Reducing Barriers to Drug Abuse Treatment Services

Summary

Principal Investigator: Richard Rapp
Affiliation: Wright State University
Country: USA
Abstract: In 1998 more than 13 million people had a potentially diagnosable substance abuse disorder (NHSDA, 1998). Substance abuse treatment is considered as an effective response to these disorders. Despite the benefits of substance abuse treatment, only a relatively small proportion of those in need of treatment receive any service. Many of those initiating treatment leave before the therapeutic benefit can be realized (IOM, 1990) Many people needing services face a range of barriers to treatment linkage and engagement. These barriers include internal or psychological ones such as denial of problem, lack of self-efficacy that services could be accessed, embarrassment, and fears of what treatment might entail. External barriers, such as transportation difficulties and childcare needs, may impose limitations to treatment entry and, importantly treatment engagement. While barriers to treatment linkage and engagement have been well documented, few interventions to removing them have been studied. The broad goal of this study is to assess the effectiveness of two interventions to facilitate treatment linkage and treatment engagement. The study's two interventions will be a Motivationally based one and Strengths-Based Case Management. Each has proven effective in either moving substance abusers towards treatment and retaining them once in service. A three-armed controlled clinical trial research design will be used to test the effectiveness of these interventions in the context of a community wide Central Intake Unit (CIU) and several community-based specialty substance abuse providers. Treatment Linkage and Engagement will be the outcome measures. We hypothesize that those receiving either of the interventions will be more likely to Link with treatment than those in the control condition. We further hypothesize that the case management condition will have better outcomes for treatment linkage and engagement than the motivational condition. The study will recruit a sample of 690 treatment seeking people and use a longitudinal design, obtaining data at 3 points. Research goals are to examine the interaction of individual factors, Community Treatment Program factors, and study-delivered interventions on the outcomes of treatment linkage and engagement. The study's parallel qualitative/ethnographic aims will describe how the processes of linkage and engagement occur at the individual level.
Funding Period: 2003-06-20 - 2009-05-31
more information: NIH RePORT

Top Publications

  1. ncbi Treatment barriers identified by substance abusers assessed at a centralized intake unit
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    J Subst Abuse Treat 30:227-35. 2006
  2. ncbi Understanding treatment readiness in recently assessed, pre-treatment substance abusers
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    Subst Abus 28:11-23. 2007
  3. ncbi The multidimensional structure of external barriers to substance abuse treatment and its invariance across gender, ethnicity, and age
    Jiangmin Xu
    Center for Intervention, Treatment, and Addiction Research CITAR, Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435 0001, USA
    Subst Abus 29:43-54. 2008
  4. ncbi Development of the pretreatment readiness scale for substance abusers: modification of an existing motivation assessment
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
    Subst Abus 29:39-50. 2008
  5. ncbi Preference-weighted health-related quality of life measures and substance use disorder severity
    Jeffrey M Pyne
    Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR 72114, USA
    Addiction 103:1320-9; discussion 1330-2. 2008
  6. ncbi Improving linkage with substance abuse treatment using brief case management and motivational interviewing
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    Drug Alcohol Depend 94:172-82. 2008
  7. ncbi A folk model of treatment readiness among drug users in Ohio
    Cristina Redko
    Center for Interventions, Treatment, and Addictions Research, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    J Ethn Subst Abuse 6:15-40. 2007
  8. ncbi Understanding the working alliance between persons with substance abuse problems and strengths-based case managers
    Cristina Redko
    Center for Interventions, Treatment and Addictions Research, Wright State University, Boonshoft School of Medicine, Dayton, OH 45435, USA
    J Psychoactive Drugs 39:241-50. 2007
  9. ncbi The strengths perspective: proving "my strengths" and '"it work"
    Richard C Rapp
    Center for Interventions, Treatment and Addictions Research, Wright State University, Boonshoft School of Medicine, Dayton, OH 45435, USA
    Soc Work 52:185-6. 2007
  10. ncbi Effectiveness of different models of case management for substance-abusing populations
    Wouter Vanderplasschen
    Ghent University, Department of Orthopedagogics, Gent, Belgium
    J Psychoactive Drugs 39:81-95. 2007

