Drug and Alcohol Treatment

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Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison

Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison

This study uses data from the Eurostat database to measure how much European governments spend on treating illegal drug and alcohol problems in hospitals. International databases facilitate cross-country compari- sons that could highlight the impact of substance abuse on public health budgets [68]. Our cross-country com- parison is restricted to hospitals since data were unavail- able for other types of treatment providers. It is not clear which proportion of the drug and alcohol clients receive hospital treatment. The Treatment Demand Indi- cator (TDI o ) used in the EU, cannot determine the pro- portion of substance use clients treated in hospitals since it only distinguishes between the proportion of il- legal drug clients in inpatient p and outpatient centers. The TDI shows that the proportion of reported clients entering inpatient centers for drug-related problems var- ies to a large extent by country (from 2% in France to 79% in Luxembourg) [64] q . Notwithstanding the limita- tions of the current analysis, the impact of hospital ex- penditures for drug and alcohol treatment on the public budget should not be underestimated. Multiple studies e.g. [6,69,70] show that the unit cost for hospital treat- ment is much higher than for outpatient treatment ser- vices. For example, inpatient detoxification in England is provided at a cost of 200 euros per patient per day and outpatient detoxification is provided at a cost of 8 euros per patient per day [71]. Moreover, Andlin-Sobocki, Jönsson, Wittchen and Olesen [72] indicate that the
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REPORT BY THE LONDON DRUG AND ALCOHOL NETWORK ON ALCOHOL TREATMENT N LONDON

REPORT BY THE LONDON DRUG AND ALCOHOL NETWORK ON ALCOHOL TREATMENT N LONDON

Alcohol treatment in London covers a wide range of interventions, including counselling, detox, structured day care, low threshold open access/drop-in services, outreach, rehabilitation, supported housing and wet houses. Most services work both with drinkers and affected others. However, because of the fragmented nature of funding for alcohol treatment in recent years, no two alcohol services look alike. There are great variations in organisation size and infrastructure, interventions offered, target client group, and funding streams. It is important to note that many services which developed solely to address the needs of people with alcohol related problems have taken on clients whose primary care needs are drug related in order to access funding streams that would otherwise be closed to them.
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Welfare conditionality and disabled people in the UK: claimants' perspectives

Welfare conditionality and disabled people in the UK: claimants' perspectives

However, this changed when she was referred to attend the Work Programme WP,2 which clashed with a referral appointment to a specialist drug and alcohol treatment programme.Although she [r]

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Therapeutic community drug treatment success in Peru: a follow-up outcome study

Therapeutic community drug treatment success in Peru: a follow-up outcome study

This study found that former clients in Peru who received drug and alcohol treatment in facilities using the TC model reported substantial positive change in use of ille- gal drugs and alcohol to intoxication at a six-month fol- low-up. The extent of change is greater than has been reported in other drug treatment program evaluations, including the Treatment Outcome Prospective Study (TOPS) [7,12], the Drug Abuse Treatment Outcome Study (DATOS)[77], and the National Treatment Improvement Evaluation Study (NTIES)[78]. Likewise, the amount of positive change in outcomes in Peru is also larger than National Treatment Outcome Research Study (NTORS)[79,33]. Because these other studies are not comparable on data collection timeframes or the sub- stance use recall period, we can not conclude greater drug and alcohol treatment success in Peru than elsewhere. However, these results are similar to a more recent evalu- ation of TC treatment success (30-day use of illegal drugs) in Thailand that used a pre-post design with baseline data collected prior to treatment – reduction = -63 percent[69]. Regarding predictors of drug treatment success, we found that high implementation fidelity produced more treat- ment success. These results support the meta-analysis of Prendergast, Podus, and Chang[44], who found that well- implemented TC drug abuse treatment and outpatient drug-free programs correlated with more positive behav- ioral outcomes. In the Peru research we also found that the importance of implementation fidelity in predicting treatment success was enhanced among younger clients. That is, while older clients tend to achieve better treatment success (see main effect of client age variable), the combi- nation of younger age and higher fidelity also contributes to better treatment success. Hansen and colleagues[49] also found higher program fidelity moderates drug pre- vention success.
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PubMedCentral-PMC5628736.pdf

PubMedCentral-PMC5628736.pdf

included data from 6 sites across the US from 1/2013–3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non- drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/ crystal (49% vs. 16%) and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics including drug use and depression. These results suggest non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse including alcohol treatment should be included in behavioral health assessments as part of clinical care.
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Admission to acute care hospitals for adolescent substance abuse: a national descriptive analysis

