CPDD 72nd Annual Meeting • Scottsdale, Arizona - The College on ...

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FACTORS ASSOCIATED WITH HIGH VS. LOW USE OF
EVIDENCE-BASED PRACTICES IN ADDICTION
TREATMENT.
Alison Breland 2 , A Fitzgerald 1 ,JMay 1 , F Taxman 3 , D Farrell-Moore 1 ,JR
Koch 2 , D Svikis 2 ; 1 Richmond Behavioral Health Authority, Richmond, VA,
2 Virginia Commonwealth University, Richmond, VA, 3 George Mason
University, Fairfax, VA
Aims: Use of evidence-based practices (EBPs) in addiction treatment has produced
positive outcomes, yet implementation gaps remain in community settings.
Researchers and policy makers seek to identify ways to increase the use and
fidelity of EBP implementation in treatment programs. Prior research has
focused on implementation issues (Simpson et al., 2007), staff motivation,
(McGovern et al., 2004) and factors associated with support for EBPs (Fuller et
al., 2007). Identifying organizational factors associated with greater EBP use can
inform efforts to promote adoption.
Methods: Staff (N = 68) from treatment facilities in central VA were administered
surveys assessing self-reported use of 32 empirically or consensus-driven
EBPs, as well as measures of organizational culture and climate (Lehman et al.,
2002; Taxman et al., 2007). Positive responses to EBP use were summed and categorized
using a median split into “high users” and “low users.” Differences
between high and low users on organizational measures were then assessed using
one-way ANOVAs.
Results: Results revealed that high user staff were more likely than low users to
obtain treatment knowledge from a variety of sources, such as professional development
and membership in professional associations (ps < .05). High users were
also more likely to score higher on measures of innovation and adaptation, efficacy,
influence, and autonomy. High users also reported having better offices,
more internet use, more positive attitudes toward change, and better training.
Conclusions: Increasing the use of EBPs by SA treatment staff may be better
facilitated by addressing organizational factors than simply promoting EBPs.
<strong>The</strong>se findings are consistent with other research indicating that training
resources are associated with the use of EBPs (Friedman et al., 2007) and that, at
an organizational level, environmental scanning is associated with use of treatment
innovations (Roman & Knudsen, 2004).
Financial Support: This research was funded by NIDA R01DA022081-03
71
PHARMACOKINETIC PROPERTIES OF A BACTERIAL
COCAINE ESTERASE TO BE USED AS A TREATMENT
AGAINST COCAINE-INDUCED TOXICITIES.
Remy L Brim, R K Sunahara, J H Woods; Pharmacology, University of
Michigan, Ann Arbor, MI
Aims: In this study we assess the process of elimination of a bacterial cocaine
esterase (CocE). CocE is rapidly eliminated from the serum of mice with a halflife
of 2.2 hours, thus limiting the in vivo duration of action of CocE.
Hypothesis: CocE is being eliminated via glomerular filtration.
Methods: 1) Male Sprague Dawley rats (3 per group) were injected intravenously
with CocE in different 14-day dosing regimens: 8 mg/kg CocE every 4
days, 8 mg/kg CocE daily, or 24 mg/kg CocE every 4 days. Saline controls were
also included. Six hours following the last dose, rats were sacrificed and perfused
with saline. Kidneys, livers, hearts and lungs were prepared for immunohistochemical
analysis. 2) Male Sprague Dawley rats (3 per time point) were injected
intravenously with 8 mg/kg CocE at 30 minutes and 1, 2, 4, 8, and 12 hours
before intravenous blood sampling and saline perfusion. Kidneys were prepared
for immunohistochemical analysis, additionally protein was extracted. Kidney
homogenates were analyzed by Western blotting.
Results: 1) No immunoreactivity was found in the liver, heart, or lungs, but was
found in the kidneys, localized to the papilla. Higher immunoreactivity was
observed in animals receiving 24 mg/kg CocE than in those receiving 8 mg/kg.
No significant difference in reactivity was observed between animals receiving 8
mg/kg daily or every 4 days. 2) Peak concentrations of CocE in the kidney, as
assessed by Western blotting and immunohistochemistry, occurs at 1 hour following
a bolus intravenous dose of 8 mg/kg. Western blot analysis reveals that
full-length CocE disappears in a time-dependent manner after 1 hour, with relatively
few proteolytic fragments detected.
Conclusions: Findings demonstrate that CocE is being eliminated through the
kidneys. <strong>The</strong> lack of difference between animals receiving an intravenous dose of
8 mg/kg CocE daily, or once every 4 days, as well as the rapid loss of reactivity
observed after 1 hour, suggests that CocE is not accumulating in the kidney, but
being rapidly and effectively eliminated from the body.
