Dennis McCarty | Oregon Health & Science University (original) (raw)

Papers by Dennis McCarty

Journal of Substance Abuse Treatment, 2007

This study examines the association between adherence to during-treatment process measures of qua... more This study examines the association between adherence to during-treatment process measures of quality (defined as initiation and engagement in treatment as developed by the Washington Circle) and outcome measures (defined as arrests and incarcerations) in the following year. The data come from the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) administrative data system linked to data from state agencies involved in criminal justice. Clients who initiated a new episode of outpatient treatment and who engaged in treatment were significantly less likely to be arrested or incarcerated during the following year. Initiation of substance abuse treatment alone, without engagement in treatment, was not significantly associated with arrests or incarcerations. These findings validate the clinical importance of the Washington Circle performance measures of initiation and engagement. These "process of care" measures can make a difference when used as a target for quality improvement at treatment facilities.

The Journal of Behavioral Health Services & Research, 2000

Journal of Substance Abuse Treatment, 2003

Journal of Substance Abuse Treatment, 2005

Admissions to 20 publicly funded alcohol and drug detoxification centers in Massachusetts were ex... more Admissions to 20 publicly funded alcohol and drug detoxification centers in Massachusetts were examined to identify program and patient variables that influenced length of stay. The last admission during fiscal year 1996 was abstracted for patients 18 years of age and older seeking alcohol, cocaine, or heroin detoxification (n=21,311; 29% women). A hierarchical generalized linear model examined the effects of patient and program characteristics on variation in length of stay and tested case-mix adjustments. Program size had the most influence on mean adjusted length of stay; stays were more than 40% longer in detoxification centers with 35 or more beds (7.69 days) than in centers with less than 35 beds (5.42 days). The study highlights the contribution of program size to treatment processes and suggests the need for more attention to program attributes in studies of patient outcomes and treatment processes.

Journal of Personality and Social Psychology, 1982

Investigations of the alcohol-related disinhibition of responses to deviant sexual stimuli sugges... more Investigations of the alcohol-related disinhibition of responses to deviant sexual stimuli suggest that the pharmacological actions of ethanol have little influence on the disinhibition process. The mere belief that alcohol is consumed is sufficient to induce increased sexual arousal. Studies with conventional stimuli, however, suggest that interactions occur between the pharmacological presence of ethanol and the psychological expectations of its presence. Thus, this article examines the contribution of pharmacological, cognitive, and environmental variables to perceived sexual arousal. A balanced-placebo design varied drink instruction and drink content independently. Pictures that elicited either a low or moderate level of self-reported sexual arousal were viewed and evaluated by men (n = 64) and women (n = 64) after completing their drinks. The evaluations and arousal measures suggested significant Instruction X Content X Arousal interactions. The strongest perceptions of arousal occurred among individuals who did not know they were drinking alcohol (i.e., subjects who were told that their alcoholic drinks did not contain alcohol). Apparently, when drinkers were unaware of the alcohol intoxication, the pharmacological excitation induced by alcohol transferred to the perception and evaluation of the slides.

Journal of Applied Social Psychology, 1981

... Attitude Norm Attitude Norm Attitude Norm Attitude Norm Attitude Norm Condom nonuser Malepill... more ... Attitude Norm Attitude Norm Attitude Norm Attitude Norm Attitude Norm Condom nonuser Malepill user Male pill nonuser Female pill user Female pill nonuser n 53 41 25 61 39 16 - ... Method Nonuser Condom Male pill Female pill .624 attitudes toward using the contraceptive. ...

