Keith Humphreys

All Publications

• Evaluating a 30-day alcohol abstinence challenge in heavy-drinking individuals with and without chronic pain: feasibility, safety, and perceived benefits. Alcohol (Fayetteville, N.Y.) You, D. S., Ziadni, M. S., Vest, N., Megerdichian, N., Maronesy, T., Castro, R. J., Darnall, B. D., Mackey, S. C., Humphreys, K. 2024

  Abstract

  To combat high-risk alcohol consumption, we introduced a 30-day alcohol abstinence challenge targeted at heavy drinkers with and without chronic pain. Our study aimed to assess the challenge's feasibility and safety and to explore its perceived benefits. Our exploratory aim was to identify participants' coping strategies during the challenge.Our single-arm study recruited heavy drinkers from a pain clinic and a university setting (n = 34, 64.7% chronic pain). Participants underwent a modified community-based 30-day challenge, which included motivational interviewing, an individualized start date, and weekly phone check-ins.We found the 30-day challenge was feasible and safe; 72.3% of eligible heavy drinkers participated in the challenge with no serious adverse events. Most challengers (94.1%) reported some benefit from the challenge, which included improvements in alcohol withdrawal symptoms, sleep, and alcohol abstinence self-efficacy, but not in pain. We identified 25 perceived benefits and 21 coping strategies.Our study confirms that a 30-day alcohol abstinence challenge is a feasible and safe intervention for heavy drinkers with and without chronic pain, yielding notable health benefits. The challenge also facilitated the development of effective coping strategies. Future studies should explore the long-term benefits of such interventions in broader outpatient settings.

  View details for DOI 10.1016/j.alcohol.2024.10.046

  View details for PubMedID 39489405

• Characterizing Collegiate Recovery Programs in the US and Canada: A Survey of Program Directors. Journal of studies on alcohol and drugs Vest, N., Flesaker, M., Bohler, R., Timko, C., Kelly, J., Stein, M., Humphreys, K. 2024

  Abstract

  BACKGROUND: Collegiate Recovery Programs (CRPs) play a vital and expanding role in supporting students in recovery from substance use disorders and behavioral addictions at higher education institutions. Despite their importance, there is a lack of comprehensive research characterizing CRPs, including their program directors and the nature and influence of their funding streams.METHODS: A survey was administered to 70 CRP directors across the US and Canada. Directors reported on their CRPs across a variety of site physical features, policy and program offerings, and funding sources, with "sustainable" funding defined as two or more sources.RESULTS: CRP directors were predominantly non-Hispanic, White, and female, with representation from gender and sexual minorities. The highest concentration of directors responding were in the US states of North Carolina, California, and Texas. CRPs with more than one funding source served twice as many students and had significantly more space, drop-in facilities, and relapse management policies. CRP directors had positive perceptions of harm reduction principles. Additionally, results highlighted the robust availability of All Recovery meetings and the wide diversity of mutual-help group meetings offered within CRPs and directors' positive perceptions of these meetings.CONCLUSION: This research lays a foundation for enhancing CRPs within higher education settings, emphasizing the significance of sustained funding and an inclusive support framework for the program directors that run CRPs. Future studies should further explore the effectiveness of CRPs and their impacts on the schools and students they serve.

  View details for DOI 10.15288/jsad.24-00207

  View details for PubMedID 39440655

• Therapeutic Potential of Psychedelic Drugs: Navigating High Hopes, Strong Claims, Weak Evidence, and Big Money. Annual review of psychology Humphreys, K., Todd Korthuis, P., Stjepanovic, D., Hall, W. 2024

  Abstract

  Therapeutic claims about many psychedelic drugs have not been evaluated in any studies of even modest rigor. The science of psychedelic drugs is strengthening however, making it easier to differentiate some promising findings amid the hype that suffuses this research area. Ketamine has risks of adverse side effects (e.g., addiction and cystitis), but multiple studies suggest it can benefit individuals with treatment-resistant depression. Other therapeutic signals from psychedelic drug research that merit rigorous replication studies include 3,4-Methylenedioxymethamphetamine (MDMA) for post-traumatic stress disorder (PTSD) and psilocybin for depression, end of life dysphoria, and alcohol use disorder. The precise mechanisms through which psychedelic drugs can produce benefit and harm are not fully understood. Rigorous research is the best path forward for evaluating the therapeutic potential and mechanisms of psychedelic drugs. Policies governing the clinical use of these drugs should be informed by evidence and prioritize the protection of public health over the profit motive.

  View details for DOI 10.1146/annurev-psych-020124-023532

  View details for PubMedID 39094057

• Social prescribing of Alcoholics Anonymous in general practice. The British journal of general practice : the journal of the Royal College of General Practitioners Finlay, I., Humphreys, K. 2024; 74 (744): 297-298

  View details for DOI 10.3399/bjgp24X738549

  View details for PubMedID 38936861

• Improving postsurgical fall detection for older Americans using LLM-driven analysis of clinical narratives. medRxiv : the preprint server for health sciences Pillai, M., Blumke, T. L., Studnia, J., Wang, Y., Veigulis, Z. P., Ware, A. D., Hoover, P. J., Carroll, I. R., Humphreys, K., Osborne, T. F., Asch, S. M., Hernandez-Boussard, T., Curtin, C. M. 2024

  Abstract

  Postsurgical falls have significant patient and societal implications but remain challenging to identify and track. Detecting postsurgical falls is crucial to improve patient care for older adults and reduce healthcare costs. Large language models (LLMs) offer a promising solution for reliable and automated fall detection using unstructured data in clinical notes. We tested several LLM prompting approaches to postsurgical fall detection in two different healthcare systems with three open-source LLMs. The Mixtral-8*7B zero-shot had the best performance at Stanford Health Care (PPV = 0.81, recall = 0.67) and the Veterans Health Administration (PPV = 0.93, recall = 0.94). These results demonstrate that LLMs can detect falls with little to no guidance and lay groundwork for applications of LLMs in fall prediction and prevention across many different settings.

  View details for DOI 10.1101/2024.06.25.24309480

  View details for PubMedID 38978655

• Predictability of buprenorphine-naloxone treatment retention: A multi-site analysis combining electronic health records and machine learning. Addiction (Abingdon, England) Nateghi Haredasht, F., Fouladvand, S., Tate, S., Chan, M. M., Yeow, J. J., Griffiths, K., Lopez, I., Bertz, J. W., Miner, A. S., Hernandez-Boussard, T., Chen, C. A., Deng, H., Humphreys, K., Lembke, A., Vance, L. A., Chen, J. H. 2024

  Abstract

  Opioid use disorder (OUD) and opioid dependence lead to significant morbidity and mortality, yet treatment retention, crucial for the effectiveness of medications like buprenorphine-naloxone, remains unpredictable. Our objective was to determine the predictability of 6-month retention in buprenorphine-naloxone treatment using electronic health record (EHR) data from diverse clinical settings and to identify key predictors.This retrospective observational study developed and validated machine learning-based clinical risk prediction models using EHR data.Data were sourced from Stanford University's healthcare system and Holmusk's NeuroBlu database, reflecting a wide range of healthcare settings. The study analyzed 1800 Stanford and 7957 NeuroBlu treatment encounters from 2008 to 2023 and from 2003 to 2023, respectively.Predict continuous prescription of buprenorphine-naloxone for at least 6 months, without a gap of more than 30 days. The performance of machine learning prediction models was assessed by area under receiver operating characteristic (ROC-AUC) analysis as well as precision, recall and calibration. To further validate our approach's clinical applicability, we conducted two secondary analyses: a time-to-event analysis on a single site to estimate the duration of buprenorphine-naloxone treatment continuity evaluated by the C-index and a comparative evaluation against predictions made by three human clinical experts.Attrition rates at 6 months were 58% (NeuroBlu) and 61% (Stanford). Prediction models trained and internally validated on NeuroBlu data achieved ROC-AUCs up to 75.8 (95% confidence interval [CI] = 73.6-78.0). Addiction medicine specialists' predictions show a ROC-AUC of 67.8 (95% CI = 50.4-85.2). Time-to-event analysis on Stanford data indicated a median treatment retention time of 65 days, with random survival forest model achieving an average C-index of 65.9. The top predictor of treatment retention identified included the diagnosis of opioid dependence.US patients with opioid use disorder or opioid dependence treated with buprenorphine-naloxone prescriptions appear to have a high (∼60%) treatment attrition by 6 months. Machine learning models trained on diverse electronic health record datasets appear to be able to predict treatment continuity with accuracy comparable to that of clinical experts.

  View details for DOI 10.1111/add.16587

  View details for PubMedID 38923168

• Crafting effective regulatory policies for psychedelics: What can be learned from the case of cannabis? Addiction (Abingdon, England) Andrews, C. M., Hall, W., Humphreys, K., Marsden, J. 2024

  Abstract

  The turn of the century brought a resurgence of interest in psychedelics as a treatment for addiction and other psychiatric conditions, accompanied by extensive positive media attention and private equity investment. Government regulatory bodies in Australia, Israel, Canada and the United States now permit use of psychedelics for medical purposes. In the United States, citizen action and corporate financing have led to petitions and ballot initiatives to legalize psilocybin and other psychedelics for medical and recreational use. Given this momentum, policymakers must grapple with important questions that define whether and how psychedelics are made available to the public, as well as how companies produce and promote them. The current push to broaden the production, sale, and use of psychedelics bears many parallels to the movement to legalize cannabis in the United States and other nations-most notably, the use of poorly-evidenced therapeutic claims to create a de facto recreational market via the health care system. Experience with cannabis highlights the value of debating the question of legalization for nonmedical use as such rather than misrepresenting it as a medical issue. The lessons of cannabis policy also suggest a need to challenge hyping of psychedelic research findings; to promote rigorous clinical research on dosing and potency; to minimize the influence of for-profit industry in shaping policies to their economic advantage; and to coordinate federal, state, and local governments to regulate the manufacture, sale and distribution of psychedelic drugs (regardless of whether they are legalized for medical and/or recreational use).

  View details for DOI 10.1111/add.16575

  View details for PubMedID 38845381

• Progress and Challenges in Medicaid-Financed Care of Substance Use Disorder. The American journal of psychiatry Humphreys, K., Andrews, C., Frank, R. G. 2024; 181 (5): 359-361

  View details for DOI 10.1176/appi.ajp.20230804

  View details for PubMedID 38706337

• A Randomized Controlled Trial of a Pay-for-Performance Initiative to Reduce Costs of Care for High-Need Psychiatric Patients. Psychiatric services (Washington, D.C.) Blonigen, D. M., Humphreys, K. 2024: appips20230481

  Abstract

  OBJECTIVE: Pay-for-performance (P4P) initiatives hold promise for improving health care delivery but are rarely applied to behavioral health or tested in randomized controlled trials (RCTs). This RCT examined the effectiveness of a P4P initiative to reduce total cost of 24-hour care among patients with high needs for psychiatric care in a large county in California.METHODS: From August 2016 to March 2022, a total of 652 adult residents of Santa Clara County, California, were enrolled in a P4P initiative (mean±SD age=46.7±13.3 years, 61% male, 51% White, and 60% diagnosed as having a bipolar or psychotic disorder). Participants were randomly assigned to usual full-service partnerships from the county (N=327) or a comparable level of care from a contractor who agreed to a schedule of financial penalties and rewards based on whether enrollees (N=325) used more or less care than a historical cohort of similar county patients. The primary outcome was total cost of 24-hour psychiatric services. Secondary outcomes were costs of each of the 24-hour care services.RESULTS: The proportion of the total sample that used 24-hour psychiatric services decreased over the 36-month study period. Intent-to-treat analyses revealed no differences between the two study conditions in total care costs during the follow-up period. No significant care utilization differences were observed between the two conditions in most of the individual 24-hour services.CONCLUSIONS: A P4P initiative for high-need patients was no more effective than usual care for reducing costs of 24-hour psychiatric care.

  View details for DOI 10.1176/appi.ps.20230481

  View details for PubMedID 38566562

• Towards global model generalizability: independent cross-site feature evaluation for patient-level risk prediction models using the OHDSI network. Journal of the American Medical Informatics Association : JAMIA Naderalvojoud, B., Curtin, C. M., Yanover, C., El-Hay, T., Choi, B., Park, R. W., Tabuenca, J. G., Reeve, M. P., Falconer, T., Humphreys, K., Asch, S. M., Hernandez-Boussard, T. 2024

  Abstract

  Predictive models show promise in healthcare, but their successful deployment is challenging due to limited generalizability. Current external validation often focuses on model performance with restricted feature use from the original training data, lacking insights into their suitability at external sites. Our study introduces an innovative methodology for evaluating features during both the development phase and the validation, focusing on creating and validating predictive models for post-surgery patient outcomes with improved generalizability.Electronic health records (EHRs) from 4 countries (United States, United Kingdom, Finland, and Korea) were mapped to the OMOP Common Data Model (CDM), 2008-2019. Machine learning (ML) models were developed to predict post-surgery prolonged opioid use (POU) risks using data collected 6 months before surgery. Both local and cross-site feature selection methods were applied in the development and external validation datasets. Models were developed using Observational Health Data Sciences and Informatics (OHDSI) tools and validated on separate patient cohorts.Model development included 41 929 patients, 14.6% with POU. The external validation included 31 932 (UK), 23 100 (US), 7295 (Korea), and 3934 (Finland) patients with POU of 44.2%, 22.0%, 15.8%, and 21.8%, respectively. The top-performing model, Lasso logistic regression, achieved an area under the receiver operating characteristic curve (AUROC) of 0.75 during local validation and 0.69 (SD = 0.02) (averaged) in external validation. Models trained with cross-site feature selection significantly outperformed those using only features from the development site through external validation (P < .05).Using EHRs across four countries mapped to the OMOP CDM, we developed generalizable predictive models for POU. Our approach demonstrates the significant impact of cross-site feature selection in improving model performance, underscoring the importance of incorporating diverse feature sets from various clinical settings to enhance the generalizability and utility of predictive healthcare models.

  View details for DOI 10.1093/jamia/ocae028

  View details for PubMedID 38412331

• Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis. Drug and alcohol dependence Qian, G., Humphreys, K., Goldhaber-Fiebert, J. D., Brandeau, M. L. 2024; 256: 111112

  Abstract

  AIM: To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM).DESIGN SETTING AND PARTICIPANTS: Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM).INTERVENTION: Buprenorphine and methadone treatment under NPRM.MEASUREMENTS: Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs.FINDINGS: For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment.CONCLUSIONS: Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.

  View details for DOI 10.1016/j.drugalcdep.2024.111112

  View details for PubMedID 38335797

• A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder. Alcohol, clinical & experimental research Padula, C. B., McCalley, D. M., Tenekedjieva, L., MacNiven, K., Rauch, A., Morales, J. M., Knutson, B., Humphreys, K., Williams, L. M., Durazzo, T. C. 2024; 48 (1): 164-177

  Abstract

  BACKGROUND: Transcranial magnetic stimulation (TMS) offers a promising treatment avenue to modulate brain function in alcohol use disorder (AUD). To the best of our knowledge, this pilot study is the first randomized, double-blind, sham-controlled trial to deliver intermittent theta burst stimulation to the left dorsolateral prefrontal cortex (DLPFC) among US veterans with AUD. We hypothesized that 20 sessions of real TMS are tolerable and feasible. As a secondary line of inquiry, we hypothesized that, relative to sham TMS, individuals receiving real TMS would experience greater reductions in 6-month relapse rates, anhedonia, and alcohol cue-reactivity.METHODS: Veterans (n=17, one woman) were enrolled in a double-blind, sham-controlled trial (2-3 sessions/day; 7-10days; 600 pulses/session; 20 sessions). Pre- and posttreatment assessments included responses to self-report questionnaires and functional magnetic resonance imaging measures of alcohol cue-reactivity. Alcohol consumption was assessed for 6months. Linear mixed-effects models were constructed to predict posttreatment craving, mood, and cue-reactivity.RESULTS: Individuals who received active iTBS (n=8) were less likely to relapse within 3months after treatment than the sham-treated group (n=9) (OR=12.0). Greater reductions in anhedonia were observed following active iTBS (Cohen's d=-0.59), relative to sham (d=-0.25). Alcohol cue-reactivity was reduced following active iTBS and increased following sham within the left insula (d=-0.19 vs. 0.51), left thalamus (d=-0.28 vs. 0.77), right insula (d=0.18 vs. 0.52), and right thalamus (d=-0.06 vs. 0.62).CONCLUSIONS: Relative to sham, we demonstrate that 20 sessions of real left DLPFC iTBS reduced the likelihood of relapse for at least 3months. The potential utility of this approach is underscored by observed decreases in anhedonia and alcohol cue-reactivity-strong predictors of relapse among veterans. These initial data offer a valuable set of effect sizes to inform future clinical trials in this patient population.

  View details for DOI 10.1111/acer.15224

  View details for PubMedID 38197808

• Left Dorsolateral Prefrontal Cortex Intermittent Theta Burst Stimulation Improves Treatment Outcomes in Veterans With Alcohol Use Disorder: A Randomized, Sham-Controlled Clinical Pilot Trial McCalley, D., Tenekedjieva, L., MacNiven, K., Rauch, A., Morales, J., Knutson, B., Humphreys, K., Williams, L., Durazzo, T., Padula, C. SPRINGERNATURE. 2023: 449

  View details for Web of Science ID 001126640300420

• Understanding predictors of mental health and substance use treatment utilization among US adults: A repeated cross-sectional study. Global epidemiology Dhinsa, J., Roman-Urrestarazu, A., van Kessel, R., Humphreys, K. 2023; 5: 100109

  Abstract

  Understanding discrepancies in mental health and substance use treatment utilization can help identify inequities in access to health services. We investigate mental health and substance use treatment utilization as function of demographic and social determinants, as well as pre-existing mental health and substance use disorders.In this repeated cross-sectional study, we used the 2017-2019 National Survey on Drug Use and Health data on US adults above age 18. Two logistic regression models were conducted, using predictors of age, gender, race/Hispanicity, sexual identity, education, insurance, family income, and past year mental health and substance use disorders, with outcomes of mental health or substance use treatment utilization. Weighted estimates of substance use disorders and insurance types and Pearson's correlation tests of vulnerability among age, gender, and treatment type were reported.Racial minorities, uninsured populations, sexual minorities, and females had lower odds of receiving mental health treatment, while older populations, lower income groups, and dual eligible enrollees had higher odds. Individuals with substance use disorders but no mental illness had higher odds of receiving mental health treatment. Those utilizing mental health treatment were mostly of high income, privately insured, and using cannabis, cocaine, and opioids. Older populations, men, and Medicaid only enrollees had higher odds of receiving substance use disorder treatment, whereas racial minorities had lower odds. Distribution of income, insurance type, and substance use were more widespread than mental health treatment.Mental health treatment can be used as an avenue for substance use treatment, particularly opioid use disorders. It is important to target vulnerable populations, like racial minorities and uninsured populations to improve access to mental health and substance use treatment.

  View details for DOI 10.1016/j.gloepi.2023.100109

  View details for PubMedID 37638373

  View details for PubMedCentralID PMC10445987

• Leadership Styles Experienced During Military Service Predict Later Anhedonic Depressive Symptoms and Self-Efficacy in Veterans With Alcohol Use Disorder. Military medicine Durazzo, T. C., Humphreys, K., LaRocca, M. A. 2023

  Abstract

  Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy.Veterans with AUD (n = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable.Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis.The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans.

  View details for DOI 10.1093/milmed/usad405

  View details for PubMedID 37897693

• A practical strategy for increasing representation of women in research. BMJ (Clinical research ed.) Humphreys, K. 2023; 383: p2405

  View details for DOI 10.1136/bmj.p2405

  View details for PubMedID 37848213

• Drug-related deaths among housed and homeless individuals in the UK and the USA: comparative retrospective cohort study. The British journal of psychiatry : the journal of mental science Roberts, E., Copeland, C., Humphreys, K., Shover, C. L. 2023: 1-7

  Abstract

  The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness.Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations.We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death.Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76-1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29-0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK.Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.

  View details for DOI 10.1192/bjp.2023.111

  View details for PubMedID 37665046

• Prediction of opioid-related outcomes in a medicaid surgical population: Evidence to guide postoperative opiate therapy and monitoring. PLoS computational biology El Hajouji, O., Sun, R. S., Zammit, A., Humphreys, K., Asch, S. M., Carroll, I., Curtin, C. M., Hernandez-Boussard, T. 2023; 19 (8): e1011376

  Abstract

  BACKGROUND: Treatment of surgical pain is a common reason for opioid prescriptions. Being able to predict which patients are at risk for opioid abuse, dependence, and overdose (opioid-related adverse outcomes [OR-AE]) could help physicians make safer prescription decisions. We aimed to develop a machine-learning algorithm to predict the risk of OR-AE following surgery using Medicaid data with external validation across states.METHODS: Five machine learning models were developed and validated across seven US states (90-10 data split). The model output was the risk of OR-AE 6-months following surgery. The models were evaluated using standard metrics and area under the receiver operating characteristic curve (AUC) was used for model comparison. We assessed calibration for the top performing model and generated bootstrap estimations for standard deviations. Decision curves were generated for the top-performing model and logistic regression.RESULTS: We evaluated 96,974 surgical patients aged 15 and 64. During the 6-month period following surgery, 10,464 (10.8%) patients had an OR-AE. Outcome rates were significantly higher for patients with depression (17.5%), diabetes (13.1%) or obesity (11.1%). The random forest model achieved the best predictive performance (AUC: 0.877; F1-score: 0.57; recall: 0.69; precision:0.48). An opioid disorder diagnosis prior to surgery was the most important feature for the model, which was well calibrated and had good discrimination.CONCLUSIONS: A machine learning models to predict risk of OR-AE following surgery performed well in external validation. This work could be used to assist pain management following surgery for Medicaid beneficiaries and supports a precision medicine approach to opioid prescribing.

  View details for DOI 10.1371/journal.pcbi.1011376

  View details for PubMedID 37578969

• Monitoring medication and illicit drug consumption in a prison by wastewater-based epidemiology: Impact of COVID-19 restrictions. Water research Wang, Z., Mueller, J. F., O'Brien, J. W., Thompson, J., Tscharke, B. J., Verhagen, R., Zheng, Q., Prichard, J., Hall, W., Humphreys, K., Thomas, K. V., Thai, P. K. 2023; 244: 120452

  Abstract

  Drug consumption in prisons is a concern for the safety of incarcerated people and staff. Typically, drug use prevalence in prisons is estimated through urinalysis and intelligence operations, which can be intrusive and stressful. An alternative approach, wastewater-based epidemiology (WBE), was used in this study to estimate the consumption of licit and illicit drugs for the entire population of a prison in Australia. Wastewater samples were collected from March to December 2020, covering periods of no restrictions and periods when prison access was restricted to prevent the transmission of COVID-19. Target biomarkers were analysed by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). The average consumption of common illicit drugs (MDMA, methamphetamine and cocaine) over the sampling period in the prison (0.5 - 4.5 mg/1000 people/day) was two to three orders of magnitude lower than in the community population (254 - 1000 mg/1000 people/day). Comparison of WBE estimates against pharmacy dispensing data suggested potential illicit buprenorphine consumption at the prison. Methamphetamine and buprenorphine use decreased when no visitors were allowed (18% - 72% decrease for methamphetamine; about half decrease for buprenorphine) and increased once these restrictions were eased (22% - 39% increase for methamphetamine; 44% - 67% increase for buprenorphine). The changes in drug use may be attributed in part to a reduction of drug trafficking into the prison from visitors or non-essential staffs and in part to the reduced contribution of urine from staff who used toilets within the prison. This study provided useful information on the scale of illicit drug use and extra-medical use of licit drugs in prison, and its changes under different security conditions.

  View details for DOI 10.1016/j.watres.2023.120452

  View details for PubMedID 37604019

• Does the advent of depot therapy represent a step change in our understanding of opioid use disorder and its treatment? Drug and alcohol review Roberts, E., Humphreys, K. 2023

  Abstract

  After years of minimal innovation in pharmacotherapeutics, impressive outcomes in the treatment of opioid use disorder are being obtained from a new way of delivering an old medication; long-acting injectable formulations of buprenorphine appear to produce compelling reductions in relapse to illicit opioid use not only during use but also following depot discontinuation. This commentary discusses potential mechanisms behind this observation, asks if the removal of the need for daily oral opioid agonist dosing furthers our understanding of addiction treatment and whether we should therefore consider expanding access to depot formulations.

  View details for DOI 10.1111/dar.13732

  View details for PubMedID 37525510

• How Addiction handles disagreements over potentially harmful terminology. Addiction (Abingdon, England) Humphreys, K., Calder, R., Marsden, J., Day, E. 2023

  View details for DOI 10.1111/add.16302

  View details for PubMedID 37489005

• Healthcare costs and use before and after opioid overdose in Veterans Health Administration patients with opioid use disorder. Addiction (Abingdon, England) Joyce, V. R., Oliva, E. M., Garcia, C. C., Trafton, J., Asch, S. M., Wagner, T. H., Humphreys, K., Owens, D. K., Bounthavong, M. 2023

  Abstract

  To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non-OD cohort).This is a retrospective cohort study of administrative and clinical data.The largest integrated national health-care system is the US Veterans Health Administration's healthcare systems.We included VHA patients diagnosed with OUD from October 1, 2017 through September 30, 2018. We identified the index date of overdose for patients who had an overdose. Our control group, which included patients with OUD who did not have an overdose, was randomly assigned an index date. A total of 66 513 patients with OUD were included for analysis (OD cohort: n = 1413; non-OD cohort: n = 65 100).Monthly adjusted healthcare-related costs and use in the year before and after the index date. We used generalized estimating equation models to compare patients with an opioid overdose and controls in a difference-in-differences framework.Compared with the non-OD cohort, an opioid overdose was associated with an increase of $16 890 [95% confidence interval (CI) = $15 611-18 169; P < 0.001] in healthcare costs for an estimated $23.9 million in direct costs to VHA (95% CI = $22.1 million, $25.7 million) within the 30 days following overdose after adjusting for baseline characteristics. Inpatient costs ($13 515; 95% CI = $12 378-14 652; P < 0.001) reflected most of this increase. Inpatient days (+6.15 days; 95% CI, = 5.33-6.97; P < 0.001), inpatient admissions (+1.01 admissions; 95% CI = 0.93-1.10; P < 0.001) and outpatient visits (+1.59 visits; 95% CI = 1.34-1.84; P < 0.001) also increased in the month after opioid overdose. Within the overdose cohort, healthcare costs and use remained higher in the year after overdose compared with pre-overdose trends.The US Veterans Health Administration patients with opioid use disorder (OUD) who have experienced an opioid overdose have increased healthcare costs and use that remain significantly higher in the month and continuing through the year after overdose than OUD patients who have not experienced an overdose.

  View details for DOI 10.1111/add.16289

  View details for PubMedID 37465971

• Promises and perils of the FDA's over-the-counter naloxone reclassification. Lancet regional health. Americas Zhu, D. T., Tamang, S., Humphreys, K. 2023; 23: 100518

  View details for DOI 10.1016/j.lana.2023.100518

  View details for PubMedID 37497396

• Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing. JMIR formative research Trivedi, R., Hirayama, S. K., Risbud, R., Suresh, M., Humber, M. B., Butler, K., Razze, A., Timko, C., Nelson, K., Zulman, D. M., Asch, S. M., Humphreys, K., Piette, J. D. 2023; 7: e43903

  Abstract

  The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient outcomes. Dyadic technology-enabled interventions that simultaneously improve outcomes for patients and caregivers are needed.This study aimed to describe the methodology used to adapt a telephone-based, facilitated, and dyadic self-management program called Self-care Using Collaborative Coping Enhancement in Diseases (SUCCEED) into a self-guided, web-based version (web-SUCCEED) and to conduct usability testing for web-SUCCEED.We developed web-SUCCEED in 6 steps: ideation-determine the intervention content areas; prototyping-develop the wireframes, illustrating the look and feel of the website; prototype refinement via feedback from focus groups; finalizing the module content; programming web-SUCCEED; and usability testing. A diverse team of stakeholders including content experts, web designers, patients, and caregivers provided input at various stages of development. Costs, including full-time equivalent employee, were summarized.At the ideation stage, we determined the content of web-SUCCEED based on feedback from the program's original pilot study. At the prototyping stage, the principal investigator and web designers iteratively developed prototypes that included inclusive design elements (eg, large font size). Feedback about these prototypes was elicited through 2 focus groups of veterans with chronic conditions (n=13). Rapid thematic analysis identified two themes: (1) web-based interventions can be useful for many but should include ways to connect with other users and (2) prototypes were sufficient to elicit feedback about the esthetics, but a live website allowing for continual feedback and updating would be better. Focus group feedback was incorporated into building a functional website. In parallel, the content experts worked in small groups to adapt SUCCEED's content, so that it could be delivered in a didactic, self-guided format. Usability testing was completed by veterans (8/16, 50%) and caregivers (8/16, 50%). Veterans and caregivers gave web-SUCCEED high usability scores, noting that it was easy to understand, easy to use, and not overly burdensome. Notable negative feedback included "slightly agreeing" that the site was confusing and awkward. All veterans (8/8, 100%) agreed that they would choose this type of program in the future to access an intervention that aims to improve their health. Developing and maintaining the software and hosting together cost approximately US $100,000, excluding salary and fringe benefits for project personnel (steps 1-3: US $25,000; steps 4-6: US $75,000).Adapting an existing, facilitated self-management support program for delivery via the web is feasible, and such programs can remotely deliver content. Input from a multidisciplinary team of experts and stakeholders can ensure the program's success. Those interested in adapting programs should have a realistic estimate of the budget and staffing requirements.

  View details for DOI 10.2196/43903

  View details for PubMedID 37327057

• Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids. JAMA health forum Claypool, A. L., DiGennaro, C., Russell, W. A., Yildirim, M. F., Zhang, A. F., Reid, Z., Stringfellow, E. J., Bearnot, B., Schackman, B. R., Humphreys, K., Jalali, M. S. 2023; 4 (5): e231080

  Abstract

  Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity.To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity.This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US.Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination.Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective.Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously.This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.

  View details for DOI 10.1001/jamahealthforum.2023.1080

  View details for PubMedID 37204803

  View details for PubMedCentralID PMC10199347

• 'Safe Supply' initiatives: Are they a recipe for harm through reduced healthcare input and supply induced toxicity and overdose? Journal of studies on alcohol and drugs Roberts, E., Humphreys, K. 2023

  Abstract

  Within the addiction field some advocates support a suite of de-regulatory policies which aim to reduce harm by providing people who use drugs with a 'safe supply' of pharmaceutical grade medications. Such initiatives have commenced without the evidence standards normally used to label medication provision as 'safe'. This perspective suggests continued debate and research in this area acknowledge the potential toxicity of any provided 'safe supply' medications and highlights that these initiatives could result in an unhelpful reduction in interactions between people who use drugs and healthcare professionals.

  View details for DOI 10.15288/jsad.23-00054

  View details for PubMedID 37114649

• Twenty-Year Trends in Drug Overdose Fatalities Among Older Adults in the US. JAMA psychiatry Humphreys, K., Shover, C. L. 2023

  View details for DOI 10.1001/jamapsychiatry.2022.5159

  View details for PubMedID 36988923

• Clinical Research: the Samples Are Narrow, But at Least the Conclusions Are Broad. Journal of general internal medicine Humphreys, K. 2023

  View details for DOI 10.1007/s11606-023-08156-w

  View details for PubMedID 36944902

• Long-Term Effects of Increasing Buprenorphine Treatment Seeking, Duration, and Capacity on Opioid Overdose Fatalities: A Model-based Analysis. Journal of addiction medicine Stringfellow, E. J., Lim, T. Y., DiGennaro, C., Zhang, Z., Paramasivam, P., Bearnot, B., Humphreys, K., Jalali, M. S. 2023; 17 (4): 439-446

  Abstract

  Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity.To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatment-seeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays.Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved.If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.

  View details for DOI 10.1097/ADM.0000000000001153

  View details for PubMedID 37579104

• Long-Term Effects of Increasing Buprenorphine Treatment Seeking, Duration, and Capacity on Opioid Overdose Fatalities: A Model-Based Analysis. Journal of addiction medicine Stringfellow, E. J., Lim, T. Y., DiGennaro, C., Zhang, Z., Paramasivam, P., Bearnot, B., Humphreys, K., Jalali, M. S. 2023

  Abstract

  Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity.To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatment-seeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays.Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved.If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.

  View details for DOI 10.1097/ADM.0000000000001153

  View details for PubMedID 36799870

• Predicting premature discontinuation of medication for opioid use disorder from electronic medical records. AMIA ... Annual Symposium proceedings. AMIA Symposium Lopez, I., Fouladvand, S., Kollins, S., Chen, C. A., Bertz, J., Hernandez-Boussard, T., Lembke, A., Humphreys, K., Miner, A. S., Chen, J. H. 2023; 2023: 1067-1076

  Abstract

  Medications such as buprenorphine-naloxone are among the most effective treatments for opioid use disorder, but limited retention in treatment limits long-term outcomes. In this study, we assess the feasibility of a machine learning model to predict retention vs. attrition in medication for opioid use disorder (MOUD) treatment using electronic medical record data including concepts extracted from clinical notes. A logistic regression classifier was trained on 374 MOUD treatments with 68% resulting in potential attrition. On a held-out test set of 157 events, the full model achieved an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% CI: 0.64-0.90) and AUROC of 0.74 (95% CI: 0.62-0.87) with a limited model using only structured EMR data. Risk prediction for opioid MOUD retention vs. attrition is feasible given electronic medical record data, even without necessarily incorporating concepts extracted from clinical notes.

  View details for PubMedID 38222349

  View details for PubMedCentralID PMC10785878

• State Cannabis Legalization and Psychosis-Related Health Care Utilization. JAMA network open Elser, H., Humphreys, K., Kiang, M. V., Mehta, S., Yoon, J. H., Faustman, W. O., Matthay, E. C. 2023; 6 (1): e2252689

  Abstract

  Psychosis is a hypothesized consequence of cannabis use. Legalization of cannabis could therefore be associated with an increase in rates of health care utilization for psychosis.To evaluate the association of state medical and recreational cannabis laws and commercialization with rates of psychosis-related health care utilization.Retrospective cohort design using state-level panel fixed effects to model within-state changes in monthly rates of psychosis-related health care claims as a function of state cannabis policy level, adjusting for time-varying state-level characteristics and state, year, and month fixed effects. Commercial and Medicare Advantage claims data for beneficiaries aged 16 years and older in all 50 US states and the District of Columbia, 2003 to 2017 were used. Data were analyzed from April 2021 to October 2022.State cannabis legalization policies were measured for each state and month based on law type (medical or recreational) and degree of commercialization (presence or absence of retail outlets).Outcomes were rates of psychosis-related diagnoses and prescribed antipsychotics.This study included 63 680 589 beneficiaries followed for 2 015 189 706 person-months. Women accounted for 51.8% of follow-up time with the majority of person-months recorded for those aged 65 years and older (77.3%) and among White beneficiaries (64.6%). Results from fully-adjusted models showed that, compared with no legalization policy, states with legalization policies experienced no statistically significant increase in rates of psychosis-related diagnoses (medical, no retail outlets: rate ratio [RR], 1.13; 95% CI, 0.97-1.36; medical, retail outlets: RR, 1.24; 95% CI, 0.96-1.61; recreational, no retail outlets: RR, 1.38; 95% CI, 0.93-2.04; recreational, retail outlets: RR, 1.39; 95% CI, 0.98-1.97) or prescribed antipsychotics (medical, no retail outlets RR, 1.00; 95% CI, 0.88-1.13; medical, retail outlets: RR, 1.01; 95% CI, 0.87-1.19; recreational, no retail outlets: RR, 1.13; 95% CI, 0.84-1.51; recreational, retail outlets: RR, 1.14; 95% CI, 0.89-1.45). In exploratory secondary analyses, rates of psychosis-related diagnoses increased significantly among men, people aged 55 to 64 years, and Asian beneficiaries in states with recreational policies compared with no policy.In this retrospective cohort study of commercial and Medicare Advantage claims data, state medical and recreational cannabis policies were not associated with a statistically significant increase in rates of psychosis-related health outcomes. As states continue to introduce new cannabis policies, continued evaluation of psychosis as a potential consequence of state cannabis legalization may be informative.

