Showing papers by "Karen L. Dugosh published in 2008"
TL;DR: Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification, and extended medication-assisted therapy may be more helpful for young individuals with opioid dependence.
Abstract: 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 (χ 2 2 = 4.93, P = .09). At week 4, 28 detox patients had positive results (61%; 95% confidence interval [CI] = 47%-75%) vs 15 12-week buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 22 detox patients had positive results (54%; 95% CI = 38%-70%) vs 12 12-week buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 21 detox patients had positive results (51%; 95% CI = 35%-67%) vs 21 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%; χ 2 1 = 32.90, P 2 1 = 18.45, P 2 1 = 6.00, P = .01), and less nonstudy addiction treatment (χ 2 1 = 25.82, P 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. Trial Registration clinicaltrials.gov Identifier: NCT00078130
333 citations
TL;DR: Higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls, and participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases.
94 citations
TL;DR: In this article, the authors evaluated a contingency management (CM) program in a drug court and found that participants with more serious criminal backgrounds might have performed better in the CM conditions.
Abstract: This study evaluated a contingency management (CM) program in a drug court. Gift certificates for compliance were delivered at 4- to 6-week intervals (total value = $390.00). Participants in one condition earned gift certificates that escalated by $5.00 increments. Participants in a second condition began earning higher magnitude gift certificates, and the density of reinforcement was gradually decreased. No main effects of CM were detected, which appears to be attributable to a ceiling effect from the intensive contingencies already delivered in the drug court and the low density of reinforcement. Preplanned interaction analyses suggested that participants with more serious criminal backgrounds might have performed better in the CM conditions. This suggests that CM programs may be best suited for more incorrigible drug offenders.
47 citations
TL;DR: Compared to drug court as usual, participants in the adaptive condition were more likely to receive responses from the drug court team for inadequate performance and received those responses after a shorter period, suggesting the adaptive algorithm more readily focused the team's attention on poorly performing individuals, allowing them to address problems before they developed too fully.
Abstract: This pilot study (N = 30) experimentally examined the effects of an adaptive intervention in an adult misdemeanor drug court. The adaptive algorithm adjusted the frequency of judicial status hearings and clinical case-management sessions according to pre-specified criteria in response to participants' ongoing performance in the program. Results revealed the adaptive algorithm was acceptable to both clients and staff, feasible to implement with greater than 85% fidelity, and showed promise for eliciting clinically meaningful improvements in drug abstinence and graduation rates. Estimated effect sizes ranged from 0.40 to 0.60 across various dependent measures. Compared to drug court as-usual, participants in the adaptive condition were more likely to receive responses from the drug court team for inadequate performance in the program and received those responses after a substantially shorter period of time. This suggests the adaptive algorithm may have more readily focused the drug court team's attention on poorly-performing individuals, thus allowing the team to "nip problems in the bud" before they developed too fully. These preliminary data justify additional research evaluating the effects of the adaptive algorithm in a fully powered experimental trial.
36 citations