Participation in an Outreach-Based Coupon Distribution Program for Free Methadone Detoxification

Bux, Donald A.; Iguchi, Martin Y.; Lidz, Victor; Baxter, Robert C.; Platt, Jerome J.

doi:10.1176/ps.44.11.1066

Cited by 16 publications

(23 citation statements)

References 15 publications

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“…While ''not being ready'' may be a convenient, self-referential shorthand for clients to describe what has deterred them, it obscures the wide range of genuine levers that deter enrollment. Bux et al (6) showed that large numbers of IDUs could be readily induced to enroll in treatment (long-term detoxification), many for the first time, by the access-improving expedient of providing vouchers for free services. The recent federal initiative Access to Recovery (7) is a welcome though quite belated acknowledgement of the importance of improving access to increase enrollment in AOD treatment.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Comparison of Major Kinds of Obstacles to Enrolling in Substance Abuse Treatment (AOD) Reported by Injecting Street Outreach Clients and Other Stakeholders

Appel

Oldak

2007

The American Journal of Drug and Alcohol Abuse

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Injecting drug users (IDU) (n=144), street outreach (n=55), and treatment program (n=71) staff and managers in stakeholder government agencies (n=11) cited or mentioned many barriers to enrolling in substance abuse treatment (AOD), using varied assessment instruments (1). Here, we aimed to investigate a possible overemphasis on individual client factors (e.g., "readiness," denial) as barriers to enrollment and the relative importance of other kinds of barriers, e.g., limitations using a four-category classification of: individual client factors (IC), treatment accessibility (TAX), treatment availability (AVL), and (lack of) client acceptability (CA), reflecting stigmatization of IDUs. TAX responses predominated for outreach staff (51%), government managers (39%), and barriers implied by client suggestions (52%). IC (60%) followed by TAX (36%) factors characterized barriers clients generated directly. The IC factor thus appears overrepresented among IDUs and TAX is important for all groups suggesting a greater focus on access may be more cost-effective than on individual treatment motivation interventions.

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Section: Discussionmentioning

confidence: 99%

A Preliminary Comparison of Major Kinds of Obstacles to Enrolling in Substance Abuse Treatment (AOD) Reported by Injecting Street Outreach Clients and Other Stakeholders

Appel

Oldak

2007

The American Journal of Drug and Alcohol Abuse

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“…Bux et al (4), for example, found, in a study done in New Jersey, that the majority of coupons for free 21-or 90-day methadone detoxification were redeemed (58.5%), many by first-time treatment participants. The relevance of Bux et al's coupon initiative is that New Jersey eliminated most ''free'' (publiclyfunded) AOD services in 1981, a policy change with obvious impact on HIV/AIDS prevention and treatment enrollment for that state's IDUs.…”

Section: Literaturementioning

confidence: 99%

Barriers to Enrollment in Drug Abuse Treatment and Suggestions for Reducing Them: Opinions of Drug Injecting Street Outreach Clients and Other System Stakeholders

Appel

Ellison

Jansky

et al. 2004

The American Journal of Drug and Alcohol Abuse

189

155

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Alcohol and other drug abuse (AOD) treatment is a major means of HIV/AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.

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“…The RAB is a structured interview that assesses a broad range of HIV risk behaviors and related health issues, sexual practices, associated venereal diseases, and opportunistic infections. The RAB has been successfully used for assessing HIV risk in addicted populations (Bux, Iguchi, Lidz, Baxter, & Platt, 1993;Iguchi et al, 1992Iguchi et al, , 1994.…”

Section: Instrumentsmentioning

confidence: 99%

Development and initial demonstration of a community-based intervention for homeless, cocaine-using, African-American Women

Stahler

Shipley

Kirby

et al. 2005

Journal of Substance Abuse Treatment

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Participation in an Outreach-Based Coupon Distribution Program for Free Methadone Detoxification

Cited by 16 publications

References 15 publications

A Preliminary Comparison of Major Kinds of Obstacles to Enrolling in Substance Abuse Treatment (AOD) Reported by Injecting Street Outreach Clients and Other Stakeholders

A Preliminary Comparison of Major Kinds of Obstacles to Enrolling in Substance Abuse Treatment (AOD) Reported by Injecting Street Outreach Clients and Other Stakeholders

Barriers to Enrollment in Drug Abuse Treatment and Suggestions for Reducing Them: Opinions of Drug Injecting Street Outreach Clients and Other System Stakeholders

Development and initial demonstration of a community-based intervention for homeless, cocaine-using, African-American Women

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