Clinical trial NCT04650386: Examining an Adaptive Approach to Providing Psychosocial Support to Buprenorphine Patients
Official title: Enhancing Office-based Buprenorphine Treatment: An Adaptive Psychosocial Approach
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Opioid-use Disorder
Keywords: Opioid Use
Medication Assisted Treatment
Psychosocial Treatment
Cognitive Behavioral Therapy
Peer Support
Peer Recovery Specialist
Certified Recovery Specialist
Opioid Use Disorder
Adaptive Intervention
Office-Based Opioid Treatment
Buprenorphine
Lead sponsor: Public Health Management Corporation
Sponsor class: OTHER
Collaborators: name: Philadelphia College of Osteopathic Medicine
name: University of Pennsylvania
First posted: 2020-12-02
Enrollment: 125
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to address important knowledge gaps regarding the optimal way to provide psychosocial treatment to patients who are receiving buprenorphine for opioid use disorder (OUD) in office-based settings. The project will develop and evaluate an adaptive treatment approach in which the interventions are delivered based on the individual needs of patients at baseline and throughout the course of care. The adaptive intervention will incorporate certified recovery specialists (CRSs) and cognitive behavioral therapy (CBT), two interventions that have been widely used in the treatment of OUD. The efficacy of the adaptive intervention will be evaluated through a randomized controlled trial (RCT) that will be conducted in federally qualified health (FQHCs) in Philadelphia.

Detailed description: This study will help to inform best practices for providing psychosocial treatment within the context of office-based opioid treatment (OBOT) with buprenorphine. We will use a staged approach to develop and evaluate an adaptive approach to the provision of adjunctive psychosocial treatment that includes medication management by a buprenorphine provider and linkage to CRSs and CBT depending on the needs of the patient. The specific aims of the proposal are listed below.

Aim 1: Work collaboratively with our multidisciplinary team to develop specific protocols for the CRS and CBT interventions and establish algorithms based on behavioral criteria to determine when each intervention should be implemented. As a part of this aim, we will also develop standard procedures for delivering each intervention and train interventionists \[i.e., CRSs and Licensed Professional Counselors (LPCs)\] to deliver them with fidelity.

Aim 2: Conduct a two-group randomized study to evaluate the efficacy of the adaptive intervention relative to TAU. Outcomes to be examined will include urinalysis-confirmed opioid use, retention in buprenorphine- based OBOT, quality of life, and psychosocial functioning through one year post-study entry.

Aim 3: Conduct a qualitative evaluation of the intervention and develop a strategic plan for its dissemination. We will conduct focus groups with clinic staff and relevant stakeholders to determine the utility and acceptability of the adaptive intervention. In addition, we will hold an expert roundtable to identify mechanisms for increasing sustainability and enhancing adoption by other office-based buprenorphine programs to inform the development of the strategic plan.

Aim 4: Establish a training program in clinical research for minority students. Eight undergraduate students from a historically minority higher education institution will be selected to participate in 9-month internships during which they will receive comprehensive and pragmatic training in the full range of clinical research from study design to dissemination.

Eligibility criteria: Inclusion Criteria:

* Have initiated office-based buprenorphine treatment for OUD at the FQHC within the last 4 weeks;
* Not require an inpatient level of care as determined by the healthcare provider; and
* Be capable of providing valid contact information and informed consent.

Exclusion Criteria:

* Patient is under the age of 18;
* Co-morbid psychiatric disorder indicating the need for more intensive residential treatment
* Patient is unable to provide informed consent.

Individuals who are intoxicated, cognitively impaired, or psychiatrically unstable at baseline will not be included; however, they may subsequently be included if the disqualifying condition subsides.

