Journal of substance use and addiction treatment最新文献

{"title":"Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD","authors":"","doi":"10.1016/j.josat.2024.209523","DOIUrl":"10.1016/j.josat.2024.209523","url":null,"abstract":"<div><h3>Introduction</h3><div>Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD.</div></div><div><h3>Method</h3><div>A total of 186 (<em>M</em>_<em>age</em> = 15, 79% boys, 78% White, 11% Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; <em>n</em> = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up.</div></div><div><h3>Results</h3><div>Two-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (<em>β</em> = −0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (<em>β</em> = 0.27). Approximately 22% of intervention participants met criteria for risky drinking behavior compared to 5% of participants in the control group.</div></div><div><h3>Conclusion</h3><div>We found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I feel like I'm always on edge”: Perceptions of parole supervision by parolees with substance use disorders","authors":"","doi":"10.1016/j.josat.2024.209529","DOIUrl":"10.1016/j.josat.2024.209529","url":null,"abstract":"<div><h3>Introduction</h3><div>While extant research has looked at parole and its various actors as an institution, few studies recount the parole experience from the perspective of parolees. Additionally, despite the prevalence of substance use disorders (SUDs) within the criminal justice system, research that assesses the additional challenges this population faces throughout parole supervision is even scarcer.</div></div><div><h3>Methods</h3><div>To address this gap, we analyze in-depth qualitative interviews (<em>n</em> = 51) conducted with reentering men with SUDs as they navigate parole in Pennsylvania. Three independent coders identified all narratives relating to a broad theme of “parole and probation experiences.” The authors then completed iterative rounds of more fine-grained independent coding within that theme.</div></div><div><h3>Results</h3><div>Our results emphasize that SUDs present a significant barrier to reentry success, and the tension of surveillance and revocation is amplified for those enduring simultaneous reentry and recovery. Importantly, our respondents regard parole officers more positively than they view parole as an institution, yet this perception of officers does not equate to provision of reintegration and recovery support. Respondents perceive that parole presents unnecessary additional hurdles to their reentry success, and their perceived risk level impacts their surveillance intensity.</div></div><div><h3>Conclusions</h3><div>The information gleaned through inclusion of perspectives from those enduring parole supervision calls for a critical assessment of current parole practices. Further, the current approach to SUDs within community supervision criminalizes relapse without provision of treatment resources or support.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing is messy: A lived experience manuscript","authors":"","doi":"10.1016/j.josat.2024.209527","DOIUrl":"10.1016/j.josat.2024.209527","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attributes of higher- and lower-performing hospitals in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program implementation: A multiple-case study","authors":"","doi":"10.1016/j.josat.2024.209528","DOIUrl":"10.1016/j.josat.2024.209528","url":null,"abstract":"<div><h3>Introduction</h3><div>Six hospitals within the New York City public hospital system implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional addiction consult service. A stepped-wedge cluster randomized controlled trial tested the effectiveness of CATCH for increasing initiation and engagement in post-discharge medication for opioid use disorder (MOUD) treatment among hospital patients with opioid use disorder (OUD). The objective of this study was to identify facility characteristics that were associated with stronger performance of CATCH.</div></div><div><h3>Methods</h3><div>This study used a mixed methods multiple-case study design. The six hospitals in the CATCH evaluation were each assigned a case rating according to intervention reach. Reach was considered high if ≥50 % of hospitalized OUD patients received an MOUD order. Cross-case rating comparison identified attributes of high-performing hospitals and inductive and deductive approaches were used to identify themes.</div></div><div><h3>Results</h3><div>Higher-performing hospitals exhibited attributes that were generally absent in lower-performing hospitals, including (1) complete medical provider staffing; (2) designated office space and resources for CATCH; (3) existing integrated OUD treatment resources; and (4) limited overlap between the implementation period and COVID-19 pandemic.