Drug and Alcohol Dependence, 2009

Journal of Substance Abuse Treatment, 2010

The National Institute on Drug Abuse (NIDA) established the National Drug Abuse Treatment Clinica... more The National Institute on Drug Abuse (NIDA) established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999 to bring researchers and treatment providers together to develop a clinically relevant research agenda. Initial CTN efforts addressed the use of buprenorphine, a mu-opioid partial agonist, as treatment for opioid dependence. Strong evidence of buprenorphine's therapeutic efficacy was demonstrated in clinical trials involving several thousand opioid-dependent participants, and in 2002, the FDA approved buprenorphine for the treatment of opioid dependence. With the advent of a sublingual tablet containing both buprenorphine and naloxone to mitigate abuse and diversion (Suboxone®), buprenorphine appeared poised to be the first-line treatment for opioid addiction. Notwithstanding its many attributes, certain implementation barriers remained to be addressed in CTN studies, and these efforts have brought a body of knowledge on buprenorphine to front-line clinicians. The purpose of this article is to review CTN-based buprenorphine research and related efforts to overcome challenges to the implementation of buprenorphine therapy in mainstream practice. Furthermore, this paper explores current issues and future challenges that may require additional CTN efforts.

American Journal on Addictions, 2004

In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone ... more In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone ® ) sublingual tablets as an opioid dependence treatment available for use outside traditionally licensed opioid treatment programs. The NIDA Center for Clinical Trials Network (CTN) sponsored two clinical trials assessing buprenorphine-naloxone for short-term opioid detoxification. These trials provided an unprecedented field test of its use in twelve diverse community-based treatment programs. Opioid-dependent men and women were randomized to a thirteen-day buprenorphine-naloxone taper regimen for short-term opioid detoxification. The 234 buprenorphine-naloxone patients averaged 37 years old and used mostly intravenous heroin. Direct and rapid induction onto buprenorphine-naloxone was safe and well tolerated. Most patients (83%) received 8 mg buprenorphine-2 mg naloxone on the first day and 90% successfully completed induction and reached a target dose of 16mg buprenorphine-4 mg naloxone in three days. Medication

The American Journal of Drug and Alcohol Abuse

Abstract Background and aims: Therapist characteristics may be associated with variation in consi... more Abstract Background and aims: Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF). Methods: Raters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy and global session performance. Results: Therapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy...

Journal of substance abuse treatment

Twelve step facilitation (TSF) is an emerging, empirically supported treatment, the study of whic... more Twelve step facilitation (TSF) is an emerging, empirically supported treatment, the study of which will be strengthened by rigorous fidelity assessment. This report describes the development, reliability and concurrent validity of the Twelve Step Facilitation Adherence Competence Empathy Scale (TSF ACES), a comprehensive fidelity rating scale for group and individual TSF treatment developed for the National Drug Abuse Treatment Clinical Trials Network study, Stimulant Abuser Groups to Engage in 12-Step. Independent raters used TSF ACES to rate treatment delivery fidelity of 966 (97% of total) TSF group and individual sessions. TSF ACES summary measures assessed therapist treatment adherence, competence, proscribed behaviors, empathy and overall session performance. TSF ACES showed fair to good overall reliability; weighted kappa coefficients for 59 co-rated sessions ranged from .31 to 1.00, with a mean of .69. Reliability ratings for session summary measures were good to excellent (...

Drug and alcohol dependence, Jan 21, 2015

Two item banks for substance use were developed as part of the Patient-Reported Outcomes Measurem... more Two item banks for substance use were developed as part of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)): severity of substance use and positive appeal of substance use. Qualitative item analysis (including focus groups, cognitive interviewing, expert review, and item revision) reduced an initial pool of more than 5300 items for substance use to 119 items included in field testing. Items were written in a first-person, past-tense format, with 5 response options reflecting frequency or severity. Both 30-day and 3-month time frames were tested. The calibration sample of 1336 respondents included 875 individuals from the general population (ascertained through an internet panel) and 461 patients from addiction treatment centers participating in the National Drug Abuse Treatment Clinical Trials Network. Final banks of 37 and 18 items were calibrated for severity of substance use and positive appeal of substance use, respectively, using the two-parameter graded...

Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 2006

The journey between research and practice in alcoholism treatment is worthwhile but can be diffic... more The journey between research and practice in alcoholism treatment is worthwhile but can be difficult because of the inherent differences between the treatment and research disciplines. This article describes how the path between research and practice can be navigated successfully, discusses the factors that influence the journey, and offers specific pharmaceutical and behavioral interventions as examples of research-based treatment approaches that can be implemented more widely.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2006

Treatment for substance abuse and human immunodeficiency virus (HIV) infection historically have ... more Treatment for substance abuse and human immunodeficiency virus (HIV) infection historically have come from different providers, often in separate locations, and have been reimbursed through separate funding streams. We describe policy and financing challenges faced by health care providers seeking to integrate buprenorphine, a new treatment for opioid dependence, into HIV primary care. Regulatory challenges include licensing and training restrictions imposed by the Drug Addiction Treatment Act of 2000 and confidentiality regulations for alcohol and drug treatment records. Potential responses include the development of local training programs and electronic medical records. Addressing the complexity of funding sources for integrated care will require administrative support, up-front investments, and federal and state leadership. A policy and financing research agenda should address evidence gaps in the rationales for regulatory restrictions and should include cost-effectiveness studi...

Public Health Frontier, 2013

Implementing specific evidence-based practices (EBPs) across a set of addiction treatment provide... more Implementing specific evidence-based practices (EBPs) across a set of addiction treatment providers have been a persistent challenge. In the Advancing Recovery(AR) demonstration project, single state agencies, the entities that distribute federal funds for substance use disorder prevention and treatment services, worked in partnership with providers to increase the use of EBPs in the treatment of addiction. The project supported two cohorts of six 2-year awards. Field observations from the first year of implementation guided development of a multilevel framework (the Advancing Recovery Framework). Government entities and other payers can use the framework as a guide for implementing evidence-based clinical practices within treatment networks. The Advancing Recover Framework calls for a combination of policy and organizational changes at both the payer (government agency) and provider levels. Using the Advancing Recovery Framework, 11 of the 12 AR payer/provider partnerships increased use of clinical EPBs. This article identifies key payer policy changes applied during different phases of EBP program implementation. The public health benefit of the demonstration project was broader use of medication-assisted therapy and continuing care in addiction treatment services.

Health Services Research, 2014

To profile state agency efforts to promote implementation of three evidence-based practices (EBPs... more To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). Primary data collected from representatives of 50 states and the District of Columbia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Single State Authorities from 2007 to 2009. The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.

Alcoholism, 2001

Managed care is affecting the organization and financing of treatment services for alcohol and dr... more Managed care is affecting the organization and financing of treatment services for alcohol and drug dependence. This paper examines the effects of managed care on program operations including the use of clinical protocols, the administrative burden, information systems, staffing, and program consolidation. It also reviews the effects of managed care on system performance related to employer-sponsored health plans, state employee health plans, and Medicaid and other public plans. Our review of managed care's influences on the alcohol and drug abuse treatment system finds evidence of systemic reductions in access to inpatient care and increased reliance on outpatient services. Moreover, although analyses of behavioral health carve-outs often suggest increases in the use of outpatient care, evaluations of substance abuse claims report reductions in ambulatory utilization for the treatment of alcohol and drug dependence.

Substance Abuse Treatment, Prevention, and Policy, 2010

Background: The gap between research and practice limits utilization of relevant, progressive and... more Background: The gap between research and practice limits utilization of relevant, progressive and empirically validated strategies in substance abuse treatment.

Substance Abuse, 2011

The National Drug Abuse Treatment Clinical Trials Network (CTN) is an alliance of drug abuse trea... more The National Drug Abuse Treatment Clinical Trials Network (CTN) is an alliance of drug abuse treatment programs and research centers testing new interventions and implementation factors for treating alcohol and drug use disorders. A workforce survey distributed to those providing direct services in 295 treatment units in the CTN obtained responses from 1750 individuals with a job title of counselor (n = 1395) or counselor supervisor (n = 355). A secondary analysis compares and describes both groups. Supervisors were more likely to be licensed or certified. Master&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s degrees were more common among counselors in outpatient and methadone programs. Counselors in residential settings tended to be on the job fewer years. Finally, higher education was associated with greater familiarity with and acceptance of evidence-based practices.