Stephen Magura

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..Randomized controlled trials (RCTs) of mutual aid, including Alcoholics Anonymous (AA), are notoriously difficult to conduct and correlational studies are problematic to interpret due to potential confounds...

..The evaluation as designed should never have been conducted. A better try would have been a controlled design in multiple media markets, including a drug testing component...

..These three refreshers may be considered "novel" in that they are not typically used to refresh CPR knowledge and skills...

..After initiating opioid agonist treatment in jail, continuing buprenorphine maintenance in the community appears to be more acceptable to offenders than continuing methadone maintenance...

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..Thus, these national surveys are largely inadequate for evaluating national drug demand reduction policies and programs...

..This study helps demonstrate the benefits of introducing 12-step, dual-focus mutual aid into psychiatric treatment programs that serve patients with co-occurring disorders...

..The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. The clinical trial is continuing...

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..We conclude that a variety of factors affect motivation for substance abuse treatment among female sex workers, and that street-based outreach is a highly effective modality for linking this population with much needed treatment...

..Because service providers are front-line implementers of new welfare regulations, their experiences, and insights should be consulted by policymakers as welfare policy continues to evolve...

..To improve outcomes, clinicians should facilitate affiliation with dual focus groups among persons with dual diagnoses as part of a comprehensive treatment approach...

..Clinical implications of the results are discussed...

..For clinicians, these findings underline the importance of fostering stable affiliation with specialized 12-Step based groups among their clients...

..Clinical implications to enhance retention in specialized 12-step groups are discussed...

..Co-occurring psychiatric disorders and polysubstance abuse at intake were common, but received clinical attention, which may explain why their effect on outcomes was minimal...

..The CES model is being evaluated in a randomized clinical trial...

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..In order for the ASAM PPC and its associated algorithm to be embraced by treatment programs, the observed differences in LOC recommendations between the algorithm and "standard" clinical assessment should be resolved...

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..Results were robust for both methods of assessment. Corroboration by more research is needed, but the ASAM Criteria show promise for reducing both detrimental undertreatment and cost-inefficient overtreatment...

..This study convened pain and addiction specialists to develop and pilot a clinical protocol for safe transitioning to Bup/Nx...

..A vocational counseling model which emphasizes assertive outreach and attends to nonvocational clinical issues as well is more likely to engage patients...

..These results underscore the need for interventions that address social influence factors among vulnerable early adolescents with HIV-positive parents...

..Mental health treatment providers should be aware of the potential for the co-occurrence of PTSD and chronic severe pain and of the many related factors in psychiatric outpatients...

..Future studies should describe HIV/HCV needle injection practices, characteristics that predict treatment outcomes, and factors that contribute to higher prevalence of persistent pain among PO abusers...

..Specialized 12-step based groups have emerged to address the needs of persons recovering from both substance abuse and psychiatric illness...

..The need to reduce health disparities through active and sustained outreach programs designed to enhance homeless persons' access to Medicaid and food stamp programs was discussed...

..The empirical support for each model of client work is summarized. Critical issues that must be addressed in this area are outlined...

..The findings indicate that methadone maintenance treatment can help dually-addicted patients reduce their cocaine use...

..Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and ASPD. Results indicate the use of assessing specific patient attributes to better inform treatment recommendations...

..12-step mutual aid. The article concludes with a proposed reconceptualization of the relationship between formal treatment and 12-step mutual aid that may help in structuring future research...

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..Clinicians' responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-Step groups...

..The study's limitations are noted. Implications of the findings for the improvement of vocational rehabilitation for addiction patients are discussed...

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..Similarities to the situation at the time of the repeal of alcohol prohibition in 1933 are discussed...

..Fourth, progress is reported in improving the quality of treatment through standardized criteria for patient placement matching...

..The CAARS may prove useful for measuring ADHD symptomatology among substance users, but additional reliability and validity evidence is needed. The CAARS should not be used by itself to diagnose individuals for ADHD...

..Behavioral counseling techniques may be especially helpful in addressing the complex needs of high-risk methadone patients, which in turn may facilitate treatment process and positive outcomes...

..Behind the call for accountability is an awareness of the gap between almost unlimited social need and limited resources" (Weiss, 2004). It is difficult to achieve accountability for ill-defined and variable vocational services...

..These results reinforce the importance of increasing access to buprenorphine treatment in the community for indigent heroin-dependent offenders...

..Participants emphasized that in linking them to others with similar problems, the DTR groups played a vital emotional role in their lives and provided a needed venue for information sharing that might have been otherwise unavailable...

..The article presents a critical review and synthesis of three decades of research on the effectiveness of specialized vocational intervention for addiction treatment clients...

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..These results indicate multiple barriers that need to be overcome to enable full implementation of the ASAM Criteria in real world program settings, even when a continuum of care is available...

..Problem recognition had a strong indirect effect on readiness mediated through desire for help. Knowledge of a drug user's motivational state and the factors leading to it can help guide the development of more effective interventions...

..Postrelease patients in primary care buprenorphine treatment had equal treatment retention and rates of opioid abstinence versus community-referred patients...

..The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals...

..Retention in a Methadone Maintenance Treatment Program (MMTP) is predictive of abstaining from heroin and has other benefits. Many individuals leave treatment before they experience these positive outcomes...

..The organizer/chair was Stephen Magura. The presentations examined: (1) How managed care organization policies may affect enrollees' use of alcohol ..

..other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified...

..Improvements in diagnostic testing and increasingly portable medical technology may make the mobile delivery of medical care to homeless persons increasingly feasible...

..Primary outcomes will continue to be defined as in specific aim #1. ..

..3) To determine the client characteristics and service process variables which predict entry to and retention in treatment/interventions for drug addiction, as well as other differences in outcomes. ..

..4) To conduct benefit-cost and cost-effectiveness analyses of the modified IPS vocational rehabilitation program. ..

..5. To conduct a process evaluation focusing on the implementation and on-going growth and development of the DTR groups (in the study clinics), as well as DTR group climate. ..

..Outcomes will be assessed at 6 months after release from jail by chart review, personal interviews and toxicologies for drugs of abuse. ..

..Moreover, by conducting the proposed RCT, the study will substantially raise the standard by which mutual aid is evaluated. ..

..Using treatment cost data and outcome results, a cost-effectiveness analysis of matching and mismatching at different Levels of Care will be conducted. ..

..Because even a brief group therapy may add to treatment costs, it is important6 to determine the cost per patient for each additional unit of positive outcome achieved (assuming outcomes improve). ..

..Moreover, by conducting the proposed RCT, the study will substantially raise the standard by which mutual aid is evaluated. ..