</div></div><div><h3>Conclusions</h3><div>Hospitals with attributes indicative of awareness and integration of OUD services into general care were generally higher performing than hospitals that had siloed OUD treatment programs. Future implementations of addiction consult services may benefit from an increased focus on hospital- and community-level buy-in and efforts to integrate MOUD treatment into general care.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of physicians and doulas on shared decision-making and decision counseling in the treatment of pregnant women with opioid use disorders","authors":"","doi":"10.1016/j.josat.2024.209526","DOIUrl":"10.1016/j.josat.2024.209526","url":null,"abstract":"<div><h3>Introduction</h3><div>Research about the application of shared decision-making (SDM) in the context of Medication Assisted Treatment (MAT) for pregnant women with opioid use disorder (OUD) is limited. The objectives of our study were to 1) examine facilitators of and barriers to SDM for the initiation of MAT in clinical practice and 2) evaluate the receptivity of clinicians and doulas involved in the care of women with OUD to the use of an online software application to facilitate SDM about MAT.</div></div><div><h3>Methods</h3><div>This qualitative study utilized semi-structured interviews with consenting physicians and doulas who provided care for pregnant women with OUD between November 2021 and May 2022. Participants were asked about factors influencing SDM in practice. In addition, the study asked participants about the feasibility of using the Jefferson Decision Counseling Guide© (JDCG) to educate pregnant women with OUD as to the benefits and risks of undergoing MAT versus no treatment and to help patients clarify their treatment preference. The study recorded the interview and transcribed it verbatim using Rev. transcription services. The study used thematic analyses to code the data and identify key barriers and facilitators of SDM and perceptions of the SDM tool.</div></div><div><h3>Results</h3><div>Nineteen participants completed interviews. The study identified several barriers to SDM including time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Peer workers or other trained personnel, giving patients more time, and comfort in decision counseling are examples of facilitators identified by the participants of the study. Participants believed that the counseling tool could facilitate conversations with patients and should be integrated into the workflow.</div></div><div><h3>Conclusion</h3><div>In this qualitative study, we identified several barriers and facilitators of SDM to initiate MAT for pregnant women with OUD. Our findings indicate that there are challenges and opportunities for healthcare systems to increase SDM in this marginalized patient population. Feedback from participants highlighted their receptivity to the use of SDM tools to facilitate meaningful conversations in various settings that can guide decision making about care.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage","authors":"","doi":"10.1016/j.josat.2024.209524","DOIUrl":"10.1016/j.josat.2024.209524","url":null,"abstract":"<div><h3>Background</h3><div>Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.</div></div><div><h3>Aim</h3><div>To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT).</div></div><div><h3>Methods</h3><div>This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes.</div></div><div><h3>Results</h3><div>Among recruited participants (<em>n</em> = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (<em>n</em> = 365). Methadone was used most often (83.9 %, <em>n</em> = 2876), followed by sublingual buprenorphine (16.2 %, <em>n</em> = 554). Over the three-year follow-up, 5.3 % of patients died (<em>n</em> = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes.</div></div><div><h3>Conclusion</h3><div>A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State program enables the identification of factors associated with naloxone awareness, self-efficacy, and use for overdose reversal: A cross-sectional, observational study in an urban emergency department population","authors":"","doi":"10.1016/j.josat.2024.209506","DOIUrl":"10.1016/j.josat.2024.209506","url":null,"abstract":"<div><h3>Introduction</h3><p>To assist the state of Ohio in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles to the development of prevention and educational strategies for reducing substance use disorder and related harms (e.g., promoting naloxone awareness). Naloxone awareness is a step in the naloxone cascade, which is a useful model for understanding the sequential steps laypeople must take to prepare themselves to intervene using naloxone; other steps include training and previous administration experience. Prior work has explored correlates of these steps among individuals with risky substance use, but fewer studies have focused on broader populations containing potential bystanders (e.g., family and community members).