Neurologist, Psychiatrist, 20 years’ experience, USA

This chapter examines the case of a patient with psychogenic non-epileptic seizures (PNES) and moral injury (MI). Identified in some civilian and military personnel, MI occurs in people who commit, witness or fail to prevent acts that transgress deeply held moral beliefs. Since returning from military service, every time he picked up his little boy at home, the patient saw the child who unknowingly stepped out in front of his target, just before he pulled the trigger. He has been seen in the posttraumatic stress disorder clinic and the substance abuse treatment program, as well as groups for veterans who saw combat overseas. None of them have taken away the pain of the core issue: MI. The patient cannot get over the guilt and shame of what he did while deployed. Knowing that no pharmacological or neuromodulatory intervention or treatment manual can provide a cure for this scar makes one question what neurologists, psychiatrists, and therapists really have to offer.

The Moderating Effect of Substance Abuse Treatment Engagement on the Connection Between Support From Program Participants and Substance-Related Recidivism for Justice-Involved Women

This study examines the prediction of substance-related technical violations and arrests from (a) a three-dimensional measure of substance abuse treatment engagement—treatment satisfaction, treatment participation, and counselor rapport—and (b) support from peers in the treatment program. The study focuses on 204 women on probation or parole who attended a substance abuse treatment program in the first 9 months of supervision. Data were collected in face-to-face interviews and from official records of violations and arrests. Generalized linear mixed-effects modeling was used to assess the main effects and the interaction effect of within-program peer support and other indicators of engagement as predictors of substance-related technical violations and arrests. Peer support was positively related to violations/arrests when treatment engagement was low. Findings suggest that for women who do not score high in treatment engagement, support from peers is related to increased recidivism, and group treatment may be contraindicated.

The Effect of Treatment Motivation Levels on Patients Sent to a Conditional Substance Abuse Treatment Program

The main purpose of this study is to examine the effect of treatment motivation levels on substance abuse behaviors of patients sent to a substance dependence treatment program based on the decision of Supervised Release made during a six-week psycho-educational group treatment program. The sample consisted of 112 participants who applied to the Ministry of Health Turkey, Sakarya University Training and Research Hospital, Psychiatry Clinic between the years 2012–2014, and were selected among patients who attended a six-week treatment program. The Treatment Motivation Questionnaire (TMQ), Demographic Information Questionnaire and interview methods were used in data collection. Patients with high treatment motivation levels were found to have a low substance abuse rate, and their adaptation to the treatment program was high. Patients who had high motivation levels at the beginning of the treatment, had low rates of substance abuse at the end of the treatment. This trend was confirmed for all of the measured four sub-types of motivation.

Breastfeeding Intention Compared With Breastfeeding Postpartum Among Women Receiving Medication-Assisted Treatment

Background: Women taking methadone or buprenorphine are encouraged to breastfeed if stable without polysubstance use. Research Aim: We aimed to determine the difference between stated intention to breastfeed prenatally in women taking methadone or buprenorphine compared with breastfeeding at discharge and 2 months postpartum. Secondary outcomes were determining whether breastfeeding was more common in women taking buprenorphine, in women without hepatitis C infection, and in women without a history of heroin use, and whether breastfeeding reduced the need for pharmacological treatment of neonatal opioid withdrawal syndrome. Methods: This was a retrospective cohort study of 228 women enrolled in a perinatal substance abuse treatment program. Electronic medical records were reviewed to abstract data on mother-infant dyads. Chi-square tests were used to analyze our outcomes. Results: Women taking buprenorphine had a higher prevalence of breastfeeding compared with women taking methadone (83% [ n = 100] vs. 71% [ n = 76]; χ2 = 4.35, p = .03), despite no difference in their prenatal intention to breastfeed (87% vs. 81%; χ2 = 1.28, p = .25). Only 31% ( n = 38) of women taking buprenorphine and 19.6% ( n = 21) of women taking methadone exclusively breastfed at discharge (χ2 = 5.43, p = .06). Exclusively breastfed infants required less pharmacological treatment for neonatal opioid withdrawal syndrome compared with formula-fed infants (15.8% [ n = 21] vs. 47.4% [ n = 38]; χ2 = 19.72, p < .05). Conclusion: Despite most women reporting a high prenatal intention to breastfeed, exclusive breastfeeding at hospital discharge postpartum was low. Breastfeeding was associated with a decreased likelihood of pharmacological treatment for neonatal opioid withdrawal syndrome.

Methodological Impression Management in Ethnographic Research

In this article, we contend that turning a sharp dramaturgical lens on the dynamics of fieldwork clarifies a number of longstanding ethical challenges in ethnography—challenges that have shifted and deepened in the new technological landscape in which ethnographers work. We encourage fieldworkers to adopt an intentional approach to what we call methodological impression management to navigate the research process more strategically. Drawing on our experiences conducting fieldwork in settings where some of our research participants had power over others (a women’s shelter and a substance abuse treatment program), we delineate the strategies we found useful for successful methodological impression management in complex settings and point to the dramaturgical underpinnings of their effectiveness. By bringing dramaturgical theory into direct conversation with the literature on ethnographic methods, we hope to illuminate a path through which ethnographers might make more deliberative methodological decisions and thoughtfully balance ethical responsibilities to their participants with their commitment to analytic rigor.

