Stress, craving and mood as predictors of early dropout from opioid agonist therapy

Panlilio, Leigh V.; Stull, Samuel W.; Kowalczyk, William J.; Phillips, Karran A.; Schroeder, Jennifer R.; Bertz, Jeremiah W.; Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Nunes, Edward V.; Epstein, David H.; Preston, Kenzie L.

doi:10.1016/j.drugalcdep.2019.05.026

Cited by 86 publications

(38 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with the literature, opioid use during the first month of treatment was predictive of early treatment discontinuation 32 . Lack of a psychiatric diagnosis was predictive of retention and consistent with a study that showed bothersome psychological problems were predictive of discontinuation 33 . This may be useful for recognizing high‐risk patients early in treatment and individualizing care accordingly; for example, it may be beneficial to schedule more frequent follow‐up visits for patients identified as high‐risk of early discontinuation.…”

Section: Discussionsupporting

confidence: 81%

Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder

Mattle

Aladeen

Blondell

et al. 2021

J Am Coll Clin Pharm

View full text Add to dashboard Cite

IntroductionTreatment with medications such as buprenorphine has been shown to improve outcomes of patients with opioid use disorder (OUD); however, there is still potential to optimize care. Clinical pharmacists may benefit OUD patient treatment by making individualized medication recommendations and enhancing care as part of a multidisciplinary team. This study evaluates a novel outpatient practice model that incorporates pharmacists to manage OUD patients.MethodsA multi‐center retrospective study compared outcomes of a multidisciplinary practice with clinical pharmacists to a physician‐only practice. Primary outcomes were treatment retention and opioid relapse rate. Secondary outcomes included patient engagement with counseling, toxicology results, and buprenorphine nonadherence. Data were collected from 75 patient records from each practice for up to 1 year after starting treatment. In addition, a prospective, observational study was conducted to describe pharmacist interventions at the multidisciplinary practice. Twenty patients were followed for up to 1 year to characterize pharmacist recommendations and assess treatment retention and opioid relapse rates among other secondary measures.ResultsIn the retrospective study, treatment retention did not differ between practices (P > .05) but multidisciplinary practice patients experienced fewer opioid relapse months (P < .05). Similar rates of engagement with counseling (P = 1) and follow‐up visits with illicit substance use (P > .05) were observed. More buprenorphine nonadherence was identified at the physician practice (P < .01). In the prospective study, pharmacist recommendations included buprenorphine regimen changes and the addition of new medications for un/undertreated conditions. Pharmacists provided care coordination, medication counseling, non‐pharmacologic recommendations, and counseling regarding future/alternative treatment options.ConclusionThis study demonstrates the ability of a practice with clinical pharmacists to provide quality care to OUD patients in an outpatient setting. These results have implications for OUD treatment by expanding addiction services in this underserved patient population.

show abstract

Section: Discussionsupporting

confidence: 81%

Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder

Mattle

Aladeen

Blondell

et al. 2021

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…Additionally, consistent with prior research, current ndings revealed that higher levels of perceived stress were negatively associated with number of days retained in treatment across models [28]. Supporting this nding, prior work has shown that individuals who report higher levels of stress experienced more frequent and stronger substance and alcohol use cravings [18,46]. Importantly, Law et al [18] found that craving mediated the relationship between stress and relapse during treatment.…”

Section: Co-occurring Mental Health Disorders and Stresssupporting

confidence: 83%

Examination of Referral Source and Retention Among Women in Residential Substance Use Disorder Treatment: A Prospective Follow-Up Study

Rivera

Dueker

Amaro

2020

Preprint

View full text Add to dashboard Cite

Background: Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose: This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or certain mental health characteristics (increased stress, depression, anxiety, and PTSD symptomology) contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods: Multivariate regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment regardless of source (CPS or CJ) remained in treatment significantly longer (CPS: M = 116.59 days, SD = 65.59, p = .023; CJ: M = 133.86 days, SD = 79.43, p = .028), compared to women not mandated (M = 96.11 days, SD = 72.09), representing a 34.4% and 31.6% increase, respectively. Findings further revealed a corresponding 2.3% decrease in retention (p = .024) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions: This study highlights the importance of future research that examines the impact of referral source, co-occurring mental disorders, and stress on women’s residential SUD treatment retention.Further research is needed examining the variability in external motivation among referral sources compounded by dynamic intersections of risk associated with having a co-occurring disorder and stress on treatment retention.ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648

show abstract

“…Additionally, consistent with prior research, current findings revealed that higher levels of perceived stress were negatively associated with number of days retained in treatment across models [ 34 ]. Supporting this finding, prior work has shown that individuals who report higher levels of stress experienced more frequent and stronger substance and alcohol use cravings [ 21 , 49 ]. Importantly, Law et al [ 21 ] found that craving mediated the relationship between stress and relapse during treatment.…”

Section: Discussionmentioning

confidence: 57%

Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study

Rivera

Dueker

Amaro

2021

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

Background Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. Trial registration ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.

show abstract

Stress, craving and mood as predictors of early dropout from opioid agonist therapy

Cited by 86 publications

References 57 publications

Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder

Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder

Examination of Referral Source and Retention Among Women in Residential Substance Use Disorder Treatment: A Prospective Follow-Up Study

Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study

Contact Info

Product

Resources

About