Jerry Stahler | Temple University (original) (raw)

Papers by Jerry Stahler

Research paper thumbnail of Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015–2018

Drug and Alcohol Dependence, Jul 1, 2022

Research paper thumbnail of The Influence of Neighborhood Environment on Treatment Continuity and Rehospitalization in Dually Diagnosed Patients Discharged From Acute Inpatient Care

American Journal of Psychiatry, Nov 1, 2009

Recently, there has been increased interest in the environmental factors affecting mental health ... more Recently, there has been increased interest in the environmental factors affecting mental health and substance use (11-16), but relatively little research relates environmental context to treatment engagement, compliance, or outcomes (17-19). The neighborhood context has been discussed and examined in relation to its effect on crime, delinquency, violence, stress, depression, and physical health (1, 11-12, 20-28). Although most practitioners implicitly recognize the importance of a patient's neighborhood environment, only limited research has been devoted to examining empirically the importance of environment in psychiatric and substance abuse treatment outcomes (17, 18). Drake et al. (29) concluded that the most important future direction for intervention research The physical and social environment in which individuals with both mental health and substance use disorders live has often been overlooked as an area of study. Dually diagnosed patients pose a particular challenge to psychiatric treatment, since they tend to have a more chronic course of illness, higher rates of relapse and rehospitalization, lower rates of treatment completion, and more complicated service needs than those with substance use problems only (1-7). The environmental context in which dually diagnosed individuals live may be particularly important, since substance abuse in this population is especially influenced by socioenvironmental factors (8). When these patients relapse, it is often environmental triggers that precipitate an episode (9, 10).

Research paper thumbnail of Centers and Institutes in the Research University

The Journal of Higher Education, Sep 1, 1994

Research paper thumbnail of At the Crossroads in the Opioid Overdose Epidemic: Will Evidence-Based "Radical" but Rational Drug Policy Strategies Prevail?

Research paper thumbnail of GeospatialTechnologyandthe"Exposome":NewPerspectivesonAddiction

Research paper thumbnail of The effect of individual, program, and neighborhood variables on continuity of treatment among dually diagnosed individuals

Springer eBooks, Sep 23, 2008

This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and... more This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and substance-use disorders who were discharged from a hospital acute inpatient unit to various outpatient treatment programs in Philadelphia. Geographic Information Systems (GIS) technology and logistic regression modeling were employed to investigate the effects of individual, neighborhood, and program-level variables on arrival to the first treatment appointment within 30 days of discharge. Four models are presented. The results of the study suggest that having had three or more treatment episodes prior to inpatient hospitalization, and living in a neighborhood in which temporary or transitional, and presumably, other low income housing is located, increased the likelihood of patients continuing with treatment in the community. Discharge to the preadmission address, a chief complaint of bizarre behavior, close proximity of two or more liquor and/or beer stores, a high density of narcotics anonymous (NA) and/or alcoholics anonymous (AA) meetings within the neighborhood, an axis I diagnosis of substance-induced mood disorder, and a urine drug screen positive for heroin reduced the likelihood of attending outpatient treatment. We conclude that geographic and community variables as they relate to substance abuse may add an important dimension to our understanding of patient functioning and well being in the community following inpatient treatment.

Research paper thumbnail of An assessment of therapist rating bias and the Hawthorne effect in a program evaluation

Research paper thumbnail of Cannabis Legalization and the Decline of Cannabis Use Disorder (CUD) Treatment Utilization in the US

Current Addiction Reports

Research paper thumbnail of The Convergence of the COVID-19 and Opioid Health Crises in the US

Research paper thumbnail of Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults

Research paper thumbnail of Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US