  View details for DOI 10.1001/jamanetworkopen.2022.52689

  View details for PubMedID 36696111

• Cost-effectiveness of office-based buprenorphine treatment for opioid use disorder. Drug and alcohol dependence Qian, G., Rao, I., Humphreys, K., Owens, D. K., Brandeau, M. L. 2022; 243: 109762

  Abstract

  To assess the effectiveness and cost-effectiveness of office-based buprenorphine treatment (OBBT) in the U.S.We performed a model-based analysis of buprenorphine treatment provided in a primary care setting for the U.S. population with OUD.Buprenorphine treatment provided in a primary care setting.Fatal and nonfatal overdoses and deaths over five years, discounted lifetime quality-adjusted life years (QALYs), costs.For a cohort of 100,000 untreated individuals who enter OBBT, approximately 9350 overdoses would be averted over five years; of these, approximately 900 would have been fatal. OBBT compared to no treatment would yield 1.07 incremental lifetime QALYs per person at an incremental cost of $17,000 per QALY gained when using a healthcare perspective. If OBBT is half as effective and twice as expensive as assumed in the base case, the incremental cost when using a healthcare perspective is $25,500 per QALY gained. Using a limited societal perspective that additionally includes patient costs and criminal justice costs, OBBT is cost-saving compared to no treatment even under pessimistic assumptions about efficacy and cost.Expansion of OBBT would be highly cost-effective compared to no treatment when considered from a healthcare perspective, and cost-saving when reduced criminal justice costs are included. Given the continuing opioid crisis in the U.S., expansion of this care option should be a high priority.

  View details for DOI 10.1016/j.drugalcdep.2022.109762

  View details for PubMedID 36621198

• A literature review of the impact of exclusion criteria on generalizability of clinical trial findings to patients with chronic pain PAIN REPORTS Salmasi, V., Lii, T. R., Humphreys, K., Reddy, V., Mackey, S. C. 2022; 7 (6): e1050

  Abstract

  The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: (("eligibility criteria" AND generalizability) OR ("exclusion criteria" AND generalizability) OR "exclusion criteria"[ti] OR "eligibility criteria"[ti]) AND pain. We only considered studies relevant if they analyzed data on (1) the prevalence and nature of exclusion criteria or (2) the impact of exclusion criteria on sample representativeness or study results. The 4 articles that were identified reported differences in patients who were included and excluded in different clinical trials: excluded patients were older, less likely to have a paid job, had more functional limitations at baseline, and used strong opioids more often. The clinical significance of these differences remains unclear. The pain medicine literature has very few published studies on the prevalence and impact of exclusion criteria, and the outcomes of excluded patients are rarely tracked. The frequent use of psychosocial exclusions is especially compromising to generalizability because chronic pain commonly co-occurs with psychiatric comorbidities. Inclusion of more representative patients in research samples can reduce recruitment barriers and broaden the generalizability of findings in patients with chronic pain. We also call for more studies that examine the use of exclusion criteria in chronic pain trials to better understand their implications.

  View details for DOI 10.1097/PR9.0000000000001050

  View details for Web of Science ID 000884105700002

  View details for PubMedID 36398200

  View details for PubMedCentralID PMC9663135

• Is good science leading the way in the therapeutic use of psychedelic drugs? PSYCHOLOGICAL MEDICINE Hall, W. D., Humphreys, K. 2022

  View details for DOI 10.1017/S0033291722003191

  View details for Web of Science ID 000870031400001

• Promoting benzodiazepine cessation through an electronically-delivered patient self-management intervention (EMPOWER-ED): Randomized controlled trial protocol. Contemporary clinical trials communications Cucciare, M. A., Hagedorn, H. J., Bounthavong, M., Abraham, T. H., Greene, C. J., Han, X., Kemp, L., Marchant, K., White, P., Humphreys, K. 2022; 29: 100994

  Abstract

  Background: Long-term benzodiazepine dependence carries significant health risks which might be reduced with low-cost patient self-management interventions. A booklet version of one such intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) proved effective in a Canadian clinical trial with older adults. Digitizing such an intervention for electronic delivery and tailoring it to different populations could expand its reach. Accordingly, this article describes the protocol for a randomized controlled trial to test the effectiveness of an electronically-delivered, direct-to-patient benzodiazepine cessation intervention tailored to U.S. military veterans.Methods: Design: Two-arm individually randomized controlled trial.Setting: US Veterans Health Administration primary care clinics.Participants: Primary care patients taking benzodiazepines for three or more months and having access to a smartphone, tablet or desktop computer.Intervention and comparator: Participants will be randomized to receive either the electronically-delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow provider recommendations regarding their benzodiazepine use (treatment-as-usual).Measurements: The primary outcomes are complete benzodiazepine cessation and 25% dose reduction, assessed using administrative and self-report data, between baseline and six-month follow-up. Secondary outcomes are self-reported anxiety symptoms, sleep quality, and overall health and quality of life, measured at baseline and 6-month follow-up, and benzodiazepine cessation at 12-month follow-up.Comments: This randomized controlled trial will evaluate whether the accessibility and effectiveness of a promising intervention for benzodiazepine cessation can be improved through digitization and population tailoring.

  View details for DOI 10.1016/j.conctc.2022.100994

  View details for PubMedID 36111174

• Adapting the Eliminating Medications Through Patient Ownership of End Results Protocol to Promote Benzodiazepine Cessation Among US Military Veterans: Focus Group Study With US Military Veterans and National Veterans Health Administration Leaders. Journal of medical Internet research Cucciare, M. A., Abraham, T. H., Kemp, L., White, P., Marchant, K., Hagedorn, H. J., Humphreys, K. 2022; 24 (9): e35514

  Abstract

  BACKGROUND: Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising self-management intervention, delivered directly to patients as a printed booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults. EMPOWER has high potential to benefit large health care systems such as the US Veterans Health Administration (VHA), which cares for many veterans who use benzodiazepines for extended periods.OBJECTIVE: We aimed to adapt the original EMPOWER booklet materials for electronic delivery and for use among US military veterans receiving VHA care who were long-term benzodiazepine users.METHODS: We used elements of Analysis, Design, Development, Implementation, and Evaluation, a framework commonly used in the field of instructional design, to guide a qualitative approach to iteratively adapting EMPOWER Electronic Delivery (EMPOWER-ED). We conducted 3 waves of focus groups with the same 2 groups of VHA stakeholders. Stakeholders were VHA-enrolled veterans (n=16) with medical chart evidence of long-term benzodiazepine use and national VHA leaders (n=7) with expertise in setting VHA policy for prescription benzodiazepine use and developing electronically delivered educational tools for veterans. Qualitative data collected from each wave of focus groups were analyzed using template analysis.RESULTS: Themes that emerged from the initial focus groups included veterans' anxiety about self-tapering from benzodiazepines and prior negative experiences attempting to self-taper without support. Participants also provided feedback on the protocol's look and feel, educational content, the tapering protocol, and website functionality; for example, feedback from policy leaders included listing, on the cover page, the most commonly prescribed benzodiazepines to ensure that veterans were aware of medications that qualify for self-taper using the EMPOWER-ED protocol. Both groups of stakeholders identified the importance of having access to supportive resources to help veterans manage sleep and anxiety in the absence of taking benzodiazepines. Both groups also emphasized the importance of ensuring that the self-taper could be personalized and that the taper instructions were clear. The policy leaders emphasized the importance of encouraging veterans to notify their provider of their decision to self-taper to help facilitate provider assistance, if needed, with the taper process and to help prevent medication stockpiling.CONCLUSIONS: EMPOWER-ED is the first direct-to-patient electronically delivered protocol designed to help US military veterans self-taper from long-term benzodiazepine use. We used the Analysis, Design, Development, Implementation, and Evaluation framework to guide the successful adaption of the original EMPOWER booklet for use with this population and for electronic delivery. The next step in this line of research is to evaluate EMPOWER-ED in a randomized controlled trial.

  View details for DOI 10.2196/35514

  View details for PubMedID 36121697

• The impact of the COVID-19 pandemic on addictive disorders-an update. Addiction (Abingdon, England) Marsden, J., Brown, J., Clark, L., Cousijn, J., Hall, W., Hickman, M., Holmes, J., Humphreys, K., Jackson, S. E., Peacock, A., Tucker, J. 2022

  View details for DOI 10.1111/add.16033

  View details for PubMedID 36068188

• Has the Opioid Crisis Affected Student Learning? A National Analysis of Growth Rates ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE Drescher, J., Steyer, L., Townley-Flores, C., Humphreys, K. 2022; 703 (1): 234-261

  View details for DOI 10.1177/00027162231151524

  View details for Web of Science ID 000954241200009

• Sociodemographic and geographic disparities in excess fatal drug overdoses during the COVID-19 pandemic in California: A population-based study. Lancet Regional Health. Americas Kiang, M. V., Acosta, R. J., Chen, Y., Matthay, E. C., Tsai, A. C., Basu, S., Glymour, M. M., Bibbins-Domingo, K., Humphreys, K., Arthur, K. N. 2022; 11: 100237

  Abstract

  Background: The coronavirus disease 2019 (COVID-19) pandemic is co-occurring with a drug addiction and overdose crisis.Methods: We fit overdispersed Poisson models, accounting for seasonality and secular trends, to estimate the excess fatal drug overdoses (i.e., deaths greater than expected), using data on all deaths in California from 2016 to 2020.Findings: Between January 5, 2020 and December 26, 2020, there were 8605 fatal drug overdoses-a 44% increase over the same period one year prior. We estimated 2084 (95% CI: 1925 to 2243) fatal drug overdoses were excess deaths, representing 5·28 (4·88 to 5·68) excess fatal drug overdoses per 100,000 population. Excess fatal drug overdoses were driven by opioids (4·48 [95% CI: 4·18 to 4·77] per 100,000), especially synthetic opioids (2·85 [95% CI: 2·56 to 3·13] per 100,000). The non-Hispanic Black and Other non-Hispanic populations were disproportionately affected with 10·1 (95% CI: 7·6 to 12·5) and 13·26 (95% CI: 11·0 to 15·5) excess fatal drug overdoses per 100,000 population, respectively, compared to 5·99 (95% CI: 5.2 to 6.8) per 100,000 population in the non-Hispanic white population. There was a steep, nonlinear educational gradient with the highest rate among those with only a high school degree. There was a strong spatial patterning with the highest levels of excess mortality in the southernmost region and consistently lower levels at progressively more northern latitudes (7·73 vs 1·96 per 100,000).Interpretation: Fatal drug overdoses disproportionately increased in 2020 among structurally marginalized populations and showed a strong geographic gradient. Local, tailored public health interventions are urgently needed to reduce growing inequities in overdose deaths.Funding: US National Institutes of Health and Department of Veterans Affairs.

  View details for DOI 10.1016/j.lana.2022.100237

  View details for PubMedID 35342895

• Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis. Science advances Stringfellow, E. J., Lim, T. Y., Humphreys, K., DiGennaro, C., Stafford, C., Beaulieu, E., Homer, J., Wakeland, W., Bearnot, B., McHugh, R. K., Kelly, J., Glos, L., Eggers, S. L., Kazemi, R., Jalali, M. S. 2022; 8 (25): eabm8147

  Abstract

  Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers' capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.

  View details for DOI 10.1126/sciadv.abm8147

  View details for PubMedID 35749492

• Modeling the evolution of the US opioid crisis for national policy development. Proceedings of the National Academy of Sciences of the United States of America Lim, T. Y., Stringfellow, E. J., Stafford, C. A., DiGennaro, C., Homer, J. B., Wakeland, W., Eggers, S. L., Kazemi, R., Glos, L., Ewing, E. G., Bannister, C. B., Humphreys, K., Throckmorton, D. C., Jalali, M. S. 2022; 119 (23): e2115714119

  Abstract

  SignificanceThe opioid crisis remains one of the greatest public health challenges in the United States. The crisis is complex, with long delays and feedbacks between policy actions and their effects, which creates a risk of unintended consequences and complicates policy decision-making. We present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), an operationally detailed national-level model of the opioid crisis, intended to enhance understanding of the crisis and guide policy decisions. Drawing on multiple data sources, SOURCE replicates how risks of opioid misuse initiation and overdose have evolved over time in response to behavioral and other changes and suggests how those risks may evolve in the future, providing a basis for projecting and analyzing potential policy impacts and solutions.

  View details for DOI 10.1073/pnas.2115714119

  View details for PubMedID 35639699

• Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial (vol 153, pg 303, 2018) JAMA SURGERY Hah, J., Mackey, S. C., Schmidt, P. 2022; 157 (6): 553

  View details for DOI 10.1001/jamasurg.2022.1392

  View details for Web of Science ID 000809213600033

• Responding to 100000 annual drug overdose deaths in the United States: a special section of commentaries. Addiction (Abingdon, England) Humphreys, K., Marsden, J. 2022; 117 (5): 1187

  View details for DOI 10.1111/add.15861

  View details for PubMedID 35373481

• Synthesizing advice to the United States from other nations that have experienced drug epidemics. Addiction (Abingdon, England) Humphreys, K., Marsden, J. 2022; 117 (5): 1202-1203

  View details for DOI 10.1111/add.15863

  View details for PubMedID 35373483

• Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial (vol 153, pg 303, 2018) JAMA SURGERY Hah, J., Mackey, S. C., Schmidt, P. 2022

  View details for DOI 10.1001/jamasurg.2017.4915

  View details for Web of Science ID 000784959200002

• Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet (London, England) Humphreys, K., Shover, C. L., Andrews, C. M., Bohnert, A. S., Brandeau, M. L., Caulkins, J. P., Chen, J. H., Cuellar, M., Hurd, Y. L., Juurlink, D. N., Koh, H. K., Krebs, E. E., Lembke, A., Mackey, S. C., Larrimore Ouellette, L., Suffoletto, B., Timko, C. 2022; 399 (10324): 555-604

  View details for DOI 10.1016/S0140-6736(21)02252-2

  View details for PubMedID 35122753

• Prescription quantity and duration predict progression from acute to chronic opioid use in opioid-naive Medicaid patients. PLOS digital health Johnson, D. G., Ho, V. T., Hah, J. M., Humphreys, K., Carroll, I., Curtin, C., Asch, S. M., Hernandez-Boussard, T. 2022; 1 (8)

  Abstract

  Opiates used for acute pain are an established risk factor for chronic opioid use (COU). Patient characteristics contribute to progression from acute opioid use to COU, but most are not clinically modifiable. To develop and validate machine-learning algorithms that use claims data to predict progression from acute to COU in the Medicaid population, Adult opioid naive Medicaid patients from 6 anonymized states who received an opioid prescription between 2015 and 2019 were included. Five machine learning (ML) Models were developed, and model performance assessed by area under the receiver operating characteristic curve (auROC), precision and recall. In the study, 29.9% (53820/180000) of patients transitioned from acute opioid use to COU. Initial opioid prescriptions in COU patients had increased morphine milligram equivalents (MME) (33.2 vs. 23.2), tablets per prescription (45.6 vs. 36.54), longer prescriptions (26.63 vs 24.69 days), and higher proportions of tramadol (16.06% vs. 13.44%) and long acting oxycodone (0.24% vs 0.04%) compared to non- COU patients. The top performing model was XGBoost that achieved average precision of 0.87 and auROC of 0.63 in testing and 0.55 and 0.69 in validation, respectively. Top-ranking prescription-related features in the model included quantity of tablets per prescription, prescription length, and emergency department claims. In this study, the Medicaid population, opioid prescriptions with increased tablet quantity and days supply predict increased risk of progression from acute to COU in opioid-naive patients. Future research should evaluate the effects of modifying these risk factors on COU incidence.

  View details for DOI 10.1371/journal.pdig.0000075

  View details for PubMedID 36203857

• Changes in postoperative opioid prescribing across three diverse healthcare systems, 2010-2020. Frontiers in digital health Coquet, J., Zammit, A., Hajouji, O. E., Humphreys, K., Asch, S. M., Osborne, T. F., Curtin, C. M., Hernandez-Boussard, T. 2022; 4: 995497

  Abstract

  Objective: The opioid crisis brought scrutiny to opioid prescribing. Understanding how opioid prescribing patterns and corresponding patient outcomes changed during the epidemic is essential for future targeted policies. Many studies attempt to model trends in opioid prescriptions therefore understanding the temporal shift in opioid prescribing patterns across populations is necessary. This study characterized postoperative opioid prescribing patterns across different populations, 2010-2020.Data Source: Administrative data from Veteran Health Administration (VHA), six Medicaid state programs and an Academic Medical Center (AMC).Data extraction: Surgeries were identified using the Clinical Classifications Software.Study Design: Trends in average daily discharge Morphine Milligram Equivalent (MME), postoperative pain and subsequent opioid prescription were compared using regression and likelihood ratio test statistics.Principal Findings: The cohorts included 595,106 patients, with populations that varied considerably in demographics. Over the study period, MME decreased significantly at VHA (37.5-30.1; p=0.002) and Medicaid (41.6-31.3; p=0.019), and increased at AMC (36.9-41.7; p<0.001). Persistent opioid users decreased after 2015 in VHA (p<0.001) and Medicaid (p=0.002) and increase at the AMC (p=0.003), although a low rate was maintained. Average postoperative pain scores remained constant over the study period.Conclusions: VHA and Medicaid programs decreased opioid prescribing over the past decade, with differing response times and rates. In 2020, these systems achieved comparable opioid prescribing patterns and outcomes despite having very different populations. Acknowledging and incorporating these temporal distribution shifts into data learning models is essential for robust and generalizable models.

  View details for DOI 10.3389/fdgth.2022.995497

  View details for PubMedID 36561925

• Substance Use, PTSD Symptoms, and Suicidal Ideation Among Veteran Psychiatry Inpatients: A Latent Class Trajectory Analysis JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Vest, N. A., Rossi, F. S., Ilgen, M., Humphreys, K., Timko, C. 2021; 82 (6): 792-800

  View details for Web of Science ID 000752489100012

• Using Peers to Increase Veterans' Engagement in a Smartphone Application for Unhealthy Alcohol Use: A Pilot Study of Acceptability and Utility PSYCHOLOGY OF ADDICTIVE BEHAVIORS Blonigen, D. M., Harris-Olenak, B., Kuhn, E., Timko, C., Humphreys, K., Smith, J. S., Dulin, P. 2021; 35 (7): 829-839

  Abstract

  Mobile apps can only increase access to alcohol treatment if patients actively engage with them. Peers may be able to facilitate such engagement by providing supportive accountability and instruction and encouragement for app use. We developed a protocol for peers to support engagement in the Stand Down app for unhealthy alcohol use in veterans and tested the acceptability and utility of the protocol. Thirty-one veteran primary care patients who screened positive for unhealthy alcohol use and were not currently in addiction treatment were given access to Stand Down for four weeks and concurrently received weekly phone support from a Department of Veterans Affairs peer specialist to facilitate engagement with the app. App usage was extracted daily, and pre/post treatment assessments measured changes in drinking patterns, via the Timeline Followback interview, and satisfaction with care, via quantitative and qualitative approaches. A priori benchmarks for acceptability were surpassed: time spent in the app (M = 93.89 min, SD = 92.1), days of app use (M = 14.05, SD = 8.0), and number of daily interviews completed for tracking progress toward a drinking goal (M = 12.64, SD = 9.7). Global satisfaction, per the Client Satisfaction Questionnaire, was high (M = 26.4 out of 32, SD = 4.5). Pre to post, total standard drinks in the prior 30 days (MPre = 142.7, MPost = 85.6), Drinks Per Drinking Day (MPre = 5.4, MPost = 4.0), and Percent Heavy Drinking Days (MPre = 35.3%, MPost = 20.1%) decreased significantly (ps < .05). Findings indicate that Peer-Supported Stand Down is highly acceptable to veteran primary care patients and may help reduce drinking in this population. A larger controlled trial of this intervention is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

  View details for DOI 10.1037/adb0000598

  View details for Web of Science ID 000716306700007

  View details for PubMedID 32597665

  View details for PubMedCentralID PMC7769861

• Effectiveness of Policies for Addressing the US Opioid Epidemic: A Model-Based Analysis from the Stanford-Lancet Commission on the North American Opioid Crisis. Lancet Regional Health. Americas Rao, I. J., Humphreys, K., Brandeau, M. L. 2021; 3

  Abstract

  Background: The U.S. opioid crisis has been exacerbated by COVID-19 and the spread of synthetic opioids (e.g., fentanyl).Methods: We model the effectiveness of reduced prescribing, drug rescheduling, prescription monitoring programs (PMPs), tamper-resistant drug reformulation, excess opioid disposal, naloxone availability, syringe exchange, pharmacotherapy, and psychosocial treatment. We measure life years, quality-adjusted life years (QALYs), and opioid-related deaths over five and ten years.Findings: Under the status quo, our model predicts that approximately 547,000 opioid-related deaths will occur from 2020 to 2024 (range 441,000 - 613,000), rising to 1,220,000 (range 996,000 - 1,383,000) by 2029. Expanding naloxone availability by 30% had the largest effect, averting 25% of opioid deaths. Pharmacotherapy, syringe exchange, psychosocial treatment, and PMPs are uniformly beneficial, reducing opioid-related deaths while leading to gains in life years and QALYs. Reduced prescribing and increasing excess opioid disposal programs would reduce total deaths, but would lead to more heroin deaths in the short term. Drug rescheduling would increase total deaths over five years as some opioid users escalate to heroin, but decrease deaths over ten years. Combined interventions would lead to greater increases in life years, QALYs, and deaths averted, although in many cases the results are subadditive.Interpretation: Expanded health services for individuals with opioid use disorder combined with PMPs and reduced opioid prescribing would moderately lessen the severity of the opioid crisis over the next decade. Tragically, even with improved public policies, significant morbidity and mortality is inevitable.

  View details for DOI 10.1016/j.lana.2021.100031

  View details for PubMedID 34790907

• Substance Use, PTSD Symptoms, and Suicidal Ideation Among Veteran Psychiatry Inpatients:A Latent Class Trajectory Analysis. Journal of studies on alcohol and drugs Vest, N. A., Rossi, F. S., Ilgen, M., Humphreys, K., Timko, C. 2021; 82 (6): 792-800

  Abstract

  OBJECTIVE: In this study, we aimed to inform clinical practice by identifying distinct subgroups of U.S. veteran psychiatry inpatients on their alcohol and drug use severity, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation over time.METHOD: Participants were 406 patients with co-occurring substance use and mental health disorders. A parallel latent growth trajectory model was used to characterize participants' symptom severity across 15 months posttreatment intake.RESULTS: Four distinct classes were identified: 47% "normative improvement," 32% "high PTSD," 11% "high drug use," and 9% "high alcohol use." Eighty percent of the sample had reduced their drinking and drug intake by half from baseline to 3 months, and those levels remained stable from 3 to 15 months. The High PTSD, High Drug Use, and High Alcohol Use classes all reported levels of PTSD symptomatology at baseline consistent with a clinical diagnosis, and symptom levels remained high and stable across all 15 months. The Normative Improvement class showed declining drug and alcohol intake and was the only class exhibiting reductions in PTSD symptomatology over time. High substance use classes showed initial declines in suicidal ideation, then an increase from 9 to 15 months.CONCLUSIONS: The reduction in frequency of drinking and drug use for 80% of the sample was substantial and supports the potential efficacy of current treatment approaches. However, the high and stable levels of PTSD for more than 50% of the sample, as well as the reemergence of suicidal ideation in a sizable subgroup, underscore the difficulty in finding and linking patients to effective interventions to decrease symptomatology over time.

  View details for PubMedID 34762039

• Robustness of estimated access to opioid use disorder treatment providers in rural vs. urban areas of the United States. Drug and alcohol dependence Kiang, M. V., Barnett, M. L., Wakeman, S. E., Humphreys, K., Tsai, A. C. 2021; 228: 109081

  Abstract

  BACKGROUND: Effective, evidence-based treatments for opioid use disorder are not equally accessible to Americans. Recent studies have found urban/rural disparities in the driving times to the nearest opioid treatment providers. These disparities may be even worse than currently reported in the literature because patients may not be able to obtain appointments with their nearest provider. We examine the robustness of the opioid treatment infrastructure by estimating how driving times to treatment change as provider availability decreases.METHODS: We used public data from the federal government to estimate the driving time from each census tract centroid to the nearest 15 treatment providers. We summarized the median and interquartile range of driving times to increasingly distant providers (i.e., nearest, second nearest, etc.), stratified by urban/rural classification.RESULTS: The median driving time to the nearest provider was greater in rural areas than urban areas for both opioid treatment programs (12min vs 61min) and buprenorphine-waivered prescribers (5min vs 21min). Importantly, driving times in rural areas increased more steeply as nearer providers became unavailable. For example, the increase in driving time between the nearest provider and the fifth nearest provider was much greater in rural areas than in urban areas for both buprenorphine-waivered prescribers (23min vs 4min) and for opioid treatment programs (54min vs 22min).CONCLUSIONS: Access to treatment for opioid use disorder is more robust in urban areas compared with rural areas. This disparity must be eliminated if the opioid overdose crisis is to be resolved.

  View details for DOI 10.1016/j.drugalcdep.2021.109081

  View details for PubMedID 34600256

• Comparison of Treatments for Cocaine Use Disorder Among Adults: A Systematic Review and Meta-analysis. JAMA network open Bentzley, B. S., Han, S. S., Neuner, S., Humphreys, K., Kampman, K. M., Halpern, C. H. 2021; 4 (5): e218049

  Abstract

  Importance: In the US and the United Kingdom, cocaine use is the second leading cause of illicit drug overdose death. Psychosocial treatments for cocaine use disorder are limited, and no pharmacotherapy is approved for use in the US or Europe.Objective: To compare treatments for active cocaine use among adults.Data Sources: PubMed and the Cochrane Database of Systematic Reviews were searched for clinical trials published between December 31, 1995, and December 31, 2017.Study Selection: This meta-analysis was registered on Covidence.org (study 8731) on December 31, 2015. Clinical trials were included if they (1) had the term cocaine in the article title; (2) were published between December 31, 1995, and December 31, 2017; (3) were written in English; (4) enrolled outpatients 18 years or older with active cocaine use at baseline; and (5) reported treatment group size, treatment duration, retention rates, and urinalysis results for the presence of cocaine metabolites. A study was excluded if (1) more than 25% of participants were not active cocaine users or more than 80% of participants had negative test results for the presence of cocaine metabolites at baseline and (2) it reported only pooled urinalysis results indicating the presence of multiple substances and did not report the specific proportion of positive test results for cocaine metabolites. Multiple reviewers reached criteria consensus. Of 831 records screened, 157 studies (18.9%) met selection criteria and were included in the analysis.Data Extraction and Synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Search results were imported from PubMed XML into Covidence.org then Microsoft Excel. Data extraction was completed in 2 iterations to ensure fidelity. Analyses included a multilevel random-effects model, a multilevel mixed-effects meta-regression model, and sensitivity analyses. Treatments were clustered into 11 categories (psychotherapy, contingency management programs, placebo, opioids, psychostimulants, anticonvulsants, dopamine agonists, antidepressants, antipsychotics, miscellaneous medications, and other therapies). Missing data were imputed using multiple imputation by chained equations. The significance threshold for all analyses was P=.05. Data were analyzed using the metafor and mice packages in R software, version 3.3.2 (R Foundation for Statistical Computing). Data were analyzed from January 1, 2018, to February 28, 2021.Main Outcomes and Measures: The primary outcome was the intention-to-treat logarithm of the odds ratio (OR) of having a negative urinalysis result for the presence of cocaine metabolites at the end of each treatment period compared with baseline. The hypothesis, which was formulated after data collection, was that no treatment category would have a significant association with objective reductions in cocaine use.Results: A total of 157 studies comprising 402 treatment groups and 15 842 participants were included. Excluding other therapies, the largest treatment groups across all studies were psychotherapy (mean [SD] number of participants, 40.04 [36.88]) and contingency management programs (mean [SD] number of participants, 37.51 [25.51]). Only contingency management programs were significantly associated with an increased likelihood of having a negative test result for the presence of cocaine (OR,2.13; 95% CI, 1.62-2.80), and this association remained significant in all sensitivity analyses.Conclusions and Relevance: In this meta-analysis, contingency management programs were associated with reductions in cocaine use among adults. Research efforts and policies that align with this treatment modality may benefit those who actively use cocaine and attenuate societal burdens.

  View details for DOI 10.1001/jamanetworkopen.2021.8049

  View details for PubMedID 33961037

• ADAPTING A DYADIC CHRONIC ILLNESS SELF-CARE PROGRAM FOR THE INTERNET: METHODOLOGY AND USABILITY Trivedi, R. B., Hirayama, S. K., Suresh, M., Risbud, R., Humber, M. B., Zulman, D. M., Asch, S. M., Nelson, K., Timko, C., Humphreys, K., Piette, J. OXFORD UNIV PRESS INC. 2021: S34

  View details for Web of Science ID 000648922700070

• Cost-effectiveness of Treatments for Opioid Use Disorder. JAMA psychiatry Fairley, M., Humphreys, K., Joyce, V. R., Bounthavong, M., Trafton, J., Combs, A., Oliva, E. M., Goldhaber-Fiebert, J. D., Asch, S. M., Brandeau, M. L., Owens, D. K. 2021

  Abstract

  Importance: Opioid use disorder (OUD) is a significant cause of morbidity and mortality in the US, yet many individuals with OUD do not receive treatment.Objective: To assess the cost-effectiveness of OUD treatments and association of these treatments with outcomes in the US.Design and Setting: This model-based cost-effectiveness analysis included a US population with OUD.Interventions: Medication-assisted treatment (MAT) with buprenorphine, methadone, or injectable extended-release naltrexone; psychotherapy (beyond standard counseling); overdose education and naloxone distribution (OEND); and contingency management (CM).Main Outcomes and Measures: Fatal and nonfatal overdoses and deaths throughout 5 years, discounted lifetime quality-adjusted life-years (QALYs), and costs.Results: In the base case, in the absence of treatment, 42 717 overdoses (4132 fatal, 38 585 nonfatal) and 12 660 deaths were estimated to occur in a cohort of 100 000 patients over 5 years, and 11.58 discounted lifetime QALYs were estimated to be experienced per person. An estimated reduction in overdoses was associated with MAT with methadone (10.7%), MAT with buprenorphine or naltrexone (22.0%), and when combined with CM and psychotherapy (range, 21.0%-31.4%). Estimated deceased deaths were associated with MAT with methadone (6%), MAT with buprenorphine or naltrexone (13.9%), and when combined with CM, OEND, and psychotherapy (16.9%). MAT yielded discounted gains of 1.02 to 1.07 QALYs per person. Including only health care sector costs, methadone cost $16 000/QALY gained compared with no treatment, followed by methadone with OEND ($22 000/QALY gained), then by buprenorphine with OEND and CM ($42 000/QALY gained), and then by buprenorphine with OEND, CM, and psychotherapy ($250 000/QALY gained). MAT with naltrexone was dominated by other treatment alternatives. When criminal justice costs were included, all forms of MAT (with buprenorphine, methadone, and naltrexone) were associated with cost savings compared with no treatment, yielding savings of $25 000 to $105 000 in lifetime costs per person. The largest cost savings were associated with methadone plus CM. Results were qualitatively unchanged over a wide range of sensitivity analyses. An analysis using demographic and cost data for Veterans Health Administration patients yielded similar findings.Conclusions and Relevance: In this cost-effectiveness analysis, expanded access to MAT, combined with OEND and CM, was associated with cost-saving reductions in morbidity and mortality from OUD. Lack of widespread MAT availability limits access to a cost-saving medical intervention that reduces morbidity and mortality from OUD. Opioid overdoses in the US likely reached a record high in 2020 because of COVID-19 increasing substance use, exacerbating stress and social isolation, and interfering with opioid treatment. It is essential to understand the cost-effectiveness of alternative forms of MAT to treat OUD.

  View details for DOI 10.1001/jamapsychiatry.2021.0247

  View details for PubMedID 33787832

• Evaluation of State Cannabis Laws and Rates of Self-harm and Assault JAMA NETWORK OPEN Matthay, E. C., Kiang, M., Elser, H., Schmidt, L., Humphreys, K. 2021; 4 (3): e211955

  Abstract

  State cannabis laws are changing rapidly. Research is inconclusive about their association with rates of self-harm and assault. Existing studies have not considered variations in cannabis commercialization across states over time.To evaluate the association of state medical and recreational cannabis laws with self-harm and assault, overall and by age and sex, while considering varying degrees of commercialization.Using a cohort design with panel fixed-effects analysis, within-state changes in claims for self-harm and assault injuries before and after changes in cannabis laws were quantified in all 50 US states and the District of Columbia. Comprehensive claims data on commercial and Medicare Advantage health plan beneficiaries from January 1, 2003, to December 31, 2017, grouped by state and month, were evaluated. Data analysis was conducted from January 31, 2020, to January 21, 2021.Categorical variable that indexed the degree of cannabis legalization in each state and month based on law type (medical or recreational) and operational status of dispensaries (commercialization).Claims for self-harm and assault injuries based on International Classification of Diseases codes.The analysis included 75 395 344 beneficiaries (mean [SD] age, 47 [22] years; 50% female; and median follow-up, 17 months [interquartile range, 8-36 months]). During the study period, 29 states permitted use of medical cannabis and 11 permitted recreational cannabis. Point estimates for populationwide rates of self-harm and assault injuries were higher in states legalizing recreational cannabis compared with states with no cannabis laws, but these results were not statistically significant (adjusted rate ratio [aRR] assault, recreational dispensaries: 1.27; 95% CI, 0.79-2.03;self-harm, recreational dispensaries aRR: 1.15; 95% CI, 0.89-1.50). Results varied by age and sex with no associations found except for states with recreational policies and self-harm among males younger than 40 years (aRR <21 years, recreational without dispensaries: 1.70; 95% CI, 1.11-2.61; aRR aged 21-39 years, recreational dispensaries: 1.46; 95% CI, 1.01-2.12). Medical cannabis was generally not associated with self-harm or assault injuries populationwide or among age and sex subgroups.Recreational cannabis legalization appears to be associated with relative increases in rates of claims for self-harm among male health plan beneficiaries younger than 40 years. There was no association between cannabis legalization and self-harm or assault, for any other age and sex group or for medical cannabis. States that legalize but still constrain commercialization may be better positioned to protect younger male populations from unintended harms.

