Assessment Of A Health System-Integrated Children's Savings Account and Financial Coaching Program Serving Low-Income Moms and Babies in Texas.

Families living in poverty with young children are particularly vulnerable to poor health outcomes. This study used a randomized controlled trial to analyze the impact of Early Bird (EB), a novel health system-integrated program that provided financial incentives to low-income mothers for achieving healthy milestones. Participants randomized to the EB condition received contributions in a tax-advantaged children's savings account (CSA) for attending a maternal six-week postpartum check-up ($25), a pediatric dental visit by age 12 months ($75), six well-check visits by age 15 months ($75), two financial coaching sessions ($30), and enrolling in the EB program and opening a CSA ($250).

Most recent, modal, or median heroin purchase: Does it matter when estimating market size?

Background: Assessing the size of illicit drug markets is an important activity of many government agencies; however, the expenditure-based method for estimating market size relies on the relatively untested assumption that the cash value of the most recent purchase is representative of the average purchase amount. Using panel data, we test the representativeness of the most recent, modal and median purchase compared to the average purchase amount.

Methods: Data were drawn from a prior study that collected daily transaction-level purchase data from a sample of 120 people who were using heroin regularly.

Economic Evaluation of a Crisis Residential Program.

This study assessed the cost savings to the local health care system from using a 16-bed crisis residential facility (the Inn) in Austin, Texas, instead of hospitalization, for individuals with acute psychiatric illness (N=1,364) during FY2017-FY2019. Health service utilization data were obtained from the provider and Central Texas's regional health information exchange. Unit cost data were obtained from the provider, Austin State Hospital, the Healthcare Cost and Utilization Project, and the Medical Expenditure Panel Survey.

The short-term impact on economic outcomes of SBIRT interventions implemented in reproductive health care settings.

Objective: To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unanswered questions related to the economic impact of this technique.

Methods: We collected data as part of a randomized clinical trial that examined whether SBIRT delivered electronically (e-SBIRT) or by a clinician (SBIRT) is superior to enhanced usual care (EUC) for substance misuse.

Cost and cost-effectiveness of three strategies for implementing motivational interviewing for substance misuse on medical inpatient units.

Background: This study conducted cost and cost-effectiveness analyses of three strategies for implementing motivational interviewing for substance misuse on general medical inpatient units: workshop, apprenticeship, and consult.

Methods: The economic analyses were conducted prospectively alongside a type 3 hybrid effectiveness-implementation randomized trial comprising 38 medical providers, 1173 inpatients, and four consultation-liaison motivational interviewing experts. The trial took place in a university affiliated teaching hospital in New Haven, CT, USA.

Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions.

Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services.

Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial.

Background: General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse.

Objective: To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients.

Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers.

Aims: To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers.

Design: Cost-effectiveness analysis based on a randomized controlled trial.

Setting: New Haven, CT, USA.

Cost-effectiveness of individual versus group female-specific cognitive behavioral therapy for alcohol use disorder.

Objective: To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT).

Methods: This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods.

A randomized controlled trial of screening and brief interventions for substance misuse in reproductive health.

Background: Screening, brief intervention, and referral to treatment may reduce substance misuse but has received minimal study among women who are treated in reproductive health settings.

Objective: The purpose of this study was to determine whether "screening, brief intervention and referral to treatment" that is delivered either electronically or by clinician are more effective than enhanced usual care in decreasing days of primary substance use.

Study Design: Women from 2 reproductive centers who smoked cigarettes or misused alcohol, illicit drugs, or prescription medication were allocated randomly to "screening, brief intervention and referral to treatment" delivered electronically or by clinician or to enhanced usual care.

Contingency management treatment in cocaine using methadone maintained patients with and without legal problems.

Background: Legal difficulties and cocaine use are prevalent in methadone maintenance patients, and they are related to one another, as well as to poor response to methadone treatment. Contingency management (CM) is efficacious for decreasing cocaine use, but the relation of CM treatment to criminal activities has rarely been studied.

Methods: This study evaluated whether baseline legal problems are related to subsequent substance use and illegal activities for cocaine using methadone maintained patients and whether CM differentially improves outcomes depending on baseline legal problems.

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go?

Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is rarely implemented in practice settings. This article briefly outlines the evidence base of CM and then describes 4 of the most often-cited concerns about it: philosophical, motivational, durability, and economic. Data supporting and refuting each of these issues are reviewed.

The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial.

The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites.

See One, Do One, Order One: a study protocol for cluster randomized controlled trial testing three strategies for implementing motivational interviewing on medical inpatient units.

Background: General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are accessible, have time for an intervention, and are often admitted for complications related to substance use that renders hospitalization a "teachable moment.

The price elasticity of demand for heroin: Matched longitudinal and experimental evidence.

