Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review

Timko, Christine; Below, Maureen; Schultz, Nicole R.; Brief, Deborah J.; Cucciare, Michael A.

doi:10.1016/j.jsat.2014.11.009

Cited by 39 publications

(36 citation statements)

References 63 publications

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“…The value of involving family or other close supportive persons in substance use treatment, and specifically in the maintenance phase of treatment (i.e., after initial detoxification) has become increasingly accepted as a component of treatment in alcohol detoxification settings (Timko et al 2015), and has been documented as an factor in general treatment for substance use disorders (Rounsaville & Kleber 1985; Riehman et al 2003; Lin, Wu & Detels 2011; Day et al 2013; Cavaiola, Fulmer & Stout 2015; Hser et al 2015; Timko et al 2015). Findings from the current study suggest that many patients in an opioid detoxification program are open to involving their SO in their treatment during their inpatient stay.…”

Section: Discussionmentioning

confidence: 99%

“…Brief interventions involving an SO and administered during detoxification have been shown to benefit patients with other substance use disorders, particularly alcohol use disorders (Timko et al 2015). In one trial, a brief family intervention (BFI) delivered during inpatient detoxification (detox) was adapted from other family interventions (Johnson 1986; Picard 1989) in Japan for use during alcohol detox (Ino & Hayasida 2000).…”

mentioning

confidence: 99%

“…Despite preliminary data supporting the value of involving SO’s in substance treatment more generally (Klostermann & Fals-Stewart 2008), and more specifically in the utility of engaging SO’s to enhance aftercare treatment following detoxification (Ino & Hayasida 2000; O’Farrell et al 2007; Brigham et al 2014; Timko et al 2015), no survey data exist regarding the proportion of patients in opiate detoxification who are able and willing to involve SO’s during opioid detox so as to promote long-term abstinence. Further, existing studies do not directly examine reasons for disinterest or dropout.…”

mentioning

confidence: 99%

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Feasibility of a Supportive Other Intervention for Opiate-Dependent Patients Entering Inpatient Detoxification

Schonbrun

Anderson

Johnson

et al. 2016

Journal of Psychoactive Drugs

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Involvement of supportive others (SOs; defined as patient’s most important person) in substance treatment is widely accepted as a valuable addition to substance use treatment, but is not routinely implemented during inpatient detoxification for opioid use disorders. The current study explores the feasibility of a brief SO intervention for individuals detoxing from opioids. Data regarding ability to identify an SO, the nature of the SO relationship, and willingness to invite an SO to help with long-term abstinence were collected from 369 patients attending inpatient opioid detoxification. For those unwilling to participate in an SO intervention, possible barriers to participation were examined. Results indicated the majority (71.8%) of patients were willing to involve SOs, and that they believed that their SO was supportive of their treatment (88.1%). Those unwilling to invite an SO reported that their identified SO was a young child or that they wanted to make life changes independently. We conclude that SO involvement in substance use treatment at the time of opioid detoxification is feasible and could be engaged in future interventions.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Feasibility of a Supportive Other Intervention for Opiate-Dependent Patients Entering Inpatient Detoxification

Schonbrun

Anderson

Johnson

et al. 2016

Journal of Psychoactive Drugs

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“…However, there are limitations to the clinical application of their conclusions as they did not assess risk of bias in the individual studies. Timko et al identified factors affecting detoxification completion and subsequent treatment in detoxified alcohol-dependent patients [47]. However, their evidence review was based on searches of a single database.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic interventions for alcohol dependence in non-inpatient settings: a systematic review and network meta-analysis (protocol)

et al. 2017

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BackgroundAlcohol dependence is common and serious cause of social and physical harm. However, the optimal management of those with moderate and severe alcohol dependence in primary and community care after detoxification remains unclear. The aim of this review is to evaluate the effectiveness of interventions for maintaining abstinence in people with alcohol dependence following detoxification.MethodsWe will systematically search electronic databases and clinical trial registries for randomized controlled trials (RCTs) examining the effectiveness of pharmacological and/or psychosocial interventions for maintaining abstinence in recently detoxified, alcohol-dependent adults. The searches will be complemented by checking references and citations from included studies and other relevant systematic reviews. No limitation on language, year, or publication status will be applied. RCTs will be selected using prespecified criteria. Descriptive information, study characteristics, and results of eligible RCTs will be extracted. A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used to assess the risk of bias in eligible RCTs. Results will be synthesized and analyzed using network meta-analysis (NMA). Overall strength of the evidence and publication bias will be evaluated. Subgroup and sensitivity analysis will also be performed.DiscussionThis network meta-analysis aims to appraise and summarize the total evidence of therapeutic interventions for alcohol-dependent patients that require support for detoxification and can be treated in the community. The evidence will determine which combination of interventions are most promising for current practice and further investigation.Systematic review registrationPROSPERO CRD42016049779 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0462-2) contains supplementary material, which is available to authorized users.

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“…Using the Andersen/Davidson model of service utilization, which theorizes that both individual and contextual factors impact service use, we selected covariates at both the client and agency level that might facilitate or hinder accessing services after discharge. Our choice of covariates also was based on prior research on continuity . For residential treatment analyses, we controlled for client's age, gender, race/ethnicity, education, marital status, employment status, past month use of substances (alcohol, marijuana, cocaine, opioids, methamphetamines, and other drugs), age at first use of any substance, and homelessness.…”

Section: Methodsmentioning

confidence: 99%

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Garnick

Horgan

Acevedo

et al. 2019

The Journal of Rural Health

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Purpose Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow‐up treatment and whether financial incentives and weekly alerts have a modifying effect. Methods For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control. Travel time was used as both a main effect and interacted with other variables to explore its modifying impact on continuity of care in conjunction with incentives or alerts. Continuity was defined as follow‐up care occurring within 14 days of discharge from detoxification or residential treatment programs. Travel time was estimated as driving time from clients’ home ZIP Code to treatment agency ZIP Code. Findings Travel times to the original treatment agency were in some cases significant with longer travel times predicting lower likelihood of continuity. For detoxification clients, those with longer travel times (over 91 minutes from their residence) are more likely to have timely continuity. Conversely, residential clients with travel times of more than 1 hour are less likely to have timely continuity. Interventions such as alerts or incentives for performance had some mitigating effects on these results. Travel times to the closest agency for potential further treatment were not significant. Conclusions Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.

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Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review

Cited by 39 publications

References 63 publications

Feasibility of a Supportive Other Intervention for Opiate-Dependent Patients Entering Inpatient Detoxification

Feasibility of a Supportive Other Intervention for Opiate-Dependent Patients Entering Inpatient Detoxification

Therapeutic interventions for alcohol dependence in non-inpatient settings: a systematic review and network meta-analysis (protocol)

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

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