Scientific Experts

Detail Information

Publications16

  1. ncbi Treatment barriers identified by substance abusers assessed at a centralized intake unit
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    J Subst Abuse Treat 30:227-35. 2006
    ..Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed...
  2. ncbi Understanding treatment readiness in recently assessed, pre-treatment substance abusers
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    Subst Abus 28:11-23. 2007
    ..This study provides an increased understanding of readiness for treatment among pre-treatment substance abusers and also supported the construct validity of the Pre-Treatment Readiness Scale...
  3. ncbi The multidimensional structure of external barriers to substance abuse treatment and its invariance across gender, ethnicity, and age
    Jiangmin Xu
    Center for Intervention, Treatment, and Addiction Research CITAR, Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435 0001, USA
    Subst Abus 29:43-54. 2008
    ..The findings suggest that it would be reasonable to consider the pattern of factor loadings and structure relations as invariant across gender, ethnic, and age groups...
  4. ncbi Development of the pretreatment readiness scale for substance abusers: modification of an existing motivation assessment
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research CITAR, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
    Subst Abus 29:39-50. 2008
    ..The implications of these findings on developing interventions for the pretreatment group will be discussed...
  5. ncbi Preference-weighted health-related quality of life measures and substance use disorder severity
    Jeffrey M Pyne
    Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR 72114, USA
    Addiction 103:1320-9; discussion 1330-2. 2008
    ..Examine the validity of preference-weighted health-related quality of life measures in a sample of substance use disorder (SUD) patients. The implications of cost-utility analyses (CUAs) of SUD interventions are discussed...
  6. ncbi Improving linkage with substance abuse treatment using brief case management and motivational interviewing
    Richard C Rapp
    Center for Interventions, Treatment, and Addictions Research, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    Drug Alcohol Depend 94:172-82. 2008
    ..Numerous behavioral interventions have been tested to determine their potential role in improving linkage...
  7. ncbi A folk model of treatment readiness among drug users in Ohio
    Cristina Redko
    Center for Interventions, Treatment, and Addictions Research, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
    J Ethn Subst Abuse 6:15-40. 2007
    ..A better understanding of drug users' perceptions can help to inform interventions designed to improve readiness for treatment...
  8. ncbi Understanding the working alliance between persons with substance abuse problems and strengths-based case managers
    Cristina Redko
    Center for Interventions, Treatment and Addictions Research, Wright State University, Boonshoft School of Medicine, Dayton, OH 45435, USA
    J Psychoactive Drugs 39:241-50. 2007
    ..Most clients concluded that a positive working alliance helped them to build trust, self-worth, and self-esteem...
  9. ncbi The strengths perspective: proving "my strengths" and '"it work"
    Richard C Rapp
    Center for Interventions, Treatment and Addictions Research, Wright State University, Boonshoft School of Medicine, Dayton, OH 45435, USA
    Soc Work 52:185-6. 2007
  10. ncbi Effectiveness of different models of case management for substance-abusing populations
    Wouter Vanderplasschen
    Ghent University, Department of Orthopedagogics, Gent, Belgium
    J Psychoactive Drugs 39:81-95. 2007
    ..Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes...
  11. ncbi Individual and system influences on waiting time for substance abuse treatment
    Carey J A Carr
    Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
    J Subst Abuse Treat 34:192-201. 2008
    ....
  12. ncbi The cost of treating addiction from the client's perspective: results from a multi-modality application of the Client DATCAP
    Kathryn E McCollister
    Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Clinical Research Building, Room 1051 R 669, Miami, FL 33136, USA
    Drug Alcohol Depend 104:241-8. 2009
    ..Policy makers and treatment providers now have a broader view of the opportunity cost of addiction treatment and can use this information to support initiatives for improved treatment access and delivery...