Drug and Alcohol Dependence, 2021

BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use... more BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) in residential treatment and the influence of race/ethnicity on the association between MOUD use and treatment retention and completion. METHODS Data were extracted from SAMHSA's 2015-2017 Treatment Episode Dataset-Discharge (TEDS-D) datasets for adult opioid admissions/discharges to short-term (ST) (30 days or less) (N = 83,032) or long-term (LT) (> 30 days) residential treatment settings (N=61,626). Logistic regression estimated the likelihood of MOUD use among racial/ethnic groups and the moderation of race/ethnicity on the probability of treatment completion and retention, controlling for background factors. RESULTS After adjusting for covariates, compared to Whites, MOUD use was less likely for Blacks in ST (OR = 0.728) and LT settings (OR = 0.725) and slightly less likely for Hispanics in ST settings (OR = 0.859) but slightly more likely for Hispanics in LT settings (OR = 1.107). In ST settings, compared to Whites, the positive effect of MOUD on retention was enhanced for Blacks (OR = 1.191) and Hispanics (OR = 1.234), and the positive effect on treatment completion was enhanced for Hispanics (OR = 1.144). In LT settings, the negative association between MOUD and treatment completion was enhanced for Hispanics (OR = 0.776). CONCLUSIONS Access to medications for opioid use disorder in short term residential treatment is particularly beneficial for Blacks and Hispanics, though adjusted models indicate they are less likely to receive it compared to Whites. Results are mixed for long-term residential treatment. Residential addiction treatment may represent an important setting for mitigating low rates of medication initiation and early discontinuation for minority patients.

Research paper thumbnail of Adolescent treatment admissions for marijuana following recreational legalization in Colorado and Washington

Drug and Alcohol Dependence, 2020

INTRODUCTION There is concern that recreational marijuana legalization (RML) may lead to increase... more INTRODUCTION There is concern that recreational marijuana legalization (RML) may lead to increased cannabis use disorder (CUD) among youth due to increased marijuana use. This study investigates whether adolescent substance use disorder treatment admissions for marijuana use increased in Colorado and Washington following RML. METHODS Annual data on 2008-2017 treatment admissions for marijuana use from the SAMHSA TEDS-A dataset for adolescents age 12-17 were used to model state treatment admissions trends. Difference-in-differences models were used to investigate whether treatment admissions increased following RML in Colorado/Washington compared to non-RML states, after adjusting for socioeconomic characteristics and treatment availability. RESULTS Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period (β=-3.375, 95 % CI=-4.842, -1.907), with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML states following RML, though this difference was not significant (β=-7.671, 95 % CI=-38.798, 23.456). CONCLUSION Adolescent treatment admissions for marijuana use did not increase in Colorado and Washington following RML. This may be because youth marijuana use did not increase, CUD did not increase (even if use did increase), or treatment seeking behaviors changed due to shifts in attitudes and perceptions of risk towards marijuana use.

Research paper thumbnail of Young adult cannabis use disorder treatment admissions declined as past month cannabis use increased in the U.S.: An analysis of states by year, 2008–2017

Addictive Behaviors, 2021

OBJECTIVE This short communication reports on the association of annual measures of young adult (... more OBJECTIVE This short communication reports on the association of annual measures of young adult (age 18-24) past month cannabis use with cannabis use disorder (CUD) treatment admissions by state in the U.S. from 2008 to 2017. METHODS Annual data on percentage of past month cannabis use and the total number of CUD treatment admissions among young adults were acquired for each state from SAMHSA NSDUH and TEDS-A data sets. For each state, the correlation over time between cannabis use and treatment admissions rate was calculated and visualized in a choropleth map. Fixed-effects regression, where effects are fixed by state, was used to investigate the association of cannabis use with treatment admissions rate. RESULTS In 38 out of 50 states, including seven out of the eight states legalizing recreational cannabis during the study period, as young adult cannabis use increased, treatment admissions declined. Cannabis use is significantly and negatively associated with treatment admissions (β = -7.21, 95% CI = -11.88, -2.54), even after controlling for health insurance coverage, criminal justice referral, treatment center availability, and cannabis legalization status. CONCLUSIONS While it is possible that across the U.S. more young adults are using cannabis without developing CUD, we speculate that increasing social acceptance of cannabis use, and declining perception of harm, may influence treatment seeking behavior, potentially resulting in growing unmet need for CUD treatment among young adults. Monitoring state-level trends in cannabis use, CUD prevalence, and treatment admissions is key to developing CUD prevention and treatment policies targeted to timely, state-specific conditions.

Research paper thumbnail of The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US

Drug and Alcohol Dependence, 2020

Background: This study examines whether MOUD increases treatment completion and retention in both... more Background: This study examines whether MOUD increases treatment completion and retention in both shortterm (ST) and long-term (LT) residential programs using a national dataset. Methods: Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay > 10 days; LT: > 90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. Results: Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. Conclusions: Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.

