California Substance Abuse Research Consortium (SARC) Meeting,

 September 2005

Table of Contents

(Scroll down to view abstracts)

SARC Supplement Number 3

November 2006

Editor’s Introduction: California Substance Abuse Research Consortium, September 2005 — Beth Rutkowski, M.P.H.; Thomas Freese, Ph.D. & Richard Rawson, Ph.D.

Judicial Supervision of Drug-Abusing Offenders —Douglas B. Marlowe, J.D., Ph.D.

Prison-Based Treatment for Drug-Dependent Women Offenders: Treatment Versus No Treatment — Nena Messina, Ph.D.; William Burdon, Ph.D. & Michael Prendergast, Ph.D.

California Drug Courts: Outcomes, Costs and Promising Practices: An Overview of Phase II in a Statewide Study — Shannon M. Carey, Ph.D.; Michael Finigan, Ph.D.; Dave Crumpton, M.P.P. & Mark Waller, B.S.

Evaluation of the Substance Abuse and Crime Prevention Act: Client Characteristics,  Treatment Completion and Re-Offending Three Years After Implementation—Elizabeth Evans, M.A.; Douglas Longshore, Ph.D.; Michael Prendergast, Ph.D. & Darren Urada, Ph.D.

California Substance Abuse Research Consortium, September 2005: Update on Recent Methamphetamine Trends in Four California Regions — Beth A. Rutkowski, M.P.H.

The Acceptability and Feasibility of the Positive Reinforcement Opportunity Project, a Community-Based Contingency Management Methamphetamine Treatment Program for Gay and Bisexual Men in San Francisco  — Frank V. Strona, M.P.H.c; Jacque McCright, M.P.H.; Hanna Hjord, M.P.H.; Katherine Ahrens, M.P.H.;  Steven Tierney, Ed.D.; Steven Shoptaw, Ph.D. & Jeffrey D. Klausner, M.D., M.P.H.

Craving and Control: Methamphetamine Users’ Narratives — Alexandra M. Bruehl, M.A.; Daniel H. Lende, Ph.D.; Melissa Schwartz, B.A.;  Claire E. Sterk, Ph.D. & Kirk Elifson, Ph.D.

Methamphetamine Use and Adverse Consequences in the Rural Southern United States: An Ethnographic Overview — Rocky L. Sexton, Ph.D.; Robert G. Carlson, Ph.D.; Carl G. Leukefeld, Ph.D.  & Brenda M. Booth, Ph.D.

Perceived Behavior of Others and AIDS Risk Behavior Among Heterosexually-Identified Methamphetamine Users — Shirley J. Semple, Ph.D.; Igor Grant, M.D. & Thomas L. Patterson, Ph.D.

Two-Year Outcomes of Treatment for Methamphetamine Use — Mary-Lynn Brecht, Ph.D.; Lisa Greenwell, Ph.D.;  Christina von Mayrhauser, Ph.D. & M. Douglas Anglin, Ph.D.

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Abstracts

Judicial Supervision of Drug-Abusing Offenders —Douglas B. Marlowe, J.D., Ph.D.
Abstract—In recent years, judges have been exercising steadily increasing influence over the disposition and management of drug abusers involved with the criminal justice system. This appears to have been motivated by a perception on the part of some judges that the courts are uniquely situated to bring about optimal outcomes for these individuals. In fact, the results of experimental and survey studies provide substantial support for this perspective, but only with regard to high-risk drug offenders who have more severe antisocial predispositions or a history of not having responded to standard community-based drug abuse treatment services. This article reviews that research evidence and considers its implications for designing effective and cost-efficient policies and programs for drug-abusing criminal offenders.
Keywords—antisocial personality disorder, criminal justice, drug court, drug policy

Prison-Based Treatment for Drug-Dependent Women Offenders: Treatment Versus No Treatment — Nena Messina, Ph.D.; William Burdon, Ph.D. & Michael Prendergast, Ph.D.
Abstract—This outcome study compared six- and 12-month return-to-custody data for 171 treatment participants and 145 nontreated general population inmates at the Central California Women’s Facility (implementing a traditional TC program). Findings showed that there were no differences between the TC treatment group and the no treatment comparison group with regard to six- and 12-month return-to-custody rates (six-month: 16% vs. 16% and 12-month: 36% vs. 27%). The only significant difference in six-month return-to-custody rates was found between treatment-only participants (21%) and the treatment plus aftercare participants (6%). Treatment participants who participated in community-based aftercare were significantly less likely to be returned to custody compared with those who did not participate in aftercare. Multivariate analysis was also used to control for the large difference in psychological impairment between the two groups and other background factors related to reincarceration, while assessing the effect of treatment group status on return-to-custody. Findings indicated that treatment/no-treatment status was not significantly related to a six- or 12-month return-to-custody. However, success on parole was associated with participation in community-based aftercare. The lack of a prison-based treatment effect could be an indication that drug-dependent women offenders need gender-responsive treatment that is designed specifically for their complex needs.
Keywords—prison-based treatment, treatment outcome, women offenders