  View details for DOI 10.1001/jamanetworkopen.2021.1955

  View details for Web of Science ID 000630467900006

  View details for PubMedID 33734416

• Our Other Epidemic: Addiction. JAMA health forum Frank, R. G., Humphreys, K., Pollack, H. 2021; 2 (3): e210273

  View details for DOI 10.1001/jamahealthforum.2021.0273

  View details for PubMedID 36218455

• Policy Responses to the Addiction Crisis. Journal of health politics, policy and law Frank, R. G., Humphreys, K. N., Pollack, H. A. 2021

  Abstract

  The COVID-19 pandemic is just one of two public health crises the new Biden administration will confront. The addiction crisis is the other. The opioid epidemic has already killed more Americans than World Wars I and II combined. And it is but the most visible sign of a broader population health challenge that includes methamphetamine, cocaine, benzodiazepines, and alcohol. This essay presents practical legislative and executive actions required to address these challenges. We focus on two broad policy challenges: (1) improving financing and delivery of treatment for substance use disorders (SUDs) and (2) reducing population exposure to addictive and lethal substances. Through both of these channels, a portfolio of well-implemented, evidence-informed policies can save many thousands of lives every year.

  View details for DOI 10.1215/03616878-8970796

  View details for PubMedID 33493325

• Primary Care Physicians and Spending on Low-Value Care. Annals of internal medicine Baum, A., Bazemore, A., Peterson, L., Basu, S., Humphreys, K., Phillips, R. L. 2021

  View details for DOI 10.7326/M20-6257

  View details for PubMedID 33460344

• Analysis of unused prescription opioids and benzodiazepines remaining after death among Medicare decedents. Drug and alcohol dependence Baum, L. V., Bruzelius, E., Kiang, M. V., Humphreys, K., Basu, S., Baum, A. 2021; 219: 108502

  Abstract

  BACKGROUND: Millions of opioid and benzodiazepine prescriptions are dispensed near end-of-life. After death, patients' unused prescription pills belong to family members, who often save rather than dispose of them. We sought to quantify this exposure in Medicare beneficiaries.METHODS: We estimated the share of decedent Medicare beneficiaries who potentially left behind opioid or benzodiazepine pills at the time of death using Part D claims of a 20 % national sample of Medicare beneficiaries between 2006-2015 linked to the National Death Index.RESULTS: We estimated that 1 in 6 Medicare beneficiaries who died between 2006-2015 potentially left behind opioid pills, and 1 in 10 who died between 2013-2015 potentially left benzodiazepines as well. Leftover pills were more common among younger, dually enrolled, and lower-income beneficiaries, as well as beneficiaries living in non-urban areas and those with a history of mental illness, drug use disorders, and chronic pain. North American Natives and Non-Hispanic Whites had higher proportions than Black, Hispanic, and Asian decedents.CONCLUSIONS: Opioids and benzodiazepines are commonly left behind at death. Policies and interventions that encourage comprehensive and safe medication disposal after death may reduce risk for intra-household diversion and misuse of prescription opioids and benzodiazepines.

  View details for DOI 10.1016/j.drugalcdep.2020.108502

  View details for PubMedID 33421803

• College programming for students in addiction recovery: A PRISMA-guided scoping review. Addictive behaviors Vest, N., Reinstra, M., Timko, C., Kelly, J., Humphreys, K. 2021; 121: 106992

  Abstract

  The health and well-being of students in recovery from substance use disorder are increasingly being recognized as a priority on college campuses. This scoping review maps the state of the existing literature evaluating collegiate recovery programming to highlight research gaps and inform policy.We conducted a systematic search of articles related to collegiate recovery programming published before August 2020. The 15 extracted study characteristics included publication type, study design, primary outcomes, reporting of behavioral addictions, mutual-help group attendance, sample demographic information, school size, ownership, and funding source.The PRISMA-guided search strategy identified 357 articles for abstract review; of 113 articles retained for full-text review, 54 studies met criteria for inclusion. Primary outcomes were coded into four domains: clinical, recovery experience, program characterization, and stigma. Most (57%) used quantitative observational designs and 41% employed qualitative research designs. Government or foundation grants funded 11% of the studies.The domains identified offer a framework for healthcare providers, college administrators, and researchers to understand and improve programs, thereby better serving this vulnerable student group.

  View details for DOI 10.1016/j.addbeh.2021.106992

  View details for PubMedID 34087765

• Mounting a Scientifically Informed Response to the Opioid Crisis in the Veterans Health Administration. Journal of general internal medicine Becker, W. C., Humphreys, K., Atkins, D., Clancy, C. M. 2020

  View details for DOI 10.1007/s11606-020-06349-1

  View details for PubMedID 33277686

• Emerging Characteristics of Isotonitazene-Involved Overdose Deaths: A Case-Control Study. Journal of addiction medicine Shover, C. L., Falasinnu, T. O., Freedman, R. B., Humphreys, K. 2020

  Abstract

  OBJECTIVES: Case reports of fatal overdoses involving the novel synthetic opioid isotonitazene have prompted the U.S. Drug Enforcement Administration to consider an emergency scheduling of the drug in June 2020. We aimed to epidemiologically characterize deaths involving isotonitazene.METHODS: We conducted a case control study using publicly available mortality records from January 1, 2020 to July 31, 2020 in Cook County, IL and Milwaukee County, WI. Cases (all deaths involving isotonitazene) and controls (all deaths involving other synthetic opioids) were compared on demographic characteristics, number of substances involved in fatal overdose, and co-involvement of other substances.RESULTS: We identified 40 fatal overdoses involving isotonitazene and 981 fatal overdoses involving other synthetic opioids. Isotonitazene deaths involved a significantly greater number of substances, and were significantly more likely to involve the designer benzodiazepine flualprazolam.DISCUSSION: Isotonitazene was involved in a substantial minority of synthetic opioid overdose deaths in the first 7 months of 2020. Future studies characterizing its prevalence in other markets are warranted. Emergence of highly potent novel synthetic opioids underscore the need for comprehensive health services for people with opioid use disorder.

  View details for DOI 10.1097/ADM.0000000000000775

  View details for PubMedID 33234804

• Patient-centered care's relationship with substance use disorder treatment utilization. Journal of substance abuse treatment Park, S. E., Mosley, J. E., Grogan, C. M., Pollack, H. A., Humphreys, K., D'Aunno, T., Friedmann, P. D. 2020; 118: 108125

  Abstract

  BACKGROUND: Calls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services.METHODS: Using nationally representative survey data from SUD treatment clinics in the United States, we examine the association between patient-centered clinical care and the utilization of six services: methadone, buprenorphine, behavioral treatment, routine medical care, HIV testing, and suicide prevention counseling. We measured clinics' practice of and emphasis on patient-centered care with two variables: (1) whether the clinic regularly invites patients into clinical decision-making processes, and (2) whether supervisors believe in patient-centered healthcare and shared decision-making practices within their clinics.RESULTS: In 2017, only 23% of SUD treatment clinics regularly invited patients into care decision-making meetings when their cases were discussed. A composite variable captured clinical supervisors' own experience with and expectations for patient-clinician interaction within their clinics (Cronbach's alpha=0.79). Results from regression models that controlled for several organizational and environmental factors show that patient-centered care was independently associated with greater utilization of four of six evidence-based services.CONCLUSIONS: A minority of SUD clinics practice patient-centered healthcare in the United States. Given the connection to evidence-based services, increasing participatory mechanisms in SUD treatment service provision can facilitate patients' access to appropriate and evidence-based services.

  View details for DOI 10.1016/j.jsat.2020.108125

  View details for PubMedID 32972650

• Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with Cooccurring Conditions: A Longitudinal Parallel Growth Mixture Model. Alcoholism, clinical and experimental research Vest, N., Sox-Harris, A., Ilgen, M., Humphreys, K., Timko, C. 2020

  Abstract

  BACKGROUND: Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses.METHODS: Participants were adults with cooccurring disorders (n=406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up.RESULTS: A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment.CONCLUSIONS: These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.

  View details for DOI 10.1111/acer.14474

  View details for PubMedID 33104268

• Will hope triumph over experience in pharmacotherapy research on cocaine use disorder? Addiction (Abingdon, England) Humphreys, K. 2020

  View details for DOI 10.1111/add.15266

  View details for PubMedID 33078477

• Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance. Drug and alcohol dependence Shover, C. L., Falasinnu, T. O., Dwyer, C. L., Santos, N. B., Cunningham, N. J., Freedman, R. B., Vest, N. A., Humphreys, K. 2020; 216: 108314

  Abstract

  BACKGROUND: Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a "fentanyl breakthrough" in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available.METHODS: We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl.RESULTS: Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown.DISCUSSION: Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.

  View details for DOI 10.1016/j.drugalcdep.2020.108314

  View details for PubMedID 33038637

• Computer-Delivered Brief Alcohol Intervention for Patients with Liver Disease: A Randomized Controlled Trial. Addiction (Abingdon, England) Cucciare, M. A., Combs, A. S., Joshi, G., Han, X., Humphreys, K. 2020

  Abstract

  BACKGROUND AND AIMS: Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer-delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease.DESIGN: Multi-site, randomized controlled trial of a cBAI plus standard care (n=67) versus standard care only (n=71). Participants were assessed at baseline and 3- and 6-month follow-up.SETTING: US Veterans Health Administration liver clinics.PARTICIPANTS: Participants were mostly male and diagnosed with hepatitis C.INTERVENTIONS AND COMPARATORS: A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease.MEASUREMENT: Primary outcomes were self-reported number of drinking days and unhealthy drinking days (defined as >2 drinks for men and >1 for women) in the past 30 days at 6-month follow-up. Secondary outcomes were these two variables at 3-month follow-up, and drinks consumed per drinking day, depression, and overall health at 3- and 6-month follow-ups. Missing data were imputed using multiple imputation.FINDINGS: Compared with standard care, cBAI participants reported significantly fewer drinking days at 6-month follow-up and fewer unhealthy drinking days at both 3- and 6-months follow-ups. Least Square means (LS-means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months (LS-mean ratio=3.78/6.89=0.55, 95% confidence interval [CI] = 0.34, 0.89). LS-means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3-months follow-up (LS-mean ratio=1.04/2.57=0.41, 95% CI = 0.19, 0.85). At 6-months follow-up, LS-means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS-mean ratio =1.18/2.75=0.43, 95% CI = 0.20, 0.91).CONCLUSIONS: A computer-delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6-month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption.

  View details for DOI 10.1111/add.15263

  View details for PubMedID 32924207

• Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials. Drug and alcohol dependence Humphreys, K., Barreto, N. B., Alessi, S. M., Carroll, K. M., Crits-Christoph, P., Donovan, D. M., Kelly, J. F., Schottenfeld, R. S., Timko, C., Wagner, T. H. 2020; 215: 108213

  Abstract

  BACKGROUND: 12 step mutual help groups are widely accessed by people with drug use disorder but infrequently subjected to rigorous evaluation. Pooling randomized trials containing a condition in which mutual help group attendance is actively facilitated presents an opportunity to assess the effectiveness of 12 step groups in large, diverse samples of drug use disorder patients.METHODS: Data from six federally-funded randomized trials were pooled (n=1730) and subjected to two-stage instrumental variables modelling, and, fixed and random effects regression models. All trials included a 12 step group facilitation condition and employed the Addiction Severity Index as a core measure.RESULTS: The ability of 12 step facilitation to increase mutual help group participation among drug use disorder patients was minimal, limiting ability to employ two-stage instrumental variable models that correct for selection bias. However, traditional fixed and random effect regression models found that greater 12 step mutual help group attendance by drug use disorder patients predicted reduced use of and problems with illicit drugs and also with alcohol.CONCLUSION: Facilitating significant and lasting involvement in 12 step groups may be more challenging for drug use disorder patients than for alcohol use disorder patients, which has important implications for clinical work and for effectiveness evaluations. Though selection bias could explain part of the results of traditional regression models, the finding that participation in 12 step mutual help groups predicts lower illicit drug and alcohol use and problems in a large, diverse, sample of drug use disorder patients is encouraging.

  View details for DOI 10.1016/j.drugalcdep.2020.108213

  View details for PubMedID 32801112

• Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers. Alcohol and alcoholism (Oxford, Oxfordshire) Kelly, J. F., Abry, A., Ferri, M., Humphreys, K. 2020

  Abstract

  AIMS: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy.METHODS: Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous.RESULTS: A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments.CONCLUSIONS: AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.

  View details for DOI 10.1093/alcalc/agaa050

  View details for PubMedID 32628263

• Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication. JAMA network open Shover, C. L., Vest, N. A., Chen, D., Stueber, A., Falasinnu, T. O., Hah, J. M., Kim, J., Mackey, I., Weber, K. A., Ziadni, M., Humphreys, K. 2020; 3 (7): e2010001

  Abstract

  Importance: Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD.Objective: To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD.Design, Setting, and Participants: This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist.Exposures: Presence of OUD on the list of qualifying conditions for a state's medical cannabis program.Main Outcomes and Measures: Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain).Results: After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P<.001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P=.002) and 28% (95% CI, 14%-42%; P<.001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P=.002).Conclusions and Relevance: In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.

  View details for DOI 10.1001/jamanetworkopen.2020.10001

  View details for PubMedID 32662844

• Investing in Community Health Centers to Expand Addiction Treatment. Psychiatric services (Washington, D.C.) Andrews, C. M., Humphreys, K. 2020; 71 (7): 647

  View details for DOI 10.1176/appi.ps.71704

  View details for PubMedID 32605507

• Debunking Cannabidiol as a Treatment for COVID-19: Time for the FDA to Adopt a Focused Deterrence Model? Cureus Shover, C. L., Humphreys, K. 2020; 12 (6): e8671

  Abstract

  Many cannabidiol (CBD) retailers make unsupported medical claims about their product. In recent years, the U.S. Food and Drug Administration (FDA) has sent warning letters to CBD retailers who promoted CBD to treat Alzheimer's disease, cancer, diabetes, and other serious conditions for which there is no evidence of its efficacy as a treatment or preventive. Compliance with these warning letters has been low. During the novel coronavirus disease 2019 (COVID-19) pandemic, the FDA has begun sending more strongly worded warning letters that appear to have better compliance in that most of these companies have removed COVID-19-related claims. However, many continue to present other unsupported medical claims on other serious medical conditions like cancer, depression, addiction, and bone fractures, among many others. We argue that adopting a strategy of focused deterrence where the FDA prioritizes enforcement related to COVID-19 claims - but when COVID-19-related claims are found, pursues all other violations by that company - would present an opportunity to efficiently cut down on harmful claims overstating CBD's benefits.

  View details for DOI 10.7759/cureus.8671

  View details for PubMedID 32699671

  View details for PubMedCentralID PMC7370674

• Debunking Cannabidiol as a Treatment for COVID-19: Time for the FDA to Adopt a Focused Deterrence Model? CUREUS Shover, C. L., Humphreys, K. 2020; 12 (6)

  View details for DOI 10.7759/cureus.8671

  View details for Web of Science ID 000540906500014

• Budget Impact Analysis of a Computer-Delivered Brief Alcohol Intervention in Veterans Affairs (VA) Liver Clinics: A Randomized Controlled Trial ALCOHOLISM TREATMENT QUARTERLY Esmaeili, A., Yu, W., Cucciare, M. A., Combs, A. S., Joshi, G., Humphreys, K. 2020

  View details for DOI 10.1080/07347324.2020.1760755

  View details for Web of Science ID 000536319000001

• Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking. Journal of psychiatric research Nguyen, L., Durazzo, T. C., Dwyer, C. L., Rauch, A. A., Humphreys, K., Williams, L. M., Padula, C. B. 2020; 126: 1–7

  Abstract

  On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months. There is a critical need to identify modifiable risk factors associated with relapse that can be addressed during AUD treatment. Candidate factors include mood disorders and cigarette smoking, which frequently co-occur with AUD. We predicted that co-occurrence of mood disorders, cigarette smoking, and other modifiable conditions will predict relapse within six months of AUD treatment. Ninety-five Veterans, 23-91 years old, completed assessments of multiple characteristics including demographic information, co-occurring psychiatric disorders, and medical conditions during residential treatment for AUD. Participants' alcohol consumption was monitored over six months after participation. Logistic regression was used to determine if, mood disorders, cigarette smoking status, alcohol consumption, educational level, and comorbid general medical conditions are associated with relapse after AUD treatment. Sixty-nine percent of Veterans (n=66) relapsed within six months of study while 31% remained abstinent (n=29). While education, comorbid general medical conditions, and mood disorder diagnoses were not predictors of relapse, Veterans with greater symptoms of anhedonia, active smokers, and fewer days of abstinence prior to treatment showed significantly greater odds for relapse within six months. Anhedonia and cigarette smoking are modifiable risk factors, and effective treatment of underlying anhedonic symptoms and implementation of smoking cessation concurrent with AUD-focused interventions may decrease risk of relapse.

  View details for DOI 10.1016/j.jpsychires.2020.04.003

  View details for PubMedID 32403028

• Still HOPEful: Reconsidering a "failed" replication of a swift, certain, and fair approach to reducing substance use among individuals under criminal justice supervision. Addiction (Abingdon, England) Humphreys, K., Kilmer, B. 2020

  View details for DOI 10.1111/add.15049

  View details for PubMedID 32281705

• Mitigating and learning from the impact of COVID-19 infection on addictive disorders. Addiction (Abingdon, England) Marsden, J., Darke, S., Hall, W., Hickman, M., Holmes, J., Humphreys, K., Neale, J., Tucker, J., West, R. 2020

  View details for DOI 10.1111/add.15080

  View details for PubMedID 32250482

• Alcoholics Anonymous and other 12-step programs for alcohol use disorder. The Cochrane database of systematic reviews Kelly, J. F., Humphreys, K., Ferri, M. 2020; 3: CD012880

  Abstract

  BACKGROUND: Alcohol use disorder (AUD) confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization. For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted.OBJECTIVES: To evaluate whether peer-led AA and professionally-delivered treatments that facilitate AA involvement (Twelve-Step Facilitation (TSF) interventions) achieve important outcomes, specifically: abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets.SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, CINAHL and PsycINFO from inception to 2 August 2019. We searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 15 November 2018. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and bibliographies of included studies.SELECTION CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs and non-randomized studies that compared AA or TSF (AA/TSF) with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants, or no treatment. We also included healthcare cost offset studies. Participants were non-coerced adults with AUD.DATA COLLECTION AND ANALYSIS: We categorized studies by: study design (RCT/quasi-RCT; non-randomized; economic); degree of standardized manualization (all interventions manualized versus some/none); and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). For analyses, we followed Cochrane methodology calculating the standard mean difference (SMD) for continuous variables (e.g. percent days abstinent (PDA)) or the relative risk (risk ratios (RRs)) for dichotomous variables. We conducted random-effects meta-analyses to pool effects wherever possible.MAIN RESULTS: We included 27 studies containing 10,565 participants (21 RCTs/quasi-RCTs, 5 non-randomized, and 1 purely economic study). The average age of participants within studies ranged from 34.2 to 51.0 years. AA/TSF was compared with psychological clinical interventions, such as MET and CBT, and other 12-step program variants. We rated selection bias as being at high risk in 11 of the 27 included studies, unclear in three, and as low risk in 13. We rated risk of attrition bias as high risk in nine studies, unclear in 14, and low in four, due to moderate (> 20%) attrition rates in the study overall (8 studies), or in study treatment group (1 study). Risk of bias due to inadequate researcher blinding was high in one study, unclear in 22, and low in four. Risks of bias arising from the remaining domains were predominantly low or unclear. AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high-certainty evidence). This effect remained consistent at both 24 and 36 months. For percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI -4.36 to 10.43; 4 studies, 1999 participants; very low-certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; low-certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; low-certainty evidence). For longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI -0.30 to 1.50; 2 studies, 136 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD -0.17, 95% CI -1.11 to 0.77; 1 study, 1516 participants; moderate-certainty evidence) and percentage days heavy drinking (PDHD) (MD -5.51, 95% CI -14.15 to 3.13; 1 study, 91 participants; low-certainty evidence). For alcohol-related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD -2.88, 95% CI -6.81 to 1.04; 3 studies, 1762 participants; moderate-certainty evidence). For alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low-certainty evidence). AA/TSF (non-manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) For the proportion of participants completely abstinent, non-manualized AA/TSF may perform as well as other clinical interventions at three to nine months follow-up (RR 1.71, 95% CI 0.70 to 4.18; 1 study, 93 participants; low-certainty evidence). Non-manualized AA/TSF may also perform slightly better than other clinical interventions for PDA (MD 3.00, 95% CI 0.31 to 5.69; 1 study, 93 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at nine months, as measured by DDD (MD -1.76, 95% CI -2.23 to -1.29; 1 study, 93 participants; very low-certainty evidence) and PDHD (MD 2.09, 95% CI -1.24 to 5.42; 1 study, 286 participants; low-certainty evidence). None of the RCTs comparing non-manualized AA/TSF to other clinical interventions assessed LPA, alcohol-related consequences, or alcohol addiction severity. Cost-effectiveness studies In three studies, AA/TSF had higher healthcare cost savings than outpatient treatment, CBT, and no AA/TSF treatment. The fourth study found that total medical care costs decreased for participants attending CBT, MET, and AA/TSF treatment, but that among participants with worse prognostic characteristics AA/TSF had higher potential cost savings than MET (moderate-certainty evidence).AUTHORS' CONCLUSIONS: There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non-manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non-manualized, may be at least as effective as other treatments for other alcohol-related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder.

  View details for DOI 10.1002/14651858.CD012880.pub2

  View details for PubMedID 32159228

• Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study. BMJ (Clinical research ed.) Kiang, M. V., Humphreys, K., Cullen, M. R., Basu, S. 2020; 368: l6968

  Abstract

  OBJECTIVE: To examine the distribution and patterns of opioid prescribing in the United States.DESIGN: Retrospective, observational study.SETTING: National private insurer covering all 50 US states and Washington DC.PARTICIPANTS: An annual average of 669495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017.MAIN OUTCOME MEASURES: Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions.RESULTS: In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years.CONCLUSIONS: Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.

  View details for DOI 10.1136/bmj.l6968

  View details for PubMedID 31996352

• Commentary on Burke et al. (2019): Safer and less-frequent opioid prescribing are both essential for US public health. Addiction (Abingdon, England) Humphreys, K. n. 2020

  View details for DOI 10.1111/add.14916

  View details for PubMedID 31900964

• Recreational cannabis legalization presents an opportunity to reduce the harms of the US medical cannabis industry. World psychiatry : official journal of the World Psychiatric Association (WPA) Humphreys, K. n., Shover, C. L. 2020; 19 (2): 191–92

  View details for DOI 10.1002/wps.20739

  View details for PubMedID 32394570

• Reducing Violent Incidents between Police Officers and People with Psychiatric or Substance Use Disorders ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE Pollack, H. A., Humphreys, K. 2020; 687 (1): 166–84

  View details for DOI 10.1177/0002716219897057

  View details for Web of Science ID 000513258900010

• Six policy lessons relevant to cannabis legalization AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Shover, C. L., Humphreys, K. 2019; 45 (6): 698–706

  View details for DOI 10.1080/00952990.2019.1569669

  View details for Web of Science ID 000497909400012

• THE VARIETIES OF CANNABIS LEGALISATION Humphreys, K. WILEY. 2019: S4

  View details for Web of Science ID 000494890100004

• Should we worry that take-home naloxone availability may increase opioid use? ADDICTION Tas, B., Humphreys, K., McDonald, R., Strang, J. 2019; 114 (10): 1723–25

  View details for DOI 10.1111/add.14637

  View details for Web of Science ID 000484993100001

• Correlates of Patient-Centered Care Practices at U.S. Substance Use Disorder Clinics. Psychiatric services (Washington, D.C.) Park, S. E., Grogan, C. M., Mosley, J. E., Humphreys, K., Pollack, H. A., Friedmann, P. D. 2019: appips201900121

  Abstract

  OBJECTIVE: Substance use disorder treatment professionals are paying increased attention to implementing patient-centered care. Understanding environmental and organizational factors associated with clinicians' efforts to engage patients in clinical decision-making processes is essential for bringing patient-centered care to the addictions field. This study examined factors associated with patient-centered care practices in substance use disorder treatment.METHODS: Data were from the 2017 National Drug Abuse Treatment System Survey, a nationally representative survey of U.S substance use disorder treatment clinics (outpatient nonopioid treatment programs, outpatient opioid treatment programs, inpatient clinics, and residential clinics). Multivariate regression analyses examined whether clinics invited patients into clinical decision-making processes and whether clinical supervisors supported and believed in patient-centered care practices.RESULTS: Of the 657 substance use disorder clinics included in the analysis, about 23% invited patients to participate in clinical decision-making processes. Clinicians were more likely to engage patients in decision-making processes when working in residential clinics (compared with outpatient nonopioid treatment programs) or in clinics serving a smaller proportion of patients with alcohol or opioid use disorder. Clinical supervisors were more likely to value patient-centered care practices if the organization's administrative director perceived less regional competition or relied on professional information sources to understand developments in the substance use disorder treatment field. Clinicians' tendency to engage patients in decision-making processes was positively associated with clinical supervisors' emphasis on patient-centered care.CONCLUSIONS: A minority of U.S. substance use disorder clinics invited patients into clinical decision-making processes. Therefore, patient-centered care may be unavailable to certain vulnerable patient groups.

  View details for DOI 10.1176/appi.ps.201900121

  View details for PubMedID 31500544

• Cannabis as a Substitute for Opioids-Reply. JAMA Humphreys, K., Saitz, R. 2019; 322 (3): 273–74

  View details for DOI 10.1001/jama.2019.6471

  View details for PubMedID 31310294

• Investing in Medicaid to End the Opioid Epidemic. Psychiatric services (Washington, D.C.) Andrews, C. M., Humphreys, K. 2019; 70 (7): 537

  View details for DOI 10.1176/appi.ps.70705

  View details for PubMedID 31258032

• Do We Know Enough to Prescribe Opioid-Agonist Therapies to Adolescents With Problematic Opioid Use? A Commentary on Camenga et al. (2019) JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Vest, N., Humphreys, K. N. 2019; 80 (4): 406–7

  View details for Web of Science ID 000485639400003

• Do We Know Enough to Prescribe Opioid-Agonist Therapies to Adolescents With Problematic Opioid Use? A Commentary on Camenga et al. (2019). Journal of studies on alcohol and drugs Vest, N., Humphreys, K. N. 2019; 80 (4): 406–7

  View details for PubMedID 31495376

• Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proceedings of the National Academy of Sciences of the United States of America Shover, C. L., Davis, C. S., Gordon, S. C., Humphreys, K. 2019

  View details for DOI 10.1073/pnas.1903434116

  View details for PubMedID 31182592

• Customizing a Clinical App to Reduce Hazardous Drinking Among Veterans in Primary Care PSYCHOLOGICAL SERVICES Blonigen, D. M., Harris-Olenak, B., Haber, J., Kuhn, E., Timko, C., Humphreys, K., Dulin, P. L. 2019; 16 (2): 250–54

  Abstract

  Within the Veterans Health Administration (VHA), 15-30% of patients seen in primary care are identified as hazardous drinkers, yet the vast majority of these patients receive no intervention. Time constraints on providers and patient-level barriers to in-person treatment contribute to this problem. The scientific literature provides a compelling case that mobile-based interventions can reduce hazardous drinking and underscores the role of peer support in behavioral change. Here, we describe the benefits of using a clinical app-Step Away-to treat hazardous drinking among VHA primary care patients as well as an approach to customizing the app to maximize its engagement and effectiveness with this population. We highlight the value of integrating use of Step Away with telephone support from a trained VHA peer support specialist. This type of integrated approach may provide the key therapeutic components necessary to generate an effective and easily implemented alcohol use intervention that can be made available to VHA primary care patients who screen positive for hazardous drinking but are unwilling or unable to attend in-person treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/ser0000300

  View details for Web of Science ID 000466773000010

  View details for PubMedID 30407060

• International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering PAIN MEDICINE Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Van Dorsten, B., Humphreys, K., Gonzalez-Sotomayor, J. A., Furlan, A., Gordon, A. J., Gordon, D. B., Hoffman, D. E., Katz, J., Kertesz, S. G., Satel, S., Lawhern, R. A., Nicholson, K. M., Polomano, R. C., Williamson, O. D., McAnally, H., Kao, M., Schug, S., Twillman, R., Lewis, T. A., Stieg, R. L., Lorig, K., Mallick-Searle, T., West, R. W., Gray, S., Ariens, S. R., Potter, J., Cowan, P., Kollas, C. D., Laird, D., Ingle, B., Grove, J., Wilson, M., Lockman, K., Hodson, F., Palackdharry, C. S., Fillingim, R. B., Fudin, J., Barnhouse, J., Manhapra, A., Henson, S. R., Singer, B., Ljosenvoor, M., Griffith, M., Doctor, J. N., Hardin, K., London, C., Mankowski, J., Anderson, A., Ellsworth, L., Budzinski, L., Brandt, B., Hartley, G., Heck, D., Zobrosky, M. J., Cheek, C., Wilson, M., Laux, C. E., Datz, G., Dunaway, J., Schonfeld, E., Cady, M., LeDantec-Boswell, T., Craigie, M., Sturgeon, J., Flood, P., Giummarra, M., Whelan, J., Thorn, B. E., Martin, R. L., Schatman, M. E., Gregory, M. D., Kirz, J., Robinson, P., Marx, J. G., Stewart, J. R., Keck, P. S., Hadland, S. E., Murphy, J. L., Lumley, M. A., Brown, K. S., Leong, M. S., Fillman, M., Broatch, J. W., Perez, A., Watford, K., Kruska, K., You, D., Ogbeide, S., Kukucka, A., Lawson, S., Ray, J. B., Martin, T., Lakehomer, J. B., Burke, A., Cohen, R. I., Grinspoon, P., Rubenstein, M. S., Sutherland, S., Walters, K., Lovejoy, T. 2019; 20 (3): 429–33

  View details for DOI 10.1093/pm/pny228

  View details for Web of Science ID 000467966600003

• Evaluating dynamic impacts of abuse-deterrent prescription opioid formulations ADDICTION Humphreys, K. 2019; 114 (3): 400-401

  View details for DOI 10.1111/add.14454

  View details for Web of Science ID 000458892400003

• Should Physicians Recommend Replacing Opioids With Cannabis? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Humphreys, K., Saitz, R. 2019; 321 (7): 639-640

  View details for DOI 10.1001/jama.2019.0077

  View details for Web of Science ID 000459068300007

• Predicting inadequate postoperative pain management in depressed patients: A machine learning approach PLOS ONE Parthipan, A., Banerjee, I., Humphreys, K., Asch, S. M., Curtin, C., Carroll, I., Hernandez-Boussard, T. 2019; 14 (2)

  View details for DOI 10.1371/journal.pone.0210575

  View details for Web of Science ID 000457874000021

• Should Physicians Recommend Replacing Opioids With Cannabis? JAMA Humphreys, K., Saitz, R. 2019

  View details for PubMedID 30707218

• Accelerating the Growth of Evidence-Based Care for Women and Men Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health Goldstein, K. M., Bastian, L. A., Duan-Porter, W. n., Gray, K. E., Hoggatt, K. J., Kelly, M. M., Wilson, S. M., Humphreys, K. n., Klap, R. n., Yano, E. M., Huang, G. D. 2019; 29 Suppl 1: S2–S5

  View details for DOI 10.1016/j.whi.2019.05.004

  View details for PubMedID 31253238

• Networking: Translating Neuroscience to Public Policy. Neuron Humphreys, K. n. 2019; 103 (6): 964–66

  Abstract

  Neuroscientific findings are rarely translated into public policies that improve the health and well-being of people experiencing serious disorders. I advocate here for investment in policymaker-scientist networks dedicated to such translation for a range of diseases.

  View details for DOI 10.1016/j.neuron.2019.08.016

  View details for PubMedID 31557460

• The relationship of Medicaid expansion to psychiatric comorbidity care within substance use disorder treatment programs. Journal of substance abuse treatment Shover, C. L., Abraham, A. n., D'Aunno, T. n., Friedmann, P. D., Humphreys, K. n. 2019; 105: 44–50

  Abstract

  Co-occurring mental health disorders are common among substance use disorder (SUD) patients. Medicaid expansion aimed to reduce barriers to SUD and mental health care and thereby improve treatment outcomes.We estimated change in the proportion of United States SUD treatment sites offering treatment for psychiatric comorbidities following Medicaid expansion as part of implementation of the Affordable Care Act (ACA) in 2014. Using panel data from the 2013-2014, n = 660, and 2016-2017, n = 638, waves of the National Drug Abuse Treatment System Survey (NDATSS), we estimated change in the proportion of sites offering antidepressant medication, other psychiatric medication, behavioral treatment, or any combination thereof for treatment of mental health comorbidities (i.e., beyond services focused on SUD). We modeled the impact of Medicaid expansion as an interaction between year and date of Medicaid expansion. We constructed a mixed-effects linear regression model for each outcome, with the interaction variable as the main exposure, site as a random effect, and site's average duration of treatment, proportion of clients with psychiatric comorbidities, average caseload per treatment prescribing-clinician on staff, type of facility and geographic region as covariates, to estimate a difference-in-differences (D-I-D) equation.The adjusted D-I-D analysis indicated that the proportion of SUD treatment sites offering antidepressants for psychiatric treatment increased 10% (95% CI 1%, 18%) in the Medicaid expansion sites compared to non-expansion sites. The D-I-D for other psychiatric medications was also 10% (95% 1%, 19%). No significant changes were observed in behavioral treatment or the combination measure. The strongest association between Medicaid expansion and offering medication for mental health comorbidities was the 34% increase observed for residential treatment settings (95% CI 10%, 59%).Availability of psychiatric medication treatment in SUD treatment settings increased following Medicaid expansion, particularly in residential SUD facilities. This policy change has facilitated integrated treatment for the substantial share of SUD treatment patients with mental health comorbidities, with the greatest benefit for patients receiving SUD treatment in residential programs.

