Health Profiles of Clients in Substance Abuse Treatment: A Comparison of Clients Dependent on Alcohol or Cocaine With Those Concurrently Dependent

Macdonald, Scott; Pakula, Basia; Martin, Gina; Wells, Samantha; Borges, Guilherme; Roth, Eric Abella; Salmon, Amy; Stockwell, Tim; Callaghan, Russell C.

doi:10.3109/10826084.2014.935791

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Further, 34% to 46% of those with HIV and co-occurring alcohol and drug use are not virally suppressed (Hayashi et al, 2016; Ingersoll et al, 2011; Parsons, Starks, Millar, Boonrai, & Marcotte, 2014). These findings are consistent with a wider, long-standing literature showing that co-occurrence of drug and alcohol use is common (Borges et al, 2015; Grant et al, 2015; Grant et al, 2016; Hasin et al, 2006; Stinson et al, 2005) and associated with increased dependence severity, impairment, health risks, and relapse probability (Arias & Kranzler, 2008; Carroll, Rounsaville, & Bryant, 1993; Heil, Badger, & Higgins, 2001; Macdonald et al, 2014). …”

Section: Introductionsupporting

confidence: 90%

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

Aharonovich

Stohl

Cannizzaro

et al. 2017

Journal of Substance Abuse Treatment

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Aims Co-occurrence of drug and alcohol use among people living with HIV is linked to poor medication adherence and lack of viral suppression. HealthCall, a technological enhancement of brief Motivational Interviewing (MI), involves brief daily self-monitoring, positive reinforcement, and personalized feedback. This randomized pilot study among people living with HIV investigated the feasibility and efficacy of reducing non-injection drug and alcohol use with MI + HealthCall as adapted for smartphone technology. Design An urban, largely-minority community sample of adults living with HIV were screened for eligibility: last 30 day use of non-injection drugs (≥4 days of crack/cocaine, methamphetamine, or heroin use) and binge drinking (≥1 day of 4+ standard drinks). Those eligible were randomized to one of two groups: MI-only (n = 21) and MI + HealthCall-S (n = 21). Trained counselors delivered the brief MI at baseline. Drug and alcohol use assessments were completed at baseline, 30 and 60 days (end of treatment). Primary outcomes derived from a Timeline Follow Back (TLFB) of the past 30 days included (1) total number of days used primary drug (NumDU) (2) total quantity of primary drug used (dollar amount spent per day; QuantU), (3) total number of drinking days (NumDD) and (4) mean number of drinks per day (QuantDD). Feasibility was determined by HealthCall use rates, patient satisfaction questionnaire (1–5 scale, 5 being best), and retention. Findings The median daily use rate for HealthCall was 95%, patient satisfaction was excellent (4.5) and retention was high (93%). Both treatment groups reduced drug and alcohol use by end of treatment, with MI+Healthcall-S showing significantly greater reductions than MI-only in QuantU (p=0.01) and NumDU (p=0.046). P-values for reductions in alcohol quantity and frequency in the MI+Healthcall group were 0.09–0.11. Conclusions This proof-of-concept randomized trial indicates that HealthCall on the smartphone is a highly feasible intervention in urban, minority individuals with HIV, and suggests efficacy in reducing co-occurring drug and alcohol use. Results suggest opportunities for brief behavioral intervention that may be enhanced through interactive mobile technology to address complex alcohol and drug use patterns that interfere with HIV care, medication adherence and ultimately, viral suppression. A larger randomized trial is warranted to replicate and extend present results.

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Section: Introductionsupporting

confidence: 90%

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

Aharonovich

Stohl

Cannizzaro

et al. 2017

Journal of Substance Abuse Treatment

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“…The concurrent use of alcohol and other drugs has been associated with increased health and social problems among both PLWHA(2,20) and people without HIV(21). Despite these well known relationships, ours is the first study to evaluate alcohol use and NIDU in the context of cART adherence among PLWHA in care at diverse clinics in Latin America.…”

Section: Discussionmentioning

confidence: 99%

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

et al. 2016

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This cross-sectional study describes substance use prevalence and its association with cART adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3% individuals reported having ≥ 1 alcoholic drinks, 5.0% reported any illicit drug use and 17.0% reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use (adjusted odds ratio (AOR)=2.46, 95% confidence interval (CI): 1.99–3.05), illicit drug use (AOR=3.57, 95% CI: 2.02–6.30), and using both alcohol and illicit drugs (AOR=4.98, 95% CI: 3.19–7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America.

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“…Most clients resided in British Columbia (BC) and Ontario. The response rate was extremely high at 97.8% (Macdonald, Pakula et al 2014), identifying 616 clients qualifying for the study.…”

Section: Methodsmentioning

confidence: 99%

The rate ratio of injury and aggressive incident for alcohol alone, cocaine alone and simultaneous use before the event: A case–crossover study

Zhao

Macdonald

Borges

et al. 2015

Accident Analysis & Prevention

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Objectives (i) To estimate the Rate Ratio (RR) of use of alcohol alone, cocaine alone, and both substances simultaneously on acute injury or an aggressive incident, (ii) To compare the RRs for simultaneous use within 3 or 6 hours of the event; and (iii) To compare the RRs of two measures of exposure, “hours of feeling effects” versus estimates based on self-reported quantity and frequency of use. Methods The study employed a case-crossover design with the frequency approach. Clients (N=616) in substance abuse treatment for alcohol or cocaine issues from 2009 to 2012 completed a self-administered questionnaire on their substance use within 3 and 6 hours before a recent injury or physically aggressive incident. Clients also reported detailed quantity and frequency information in relation to their typical substance use, as well as information on “feeling effects”. The RR of acute harms due to substance use was estimated using the Mantel-Haenszel estimator. Results In the 6-hour window before the event, use of cocaine alone, alcohol alone and simultaneous alcohol and cocaine use were each significantly (P <0.05) related to a recent injury and aggressive incident. Simultaneous use was not significantly greater than use of either drug alone. Estimates of RR based on simultaneous use for a 3-hour window before the event were consistently larger than those based on a 6-hour window, and comparisons were significant (P <0.05) for an aggressive incident but not an injury. With reference to the two measures of exposure, three of eight comparisons of RRs were significantly larger for feeling the effects of the substance in comparison to quantity and frequency of substance use. Conclusion These findings are consistent with increased likelihood of harms related to the acute effects of alcohol alone, cocaine alone or simultaneous use. The results are suggestive that the acute effects of these drugs may be better measured within a 3-hour time window than a 6-hour window. Finally, we found that “hours of feeling effects” yielded higher estimates of RR than the quantity-frequency approach; however both measures support the overall findings.

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Health Profiles of Clients in Substance Abuse Treatment: A Comparison of Clients Dependent on Alcohol or Cocaine With Those Concurrently Dependent

Abstract: These findings can aid health care professionals to better respond to issues related to concurrent dependence of cocaine and alcohol.

Cited by 13 publications

References 29 publications

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

The rate ratio of injury and aggressive incident for alcohol alone, cocaine alone and simultaneous use before the event: A case–crossover study

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