California Drug Courts: Outcomes, Costs and Promising Practices: An Overview of Phase II in a Statewide Study — Shannon M. Carey, Ph.D.; Michael Finigan, Ph.D.; Dave Crumpton, M.P.P. & Mark Waller, B.S.
Abstract—The rapid expansion of drug courts in California and the state’s uncertain fiscal climate highlighted the need for definitive cost information on drug court programs. This study focused on creating a research design that can be utilized for statewide and national cost-assessment of drug courts by conducting in-depth case studies of the costs and benefits in nine adult drug courts in California. A Transactional Institutional Costs Analysis (TICA) approach was used, allowing researchers to calculate costs based on every individual’s transactions within the drug court or the traditional criminal justice system. This methodology also allows the calculation of costs and benefits by agency (e.g., Public Defender’s office, court, District Attorney). Results in the nine sites showed that the majority of agencies save money in processing an offender though drug court. Overall, for these nine study sites, participation in drug court saved the state over $9 million in criminal justice and treatment costs due to lower recidivism in drug court participants. Based on the lessons learned in Phases I and II, Phase III of this study focuses on the creation of a web-based drug court cost self-evaluation tool (DC-CSET) that drug courts can use to determine their own costs and benefits.
Keywords—cost-benefit, criminal justice, drug courts, evaluation

Evaluation of the Substance Abuse and Crime Prevention Act: Client Characteristics, Treatment Completion and Re-Offending Three Years After Implementation —Elizabeth Evans, M.A.; Douglas Longshore, Ph.D.; Michael Prendergast, Ph.D. & Darren Urada, Ph.D.
Abstract—Representing a major shift in criminal justice policy, Proposition 36 became law in November 2000 as the Substance Abuse and Crime Prevention Act (SACPA), permitting eligible offenders to receive probation with drug treatment instead of probation or incarceration. UCLA’s Integrated Substance Abuse Programs was chosen by the California Department of Alcohol and Drug Programs to conduct an independent evaluation of SACPA. Analysis of the first three years of data provides information on the flow of offenders through SACPA, client and program characteristics, treatment completion rates, and effects on re-offending. Results show that most eligible offenders chose to participate in SACPA; almost two-thirds of these went on to enter treatment. Compared to other treatment clients, SACPA treatment clients included fewer women, were predominately between 26 and 45 years old, were more likely to use methamphetamine, and had been using drugs a longer. Most SACPA clients were referred to outpatient drug-free treatment regardless of primary drug problem, and about one-third completed treatment. Re-offending was lowest among SACPA offenders who completed treatment. Felony and misdemeanor drug arrests were higher among SACPA-era drug offenders than in a similar group of pre-SACPA drug offenders. Future reports will cover possible SACPA cost savings, additional clients outcomes, and overall lessons learned.
Keywords—drug offense, Proposition 36, Substance Abuse and Crime Prevention Act of 2000, treatment

California Substance Abuse Research Consortium, September 2005: Update on Recent Methamphetamine Trends in Four California Regions — Beth A. Rutkowski, M.P.H.
Abstract—California Substance Abuse Research Consortium (SARC) meetings have become a mainstay in supporting the exchange of new alcohol and other drug information on research to policy and other initiatives throughout the state. A cornerstone of SARC is a discussion of regional substance abuse patterns and trends. This article provides readers with a brief overview of recently released methamphetamine statistics, as well as a more detailed review of the methamphetamine information presented during the substance abuse epidemiology portion of the September 2005 meeting, as presented for Kern County, Los Angeles County, San Diego County, the San Francisco Bay Area, and the state of California.
Keywords—epidemiology, indicators, methamphetamine, patterns, substance abuse, trends

The Acceptability and Feasibility of the Positive Reinforcement Opportunity Project, a Community-Based Contingency Management Methamphetamine Treatment Program for Gay and Bisexual Men in San Francisco — Frank V. Strona, M.P.H.c; Jacque McCright, M.P.H.; Hanna Hjord, M.P.H.; Katherine Ahrens, M.P.H.; Steven Tierney, Ed.D.; Steven Shoptaw, Ph.D. & Jeffrey D. Klausner, M.D., M.P.H.
Abstract—The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in high-risk sexual activity. Of the 178 men who participated in PROP from December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.
Keywords—contingency management, gay and bisexual men, HIV, methamphetamine

