Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms. (Am J Public Health. 2004;94:651‐656)

/pdf/housing-first-consumer-choice-and-harm-reduction-for-1zh6cydsx5.pdf

Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis

Objective: Despite significant advances in psychosocial treatments for substance use disorders, the relative success of these approaches has not been well documented. In this meta-analysis, the authors provide effect sizes for various types of psychosocial treatments, as well as abstinence and treatment-retention rates for cannabis, cocaine, opiate, and polysubstance abuse and dependence treatment trials. Method: With a comprehensive series of literature searches, the authors identified a total of 34 well-controlled treatment conditions—five for cannabis, nine for cocaine, seven for opiate, and 13 for polysubstance users—representing the treatment of 2,340 patients. Psychosocial treatments evaluated included contingency management, relapse prevention, general cognitive behavior therapy, and treatments combining cognitive behavior therapy and contingency management. Results: Overall, controlled trial data suggest that psychosocial treatments provide benefits reflecting a moderate effect size according to C...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2007.06111851

A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders

The ability of drugs of abuse to increase dopamine in nucleus accumbens underlies their reinforcing effects. However, preclinical studies have shown that with repeated drug exposure neutral stimuli paired with the drug (conditioned stimuli) start to increase dopamine by themselves, which is an effect that could underlie drug-seeking behavior. Here we test whether dopamine increases occur to conditioned stimuli in human subjects addicted to cocaine and whether this is associated with drug craving. We tested eighteen cocaine-addicted subjects using positron emission tomography and [11C]raclopride (dopamine D2 receptor radioligand sensitive to competition with endogenous dopamine). We measured changes in dopamine by comparing the specific binding of [11C]raclopride when subjects watched a neutral video (nature scenes) versus when they watched a cocaine-cue video (scenes of subjects smoking cocaine). The specific binding of [11C]raclopride in dorsal (caudate and putamen) but not in ventral striatum (in which nucleus accumbens is located) was significantly reduced in the cocaine-cue condition and the magnitude of this reduction correlated with self-reports of craving. Moreover, subjects with the highest scores on measures of withdrawal symptoms and of addiction severity that have been shown to predict treatment outcomes, had the largest dopamine changes in dorsal striatum. This provides evidence that dopamine in the dorsal striatum (region implicated in habit learning and in action initiation) is involved with craving and is a fundamental component of addiction. Because craving is a key contributor to relapse, strategies aimed at inhibiting dopamine increases from conditioned responses are likely to be therapeutically beneficial in cocaine addiction.

https://www.jneurosci.org/content/jneuro/26/24/6583.full.pdf

Cocaine cues and dopamine in dorsal striatum: mechanism of craving in cocaine addiction.

Objective. To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain.

Design.  One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0–3 (low risk), 4–7 (moderate risk), or ≥ 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits.

Results.  For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models.

Conclusion.  In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.

/pdf/predicting-aberrant-behaviors-in-opioid-treated-patients-2mpgboaast.pdf

Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool.

Substance abuse treatment entry, retention, and outcome in women: a review of the literature.

The fifth edition of the addiction severity index

Credible estimates of the prevalence of alcohol and drug abuse suggest that alcohol abuse affects 30% to 40% and drug abuse 10% to 15% of homeless persons. A review of policies that address substance abuse among the homeless finds that interventions alternate between control and rehabilitation. However, the unique needs of a changing homeless population require an integration of alcoholism and drug abuse recovery services with programs for women, adolescents, and the mentally ill. Alcohol- and drug-free housing is essential to support and maintain recovery. Psychology can contribute in the development of effective programs for homeless individuals struggling with addiction and alcoholism.

Milton Argeriou

Papers

The fifth edition of the addiction severity index

Alcoholism, Drug Abuse, and the Homeless.

Substance abuse treatment for pregnant women: a window of opportunity?

Use of the addiction severity index with homeless substance abusers

The costs of crime and the benefits of substance abuse treatment for pregnant women