This paper reports estimates of the price elasticity of demand for heroin based on a newly constructed dataset. The dataset has two matched components concerning the same sample of regular heroin users: longitudinal information about real-world heroin demand (actual price and actual quantity at daily intervals for each heroin user in the sample) and experimental information about laboratory heroin demand (elicited by presenting the same heroin users with scenarios in a laboratory setting). Two empirical strategies are used to estimate the price elasticity of demand for heroin.

Health-care service utilization in substance abusers receiving contingency management and standard care treatments.

Aim:   To determine the impact of standard care and contingency management treatments on the utilization of general health-care services by substance abusers. PARTICIPANTS, DESIGN AND MEASUREMENTS:  This secondary analysis pooled 1028 treatment-seeking substance abusers from five randomized clinical trials that compared the effects of standard care (SC, n = 362) to standard care plus contingency management (CM, n = 666). In each trial, subjects in the CM condition showed significantly greater reductions in substance use than their SC counterparts.

Counselor training in several evidence-based psychosocial addiction treatments in private US substance abuse treatment centers.

Background: Given that most addiction counselors enter the field unprepared to implement psychosocial evidence-based practices (EBPs), surprisingly little is known about the extent to which substance abuse treatment centers provide their counselors with formal training in these treatments. This study examines the extent of formal training that treatment centers provide their counselors in cognitive behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), and brief strategic family therapy (BSFT).

Methods: Face-to-face interviews with 340 directors of a nationally representative sample of privately funded US substance abuse treatment centers.

Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction.

Aim: To determine the cost-effectiveness, from clinic and patient perspectives, of a computer-based version of cognitive-behavioral therapy (CBT4CBT) as an addition to regular clinical practice for substance dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: This cost-effectiveness study is based on a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to treatment as usual (TAU) or TAU plus biweekly access to computer-based training in CBT (TAU plus CBT4CBT). The primary patient outcome measure was the total number of drug-free specimens provided during treatment.

Income does not affect response to contingency management treatments among community substance abuse treatment-seekers.

The present study examined a commonly held belief that contingency management (CM) may be less effective for substance abusers with relatively more economic resources compared to those with relatively few resources. Using a combined sample of 393 treatment-seeking cocaine abusers from three clinical trials involving randomization to standard care or standard care plus CM conditions, we assessed the impact of past year income, alone and in combination with treatment condition, as well as income type (i.e.

The cost-effectiveness of prize-based and voucher-based contingency management in a population of cocaine- or opioid-dependent outpatients.

Objective: To evaluate the cost-effectiveness of using prize-based and voucher-based contingency management (CM) as additions to standard treatment for cocaine- or heroin-dependent outpatients in community treatment centers.

Methods: This cost-effectiveness analysis is based on a randomized clinical trial conducted at three community-based outpatient psychosocial substance abuse treatment clinics. A total of 142 cocaine- or heroin-dependent outpatients were randomly assigned to one of three treatment conditions: standard treatment (ST), ST with prizes (prize CM), or ST with vouchers (voucher CM) for 12 weeks.

Clinic variation in the cost-effectiveness of contingency management.

This study determined whether, and by how much, the cost-effectiveness of contingency management (CM) varied across the eight clinics in the National Institute on Drug Abuse Clinical Trials Network MIEDAR trial. Incremental costs, incremental outcomes, and incremental cost-effectiveness ratios (ICERs) of CM compared to usual care were calculated, compared and contrasted for each of the clinics. Results showed that the incremental cost of using CM compared to usual care varied by a factor of 1.

The cost-effectiveness of four treatments for marijuana dependence.

Aim: To analyze data from a randomized clinical trial to determine the cost-effectiveness of using contingency management (CM) and motivational/skills building therapy (motivational enhancement therapy/cognitive-behavioral therapy: MET/CBT) to treat young adults with marijuana dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: A total of 136 marijuana-dependent young adults, all referred by the criminal justice system, were randomized to one of four treatment conditions: MET/CBT with CM, MET/CBT without CM, drug counseling (DC) with CM and DC without CM. Patient outcome measures include the longest duration of confirmed marijuana abstinence (LDA) during treatment and the total number of marijuana-free urine specimens provided during treatment.

Cost-effectiveness of prize-based contingency management in methadone maintenance treatment programs.

Aim: To determine if prize-based contingency management (CM), which has been shown to improve treatment outcomes over usual care (UC) alone, is cost-effective.

Design: A cost-effectiveness study of a multi-site clinical trial. Data on the outcome measures came from the original effectiveness trial.

Why are recovering substance abuse counselors paid less?

The goal of this study is to determine why recovering substance abuse counselors are paid less, on average and controlling for other factors, than nonrecovering substance abuse counselors. The data come from the 2002-2003 wave of the National Treatment Center Study and consist of 1,487 full-time counselors from nationally representative samples of public and private substance abuse treatment programs in the United States. We use ordinary least squares regression models to estimate the differential impacts of numerous personal and program characteristics on the self-reported annual salaries of recovering and nonrecovering counselors.