Craving and Control: Methamphetamine Users’ Narratives — Alexandra M. Bruehl, M.A.; Daniel H. Lende, Ph.D.; Melissa Schwartz, B.A.; Claire E. Sterk, Ph.D. & Kirk Elifson, Ph.D.
Abstract—In this article the authors explore the experience of craving of methamphetamine users and seek to illuminate how differences in craving contribute to use patterns. Using in-depth interviewing, data were collected from 82 active methamphetamine users in the metropolitan Atlanta area. The constant comparison method common in grounded theory guided the data analysis. Narrative responses corresponded with three types of craving described in the literature: cue-, drug- and withdrawal-induced. However, the narratives also problematize this typological view as well as the characterization of craving as invariably leading to drug use. Types of craving cues were sometimes inseparable, and users indicated that the different types of craving could occur in the same situation. Further, many users described being able to overcome craving through personalized methods of control. This study complements the largely quantitative work on craving and highlights the importance of improving drug abuse treatment and harm reduction programs.
Keywords—craving, control mechanisms, methamphetamine, qualitative research

Methamphetamine Use and Adverse Consequences in the Rural Southern United States: An Ethnographic Overview — Rocky L. Sexton, Ph.D.; Robert G. Carlson, Ph.D.; Carl G. Leukefeld, Ph.D. & Brenda M. Booth, Ph.D.
Abstract—Research on methamphetamine use and related issues often uses data from in-treatment and post-treatment populations in urban areas. Rural ethnographic studies are less common, particularly self-assessments by active methamphetamine users that explore use patterns and their adverse consequences. Such work is especially rare in the rural South, where illicit methamphetamine manufacture and use have recently been increasing. This article presents an ethnographic overview of methamphetamine use in rural Kentucky and Arkansas based on qualitative interviews conducted with 34 active, not-in-treatment, primary methamphetamine users. Methamphetamine supply, distribution, and prevalence of methamphetamine use are described. Pathways and motivations for methamphetamine use and use patterns are outlined as well. A discussion of the adverse consequences and potential risks of methamphetamine use follows. The findings indicate that informed drug treatment outreach and reduction of potential adverse consequences among methamphetamine users in rural areas are important issues for public health and for interventions.
Keywords— adverse consequences, ethnography, harm reduction, methamphetamine, rural southern United States

Perceived Behavior of Others and AIDS Risk Behavior Among Heterosexually-Identified Methamphetamine Users — Shirley J. Semple, Ph.D.; Igor Grant, M.D. & Thomas L. Patterson, Ph.D.
Abstract—This study used cross-sectional data to examine perceived risk behavior of social network members as a correlate of AIDS risk behavior in a sample of 230 heterosexually-identified, methamphetamine (meth) users. The highest ratings of risk behavior within participants’ social networks were associated with meth use and non-use of condoms. Friends received the highest ratings in terms of overall perceived involvement in drug and sexual risk behaviors. In a multivariate analysis, perceived risk behavior of others, social norms, and attitudes toward AIDS preventive behaviors were significantly associated with intentions to always use condoms. Strategies for addressing negative social influences in the context of sexual risk reduction interventions are described.
Keywords—heterosexual, HIV risk behavior, methamphetamine, social network, Theory of Reasoned Action

Two-Year Outcomes of Treatment for Methamphetamine Use — Mary-Lynn Brecht, Ph.D.; Lisa Greenwell, Ph.D.; Christina von Mayrhauser, Ph.D. & M. Douglas Anglin, Ph.D.
Abstract—While evaluation research supports the general effectiveness of substance abuse treatment, there is not a comprehensive literature on treatment effectiveness for methamphetamine (MA) use. The authors consider three outcome measures—MA use, criminal activity, and employment—compared across three periods: 24-months pretreatment, during treatment, and 24-months post-treatment. Data are from an intensive natural history interview conducted two to three years after treatment for 349 randomly selected admissions to treatment for MA abuse in a large publicly-funded county treatment system. Through this naturalistic design, data provide a system-wide perspective on effectiveness of treatment as usual. Results showed reduction in MA use and crime during and following treatment and increased employment following treatment over pretreatment levels. Regression analyses showed higher levels of education and more time in treatment related to more positive post-treatment outcomes for all three measures. Lower percentage of post-treatment months with MA use also was related to more pretreatment MA-related problems, lower pretreatment MA use, and residential (compared to outpatient) treatment modality. Lower post-treatment criminal activity was also related to gender (being female), lower pretreatment criminal activity, and residential modality. Higher percentage of post-treatment months with employment also was related to gender (being male), ethnicity (not African-American), and higher pretreatment employment.
Keywords—criminal activity, employment, longitudinal study, long-term outcomes, methamphetamines, treatment effectiveness