Context The usual treatment for opioid-addicted youth is detoxification and counseling. Extended medication-assisted therapy may be more helpful. Objective To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth. Design, Setting, and Patients Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper (detox). Interventions Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg per day and then tapered to day 14. All were offered weekly individual and group counseling. Main Outcome Measure Opioid-positive urine test result at weeks 4, 8, and 12. Results The number of patients younger than 18 years was too small to analyze separately, but overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12 ( χ22 = 4.93, P = .09). At week 4, 59 detox patients had positive results (61%; 95% confidence interval [CI] = 47%-75%) vs 58 12-week buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 53 detox patients had positive results (54%; 95% CI = 38%-70%) vs 52 12-week buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 53 detox patients had positive results (51%; 95% CI = 35%-67%) vs 49 12-week buprenorphine-naloxone patients (43%; 95% CI = 29%-57%). By week 12, 16 of 78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week buprenorphine-naloxone patients (70%; χ12 = 32.90, P < .001). During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less opioid use ( χ12 = 18.45, P < .001), less injecting ( χ12 = 6.00, P = .01), and less nonstudy addiction treatment ( χ12 = 25.82, P < .001). High levels of opioid use occurred in both groups at follow-up. Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12. Conclusions Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification. Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence.

Research on group brainstorming has demonstrated that it is less effective for generating large numbers of ideas than individual brainstorming, yet various scholars have presumed that group idea sharing should enhance cognitive stimulation and idea production. Three experiments examined the potential of cognitive stimulation in brainstorming. Experiments 1 and 2 used a paradigm in which individuals were exposed to ideas on audiotape as they were brainstorming, and Experiment 3 used the electronic brainstorming paradigm. Evidence was obtained for enhanced idea generation both during and after idea exposure. The attentional set of the participant and the content of the exposure manipulation (number of ideas, presence of irrelevant information) influenced this effect. These results are consistent with a cognitive perspective on group brainstorming.

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Opioid use and overdose rates have risen to epidemic levels in the United States over the past decade. Fortunately, there are effective medications (i.e., methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of three prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction.

Aim To review randomized controlled trials to assess efficacy of a prize-based contingency management procedure in reducing substance use (where a drug-free breath or urine sample provides a chance of winning a prize). Methods A meta-analysis was conducted on articles published from January 2000 to February 2013 to determine the effect size of studies comparing prize-based contingency management to a treatment-as-usual control condition (k=19 studies). Parallel analyses evaluated the efficacy of both short- (k=9 studies) and long-term outcomes (k=6 studies) of prize-based contingency management . Results The average end-of-treatment effect size (Cohen's d) was .46 [95% CI=0.37,0.54). This effect size decreased at the short-term (≤ 3-month) post-intervention follow-up to .33 (95% CI=0.12,0.54) and at the 6-month follow-up time point there was no detectable effect (d=-.09 (95% CI=−0.28,0.10)). Conclusion Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence but the effect does not appear to persist to 6 months.

This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts.Keywords drug court; risk assessment; drug abuse; antisocial personality disorder Drug courts are special criminal court dockets that provide a judicially supervised regimen of drug abuse treatment and case management services to offenders who are nonviolent and abuse drugs in lieu of criminal prosecution or incarceration. According to the National Association of Drug Court Professionals (NADCP, 1997), the "key components" of a drug court include (a) ongoing status hearings before the judge in court, (b) mandatory completion of drug abuse treatment, (c) random urine drug screens, and (d) progressive negative sanctions for program infractions and positive rewards for achievements. In preplea or diversion drug courts, participants who satisfactorily complete the program may have their criminal charges dropped and may be eligible for record expungement after remaining arrest free for an additional waiting period and meeting other obligations such as paying a filing fee. In postadjudication drug courts, graduates may avoid incarceration, consolidate their probationary requirements, or receive a sentence of time served in the program. DOUGLAS B. MARLOWE, J.D., Ph.D., is the director of the Section on Law and Ethics Research at the Treatment Research Institute (TRI) and an adjunct associate professor of psychiatry at the University of Pennsylvania School of Medicine. His research focuses on examining the role of coercion in drug abuse treatment, the effects of drug courts and other diversion programs for drug-abusing offenders, and behavioral treatments for drug abusers and offenders. DAVID S. FESTINGER, Ph.D., is a senior scientist in the Section on Law and Ethics Research at the TRI. His research focuses on evaluating the clinical effects and ethical impacts of coercive interventions for drug-abusing criminal offenders. PATRICIA A. LEE, M.S. is the research coordinator for the Section on Law and Ethics Research at the TRI. She is primarily responsible for managing all aspects of ...

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