Our node served as the Lead Node for this project, working with CTPs and researchers from the ATS, FNA, OV, PR, SC, TX, and WS nodes.

The study evaluated the effectiveness of an 8-week combined group plus individual 12-step facilitative intervention on stimulant drug use and 12-step meeting attendance and service. Individuals were randomized into treatment as usual (TAU) or TAU into which the STAGE-12 intervention was integrated. Assessments were carried out at baseline, mid-treatment, end of treatment, and 3- and 6- month post-randomization follow-ups.

Conclusions: Though the findings were mixed with respect to the impact of integrating the STAGE-12 intervention into intensive outpatient drug treatment compared with TAU on stimulant drug use, the results more clearly indicate that individuals in STAGE-12, compared to those in TAU, have higher rates of 12-step meeting attendance and engage in more related activities throughout both the active treatment phase and the entire 6-month follow-up.

Congratulations to all the Pacific Northwest Node researchers and community treatment providers who participated in this protocol!

Citation: Donovan DM, Daley CD, Brigham GS, et al. Stimulant Abuser Groups to Engage in 12-Step (STAGE-12): A Multisite Trial in the National Institute on Drug Abuse Clinical Trials Network. Journal of Substance Abuse Treatment 2012 (in press).


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NFATTC Addiction Messenger: Twelve-Step Facilitation Series

November 12, 2009

Twelve-Step Facilitation is the topic of the latest issue (July – Sept) in the NFATTC Addiction Messenger series.  Reading this series should help you better understand the CTN STAGE-12 Protocol (Stimulant Abuser Groups to Engage in 12-Step).  Also, you can earn 2.0 NAADAC CEUs by reading all three issues, paying a $20 fee, and taking a short test.

Download or subscribe to the free monthly Addiction Messenger at: http://www.attcnetwork.org/regcenters/index_northwestfrontier.asp

STAGE-12 Update

November 12, 2009

After months of hard work, the STAGE-12 protocol has met and exceeded their recruitment goal, ending recruitment on September 31st with 471 participants, 21 over the target! The end of the randomization phase came roughly 7 weeks ahead of earlier projections. The PNW Node has two sites participating in the study. Recovery Centers of King County (RCKC) was a part of the first wave, and has now completed all follow-up interviews. As one of only three CTPs to initiate the study, RCKC staff were responsible for helping to fine-tune the protocol as they recruited and tracked participants. Evergreen Manor was part of wave two, and despite the shortened recruitment period, they were able to meet their target of recruiting 40-50 participants! Congratulations to the staff at both of these sites! All follow-ups for this study should be complete by April 12th, 2010.