Research paper thumbnail of Treatment admissions for opioids, cocaine, and methamphetamines among adolescents and emerging adults after legalization of recreational marijuana

Journal of Substance Abuse Treatment, 2021

BACKGROUND A public health concern stemming from recreational marijuana legalization (RML) is the... more BACKGROUND A public health concern stemming from recreational marijuana legalization (RML) is the idea that marijuana may act as a "gateway" drug among youth and young adults, where growing marijuana use will lead to increasing substance use disorder (SUD) for "harder" illicit drugs. This study investigates whether SUD treatment admissions for cocaine, opioids, and methamphetamines increased following RML enactment in Colorado and Washington for adolescents and emerging adults. METHODS We entered annual 2008-2017 treatment admissions data from the SAMHSA Treatment Episode Dataset - Admissions (TEDS-A) into difference-in-differences models to investigate whether the difference in treatment admissions for cocaine, opioids, and methamphetamines among adolescents (12-17), early emerging adults (18-20), and late emerging adults (21-24) before versus after RML enactment differed between Colorado and Washington and states without RML. RESULTS There was no significant difference (p < 0.05) between Colorado and Washington and other states in the pre- versus postlegalization trajectories of SUD treatment admissions for cocaine, opioids, or methamphetamines for adolescents (β = -0.152, 95% CI = -0.500, 0.196; β = -0.374, 95% CI = -1.188, 0.439; β = 0.787, 95% CI = -0.511, 2.084, respectively), early emerging adults (β = -0.153, 95% CI = -0.762, 0.455; β = 0.960, 95% CI = -4.771, 6.692; β = 0.406, 95% CI = -2.232, 3.044, respectively) or late emerging adults (β = -0.347, 95% CI = -1.506, 0.812; β = -4.417, 95% CI = -16.264, 7.431; β = 1.804, 95% CI = -2.315, 5.923, respectively). CONCLUSION RML in Washington and Colorado was not associated with an increase in adolescent or emerging adult SUD treatment admissions for opioids, cocaine, or methamphetamines. Future studies should extend this research to other states, other substances, for older adults, and over longer time periods; and consider how the effects of drug policies may differ across different jurisdictions.

Research paper thumbnail of How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks, Hispanics, and Whites in the US

Addictive Behaviors, 2019

Blacks and Hispanics take longer to complete outpatient SUD treatment than Whites. • Treatment du... more Blacks and Hispanics take longer to complete outpatient SUD treatment than Whites. • Treatment duration does not fully explain the racial/ethnic disparity in completion. • For Hispanics, the differential effect of duration on completion varies by substance. • Socioeconomic factors may influence the duration required for treatment completion.

Research paper thumbnail of A qualitative study of treatment success among homeless crack-addicted men: definitions and attributions

Contemporary Drug Problems, 1995

Research paper thumbnail of Editors’ Introduction: Homelessness and substance abuse in the 1990s

Contemporary Drug Problems, 1995

His research interests center on the evaluation of human services programs as well as on substanc... more His research interests center on the evaluation of human services programs as well as on substance abuse among the homeless. Eric Cohen, a sociologist, is completing a postdoctoral fellowship in the Department of Psychiatry at the University of Pennsylvania. He is involved in research on crack and heroin addiction.

Research paper thumbnail of Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances

Journal of substance abuse treatment, 2016

This study investigates how racial and ethnic disparities in treatment episode completion vary ac... more This study investigates how racial and ethnic disparities in treatment episode completion vary across different problem substances in an urban sample of 416,224 outpatient treatment discharges drawn from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. Fixed effects logistic regression is employed to test for the association of race and ethnicity with treatment episode completion for different substances of use while controlling for confounding demographic, socioeconomic, and geographic clustering factors. Results show that African Americans and Hispanics are less likely to complete a treatment episode than Whites, and that these disparities vary among users of different substances. For African Americans, this disparity is observed over all substances, but is particularly acute among users of alcohol and methamphetamine, substances for which African Americans generally have lower rates of use disorder as compared to Whites. For Hispanics, this disparity is driven...