Admission to acute care hospitals for adolescent substance abuse: a national descriptive analysis

The analysis describes hospital admissions for substance abuse across a number of demographic and utilization variables. Patient variables of age, gender, median income for zip code of residence, principal and secondary diag- noses, expected primary payer, total charges, and length of stay are taken directly from the HCUP-KID database along with hospital characteristic variables of location (urban/ rural), and NACHRI hospital type (children's/general hos- pital/children's unit in a general hospital). This analysis also examines the inpatient utilization of Alcohol and Drug Rehabilitation/Detoxification (CCS Procedure 219) and Psychological and Psychiatric Evaluation and Ther- apy (CCS Procedure 218) for patients admitted for sub- stance abuse and the discharge disposition of these patients.
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Preventing and Addressing Alcohol and Drug Problems - A Handbook for Clergy

Preventing and Addressing Alcohol and Drug Problems - A Handbook for Clergy

Father George Clements of the One Church-One Addict program tells the sto- ry of a parishioner who asked him to offer a prayer for someone in her family who had a drug problem. Father Clements related that he agreed and during his early Mass that Sunday brought the issue to the congregation. He began by noting the request for prayer and added that he wanted to expand it to include all those who either had drug or alcohol problems or were being affected by someone with drug or alcohol problems. He asked for all of those present who were in such a situation to stand. When almost the entire congregation of over 500 stood, he relates that he thought, and almost said out loud, “Damn!” He was taken aback and was totally unaware of the prevalence of the issue within his flock. Take this as a lesson and be aware that alcoholism, addiction and re- covery exist in every congregation. None are immune, and the shear numbers of people that have been affected by the disease are sometimes shocking. Congregational responses to these issues run the gamut from no response, to
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The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach

The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach

First, the Healing Model of Care articulated in this paper could be easily be scaled up and applied across other Indigenous drug and alcohol residential rehabilitation services using a similar CBPR framework. By adopting a more standardised approach, the logic model specifically aligns each treatment component and outcome with the mechanism of change for the client or organisation, which then allows for rigorous evaluation and ongoing quality improvement to ensure improved outcomes. As such, this model has the potential to rapidly develop a larger and more rigorous evidence-base to improve outcomes for clients attending Indigenous residential rehabilitation services, both within Australia and inter- nationally, including for Native American or Maori services. It could therefore be adapted and applied to a range of cultural or ethnic minority communities where there may be key components or flexible activities of effective treatment that are specific to their culture. As such, this provides one possible solution to how to pro- vide better care for the large and growing population of Indigenous people with substance dependence transi- tioning from custody to community. Second, no evalua- tions published to date have undertaken an economic analysis to weigh the benefits of the treatment approach against its costs (James et al., 2017, under review). This makes it difficult for governments and other agencies to justify funding programs on the basis of a likely economic return for their investment. Therefore, this paper recom- mends an economic analysis of Indigenous drug and alco- hol residential rehabilitation services to methodologically guide future efficiency and resource equity considerations for services, researchers and funding bodies.
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Barriers to alcohol and other drug treatment use among Black African and Coloured South Africans

Barriers to alcohol and other drug treatment use among Black African and Coloured South Africans

Despite 18 years of democracy, South Africa is still grappling with the legacy of apartheid and the challenges of promoting equitable access to public services for all racially-defined social groups. Race remains an import- ant marker of socio-economic advantage in the country which impacts on the extent to which individuals are able to access services [7]. Poor Black African and Coloured persons continue to experience the most diffi- culty in accessing health services (including AOD ser- vices) relative to other groups [6,8]. Only about 16% of South Africans are members of private health insurance schemes (known as medical schemes) and use health services in the private health sector. The remaining 84% of the population, disproportionately represented by poor Black African and Coloured South Africans, are mainly dependent on the overburdened and under- resourced public services sector for access to health care (although some pay out-of-pocket for basic primary care services in the private sector) [8]. Racial disparities in ac- cess to AOD treatment are likely to be entrenched by the limited availability of free AOD treatment services in the public service sector. For example in the Western Cape province, which arguably is among the better resourced provinces in terms of access to AOD treat- ment services [4,5], there are only three AOD outpatient services and three inpatient facilities available in the public service sector that offer free treatment services. The remainder of the AOD inpatient treatment facilities in the province are either private non-profit facilities that offer reduced-cost services but still charge co- payment fees or private for-profit facilities that cater for the proportion of the population with access to medical insurance and charge high fees. Apart from outpatient services offered in the public sector, there are also out- patient services provided by private non-profit treatment providers. Although these agencies provide low-cost ser- vices, some do require clients to make a financial contri- bution towards each appointment. While these AOD services are among the least expensive, these are often unaffordable to poor South Africans, especially when coupled with the costs of travelling to these services.
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Multi-Drug Resistant Tuberculosis (MDR-TB) and its drug Treatment