  View details for DOI 10.1016/j.jsat.2019.07.012

  View details for PubMedID 31443890

• Addiction's policy on publishing effectiveness studies of involuntary treatment of addiction and its variants. Addiction (Abingdon, England) Hall, W. n., Darke, S. n., Humphreys, K. n., Marsden, J. n., Neale, J. n., West, R. n. 2019

  View details for DOI 10.1111/add.14933

  View details for PubMedID 31840309

• Predicting inadequate postoperative pain management in depressed patients: A machine learning approach. PloS one Parthipan, A., Banerjee, I., Humphreys, K., Asch, S. M., Curtin, C., Carroll, I., Hernandez-Boussard, T. 2019; 14 (2): e0210575

  Abstract

  Widely-prescribed prodrug opioids (e.g., hydrocodone) require conversion by liver enzyme CYP-2D6 to exert their analgesic effects. The most commonly prescribed antidepressant, selective serotonin reuptake inhibitors (SSRIs), inhibits CYP-2D6 activity and therefore may reduce the effectiveness of prodrug opioids. We used a machine learning approach to identify patients prescribed a combination of SSRIs and prodrug opioids postoperatively and to examine the effect of this combination on postoperative pain control. Using EHR data from an academic medical center, we identified patients receiving surgery over a 9-year period. We developed and validated natural language processing (NLP) algorithms to extract depression-related information (diagnosis, SSRI use, symptoms) from structured and unstructured data elements. The primary outcome was the difference between preoperative pain score and postoperative pain at discharge, 3-week and 8-week time points. We developed computational models to predict the increase or decrease in the postoperative pain across the 3 time points by using the patient's EHR data (e.g. medications, vitals, demographics) captured before surgery. We evaluate the generalizability of the model using 10-fold cross-validation method where the holdout test method is repeated 10 times and mean area-under-the-curve (AUC) is considered as evaluation metrics for the prediction performance. We identified 4,306 surgical patients with symptoms of depression. A total of 14.1% were prescribed both an SSRI and a prodrug opioid, 29.4% were prescribed an SSRI and a non-prodrug opioid, 18.6% were prescribed a prodrug opioid but were not on SSRIs, and 37.5% were prescribed a non-prodrug opioid but were not on SSRIs. Our NLP algorithm identified depression with a F1 score of 0.95 against manual annotation of 300 randomly sampled clinical notes. On average, patients receiving prodrug opioids had lower average pain scores (p<0.05), with the exception of the SSRI+ group at 3-weeks postoperative follow-up. However, SSRI+/Prodrug+ had significantly worse pain control at discharge, 3 and 8-week follow-up (p < .01) compared to SSRI+/Prodrug- patients, whereas there was no difference in pain control among the SSRI- patients by prodrug opioid (p>0.05). The machine learning algorithm accurately predicted the increase or decrease of the discharge, 3-week and 8-week follow-up pain scores when compared to the pre-operative pain score using 10-fold cross validation (mean area under the receiver operating characteristic curve 0.87, 0.81, and 0.69, respectively). Preoperative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. We provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. Current prescribing patterns indicate that prescribers may not account for this interaction when choosing an opioid. The study results imply that prescribers might instead choose direct acting opioids (e.g. oxycodone or morphine) in depressed patients on SSRIs.

  View details for PubMedID 30726237

• Six policy lessons relevant to cannabis legalization. The American journal of drug and alcohol abuse Shover, C. L., Humphreys, K. n. 2019: 1–9

  Abstract

  Cannabis (marijuana) has been legalized for recreational and/or medicinal use in many US states, despite remaining a Schedule-I drug at the federal level. As legalization regimes are established in multiple countries, public health professionals should leverage decades of knowledge from other policy areas (e.g., alcohol and tobacco regulation) to inform cannabis policy.Identify policy lessons from other more established policy areas that can inform cannabis policy in the United States, Canada, and any other nations that legalize recreational cannabis.Narrative review of policy and public health literature.We identified six key lessons to guide cannabis policy. To avoid the harms of "a medical system only in name," medical cannabis programs should either be regulated like medicine or combined with the recreational market. Capping potency of cannabis products can reduce the harms of the drug, including addiction. Pricing policies that promote public health may include minimum unit pricing or taxation by weight. Protecting science and public health from corporate interest can prevent the scenarios we have seen with soda and tobacco lobbies funding studies to report favorable results about their products. Legalizing states can go beyond reducing possession arrests (which can be accomplished without legalization) by expunging prior criminal records of cannabis-related convictions. Finally, facilitating rigorous research can differentiate truth from positive and negative hype about cannabis' effects.Scientists and policymakers can learn from the successes and failures of alcohol and tobacco policy to regulate cannabis products, thereby mitigating old harms of cannabis prohibition while reducing new harms from legalization.

  View details for PubMedID 30870053

• Predictors of availability of long-acting medication for opioid use disorder. Drug and alcohol dependence Shover, C. L., Humphreys, K. n. 2019; 204: 107586

  Abstract

  The U.S. Food and Drug Administration has approved three long-acting medications for opioid use disorder (MOUD): extended-release naltrexone (XR-NTX) in 2010, a subdermal buprenorphine implant in 2016, and a depot buprenorphine injection in 2017. Long-acting MOUD options may improve adherence while reducing diversion, but their availability compared to daily-dosing MOUD has not been well-characterized. The objective of this analysis was to characterize the availability of long-acting MOUD in substance use disorder treatment settings in the United States.Using the 2017 National Survey on Substance Abuse Treatment Services (N-SSATS) and state-level opioid overdose mortality, we examined associations between state- and facility-level factors and offering long-acting MOUD, which included XR-NTX and the buprenorphine implant. We constructed multivariable mixed logistic regression models for both types of long-acting MOUD.Nationwide, 38% (n = 5141) of substance use treatment facilities provided any kind of MOUD (daily or long-acting). Of these, 62% provided XR-NTX, whereas only 3% offered the buprenorphine implant. Facilities in the East North Central, East South Central, West North Central and Mountain regions had higher odds of offering XR-NTX, as did federally-funded facilities, and facilities in states with the highest opioid overdose mortality rates.In 2017, XR-NTX was available at most of the minority of facilities offering MOUD, but the buprenorphine implant was not. Increasing the availability of MOUD, including long-acting options, is necessary to address unmet need for opioid use disorder treatment.

  View details for DOI 10.1016/j.drugalcdep.2019.107586

  View details for PubMedID 31593871

• Reducing the risks of distortion in cannabis research. Addiction (Abingdon, England) Humphreys, K. n., Hall, W. D. 2019

  View details for DOI 10.1111/add.14801

  View details for PubMedID 31491039

• Designing Studies for Sex and Gender Analyses: How Research Can Derive Clinically Useful Knowledge for Women's Health. Women's health issues : official publication of the Jacobs Institute of Women's Health Klap, R. n., Humphreys, K. n. 2019; 29 Suppl 1: S12–S14

  View details for DOI 10.1016/j.whi.2019.05.002

  View details for PubMedID 31253235

• Does Take-Home Naloxone Availability Increase Opioid Use? Addiction (Abingdon, England) Tas, B. n., Humphreys, K. n., McDonald, R. n., Strang, J. n. 2019

  View details for PubMedID 31013396

• How Medicaid work requirements could exacerbate the opioid epidemic. The American journal of drug and alcohol abuse Andrews, C. M., Humphreys, K. n., Grogan, C. M. 2019: 1–3

  Abstract

  In 2018, the Trump Administration took the unprecedented step of allowing states to impose work requirements as a condition of Medicaid eligibility. States can apply for a demonstration waiver to require Medicaid beneficiaries aged 19-64 who do not meet exemption criteria (e.g., disability, caring for a sick relative) to participate in "community engagement" activities, which include employment, volunteering, and enrollment in a qualifying education or job training program. Debate thus far has focused primarily around the important issue of whether such requirements are legal. Less attention has focused on another serious concern - namely, that work requirements could exacerbate the nation's most urgent public health crisis: the opioid epidemic. Many enrollees with opioid use disorder who are unable to meet states' community engagement criteria will not qualify for an exemption from the work requirements, and risk being dropped from Medicaid enrollment. Refusing health insurance to individuals who are unable to meet work requirements could result in significant losses in coverage among a highly vulnerable population. Implementing new barriers to Medicaid coverage will hinder the effectiveness of massive state and federal investments in improving access to evidence-based addiction treatment.

  View details for DOI 10.1080/00952990.2019.1686760

  View details for PubMedID 31800334

• Implications of Lifestyle Medicine and Psychiatry for Health Care Systems and Population Health LIFESTYLE PSYCHIATRY Bonnet, K., Noordsy, D. L., Humphreys, K., Noordsy, D. L. 2019: 353–66

  View details for Web of Science ID 000552225000022

• Association of Neural Responses to Drug Cues With Subsequent Relapse to Stimulant Use. JAMA network open MacNiven, K. H., Jensen, E. L., Borg, N., Padula, C. B., Humphreys, K., Knutson, B. 2018; 1 (8): e186466

  Abstract

  Although chronic relapse is a characteristic of addiction to stimulants, conventional measures (eg, clinical, demographic, and self-report) do not robustly identify which individuals are most vulnerable to relapse.To test whether drug cues are associated with increased mesolimbic neural activity in patients undergoing treatment for stimulant use disorder and whether this activity is associated with risk for subsequent relapse.This prospective cohort study of 76 participants included a control group for baseline group comparisons. Veteran patients (n = 36) with stimulant use disorders were recruited from a 28-day residential treatment program at the Veterans Affairs Palo Alto Health Care System. Healthy controls (n = 40) were recruited from the surrounding community. Baseline data were collected between September 21, 2015, and January 26, 2018, from patients and healthy controls using functional magnetic resonance imaging during a performance of a reward cue task. Patients' stimulant use was subsequently assessed after treatment discharge (at approximately 1, 3, and 6 months) to assess relapse outcomes.Primary measures included neural responses to drug and food cues in estimated mesolimbic volumes of interest, including the medial prefrontal cortex, nucleus accumbens (NAcc), and ventral tegmental area. The primary outcome variable was relapse (defined as any stimulant use), assessed both dichotomously (3 months after discharge) and continuously (days to relapse). Brain activity measures were contrasted between groups to validate neural measures of drug cue reactivity, which were then used to estimate relapse outcomes of patients.Relative to controls (n = 40; 16 women and 24 men; mean [SD] age, 32.0 [11.6] years), patients (n = 36; 2 women and 34 men; mean [SD] age, 43.4 [13.3] years) showed increased mesolimbic activity in response to drug cues (medial prefrontal cortex, t74 = 2.90, P = .005, Cohen d = 0.66; NAcc, t74 = 2.39, P = .02, Cohen d = 0.54; and ventral tegmental area, t74 = 4.04, P < .001, Cohen d = 0.92). In patients, increased drug cue response in the NAcc (but not other volumes of interest) was associated with time to relapse months later (Cox proportional hazards regression hazard ratio, 2.30; 95% CI, 1.40-3.79). After controlling for age, NAcc response to drug cues classified relapsers (12 patients; 1 woman and 11 men; mean [SD] age, 49.3 [14.1] years) and abstainers (21 patients; 1 woman and 20 men; mean [SD] age, 39.3 [12.3] years) at 3 months with 75.8% classification accuracy. Model comparison further indicated that NAcc responses to drug cues were associated with relapse above and beyond estimations of relapse according to conventional measures.Responses in the NAcc to stimulant cues appear to be associated with relapse in humans. Identification of neural markers may eventually help target interventions to the most vulnerable individuals.

  View details for DOI 10.1001/jamanetworkopen.2018.6466

  View details for PubMedID 30646331

  View details for PubMedCentralID PMC6324538

• International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering. Pain medicine (Malden, Mass.) Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Van Dorsten, B., Humphreys, K., Gonzalez-Sotomayor, J. A., Furlan, A., Gordon, A. J., Gordon, D. B., Hoffman, D. E., Katz, J., Kertesz, S. G., Satel, S., Lawhern, R. A., Nicholson, K. M., Polomano, R. C., Williamson, O. D., McAnally, H., Kao, M., Schug, S., Twillman, R., Lewis, T. A., Stieg, R. L., Lorig, K., Mallick-Searle, T., West, R. W., Gray, S., Ariens, S. R., Sharpe Potter, J., Cowan, P., Kollas, C. D., Laird, D., Ingle, B., Julian Grove, J., Wilson, M., Lockman, K., Hodson, F., Palackdharry, C. S., Fillingim, R. B., Fudin, J., Barnhouse, J., Manhapra, A., Henson, S. R., Singer, B., Ljosenvoor, M., Griffith, M., Doctor, J. N., Hardin, K., London, C., Mankowski, J., Anderson, A., Ellsworth, L., Davis Budzinski, L., Brandt, B., Harkootley, G., Nickels Heck, D., Zobrosky, M. J., Cheek, C., Wilson, M., Laux, C. E., Datz, G., Dunaway, J., Schonfeld, E., Cady, M., LeDantec-Boswell, T., Craigie, M., Sturgeon, J., Flood, P., Giummarra, M., Whelan, J., Thorn, B. E., Martin, R. L., Schatman, M. E., Gregory, M. D., Kirz, J., Robinson, P., Marx, J. G., Stewart, J. R., Keck, P. S., Hadland, S. E., Murphy, J. L., Lumley, M. A., Brown, K. S., Leong, M. S., Fillman, M., Broatch, J. W., Perez, A., Watford, K., Kruska, K., Sophia You, D., Ogbeide, S., Kukucka, A., Lawson, S., Ray, J. B., Wade Martin, T., Lakehomer, J. B., Burke, A., Cohen, R. I., Grinspoon, P., Rubenstein, M. S., Sutherland, S., Walters, K. R., Lovejoy, T. 2018

  View details for PubMedID 30496540

• Evaluating dynamic impacts of abuse-deterrent prescription opioid formulations. Addiction (Abingdon, England) Humphreys, K. 2018

  View details for PubMedID 30380587

• Modeling Health Benefis and Harms of Public Policy Responses to the US Opioid Epidemic AMERICAN JOURNAL OF PUBLIC HEALTH Pitt, A. L., Humphreys, K., Brandeau, M. L. 2018; 108 (10): 1394-1400

  View details for DOI 10.2105/AJPH.2018.304590

  View details for Web of Science ID 000444410800048

• Toward a Neuroscience of Long-term Recovery From Addiction JAMA PSYCHIATRY Humphreys, K., Bickel, W. K. 2018; 75 (9): 875–76

  View details for PubMedID 29847627

• A revised checklist for writing up research reports ADDICTION West, R., Marsden, J., Humphreys, K., Darke, S. 2018; 113 (9): 1567–70

  View details for PubMedID 29920830

• Internet searches for opioids predict future emergency department heroin admissions. Drug and alcohol dependence Young, S. D., Zheng, K., Chu, L. F., Humphreys, K. 2018; 190: 166-169

  Abstract

  For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes. We aimed to determine whether data on opioid-related internet searches might predict future heroin-related admissions to emergency departments (ED).Across nine metropolitan statistical areas (MSAs) in the United States, we obtained data on Google searches for prescription and non-prescription opioids, as well as Substance Abuse and Mental Health Services Administration (SAMHSA) data on heroin-related ED visits from 2004 to 2011. A linear mixed model assessed the relationship between opioid-related Internet searches and following year heroin-related visits, controlling for MSA GINI index and total number of ED visits.The best-fitting model explained 72% of the variance in heroin-related ED visits. The final model included the search keywords "Avinza," "Brown Sugar," "China White," "Codeine," "Kadian," "Methadone," and "Oxymorphone." We found regional differences in where and how people searched for opioid-related information.Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions. In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends. We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States.

  View details for DOI 10.1016/j.drugalcdep.2018.05.009

  View details for PubMedID 30036853

• Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. American journal of public health Pitt, A. L., Humphreys, K., Brandeau, M. L. 2018: e1–e7

  Abstract

  OBJECTIVES: To estimate health outcomes of policies to mitigate the opioid epidemic.METHODS: We used dynamic compartmental modeling of US adults, in various pain, opioid use, and opioid addiction health states, to project addiction-related deaths, life years, and quality-adjusted life years from 2016 to 2025 for 11 policy responses to the opioid epidemic.RESULTS: Over 5 years, increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths. Other policies reduced opioid prescription supply and related deaths but led some addicted prescription users to switch to heroin use, which increased heroin-related deaths. Over a longer horizon, some such policies may avert enough new addiction to outweigh the harms. No single policy is likely to substantially reduce deaths over 5 to 10 years.CONCLUSIONS: Policies focused on services for addicted people improve population health without harming any groups. Policies that reduce the prescription opioid supply may increase heroin use and reduce quality of life in the short term, but in the long term could generate positive health benefits. A portfolio of interventions will be needed for eventual mitigation. (Am J Public Health. Published online ahead of print August 23, 2018: e1-e7. doi:10.2105/AJPH.2018.304590).

  View details for PubMedID 30138057

• THE NEED FOR MORE CONSISTENT EVIDENTIAL STANDARDS IN CANNABIS POLICY EVALUATIONS ADDICTION Hall, W., West, R., Marsden, J., Humphreys, K., Neale, J., Petry, N. 2018; 113 (8): 1553–54

  View details for PubMedID 29882222

• Reconciling the Present and the Future in Opioid Prescription Policy: An Ethical Dilemma PAIN MEDICINE Humphreys, K. 2018; 19 (8): 1514-1515

  View details for DOI 10.1093/pm/pny120

  View details for Web of Science ID 000444274300003

• AN EXPERIMENTAL METHOD FOR ASSESSING WHETHER MARIJUANA USE REDUCES OPIOID USE IN PATIENTS WITH CHRONIC PAIN ADDICTION Darnall, B. D., Humphreys, K. N. 2018; 113 (8): 1552-1553

  View details for DOI 10.1111/add.14239

  View details for Web of Science ID 000438336500028

• Medicaid Benefits For Addiction Treatment Expanded After Implementation Of The Affordable Care Act. Health affairs (Project Hope) Andrews, C. M., Grogan, C. M., Smith, B. T., Abraham, A. J., Pollack, H. A., Humphreys, K., Westlake, M. A., Friedmann, P. D. 2018; 37 (8): 1216–22

  Abstract

  The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Columbia regarding their addiction treatment benefits and utilization controls in standard and alternative benefit plans in 2014 and 2017, when plans were subject to ACA parity requirements. The number of state plans that provided benefits for residential treatment and opioid use disorder medications increased substantially. States imposing annual service limits on outpatient addiction treatment decreased by over 50percent. Fewer states required preauthorization for services, with the largest reductions for medications treating opioid use disorder. The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans. This trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.

  View details for DOI 10.1377/hlthaff.2018.0272

  View details for PubMedID 30080460

• Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically JOURNAL OF ADDICTION MEDICINE Caputi, T. L., Humphreys, K. 2018; 12 (4): 295-299

  View details for DOI 10.1097/ADM.0000000000000405

  View details for Web of Science ID 000448416100008

• Reconciling the Present and the Future in Opioid Prescription Policy: An Ethical Dilemma. Pain medicine (Malden, Mass.) Humphreys, K. 2018

  View details for PubMedID 29901769

• An experimental method for assessing whether marijuana use reduces opioid use in patients with chronic pain. Addiction (Abingdon, England) Darnall, B. D., Humphreys, K. N. 2018

  View details for PubMedID 29882256

• It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis ADDICTION Hall, W., West, R., Marsden, J., Humphreys, K., Neale, J., Petry, N. 2018; 113 (6): 987–88

  View details for PubMedID 29468760

• Big Data and the Opioid Crisis: Balancing Patient Privacy with Public Health. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics Butler, J. M., Becker, W. C., Humphreys, K. 2018; 46 (2): 440-453

  Abstract

  Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement "lock-in" programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements - mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping - that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.

  View details for DOI 10.1177/1073110518782952

  View details for PubMedID 30146994

• Big Data and the Opioid Crisis: Balancing Patient Privacy with Public Health JOURNAL OF LAW MEDICINE & ETHICS Butler, J., Becker, W. C., Humphreys, K. 2018; 46 (2): 440–53

  View details for DOI 10.1177/1073110518782952

  View details for Web of Science ID 000439630000022

• How Medicaid Can Strengthen the National Response to the Opioid Epidemic. American journal of public health Humphreys, K. 2018; 108 (5): 589–90

  View details for PubMedID 29617609

• How Medicaid Can Strengthen the National Response to the Opioid Epidemic AMERICAN JOURNAL OF PUBLIC HEALTH Humphreys, K. 2018; 108 (5): 589-590

  View details for DOI 10.2105/AJPH.2018.304393

  View details for Web of Science ID 000440272300013

• Opioids of the Masses Stopping an American Epidemic From Going Global FOREIGN AFFAIRS Humphreys, K., Caulkins, J. P., Felbab-Brown, V. 2018; 97 (3): 118–29

  View details for Web of Science ID 000430264700011

• Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically. Journal of addiction medicine Caputi, T. L., Humphreys, K. 2018

  Abstract

  OBJECTIVES: Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use.METHODS: Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana.RESULTS: Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16).CONCLUSIONS: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

  View details for PubMedID 29664895

• State-Targeted Funding and Technical Assistance to Increase Access to Medication Treatment for Opioid Use Disorder. Psychiatric services (Washington, D.C.) Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D'Aunno, T., Humphreys, K., Friedmann, P. D. 2018; 69 (4): 448–55

  Abstract

  OBJECTIVE: As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technical assistance and adoption of three medications for treating opioid use disorder: oral naltrexone, injectable naltrexone, and buprenorphine.METHODS: This study draws from the 2013-2014 wave of the National Drug Abuse Treatment System Survey, a nationally representative, longitudinal study of substance use disorder treatment programs. The sample includes data from 695 treatment programs (85.5% response rate) and representatives from single-state agencies in 49 states and Washington, D.C. (98% response rate). Logistic regression was used to examine the relationships of single-state agency targeted funding and technical assistance to availability of opioid use disorder medications among treatment programs.RESULTS: State-targeted funding was associated with increased program-level adoption of oral naltrexone (adjusted odds ratio [AOR]=3.14, 95% confidence interval [CI]=1.49-6.60, p=.004) and buprenorphine (AOR=2.47, 95% CI=1.31-4.67, p=.006). Buprenorphine adoption was also correlated with state technical assistance to support medication provision (AOR=1.18, 95% CI=1.00-1.39, p=.049).CONCLUSIONS: State-targeted funding for medications may be a viable policy lever for increasing access to opioid use disorder medications. Given the historically low rates of opioid use disorder medication adoption in treatment programs, single-state agency targeted funding is a potentially important tool to reduce mortality and morbidity associated with opioid disorders and misuse.

  View details for PubMedID 29241428

• State-Targeted Funding and Technical Assistance to Increase Access to Medication Treatment for Opioid Use Disorder PSYCHIATRIC SERVICES Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D'Aunno, T., Humphreys, K., Friedmann, P. D. 2018; 69 (4): 448-455

  View details for DOI 10.1176/appi.ps.201700196

  View details for Web of Science ID 000435443600013

• The Opioid Epidemic as a Watershed Moment for Physician Training in Addiction Medicine ACADEMIC PSYCHIATRY Lembke, A., Humphreys, K. 2018; 42 (2): 269–72

  View details for PubMedID 29536394

• What can treatment research offer general practice? LANCET PSYCHIATRY Humphreys, K., Williams, L. M. 2018; 5 (4): 295–97

  View details for PubMedID 29248404

• Of moral judgments and sexual addictions ADDICTION Humphreys, K. 2018; 113 (3): 387–88

  View details for PubMedID 29164740

• Exclusion criteria and generalizability in bipolar disorder treatment trials CONTEMPORARY CLINICAL TRIALS COMMUNICATIONS Wong, J. J., Jones, N., Timko, C., Humphreys, K. 2018; 9: 130–34

  Abstract

  The current paper reviews the English-language research on exclusion criteria in bipolar disorder treatment trials and discusses how study samples compare to the general bipolar patient population.& Results: Across 8 identified studies of exclusion criteria and their impact, between 55% and 96% of people with bipolar disorder would be excluded from treatment research. The number of exclusion criteria varies across bipolar disorder treatment research, with one study estimate of a median of 7 criteria used across studies. The criteria that excluded the greatest number of potential participants were comorbid substance use disorder, suicidal risk, and comorbid medical conditions. Both studies that compared treatment responses among participants who met and did not meet exclusion criteria found no statistically significant differences.Most potential participants are excluded from outcome research, which creates challenges for recruitment and limits generalizability of study findings. Common exclusionary practices lead to unrepresentative samples that limit generalizability and reduce the confidence of clinicians that findings can be translated to front-line practice with bipolar disorder patients.

  View details for PubMedID 29696235

• Our Other Prescription Drug Problem NEW ENGLAND JOURNAL OF MEDICINE Lembke, A., Papac, J., Humphreys, K. 2018; 378 (8): 693–95

  View details for PubMedID 29466163

• Extending Addiction's conflict of interest policy to cover the emerging cannabis industry ADDICTION Humphreys, K., Darke, S., Marsden, J., West, R. 2018; 113 (2): 205

  View details for PubMedID 29210141

• A public health approach to opioid addiction in North America Reply LANCET Humphreys, K. 2018; 391 (10117): 202

  View details for Web of Science ID 000423867000018

• A public health approach to opioid addiction in North America - Author's reply. Lancet (London, England) Humphreys, K. 2018; 391 (10117): 202

  View details for DOI 10.1016/S0140-6736(18)30058-8

  View details for PubMedID 30277884

• Association of Neural Responses to Drug Cues With Subsequent Relapse to Stimulant Use JAMA Netw Open MacNiven, K. H., Jensen, E. L., Borg, N., Padula, C. B., Humphreys, K., Knutson, B. 2018

  View details for DOI 10.1001/jamanetworkopen.2018.6466

• Internet searches for opioids predict future emergency department heroin admissions. Drug and alcohol dependence Young, S. D., Zheng, K., Chu, L. F., Humphreys, K. 2018; 190: 166–69

  Abstract

  For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes. We aimed to determine whether data on opioid-related internet searches might predict future heroin-related admissions to emergency departments (ED).Across nine metropolitan statistical areas (MSAs) in the United States, we obtained data on Google searches for prescription and non-prescription opioids, as well as Substance Abuse and Mental Health Services Administration (SAMHSA) data on heroin-related ED visits from 2004 to 2011. A linear mixed model assessed the relationship between opioid-related Internet searches and following year heroin-related visits, controlling for MSA GINI index and total number of ED visits.The best-fitting model explained 72% of the variance in heroin-related ED visits. The final model included the search keywords "Avinza," "Brown Sugar," "China White," "Codeine," "Kadian," "Methadone," and "Oxymorphone." We found regional differences in where and how people searched for opioid-related information.Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions. In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends. We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States.

  View details for DOI 10.1016/j.drugalcdep.2018.05.009

• Benefit requirements for substance use disorder treatment in state health insurance exchanges AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Smith, B., Seaton, K., Andrews, C., Grogan, C. M., Abraham, A., Pollack, H., Friedmann, P., Humphreys, K. 2018; 44 (4): 426–30

  Abstract

  Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations.How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls.Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey.States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used.Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.

  View details for PubMedID 29261341

  View details for PubMedCentralID PMC5940489

• Avoiding globalisation of the prescription opioid epidemic. Lancet (London, England) Humphreys, K. 2017; 390 (10093): 437-439

  View details for DOI 10.1016/S0140-6736(17)31918-9

  View details for PubMedID 28792397

• How to Deliver a More Persuasive Message Regarding Addiction as a Medical Disorder. Journal of addiction medicine Humphreys, K. 2017; 11 (3): 174-175

  Abstract

  : Many members of our field are frustrated that the public does not see addiction as a legitimate medical disorder which should be compassionately addressed as a health problem rather than a criminal justice problem. Although some attribute the disconnect to the public's lack of scientific knowledge or attachment to outdated moral views regarding substance use, this commentary suggests that the problem may well be our own messaging. We would be more persuasive if we acknowledged that addiction is different from most medical disorders because of its high negative externalities, and that this understandably makes the public more scared of and angry about addiction than they are about conditions like asthma, type II diabetes, and hypertension. Relatedly, because of the amount of violence and other crimes associated with addiction, we should acknowledge that the public's belief that law enforcement has an important role to play in responding to addiction has a rational basis.

  View details for DOI 10.1097/ADM.0000000000000306

  View details for PubMedID 28557959

• Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure. Journal of addiction medicine Schmidt, E. M., Gupta, S., Bowe, T., Ellerbe, L. S., Phelps, T. E., Finney, J. W., Humphreys, K., Trafton, J., Vanneman, M. E., Harris, A. H. 2017; 11 (3): 205-210

  Abstract

  Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA).A national sample of patients who received detoxification from alcohol or opiates (N = 25,354) was identified in VHA administrative data. Propensity score-weighted mixed-effects regressions modeled associations between receiving an outpatient follow-up visit within 7 days of completing detoxification and patient outcomes, controlling for facility-level performance and clustering of patients within facilities.Baseline differences between patients who did (39.6%) and did not (60.4%) receive the follow-up visit were reduced or eliminated with propensity score weighting. Meeting the quality measure was associated with significantly more outpatient treatment for SUD (b = 1.07 visits) and other mental health conditions (b = 0.58 visits), and higher inpatient utilization for SUD (b = 0.75 admissions) and other mental health conditions (b = 0.76 admissions). Notably, meeting the quality measure was associated with 53.3% lower odds of 2-year mortality (P < 0.001 for all).These findings support the predictive validity of 7-day follow-up after detoxification as a care coordination measure. Well-coordinated care may be associated with higher outpatient and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates.

  View details for DOI 10.1097/ADM.0000000000000298

  View details for PubMedID 28282324

• Exclusion criteria in treatment research on alcohol, tobacco and illicit drug use disorders: A review and critical analysis DRUG AND ALCOHOL REVIEW Moberg, C. A., Humphreys, K. 2017; 36 (3): 378-388

  Abstract

  High rates of exclusion in substance use disorder treatment studies reduce the external validity and clinical utility of research findings to an unknown extent. Accordingly, the current review examined commonly used exclusion criteria and their effect on study samples and outcomes.English-language literature was identified by PubMed searches and review of identified articles' reference lists. Studies were included if they analysed data on: (i) the prevalence and nature of exclusion criteria in the substance use disorder treatment field; and/or (ii) the impact of exclusion criteria on sample representativeness or study results.The search yielded 22 studies examining different aspects of exclusion criteria, including 15 empirical examinations of the impact of study exclusion criteria across different substance use disorder treatments on enrolment and outcome results. Aggregating across these 15 studies, we estimated that between 64 and 96% of potential study participants are excluded from substance use disorder treatment studies.The widespread exclusion of large proportions of people with substance use disorders limits the external validity of the substance use disorder treatment research literature.Although some eligibility criteria are necessary to protect participant safety and ensure internal validity, researchers conducting studies on substance use disorder treatments should thoughtfully consider the justification for and specific operationalisation of the extensive exclusion criteria they often utilise. [Moberg C, Humphreys K. Exclusion criteria in treatment research on alcohol, tobacco and illicit drug use disorders: A review and critical analysis. Drug Alcohol Rev 2017;36:378-388].

  View details for DOI 10.1111/dar.12438

  View details for Web of Science ID 000401238500013

• ADDICTION TREATMENT ORGANIZATIONS' ADOPTION OF ELECTRONIC HEALTH RECORDS: A NATIONAL SURVEY AT THE ONSET OF HEALTH REFORM Friedmann, P. D., Wilson, D., Andrews, C., Pollack, H., D'Aunno, T., Humphreys, K. SPRINGER. 2017: S107

  View details for Web of Science ID 000440259000055

• Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis BMJ-BRITISH MEDICAL JOURNAL Sun, E. C., Dixit, A., Humphreys, K., Darnall, B. D., Baker, L. C., Mackey, S. 2017; 356

  Abstract

  Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose.Design Retrospective analysis of claims data, 2001-13.Setting Administrative health claims database.Participants 315 428 privately insured people aged 18-64 who were continuously enrolled in a health plan with medical and pharmacy benefits during the study period and who also filled at least one prescription for an opioid.Interventions Concurrent benzodiazepine/opioid use, defined as an overlap of at least one day in the time periods covered by prescriptions for each drug. Main outcome measures Annual percentage of opioid users with concurrent benzodiazepine use; annual incidence of visits to emergency room and inpatient admissions for opioid overdose.Results 9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative increase). This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users. Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users. If this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15% (95% confidence interval 14 to 16).Conclusions From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.

  View details for DOI 10.1136/bmj.j760

  View details for Web of Science ID 000397014900002

  View details for PubMedID 28292769

• How ACA Repeal Would Worsen the Opioid Epidemic. The New England journal of medicine Friedmann, P. D., Andrews, C. M., Humphreys, K. 2017; 376 (10): e16

  View details for DOI 10.1056/NEJMp1700834

  View details for PubMedID 28273016

• Addiction Debates: challenging ideas, challenging ourselves. Addiction (Abingdon, England) Neale, J., Humphreys, K. 2017; 112 (2): 204

  View details for DOI 10.1111/add.13690

  View details for PubMedID 28078698

• Mandatory sobriety programmes for alcohol-involved criminal offenders. Journal of the Royal Society of Medicine Finlay, I. G., Humphreys, K. 2017; 110 (2): 52-53

  View details for DOI 10.1177/0141076816682366

  View details for PubMedID 28169589

• Adapting a computer-delivered brief alcohol intervention for veterans with Hepatitis C. Informatics for health & social care Cucciare, M. A., Jamison, A. L., Combs, A. S., Joshi, G., Cheung, R. C., Rongey, C., Huggins, J., Humphreys, K. 2017: 1-15

  Abstract

  This study adapted an existing computer-delivered brief alcohol intervention (cBAI) for use in Veterans with the hepatitis C virus (HCV) and examined its acceptability and feasibility in this patient population.A four-stage model consisting of initial pilot testing, qualitative interviews with key stakeholders, development of a beta version of the cBAI, and usability testing was used to achieve the study objectives.In-depth interviews gathered feedback for modifying the cBAI, including adding HCV-related content such as the health effects of alcohol on liver functioning, immune system functioning, and management of HCV, a preference for concepts to be displayed through "newer looking" graphics, and limiting the use of text to convey key concepts. Results from usability testing indicated that the modified cBAI was acceptable and feasible for use in this patient population.The development model used in this study is effective for gathering actionable feedback that can inform the development of a cBAI and can result in the development of an acceptable and feasible intervention for use in this population. Findings also have implications for developing computer-delivered interventions targeting behavior change more broadly.

  View details for DOI 10.1080/17538157.2016.1255628

  View details for PubMedID 28068154

• Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial. JAMA surgery Hah, J. n., Mackey, S. C., Schmidt, P. n., McCue, R. n., Humphreys, K. n., Trafton, J. n., Efron, B. n., Clay, D. n., Sharifzadeh, Y. n., Ruchelli, G. n., Goodman, S. n., Huddleston, J. n., Maloney, W. J., Dirbas, F. M., Shrager, J. n., Costouros, J. n., Curtin, C. n., Carroll, I. n. 2017

  Abstract

  Guidelines recommend using gabapentin to decrease postoperative pain and opioid use, but significant variation exists in clinical practice.To determine the effect of perioperative gabapentin on remote postoperative time to pain resolution and opioid cessation.A randomized, double-blind, placebo-controlled trial of perioperative gabapentin was conducted at a single-center, tertiary referral teaching hospital. A total of 1805 patients aged 18 to 75 years scheduled for surgery (thoracotomy, video-assisted thoracoscopic surgery, total hip replacement, total knee replacement, mastectomy, breast lumpectomy, hand surgery, carpal tunnel surgery, knee arthroscopy, shoulder arthroplasty, and shoulder arthroscopy) were screened. Participants were enrolled from May 25, 2010, to July 25, 2014, and followed up for 2 years postoperatively. Intention-to-treat analysis was used in evaluation of the findings.Gabapentin, 1200 mg, preoperatively and 600 mg, 3 times a day postoperatively or active placebo (lorazepam, 0.5 mg) preoperatively followed by inactive placebo postoperatively for 72 hours.Primary outcome was time to pain resolution (5 consecutive reports of 0 of 10 possible levels of average pain at the surgical site on the numeric rating scale of pain). Secondary outcomes were time to opioid cessation (5 consecutive reports of no opioid use) and the proportion of participants with continued pain or opioid use at 6 months and 1 year.Of 1805 patients screened for enrollment, 1383 were excluded, including 926 who did not meet inclusion criteria and 273 who declined to participate. Overall, 8% of patients randomized were lost to follow-up. A total of 202 patients were randomized to active placebo and 208 patients were randomized to gabapentin in the intention-to-treat analysis (mean [SD] age, 56.7 [11.7] years; 256 (62.4%) women and 154 (37.6%) men). Baseline characteristics of the groups were similar. Perioperative gabapentin did not affect time to pain cessation (hazard ratio [HR], 1.04; 95% CI, 0.82-1.33; P = .73) in the intention-to-treat analysis. However, participants receiving gabapentin had a 24% increase in the rate of opioid cessation after surgery (HR, 1.24; 95% CI, 1.00-1.54; P = .05). No significant differences were noted in the number of adverse events as well as the rate of medication discontinuation due to sedation or dizziness (placebo, 42 of 202 [20.8%]; gabapentin, 52 of 208 [25.0%]).Perioperative administration of gabapentin had no effect on postoperative pain resolution, but it had a modest effect on promoting opioid cessation after surgery. The routine use of perioperative gabapentin may be warranted to promote opioid cessation and prevent chronic opioid use. Optimal dosing and timing of perioperative gabapentin in the context of specific operations to decrease opioid use should be addressed in further research.clinicaltrials.gov Identifier: NCT01067144.