Implementation and results of a symptom-triggered opioid withdrawal protocol at a Veterans Affairs medical center

Introduction: The Chillicothe Veterans Affairs Medical Center serves veterans from southern Ohio, Kentucky, and West Virginia, where the rates of non-medical opioid use are some of the highest in the nation. Prior to this project, there was not a standardized practice for the treatment of veterans undergoing opioid withdrawal at the facility. In May 2015, a symptom-triggered protocol was initiated to improve the quality of care and decrease the length of detoxification for veterans treated at the Chillicothe Veterans Affairs Medical Center. Methods: This paper reflects a 2-phase project that took place from August 2014 through June 2016. Phase 1 focused on the development of a symptom-triggered opioid withdrawal protocol using the Clinical Opiate Withdrawal Scale for assessment and buprenorphine/naloxone or clonidine for treatment. Phase 2 was a retrospective cohort analysis comparing outcomes between group 1, before protocol initiation; group 2, after protocol initiation with clonidine; and group 3, after protocol initiation with buprenorphine/naloxone. The primary outcome assessed was length of detoxification (in days). Secondary outcomes included length of hospitalization (in days) for the index admission, outpatient substance abuse treatment program participation rates, and opioid sobriety rates at 3 months after detoxification. Results: A statistically significant reduction in the duration of detoxification days was detected after protocol initiation in veterans who received buprenorphine/naloxone or clonidine in accordance with the protocol. Discussion: This retrospective quality analysis supports the use of a symptom-triggered opioid withdrawal protocol using the Clinical Opiate Withdrawal Scale for assessment and clonidine or buprenorphine/naloxone for detoxification treatment.

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OBJECTIVES/SPECIFIC AIMS: This study sought to determine the accessibility, utilization, and preference for mobile phone use among a marginalized population of teens enrolled in an adolescent substance abuse treatment program and their parents. Specific study aims were to: (1) characterize mobile phone use, (2) assess the accessibility and reliability of mobile phone usage, (3) determine specific barriers to mobile phone use, and (4) examine parent and teen perceptions of the utility of integrating communication technology in substance use treatment. METHODS/STUDY POPULATION: In total, 103 (78.6% female; 75.7% Hispanic) parents of teens participating in an outpatient substance abuse treatment program with an average age of 42.60 (SD=9.28) participated in our study. Upon enrollment in a substance abuse treatment program between October 2014 and July 2016, parents completed a technology use survey as part of program development and a chart review of clinic outbound calls to parent mobile phones was completed to evaluate reliability of parent mobile phone access throughout treatment. Survey collection among teens is ongoing. Study population information for teens will be presented at the conference. RESULTS/ANTICIPATED RESULTS: The vast majority of parents owned a cell phone and used it as their primary phone (97.1%); 83% of parents owned smart phones in particular, with the majority being Android phones (68.7%). Parents were more likely to have pay-as-you-go (41.4%) and yearly (32.3%) contracts, and only 15% of the sample endorsed changing their phone number more than once in the past year (64%=never; 21%=once). Parents reported using several of the phone features: text (97%), email (76%), pictures (93%), and accessing the internet (92%); 92% reported they did not have a texting limit; and the most popular use of the mobile phone was to send and receive text messages (58.6%), followed by accessing the internet (19.2%). During the course of a 10-week treatment program, the clinic made 2776 confirmation phone calls to parents who completed surveys. Report of accessibility matched the clinic’s ability to reach parents. Of the 2776 calls, 97.2% were made to the original number provided, which was in service. Only 2.7% were determined to be disconnected, with the median number of days for disconnected service being 2 days with no voice and no texting capabilities (range=14) and 2 days with no voice, but with texting capabilities (range=28). In terms of parent perceptions of the utility of integrating communication technology in substance use treatment, 91% of parents reported they would be receptive to receiving text messages with parenting tips as aftercare support. Preferred content areas included: strategies for monitoring teen substance use (56%), strategies for using consequences (62%), suggestions for encouraging positive activities (62%), and ways to improve parent-child communication (63%). Accessibility, utilization, and preference for mobile phone use in a treatment program among teen respondents will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: This study characterized both subjective and objective mobile phone accessibility and usability among teens participating in an adolescent substance abuse treatment program and their parents. This study also provides information on teen and parent perceptions of using mobile phones during the aftercare period and ratings of acceptable messages following treatment. This data will help researchers design mobile-based interventions both during and after treatment, which is the future direction of our research group.

An innovative service collaboration to reduce criminal recidivism for inmates with severe addictions

Agencies with overlapping mandates can form partnerships to aid development of effective programming. In 2008, the Dedicated Substance Abuse Treatment Unit (DSATU) opened at Regina Correctional Centre through a tripartite collaboration between the Saskatchewan (SK) Ministry of Justice, Corrections and Policing; Addiction Services, Regina Qu’Appelle Health Region; and the SK Ministry of Health. Stakeholders researched existing best practices in the field and developed an evidence-based substance abuse treatment program for sentenced inmates at high risk to re-offend. An evaluation of the DSATU program completed in 2016 concluded that the DSATU was effective, sustainable, and likely transferable to other correctional facilities wishing to offer this type of programming. The stakeholder partnership was a key ingredient in the program’s success. This paper describes the process by which the partners worked together to develop, implement, and sustain this innovative and evidence-based substance abuse treatment program. The partners’ willingness to compromise, to take a collaborative approach to building the partnership and developing the program, and to put clients ahead of individual organizational mandates all contributed to the success of the partnership.