Research paper thumbnail of Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice

Addictive Behaviors, 2016

This study investigates the impact of residential versus outpatient treatment setting on treatmen... more This study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States. This is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression. Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively. We speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

Research paper thumbnail of Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015–2018

Drug and Alcohol Dependence, Jul 1, 2022

Research paper thumbnail of The Influence of Neighborhood Environment on Treatment Continuity and Rehospitalization in Dually Diagnosed Patients Discharged From Acute Inpatient Care

American Journal of Psychiatry, Nov 1, 2009

Recently, there has been increased interest in the environmental factors affecting mental health ... more Recently, there has been increased interest in the environmental factors affecting mental health and substance use (11-16), but relatively little research relates environmental context to treatment engagement, compliance, or outcomes (17-19). The neighborhood context has been discussed and examined in relation to its effect on crime, delinquency, violence, stress, depression, and physical health (1, 11-12, 20-28). Although most practitioners implicitly recognize the importance of a patient's neighborhood environment, only limited research has been devoted to examining empirically the importance of environment in psychiatric and substance abuse treatment outcomes (17, 18). Drake et al. (29) concluded that the most important future direction for intervention research The physical and social environment in which individuals with both mental health and substance use disorders live has often been overlooked as an area of study. Dually diagnosed patients pose a particular challenge to psychiatric treatment, since they tend to have a more chronic course of illness, higher rates of relapse and rehospitalization, lower rates of treatment completion, and more complicated service needs than those with substance use problems only (1-7). The environmental context in which dually diagnosed individuals live may be particularly important, since substance abuse in this population is especially influenced by socioenvironmental factors (8). When these patients relapse, it is often environmental triggers that precipitate an episode (9, 10).

Research paper thumbnail of Centers and Institutes in the Research University

The Journal of Higher Education, Sep 1, 1994

Research paper thumbnail of At the Crossroads in the Opioid Overdose Epidemic: Will Evidence-Based "Radical" but Rational Drug Policy Strategies Prevail?

Research paper thumbnail of GeospatialTechnologyandthe"Exposome":NewPerspectivesonAddiction

Research paper thumbnail of The effect of individual, program, and neighborhood variables on continuity of treatment among dually diagnosed individuals

Springer eBooks, Sep 23, 2008

This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and... more This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and substance-use disorders who were discharged from a hospital acute inpatient unit to various outpatient treatment programs in Philadelphia. Geographic Information Systems (GIS) technology and logistic regression modeling were employed to investigate the effects of individual, neighborhood, and program-level variables on arrival to the first treatment appointment within 30 days of discharge. Four models are presented. The results of the study suggest that having had three or more treatment episodes prior to inpatient hospitalization, and living in a neighborhood in which temporary or transitional, and presumably, other low income housing is located, increased the likelihood of patients continuing with treatment in the community. Discharge to the preadmission address, a chief complaint of bizarre behavior, close proximity of two or more liquor and/or beer stores, a high density of narcotics anonymous (NA) and/or alcoholics anonymous (AA) meetings within the neighborhood, an axis I diagnosis of substance-induced mood disorder, and a urine drug screen positive for heroin reduced the likelihood of attending outpatient treatment. We conclude that geographic and community variables as they relate to substance abuse may add an important dimension to our understanding of patient functioning and well being in the community following inpatient treatment.

Research paper thumbnail of An assessment of therapist rating bias and the Hawthorne effect in a program evaluation

Research paper thumbnail of Cannabis Legalization and the Decline of Cannabis Use Disorder (CUD) Treatment Utilization in the US

Current Addiction Reports

Research paper thumbnail of The Convergence of the COVID-19 and Opioid Health Crises in the US

Research paper thumbnail of Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults

Research paper thumbnail of Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US