  View details for PubMedID 29238824

• Brains, environments, and policy responses to addiction. Science (New York, N.Y.) Humphreys, K. n., Malenka, R. C., Knutson, B. n., MacCoun, R. J. 2017; 356 (6344): 1237–38

  View details for PubMedID 28642399

• Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications HEALTH AFFAIRS Grogan, C. M., Andrews, C., Abraham, A., Humphreys, K., Pollack, H. A., Smith, B. T., Friedmann, P. D. 2016; 35 (12): 2289-2296

  Abstract

  The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treatment and opioid use disorder medications across the United States. Many states did not cover all levels of care required for effective substance use disorder treatment or medications required for effective opioid use disorder treatment as defined by American Society of Addiction Medicine criteria, which could result in lack of access to needed services for low-income populations.

  View details for DOI 10.1377/hlthaff.2016.0623

  View details for Web of Science ID 000390328000018

  View details for PubMedID 27920318

  View details for PubMedCentralID PMC5304419

• Predictive validity of a quality measure for intensive substance use disorder treatment. Substance abuse Schmidt, E. M., Gupta, S., Bowe, T., Ellerbe, L. S., Phelps, T. E., Finney, J. W., Asch, S. M., Humphreys, K., Trafton, J., Vanneman, M., Harris, A. H. 2016: 1-7

  Abstract

  Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined.Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility.Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol- and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001).Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.

  View details for PubMedID 27435754

• Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States ANNALS OF INTERNAL MEDICINE Bernard, C. L., Brandeau, M. L., Humphreys, K., Bendavid, E., Holodniy, M., Weyant, C., Owens, D. K., Goldhaber-Fiebert, J. D. 2016; 165 (1): 10-?

  View details for DOI 10.7326/M15-2634

  View details for Web of Science ID 000379215800003

• Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries ADDICTION Kalinowski, A., Humphreys, K. 2016; 111 (7): 1293-1298

  Abstract

  One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries.A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country.Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10 g pure ethanol, but variation was wide (8-20 g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42 g per day for women and 10-56 g per day for men to 98-140 g per week for women and 150-280 g per week for men.Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research.

  View details for DOI 10.1111/add.13341

  View details for Web of Science ID 000379951700027

  View details for PubMedID 27073140

• Grappling with the generalizability crisis in addiction treatment research. Addiction (Abingdon, England) Humphreys, K. 2016; 111 (7): 1141-2

  View details for DOI 10.1111/add.13376

  View details for PubMedID 27079280

• Exclusion criteria in treatment research on alcohol, tobacco and illicit drug use disorders: A review and critical analysis. Drug and alcohol review Moberg, C. A., Humphreys, K. 2016

  Abstract

  High rates of exclusion in substance use disorder treatment studies reduce the external validity and clinical utility of research findings to an unknown extent. Accordingly, the current review examined commonly used exclusion criteria and their effect on study samples and outcomes.English-language literature was identified by PubMed searches and review of identified articles' reference lists. Studies were included if they analysed data on: (i) the prevalence and nature of exclusion criteria in the substance use disorder treatment field; and/or (ii) the impact of exclusion criteria on sample representativeness or study results.The search yielded 22 studies examining different aspects of exclusion criteria, including 15 empirical examinations of the impact of study exclusion criteria across different substance use disorder treatments on enrolment and outcome results. Aggregating across these 15 studies, we estimated that between 64 and 96% of potential study participants are excluded from substance use disorder treatment studies.The widespread exclusion of large proportions of people with substance use disorders limits the external validity of the substance use disorder treatment research literature.Although some eligibility criteria are necessary to protect participant safety and ensure internal validity, researchers conducting studies on substance use disorder treatments should thoughtfully consider the justification for and specific operationalisation of the extensive exclusion criteria they often utilise. [Moberg C, Humphreys K. Exclusion criteria in treatment research on alcohol, tobacco and illicit drug use disorders: A review and critical analysis. Drug Alcohol Rev 2017;36:378-388].

  View details for DOI 10.1111/dar.12438

  View details for PubMedID 27324921

• Weighing the Risks and Benefits of Chronic Opioid Therapy AMERICAN FAMILY PHYSICIAN Lembke, A., Humphreys, K., Newmark, J. 2016; 93 (12): 982-990

  Abstract

  Evidence supports the use of opioids for treating acute pain. However, the evidence is limited for the use of chronic opioid therapy for chronic pain. Furthermore, the risks of chronic therapy are significant and may outweigh any potential benefits. When considering chronic opioid therapy, physicians should weigh the risks against any possible benefits throughout the therapy, including assessing for the risks of opioid misuse, opioid use disorder, and overdose. When initiating opioid therapy, physicians should consider buprenorphine for patients at risk of opioid misuse, opioid use disorder, and overdose. If and when opioid misuse is detected, opioids do not necessarily need to be discontinued, but misuse should be noted on the problem list and interventions should be performed to change the patient's behavior. If aberrant behavior continues, opioid use disorder should be diagnosed and treated accordingly. When patients are discontinuing opioid therapy, the dosage should be decreased slowly, especially in those who have intolerable withdrawal. It is not unreasonable for discontinuation of chronic opioid therapy to take many months. Benzodiazepines should not be coprescribed during chronic opioid therapy or when tapering, because some patients may develop cross-dependence. For patients at risk of overdose, naloxone should be offered to the patient and to others who may be in a position to witness and reverse opioid overdose.

  View details for Web of Science ID 000377633800003

  View details for PubMedID 27304767

• A call to include people with mental illness and substance use disorders alongside 'regular' smokers in smoking cessation research. Tobacco control Lembke, A., Humphreys, K. 2016; 25 (3): 261-2

  Abstract

  This commentary points out that smoking is increasingly concentrated among people with psychiatric problems and other substance use disorders (eg, alcohol use disorder), and argues that for clinical, ethical and efficiency reasons, such individuals should be routinely enrolled in smoking cessation research.

  View details for DOI 10.1136/tobaccocontrol-2014-052215

  View details for PubMedID 25882685

• Excellent Patient Care Processes in Poor Hospitals? Why Hospital-Level and Patient-Level Care Quality-Outcome Relationships Can Differ JOURNAL OF GENERAL INTERNAL MEDICINE Finney, J. W., Humphreys, K., Kivlahan, D. R., Harris, A. H. 2016; 31: 74-77

  Abstract

  Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.

  View details for DOI 10.1007/s11606-015-3564-3

  View details for Web of Science ID 000373159900013

  View details for PubMedCentralID PMC4803671

• Excellent Patient Care Processes in Poor Hospitals? Why Hospital-Level and Patient-Level Care Quality-Outcome Relationships Can Differ. Journal of general internal medicine Finney, J. W., Humphreys, K., Kivlahan, D. R., Harris, A. H. 2016; 31: 74-77

  Abstract

  Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.

  View details for DOI 10.1007/s11606-015-3564-3

  View details for PubMedID 26951280

  View details for PubMedCentralID PMC4803671

• The liability risks of naloxone access expansion should be the least of our worries. American journal of drug and alcohol abuse Humphreys, K. 2016; 42 (2): 115-116

  View details for DOI 10.3109/00952990.2015.1137299

  View details for PubMedID 26905668

• Assessing understandings of substance use disorders among Norwegian treatment professionals, patients and the general public BMC HEALTH SERVICES RESEARCH Vederhus, J., Clausen, T., Humphreys, K. 2016; 16

  Abstract

  Beliefs about substance use disorder (SUD) shape how patients, treatment professionals and the general public view addiction and its treatment. A U.S. developed scale exists to assess such beliefs, but it has never been tested in Norway nor normed on any general population sample.The Short Understanding of Substance Abuse Scale (SUSS) was translated from English to Norwegian and used to assess beliefs about the nature of addiction among addiction treatment professionals (N = 291), patients with SUDs (N = 133) and respondents from the general public (N = 216). The disease and psychosocial model subscales of the SUSS were examined with a multigroup factor analysis to confirm that the constructs were invariant across the studied groups. We also controlled for demographic covariates in a multiple indicator multiple cause model.The multigroup confirmatory factor analysis of the SUSS yielded a partial scalar invariant model and thus, we were able to compare latent means between groups. In unadjusted comparisons, patients and the general public reported significantly higher endorsement of disease model beliefs than did professionals. However, the difference between professionals and the general public disappeared when the comparison was adjusted for covariates (i.e., age, gender, education). In both unadjusted and adjusted analyses, the general public group but not the patient group scored significantly lower than professionals on the psychosocial belief scale.The SUSS is useable with slight adaptations in Norwegian samples. Norwegian treatment professionals have different views of substance use disorder than do patients and the general public. This may create opportunities for dialogue and mutual learning, but also presents risk of miscommunication and distrust.

  View details for DOI 10.1186/s12913-016-1306-9

  View details for Web of Science ID 000369969600001

  View details for PubMedID 26873360

  View details for PubMedCentralID PMC4752790

• Distribution of Opioids by Different Types of Medicare Prescribers. JAMA internal medicine Chen, J. H., Humphreys, K., Shah, N. H., Lembke, A. 2016; 176 (2): 259-61

  View details for DOI 10.1001/jamainternmed.2015.6662

  View details for PubMedID 26658497

  View details for PubMedCentralID PMC5374118

• The Paucity of Attention to Narcotics Anonymous in Current Public, Professional, and Policy Responses to Rising Opioid Addiction ALCOHOLISM TREATMENT QUARTERLY White, W., Galanter, M., Humphreys, K., Kelly, J. 2016; 34 (4): 437-462

  View details for DOI 10.1080/07347324.2016.1217712

  View details for Web of Science ID 000388606100007

• Pain Duration and Resolution following Surgery: An Inception Cohort Study PAIN MEDICINE Carroll, I. R., Hah, J. M., Barelka, P. L., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F. M., Mackey, S. C. 2015; 16 (12): 2386-2396

  Abstract

  Preoperative determinants of pain duration following surgery are poorly understood. We identified preoperative predictors of prolonged pain after surgery in a mixed surgical cohort.We conducted a prospective longitudinal study of patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured pain and opioid use after surgery until patients reported the cessation of both opioid consumption and pain. The primary endpoint was time to opioid cessation, and those results have been previously reported. Here, we report preoperative determinants of time to pain resolution following surgery in Cox proportional hazards regression.Between January 2007 and April 2009, we enrolled 107 of 134 consecutively approached patients undergoing the aforementioned surgical procedures. In the final multivariate model, preoperative self-perceived risk of addiction predicted more prolonged pain. Unexpectedly, anxiety sensitivity predicted more rapid pain resolution after surgery. Each one-point increase (on a four point scale) of self-perceived risk of addiction was associated with a 38% (95% CI 3-61) reduction in the rate of pain resolution (P = 0.04). Furthermore, higher anxiety sensitivity was associated with an 89% (95% CI 23-190) increased rate of pain resolution (P = 0.004).Greater preoperative self-perceived risk of addiction, and lower anxiety sensitivity predicted a slower rate of pain resolution following surgery. Each of these factors was a better predictor of pain duration than preoperative depressive symptoms, post-traumatic stress disorder symptoms, past substance use, fear of pain, gender, age, preoperative pain, or preoperative opioid use.

  View details for DOI 10.1111/pme.12842

  View details for Web of Science ID 000368297000020

  View details for PubMedCentralID PMC4706803

• Pain Duration and Resolution following Surgery: An Inception Cohort Study. Pain medicine Carroll, I. R., Hah, J. M., Barelka, P. L., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F. M., Mackey, S. C. 2015; 16 (12): 2386-2396

  Abstract

  Preoperative determinants of pain duration following surgery are poorly understood. We identified preoperative predictors of prolonged pain after surgery in a mixed surgical cohort.We conducted a prospective longitudinal study of patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured pain and opioid use after surgery until patients reported the cessation of both opioid consumption and pain. The primary endpoint was time to opioid cessation, and those results have been previously reported. Here, we report preoperative determinants of time to pain resolution following surgery in Cox proportional hazards regression.Between January 2007 and April 2009, we enrolled 107 of 134 consecutively approached patients undergoing the aforementioned surgical procedures. In the final multivariate model, preoperative self-perceived risk of addiction predicted more prolonged pain. Unexpectedly, anxiety sensitivity predicted more rapid pain resolution after surgery. Each one-point increase (on a four point scale) of self-perceived risk of addiction was associated with a 38% (95% CI 3-61) reduction in the rate of pain resolution (P = 0.04). Furthermore, higher anxiety sensitivity was associated with an 89% (95% CI 23-190) increased rate of pain resolution (P = 0.004).Greater preoperative self-perceived risk of addiction, and lower anxiety sensitivity predicted a slower rate of pain resolution following surgery. Each of these factors was a better predictor of pain duration than preoperative depressive symptoms, post-traumatic stress disorder symptoms, past substance use, fear of pain, gender, age, preoperative pain, or preoperative opioid use.

  View details for DOI 10.1111/pme.12842

  View details for PubMedID 26179223

• The exclusion of people with psychiatric disorders from medical research JOURNAL OF PSYCHIATRIC RESEARCH Humphreys, K., Blodgett, J. C., Roberts, L. W. 2015; 70: 28-32

  Abstract

  People with psychiatric disorders are excluded from medical research to an unknown degree with unknown effects. We examined the prevalence of reported psychiatric exclusion criteria using a sample of 400 highly-cited randomized trials (2002-2010) across 20 common chronic disorders (6 psychiatric and 14 other medical disorders). Two coders rated the presence of psychiatric exclusion criteria for each trial. Half of all trials (and 84% of psychiatric disorder treatment trials) reported possible or definite psychiatric exclusion criteria, with significant variation across disorders (p < .001). Non-psychiatric conditions with high rates of reported psychiatric exclusion criteria included low back pain (75%), osteoarthritis (57%), COPD (55%), and diabetes (55%). The most commonly reported type of psychiatric exclusion criteria were those related to substance use disorders (reported in 48% of trials reporting at least one psychiatric exclusion criteria). General psychiatric exclusions (e.g., "any serious psychiatric disorder") were also prevalent (38% of trials). Psychiatric disorder trials were more likely than other medical disorder trials to report each specific type of psychiatric exclusion (p's < .001). Because published clinical trial reports do not always fully describe exclusion criteria, this study's estimates of the prevalence of psychiatric exclusion criteria are conservative. Clinical trials greatly influence state-of-the-art medical care, yet individuals with psychiatric disorders are often actively excluded from these trials. This pattern of exclusion represents an under-recognized and worrisome cause of health inequity. Further attention should be paid to how individuals with psychiatric disorders can be safely included in medical research to address this important clinical and social justice issue.

  View details for DOI 10.1016/j.jpsychires.2015.08.005

  View details for Web of Science ID 000363826800004

  View details for PubMedID 26424420

• An Overdose Antidote Goes Mainstream. Health affairs Humphreys, K. 2015; 34 (10): 1624-1627

  View details for DOI 10.1377/hlthaff.2015.0934

  View details for PubMedID 26438736

• Participant exclusion criteria in treatment research on neurological disorders: Are unrepresentative study samples problematic? Contemporary clinical trials Trivedi, R. B., Humphreys, K. 2015; 44: 20-25

  Abstract

  Exclusion criteria are an important determinant of the external validity of treatment research findings, yet the prevalence and impact of exclusion criteria have not been studied systematically. Our objective was to describe prevalent exclusion criteria in treatment research on neurological disorders and to analyze their impact on sample representativeness and generalizability of findings.Narrative literature review of studies focusing on treatment for neurological disorders. Studies were identified from PubMed and bibliographies.Eight studies were included in the narrative review: 3 studies focused on Alzheimer's disease/dementia, 2 each focused on traumatic brain injury (TBI) and epilepsy, and 1 focused on amyotrophic lateral sclerosis (ALS). The total number of patients screened across all studies was 20,018, of which 14,721 (73.5%) were excluded. An average of 6 exclusion criteria was applied. The criteria that contributed most to exclusion were the presence of comorbid psychiatric conditions, a history of alcohol or other substance misuse, and cognitive impairments. Women and the elderly were underrepresented among included samples. Race/ethnicity proportions were seldom reported.Exclusion criteria are used extensively in neurological treatment research and prevent about 3 in 4 patients from participating in research. This limits the generalizability of current findings. Further, because excluded individuals are disproportionately from vulnerable populations, extensive exclusion also raises ethical concerns. Exclusion criteria should be used only in cases where there is a strong rationale so that neurological treatment research can make a greater impact on clinical care.

  View details for DOI 10.1016/j.cct.2015.07.009

  View details for PubMedID 26188162

• Participant exclusion criteria in treatment research on neurological disorders: Are unrepresentative study samples problematic? CONTEMPORARY CLINICAL TRIALS Trivedi, R. B., Humphreys, K. 2015; 44: 20-25

  Abstract

  Exclusion criteria are an important determinant of the external validity of treatment research findings, yet the prevalence and impact of exclusion criteria have not been studied systematically. Our objective was to describe prevalent exclusion criteria in treatment research on neurological disorders and to analyze their impact on sample representativeness and generalizability of findings.Narrative literature review of studies focusing on treatment for neurological disorders. Studies were identified from PubMed and bibliographies.Eight studies were included in the narrative review: 3 studies focused on Alzheimer's disease/dementia, 2 each focused on traumatic brain injury (TBI) and epilepsy, and 1 focused on amyotrophic lateral sclerosis (ALS). The total number of patients screened across all studies was 20,018, of which 14,721 (73.5%) were excluded. An average of 6 exclusion criteria was applied. The criteria that contributed most to exclusion were the presence of comorbid psychiatric conditions, a history of alcohol or other substance misuse, and cognitive impairments. Women and the elderly were underrepresented among included samples. Race/ethnicity proportions were seldom reported.Exclusion criteria are used extensively in neurological treatment research and prevent about 3 in 4 patients from participating in research. This limits the generalizability of current findings. Further, because excluded individuals are disproportionately from vulnerable populations, extensive exclusion also raises ethical concerns. Exclusion criteria should be used only in cases where there is a strong rationale so that neurological treatment research can make a greater impact on clinical care.

  View details for DOI 10.1016/j.cct.2015.07.009

  View details for Web of Science ID 000362616300003

• Griffith Edwards' rigorous sympathy with Alcoholics Anonymous ADDICTION Humphreys, K. 2015; 110: 16-18

  Abstract

  Griffith Edwards made empirical contributions early in his career to the literature on Alcoholics Anonymous (AA), but the attitude he adopted towards AA and other peer-led mutual help initiatives constitutes an even more important legacy. Unlike many treatment professionals who dismissed the value of AA or were threatened by its non-professional approach, Edwards was consistently respectful of the organization. However, he never became an uncritical booster of AA or overgeneralized what could be learnt from it. Future scholarly and clinical endeavors concerning addiction-related mutual help initiatives will benefit by continuing Edwards' tradition of 'rigorous sympathy'.

  View details for DOI 10.1111/add.12900

  View details for Web of Science ID 000355769700005

  View details for PubMedID 26042562

• Vote of thanks to Professor Tom Babor ADDICTION West, R., Marsden, J., Darke, S., Humphreys, K., Miller, P., Hall, W., Petry, N. 2015; 110 (7): 1060

  View details for DOI 10.1111/add.12959

  View details for Web of Science ID 000356808500002

  View details for PubMedID 26094491

• Examining the Specification Validity of the HEDIS Quality Measures for Substance Use Disorders JOURNAL OF SUBSTANCE ABUSE TREATMENT Harris, A. H., Ellerbe, L., Phelps, T. E., Finney, J. W., Bowe, T., Gupta, S., Asch, S. M., Humphreys, K., Trafton, J. 2015; 53: 16-21

  Abstract

  Accurate operationalization is a major challenge in developing quality measures for substance use disorder treatment. Specification validity is a term used to describe whether a quality measure is operationalized such that it captures the intended care processes and patients. This study assessed the specification validity of the 2009 Healthcare Effectiveness Data and Information Set (HEDIS®) substance use disorder initiation and engagement measures by examining whether encounters assumed to include relevant treatment have corroborating evidence in the clinical progress notes. The positive predictive values were excellent (>90%) for residential and outpatient records selected from addiction treatment programs but more modest for records generated in non-addiction settings, and were highly variable across facilities. Stakeholders using these measures to compare care quality should be mindful of the clinical composition of the data and determine if similar validation work has been conducted on the systems being evaluated.

  View details for DOI 10.1016/j.jsat.2015.01.002

  View details for Web of Science ID 000354505900003

  View details for PubMedID 25736624

• Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform. Health affairs Andrews, C., Abraham, A., Grogan, C. M., Pollack, H. A., Bersamira, C., Humphreys, K., Friedmann, P. 2015; 34 (5): 828-835

  Abstract

  The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment.

  View details for DOI 10.1377/hlthaff.2014.1330

  View details for PubMedID 25941285

• State-level relationships cannot tell us anything about individuals. American journal of public health Harris, A. H., Humphreys, K., Finney, J. W. 2015; 105 (4)

  View details for DOI 10.2105/AJPH.2015.302604

  View details for PubMedID 25713959

• What ecologic analyses cannot tell us about medical marijuana legalization and opioid pain medication mortality. JAMA internal medicine Finney, J. W., Humphreys, K., Harris, A. H. 2015; 175 (4): 655-656

  View details for DOI 10.1001/jamainternmed.2014.8006

  View details for PubMedID 25844747

• Addiction Treatment Professionals Are Not the Gatekeepers of Recovery SUBSTANCE USE & MISUSE Humphreys, K. 2015; 50 (8-9): 1024-1027

  Abstract

  Addiction treatment is beneficial to many individuals who have substance use disorders. However, only a minority of individuals who recover from addiction receive it. Despite this, addiction treatment is sometimes granted the status of the "gatekeeper of recovery." The myth that treatment is necessary for recovery has no empirical support. It also undermines the confidence of individuals in their ability to change on their own and is unduly dismissive of the efforts of nonprofessional helpers.

  View details for DOI 10.3109/10826084.2015.1007678

  View details for Web of Science ID 000361331800020

  View details for PubMedID 25774891

• Predictive validity of two process-of-care quality measures for residential substance use disorder treatment. Addiction science & clinical practice Harris, A. H., Gupta, S., Bowe, T., Ellerbe, L. S., Phelps, T. E., Rubinsky, A. D., Finney, J. W., Asch, S. M., Humphreys, K., Trafton, J. 2015; 10: 22-?

  Abstract

  In order to monitor and ultimately improve the quality of addiction treatment, professional societies, health care systems, and addiction treatment programs must establish clinical practice standards and then operationalize these standards into reliable, valid, and feasible quality measures. Before being implemented, quality measures should undergo tests of validity, including predictive validity. Predictive validity refers to the association between process-of-care quality measures and subsequent patient outcomes. This study evaluated the predictive validity of two process quality measures of residential substance use disorder (SUD) treatment.Washington Circle (WC) Continuity of Care quality measure is the proportion of patients having an outpatient SUD treatment encounter within 14 days after discharge from residential SUD treatment. The Early Discharge measure is the proportion of patients admitted to residential SUD treatment who discharged within 1 week of admission. The predictive validity of these process measures was evaluated in US Veterans Health Administration patients for whom utilization-based outcome and 2-year mortality data were available. Propensity score-weighted, mixed effects regression adjusted for pre-index imbalances between patients who did and did not meet the measures' criteria and clustering of patients within facilities.For the WC Continuity of Care measure, 76 % of 10,064 patients had a follow-up visit within 14 days of discharge. In propensity score-weighted models, patients who had a follow-up visit had a lower 2-year mortality rate [odds ratio (OR) = 0.77, p = 0.008], but no difference in subsequent detoxification episodes relative to patients without a follow-up visit. For the Early Discharge measure, 9.6 % of 10,176 discharged early and had significantly higher 2-year mortality (OR = 1.49, p < 0.001) and more subsequent detoxification episodes.These two measures of residential SUD treatment quality have strong associations with 2-year mortality and the Early Discharge measure is also associated with more subsequent detoxification episodes. These results provide initial support for the predictive validity of residential SUD treatment quality measures and represent the first time that any SUD quality measure has been shown to predict subsequent mortality.

  View details for DOI 10.1186/s13722-015-0042-5

  View details for PubMedID 26520402

  View details for PubMedCentralID PMC4672518

• The Affordable Care Act will revolutionize care for substance use disorders in the United States. Addiction (Abingdon, England) Humphreys, K., Frank, R. G. 2014; 109 (12): 1957-8

  View details for DOI 10.1111/add.12606

  View details for PubMedID 24965487

• Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Blodgett, J. C., Wagner, T. H. 2014; 38 (11): 2688-2694

  Abstract

  Observational studies of Alcoholics Anonymous' (AA) effectiveness are vulnerable to self-selection bias because individuals choose whether or not to attend AA. The present study, therefore, employed an innovative statistical technique to derive a selection bias-free estimate of AA's impact.Six data sets from 5 National Institutes of Health-funded randomized trials (1 with 2 independent parallel arms) of AA facilitation interventions were analyzed using instrumental variables models. Alcohol-dependent individuals in one of the data sets (n = 774) were analyzed separately from the rest of sample (n = 1,582 individuals pooled from 5 data sets) because of heterogeneity in sample parameters. Randomization itself was used as the instrumental variable.Randomization was a good instrument in both samples, effectively predicting increased AA attendance that could not be attributed to self-selection. In 5 of the 6 data sets, which were pooled for analysis, increased AA attendance that was attributable to randomization (i.e., free of self-selection bias) was effective at increasing days of abstinence at 3-month (B = 0.38, p = 0.001) and 15-month (B = 0.42, p = 0.04) follow-up. However, in the remaining data set, in which preexisting AA attendance was much higher, further increases in AA involvement caused by the randomly assigned facilitation intervention did not affect drinking outcome.For most individuals seeking help for alcohol problems, increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high preexisting AA involvement, further increases in AA attendance may have little impact.

  View details for DOI 10.1111/acer.12557

  View details for Web of Science ID 000345620400001

  View details for PubMedID 25421504

  View details for PubMedCentralID PMC4285560

• Addiction editors respond to Mr. Leverton. Addiction Babor, T., Hall, W., Humphreys, K., Miller, P., Petry, N., West, R. 2014; 109 (7): 1209-1211

  View details for DOI 10.1111/add.12555

  View details for PubMedID 24903296

• Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate PAIN MEDICINE Hah, J. M., Mackey, S., Barelka, P. L., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F. M., Schmidt, P. C., Carroll, I. R. 2014; 15 (6): 954-964

  Abstract

  We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery.We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression.The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037).Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

  View details for DOI 10.1111/pme.12439

  View details for Web of Science ID 000338025900009

  View details for PubMedCentralID PMC4083472

• Self-loathing aspects of depression reduce postoperative opioid cessation rate. Pain medicine Hah, J. M., Mackey, S., Barelka, P. L., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F. M., Schmidt, P. C., Carroll, I. R. 2014; 15 (6): 954-964

  Abstract

  We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery.We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression.The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037).Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

  View details for DOI 10.1111/pme.12439

  View details for PubMedID 24964916

• Action is needed to deter the trumpeting of non-peer-reviewed findings to the media. Addiction (Abingdon, England) Humphreys, K. 2014; 109 (5): 691-2

  View details for DOI 10.1111/add.12476

  View details for PubMedID 24720820

• Do Clinical Trials of Treatment of Alcohol Dependence Adequately Enroll Participants With Co-Occurring Independent Mood and Anxiety Disorders? An Analysis of Data From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) JOURNAL OF CLINICAL PSYCHIATRY Hoertel, N., Falissard, B., Humphreys, K., Gorwood, P., Seigneurie, A., Limosin, F. 2014; 75 (3): 231-237

  Abstract

  In the care of alcohol-dependent patients, co-occurring independent (ie, not substance-induced) mood and anxiety disorders present a significant challenge. Clinical trials of alcohol dependence treatment could help clinicians meet this challenge, but only if they enroll such complex patients. This study examined whether such individuals are likely to be included in alcohol dependence treatment trials under typical eligibility criteria.Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national representative sample of 43,093 adults in the United States population. Psychiatric diagnoses were made according to the DSM-IV criteria with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV).Of 1,484 alcohol-dependent participants, 39.22% (SE = 1.67) had a co-occurring independent mood or anxiety disorder; more than 60% of these individuals would be ineligible for an alcohol dependence treatment trial under typical eligibility criteria. Alcohol-dependent individuals with current major depressive episode, mania, dysthymia, panic disorder, and generalized anxiety disorder were particularly likely to be excluded from clinical trials. In a subsample of 185 individuals who had sought alcohol treatment, 52.59% (SE = 4.42) had an independent mood or anxiety disorder. Remarkably, almost all of these individuals (96.93%, SE = 1.97) would have been ineligible for clinical trials.Independent mood and anxiety disorders are prevalent in the alcohol-dependent population but not in clinical trial research samples. For alcohol dependence treatment trials to adequately inform clinical practice, the enrollment of patients with co-occurring mood or anxiety disorders must be increased, through trials tailored to this population, a general relaxation of overly stringent eligibility criteria, or both.

  View details for DOI 10.4088/JCP.13m08424

  View details for Web of Science ID 000334422000008

  View details for PubMedID 24569017

• Recovery-oriented policy and care systems in the UK and USA. Drug and alcohol review Humphreys, K., Lembke, A. 2014; 33 (1): 13-18

  Abstract

  The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and regulations. Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions.

  View details for DOI 10.1111/dar.12092

  View details for PubMedID 24267515

• Who is responsible for the public's health? The role of the alcohol industry in the WHO global strategy to reduce the harmful use of alcohol ADDICTION Babor, T., Hall, W., Humphreys, K., Miller, P., Petry, N., West, R. 2013; 108 (12): 2045–47

  View details for DOI 10.1111/add.12368

  View details for Web of Science ID 000327954000001

  View details for PubMedID 24237892

• Representativeness of patients enrolled in influential clinical trials: a comparison of substance dependence with other medical disorders. Journal of studies on alcohol and drugs Humphreys, K., Maisel, N. C., Blodgett, J. C., Finney, J. W. 2013; 74 (6): 889-893

  Abstract

  ABSTRACT. Objective: The purpose of this study was to determine whether randomized trials of treatments for substance dependence differ from those for other medical disorders on quality of enrollment information reporting and sample representativeness. Method: Twenty highly cited clinical trials (publication date 2002-2010) of treatments for each of 14 prevalent disorders were identified by structured literature search. The disorders were alcohol dependence, drug dependence, nicotine dependence, Alzheimer's disease, breast cancer, colorectal cancer, chronic obstructive pulmonary disease, depression, diabetes, HIV/AIDS, hypertension, ischemic heart disease, lung cancer, and schizophrenia. The 280 clinical trials were coded for number of individuals screened for eligibility, number of screened individuals meeting eligibility criteria, and number of eligible individuals refusing to participate. Results: Substance-dependence treatment trials were significantly more likely to track and report enrollment information (75% vs. 45% of clinical trials for other disorders, p < .001). Substance-dependence trials did not differ from trials focused on other disorders on mean rate of non-enrollment. Across disorders, the primary driver of non-enrollment appeared to be clinical trial exclusion criteria rather than eligible patients refusing to enroll. Conclusions: Relative to other disorders, trials in the substance-dependence field do a better (although imperfect) job of tracking and reporting enrollment information. Low enrollment rates and unrepresentative samples are not challenges unique to treatment outcome studies in the substance-dependence field. Across a range of disorders, clinical trials that use eligibility criteria judiciously are more likely to produce findings that generalize to front-line clinical practice than are trials that restrict enrollment to a small and unrepresentative subset of patients. (J. Stud. Alcohol Drugs, 74, 889-893, 2013).

  View details for PubMedID 24172115

• Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services? JOURNAL OF SUBSTANCE ABUSE TREATMENT Laudet, A. B., Humphreys, K. 2013; 45 (1): 126-133

  Abstract

  As both a concept and a movement, "recovery" is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform.

  View details for DOI 10.1016/j.jsat.2013.01.009

  View details for Web of Science ID 000318755400016

  View details for PubMedID 23506781

  View details for PubMedCentralID PMC3642237

• Extent and reporting of patient nonenrollment in influential randomized clinical trials, 2002 to 2010. JAMA internal medicine Humphreys, K., Maisel, N. C., Blodgett, J. C., Fuh, I. L., Finney, J. W. 2013; 173 (11): 1029-1031

  View details for DOI 10.1001/jamainternmed.2013.496

  View details for PubMedID 23608926

• Commentary on Gustafson et?al. (2013): Can we know that addiction treatment has been improved without evidence of better patient outcomes? Addiction Humphreys, K. 2013; 108 (6): 1158-1159

  View details for DOI 10.1111/add.12144

  View details for PubMedID 23659846

• Determinants of time to opioid cessation post-surgery Ruchelli, G., Clay, D., Schmidt, P., Humphreys, K., Trafton, J., Dirbas, F., Giori, N., Goodman, S., Hoang, C., Huddleston, J., Maloney, W., Merritt, R., Miller, M., Shrager, J., Whyte, R., Mackey, S., Carroll, I. CHURCHILL LIVINGSTONE. 2013: S18–S18

  View details for Web of Science ID 000317639400072

• Analysis of preoperative measures that predict interference with sleep recovery after surgery Schmidt, P., Hah, J., Barelka, P., Wang, C., Wang, B., Gillespie, M., McCue, R., Younger, J., Trafton, J., Humphreys, K., Goodman, S., Dirbas, F., Whyte, R., Donington, J., Cannon, W., Mackey, S., Carroll, I. CHURCHILL LIVINGSTONE. 2013: S19–S19

  View details for Web of Science ID 000317639400076

• Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? ADDICTION Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., Finney, J. W. 2013; 108 (2): 275-293

  Abstract

  Although debates over the efficacy of oral naltrexone and acamprosate in treating alcohol use disorders tend to focus on their global efficacy relative to placebo or their efficacy relative to each other, the underlying reality may be more nuanced. This meta-analysis examined when naltrexone and acamprosate are most helpful by testing: (i) the relative efficacy of each medication given its presumed mechanism of action (reducing heavy drinking versus fostering abstinence) and (ii) whether different ways of implementing each medication (required abstinence before treatment, detoxification before treatment, goal of treatment, length of treatment, dosage) moderate its effects.A systematic literature search identified 64 randomized, placebo-controlled, English-language clinical trials completed between 1970 and 2009 focused on acamprosate or naltrexone.Acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence, and naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving. For naltrexone, requiring abstinence before the trial was associated with larger effect sizes for abstinence maintenance and reduced heavy drinking compared with placebo. For acamprosate, detoxification before medication administration was associated with better abstinence outcomes compared with placebo.In treatment for alcohol use disorders, acamprosate has been found to be slightly more efficacious in promoting abstinence and naltrexone slightly more efficacious in reducing heavy drinking and craving. Detoxification before treatment or a longer period of required abstinence before treatment is associated with larger medication effects for acamprosate and naltrexone respectively.