Primary outcomes:
measure: Urinalysis-confirmed abstinence from opioids at 3 month follow up
timeFrame: 3 months post study entry
measure: Urinalysis-confirmed abstinence from opioids at 6 month follow up
timeFrame: 6 months post study entry
measure: Urinalysis-confirmed abstinence from opioids at 9 month follow up
timeFrame: 9 months post study entry
measure: Urinalysis-confirmed abstinence from opioids at 12 month follow up
timeFrame: 12 months post study entry
Secondary outcomes:
measure: Abstinence from or reductions in use of other (non-opioid) psychoactive substances
timeFrame: Through 12 months post-study entry
measure: Retention in buprenorphine-based OBOT
timeFrame: Through 12 months post-study entry
measure: Quality of life assessment
timeFrame: Through 12 months post-study entry
measure: Psychosocial functioning/Multidimensional problem severity
timeFrame: Through 12 months post-study entry
measure: Treatment satisfaction
timeFrame: Through 12 months post-study entry
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: Project HOME Stephen J. Klein Wellness Center
state: Pennsylvania
city: Philadelphia
country: United States
facility: PHMC Care Clinic
state: Pennsylvania
Study officials:
affiliation: PHMC
name: Karen Dugosh, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005031. doi: 10.1002/14651858.CD005031.pub4.
citation: Alford DP, LaBelle CT, Kretsch N, Bergeron A, Winter M, Botticelli M, Samet JH. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011 Mar 14;171(5):425-31. doi: 10.1001/archinternmed.2010.541.
citation: Andraka-Christou B, Capone MJ. A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. Int J Drug Policy. 2018 Apr;54:9-17. doi: 10.1016/j.drugpo.2017.11.021. Epub 2018 Jan 8.
citation: Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet. 2003 Mar 22;361(9362):995-1000. doi: 10.1016/S0140-6736(03)12825-5.
citation: Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O'Connor PG, Schottenfeld RS, Fiellin DA. Integrating buprenorphine treatment into office-based practice: a qualitative study. J Gen Intern Med. 2009 Feb;24(2):218-25. doi: 10.1007/s11606-008-0881-9. Epub 2008 Dec 17.
citation: Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review. J Subst Abuse Treat. 2016 Apr;63:1-9. doi: 10.1016/j.jsat.2016.01.003. Epub 2016 Jan 13.
citation: Beck AT. Cognitive therapy : nature and relation to behavior therapy. J Psychother Pract Res. 1993 Fall;2(4):342-56. No abstract available.
citation: Breslin FC, Sobell MB, Sobell LC, Cunningham JA, Sdao-Jarvie K, Borsoi D. Problem drinkers: evaluation of a stepped-care approach. J Subst Abuse. 1998;10(3):217-32. doi: 10.1016/s0899-3289(99)00008-5.
citation: Brooner RK, Kidorf M. Using behavioral reinforcement to improve methadone treatment participation. Sci Pract Perspect. 2002 Jul;1(1):38-47. doi: 10.1151/spp021138.
citation: Brooner RK, Kidorf MS, King VL, Stoller KB, Peirce JM, Bigelow GE, Kolodner K. Behavioral contingencies improve counseling attendance in an adaptive treatment model. J Subst Abuse Treat. 2004 Oct;27(3):223-32. doi: 10.1016/j.jsat.2004.07.005.
citation: Brooner RK, Kidorf MS, King VL, Stoller KB, Neufeld KJ, Kolodner K. Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence. Drug Alcohol Depend. 2007 May;88 Suppl 2(Suppl 2):S14-23. doi: 10.1016/j.drugalcdep.2006.12.006. Epub 2007 Jan 24.
citation: Cacciola JS, Alterman AI, McLellan AT, Lin YT, Lynch KG. Initial evidence for the reliability and validity of a "Lite" version of the Addiction Severity Index. Drug Alcohol Depend. 2007 Mar 16;87(2-3):297-302. doi: 10.1016/j.drugalcdep.2006.09.002. Epub 2006 Oct 11.
citation: Carels RA, Darby L, Cacciapaglia HM, Douglass OM, Harper J, Kaplar ME, Konrad K, Rydin S, Tonkin K. Applying a stepped-care approach to the treatment of obesity. J Psychosom Res. 2005 Dec;59(6):375-83. doi: 10.1016/j.jpsychores.2005.06.060.
citation: Choi NG, DiNitto DM, Marti CN. Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults. Drug Alcohol Depend. 2014 Dec 1;145:113-20. doi: 10.1016/j.drugalcdep.2014.10.004. Epub 2014 Oct 16.