</p></div><div><h3>Methods</h3><p>This study was a secondary data analysis of patients from three urban emergency departments. Subsamples differed across five models (<em>n</em> = 479–1208) and included opioid-exposed and -naïve participants. Logistic regression characterized clinically useful sociodemographic predictors (e.g., race, ethnicity, education, employment, housing status) of naloxone awareness, self-efficacy (which relates to training), and previous-overdose administration. Two additional logistic regressions tested associations between risk factors for witnessing an opioid overdose and two cascade steps (awareness and self-efficacy).</p></div><div><h3>Results</h3><p>Non-White race, Hispanic ethnicity, and lower education predicted not being aware of naloxone; non-White race also predicted lower naloxone self-efficacy, and older age predicted lack of previous-overdose administration. Having family members with risky opioid use was heavily associated with awareness, while personal substance-use behaviors and previous overdose witnessing were associated with both awareness and higher naloxone self-efficacy.</p></div><div><h3>Conclusions</h3><p>Characteristics associated with lower likelihood of completing each cascade step highlight opportunities for targeted interventions. Specifically, findings indicated the importance of expanding naloxone education and training programs to more diverse populations and to family members of individuals with risky opioid use. Further, these findings demonstrate how a state-funded program such as SCOPE can have a positive impact on identifying strategies that may assist in reducing mortality associated with opioid overdose.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An economic analysis of the cost of mobile units for harm reduction, naloxone distribution, and medications for opioid use disorder","authors":"","doi":"10.1016/j.josat.2024.209517","DOIUrl":"10.1016/j.josat.2024.209517","url":null,"abstract":"<div><h3>Background &amp; objective</h3><p>Mobile substance use treatment units are effective approaches to increase treatment access and reduce barriers to opioid use disorder (OUD) care. However, little is known about the economic costs of maintaining and operating these units. This study aimed to estimate the economic costs of starting and maintaining mobile units providing harm reduction, overdose education and naloxone distribution (OEND), and medication for opioid use disorder (MOUD).</p></div><div><h3>Methods</h3><p>As part of the HEALing Communities Study, four communities in Massachusetts (Bourne/Sandwich, Brockton, Gloucester, Salem) implemented mobile units offering OEND and MOUD (buprenorphine and naltrexone only); each selected different services tailored to their community. All provided MOUD linkage via telehealth, but only one offered in-person MOUD prescribing on the unit. We retrospectively collected detailed resource utilization data from invoices to estimate the direct economic costs from August 2020 through June 2022. Cost components were categorized into start-up and operating costs. We calculated total economic cost over the study period and the average monthly operating cost.</p></div><div><h3>Results</h3><p>Implementing a mobile unit offering OEND and MOUD required a one-time median start-up cost of $59,762 (range: $52,062–$113,671), with 80 % of those costs attributed to the vehicle purchase. The median monthly operating cost was $14,464. The largest cost category for all mobile units was personnel costs. The monthly ongoing costs varied by community settings and services: approximately $5000 for two urban communities offering OEND and MOUD linkage via telehealth (Gloucester, Salem), $28,000 for a rural community (Bourne/Sandwich), and $23,000 for an urban community also providing in-person MOUD prescribing on the unit (Brockton).</p></div><div><h3>Conclusion</h3><p>The economic costs of mobile substance use treatment and harm reduction units are substantial but vary by community settings and services offered. Our results provide valuable community-level economic data to stakeholders and policymakers considering establishing and/or expanding mobile units with OEND and MOUD services. Further exploration of cost-effectiveness and efficiency should be considered across different settings.