  View details for DOI 10.1111/j.1360-0443.2012.04054.x

  View details for Web of Science ID 000313746200011

  View details for PubMedID 23075288

• Personality and Psychopathology in African Unaccompanied Refugee Minors: Repression, Resilience and Vulnerability CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huemer, J., Voelkl-Kernstock, S., Karnik, N., Denny, K. G., Granditsch, E., Mitterer, M., Humphreys, K., Plattner, B., Friedrich, M., Shaw, R. J., Steiner, H. 2013; 44 (1): 39-50

  Abstract

  Examining personality and psychopathological symptoms among unaccompanied refugee minors (URMs), we measured intra-individual dimensions (repression and correlates thereof) usually associated with resilience. Forty-one URMs completed the Weinberger Adjustment Inventory (WAI), assessing personality, and the Youth Self-Report (YSR), describing current symptoms. URMs endorsed high levels of Repressive Defensiveness, Denial of Distress, and Restraint; unexpectedly, URMs reported high Distress and reduced Happiness (WAI, p's < 0.05). Although YSR symptoms were below clinical cut points, there were notable correlations between Distress and Attention Problems, Self-destructive, and Aggressive Behavior (all on the YSR), correcting for multiple comparisons (p's < 0.004). URMs exposed to non-normative stressors reported non-symptomatic outcomes, and high levels of personality dimensions correlating with resilience. However, URMs also endorsed high Distress and low Happiness, calling their resilience into question. Positive correlations between WAI Distress and YSR symptom subscales suggest that URMs harbor vulnerabilities of clinical and forensic significance.

  View details for DOI 10.1007/s10578-012-0308-z

  View details for Web of Science ID 000314065000003

  View details for PubMedID 22661148

• Ultra-Brief Intervention for Problem Drinkers: Results from a Randomized Controlled Trial PLOS ONE Cunningham, J. A., Neighbors, C., Wild, C., Humphreys, K. 2012; 7 (10)

  Abstract

  There are a number of evidence-based, in-person clinical inteventions for problem drinkers, but most problem drinkers will never seek such treatments. Reaching the population of non-treatment seeking problem drinkers will require a different approach. Accordingly, this randomized clinical trial evaluated an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as an indicated public health intervention (i.e., targeting the population of non-treatment seeking problem drinkers).Problem drinkers (N = 1767) completed a baseline population telephone survey and then were randomized to one of three conditions - a personalized feedback pamphlet condition, a control pamphlet condition, or a no intervention control condition. In the week after the baseline survey, households in the two pamphlet conditions were sent their respective interventions by postal mail addressed to 'Check Your Drinking.' Changes in drinking were assessed post intervention at three-month and six-month follow-ups. The follow-up rate was 86% at three-months and 76% at six-months. There was a small effect (p = .04) in one of three outcome variables (reduction in AUDIT-C, a composite measure of quantity and frequency of drinking) observed for the personalized feedback pamphlet compared to the no intervention control. No significant differences (p>.05) between groups were observed for the other two outcome variables - number of drinks consumed in the past seven days and highest number of drinks on one occasion.Based on the results of this study, we tentatively conclude that a brief intervention, modified to an ultra-brief, public health format can have a meaningful impact.ClinicalTrials.gov NCT00688584.

  View details for DOI 10.1371/journal.pone.0048003

  View details for Web of Science ID 000310310200133

  View details for PubMedID 23110157

  View details for PubMedCentralID PMC3480504

• A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery ANESTHESIA AND ANALGESIA Carroll, I., Barelka, P., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F., Whyte, R. I., Donington, J. S., Cannon, W. B., Mackey, S. C. 2012; 115 (3): 694-702

  Abstract

  Determinants of the duration of opioid use after surgery have not been reported. We hypothesized that both preoperative psychological distress and substance abuse would predict more prolonged opioid use after surgery.Between January 2007 and April 2009, a prospective, longitudinal inception cohort study enrolled 109 of 134 consecutively approached patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain. The primary end point was time to opioid cessation. All analyses were controlled for the type of surgery done.Overall, 6% of patients continued on new opioids 150 days after surgery. Preoperative prescribed opioid use, depressive symptoms, and increased self-perceived risk of addiction were each independently associated with more prolonged opioid use. Preoperative prescribed opioid use was associated with a 73% (95% confidence interval [CI] 0.51%-87%) reduction in the rate of opioid cessation after surgery (P = 0.0009). Additionally, each 1-point increase (on a 4-point scale) of self-perceived risk of addiction was associated with a 53% (95% CI 23%-71%) reduction in the rate of opioid cessation (P = 0.003). Independent of preoperative opioid use and self-perceived risk of addiction, each 10-point increase on a preoperative Beck Depression Inventory II was associated with a 42% (95% CI 18%-58%) reduction in the rate of opioid cessation (P = 0.002). The variance in the duration of postoperative opioid use was better predicted by preoperative prescribed opioid use, self-perceived risk of addiction, and depressive symptoms than postoperative pain duration or severity.Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.

  View details for DOI 10.1213/ANE.0b013e31825c049f

  View details for PubMedID 22729963

• Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence PSYCHIATRIC SERVICES Harris, A. H., Oliva, E., Bowe, T., Humphreys, K. N., Kivlahan, D. R., Trafton, J. A. 2012; 63 (7): 679-685

  Abstract

  This study assessed changes since 2007 at Veterans Health Administration (VHA) facilities (N=129) in use of the medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorders.VHA data from fiscal years (FYs) 2008 and 2009 were used to identify patients with a diagnosis of an alcohol use disorder who received oral or extended-release naltrexone, disulfiram, or acamprosate as well as the proportion of days covered (PDC) in the 180 days after initiation and the time to first ten-day gap in possession (persistence) for each medication. Multilevel, mixed-effects logistic regression models examined the association between patient and facility characteristics and use of medications.Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12%. In fully adjusted analyses, facilities offering evening and weekend services had higher rates of medication receipt, but other facility characteristics, such as having prescribers on the addiction program's staff or using medication to treat opioid or tobacco dependence, were unrelated to medication receipt. The mean PDC of acamprosate was significantly lower than mean PDCs of the other medications (p<.05), and persistence in use of naltrexone was significantly greater than use of acamprosate and significantly less than use of disulfiram (p<.05).Use of these medications is increasing but remains variable across the VHA system. Interventions are needed to optimize initiation of and persistence in use of these medications.

  View details for DOI 10.1176/appi.ps.201000553

  View details for Web of Science ID 000305931900011

  View details for PubMedID 22549276

• Scientific evidence alone is not sufficient basis for health policy BRITISH MEDICAL JOURNAL Humphreys, K., Piot, P. 2012; 344

  View details for DOI 10.1136/bmj.e1316

  View details for Web of Science ID 000301229800009

  View details for PubMedID 22371864

• What can we learn from the failure of yet another miracle cure' for addiction? ADDICTION Humphreys, K. 2012; 107 (2): 237-239

  View details for DOI 10.1111/j.1360-0443.2011.03652.x

  View details for Web of Science ID 000299156100001

  View details for PubMedID 22248129

• Drug policy and the public good: evidence for effective interventions LANCET Strang, J., Babor, T., Caulkins, J., Fischer, B., Foxcroft, D., Humphreys, K. 2012; 379 (9810): 71-83

  Abstract

  Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.

  View details for Web of Science ID 000298913000039

  View details for PubMedID 22225672

• Federal Policy on Criminal Offenders Who Have Substance Use Disorders: How Can We Maximize Public Health and Public Safety? SUBSTANCE ABUSE Humphreys, K. 2012; 33 (1): 5-8

  Abstract

  The Obama Administration is striving to promote both public health and public safety by improving the public policy response to criminal offenders who have substance use disorders. This includes supporting drug courts, evidence-based probation and parole programs, addiction treatment and re-entry programs. Scientists and clinicians in the addiction field have a critical role to play in this much-needed effort to break the cycle of addiction, crime and incarceration.

  View details for DOI 10.1080/08897077.2011.616805

  View details for Web of Science ID 000302609500002

  View details for PubMedID 22263708

• Moderation Management: A Mutual-Help Organization for Problem Drinkers Who Are Not Alcohol-Dependent JOURNAL OF GROUPS IN ADDICTION & RECOVERY Lembke, A., Humphreys, K. 2012; 7 (2-4): 130-141

  View details for DOI 10.1080/1556035X.2012.705657

  View details for Web of Science ID 000214087100005

• Normative Misperceptions about Alcohol Use in a General Population Sample of Problem Drinkers from a Large Metropolitan City ALCOHOL AND ALCOHOLISM Cunningham, J. A., Neighbors, C., Wild, T. C., Humphreys, K. 2012; 47 (1): 63-66

  Abstract

  Heavy drinkers tend to overestimate how much others drink (normative fallacy), at least in college samples. Little research has been conducted to evaluate whether normative misperceptions about drinking extend beyond the college population. The present study explored normative misperceptions in an adult general population sample of drinkers.As part of a larger study, in Toronto, Canada, a random digit dialling telephone survey was conducted with 14,009 participants who drank alcohol at least once per month. Respondents with Alcohol Use Disorders Identification Test of eight or more (n = 2757) were asked to estimate what percent of Canadians of their same sex: (a) drank more than they do; (b) were abstinent and (c) drank seven or more drinks per week. Respondents' estimates of these population drinking norms were then compared with the actual levels of alcohol consumption in the Canadian population.A substantial level of normative misperception was observed for estimates of levels of drinking in the general population. Estimates of the proportion of Canadians who were abstinent were fairly accurate. There was some evidence of a positive relationship between the respondents' own drinking severity and the extent of normative misperceptions. Little evidence was found of a relationship between degree of normative misperceptions and age.Normative misperceptions have been successfully targeted in social norms media campaigns as well as in personalized feedback interventions for problem drinkers. The present research solidifies the empirical bases for extending these interventions more widely into the general population.

  View details for DOI 10.1093/alcalc/agr125

  View details for Web of Science ID 000298384600010

  View details for PubMedID 22028458

  View details for PubMedCentralID PMC3243438

• A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients ADDICTION Humphreys, K., McLellan, A. T. 2011; 106 (12): 2058-2066

  Abstract

  To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers.  We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into 'process-focused quality improvement strategies' that attempt to change some aspect of treatment (e.g. increased retention, greater use of evidence-based practices) and 'patient-focused strategies' that attempt to reward outcomes directly (e.g. contingency management for patients, payment by results for providers).  Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.

  View details for DOI 10.1111/j.1360-0443.2011.03464.x

  View details for Web of Science ID 000296534200002

  View details for PubMedID 21631620

• Cross-Level Bias and Variations in Care JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Finney, J. W., Humphreys, K., Harris, A. H. 2011; 306 (19): 2096-2097

  View details for Web of Science ID 000297013000014

  View details for PubMedID 22089717

• If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Wagner, T. H., Gage, M. 2011; 41 (3): 243-251

  Abstract

  Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? This article attempts to explain this puzzling discrepancy by analyzing 1998-2006 data from the national Veterans Affairs (VA) health care system. The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.

  View details for DOI 10.1016/j.jsat.2011.04.006

  View details for Web of Science ID 000294982100004

  View details for PubMedID 21664790

• Who uses online interventions for problem drinkers? JOURNAL OF SUBSTANCE ABUSE TREATMENT Cunningham, J. A., Wild, T. C., Humphreys, K. 2011; 41 (3): 261-264

  Abstract

  The goal of this research was to understand why some people use online interventions for drinking problems, whereas others with comparable access to the interventions do not. As part of a randomized controlled trial, 92 participants in the experimental condition were provided access to a password-protected version of a Web-based personalized feedback intervention (the Check Your Drinking [CYD] screener, www.CheckYourDrinking.net). Information collected at baseline was compared between those who accessed the Web site and those who did not. Those who accessed the Web site tended to be more frequent users of the Internet, to drink less, and to perceive that others of the same age and gender drank less as compared with those who did not access the intervention. Some of these results are troubling as the preferred target of this type of intervention would be those who drink more and perceive that others are also heavy alcohol consumers.

  View details for DOI 10.1016/j.jsat.2011.03.003

  View details for Web of Science ID 000294982100006

  View details for PubMedID 21632197

  View details for PubMedCentralID PMC3166539

• Why Health Care Process Performance Measures Can Have Different Relationships to Outcomes for Patients and Hospitals: Understanding the Ecological Fallacy AMERICAN JOURNAL OF PUBLIC HEALTH Finney, J. W., Humphreys, K., Kivlahan, D. R., Harris, A. H. 2011; 101 (9): 1635-1642

  Abstract

  Relationships between health care process performance measures (PPMs) and outcomes can differ in magnitude and even direction for patients versus higher level units (e.g., health care facilities). Such discrepancies can arise because facility-level relationships ignore PPM-outcome relationships for patients within facilities, may have different confounders than patient-level PPM-outcome relationships, and may reflect facility effect modification of patient PPM-outcome relationships. If a patient-level PPM is related to better patient outcomes, that care process should be encouraged. However, the finding in a multilevel analysis that the proportion of patients receiving PPM care across facilities nevertheless is linked to poor hospital outcomes would suggest that interventions targeting the health care facility also are needed.

  View details for DOI 10.2105/AJPH.2011.300153

  View details for Web of Science ID 000294090500017

  View details for PubMedID 21778493

  View details for PubMedCentralID PMC3154212

• Addiction's priorities when evaluating submissions ADDICTION West, R., Miller, P. G., Babor, T., Marsden, J., Darke, S., Humphreys, K., Edwards, G., Hall, W. 2011; 106 (3): 463-465

  View details for DOI 10.1111/j.1360-0443.2011.03367.x

  View details for Web of Science ID 000287032500001

• A New Paradigm for Long-Term Recovery SUBSTANCE ABUSE DuPont, R. L., Humphreys, K. 2011; 32 (1): 1-6

  View details for DOI 10.1080/08897077.2011.540497

  View details for Web of Science ID 000287030800001

  View details for PubMedID 21302178

• OUR MAP SHOULD CORRESPOND WITH THE TERRITORY ADDICTION Humphreys, K. 2010; 105 (12): 2054-2056

  View details for DOI 10.1111/j.1360-0443.2010.03156.x

  View details for Web of Science ID 000283946600006

  View details for PubMedID 21105304

• Brief Intervention, Treatment, and Recovery Support Services for Americans Who Have Substance Use Disorders: An Overview of Policy in the Obama Administration PSYCHOLOGICAL SERVICES Humphreys, K., McLellan, A. T. 2010; 7 (4): 275-284

  View details for DOI 10.1037/a0020390

  View details for Web of Science ID 000292529900006

• Something Must Be Done!: But Is Moore Correct that Something Can Be Worse than Nothing in Alcohol Control Policy? ALCOHOL AND ALCOHOLISM Humphreys, K. 2010; 45 (5): 409-411

  View details for DOI 10.1093/alcalc/agq044

  View details for Web of Science ID 000281528300003

  View details for PubMedID 20705618

• The cost of concordance with opiate substitution treatment guidelines JOURNAL OF SUBSTANCE ABUSE TREATMENT Barnett, P. G., Trafton, J. A., Humphreys, K. 2010; 39 (2): 141-149

  Abstract

  The Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

  View details for DOI 10.1016/j.jsat.2010.05.012

  View details for Web of Science ID 000280623600007

  View details for PubMedID 20598830

• Twelve-Month Follow-up Results from a Randomized Controlled Trial of a Brief Personalized Feedback Intervention for Problem Drinkers ALCOHOL AND ALCOHOLISM Cunningham, J. A., Wild, T. C., Cordingley, J., van Mierlo, T., Humphreys, K. 2010; 45 (3): 258-262

  Abstract

  To examine the impact of a web-based personalized feedback intervention, the Check Your Drinking (CYD; www.CheckYourDrinking.net) screener at 12-month follow-up.Respondents (N = 185) were recruited from a general population telephone survey of Ontario, Canadian adults (> or =18 years) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers. Those randomly assigned to the intervention condition were provided with the web address and a unique password to a study-specific copy of the CYD. Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be. Respondents were followed up at 3, 6 and 12 months.By the 12-month follow-up, the impact of the intervention previously reported at 3 and 6 months of CYD on problem drinkers' alcohol consumption was no longer apparent (P > 0.05).Recognizing that many people with alcohol concerns will never seek treatment, recent years have seen an increase in efforts to find ways to take treatment to problem drinkers. The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term (i.e. 6 months). Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns.

  View details for DOI 10.1093/alcalc/agq009

  View details for Web of Science ID 000276995500008

  View details for PubMedID 20150170

  View details for PubMedCentralID PMC2857148

• Predictors of Attrition from a National Sample of Methadone Maintenance Patients AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Mancino, M., Curran, G., Han, X., Allee, E., Humphreys, K., Booth, B. M. 2010; 36 (3): 155-160

  Abstract

  Methadone substitution therapy is an effective harm reduction treatment method for opioid dependent persons. Ability to retain patients in methadone treatment is an accepted predictor of treatment outcomes.The current study evaluates the roles of psychiatric comorbidity, medical comorbidity, and sociodemographic characteristics as predictors of retention in methadone treatment utilizing retrospective analysis of data from a nationwide sample of patients in methadone treatment in the VA.Data were gathered using the VA's national health services use database. A cohort of veterans with a new episode of "opiate substitution" in fiscal year 1999 was identified, and their continuous service use was tracked through fiscal year 2002. The sample included a total of 2,363 patients in 23 VA medical centers. Survival analysis was used to explore factors associated with retention in methadone treatment.Younger age, having a serious mental illness, being African American, or having race recorded as unknown were associated with lower rates of retention in methadone treatment programs in this population of veterans (controlling for site).Given that extended methadone treatment is associated with improved outcomes while patients remain in treatment, more longitudinal studies using primary data collection are needed to fully explore factors related to retention. For the VA population specifically, further research is necessary to fully understand the relationship between race/ethnicity and treatment retention.This is the first retention study the authors are aware of that utilizes data from a nationwide, multisite, population of participants in methadone treatment.

  View details for DOI 10.3109/00952991003736389

  View details for Web of Science ID 000279669400004

  View details for PubMedID 20465373

  View details for PubMedCentralID PMC3314423

• Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration PSYCHIATRIC SERVICES Harris, A. H., Kivlahan, D. R., Bowe, T., Humphreys, K. N. 2010; 61 (4): 392-398

  Abstract

  Acamprosate, oral and long-acting injectable naltrexone, and disulfiram are approved for treatment of alcohol dependence. Their availability and consideration of their use in treatment are now standards of high-quality care. This study determined rates of medication initiation among Veterans Health Administration (VHA) patients.VHA pharmacy and administrative data were used to identify patients with alcohol use disorder diagnoses in fiscal years (FY) 2006 and 2007 and the proportion (nationally and by facility) who received each medication. Patient characteristics associated with receipt were also examined.Among more than a quarter-million patients with alcohol use disorder diagnoses, the percentage receiving any of the medications increased from 2.8% in FY 2006 to 3.0% in FY 2007. Receipt of these medications was more likely among patients who received specialty addiction care, those with alcohol dependence (compared with abuse), those younger than 55 years, and females. In the patient subgroups examined, the largest proportion to receive any of the medications was 11.6%. Across 128 VHA facilities, rates of use among patients in the sample who had received past-year specialty addiction treatment ranged from 0% to 20.5%; rates ranged from 0% to 4.3% among those with no specialty treatment. Patient preferences and medical contraindications could not be determined from the data.Findings suggest the need to better understand systemwide variation in use of these medications and their use as a rough proxy for availability and consideration of pharmacotherapy--a standard of care with strong organizational support.

  View details for Web of Science ID 000276254200011

  View details for PubMedID 20360279

• Ineligibility and refusal to participate in randomised trials of treatments for drug dependence DRUG AND ALCOHOL REVIEW Melberg, H. O., Humphreys, K. 2010; 29 (2): 193-201

  Abstract

  The aim of this study is to examine the extent to which drug-dependent patients are ineligible for or unwilling to participate in randomised clinical trials. This is important because unrepresentative sample selection is a potentially important problem for randomised trials in the drug dependence field and little is known about the magnitude of the problem.A total of 98 clinical trials were drawn for analysis from a systematic review of the drug dependence treatment literature.The trials reviewed excluded an average of 29% of potential subjects as ineligible; a further 29% of the eligible subjects were unwilling to participate. Trials comparing widely different treatments had a higher proportion of ineligible and unwilling subjects than did studies comparing more similar treatments. Experiments with large samples enrolled a smaller proportion of patients from their sampling pool than did experiments with small samples.Drug-dependent trial subjects are a minority of all drug patients seen in real-world clinical practice. It is necessary to improve the reporting of these potential problems in randomised trials. Systematic reviews of the literature ought to use this information to distinguish reliable from less reliable findings.Unrepresentative sample selection is a serious problem for randomised trials in the drug dependence field.

  View details for DOI 10.1111/j.1465-3362.2009.00096.x

  View details for Web of Science ID 000275142500013

  View details for PubMedID 20447229

• Does Meeting the HEDIS Substance Abuse Treatment Engagement Criterion Predict Patient Outcomes? JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH Harris, A. H., Humphreys, K., Bowe, T., Tiet, Q., Finney, J. W. 2010; 37 (1): 25-39

  Abstract

  This study examines the patient-level associations between the Health Plan Employer Data and Information Set (HEDIS) substance use disorder (SUD) treatment engagement quality indicator and improvements in clinical outcomes. Administrative and survey data from 2,789 US Department of Veterans Affairs SUD patients were used to estimate the effects of meeting the HEDIS engagement criterion on improvements in Addiction Severity Index Alcohol, Drug, and Legal composite scores. Patients meeting the engagement indicator improved significantly more in all domains than patients who did not engage, and the relationship was stronger for alcohol and legal outcomes for patients seen in outpatient settings. The benefit accrued by those who engaged was statistically significant but clinically modest. These results add to the literature documenting the clinical benefits of treatment entry and engagement. Although these findings only indirectly support the use of the HEDIS engagement measure for its intended purpose-discriminating quality at the facility or system level-they confirm that the processes of care captured by the measure are associated with important patient outcomes.

  View details for DOI 10.1007/s11414-008-9142-2

  View details for Web of Science ID 000273686300003

  View details for PubMedID 18770044

• RESEARCH ON ALCOHOLICS ANONYMOUS AND SPIRITUALITY IN ADDICTION RECOVERY. (RECENT DEVELOPMENTS IN ALCOHOLISM vol 18) (Book Review) ADDICTION Book Review Authored by: Humphreys, K. 2010; 105 (1): 179-180

  View details for DOI 10.1111/j.1360-0443.2009.02868_3.x

  View details for Web of Science ID 000272769800033

• The Contributions of Mutual Help Groups for Mental Health Problems to Psychological Well-Being: A Systematic Review MENTAL HEALTH SELF-HELP: CONSUMER AND FAMILY INITIATIVES Pistrang, N., Barker, C., Humphreys, K., Brown, L. D., Wituk, S. 2010: 61-85

  View details for DOI 10.1007/978-1-4419-6253-9_4

  View details for Web of Science ID 000281455900004

• Assessing why substance use disorder patients drop out from or refuse to attend 12-step mutual-help groups: The "REASONS" questionnaire ADDICTION RESEARCH & THEORY Kelly, J. F., Kahler, C. W., Humphreys, K. 2010; 18 (3): 316-325

  View details for DOI 10.3109/16066350903254775

  View details for Web of Science ID 000277006600006

• Developing and Validating Process Measures of Health Care Quality An Application to Alcohol Use Disorder Treatment Academy Health Annual Research Meeting Harris, A. H., Kivlahan, D. R., Bowe, T., Finney, J. W., Humphreys, K. LIPPINCOTT WILLIAMS & WILKINS. 2009: 1244–50

  Abstract

  Health care process quality measures usually are designed by expert panels attempting to synthesize nuanced clinical evidence and subsequently operationalized using administrative data. Many quality measures are then adopted without directly validating their presumed links with outcomes. Later efforts to validate process measures often yield negative results, leaving policy makers without a defensible means of measuring quality. This article presents an alternative strategy for developing and validating process quality measures. The development of an alcohol use disorder (AUD) treatment quality measure is used as an example.An expert panel generated a range of candidate process quality measures of AUD treatment derivable from administrative data that were then tested to determine which had the strongest associations with facility- and patient-level outcomes. Outcome and process data were from 2701 US Veterans Health Administration patients starting a new episode of care at 54 VA facilities.Several of the candidate process-of-care quality measures predicted facility- and patient-level outcomes. Having at least 3 visits during the first month of specialty AUD treatment was correlated with improvement on the Addiction Severity Index Alcohol composite at the facility level, r = 0.41 (95% Confidence Interval 0.16-0.61), and at the patient level, r = 0.07 (CI: 0.03-0.11).These "prevalidated" quality measures can now be judged for the extent they map onto the extant clinical literature and other design requirements. The development and validation strategy we describe should aid in efficiently producing quality measures in other areas of health care.

  View details for Web of Science ID 000272488100008

  View details for PubMedID 19786908

• A randomized controlled trial of an internet-based intervention for alcohol abusers ADDICTION Cunningham, J. A., Wild, T. C., Cordingley, J., van Mierlo, T., Humphreys, K. 2009; 104 (12): 2023-2032

  Abstract

  Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener ( http://www.CheckYourDrinking.net).Participants (n = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group.Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents.The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment.

  View details for DOI 10.1111/j.1360-0443.2009.02726.x

  View details for Web of Science ID 000271625500011

  View details for PubMedID 19922569

  View details for PubMedCentralID PMC2779998

• Responding to the Psychological Impact of War on the Iraqi People and US Veterans: Mixing Icing, Praying for Cake AMERICAN PSYCHOLOGIST Humphreys, K. 2009; 64 (8): 712-723

  Abstract

  The psychological impact of the war in Iraq stimulated major initiatives to build a modern mental health care system for the Iraqi people and to improve mental health services for U.S. veterans of the Iraq war. Although these two initiatives differ in important respects, they are both informed by general principles of psychology concerning the nature of social problem definition, the process of human adaptation to extreme stress and its aftermath, and the role and limits of mental health services. Building on these common themes and my own experiences, I describe how two nations are trying to address the colossal psychological damage wrought by the war in Iraq.

  View details for Web of Science ID 000271875300016

  View details for PubMedID 19899875

• How Internet technology can improve the quality of care for substance use disorders. Current drug abuse reviews Cucciare, M. A., Weingardt, K. R., Humphreys, K. 2009; 2 (3): 256-262

  Abstract

  By allowing for the efficient delivery of instructional content and the secure collection of self-report data regarding substance use and related problems, the Internet has tremendous potential to improve the effectiveness and accessibility of addiction treatment services. This article discusses some of the ways in which Internet technology can facilitate, complement and support the process of traditional clinician-delivered treatment for individuals with substance use disorders. Internet applications are being used to support a range of activities including (a) the assessment and feedback process that constitutes a central feature of brief motivational interventions, (b) the concurrent monitoring of individual level outcomes among patients who are currently enrolled in addiction treatment programs, (c) the continuing care and ongoing recovery of patients who have completed treatment, and (d) the delivery of clinical training in evidence based practices for addiction treatment providers. This emerging body of literature suggests that addiction counselors and program administrators can enhance the quality of clinician-delivered treatment by incorporating internet applications into existing processes of care. Internet applications provide an unparalleled opportunity to engage patients in the treatment process, incorporate real-time data into treatment planning, prevent relapse, and promote evidence-based treatment approaches.

  View details for PubMedID 20443772

• HEDIS Initiation and Engagement Quality Measures of Substance Use Disorder Care: Impact of Setting and Health Care Specialty POPULATION HEALTH MANAGEMENT Harris, A. H., Bowe, T., Finney, J. W., Humphreys, K. 2009; 12 (4): 191-196

  Abstract

  Many health care systems track the HEDIS measures of initiation and engagement in substance use disorder (SUD) care. However, the impact of setting of care (inpatient vs. outpatient) and health care specialty (SUD, psychiatric, other) on the likelihood of patients meeting the initiation and engagement criteria are unknown. If the vast majority of initiation and engagement occurs within SUD specialty clinics, then these quality measures could be used to discriminate among and incentivize SUD clinic managers. However, if these criteria are satisfied in different settings and specialties, then they should be considered characteristics of the entire facility, rather than just specialty SUD units. Using a Markov model, the probabilities of advancing to treatment initiation and engagement given initial setting and specialty of care were estimated for 320,238 SUD-diagnosed Veterans Health Affairs (VA) patients. Patients in SUD specialty units progressed more often (diagnosis to initiation, initiation to engagement) than patients in other specialties. Progression through the criteria differed for inpatients vs. outpatients. Approximately 25% of initiation and over 40% of engagement occurred outside of SUD specialty care. VA patients who have contact with SUD specialty treatment have higher rates of advancing to initiation, and from initiation to engagement, compared to SUD-diagnosed patients in psychiatric or other medical locations. Even so, a substantial portion of initiation and engagement occurs outside of SUD specialty units. Therefore, these quality measures should be considered measures of facility performance rather than measures of the quality of SUD specialty care. The usual combining of inpatient and outpatient performance on these measures into overall facility scores clouds measurement and interpretation.

  View details for DOI 10.1089/pop.2008.0028

  View details for Web of Science ID 000268811100004

  View details for PubMedID 19663621

• The Role of AA Sponsors: A Pilot Study ALCOHOL AND ALCOHOLISM Whelan, P. J., Marshall, E. J., Ball, D. M., Humphreys, K. 2009; 44 (4): 416-422

  Abstract

  The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors' responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range 5-28); the median length of sobriety was 11 years (range 4.5-28); the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56). Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1) encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact, emotional support and practical support); and (3) carrying the message of AA (sharing sponsor's personal experience of recovery with sponsees).The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

  View details for DOI 10.1093/alcalc/agp014

  View details for Web of Science ID 000267440300012

  View details for PubMedID 19297380

• Datapoints: Iraqi psychiatrists' perceptions of substance use disorders among patients. Psychiatric services Al-Hasnawi, S. M., Aqrawi, R., Sadik, S., Humphreys, K. 2009; 60 (6): 728-?

  View details for DOI 10.1176/appi.ps.60.6.728

  View details for PubMedID 19487343

• Organizational contexts of primary care approaches for managing problem drinking JOURNAL OF SUBSTANCE ABUSE TREATMENT Schutte, K., Yano, E. M., Kilbourne, A. M., Wickrama, B., Kirchner, J. E., Humphreys, K. 2009; 36 (4): 435-445

  Abstract

  Little is known about the organizational contexts associated with different primary care (PC) approaches to managing PC patients with drinking problems. Relying upon the Chronic Care Model and a theoretically based taxonomy of health care systems, we identified organizational factors distinguishing PC practices using PC-based approaches (managed by PC providers, mental health specialists, or jointly with specialty services) versus referral-based management in the Veterans Affairs health care system. Data were obtained from a national survey of 218 PC practices characterizing usual management approaches as well as practices' leadership, delivery system design, information system, and decision support characteristics and from a national survey of substance use disorder specialty programs. PC- and referral-based practices did not differ on the sufficiency of their structural resources, physician staffing, or on the availability of specialty services. However, PC-based practices were found to take more responsibility for managing patients' chronic conditions and had more staff for decision support activities.

  View details for DOI 10.1016/j.jsat.2008.09.002

  View details for Web of Science ID 000265990600010

  View details for PubMedID 19004595

• Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure JOURNAL OF SUBSTANCE ABUSE TREATMENT Harris, A. H., Humphreys, K., Bowe, T., Kivlahan, D. R., Finney, J. W. 2009; 36 (3): 294-305

  Abstract

  This study examined the patient- and facility-level associations between the continuity of care performance measure adopted by the Department of Veterans Affairs (VA) and improvements in self-administered Addiction Severity Index (ASI) composites and other indicators of problematic substance use. Up to 50 patients from each of a nationally representative sample of 109 VA substance use disorder (SUD) treatment programs at 73 VA facilities were assessed at intake and posttreatment. The continuity of care performance measure specifies that patients should receive at least two SUD outpatient visits in each of the three consecutive 30-day periods after they qualify as new SUD patients. In analyses adjusting for baseline characteristics, meeting the continuity of care performance measure was not associated with patient-level improvements in the ASI alcohol or drug composites, days of alcohol intoxication, or days of substance-related problems. Facility-level rates of continuity of care were negatively associated with improvements in ASI alcohol and drug composites. The continuity of care performance measure derived from prior patient-level evidence did not discriminate facility-level performance as predicted. Translating research into process-of-care quality measures requires postconstruction validation.

  View details for DOI 10.1016/j.jsat.2008.05.011

  View details for Web of Science ID 000264510000006

  View details for PubMedID 18835678

• Searching Where the Light Is Worse: Overemphasizing Genes and Underplaying Environment in the Quest to Reduce Substance Misuse CLINICAL PHARMACOLOGY & THERAPEUTICS Humphreys, K. 2009; 85 (4): 357-358

  View details for DOI 10.1038/clpt.2008.263

  View details for Web of Science ID 000264455300007

  View details for PubMedID 19295533

• Extending the benefits of addiction treatment: Practical strategies for continuing care and recovery JOURNAL OF SUBSTANCE ABUSE TREATMENT McKay, J. R., Carise, D., Dennis, M. L., Dupont, R., Humphreys, K., Kemp, J., Reynolds, D., White, W., Armstrong, R., Chalk, M., Haberle, B., McLellan, T., O'Connor, G., Pakull, B., Schwartzlose, J. 2009; 36 (2): 127-130

  View details for DOI 10.1016/j.jsat.2008.10.005

  View details for Web of Science ID 000263305700001

  View details for PubMedID 19161893

  View details for PubMedCentralID PMC2744393

• Performance Monitoring of Substance Use Disorder Interventions in the Veterans Health Administration AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Humphreys, K., Harris, A. H., Kivlahan, D. R. 2009; 35 (3): 123-127

  Abstract

  Measuring and improving the quality of treatment for patients with substance use disorders are enduring challenges.This article describes how the Veterans Affairs health care system is using incentivized performance measures to promote more effective delivery of interventions for nicotine, illegal drug, and alcohol disorders.The monitoring and incentive system has increased the delivery of evidence-based services, including screening for alcohol use disorders.Further work remains to be done to strengthen the connection between process-based measures and longer-term patient outcomes.

  View details for DOI 10.1080/00952990802707042

  View details for Web of Science ID 000266277700002

  View details for PubMedID 19462294

• Responding to Rising Substance Misuse in Iraq SUBSTANCE USE & MISUSE Aqrawi, R., Humphreys, K. 2009; 44 (12): 1744-1748

  Abstract

  We present an overview of the current substance misuse situation in Iraq. Numerous indicators as well as first-hand observations of the authors, suggest that substance misuse is increasing in Iraq. Violence, economic uncertainty, poorly monitored borders, and a porous pharmacy system, all appear to be contributing to the problem. Yet, Iraq also has significant features that put some restraints on the size of the problem, most notably highly cohesive families and prevalent religiosity. The Iraqi Ministry of Health is leading an international effort to respond to rising substance misuse and associated mental and physical health conditions.