citation: Collins LM, Murphy SA, Bierman KL. A conceptual framework for adaptive preventive interventions. Prev Sci. 2004 Sep;5(3):185-96. doi: 10.1023/b:prev.0000037641.26017.00.
citation: Dugosh K, Abraham A, Seymour B, McLoyd K, Chalk M, Festinger D. A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction. J Addict Med. 2016 Mar-Apr;10(2):93-103. doi: 10.1097/ADM.0000000000000193.
citation: Dugosh KL, Festinger DS, Croft JR, Marlowe DB. Measuring coercion to participate in research within a doubly vulnerable population: initial development of the coercion assessment scale. J Empir Res Hum Res Ethics. 2010 Mar;5(1):93-102. doi: 10.1525/jer.2010.5.1.93.
citation: Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008 Feb;165(2):179-87. doi: 10.1176/appi.ajp.2007.06111851. Epub 2008 Jan 15.
citation: Dryden W, Bond FW. Reason and emotion in psychotherapy: Albert Ellis. Br J Psychiatry. 1994 Jul;165(1):131-5. doi: 10.1192/bjp.165.1.131.
citation: Festinger DS, Marlowe DB, Lee PA, Kirby KC, Bovasso G, McLellan AT. Status hearings in drug court: when more is less and less is more. Drug Alcohol Depend. 2002 Oct 1;68(2):151-7. doi: 10.1016/s0376-8716(02)00187-4.
citation: Fiellin DA, Barry DT, Sullivan LE, Cutter CJ, Moore BA, O'Connor PG, Schottenfeld RS. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med. 2013 Jan;126(1):74.e11-7. doi: 10.1016/j.amjmed.2012.07.005.
citation: Fiellin DA, Moore BA, Sullivan LE, Becker WC, Pantalon MV, Chawarski MC, Barry DT, O'Connor PG, Schottenfeld RS. Long-term treatment with buprenorphine/naloxone in primary care: results at 2-5 years. Am J Addict. 2008 Mar-Apr;17(2):116-20. doi: 10.1080/10550490701860971.
citation: Fox AD, Sohler NL, Starrels JL, Ning Y, Giovanniello A, Cunningham CO. Pain is not associated with worse office-based buprenorphine treatment outcomes. Subst Abus. 2012;33(4):361-5. doi: 10.1080/08897077.2011.638734.
citation: Haddad MS, Zelenev A, Altice FL. Integrating buprenorphine maintenance therapy into federally qualified health centers: real-world substance abuse treatment outcomes. Drug Alcohol Depend. 2013 Jul 1;131(1-2):127-35. doi: 10.1016/j.drugalcdep.2012.12.008. Epub 2013 Jan 17.
citation: Inocencio TJ, Carroll NV, Read EJ, Holdford DA. The economic burden of opioid-related poisoning in the United States. Pain Med. 2013 Oct;14(10):1534-47. doi: 10.1111/pme.12183. Epub 2013 Jul 10.
citation: Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med. 1997 Jun;19(2):179-86. doi: 10.1093/oxfordjournals.pubmed.a024606.
citation: Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. J Addict Med. 2015 Sep-Oct;9(5):358-67. doi: 10.1097/ADM.0000000000000166.
citation: Kidorf M, Neufeld K, Brooner RK. Combining stepped-care approaches with behavioral reinforcement to motivate employment in opioid-dependent outpatients. Subst Use Misuse. 2004;39(13-14):2215-38. doi: 10.1081/ja-200034591.
citation: Kidorf M, Neufeld K, King VL, Clark M, Brooner RK. A stepped care approach for reducing cannabis use in opioid-dependent outpatients. J Subst Abuse Treat. 2007 Jun;32(4):341-7. doi: 10.1016/j.jsat.2006.09.005. Epub 2006 Dec 11.
citation: King VL, Stoller KB, Hayes M, Umbricht A, Currens M, Kidorf MS, Carter JA, Schwartz R, Brooner RK. A multicenter randomized evaluation of methadone medical maintenance. Drug Alcohol Depend. 2002 Jan 1;65(2):137-48. doi: 10.1016/s0376-8716(01)00155-7.
citation: Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006;25(4):91-103. doi: 10.1300/J069v25n04_09.
citation: Kumari S, Manalai P, Leong S, Wooditch A, Malik M, Lawson WB. Factors associated with non-adherence to Buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review. Am J Addict. 2016 Mar;25(2):110-7. doi: 10.1111/ajad.12325. Epub 2016 Jan 8.
citation: Lavori PW. Clinical trials in psychiatry: should protocol deviation censor patient data? Neuropsychopharmacology. 1992 Jan;6(1):39-48; discussion 49-63.