Financial Support: USPHS grants DA021416, GM007767.
<strong>CPDD</strong> <strong>72nd</strong> <strong>Annual</strong> <strong>Meeting</strong> <strong>•</strong> <strong>Scottsdale</strong>, <strong>Arizona</strong>
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70
MINDFULNESS TRAINING AND STRESS REACTIVITY IN
SUBSTANCE ABUSE: RESULTS FROM A RANDOMIZED,
CONTROLLED STAGE I PILOT STUDY.
Judson Brewer, R Sinha, J Chen, R Michalsen, T Babuscio, C Nich, A Greer, K
Bergquist, D Reis, M Potenza, K Carroll, B Rounsaville; Psychiatry, Yale
University School of Medicine, West Haven, CT
Aims: Addictions are major chronic and public health problems for which few
effective treatments exist. Stress has been shown to play a major contributory role
in substance use and relapse. Mindfulness training (MT) has shown promise in
a number of stress-related maladies. However, no prior studies have compared
mindfulness training to empirically-validated treatments for substance use disorders
or assessed its impact on stress provocation in individuals with addictions.
Methods: Thirty-six treatment-seeking individuals with alcohol and/or cocaine
use disorders were randomly assigned to receive manualized MT or cognitive
behavioral therapy (CBT) in an outpatient community setting. After treatment,
psychological and physiological responses to personalized stress provocation
were measured by self-report, skin conductance, heart rate, and heart rate variability.
<strong>The</strong> primary outcomes were number of days of substance use and stress
reactivity.
Results: Individuals assigned to MT showed equivalent abstinence to those
assigned to CBT. Additionally, they demonstrated reduced psychological anxiety,
and reduced physiological indices of stress during provocation.
Conclusions: This pilot study suggests that mindfulness training may be efficacious
as a treatment for substance use disorders by targeting a critical component
of addictions: stress.
Financial Support: NIDA K12-DA00167 (JAB), P50-DA09241 (BJR), R37-
DA15969 (KMC), T32-DA007238 (JAB), K05-DA00457 (KMC), K05-
DA00089 (BJR), P50-DA16556 (RS), K02-DA17232 (RS), R01 DA020908
(MNP), RL1 AA017539 (MNP), the U.S. Veterans Affairs New England Mental
Illness Research, Education, and Clinical Center (MIRECC) (BJR), and a Varela
grant from the Mind and Life Institute (JAB).
72
FEASIBILITY AND EFFECTIVENESS OF COMPUTER-BASED
THERAPY IN A COMMUNITY-BASED PROGRAM.
Adam C Brooks, D Ryder, D Carise, K Kirby; Treatment Research Institute,
Philadelphia, PA
Aims: Computerized and web-based therapy approaches may expand the reach
of evidence-based substance abuse treatment; however, it is unclear how webbased
therapies can be optimally integrated into community-based treatment
and how effective they will be if they are only partially implemented. We conducted
a two-phase pilot study to explore 1) whether client use of the
<strong>The</strong>rapeutic Education System (TES), a web-based Community Reinforcement
Approach learning program, would benefit clients in the absence of counselor
support, and 2) whether counselors and clients would use the TES in the absence
of tangible reinforcement.
Methods: In Phase 1, we randomly assigned 28 cocaine-dependent clients in
intensive outpatient treatment to receive either 8 weeks of 1) treatment-as-usual
plus cash incentives for completing computerized behavior therapy modules
(TES), or 2) treatment-as-usual plus incentives yoked to the performance of a
patient in the experimental group, with no exposure to the TES (YC). We
assessed client knowledge and coping skills acquisition, as well as urinalysis-verified
cocaine use during and after exposure to the TES.
Results: Clients in the TES condition demonstrated large improvements in
knowledge acquisition (F (1, 20) = 8.90, p = 0.007; d = 1.05), and small-to-moderate
effects on various indices of improved coping skill acquisition. TES clients
were significantly more likely to select CBT-style coping responses (F (1, 20) =
11.95, p = 0.002; d = 1.16). We also detected small, non-significant effects indicating
decreases in frequency and amount of cocaine used during treatment. In
Phase 2, we studied counselor and client use of the TES following brief training,
and found that counselors referred only around 10% of their caseloads to the
TES, and that without tangible reinforcement, less than 20% of patients engaged
with the TES for more than 2 to 3 visits.
Conclusions: Computer-based therapy approaches are viable to improve community-based
outpatient treatment, but must be integrated with contingency
management systems to insure engagement.
Financial Support: Commonwealth of Pennsylvania SAP Number 4100042753