  View details for DOI 10.3109/10826080902963415

  View details for Web of Science ID 000272093000007

  View details for PubMedID 19895304

• Assessing spirituality/religiosity in the treatment environment: The Treatment Spirituality/Religiosity Scale JOURNAL OF SUBSTANCE ABUSE TREATMENT Lillis, J., Gifford, E., Humphreys, K., Moos, R. 2008; 35 (4): 427-433

  Abstract

  There has been much interest in measuring and evaluating the role of spirituality/religiosity (S/R) in substance use disorder (SUD) treatment. This study presents the initial evaluation of a new measure of S/R in the treatment environment: the Treatment Spirituality/Religiosity Scale (TSRS). The TSRS has 10 items and can be completed by both patient and staff to measure the emphasis on S/R in a given treatment program, which may have important implications for patient-program fit. Data on the TSRS were gathered from 3,018 patients and 329 staff members from 15 residential SUD treatment programs within the Department of Veterans Affairs Health Care System. The TSRS showed good internal consistency (alpha = .77), a single-factor structure, close agreement between patients and staff members (r = .93), and good discriminant validity. The TSRS appears to be a brief, easily administered, and potentially useful measure of the emphasis on S/R in residential SUD treatment programs.

  View details for DOI 10.1016/j.jsat.2008.02.002

  View details for Web of Science ID 000260800700009

  View details for PubMedID 18424049

• Subject eligibility criteria can substantially influence the results of alcohol-treatment outcome research JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Humphreys, K., Harris, A. H., Weingardt, K. R. 2008; 69 (5): 757-764

  Abstract

  Most alcohol-treatment studies exclude some patients from participation based on particular criteria (e.g., comorbid illegal drug abuse, homelessness). The current study evaluated whether such eligibility criteria can change the outcome results a study obtains.Five widely used treatment research eligibility criteria--(1) psychiatric problems, (2) medical problems, (3) social-residential instability, (4) low motivation/noncompliance, and (5) drug problems--were applied to two samples of real-world alcohol patients whose outcomes were known. Comparing outcomes of the samples with and without the application of eligibility criteria produced estimates of bias in outcome results, as well as an assessment of change in statistical power.Medical and psychiatric eligibility criteria produced a moderate bias in outcome estimates (e.g., a 10% or less change in outcome results). In contrast, social-residential instability, low motivation/noncompliance, and drug use produced a large (e.g., up to an 18% change) to a very large (e.g., up to a 51% change) bias in outcome estimates. Sensitivity analyses showed that these biases are even larger if eligibility criteria are operationalized in a broad rather than a narrow fashion. Contrary to expectation, eligibility criteria did not produce their theoretically expected benefit of increased statistical power.Researchers who use eligibility criteria should do so judiciously and interpret outcome results in light of potential bias introduced by the ineligibility of some patients for study enrollment. Efforts to integrate findings across treatment outcome studies should also consider how conclusions might be affected by the eligibility criteria used in different research areas.

  View details for Web of Science ID 000259205200015

  View details for PubMedID 18781251

  View details for PubMedCentralID PMC2575392

• Mutual help groups for mental health problems: A review of effectiveness studies AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Pistrang, N., Barker, C., Humphreys, K. 2008; 42 (1-2): 110-121

  Abstract

  This paper reviews empirical studies on whether participating in mutual help groups for people with mental health problems leads to improved psychological and social functioning. To be included, studies had to satisfy four sets of criteria, covering: (1) characteristics of the group, (2) target problems, (3) outcome measures, and (4) research design. The 12 studies meeting these criteria provide limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement. Seven studies reported positive changes for those attending support groups. The strongest findings come from two randomized trials showing that the outcomes of mutual help groups were equivalent to those of substantially more costly professional interventions. Five of the 12 studies found no differences in mental health outcomes between mutual help group members and non-members; no studies showed evidence of negative effects. There was no indication that mutual help groups were differentially effective for certain types of problems. The studies varied in terms of design quality and reporting of results. More high-quality outcome research is needed to evaluate the effectiveness of mutual help groups across the spectrum of mental health problems.

  View details for DOI 10.1007/s10464-008-9181-0

  View details for Web of Science ID 000258653100010

  View details for PubMedID 18679792

• A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Greenfield, T. K., Stoneking, B. C., Humphreys, K., Sundby, E., Bond, J. 2008; 42 (1-2): 135-144

  Abstract

  This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment.

  View details for DOI 10.1007/s10464-008-9180-1

  View details for Web of Science ID 000258653100012

  View details for PubMedID 18626766

  View details for PubMedCentralID PMC2782949

• Ultra-brief intervention for problem drinkers: research protocol BMC PUBLIC HEALTH Cunningham, J. A., Neighbors, C., Wild, C., Humphreys, K. 2008; 8

  Abstract

  Helping the large number of problem drinkers who will never seek treatment is a challenging issue. Public health initiatives employing educational materials or mass media campaigns have met with mixed success. However, clinical research has developed effective brief interventions to help problem drinkers. This project will employ an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as a public health intervention. The major objective of this study is to conduct a randomized controlled trial to establish the effectiveness of an ultra-brief, personalized feedback intervention for problem drinkers.Problem drinkers recruited on a baseline population telephone survey conducted in a major metropolitan city in Canada will be randomized to one of three conditions - a personalized feedback pamphlet condition, a control pamphlet condition, or a no intervention control condition. In the week after the baseline survey, households in the two pamphlet conditions will be sent their respective pamphlets. Changes in drinking will be assessed post intervention at three-month and six-month follow-ups. Drinking outcomes will be compared between experimental conditions using Structural Equation Modeling. The primary hypothesis is that problem drinkers from households who receive the personalized feedback pamphlet intervention will display significantly improved drinking outcomes at three and six-month follow-ups as compared to problem drinkers from households in the no intervention control condition. Secondary hypotheses will test the impact of the intervention on help seeking, and explore the mediating or moderating role of perceived drinking norms, perceived alcohol risks and the problem drinker's social reasons for drinking.This trial will provide information on the effectiveness of a pamphlet-based personalized feedback intervention for problem drinkers in a community setting.ClinicalTrials.gov registration #NCT00688584.

  View details for DOI 10.1186/1471-2458-8-298

  View details for Web of Science ID 000258797400001

  View details for PubMedID 18727823

  View details for PubMedCentralID PMC2528012

• The underrepresentation of African Americans in online cancer support groups JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Fogel, J., Ribisl, K. M., Morgan, P. D., Humphreys, K., Lyons, E. J. 2008; 100 (6): 705-712

  Abstract

  The Internet is increasingly important for many cancer survivors because it provides access to the latest information on cancer treatments and also allows them to receive support by participating in online cancer support groups. Unfortunately, little is known about why African-American cancer survivors are underrepresented in online cancer support groups. This article reviews the relevant literature and discusses three possible explanations for why African Americans are underrepresented in online cancer support groups: the digital divide/digital inequality, preferences for face-to-face support or culture-specific online support, and trust concerns. We conclude that a health inequity exists with regard to the utilization of information that can be obtained from online cancer support groups. However, with regard to the potential benefits of the psychosocial and emotional support aspect of online cancer support groups, a health inequity may not exist, as African Americans have other preferred avenues for obtaining needed support, and there is no evidence that this is detrimental to their health.

  View details for Web of Science ID 000256771200007

  View details for PubMedID 18595573

• Can Dr Orford's patient be saved? ADDICTION Humphreys, K. 2008; 103 (6): 887-888

  View details for DOI 10.1111/j.1360-0443.2008.02163.x

  View details for Web of Science ID 000255914400004

• Does following research-derived practice guidelines improve opiate-dependent patients' outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Trafton, J. A., Oliva, E. M. 2008; 34 (2): 173-179

  Abstract

  The Multisite Opiate Substitution Treatment study evaluated whether adhering to clinical-trial-derived practice guidelines improves treatment outcomes of unselected opiate-dependent patients seen in everyday practice. Clinics that were relatively concordant (n = 4) or nonconcordant (n = 4) with guidelines concerning medication dose levels and psychosocial service provision were identified. Staff interviewed 256 patients at intake and 6-month follow-up regarding past month heroin use, criminal activities, and mental health. To represent real-world practice conditions, clinics provided care in accordance with their usual approach, and no patient exclusion criteria were employed. Patients in each type of clinic were similar at baseline, but by follow-up, heroin use and mental health outcomes were significantly better in guideline-concordant clinics than in guideline-discordant clinics. Notably, 60.6% of patients in concordant clinics had urinalysis-confirmed heroin abstinence versus only 40.0% in nonconcordant clinics. Following research-derived practice guidelines seems to increase opiate substitution treatment effectiveness for opiate-dependent patients in the real world.

  View details for DOI 10.1016/j.jsat.2007.03.001

  View details for Web of Science ID 000253222900004

  View details for PubMedID 17499955

• Veterans affairs facility performance on Washington circle indicators and casemix-adjusted effectiveness JOURNAL OF SUBSTANCE ABUSE TREATMENT Harris, A. H., Humphreys, K., Finney, J. W. 2007; 33 (4): 333-339

  Abstract

  Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in 1 of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.

  View details for DOI 10.1016/j.jsat.2006.12.015

  View details for Web of Science ID 000251110700001

  View details for PubMedID 17400416

• Alcohol, addiction and christian ethics (Book Review) ADDICTION Book Review Authored by: Humphreys, K. 2007; 102 (12): 1989-1990

  View details for DOI 10.1111/j.1360-0443.2007.02044.x

  View details for Web of Science ID 000251185000022

• Improving medicare coverage of psychological services for older Americans AMERICAN PSYCHOLOGIST Karlin, B. E., Humphreys, K. 2007; 62 (7): 637-649

  Abstract

  Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.

  View details for DOI 10.1037/0003-066X.62.7.637

  View details for Web of Science ID 000250131700002

  View details for PubMedID 17924748

• Consistent adherence to guidelines improves opioid dependent patients' first year outcomes JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH Trafton, J. A., Humphreys, K., Harris, A. H., Oliva, E. 2007; 34 (3): 260-271

  Abstract

  Clinical practice guidelines for opioid substitution treatment (OST) for opioid dependence recommend that patients receive at least 60 mg daily methadone and have access to a broad array of psychosocial services. However, there is still wide variation in clinical practice in OST clinics. In real-world settings, patients could receive lower methadone doses and less psychosocial care because they require less intensive care for recovery; alternatively, barriers to delivery of guideline concordant care could limit treatment received and impair recovery. The Multisite Opioid Substitution Treatment (MOST) study examines the impact of more consistent adherence to guideline recommendations in eight Veterans Affairs OST clinics. While patients at all clinics demonstrated improvements in substance use over the first year in treatment, patients at clinics that more consistently adhered to guidelines had greater reductions in heroin and cocaine use and greater improvement in mental health. These results suggest that efforts to increase guideline adherence in OST will improve patient outcomes.

  View details for DOI 10.1007/s11414-007-9074-2

  View details for Web of Science ID 000249225600003

  View details for PubMedID 17610159

• Influence of subject eligibility criteria on compliance with national institutes of health guidelines for inclusion of women, minorities, and children in treatment research ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Weingardt, K. R., Harris, A. H. 2007; 31 (6): 988-995

  Abstract

  Many alcohol treatment outcome studies exclude some patients with particular problems, such as psychiatric disorders, noncompliance, and homelessness. Such criteria may increase the likelihood of a study being successfully conducted, but may also have the unintended consequence of reducing a study's ability to comply with National Institutes of Health guidelines for inclusion of racial minorities, women, and children in treatment research.This paper examined this issue empirically using 5 prior studies of treatment systems enrolling over 100,000 alcohol patients. Widely used eligibility criteria in the alcohol treatment field typically exclude between one-fifth to one-third of patients from enrolling in research. Under several eligibility criteria, most notably those for drug use and social/residential instability, women and African-American patients are substantially more likely to be excluded than are men and non-African-American patients, respectively.In designing treatment studies with many eligibility criteria, researchers may therefore inadvertently be thwarting their own good faith efforts to ensure that a range of vulnerable populations are able to participate in research. We analyze the implications of this dilemma for the generalizability of treatment results and for research design, and provide data that may help researchers working in different treatment systems estimate the impact of various eligibility criteria.

  View details for DOI 10.1111/j.1530-0277/2007.00391.x

  View details for Web of Science ID 000246576500009

  View details for PubMedID 17428295

• Different components of opioid-substitution treatment predict outcomes of patients with and without a parent with substance-use problems JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Trafton, J. A., Tracy, S. W., Oliva, E. M., Humphreys, K. 2007; 68 (2): 165-172

  Abstract

  The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems.This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined.Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use.The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.

  View details for Web of Science ID 000248712700001

  View details for PubMedID 17286334

• The psychological science of addiction ADDICTION Gifford, E., Humphreys, K. 2007; 102 (3): 352-361

  Abstract

  To discuss the contributions and future course of the psychological science of addiction.The psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory through increasingly broad relational contexts, including patient-practitioner interactions, families, social networks, institutional settings, economics and culture. Some of the contributions discussed here include applications of behavioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment. Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context, psychology is an integrated discipline using diverse methods well-suited to capture the multi-dimensional nature of addictive behavior.Psychology has a unique ability to integrate basic experimental and applied clinical science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of addiction.

  View details for DOI 10.1111/j.1360-0443.2006.01706.x

  View details for Web of Science ID 000244098000005

  View details for PubMedID 17298641

• How are substance use disorders addressed in VA psychiatric and primary care settings? Results of a national survey PSYCHIATRIC SERVICES Tracy, S. W., Trafton, J. A., Weingardt, K. R., Aton, E. G., Humphreys, K. 2007; 58 (2): 266-269

  Abstract

  This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings.National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders.Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs.Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

  View details for Web of Science ID 000244070800018

  View details for PubMedID 17287386

• Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Moos, R. H. 2007; 31 (1): 64-68

  Abstract

  Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients' health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients' substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

  View details for DOI 10.1111/j.1530-0277.2006.00273.x

  View details for Web of Science ID 000243022200009

  View details for PubMedID 17207103

• Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures (Book Review) ADDICTION RESEARCH & THEORY Book Review Authored by: Humphreys, K. 2006; 14 (6): 647-648

  View details for DOI 10.1080/16066350600604702

  View details for Web of Science ID 000244208200011

• Inquirers, triers, and buyers of an alcohol harm reduction self-help organization ADDICTION RESEARCH & THEORY Klaw, E., Horst, D., Humphreys, K. 2006; 14 (5): 527-535

  View details for DOI 10.1080/16066350500537580

  View details for Web of Science ID 000241557100007

• Closing remarks: Swimming to the horizon-reflections on a special series ADDICTION Humphreys, K. 2006; 101 (9): 1238-1240

  View details for DOI 10.1111/j.1360-0443.2006.01395.x

  View details for Web of Science ID 000239617700005

  View details for PubMedID 16911721

• Predictors of retention in methadone programs: A signal detection analysis DRUG AND ALCOHOL DEPENDENCE Villafranca, S. W., McKellar, J. D., Trafton, J. A., Humphreys, K. 2006; 83 (3): 218-224

  Abstract

  Retention in Opioid Agonist Therapy (OAT) is associated with reductions in substance use, HIV risk behavior, and criminal activities in opioid dependent patients. To improve the effectiveness of treatment for opioid dependence, it is important to identify predisposing characteristics and provider-related variables that predict retention in OAT. Participants include 258 veterans enrolled in 8 outpatient methadone/l-alpha-acetylmethadol (LAAM) treatment programs. Signal detection analysis was utilized to identify variables predictive of 1-year retention and to identify the optimal cut-offs for significant predictors. Provider-related variables play a vital role in predicting retention in OAT programs, as higher methadone dose (> or =59 mg/day) and greater treatment satisfaction were among the strongest predictors of retention at 1-year follow-up.

  View details for DOI 10.1016/j.drugalcdep.2005.11.020

  View details for Web of Science ID 000239081300005

  View details for PubMedID 16384657

• Rebuilding Iraq's mental health system. Behavioral healthcare Humphreys, K., Sadik, S. 2006; 26 (7): 34-35

  View details for PubMedID 16915888

• Response to methadone maintenance treatment of opiate dependent patients with and without significant pain DRUG AND ALCOHOL DEPENDENCE Ilgen, M. A., Trafton, J. A., Humphreys, K. 2006; 82 (3): 187-193

  Abstract

  Both clinicians and researchers have expressed doubt that opiate dependent patients with significant pain can be effectively treated in methadone maintenance treatment (MMT) programs; however, little research exists on this topic. Patients who report significant pain in the month preceding entry to MMT present with a distinct and more severe pattern of polysubstance use, medical and psychosocial problems than do those without pain. The present study investigated the 1-year treatment outcomes of MMT patients with opiate dependence and pain.Analyses were based on a national sample of 200 patients presenting in MMT programs for treatment of opiate dependence. Substance use and related problems were measured at treatment entry and 12 months later. Patients reported pain severity over the month preceding treatment entry.Compared to patients without significant pain, patients who reported significant pain at baseline (n = 103) showed similar substance-related functioning, but poorer psychosocial functioning at 1 year.Patients with and without significant pain experience comparable reductions in substance use when provided with standard care in MMT programs. However, additional medical and/or mental health treatment is needed for their pain and other problems.

  View details for DOI 10.1016/j.drugalcdep.2005.09.005

  View details for Web of Science ID 000237317000002

  View details for PubMedID 16219429

• The trials of Alcoholics Anonymous ADDICTION Humphreys, K. 2006; 101 (5): 617-618

  View details for DOI 10.1111/j.1360-0443.2006.01447.x

  View details for Web of Science ID 000236911800001

  View details for PubMedID 16669879

• Determining effective methadone doses for individual opioid-dependent patients PLOS MEDICINE Trafton, J. A., Minkel, J., Humphreys, K. 2006; 3 (3): 380-387

  Abstract

  Randomized clinical trials of methadone maintenance have found that on average high daily doses are more effective for reducing heroin use, and clinical practice guidelines recommend 60 mg/d as a minimum dosage. Nevertheless, many clinicians report that some patients can be stably maintained on lower methadone dosages to optimal effect, and clinic dosing practices vary substantially. Studies of individual responses to methadone treatment may be more easily translated into clinical practice.A volunteer sample of 222 opioid-dependent US veterans initiating methadone treatment was prospectively observed over the year after treatment entry. In the 168 who achieved at least 1 mo of heroin abstinence, methadone dosages on which patients maintained heroin-free urine samples ranged from 1.5 mg to 191.2 mg (median = 69 mg). Among patients who achieved heroin abstinence, higher methadone dosages were predicted by having a diagnosis of posttraumatic stress disorder or depression, having a greater number of previous opioid detoxifications, living in a region with lower average heroin purity, attending a clinic where counselors discourage dosage reductions, and staying in treatment longer. These factors predicted 42% of the variance in dosage associated with heroin abstinence.Effective and ineffective methadone dosages overlap substantially. Dosing guidelines should focus more heavily on appropriate processes of dosage determination rather than solely specifying recommended dosages. To optimize therapy, methadone dosages must be titrated until heroin abstinence is achieved.

  View details for DOI 10.1371/journal.pmed.0030080

  View details for Web of Science ID 000236897500018

  View details for PubMedID 16448216

  View details for PubMedCentralID PMC1360079

• Access to the Internet among drinkers, smokers and illicit drug users: Is it a barrier to the provision of interventions on the World Wide Web? MEDICAL INFORMATICS AND THE INTERNET IN MEDICINE Cunningham, J. A., Selby, P. L., Kypri, K., Humphreys, K. N. 2006; 31 (1): 53-58

  Abstract

  Expanding Internet-based interventions for substance use will have little benefit if heavy substance users are unlikely to have Internet access. This paper explored whether access to the Internet was a potential barrier to the provision of services for smokers, drinkers and illicit drug users.As part of a general population telephone survey of adults in Ontario, Canada, respondents were asked about their use of different drugs and also about their use of the Internet.Pack-a-day smokers were less likely (48%) to have home Internet access than non-smokers (69%), and current drinkers (73%) were more likely to have home access than abstainers (50%). These relationships remained true even after controlling for demographic characteristics. Internet access was less clearly associated with cannabis or cocaine use.Even though there is variation in access among smokers, drinkers and illicit drug users, the World Wide Web remains an excellent opportunity to potentially provide services for substance abusers who might never access treatment in person because, in absolute terms, the majority of substance abusers do use the Internet.

  View details for DOI 10.1080/14639230600562816

  View details for Web of Science ID 000238135000005

  View details for PubMedID 16754367

• Opioid substitution treatment reduces substance use equivalently in patients with and without posttraumatic stress disorder JOURNAL OF STUDIES ON ALCOHOL Trafton, J. A., Minkel, J., Humphreys, K. 2006; 67 (2): 228-235

  Abstract

  The purpose of this study was to determine whether opioid-dependent patients with diagnosed posttraumatic stress disorder (PTSD) have poorer long-term outcomes in opioid substitution treatment than do patients without PTSD.This prospective observational study examined outcomes of 255 opioid-dependent patients (men = 248) entering opioid substitution treatment at eight clinics in the Veterans Health Administration (VHA). Subjects were interviewed at treatment entry, 6 months, and 1 year about substance use and related problems, health status, treatment satisfaction, and non-VHA health care utilization. Medical records were reviewed to obtain toxicology results, health care utilization data, and diagnoses. Medical record review identified a diagnosis of PTSD in 71 (28%) patients. Substance-use and mental-health outcomes and health care utilization in the first year following treatment entry were compared between patients with and without a diagnosis of PTSD.Patients with and without PTSD had similar treatment responses. Although patients with PTSD had longer histories of drug use at intake, at 1-year follow-up they showed reductions in heroin, cocaine, and alcohol use, comparable to patients without the disorder. PTSD patients received higher doses of opiate medication, attended more psychosocial treatment sessions for substance-use disorder, and had better treatment retention. Psychiatric symptoms for patients with PTSD were more severe at intake and showed little improvement throughout treatment.Opioid substitution therapy is as effective at reducing substance use in PTSD patients as it is in patients without the disorder, but additional services are needed for treatment of psychological problems that are largely unchanged by treatment for addiction.

  View details for Web of Science ID 000235318900005

  View details for PubMedID 16562404

• Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers JOURNAL OF MEDICAL INTERNET RESEARCH Cunningham, J. A., Humphreys, K., Kypri, K., van Mierlo, T. 2006; 8 (2)

  Abstract

  In recent years, online services for problem drinkers have been developed. This paper describes ongoing efforts to improve one of these services, the Alcohol Help Center.This report summarizes new modules added to the Check Your Drinking (CYD) screener, a component of the Alcohol Help Center, to make the CYD screener more useful to periodic heavy drinkers, as well as to regular alcohol consumers. Participants' initial reactions to the CYD screener and the changes in their drinking habits at a three-month follow-up are presented.The CYD screener provides a free personalized Final Report that compares the user's drinking to that of others in the general population of the same age, gender, and country of origin. Current alcohol consumption and demographic characteristics are collected as part of the CYD screening process. After users were presented with a customized Final Report, they were hot-linked to a volunteer feedback survey. The voluntary feedback survey asked about impressions of the CYD Final Report. Respondents agreeing to participate were sent a follow-up survey after three months.We recruited 388 volunteers (69% female) who were registered users of another free-to-consumer online eHealth service. Of the 343 respondents agreeing to participate in the three-month follow-up, 138 accessed the survey, and 97 provided complete data (participation rate = 40%; completion rate = 70%). Compared to moderate drinkers, current problem drinkers judged the Final Report to be more useful (34% vs. 69%, chi2 (1) = 41.5, P < .001) and accurate (43% vs. 76%, chi2 (1) = 36.0, P < .001). Respondents who participated in the three-month follow-up displayed reductions in drinking compared to baseline (F(4,76) = 12.2, P = .001).Improvements can still be made to make the CYD screener more relevant to specific populations, particularly periodic heavy drinkers. There is a need to further tailor algorithms that can present questions only relevant to specific populations. There also appears to be a need to further customize the Final Report for respondents who identify themselves as infrequent heavy drinkers. These improvements will be made, and a randomized controlled trial is planned to conduct a rigorous evaluation of the CYD screener as an intervention to help problem drinkers.

  View details for DOI 10.2196/jmir.8.2.e5

  View details for Web of Science ID 000239759200002

  View details for PubMedID 16867968

  View details for PubMedCentralID PMC1550700

• Knitting together some ripping yarns ADDICTION Humphreys, K., Wilbourne, P. 2006; 101 (1): 4-5

  View details for DOI 10.1111/j.1360-0443.2005.01325.x

  View details for Web of Science ID 000234543000002

  View details for PubMedID 16393185

• Prevalence and predictors of research participant eligibility criteria in alcohol treatment outcome studies, 1970-98 ADDICTION Humphreys, K., Weingardt, K. R., Horst, D., Joshi, A. A., Finney, J. W. 2005; 100 (9): 1249-1257

  Abstract

  To describe the eligibility criteria (i.e. study participant inclusion and exclusion rules) employed in alcohol treatment outcome research and to identify predictors of their use.The eligibility criteria of 683 alcohol treatment outcome studies conducted between 1970 and 1998 were coded reliably into 14 general categories. Predictors of the use of eligibility criteria were then examined.Patients were most often ruled ineligible for research studies because of their level of alcohol problems (39.1% of studies), comorbid psychiatric problems (37.8%), past or concurrent utilization of alcohol treatment (31.8%), co-occurring medical conditions (31.6%), and because they were deemed non-compliant and unmotivated (31.5%). The number of eligibility criteria employed in studies increased from the 1970s through the 1990s, and was positively associated with funding from the US National Institute of Alcohol Abuse and Alcoholism (NIAAA) and from the private sector, lack of an inpatient/residential treatment condition, presence of a pharmacotherapy, and use of a randomized, multiple-condition design. Principal investigators with doctoral degrees used more eligibility criteria than those with lower degrees.Participant eligibility criteria are extensively employed in alcohol treatment outcome research, and vary significantly across historical periods, funders and research designs. Researchers should report the details of subject eligibility criteria and excluded patients more fully, and, evaluate how eligibility criteria affect the cost, feasibility, and generalizability of treatment outcome research.

  View details for DOI 10.1111/j.1360-0443.2005.01175.x

  View details for Web of Science ID 000231505700014

  View details for PubMedID 16128714

• Internet and paper self-help materials for problem drinking: Is there an additive effect? ADDICTIVE BEHAVIORS Cunningham, J. A., Humphreys, K., Koski-Jannes, A., Cordingley, J. 2005; 30 (8): 1517-1523

  Abstract

  The objective of this study was to conduct a preliminary evaluation of an Internet-based intervention for problem drinkers, comparing changes in drinking between respondents who only received the intervention to those who also received a self-help book. After receiving a personalized feedback summary on the Internet, 83 respondents provided complete baseline information and volunteered to participate in a 3-month follow-up survey. Half of the respondents were randomized to receive an additional self-help book. The follow-up was returned by 48 respondents (69% female). Repeated measures ANOVAs were conducted to compare drinking levels at baseline and 3-month follow-up among respondents who only received the Internet-based intervention. There was minimal support for an impact of the Internet intervention alone. In addition, hierarchical regression analyses were conducted to compare respondents in the two intervention conditions on their drinking at follow-up, controlling for baseline consumption. Respondents who received the additional self-help book reported drinking less and experiencing fewer consequences at follow-up as compared to respondents who received only the Internet-based intervention. While the results are promising, they cannot be taken as evidence of the efficacy of Internet-based personalized feedback as a stand-alone intervention because of the absence of a control group that did not receive the intervention. Further research on this topic should be a priority because of the potential for Internet-based interventions to reach problem drinkers underserved by traditional treatment.

  View details for DOI 10.1016/j.addbeh.2005.03.003

  View details for Web of Science ID 000232088200003

  View details for PubMedID 15893433

• From addiction treatment research reviews to better widgets ADDICTION Humphreys, K. 2005; 100 (6): 751-752

  View details for DOI 10.1111/j.1360-0443.2005.01107.x

  View details for Web of Science ID 000229583900007

  View details for PubMedID 15918804

• Does writing affect asthma? - A randomized trial PSYCHOSOMATIC MEDICINE Harris, A. H., Thoresen, C. E., Humphreys, K., Faul, J. 2005; 67 (1): 130-136

  Abstract

  Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy. Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study. Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics.We conducted a randomized, controlled trial of outpatient asthmatics recruited from hospitals and the community. Of the 137 adult patients with asthma who were randomized, 117 began and 114 completed the study. Patients were randomly assigned to write for 20 minutes, once per week, for 3 weeks about stressful experiences (n = 41), positive experiences (n = 37), or neutral experiences (n = 36; control group). At baseline, postintervention, and 2-month follow up, patients were assessed by spirometry.The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second (FEV1) was 4.2% in the stress-writing group, 1.3% in the positive-writing group, and 3.0% in the control group. In forced vital capacity (FVC), there was 3.1% improvement in the stress-writing group, 3.6% in the positive-writing group, and 2.4% in the control group. These changes were not statistically or clinically significant.The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients.

  View details for DOI 10.1097/01.psy.0000146345.73510.d5

  View details for Web of Science ID 000226673700019

  View details for PubMedID 15673635

• Validity and reliability of the German version of the short understanding of substance abuse scale EUROPEAN ADDICTION RESEARCH Moggi, F., Giovanoli, A., Sutter, M., Humphreys, K. 2005; 11 (4): 172-179

  Abstract

  This paper presents the German version of the Short Understanding of Substance Abuse Scale (SUSS) [Humphreys et al.: Psychol Addict Behav 1996;10:38-44], the Verstandnis von Storungen durch Substanzkonsum (VSS), and evaluates its psychometric properties. The VSS assesses clinicians' beliefs about the nature and treatment of substance use disorders, particularly their endorsement of psychosocial and disease orientation. The VSS was administered to 160 treatment staff members at 12 substance use disorder treatment programs in the German-speaking part of Switzerland. Because the confirmatory factor analysis of the VSS did not completely replicate the factorial structure of the SUSS, an exploratory factor analysis was undertaken. This analysis identified two factors: the Psychosocial model factor and a slightly different Disease model factor. The VSS Disease and Psychosocial subscales showed convergent and discriminant validity, as well as sufficient reliability.

  View details for DOI 10.1159/000086398

  View details for Web of Science ID 000233954300003

  View details for PubMedID 16110223

• Expanding self-help group participation in culturally diverse urban areas: Media approaches to leveraging referent power JOURNAL OF COMMUNITY PSYCHOLOGY Humphreys, K., Macus, S., Stewart, E., Oliva, E. 2004; 32 (4): 413-424

  View details for DOI 10.1002/jcop.20009

  View details for Web of Science ID 000222044700004

• Depression increases diabetes symptoms by complicating patients' self-care adherence DIABETES EDUCATOR McKellar, J. D., Humphreys, K., Piette, J. D. 2004; 30 (3): 485-492

  Abstract

  This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen.Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations.An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year.Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health.

  View details for Web of Science ID 000223738100012

  View details for PubMedID 15208846

• Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Klvlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morgenstern, J., Townsend, M., Weiss, R. 2004; 26 (3): 151-158

  Abstract

  This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse.

  View details for DOI 10.1016/S0740-5472(03)00212-5

  View details for Web of Science ID 000220939400002

  View details for PubMedID 15063905

• A few apologies, but no regrets ADDICTION Humphreys, K. 2004; 99 (2): 155-156

  View details for Web of Science ID 000189144000008

  View details for PubMedID 14756704

• Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment DRUG AND ALCOHOL DEPENDENCE Trafton, J. A., Oliva, E. M., Horst, D. A., Minkel, J. D., Humphreys, K. 2004; 73 (1): 23-31

  Abstract

  Although pain problems are prevalent in substance use disorder (SUD) patients, the special treatment needs of SUD patients with pain have not been investigated. This study examines the problems and behaviors associated with reported pain among veterans treated at eight opioid substitution treatment clinics. Patients reporting pain had more severe medical and psychiatric problems and greater health care utilization. Pain was associated with an increased propensity for misuse of substances with analgesic effects, suggesting that ongoing pain contributes to an altered and more severe pattern of drug-seeking behavior. Patients without pain rarely abused sedatives or opioid medication, indicating that misuse of these substances is unique to co-morbid pain and SUD patients. Patients reporting pain did not differ from patients without pain in use of heroin, alcohol, cocaine or in injection practices, demonstrating that they are truly SUD patients in need of SUD treatment. Pain complicates the treatment of SUD and should be addressed as an important co-morbidity during treatment.

  View details for DOI 10.1016/j.drugalcdep.2003.08.007

  View details for Web of Science ID 000188121900003

  View details for PubMedID 14687956

• Circles of Recovery: Self-help organizations for addictions. Cambridge, UK: Cambridge University Press Humphreys, K. 2004
• Datapoints: do participants in alcoholism treatment outcome studies resemble patients seen in everyday practice? Psychiatric services Humphreys, K. 2003; 54 (12): 1576-?

  View details for PubMedID 14645790

• Characteristics and motives of problem drinkers seeking help from moderation management self-help groups COGNITIVE AND BEHAVIORAL PRACTICE Klaw, E., Luft, S., Humphreys, K. 2003; 10 (4): 384-389

  View details for Web of Science ID 000228551000012

• Response: the marriage of drug abuse treatment and 12-step strategies. Science & practice perspectives / a publication of the National Institute on Drug Abuse, National Institutes of Health Forman, R. R., Humphreys, K., Tonigan, J. S. 2003; 2 (1): 52-54

  View details for PubMedID 18552723

• The cost of institutional review board procedures in Multicenter Observational Research ANNALS OF INTERNAL MEDICINE Humphreys, K., Trafton, J., Wagner, T. H. 2003; 139 (1): 77-77

  View details for Web of Science ID 000183823200014

  View details for PubMedID 12834327

• Alcohol & drug abuse: A research-based analysis of the Moderation Management controversy. Psychiatric services Humphreys, K. 2003; 54 (5): 621-622

  View details for PubMedID 12719491

• Alcoholics anonymous involvement and positive alcohol-related outcomes: Cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY McKellar, J., Stewart, E., Humphreys, K. 2003; 71 (2): 302-308

  Abstract

  A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes.

  View details for DOI 10.1037/0022-006X.71.2.302

  View details for Web of Science ID 000181602000009

  View details for PubMedID 12699024

• Participation in alcoholics anonymous: Intended and unintended change mechanisms ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Owen, P. L., Slaymaker, V., Tonigan, J. S., McCrady, B. S., Epstein, E. E., Kaskutas, L. A., Humphreys, K., Miller, W. R. 2003; 27 (3): 524-532

  Abstract

  This article is a compilation of the information presented at a symposium at the 2001 RSA Meeting in Montreal, Canada. The presentations were: (1) Maintaining change after conjoint behavioral alcohol treatment for men: the role of involvement with Alcoholics Anonymous, by Barbara S. McCrady and Elizabeth E. Epstein; (2) Changing AA practices and outcomes: Project MATCH 3-year follow-up, by J. Scott Tonigan; (3) Life events and patterns of recovery of AA-exposed adults and adolescents, by Patricia L. Owen and Valerie Slaymaker; (4) Social networks and AA involvement as mediators of change, by Lee Ann Kaskutas and Keith Humphreys; and (5) What do we know about Alcoholics Anonymous? by William R. Miller, discussant.