citation: Lee CS, Liebschutz JM, Anderson BJ, Stein MD. Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict. 2017 Oct;26(7):667-672. doi: 10.1111/ajad.12533. Epub 2017 Mar 21.
citation: Lee JD, Nunes EV Jr, Novo P, Bachrach K, Bailey GL, Bhatt S, Farkas S, Fishman M, Gauthier P, Hodgkins CC, King J, Lindblad R, Liu D, Matthews AG, May J, Peavy KM, Ross S, Salazar D, Schkolnik P, Shmueli-Blumberg D, Stablein D, Subramaniam G, Rotrosen J. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018 Jan 27;391(10118):309-318. doi: 10.1016/S0140-6736(17)32812-X. Epub 2017 Nov 14.
citation: Ling W, Hillhouse M, Ang A, Jenkins J, Fahey J. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013 Oct;108(10):1788-98. doi: 10.1111/add.12266. Epub 2013 Jul 12.
citation: Litz M, Leslie D. The impact of mental health comorbidities on adherence to buprenorphine: A claims based analysis. Am J Addict. 2017 Dec;26(8):859-863. doi: 10.1111/ajad.12644. Epub 2017 Nov 16.
citation: Marlowe DB, Festinger DS, Dugosh KL, Arabia PL, Kirby KC. An effectiveness trial of contingency management in a felony preadjudication drug court. J Appl Behav Anal. 2008 Winter;41(4):565-77. doi: 10.1901/jaba.2008.41-565.
citation: Marlowe DB, Festinger DS, Dugosh KL, Benasutti KM, Fox G, Croft JR. Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial. Crim Justice Behav. 2012 Apr 1;39(4):514-532. doi: 10.1177/0093854811432525.
citation: Marlowe DB, Festinger DS, Dugosh KL, Benasutti KM, Fox G, Harron A. An Experimental Trial of Adaptive Programming in Drug Court: Outcomes at 6, 12 and 18 Months. J Exp Criminol. 2014 Jun 1;10(2):129-149. doi: 10.1007/s11292-013-9196-x.
citation: Marlowe DB, Festinger DS, Dugosh KL, Lee PA, Benasutti KM. Adapting judicial supervision to the risk level of drug offenders: discharge and 6-month outcomes from a prospective matching study. Drug Alcohol Depend. 2007 May;88 Suppl 2(Suppl 2):S4-13. doi: 10.1016/j.drugalcdep.2006.10.001. Epub 2006 Oct 30.
citation: Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organization; 2009. Available from http://www.ncbi.nlm.nih.gov/books/NBK143185/
citation: Weiss RD, Potter JS, Fiellin DA, Byrne M, Connery HS, Dickinson W, Gardin J, Griffin ML, Gourevitch MN, Haller DL, Hasson AL, Huang Z, Jacobs P, Kosinski AS, Lindblad R, McCance-Katz EF, Provost SE, Selzer J, Somoza EC, Sonne SC, Ling W. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011 Dec;68(12):1238-46. doi: 10.1001/archgenpsychiatry.2011.121. Epub 2011 Nov 7.
citation: Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83.
citation: Vogt DS, King DW, King LA. Focus groups in psychological assessment: enhancing content validity by consulting members of the target population. Psychol Assess. 2004 Sep;16(3):231-43. doi: 10.1037/1040-3590.16.3.231.
citation: Tesema L, Marshall J, Hathaway R, Pham C, Clarke C, Bergeron G, Yeh J, Soliman M, McCormick D. Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors. Subst Abus. 2018;39(4):434-440. doi: 10.1080/08897077.2018.1449047. Epub 2018 May 14.
citation: Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. Report No.: (SMA) 04-3939. Available from http://www.ncbi.nlm.nih.gov/books/NBK64245/
citation: Stein BD, Dick AW, Sorbero M, Gordon AJ, Burns RM, Leslie DL, Pacula RL. A population-based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees. Subst Abus. 2018;39(4):419-425. doi: 10.1080/08897077.2018.1449166. Epub 2018 Jun 22.
citation: Sobell MB, Sobell LC. Stepped care as a heuristic approach to the treatment of alcohol problems. J Consult Clin Psychol. 2000 Aug;68(4):573-9.
citation: Reif S, Braude L, Lyman DR, Dougherty RH, Daniels AS, Ghose SS, Salim O, Delphin-Rittmon ME. Peer recovery support for individuals with substance use disorders: assessing the evidence. Psychiatr Serv. 2014 Jul;65(7):853-61. doi: 10.1176/appi.ps.201400047.
citation: Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring programs and death rates from drug overdose. Pain Med. 2011 May;12(5):747-54. doi: 10.1111/j.1526-4637.2011.01062.x. Epub 2011 Feb 18.
