Accuracy of five on-site immunoassay drugs-of-abuse testing devices.
Many current "on-site" urine drug-testing products claim performance equivalent to laboratory testing. Five commercially available products (PharmScreen, Roche TestCup, Accusign DOA 2, Status DS, and American Bio Medica-Rapid Drug Screen) were challenged with quality-control specimens of known drug metabolite concentrations, 25% above and 25% below the SAMHSA cutoffs, and with known positive and negative donor specimens previously analyzed by immunoassay and gas chromatography-mass spectrometry. The results indicate discrepancies between claims and performance for all products, particularly with amphetamines. The implications for employer-based drug testing are discussed. (+info)
Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need.
In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated. (+info)
What drove private health insurance spending on mental health and substance abuse care, 1992-1999?
Trends in MH/SA treatment spending from 1992 to 1999 were examined using employer claims data from approximately 1.7 million covered lives in each year. The analysis finds that employer-based private insurance spending on MH/SA treatment did not keep pace with total employer-based private insurance spending or general price inflation. MH/SA spending dropped from 7.2 percent of total private insurance spending in 1992 to 5.1 percent in 1999. The decline was attributable to a dramatic decrease in inpatient MH/SA treatment--specifically, the probability of admissions and average length-of-stay. (+info)
The Massachusetts HIV, hepatitis, addiction services integration (HHASI) experience: responding to the comprehensive needs of individuals with co-occurring risks and conditions.
Categorical funding mechanisms traditionally used to fund public health programs are a challenge to providers serving individuals with complex needs that often span multiple service areas. Integration--a formalized, collaborative process among service systems--responds to the challenge by decreasing fragmentation of care and improving coordination. In 2000, the Massachusetts Department of Public Health (MDPH) received a one-year planning grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate opportunities for integrating HIV/AIDS programs and substance abuse treatment programs. The project was later expanded to include viral hepatitis programming. Outcomes include the development of a strategic plan, joint procurement initiatives, and an ongoing commitment to sustain inter-bureau integration efforts, even in the face of substantial budget reductions. Integrated approaches can promote greater efficiency, improving communication and coordination among clients, providers, and government funding agencies. (+info)
Charting a course for health services research at the National Institute on Drug Abuse.
Through research, we continue to develop and refine an array of safe and efficacious interventions to prevent and treat drug abuse; however, these interventions have not led to widespread improvements in prevention and treatment services in nonresearch settings. In addition, investigator-initiated research rarely examine or refine interventions that practitioners have found relevant and that are widely practiced. To address these problems, the National Institute on Drug Abuse convened a blue ribbon task force to examine its health services research program. The report served as a catalyst for the institute to promote a vigorous program of research that seeks to examine prevention and treatment intervention delivery systems and policies that facilitate provision of effective care in a range of real world settings. Findings from this research should help address the translational bottleneck of bringing evidence-based interventions into the community. (+info)
Efficacy vs effectiveness trial results of an indicated "model" substance abuse program: implications for public health.
OBJECTIVES: The US Department of Education requires schools to choose substance abuse and violence prevention programs that meet standards of effectiveness. The Substance Abuse and Mental Health Services Agency certifies "model" programs that meet this standard. We compared findings from a large, multisite effectiveness trial of 1 model program to its efficacy trial findings, upon which the certification was based. METHODS: 1370 high-risk youths were randomized to experimental or control groups across 9 high schools in 2 large urban school districts. We used intent-to-treat and on-treatment approaches to examine baseline equivalence, attrition, and group differences in outcomes at the end of the program and at a 6-month follow-up. RESULTS: Positive efficacy trial findings were not replicated in the effectiveness trial. All main effects were either null or worse for the experimental than for the control group. CONCLUSIONS: These findings suggest that small efficacy trials conducted by developers provide insufficient evidence of effectiveness. Federal agencies and public health scientists must work together to raise the standards of evidence and ensure that data from new trials are incorporated into ongoing assessments of program effects. (+info)
Substance abuse prevention program content: systematizing the classification of what programs target for change.
We conducted an analysis of programs listed on the National Registry of Effective Programs and Practices as of 2003. This analysis focused on programs that addressed substance abuse prevention from among those on the effective or model program lists and that had manuals. A total of 48 programs met these inclusion criteria. We coded program manuals for content that was covered based on how much time was devoted to changing targeted mediating variables. The value of this approach is that program content can be judged using an impartial standard that can be applied to a wide range of intervention approaches. On average, programs addressed eight of 23 possible content areas. Our analyses suggested there were seven distinguishable approaches that have been used in substance abuse prevention programs. These include (i) changing access within the environment, (ii) promoting the development of personal and social skills, (iii) promoting positive affiliation, (iv) addressing social influences, (v) providing social support and helping participants develop goals and alternatives, (vi) developing positive schools and (vii) enhancing motivation to avoid substance use. We propose that the field use such analyses as the basis of future theory development. (+info)
Sobering thoughts: town Hall meetings on fetal alcohol spectrum disorders.
Prenatal exposure to alcohol is one of the leading causes of preventable birth defects and developmental disabilities. During the past 30 years, fetal alcohol spectrum disorders (FASD), including fetal alcohol syndrome, have gradually begun to attract attention. However, awareness and understanding of the disorders remain low, and people who are affected are seriously underserved. The FASD Center for Excellence held a series of town hall meetings in 2002 and 2003 to gauge the issues surrounding FASD nationwide. On the basis of its findings, the center proposed a series of recommendations to begin to remedy some of the deficiencies that were identified. (+info)