Multi-Drug Resistant Tuberculosis (MDR-TB) and its drug Treatment

The second line drugs have lower efficacy and are associated with more adverse effects in comparison to the first line agents & are therefore used in special circumstances such as for treatment of MDR-TB. This group includes Aminoglycosides such as Kanamycin, Amikacin and Capreomycin, Flouroquinolones such as Ofloxacin, Moxifloxacin, Levofloxacin, oral bacterostatic agents such as Ethionamide , Prothionamide, Cycloserine, Terizidone, p-aminosalicylic acid (PAS) and ‘Group Five’ drugs which includes Clofazimine, Linezolid, Amoxicillin/Clavulanate, Thioacetazone, Clarithromycin, and Imipenem.
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Tribal Healing to Wellness Courts - Key Components

Tribal Healing to Wellness Courts - Key Components

primary goal of all tribes is to have a healthy and strong citizenry that can produce effective leaders and governance institutions that in turn protect and promote the well-being of individuals, families, extended families, and the tribal community. For tribal government and community leaders, there is an important interconnection among internal nation-building activities, the physical and spiritual well-being of their people, and the future of the tribal government and its citizens as a people. Tribal communities today face tough challenges in the form of violent crime rates at twice the national average (with violent crime rates exceeding 20 times the national average on some reservations), an epidemic of domestic and sexual violence (34% of American Indian and Alaska Native (AI/AN) women are likely to be raped in their lifetimes, and 39% are likely to suffer domestic violence), and AI/AN youth experiencing 50% higher rates of child abuse compared to non-Native youth. 11 Researchers have identified alcohol- and drug- related crimes as the greatest law and order problem in Indian country. 12 Tribal government and community leaders are adopting locally and culturally tailored drug court models (also known as “Tribal Healing to Wellness Court“) to
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Technology Assisted Addiction Treatment for Key Populations

Technology Assisted Addiction Treatment for Key Populations

In the United States, approved pharmacotherapies for the treatment of opioid dependence are methadone, bu- prenorphine and naltrexone. Methadone and buprenorphine are controlled medications and thus the dispensing of methadone and prescription of buprenrophine is controlled by federal regulations (Kresina, Litwin, Marion, Lubran, & Clark, 2009). Federal regulations in the United States require methadone, for the purpose of addiction treatment, to be dispensed in opioid treatment programs and in liquid form on a daily basis. Initially, liquid me- thadone was dispensed using manual pumps for individual dosing. Technological advances have brought about computer controlled automated dispensing pumps, allowing for accurate measured dosing and integration with patient management software (IVEK Corporation. Accuvert Controlled Methadone Dispensing System; SciLog, Bio Processing Systems. Lab Tec Smart Methadone Dispensing Pump). Other automated dispensing systems identify patients through biometrics (iris or fingerprint recognition), dispensing the individual dosage based on the patient electronic dispensing record and upon completed dosing updating the patient electronic medical record (DRX Systems, Automated Methadone Dispensing). This integrated automated system can complete the dosing of methadone or buprenorphine to patients in as little as twenty seconds, substantially increasing effi- ciency. Additional clinic addiction management systems can provide inventory control, dispensing, administra- tion, regulatory agency reporting and patient/medical provider electronic signatures (Netsmart, Clinic Addiction Management Systems). These technological advances not only increase efficiency but also are important tools for research studies that address patient and treatment issues related to pharmacologic dosing (Cleary, Reynolds, Eogen, O’Connell, Fahey, Gallagher, Clarke, White, McDermott, O’Sullivan, Carmody, Gleeson, & Murphy, 2013; Walley, Cheng, Pierce, Chen, Filippell, Same, & Alford, 2012).
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Sterling_unc_0153D_15942.pdf