citation: O'Malley SS, Rounsaville BJ, Farren C, Namkoong K, Wu R, Robinson J, O'Connor PG. Initial and maintenance naltrexone treatment for alcohol dependence using primary care vs specialty care: a nested sequence of 3 randomized trials. Arch Intern Med. 2003 Jul 28;163(14):1695-704. doi: 10.1001/archinte.163.14.1695.
citation: Netherland J, Botsko M, Egan JE, Saxon AJ, Cunningham CO, Finkelstein R, Gourevitch MN, Renner JA, Sohler N, Sullivan LE, Weiss L, Fiellin DA; BHIVES Collaborative. Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009 Apr;36(3):244-51. doi: 10.1016/j.jsat.2008.06.006. Epub 2008 Aug 20.
citation: Murphy SA, Lynch KG, Oslin D, McKay JR, TenHave T. Developing adaptive treatment strategies in substance abuse research. Drug Alcohol Depend. 2007 May;88 Suppl 2(Suppl 2):S24-30. doi: 10.1016/j.drugalcdep.2006.09.008. Epub 2006 Oct 23.
citation: Murphy SA. An experimental design for the development of adaptive treatment strategies. Stat Med. 2005 May 30;24(10):1455-81. doi: 10.1002/sim.2022.
citation: Morgan K, Lee J, Sebar B. Community health workers: a bridge to healthcare for people who inject drugs. Int J Drug Policy. 2015 Apr;26(4):380-7. doi: 10.1016/j.drugpo.2014.11.001. Epub 2014 Nov 13.
citation: Moore BA, Fiellin DA, Barry DT, Sullivan LE, Chawarski MC, O'Connor PG, Schottenfeld RS. Primary care office-based buprenorphine treatment: comparison of heroin and prescription opioid dependent patients. J Gen Intern Med. 2007 Apr;22(4):527-30. doi: 10.1007/s11606-007-0129-0.
citation: Moore BA, Barry DT, Sullivan LE, O'connor PG, Cutter CJ, Schottenfeld RS, Fiellin DA. Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study. J Addict Med. 2012 Sep;6(3):205-11. doi: 10.1097/ADM.0b013e3182596492.
citation: McLellan AT, Cacciola JC, Alterman AI, Rikoon SH, Carise D. The Addiction Severity Index at 25: origins, contributions and transitions. Am J Addict. 2006 Mar-Apr;15(2):113-24. doi: 10.1080/10550490500528316.
citation: McKay JR, Van Horn DH, Lynch KG, Ivey M, Cary MS, Drapkin ML, Coviello DM, Plebani JG. An adaptive approach for identifying cocaine dependent patients who benefit from extended continuing care. J Consult Clin Psychol. 2013 Dec;81(6):1063-73. doi: 10.1037/a0034265. Epub 2013 Sep 16.
citation: McKay JR, Lynch KG, Shepard DS, Pettinati HM. The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Arch Gen Psychiatry. 2005 Feb;62(2):199-207. doi: 10.1001/archpsyc.62.2.199.
citation: McKay JR, Drapkin ML, Van Horn DH, Lynch KG, Oslin DW, DePhilippis D, Ivey M, Cacciola JS. Effect of patient choice in an adaptive sequential randomization trial of treatment for alcohol and cocaine dependence. J Consult Clin Psychol. 2015 Dec;83(6):1021-32. doi: 10.1037/a0039534. Epub 2015 Jul 27.
citation: McHugh RK, Hearon BA, Otto MW. Cognitive behavioral therapy for substance use disorders. Psychiatr Clin North Am. 2010 Sep;33(3):511-25. doi: 10.1016/j.psc.2010.04.012.
citation: Matejkowski, J., Dugosh, K. L., Clements, N. T., & Festinger, D. S. (2015). Pilot Testing of an Online Training for Criminal Justice Professionals on Medication-Assisted Treatment. Journal of Addictions & Offender Counseling, 36(1), 13-27.
citation: McDowell, I., & Newell, C. (1996). The Short Form 36 Health Survey. Measuring Health, 446-454.
citation: McKay, J. R. (2009). Treating substance use disorders with adaptive continuing care. Washington, D.C.: American Psychological Association.
citation: McKay JR, Lynch KG, Shepard DS, Morgenstern J, Forman RF, Pettinati HM. Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction. 2005 Feb;100(2):216-26. doi: 10.1111/j.1360-0443.2005.00972.x.
citation: Murphy, S. A., & McKay, J. R. (2004). Adaptive treatment strategies: an emerging approach for improving treatment effectiveness. Clinical Science, 12, 7-13.
citation: National Institute on Drug Abuse. (2018). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
citation: Philadelphia DBHIDS. (2018). Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia. The Opioid Epidemic in Philadelphia. Philadelphia, PA: City of Philadelphia DBHIDS. Mar p. 40.
