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Reinforcing exercise to improve drug abuse treatment outcomes: A randomized controlled study in a substance use disorder outpatient treatment setting.

ABSTRACT: Exercise holds potential to reduce substance use, but engaging patients in exercise regimens is challenging. Contingency management (CM) interventions can directly address adherence by targeting initiation and maintenance of exercise behavior. This study evaluated the efficacy of a CM-reinforced exercise intervention as an adjunct to standard outpatient substance use disorder treatment. Participants were 120 patients with substance use disorders who were randomly assigned to standard care with CM for completing exercise goals or CM for completing general nonexercise goals weekly for a 4-month treatment period. Urine samples were tested for evidence of illicit substance use up to twice a week during treatment and at follow-ups through month 12. Results found that the CM-exercise condition demonstrated during-treatment improvements on several physical activity and relevant psychosocial functioning indices (e.g., self-efficacy for exercise). The CM-exercise condition had no advantage relative to the CM-general condition in decreasing substance use. Overall, this study adds to a small body of well-powered trials assessing effects of exercise interventions as adjunct treatment for substance use disorders and finds no benefit over an alternate CM approach in terms of drug abstinence. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

SUBMITTER: Alessi SM

PROVIDER: S-EPMC7007340 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Reinforcing exercise to improve drug abuse treatment outcomes: A randomized controlled study in a substance use disorder outpatient treatment setting.

Alessi Sheila M SM Rash Carla J CJ Pescatello Linda S LS

Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors 20191010 1

Exercise holds potential to reduce substance use, but engaging patients in exercise regimens is challenging. Contingency management (CM) interventions can directly address adherence by targeting initiation and maintenance of exercise behavior. This study evaluated the efficacy of a CM-reinforced exercise intervention as an adjunct to standard outpatient substance use disorder treatment. Participants were 120 patients with substance use disorders who were randomly assigned to standard care with C ...[more]

PMID: 31599603

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Project description:BACKGROUND:While treatment satisfaction has been associated with better outcomes in substance abuse treatment, there is an obvious need for a more profound understanding of what predicts client's satisfaction with treatment. This study elucidates factors relevant to treatment outcome measured at follow-up in terms of satisfaction with the treatment received. METHODS:The research was implemented as a multisite study in outpatient clinics (N?=?7) in southern and western Finland. Data consists of therapists (N?=?33) and their clients (N?=?327). Each consenting client beginning a treatment period was accepted as a research subject and all therapists at the clinics in question participated. The study was conducted as part of the clinic's normal activity. Clients were allocated to therapists according to a randomization list drawn up in advance. Apart from the randomisation and the completion of questionnaires, it did not interfere with the progress of treatment. Follow-up lasted 6 months. Multiple Classification Analysis (MCA) was used through combinations of variables organized by content, e.g. client demographics, previous substance use, therapist's characteristics and client's expectations. The analyses were based in part on conventional statistical testing (t -test, ?2-test, ANOVA). RESULTS:Among 37 independent variables few were statistically significant in the final model. The results suggest that high treatment expectations at baseline are a strong predictor of satisfaction at follow-up. Also, previous substance use predicted treatment satisfaction; people using multiple substances were less satisfied than those taking only one substance. Stronger predictors reduced the statistical significance of those independent variables that were statistically significant in the first analyses. Therefore, therapist's role in recovery and readiness to change should be also seen as antecedents to treatment satisfaction. CONCLUSIONS:It seems that treatment expectations are fulfilled among those participating in follow-up. Yet many are lost during treatment and by follow-up. Service users have experiential knowledge that differs from professionals' and policymakers' knowledge. It is clinically relevant to understand what factors affect client's satisfaction. Hence, it is possible to identify the population whose treatment should receive the most attention, how the client's experience, their commitment to treatment, and treatment effectiveness could be improved.

Project description:ObjectiveClinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system.MethodsIn a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics.ResultsGuideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio=0.79, 95% CI=0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio=0.74, 95% CI=0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio=0.87, 95% CI=0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio=0.81; 95% CI=0.73, 0.89) of psychotherapy continuation.ConclusionsDespite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment.

Dataset Information

Reinforcing exercise to improve drug abuse treatment outcomes: A randomized controlled study in a substance use disorder outpatient treatment setting.

Publications

Reinforcing exercise to improve drug abuse treatment outcomes: A randomized controlled study in a substance use disorder outpatient treatment setting.

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