Sterling_unc_0153D_15942.pdf

While behavioral health problems – substance use and mental health – are among the most common pediatric health conditions in the U.S., 42 far fewer than half the children and adolescents in need of care ever receive services, particularly specialty substance abuse treatment. 43,44 Certain population groups, including Latinos and African Americans, are especially unlikely to receive care. 43-46 Many families never seek care, and many of those that do, because of issues of system capacity and insurance coverage, among others, have difficulty obtaining it. 47 Because most families will never seek specialty care, primary care visits provide critical opportunities to detect substance problems, 48 and more children in the U.S. with behavioral health conditions receive care for these conditions from their primary care provider than from any other type of provider. 49 Studies have found that PCPs may be especially effective agents to provide this care, 4 and adolescents and their parents have been found to be receptive to screening and intervention by pediatricians, 50 and to have positive perceptions of care when their pediatrician discusses “sensitive” topics, including substance use, with them. 51 Effective adolescent substance abuse prevention and early intervention relies on identification and intervention approaches that are effective, feasible, flexible and implementable in real-world clinical settings. As yet however, standardized screening and intervention for adolescent substance use problems has not been widely adopted in pediatric primary care in the United States.
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Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study

Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study

and those who use them. One is the social position of substance use in Australian society. Use of alcohol is dif- ferentiated from non-medical use of other PDOCs not only by its legality, but also by a wide acceptance of use, and of relatively heavy use by young adults. For example, in objecting to an official drinking guideline suggesting an upper limit of four drinks on any occasion, Tony Abbot, then the Minister of Health, spoke in 2008 of a “moral panic”, noting that “what an individual does is his or her responsibility, particularly with something that is legal … We need to know the real enemy, and that is illicit drugs” [30]. In Australian and cognate cultures, adults are expected to cut down their drinking only as they move on in their late 20s to a settled career and forming a family [31], while illicit drug use by young adults is to some extent furtive and much less widely ac- cepted – particularly for heroin and other illicit opiate use. Young people habitually using illicit drugs are thus more likely to encounter informal and formal pressures to enter treatment for drug use, while such pressures concerning habitual heavy use of alcohol normatively occur when they are as much as a decade older. The greater marginalisation of those with illicit drugs as PDOC reflects the selective effects of stigmatisation as- sociated with criminal law and other deterrence [7]. The second dimension of differentiation is that heavy use of alcohol is in many ways more harmful to health than heavy use of most illicit drugs [32, 33]. The multiple health risks of heavy drinking are likely to be a substan- tial factor in the high rates of GP, ambulance, and emer- gency department attendance, particularly relative to those with cannabinoids and stimulants as their PDOC.
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Forensic Identification of Sexual Assault by use of Date Rape Drugs

Forensic Identification of Sexual Assault by use of Date Rape Drugs

LSD (lysergic acid diethylamide), first synthesized in 1938, is an extremely potent hallucinogen. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.LSD is produced in crystalline form and then mixed with excipients, or diluted as a liquid for production in ingestible forms. It is odorless, colorless and has a slightly bitter taste. LSD is sold in tablet form (usually small tablets known as Microdots), on Sugar Cubes, in thin squares of gelatin (commonly referred to as Window Panes), and most commonly, as blotter paper (sheets of absorbent paper soaked in or impregnated with LSD, covered with colorful designs or artwork, and perforated into one-quarter inch square, individual dosage units). Under the influence of LSD, the ability to make sensible judgments and see common dangers is impaired, making the user susceptible to personal injury, which can be fatal. After an LSD trip, the user may suffer acute anxiety or depression, and may also experience flashbacks, which are recurrences of the effects of LSD days or even months after taking the last dose. A flashback occurs suddenly, often without warning, usually in people who use hallucinogens chronically or have an underlying personality problem. Healthy people who use LSD occasionally may also have flashbacks. Bad trips and flashbacks are only part of the risks of LSD use. LSD users may also manifest relatively long- lasting psychoses, such as schizophrenia or severe depression.LSD produces tolerance, so some users who take the drug repeatedly must take progressively higher
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Gastric pain

Gastric pain

chelating agents, such as the tetracycline and fluoroquinolone antimicrobial agents, and several other drug interactions are possible. Combining an antacid with an alginate may actually prevent reflux in that the alginate literally forms a “floating gel” on top of the gastric contents. Calcium carbonate and sodium bicarbonate may also be used as a simple antacid. However, care should be taken with these agents since calcium carbonate may interfere with the normal acid base balance and cause metabolic alkalosis, or may elicit rebound gastric acid secretion, making it suitable for short-term use only. Sodium bicarbonate should be used with caution in patients who require a restricted sodium intake. Dimethicone and simethicone may relieve a “bloated feeling” by acting as an antiflatulent or defoaming agent. These latter agents may also be of benefit in the management of intestinal colic in infants and children. 19,20,23
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Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review

Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review

Like alcohol, cannabis may improve subjective sleep complaints [56], particularly when used over short peri- ods of time. For instance; in studies using self-report questionnaires (e.g., Leeds Sleep Evaluation Question- naire) participants report greater ease in getting to sleep [50]. However, like alcohol, chronic cannabis use is asso- ciated with negative subjective effects on sleep that are manifested most prominently during withdrawal. Nota- bly, these subjective effects are present during discon- tinuation of cannabis use even among persons who were exposed to low dosages [97], and are common among regular users [61, 188]. Symptoms reported include sleep difficulties [61] such as strange dreams, insomnia, and poor sleep quality. Such symptoms occur in anywhere from 32 % [58] to 76 % [27, 222] of persons experiencing withdrawal. These studies have been conducted in both the inpatient (residential) [61, 97, 98] and outpatient lev- els of care [42, 44], and in studies with as many as 450 participants [222]. Placebo-controlled studies have exam- ined what happens after discontinuation of oral THC use [97] or after discontinuation of smoked marijuana [98]. Regardless of design, studies of the effects of chronic use have consistently shown reliable and significant changes in subjective reports of sleep during abstinence in com- parison to baseline [42].
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The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

The population of Brazil is 200 million, 22 % of whom (41 million) live in SPS [39]. The state has 645 munici- palities with distinct characteristics. The Human Devel- opment Index (HDI) ranges from 0.639 to 0.862, and within the main city (São Paulo), the HDI ranges from 0.245 to 0.811. In 2003, a study reported that 27 % of the population of SPS lived in poverty, with marked income inequality (Gini index = 0.45) [39]. In Brazil, TB treatment is fully covered by the public health system. In SPS, following the National TB Program, directly ob- served therapy (DOT) is recommended for all patients. However, the final decision is shared between patients and multidisciplinary health staff [38]. DOT can bring additional support during treatment, such as food and transport vouchers [38, 40]. Although the national guide- lines strongly recommend DOT for vulnerable groups such as homeless patients, there is no specific campaign to support its use among the homeless.
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Confidentiality: 42 CFR Part 2 Final Rule Update 2018 for Alcohol and Drug Treatment

Confidentiality: 42 CFR Part 2 Final Rule Update 2018 for Alcohol and Drug Treatment

SAMHSA also received a number of comments requesting that certain activities on the list of payment and health care operations activities be restricted or narrowed. A number of commenters requested that SAMHSA remove or narrow proposed § 2.33(b)(15) & (16) to ensure patients' protected substance use disorder information will not be used to limit or deny insurance coverage or access to health care. Some commenters expressed concern that the proposed § 2.33(b)(2) could be interpreted as allowing protected information to be disclosed to employers. Many of these commenters stated they did not support the SNPRM’s proposed changes in general, or SAMHSA’s proposal to permit lawful holders to disclose patient identifying information obtained pursuant to patient consent to contractors, subcontractors, and legal representatives for payment and health care operations purposes, in particular, without further protections and safeguards. Two commenters disagreed with the inclusion of five of the proposed activities (§§ 2.33(b)(6), 2.33(b)(10), 2.33(b)(12), 2.33(b)(15), and 2.33(b)(16)) because they could adversely affect patient enrollment in health plans and determinations regarding insurability, treatment, and eligibility.
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Geochemical Signatures of Stream Capture in the Retreating Blue Ridge Escarpment, Southern Appalachian Mountains

Geochemical Signatures of Stream Capture in the Retreating Blue Ridge Escarpment, Southern Appalachian Mountains

Increased recognition of the link between drug use and crime (Bennett, Holloway, & Farrington, 2008) has highlighted the potential of substance abuse treatment as an e↵ective crime prevention strategy (Prendergast, Podus, Chang, & Urada, 2002). Accumulating evidence shows that substance abuse treatment is associated with reductions in both drug use and recidivism (Holloway, Bennett, & Farrington, 2006), however criminal behavior is rarely considered in outcome evaluations of substance abuse treatment programs, despite its significance both to the user and society at large (Ti↵any, Friedman, Greenfield, Hasin, & Jackson, 2012). Substance abuse treatment has also been extensively integrated into rehabilitation programs delivered in the criminal justice system (Werb et al., 2016). There is evidence that such intensive intervention can be ine↵ective or even harmful for clients that are at relatively low or moderate risk for recidivism (Lowenkamp & Latessa, 2004), and recent research suggests that this group of individuals is likely to benefit from
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