citation: Philadelphia Department of Public Health (2018). Opioid Surveillance. Retrieved from https://hip.phila.gov/datareports/opioid
citation: Reid R, Pipe A, Higginson L, Johnson K, D'Angelo MS, Cooke D, Dafoe W. Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease. J Cardiopulm Rehabil. 2003 May-Jun;23(3):176-82. doi: 10.1097/00008483-200305000-00003.
citation: Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1378-82. doi: 10.15585/mmwr.mm6450a3.
citation: Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Gandhi D, Olsen Y, Jaffe JH. Patient-centered methadone treatment: a randomized clinical trial. Addiction. 2017 Mar;112(3):454-464. doi: 10.1111/add.13622. Epub 2016 Nov 10.
citation: Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):349-358. doi: 10.15585/mmwr.mm6712a1.
citation: Substance Abuse and Mental Health Services Administration. (2011). Consumer-operated services: the evidence (HHS Pub. No. SMA-11-4633). Rockville, MD: U.S. Department of Health and Human Services.
citation: Substance Abuse and Mental Health Services Administration. (2015). Medication and counseling treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment.
citation: Substance Abuse and Mental Health Services Administration. (2017). Behavioral health treatments and services. Retrieved from https://www.samhsa.gov/treatment
citation: Taylor, P. (2014). Drug court practitioner fact sheet: building recovery oriented systems of care for drug court participants. National Drug Court Institute. Retrieved from http://www.ndci.org/sites/default/files/nadcp/Recovery-Oriented%20Systems%20of%20Care.pdf.
citation: Marlowe, D. B., & Wong, C. J. (2008). Contingency management in adult criminal drug courts. Contingency management in substance abuse treatment, 334-354.
citation: Dugosh, K. D. & Festinger, D. S. (2017). Ohio Addiction Treatment Program final report. Retrieved from http://mha.ohio.gov/Portals/0/assets/Initiatives/ATPP/Final-ATP-Evaluation-Report.pdf
citation: Drug Enforcement Administration. (2017). Analysis of overdose deaths in Pennsylvania, 2016 (DEA-PHL-DIR- 034-17). Pittsburgh, PA: University of Pittsburgh.
citation: Diggle, P. J., Heagerty, P., Liang, K. Y., & Zeger, S. L. (2002). Analysis of longitudinal data. Oxford, UK: Oxford University Press. Drug Addiction Treatment Act of 2000, H.R. 2634, 106th Cong. (2000).
citation: Department of Health and Human Services. (2016). Medication assited treatment for opioid use disorder (42 CFR Part 8, RIN 0930-AA22). Rockville, MD: Substance Abuse and Mental Health Services Administration.
citation: Department of Health and Human Services. (2013). Addressing current drug abuse in the United States: current activities and future opportunities. Retrieved from: https://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf
citation: Comprehensive Addiction Recovery Act of 2015, H.R. 953, 114th Cong. (2015). Comprehensive Addiction Recovery Act of 2016, S.524, 114th Cong. (2016).
citation: Centers for Disease Control and Prevention. (2018). State of the state of Pennsylvania. Retrieved from https://www.cdc.gov/nchs/pressroom/states/pennsylvania/pennsylvania.htm
citation: Centers for Disease Control and Prevention. (2017). Wide-ranging online data for epidemionlogic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics. Retrieved from http://wonder.cdc.gov.
citation: Centers for Disease Control and Prevention (2018). Provisional Drug Overdose Death Counts. Retrieved from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
citation: Blash, L., Chan, K., & Chapman, S. (2015). The peer provider workforce in behavioral health: a landscape analysis. San Francisco, CA: UCSF Health Workforce Research Center on Long-Term Care.
citation: American Society of Addiction Medicine. (2013). Advancing access to addiction medications: implications for opioid addiction treatment. Chevy Chase, MD.
citation: Allison, P. D. (2010). Survival analysis using SAS: a practical guide, 2nd edition. Cary, NC: SAS Institute, Inc.