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-stage implementation of peer-led interventions for emergency department patients with substance use disorder: Findings from a formative qualitative evaluation","authors":"","doi":"10.1016/j.josat.2024.209518","DOIUrl":"10.1016/j.josat.2024.209518","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency department (ED)-based peer recovery coach (PRC) programs can improve access to substance use disorder treatment (SUD) for ED patients. As literature on early stages of PRC implementation is limited, we conducted a qualitative assessment of ED PRC program implementation from several US-based PRC programs focusing on barriers and facilitators for implementation and providing recommendations based on the findings.</p></div><div><h3>Methods</h3><p>We collected qualitative data from 39 key informants (peer recovery coaches, PRC program managers, ED physicians and staff, representatives of community-based organizations) via 6 focus groups and 21 interviews in February–December 2023. We transcribed audio-recordings and analyzed data using codebook thematic analysis.</p></div><div><h3>Results</h3><p>We identified the following major themes related to specific barriers and recommendations to address them. To facilitate <em>timely linkage to PRCs</em>, programs would regularly inform ED staff about the program and its linkage procedures, establish trust between PRC and ED staff, streamline the linkage procedures, and choose an “opt-out” linkage approach. To address barriers related to <em>external referrals,</em> programs use “warm handoff” and “warm line” strategies, maintain and update a comprehensive catalog of resources, and familiarize peer coaches with local service providers. <em>Telehealth services</em> implementation requires addressing logistical barriers, ensuring patients' privacy, and training peer coaches on building trust and rapport online. Peer coaches' <em>wellness and quality of services</em> can be improved by limiting PRC's workload, prioritizing quality over quantity, facilitating self-, peer- and professional care to mitigate stress and burnout; and, importantly, by providing supportive supervision and training to peer coaches and advocating for PRC team as an equal partner in the ED settings. To facilitate PRC <em>program adoption and sustainment</em> program managers engage local communities and program champions, seek diverse sources of funding, and advocate for structural changes to accommodate recruitment and retention of peer recovery coaches.</p></div><div><h3>Conclusions</h3><p>We compiled a wealth of best practices used by PRC programs to address numerous implementation barriers and challenges. These recommendations are intended for PRC program planners, managers and champions, hospital leadership, and state and local public health agencies leading SUD epidemic response.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the impact of low magnitude incentives in contingency management protocols: Non-engagement in Petry et al. 2004","authors":"","doi":"10.1016/j.josat.2024.209522","DOIUrl":"10.1016/j.josat.2024.209522","url":null,"abstract":"<div><h3>Introduction/method</h3><div>Current federal regulations limit the use of incentives in contingency management (CM) interventions to a nominal total value (i.e., up to $75/patient/year in aggregate of federal funds). This limit represents a striking divergence from the magnitudes used in evidence-based CM protocols. In the present report, we re-analyze data from the Petry et al. (2004) study, which was designed to test the efficacy of two different magnitude CM protocols ($80 and $240 in 2004 dollars) relative to usual intensive outpatient services for treatment-seeking patients with cocaine use. Petry et al. (2004) found that the $240 condition [~$405 in 2024 dollars], but not the $80 condition [~$135 in 2024 dollars], improved abstinence outcomes relative to usual care. The lower-cost $80 condition is the closest condition to the current federal $75 limit that permits a head-to-head comparison of magnitudes. A re-analysis offers an opportunity to examine the impact of low magnitude protocols in more detail, specifically in terms of non-engagement with treatment (defined as absence of negative samples and thus not encountering incentives for abstinence).</div></div><div><h3>Results</h3><div>We found moderate to large effects favoring the $240 condition over both usual care (<em>d</em>s ranging 0.33 to 0.97) and the $80 condition (<em>d</em>s ranging 0.39 to 0.83) across various thresholds of non-engagement with the incentives/reinforcers for abstinence. Importantly, the $80 condition evidenced higher (worse) rates of non-engagement compared to the usual care condition (i.e., small and negative effect sizes ranging −0.30 to 0.14), though not reaching statistical significance.</div></div><div><h3>Conclusions</h3><div>These results suggest that CM protocols designed to stay within the federal limitation of $75 should be discouraged, and evidence-based protocols should be recommended along with the regulatory reforms necessary to support their implementation.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}