Race, Age, and Back Pain as Factors in Completion of Residential Substance Abuse Treatment by Veterans

Abstract

White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

Characterizing pain and associated coping strategies in methadone and buprenorphine-maintained patients

“…There are numerous approved and empirically-supported methods for managing pain, and evidence from this and other studies suggests these strategies are under-utilized in OMT patients. Persistent chronic pain has been associated with poor OMT response (Berg and Brevik, 1998; Jamison et al, 2000; Stack et al, 2000; Rosenblum et al, 2003; Trafton et al, 2004), so there is value in identifying methods for increasing coping strategy utilization. This may include regularly screening patients for pain and providing referrals for treatment, partnering with local pain treatment providers, or supporting training for OMT staff deliver pain treatments and offer specialized groups (Barry et al, 2014).…”

“…Concurrent chronic pain and OUD has been associated with more severe medical and psychiatric problems, misuse of illicit substances, and poorer retention in OMT (Berg and Brevik, 1998; Jamison et al, 2000; Stack et al, 2000; Rosenblum et al, 2003; Trafton et al, 2004; Potter et al, 2015), and providers may prioritize the treatment of OUD in these patients, leaving the concurrent pain untreated (Berg et al, 2009). Opioid narcotic medications, which are first-line treatments for pain, may not be appropriate for OMT patients due to cross-tolerance (i.e., decreasing analgesic efficacy), or other medication interactions (e.g., increased risk of respiratory depression) in methadone patients or the antagonistic properties of buprenorphine.…”

Are Special Treatments Needed for Special Populations?

“…Other studies have provided inconsistent results in evaluating main effects of ethnicity on addiction treatment outcomes. Comparisons of Black (African-American) and White subgroups have shown better (Stack, Cortina, Samples, Zapata, & Arcand, 2000), similar (Brower & Carey, 2003;Henggeler, Melton, & Smith, 1992), and worse (Booth, Blow, Cook, Bunn, & Fortney, 1992) overall outcomes for Blacks. Native Americans have similarly been reported to have better (Booth et al, 1992), similar (Villanueva et al, 2003), and worse overall treatment outcomes (Query, 1985).…”

Counselors’ Experiences Treating Methadone-maintained Patients with Chronic Pain: A Needs Assessment Study

“…[1][2][3] Unrelieved chronic pain is generally associated with poorer drug treatment outcomes, including increased nonprescribed use of psychoactive drugs and early treatment termination. [3][4][5][6] Compared with MMT patients without pain, those with pain have significantly more health problems, psychopathology, prescription and nonprescription medication use, and are more likely to report that they are undertreated. [1][2][3] Psychosocial interventions enhance the effects of methadone maintenance in a cost-effective manner, [7][8][9] are required by federal law to be offered on-site at MMT clinics, and are effective in treating chronic pain in a cost-effective manner in pain treatment programs.…”