Drug and Alcohol Dependence, 2021

BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use... more BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) in residential treatment and the influence of race/ethnicity on the association between MOUD use and treatment retention and completion. METHODS Data were extracted from SAMHSA's 2015-2017 Treatment Episode Dataset-Discharge (TEDS-D) datasets for adult opioid admissions/discharges to short-term (ST) (30 days or less) (N = 83,032) or long-term (LT) (> 30 days) residential treatment settings (N=61,626). Logistic regression estimated the likelihood of MOUD use among racial/ethnic groups and the moderation of race/ethnicity on the probability of treatment completion and retention, controlling for background factors. RESULTS After adjusting for covariates, compared to Whites, MOUD use was less likely for Blacks in ST (OR = 0.728) and LT settings (OR = 0.725) and slightly less likely for Hispanics in ST settings (OR = 0.859) but slightly more likely for Hispanics in LT settings (OR = 1.107). In ST settings, compared to Whites, the positive effect of MOUD on retention was enhanced for Blacks (OR = 1.191) and Hispanics (OR = 1.234), and the positive effect on treatment completion was enhanced for Hispanics (OR = 1.144). In LT settings, the negative association between MOUD and treatment completion was enhanced for Hispanics (OR = 0.776). CONCLUSIONS Access to medications for opioid use disorder in short term residential treatment is particularly beneficial for Blacks and Hispanics, though adjusted models indicate they are less likely to receive it compared to Whites. Results are mixed for long-term residential treatment. Residential addiction treatment may represent an important setting for mitigating low rates of medication initiation and early discontinuation for minority patients.

Research paper thumbnail of Adolescent treatment admissions for marijuana following recreational legalization in Colorado and Washington

Drug and Alcohol Dependence, 2020

INTRODUCTION There is concern that recreational marijuana legalization (RML) may lead to increase... more INTRODUCTION There is concern that recreational marijuana legalization (RML) may lead to increased cannabis use disorder (CUD) among youth due to increased marijuana use. This study investigates whether adolescent substance use disorder treatment admissions for marijuana use increased in Colorado and Washington following RML. METHODS Annual data on 2008-2017 treatment admissions for marijuana use from the SAMHSA TEDS-A dataset for adolescents age 12-17 were used to model state treatment admissions trends. Difference-in-differences models were used to investigate whether treatment admissions increased following RML in Colorado/Washington compared to non-RML states, after adjusting for socioeconomic characteristics and treatment availability. RESULTS Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period (β=-3.375, 95 % CI=-4.842, -1.907), with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML states following RML, though this difference was not significant (β=-7.671, 95 % CI=-38.798, 23.456). CONCLUSION Adolescent treatment admissions for marijuana use did not increase in Colorado and Washington following RML. This may be because youth marijuana use did not increase, CUD did not increase (even if use did increase), or treatment seeking behaviors changed due to shifts in attitudes and perceptions of risk towards marijuana use.

Research paper thumbnail of Young adult cannabis use disorder treatment admissions declined as past month cannabis use increased in the U.S.: An analysis of states by year, 2008–2017

Addictive Behaviors, 2021

OBJECTIVE This short communication reports on the association of annual measures of young adult (... more OBJECTIVE This short communication reports on the association of annual measures of young adult (age 18-24) past month cannabis use with cannabis use disorder (CUD) treatment admissions by state in the U.S. from 2008 to 2017. METHODS Annual data on percentage of past month cannabis use and the total number of CUD treatment admissions among young adults were acquired for each state from SAMHSA NSDUH and TEDS-A data sets. For each state, the correlation over time between cannabis use and treatment admissions rate was calculated and visualized in a choropleth map. Fixed-effects regression, where effects are fixed by state, was used to investigate the association of cannabis use with treatment admissions rate. RESULTS In 38 out of 50 states, including seven out of the eight states legalizing recreational cannabis during the study period, as young adult cannabis use increased, treatment admissions declined. Cannabis use is significantly and negatively associated with treatment admissions (β = -7.21, 95% CI = -11.88, -2.54), even after controlling for health insurance coverage, criminal justice referral, treatment center availability, and cannabis legalization status. CONCLUSIONS While it is possible that across the U.S. more young adults are using cannabis without developing CUD, we speculate that increasing social acceptance of cannabis use, and declining perception of harm, may influence treatment seeking behavior, potentially resulting in growing unmet need for CUD treatment among young adults. Monitoring state-level trends in cannabis use, CUD prevalence, and treatment admissions is key to developing CUD prevention and treatment policies targeted to timely, state-specific conditions.

Research paper thumbnail of The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US

Drug and Alcohol Dependence, 2020

Background: This study examines whether MOUD increases treatment completion and retention in both... more Background: This study examines whether MOUD increases treatment completion and retention in both shortterm (ST) and long-term (LT) residential programs using a national dataset. Methods: Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay > 10 days; LT: > 90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. Results: Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. Conclusions: Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.