  View details for DOI 10.1097/01.ALC.0000057941.57330.39

  View details for Web of Science ID 000181843000018

  View details for PubMedID 12658120

• Electronic support groups for breast carcinoma - A clinical trial of effectiveness 22nd Annual Meeting of the Society-of-Behavioral-Medicine Lieberman, M. A., Golant, M., Giese-Davis, J., Winzlenberg, A., Benjamin, H., Humphreys, K., Kronenwetter, C., Russo, S., Spiegel, D. WILEY-BLACKWELL. 2003: 920–25

  Abstract

  A recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information. Clinical trials of face-to-face breast carcinoma support groups show evidence of 1) improvement in quality of life, 2) reduction of psychologic symptoms, 3) improvement in coping responses, and 4) a reduction in pain. To the authors' knowledge, a few studies published to date have investigated Internet-delivered electronic support groups (ESGs) for cancer. The most sophisticated is the Comprehensive Health Enhancement Support System (CHESS) program, which provides integrated information, referral, and a newsgroup-based social support program. However, to the authors' knowledge, no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial.Sixty-seven women completed the initial baseline questionnaires, 32 of whom accepted the authors' invitation and began the groups. With regard to geographic location, 49% lived in rural/small towns, 41% lived in medium-sized cities, and 10% lived in large cities. Diagnostic stages of disease were: Stage I, 22%; Stage II, 56%; Stage III, 12%; and other forms, 10%. There were 4 intervention groups, of which 8 participants led by trained Wellness Community (TWC) (a national agency) leaders met for 1.5 hours once a week for 16 weeks. Student t tests for paired outcome data were computed using baseline and postgroup scores.The results of the current study indicated that breast carcinoma patients significantly reduced depression (Center for Epidemiologic Studies-Depression [CES-D] scale) and Reactions to Pain. They also demonstrated a trend toward increases on The Posttraumatic Growth Inventory (PTGI) in two subscales: New Possibilities and Spirituality. Counterintuitively, breast carcinoma patients appeared to demonstrate an increase in emotional suppression. Postinterview results indicated that approximately 67% of patients found the group to be beneficial. Those who withdrew from the groups (20%) demonstrated low scores in their ability to contain anxiety and appeared to be more likely to suppress their thoughts and feelings regarding their illness.The findings of the current study are encouraging, particularly because it was conducted through TWC, a national agency willing to make this type of intervention readily available at no cost. A limitation of the current study was the lack of randomization and a control group comparison. Although the authors were not able to demonstrate effectiveness without the addition of a control condition, the analysis of pregroup and postgroup outcomes suggests that a randomized trial is worthwhile. Women with a devastating disease will join and commit themselves to an online support group. In addition, because a large percentage of these women were from rural locations, this type of intervention may hold promise for those who have limited access to support groups.

  View details for DOI 10.1002/cncr.11145

  View details for Web of Science ID 000180795500004

  View details for PubMedID 12569591

• Alcoholics Anonymous and 12-step alcoholism treatment programs. Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism Humphreys, K. 2003; 16: 149-164

  Abstract

  Alcoholics Anonymous (AA) self-help groups are the most commonly accessed component of the de facto system of care for alcohol problems in the United States. Further, AA's concepts and approach have strongly influenced a significant number of professional treatment programs. Nevertheless, only a modest number of longitudinal, comparative outcome studies on AA and on professional 12-step treatment programs have been conducted, which has limited both the certainty and scope of conclusions that can be drawn about these interventions. Research indicates that participation in Alcoholics Anonymous and in 12-step treatment are associated with significant reductions in substance abuse and psychiatric problems. Further, such interventions, it has been found, reduce health care costs over time in naturalistic, quasi-experimental, and experimental studies. Evaluation studies have also begun to illuminate the processes through which self-help groups and 12-step treatment programs exert their effects. To build on this knowledge base, future research should (1) be methodologically flexible and well-matched to its phenomenon of interest, (2) include evaluation of the unique features of self-help organizations, (3) increase representation of African-Americans and women in research samples, and (4) increase statistical power through larger sample sizes and more reliable measurement. Key content areas for future enquiry include further longitudinal evaluation of the outcomes of participation in AA and 12-step treatment (particularly in outpatient samples); better specification of the aspects of AA that influence outcome; and individual-, community-, and health organization-level controlled studies of the health care cost consequences of 12-step interventions.

  View details for PubMedID 12638636

• Datapoints: moving from inpatient to residential substance abuse treatment in the VA. Psychiatric services Humphreys, K., Horst, D. 2002; 53 (8): 927-?

  View details for PubMedID 12161662

• Social networks as mediators of the effect of Alcoholics Anonymous ADDICTION Kaskutas, L. A., Bond, J., Humphreys, K. 2002; 97 (7): 891-900

  Abstract

  This study tested the hypothesis that the relationship between Alcoholics Anonymous (AA) involvement and reduced substance use is partially explained (or 'mediated') by changes in social networks.This is a naturalistic longitudinal study of the course of alcohol problems.Study sites were the 10 largest public and private alcohol treatment programs in a northern California county.Three hundred and seventy-seven men and 277 women were recruited upon seeking treatment at study sites.At baseline and 1-year follow-up, we assessed alcohol consequences and dependence symptoms, consumption, social support for abstinence, pro-drinking social influences and AA involvement.In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow-up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty-day abstinence was predicted by AA involvement (OR=2.9), not having pro-drinking influences in one's network (OR=0.7) and having support for reducing consumption from people met in AA (versus no support; OR=3.4). In contrast, having support from non-AA members was not a significant predictor of abstinence. For alcohol-related outcomes other than abstinence, significant relationships were found for both AA-based and non-AA-based support.The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on outcomes reflective of AA's goals (such as abstinence) when studying how AA works.

  View details for Web of Science ID 000176684600018

  View details for PubMedID 12133128

• Toward more responsive and effective intervention systems for alcohol-related problems - Introduction ADDICTION Humphreys, K., Tucker, J. A. 2002; 97 (2): 126-132

  View details for DOI 10.1046/j.1360-0443.2002.00004.x

  View details for Web of Science ID 000173651500001

  View details for PubMedID 11860378

• Pilot study of racial and geographic HIV risk among methadone patients 14th International AIDS Conference Oliva, E., Horst, D., Trafton, J., Humphreys, K. MEDIMOND S R L. 2002: 279–282

  View details for Web of Science ID 000180241900057

• Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Mankowski, E. S., Humphreys, K., Moos, R. H. 2001; 29 (4): 537-563

  Abstract

  Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.

  View details for PubMedID 11554152

• Can targeting nondependent problem drinkers and providing Internet-based services expand access to assistance for alcohol problems? A study of the moderation management self-help/mutual aid organization JOURNAL OF STUDIES ON ALCOHOL Humphreys, K., Klaw, E. 2001; 62 (4): 528-532

  Abstract

  Moderation Management (MM) is the only alcohol self-help organization to target nondependent problem drinkers and to allow moderate drinking goals. This study evaluated whether MM drew into assistance an untapped segment of the population with nondependent alcohol problems. It also examined how access to the organization was influenced by the provision of Internet-based resources.A survey was distributed to participants in MM face-to-face and Internet-based self-help groups. MM participants (N = 177, 50.9% male) reported on their demographic characteristics, alcohol consumption, alcohol problems and utilization of professional and peer-run helping resources.MM appears to attract women and young people, especially those who are nondependent problem drinkers. It was also found that a significant minority of members experienced multiple alcohol dependence symptoms and therefore may have been poorly suited to a moderate drinking program.Tailoring services to nondependent drinkers and offering assistance over the Internet are two valuable methods of broadening the base of treatment for alcohol problems. Although interventions like MM are unlikely to benefit all individuals who access them, they do attract problem drinkers who are otherwise unlikely to use existing alcohol-related services.

  View details for Web of Science ID 000170348900014

  View details for PubMedID 11513231

• Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Moos, R. 2001; 25 (5): 711-716

  Abstract

  Twelve-step-oriented inpatient treatment programs emphasize 12-step treatment approaches and the importance of ongoing attendance at 12-step self-help groups more than do cognitive-behavioral (CB) inpatient treatment programs. This study evaluated whether this difference in therapeutic approach leads patients who are treated in 12-step programs to rely less on professionally provided services and more on self-help groups after discharge, thereby reducing long-term health care costs.A prospective, quasi-experimental comparison of 12-step-based (N = 5) and cognitive-behavioral (n = 5) inpatient treatment programs was conducted. These treatments were compared on the degree to which their patients participated in self-help groups, used outpatient and inpatient mental health services, and experienced positive outcomes (e.g., abstinence) in the year following discharge. Using a larger sample from an ongoing research project, 887 male substance-dependent patients from each type of treatment program were matched on pre-intake health care costs (N = 1774). At baseline and 1-year follow-up, patients' involvement in self-help groups (e.g., Alcoholics Anonymous), utilization and costs of mental health services, and clinical outcomes were assessed.Compared with patients treated in CB programs, patients treated in 12-step programs had significantly greater involvement in self-help groups at follow-up. In contrast, patients treated in CB programs averaged almost twice as many outpatient continuing care visits after discharge (22.5 visits) as patients treated in 12-step treatment programs (13.1 visits), and also received significantly more days of inpatient care (17.0 days in CB versus 10.5 in 12-step), resulting in 64% higher annual costs in CB programs ($4729/patient, p < 0.001). Psychiatric and substance abuse outcomes were comparable across treatments, except that 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB programs, p < 0.001).Professional treatment programs that emphasize self-help approaches increase their patients' reliance on cost-free self-help groups and thereby lower subsequent health care costs. Such programs therefore represent a cost-effective approach to promoting recovery from substance abuse.

  View details for Web of Science ID 000168773500012

  View details for PubMedID 11371720

• Self-help group participation among substance use disorder patients with posttraumatic stress disorder JOURNAL OF SUBSTANCE ABUSE TREATMENT Ouimette, P., Humphreys, K., Moos, R. H., Finney, J. W., Cronkite, R., FEDERMAN, B. 2001; 20 (1): 25-32

  Abstract

  Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participation was similar for SUD patients with and without PTSD. PTSD patients with worldviews (e.g., holding disease model beliefs) that more closely matched 12-step philosophy participated more in 12-step activities. Although greater participation was associated with better concurrent functioning, participation did not prospectively predict outcomes after case mix adjustment. An exception was that greater participation predicted decreased distress among PTSD patients whose identity was more consistent with 12-step philosophy. In summary, PTSD patients participate in and benefit from 12-step participation; continuing involvement may be necessary to maintain positive benefits.

  View details for Web of Science ID 000167491300005

  View details for PubMedID 11239725

• A comparative, process-effectiveness evaluation of VA substance abuse treatment. Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism Finney, J. W., Ouimette, P. C., Humphreys, K., Moos, R. H. 2001; 15: 373-391

  Abstract

  Over 3,000 patients from 15 VA inpatient, substance abuse treatment programs showed considerable improvement from intake to a one-year follow-up. Patients in 12-step programs, as opposed to cognitive-behavioral (CB) or eclectic programs, and those with more extended continuing outpatient mental health care and 12-step self-help group involvement, were more likely to be abstinent and free of substance use problems at follow-up. Consistent with their better one-year outcomes, patients in 12-step programs improved more between intake and discharge than CB patients on proximal outcomes assumed to be specific to 12-step treatment (e.g., disease model beliefs) and as much or more on CB proximal outcomes. Proximal outcomes assessed at treatment discharge and follow-up were, at best, modestly related to one-year substance use and other outcomes. No evidence was found that CB or 12-step treatment is more beneficial for certain types of patients.

  View details for PubMedID 11449754

• Assessing readmission to substance abuse treatment as an indicator of outcome and program performance PSYCHIATRIC SERVICES Humphreys, K., Weingardt, K. R. 2000; 51 (12): 1568-1569

  Abstract

  Managed health care systems often use treatment readmission data as an indicator of psychiatric patient outcome and program performance. This study of 3,018 inpatients being treated for substance abuse in Department of Veterans Affairs medical centers found that across a range of measures and patient subpopulations, patient outcomes and program performance were virtually independent of treatment readmission. These findings suggest that even though readmission for substance abuse treatment may have value as an easily obtainable measure of health care utilization and cost, it cannot serve as a valid substitute for direct assessment of patient outcome or program performance.

  View details for Web of Science ID 000165681400017

  View details for PubMedID 11097655

• Providing personalized assessment feedback for problem drinking on the Internet: A pilot project JOURNAL OF STUDIES ON ALCOHOL Cunningham, J. A., Humphreys, K., Koski-Jannes, A. 2000; 61 (6): 794-798

  Abstract

  This project developed an Internet program that conducts a brief assessment of an individual's drinking habits and then provides normative feedback comparing the user's drinking to that of others of the same gender and age group. The Internet program, "Try Our Free Drinking Evaluation," was based at the Addiction Research Foundation Internet web site (now at http://notes.camh.net/efeed.nsf/ newform).A voluntary survey linked to the participant's feedback summary collected respondents' impressions of the program.During the trial period, the site received approximately 500 hits per month. While the feedback was generally well received, the weekly summary format was less credible to those individuals who drink less than once per week or whose consumption varies a great deal over time.Given these pilot results indicating that there is an audience for Internet-based interventions, the next step is to evaluate whether receiving such personalized feedback materials on the Internet leads to any change in drinking behavior by participants

  View details for Web of Science ID 000165874700004

  View details for PubMedID 11188484

• Psychologists' ethical responsibilities in Internet-based groups: Issues, strategies, and a call for dialogue PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Humphreys, K., Winzelberg, A., Klaw, E. 2000; 31 (5): 493-496

  Abstract

  How can psychologists participate ethically as facilitators, advisers, and peer members in Internet-based groups? The astonishing growth of Internet technology and on-line groups has outpaced the development of formal ethical guidelines for psychologists involved in on-line groups. This article provides an initial appraisal of psychologists' ethical responsibilities in discussion, support, and self-help groups that operate on the Internet and offers practical strategies for avoiding ethical problems. By presenting initial strategies and guidelines for ethical behavior in Internet-based groups, the authors hope to stimulate the field to further discuss and analyze these issues.

  View details for Web of Science ID 000089750800008

  View details for PubMedID 14621714

• Communication patterns in an on-line mutual help group for problem drinkers JOURNAL OF COMMUNITY PSYCHOLOGY Klaw, E., Huebsch, P. D., Humphreys, K. 2000; 28 (5): 535-546

  View details for Web of Science ID 000088819000007

• Beyond the mental health clinic: New settings and activities for clinical psychology internships PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Humphreys, K. 2000; 31 (3): 300-304

  View details for DOI 10.1037//0735-7028.31.3.300

  View details for Web of Science ID 000087608700010

• Use of exclusion criteria in selecting research subjects and its effect on the generalizability of alcohol treatment outcome studies AMERICAN JOURNAL OF PSYCHIATRY Humphreys, K., Weisner, C. 2000; 157 (4): 588-594

  Abstract

  Researchers have not systematically examined how exclusion criteria used in selection of research subjects affect the generalizability of treatment outcome research. This study evaluated the use of exclusion criteria in alcohol treatment outcome research and its effects on the comparability of research subjects with real-world individuals seeking alcohol treatment.Eight of the most common exclusion criteria described in the alcohol treatment research literature were operationalized and applied to large, representative clinical patient samples from the public and private sectors to determine whether the hypothetical research samples differed substantially from real-world samples. Five hundred ninety-three consecutive individuals seeking alcohol treatment at one of eight treatment programs participated. A trained research technician gathered information from participants on demographic variables and on alcohol, drug, and psychiatric problems as measured by the Addiction Severity Index.Large proportions of potential research subjects were excluded under most of the criteria tested. The overall pattern of results showed that African Americans, low-income individuals, and individuals who had more severe alcohol, drug, and psychiatric problems were disproportionately excluded under most criteria.Exclusion criteria can result in alcohol treatment outcome research samples that are more heavily composed of white, economically stable, and higher-functioning individuals than are real-world samples of substance abuse patients seen in clinical practice, potentially compromising the generalizability of results. For both scientific and ethical reasons, in addition to studies that use exclusion criteria, outcome research that uses no or minimal exclusion criteria should be conducted so that alcohol treatment outcome research can be better generalized to vulnerable populations.

  View details for Web of Science ID 000086232300014

  View details for PubMedID 10739418

• Alcohol & drug abuse: the transformation of the Veterans Affairs substance abuse treatment system. Psychiatric services Humphreys, K., Huebsch, P. D., Moos, R. H., Suchinsky, R. T. 1999; 50 (11): 1399-1401

  View details for PubMedID 10543846

• Alcoholics anonymous affiliation at treatment intake among white and black Americans JOURNAL OF STUDIES ON ALCOHOL Kaskutas, L. A., Weisner, C., Lee, M. J., Humphreys, K. 1999; 60 (6): 810-816

  Abstract

  Black Americans are overrepresented in the public alcohol treatment system, but may be less likely to use informal services such as Alcoholics Anonymous (AA). Some commentators perceive AA as a white, middle-class organization that is unlikely to appeal to blacks. This epidemiological study considers prior attendance and engagement in AA among 791 black and white men and women entering treatment in public, private and HMO substance abuse programs.Clients were interviewed in-person within the first 3 days of inpatient treatment or the first 3 weeks of outpatient treatment.Black clients dominate public detoxification programs and report more drug and employment problems than whites (who report more family problems). Those with prior treatment experiences and those reporting they had gone to AA as part of treatment reported overall higher rates of AA affiliation, with blacks more likely to say they felt like a member of AA (64% vs 54% of whites), had a spiritual awakening as a result of AA (38% vs 27%) and had done service at AA meetings in the last year (48% vs 37%); whites were more likely to have had a sponsor (23% vs 14%) and to have read program literature (77% vs 67%).Controlling for other effects such as prior inpatient or outpatient treatment, blacks are about twice as likely as whites to report having attended AA as part of treatment (OR = 1.70). More research is needed to understand referral pathways to AA among blacks, and the differential effect this may have on sustained participation in AA and on long-term sobriety.

  View details for Web of Science ID 000083530700012

  View details for PubMedID 10606493

• Should patients' religiosity influence clinicians' referral to 12-step self-help groups? Evidence from a study of 3,018 male substance abuse patients JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Winzelberg, A., Humphreys, K. 1999; 67 (5): 790-794

  Abstract

  Twelve-step self-help organizations maintain that anyone, regardless of his or her religious beliefs, can benefit from participation in their groups. Yet many addiction professionals have reservations about referring nonreligious patients to 12-step groups. The present study examined the influence of patients' religiosity on whether they were referred to and benefited from 12-step groups. Participants were 3,018 male substance abuse inpatients. Individuals who engaged in fewer religious behaviors in the past year were referred to 12-step groups less frequently by clinicians. However, referrals to 12-step groups were effective at increasing meeting attendance, irrespective of patients' religious background, and all experienced significantly better substance abuse outcomes when they participated in 12-step groups. The viewpoint that less religious patients are unlikely to attend or benefit from 12-step groups may therefore be overstated.

  View details for Web of Science ID 000083117200018

  View details for PubMedID 10535246

• The case for a partnership with self-help groups PUBLIC HEALTH REPORTS Humphreys, K., Ribisl, K. M. 1999; 114 (4): 322-?

  View details for Web of Science ID 000081929200014

  View details for PubMedID 10501131

• A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups 151st Annual Meeting of the American-Psychiatric-Association Humphreys, K., Huebsch, P. D., Finney, J. W., Moos, R. H. WILEY-BLACKWELL PUBLISHING, INC. 1999: 558–63

  Abstract

  Affiliation with Alcoholics Anonymous (AA) and other 12-Step self-help groups is becoming more common at the same time as professional substance abuse treatment services are becoming less available and of shorter duration. As a result of these two trends, patients' outcomes may be increasingly influenced by the degree to which professional treatment programs help patients take maximum advantage of self-help groups. The present study of 3018 treated veterans examined how the theoretical orientation of a substance abuse treatment program affects (1) the proportion of its patients that participate in self-help groups, and, (2) the degree of benefit patients derive from participation in self-help groups. Patients treated in 12-Step and eclectic treatment programs had higher rates of subsequent participation in 12-Step self-help groups than did patients treated in cognitive behavioral programs. Furthermore, the theoretical orientation of treatment moderated the outcome of self-help group participation: As the degree of programs' emphasis on 12-Step approaches increased, the positive relationships of 12-Step group participation to better substance use and psychological outcomes became stronger. Hence, it appears that 12-Step oriented treatment programs enhance the effectiveness of 12-Step self-help groups. Findings are discussed in terms of implications for clinical practice and for future evaluations of the combined effects of treatment and self-help groups.

  View details for Web of Science ID 000079269900028

  View details for PubMedID 10195833

• A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-Step and cognitive-behavioral treatment to substance use outcomes ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Finney, J. W., Moos, R. H., Humphreys, K. 1999; 23 (3): 537-544

  Abstract

  This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment, traditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year follow-up. A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry, at or near discharge, and at a 1-year follow-up. Based on the results of factor analyses, composite proximal outcomes variables were constructed to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral beliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatment discharge were linked to 1-year outcomes, but the relationships were weak (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were stronger, but still modest in magnitude (r = .16 to .39). The weak predictive findings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved more frequently. In this regard, participation in continuing care was associated with enhanced maintenance of treatment gains on proximal outcomes. However, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficiently comprehensive.

  View details for Web of Science ID 000079269900025

  View details for PubMedID 10195830

• Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? 20th Annual Meeting of the Research-Society-on-Alcoholism Humphreys, K., Mankowski, E. S., Moos, R. H., Finney, J. W. SPRINGER. 1999: 54–60

  Abstract

  Self-help groups are the most commonly sought source of help for substance abuse problems, but few studies have evaluated the mechanisms through which they exert their effects on members. The present project evaluates mediators of the effects of self-help groups in a sample of 2,337 male veterans who were treated for substance abuse. The majority of participants became involved in self-help groups after inpatient treatment, and this involvement predicted reduced substance use at 1-year follow-up. Both enhanced friendship networks and increased active coping responses appeared to mediate these effects. Implications for self-help groups and professional treatments are discussed.

  View details for Web of Science ID 000085538800009

  View details for PubMedID 18425655

• Evaluating and improving VA substance abuse patients ' care AMERICAN JOURNAL OF MEDICAL QUALITY Moos, R. H., Humphreys, K., Ouimette, P. C., Finney, J. 1999; 14 (1): 45-54

  Abstract

  The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.

  View details for Web of Science ID 000083697400007

  View details for PubMedID 10446663

• The Alcoholics Anonymous affiliation scale: Development, reliability, and norms for diverse treated and untreated populations ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Kaskutas, L. A., Weisner, C. 1998; 22 (5): 974-978

  Abstract

  Affiliation with Alcoholics Anonymous (AA) is an important variable to measure in many clinical and research activities. This paper reports on the development of an AA affiliation scale, and demonstrates its utility in a sample of 927 alcohol treatment seekers and 674 untreated problem drinkers. The scale is short (9 items), covers a range of AA experiences, and is internally consistent across diverse demographic groups, multiple health services settings, and treated and untreated populations. The validity of the scale is supported by the findings that treatment seekers report significantly higher AA affiliation than do untreated problem drinkers, and inpatients report higher affiliation than outpatients. Potential clinical and research applications of the scale are proposed.

  View details for Web of Science ID 000075475100002

  View details for PubMedID 9726265

• Treatment involvement and outcomes for four subtypes of homeless veterans AMERICAN JOURNAL OF ORTHOPSYCHIATRY Humphreys, K., Rosenheck, R. 1998; 68 (2): 285-294

  Abstract

  A longitudinal study examined treatment services and outcomes in a nationwide sample of 565 homeless veterans who were classified as alcoholic, psychiatrically impaired, multiproblem, or best-functioning. All four groups experienced some improvement in their primary problem area, in employment status, and in residential quality at eight-month follow-up, but there were significant differences in degree of improvement across groups. Implications for the design of homeless programs and policies are discussed.

  View details for Web of Science ID 000073293200013

  View details for PubMedID 9589766

• The relationship of pre-treatment Alcoholics Anonymous affiliation with problem severity, social resources and treatment history 20th Annual Meeting of the Research-Society-on-Alcoholism Humphreys, K., Kaskutas, L. A., Weisner, C. ELSEVIER IRELAND LTD. 1998: 123–31

  Abstract

  Little research has examined the relationship of substance abuse patients' prior Alcoholics Anonymous (AA) affiliation to important treatment-related variables. This study of 927 individuals seeking treatment in public, health maintenance organization (HMO) and private-for-profit medical programs, found that 82.8% of patients presented at treatment with a history of AA affiliation. Degree of prior AA affiliation was significantly associated with more extensive prior utilization of formal and informal helping resources, current seeking of treatment in the public sector, having low income, being divorced/separated and having more severe alcohol, employment/support and psychiatric problems. Implications for service delivery and future research are discussed.

  View details for Web of Science ID 000072544800006

  View details for PubMedID 9543649

• Policy-relevant program evaluation in a national substance abuse treatment system JOURNAL OF MENTAL HEALTH ADMINISTRATION Humphreys, K., Hamilton, E. G., Moos, R. H., Suchinsky, R. T. 1997; 24 (4): 373-385

  Abstract

  This article discusses recent trends in public and private substance abuse services and offers suggestions on how the evaluation of such services can inform clinical practice and policy making. This analysis focuses particularly on the Department of Veterans Affairs (VA), which operates the largest substance abuse treatment system in the United States. In recent years, there has been an erosion of services for substance abuse outside the VA. In contrast, due to increased funding from the U.S. Congress, the VA significantly expanded substance abuse treatment from 1990 to 1994. However, efforts to "reinvent" and downsize government initiated a reversal of this growth trend in 1994, and VA services may shrink further as the system becomes more decentralized and adopts managed care strategies from the private sector. Drawing from the VA Program Evaluation and Resource Center's (PERC) experience of evaluating the VA system and working with federal policy makers, this article presents examples and suggestions for making evaluations of substance abuse treatment systems more useful in policy discussions and in day-to-day clinical practice.

  View details for Web of Science ID 000070961800001

  View details for PubMedID 9364108

• Social and community resources and long-term recovery from treated and untreated alcoholism 1996 Kettil-Bruun-Society Annual Meeting Humphreys, K., Moos, R. H., Cohen, C. ALCOHOL RES DOCUMENTATION INC CENT ALCOHOL STUD RUTGERS UNIV. 1997: 231–38

  Abstract

  Long-term studies of the course of alcoholism suggest that a variety of factors other than professional treatment influence the process of recovery. This study evaluated the role of demographic factors, baseline alcohol-related problems and depression, professional treatment, Alcoholics Anonymous (AA) and other social and community resources in predicting remission and psychosocial outcome over 8 years.A sample of 628 previously untreated alcoholic individuals was recruited at detoxification units and alcoholism information and referral services. Of these participants, 395 (68.2%) were followed 3 and 8 years later. Most (83.3%) were white (n = 329) and 50.1% (n = 198) were men. At each contact point, participants completed a self-administered inventory that assessed their current problems, treatment utilization, AA participation and quality of relationships.Number of inpatient treatment days received in the 3 years after baseline were not independently related to 8-year remission or psychosocial outcomes. More outpatient treatment in the first 3 years increased the likelihood of 8-year remission, but was not related to psychosocial outcomes. The number of AA meetings attended in the first 3 years predicted remission, lower depression, and higher quality relationships with friends and spouse/partner at 8 years. Extended family quality at baseline also predicted remission and higher quality friendships and family relationships at 8 years.Given that alcoholism is a chronic, context-dependent disorder, it is not surprising that short-term interventions have little long-term impact. Social and community resources that are readily available for long periods are more likely to have a lasting influence on the course of alcoholism.

  View details for Web of Science ID A1997WU28900002

  View details for PubMedID 9130214

• Treatment of VA inpatients with diagnoses of substance abuse PSYCHIATRIC SERVICES Humphreys, K., BAISDEN, K., Piette, J. D., Moos, R. H. 1997; 48 (2): 171-171

  View details for Web of Science ID A1997WG88400003

  View details for PubMedID 9021845

• The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients Meeting of the Society-for-Community-Research-and-Action Humphreys, K., Noke, J. M. SPRINGER/PLENUM PUBLISHERS. 1997: 1–16

  Abstract

  The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement) and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.

  View details for Web of Science ID A1997XK42700001

  View details for PubMedID 9231993

• Addressing self-selection effects in evaluations of mutual help groups and professional mental health services: An introduction to two-stage sample selection models EVALUATION AND PROGRAM PLANNING Humphreys, K., Phibbs, C. S., Moos, R. H. 1996; 19 (4): 301-308

  View details for Web of Science ID A1996VZ90400003

• Datapoints. Psychiatric services in VA substance abuse treatment programs. Psychiatric services Humphreys, K., Moos, R. H., Hamilton, E. G. 1996; 47 (11): 1203-?

  View details for PubMedID 8916236

• Psychiatric services in VA substance abuse treatment programs PSYCHIATRIC SERVICES Humphreys, K., Moos, R. H., Hamilton, E. G. 1996; 47 (11): 1203-1203

  View details for Web of Science ID A1996VP79400007

• Life domains, alcoholics anonymous, and role incumbency in the 3-year course of problem drinking JOURNAL OF NERVOUS AND MENTAL DISEASE Humphreys, K., Moos, R. H., Finney, J. W. 1996; 184 (8): 475-481

  Abstract

  This study examined the course of problem drinking among 439 individuals over 3 years, using a life domains perspective that distinguishes life stressors and social resources in different contexts. More severe chronic financial stressors both predicted and were predicted by more alcohol consumption and drinking-related problems. Among social resources, Alcoholics Anonymous was the most robust predictor of better functioning on multiple outcome criteria. Support from friends and extended family also predicted better outcomes; this effect was stronger for individuals who were low on primary role incumbency (i.e., who were unemployed and/or did not have a spouse/partner).

  View details for Web of Science ID A1996VD33100004

  View details for PubMedID 8752076

• Reduced substance-abuse-related health care costs among voluntary participants in alcoholics anonymous International Congress on Alcohol and Drug Dependence Humphreys, K., Moos, R. H. AMER PSYCHIATRIC ASSOCIATION. 1996: 709–13

  Abstract

  This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider.Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years.At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group.Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.

  View details for Web of Science ID A1996UV45800006

  View details for PubMedID 8807683

• World view change in Adult Children of Alcoholics Al-Anon self-help groups: Reconstruction the alcoholic family INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY Humphreys, K. 1996; 46 (2): 255-263

  Abstract

  Although 12-step self-help groups have become extremely popular in U.S. society, clinicians and researchers have devoted little attention to how these groups affect members. This project used naturalistic and qualitative methods to examine the processes through which committed members of self-help groups for adult children of alcoholics experience alterations in their perceptions of family of origin. Results suggest that world view transformation in the family of origin domain involves learning to define the family as pathological, assigning responsibility for this pathology to a disease, forgiving oneself, accepting that one was adversely affected by the family's problem, and ultimately learning to accept one's parents' shortcomings.

  View details for Web of Science ID A1996UE73900007

  View details for PubMedID 8935765

• Clinical psychologists as psychotherapists - History, future, and alternatives AMERICAN PSYCHOLOGIST Humphreys, K. 1996; 51 (3): 190-197

  Abstract

  As managed care and other cost-containment strategies become central features of the American health care system, doctoral-level clinical psychologists will be increasingly supplanted in the role of psychotherapist by lower cost providers such as social workers, marriage and family counselors, and masters-level psychologists. To provide one basis for clinical psychologists to make judgments about their role in psychotherapy; this article describes what the field was like before psychotherapy became a core activity and then compares the present transition with its historical counterpart: the opening up of the psychotherapy profession to doctoral-level clinical psychologists after World War II. History suggests that efforts to resist the current changes will be unsuccessful and that the most adaptive coping strategy for clinical psychologists is to take advantage of the transition by reenvisioning training and practice of clinical psychologists.

  View details for Web of Science ID A1996UB19800002

  View details for PubMedID 8881525

• Reliability, validity, and normative data for a short version of the understanding of alcoholism scale PSYCHOLOGY OF ADDICTIVE BEHAVIORS Humphreys, K., Greenbaum, M. A., Noke, J. M., Finney, J. W. 1996; 10 (1): 38-44

  View details for Web of Science ID A1996UA16700005

• Recovering substance abuse staff members' beliefs about addiction JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Noke, J. M., Moos, R. H. 1996; 13 (1): 75-78

  Abstract

  This study of 329 substance abuse treatment staff assessed how recovery status, in combination with other variables, influences beliefs about the causes and treatment of substance abuse. About 15% (n = 47) of participants were "in recovery" from substance abuse problems; these staff members were not significantly different than nonrecovering staff members on education, age, race/ethnicity, years of clinical experience, or amount of client contact. When examined in a multiple regression equation that also included age, education, and treatment program goals and activities, staff members' recovery status was not associated with endorsement of disease and psychosocial models of substance abuse. However, being in recovery was associated with endorsing an eclectic approach to substance abuse treatment. The importance of recognizing the diversity of beliefs about substance abuse among recovering staff and of acknowledging that multiple influences affect all staff members viewpoints on treatment is discussed.

  View details for Web of Science ID A1996UD52700009

  View details for PubMedID 8699546

• 2 PATHWAYS OUT OF DRINKING PROBLEMS WITHOUT PROFESSIONAL TREATMENT ADDICTIVE BEHAVIORS Humphreys, K., Moos, R. H., Finney, J. W. 1995; 20 (4): 427-441

  Abstract

  This 3-year longitudinal study examined two recovery pathways among 135 problem drinking individuals who never received professional treatment. Almost half (48.3%) of those individuals for whom outcome could be clearly determined became moderate drinkers or stably abstinent. At baseline, individuals who subsequently became abstinent (n = 28) were of low socioeconomic status, had severe drinking problems, and believed their drinking was a very serious problem. Once they began their recovery, they relied heavily on Alcoholics Anonymous as a maintenance factor. In contrast, individuals who became moderate drinkers (n = 29) had higher socioeconomic status and more social support at baseline than did individuals who became abstinent or continued to have drinking problems. A logistic regression on baseline data showed that it was possible to predict which natural recovery pathway an individual drinker would follow. The implications of these findings for alcoholism treatment and policy are discussed.

  View details for Web of Science ID A1995RH48600002

  View details for PubMedID 7484324

• SEQUENTIAL VALIDATION OF CLUSTER ANALYTIC SUBTYPES OF HOMELESS VETERANS AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Humphreys, K., Rosenheck, R. 1995; 23 (1): 75-98

  View details for Web of Science ID A1995RT87700005

• World views of Alcoholics Anonymous, Women for Sobriety, and Adult Children of Alcoholics/Al-Anon mutual help groups ADDICTION RESEARCH Humphreys, K., Kaskutas, L. A. 1995; 3 (3): 231-243

  View details for Web of Science ID A1995UU78500006

• APPLYING A STRESS AND COPING FRAMEWORK TO RESEARCH ON MUTUAL HELP ORGANIZATIONS JOURNAL OF COMMUNITY PSYCHOLOGY Humphreys, K., Finney, J. W., Moos, R. H. 1994; 22 (4): 312-327

  View details for Web of Science ID A1994PQ01700003