Research paper thumbnail of Treatment admissions for opioids, cocaine, and methamphetamines among adolescents and emerging adults after legalization of recreational marijuana

Journal of Substance Abuse Treatment, 2021

BACKGROUND A public health concern stemming from recreational marijuana legalization (RML) is the... more BACKGROUND A public health concern stemming from recreational marijuana legalization (RML) is the idea that marijuana may act as a "gateway" drug among youth and young adults, where growing marijuana use will lead to increasing substance use disorder (SUD) for "harder" illicit drugs. This study investigates whether SUD treatment admissions for cocaine, opioids, and methamphetamines increased following RML enactment in Colorado and Washington for adolescents and emerging adults. METHODS We entered annual 2008-2017 treatment admissions data from the SAMHSA Treatment Episode Dataset - Admissions (TEDS-A) into difference-in-differences models to investigate whether the difference in treatment admissions for cocaine, opioids, and methamphetamines among adolescents (12-17), early emerging adults (18-20), and late emerging adults (21-24) before versus after RML enactment differed between Colorado and Washington and states without RML. RESULTS There was no significant difference (p < 0.05) between Colorado and Washington and other states in the pre- versus postlegalization trajectories of SUD treatment admissions for cocaine, opioids, or methamphetamines for adolescents (β = -0.152, 95% CI = -0.500, 0.196; β = -0.374, 95% CI = -1.188, 0.439; β = 0.787, 95% CI = -0.511, 2.084, respectively), early emerging adults (β = -0.153, 95% CI = -0.762, 0.455; β = 0.960, 95% CI = -4.771, 6.692; β = 0.406, 95% CI = -2.232, 3.044, respectively) or late emerging adults (β = -0.347, 95% CI = -1.506, 0.812; β = -4.417, 95% CI = -16.264, 7.431; β = 1.804, 95% CI = -2.315, 5.923, respectively). CONCLUSION RML in Washington and Colorado was not associated with an increase in adolescent or emerging adult SUD treatment admissions for opioids, cocaine, or methamphetamines. Future studies should extend this research to other states, other substances, for older adults, and over longer time periods; and consider how the effects of drug policies may differ across different jurisdictions.

Research paper thumbnail of How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks, Hispanics, and Whites in the US

Addictive Behaviors, 2019

Blacks and Hispanics take longer to complete outpatient SUD treatment than Whites. • Treatment du... more Blacks and Hispanics take longer to complete outpatient SUD treatment than Whites. • Treatment duration does not fully explain the racial/ethnic disparity in completion. • For Hispanics, the differential effect of duration on completion varies by substance. • Socioeconomic factors may influence the duration required for treatment completion.

Research paper thumbnail of A qualitative study of treatment success among homeless crack-addicted men: definitions and attributions

Contemporary Drug Problems, 1995

Research paper thumbnail of Editors’ Introduction: Homelessness and substance abuse in the 1990s

Contemporary Drug Problems, 1995

His research interests center on the evaluation of human services programs as well as on substanc... more His research interests center on the evaluation of human services programs as well as on substance abuse among the homeless. Eric Cohen, a sociologist, is completing a postdoctoral fellowship in the Department of Psychiatry at the University of Pennsylvania. He is involved in research on crack and heroin addiction.

Research paper thumbnail of Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances

Journal of substance abuse treatment, 2016

This study investigates how racial and ethnic disparities in treatment episode completion vary ac... more This study investigates how racial and ethnic disparities in treatment episode completion vary across different problem substances in an urban sample of 416,224 outpatient treatment discharges drawn from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. Fixed effects logistic regression is employed to test for the association of race and ethnicity with treatment episode completion for different substances of use while controlling for confounding demographic, socioeconomic, and geographic clustering factors. Results show that African Americans and Hispanics are less likely to complete a treatment episode than Whites, and that these disparities vary among users of different substances. For African Americans, this disparity is observed over all substances, but is particularly acute among users of alcohol and methamphetamine, substances for which African Americans generally have lower rates of use disorder as compared to Whites. For Hispanics, this disparity is driven...

Research paper thumbnail of Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice

Addictive Behaviors, 2016

This study investigates the impact of residential versus outpatient treatment setting on treatmen... more This study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States. This is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression. Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively. We speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.