Natural History/Treatment Process and Outcomes Projects


Two Models of Telephone Support
for Stimulant Recovery

David Farabee, Ph.D., Principal Investigator
(dfarabee@ucla.edu)
Richard Rawson, Ph.D., Mitchell Karno, Ph.D., &
M. Douglas Anglin, Ph.D., Co-Investigators
Valerie Pearce, B.A., Project Director

The purpose of this study is to develop and compare the efficacy of four low-cost, telephone support protocols for patients who have completed the intensive phase of a structured, outpatient stimulant abuse treatment protocol. Patients (N = 500) who have successfully completed the 4-month Matrix Outpatient Model of stimulant abuse treatment are randomly assigned to one of five aftercare counseling conditions: (1) unstructured/non-directive, (2) unstructured/directive, (3) structured/non-directive, (4) structured/directive, or (5) standard referral to aftercare without telephone counseling (control). The two structured conditions are based on the behavioral “prompts” identified by Farabee et al. (2002) as being associated with drug avoidance. In the non-directive conditions, patients state their own goals and how they intend to achieve them. In the directive conditions, the coaches provide specific recommendations for the adoption of as many drug-avoidance activities as possible. Certain patient personality traits or styles are also assessed for their possible interaction with the telephone counseling dimensions. Outcomes will be tracked at 6 and 12 months following completion of primary treatment and will include measurement of participation in drug-avoidance activities (including aftercare participation), as well as self-reported and objective measures of substance use and associated prosocial behavior change.

Two Models of Telephone Support for Stimulant Recovery was funded by the National Institute on Drug Abuse, Grant 1 R01 DA018208 (August 2005 through July 2010).

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Gender Differences in a Long-Term
Follow-up of Opiate Users in California

Christine E. Grella, Ph.D., Principal Investigator
(grella@ucla.edu)
M. Douglas Anglin, Ph.D., Co-Investigator

This study is conducting a 25-year follow-up of opiate-dependent women (n = 337) and men (n = 577) who were originally sampled from methadone maintenance clinics in six Central and Southern California counties in the late 1970s. In-depth natural history interviews were conducted with subjects between 1978 and 1981. The natural history database established by this initial assessment will be extended in the current study, covering an additional period of approximately 25 years. The focus of the study is on gender differences in the factors that influence relapse to and cessation of opiate use over the course of the addiction career; transitions to other types of drug use; the relationship of psychosocial functioning to patterns of use; patterns of criminal activity, arrest, incarceration, and legal supervision; drug treatment utilization and other social interventions and associated outcomes; health status and health services utilization; and predictors and correlates of mortality. Information on the cause of death for deceased subjects is also being collected, and standard mortality ratios and years of life lost will be computed for gender differences within the sample and in comparison to the general population. The study will improve our understanding of gender differences in the long-term patterns and consequences of opiate use among this California-based treatment sample.

Gender Differences in a Long-Term Follow-up of Opiate Users in California was funded by the National Institute on Drug Abuse, Grant 1 R01 DA015390 (May 2004 through February 2008).

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Center for Advancing Longitudinal
Drug Abuse Research (CALDAR)

Yih-Ing Hser, Ph.D., Principal Investigator
(yhser@ucla.edu)
Co-Investigators:
Mary-Lynn Brecht, Ph.D., Christine E. Grella, Ph.D.,
Debra A. Murphy, Ph.D., & Constance Weisner, Dr.P.H., M.S.W.
Project Director: Cheryl Teruya, Ph.D.

The overarching theme of the UCLA Center for Advancing Longitudinal Drug Abuse Research (CALDAR), a multidisciplinary research unit, is the development and application of rigorous scientific approaches for advancing longitudinal research on substance abuse and its interplay with HIV infection, substance abuse treatment, and other service systems. The aims of CALDAR are to: (1) increase knowledge of longitudinal patterns of drug addiction and their interplay with HIV infection, drug treatment, and other service systems (e.g., mental health, criminal justice, welfare, medical care); (2) enhance the quality and efficiency of research conducted by Center-supported projects by providing centralized support to serve common project functions; (3) provide opportunities for scientific collaboration and cross-project analyses, stimulating conceptual development and integration, and advancing improved research methodologies and statistical approaches; and (4) enhance the relevance and application of longitudinal research on drug use by facilitating dissemination of integrated project findings to a variety of communities. Infrastructure and activities of the Center are designed to provide intensive training for enhancing the conceptualization of and methodological approaches to conducting longitudinal research, and to disseminate empirical findings on life-course drug-use trajectories and their interplay with social and service systems. Special emphasis is placed on minority and/or underserved populations, who often carry a disproportionate burden of the social problems related to substance abuse and HIV/AIDS. (Additional information is available at www.CALDAR.org.)

The Center for Advancing Longitudinal Drug Abuse Research was funded by the National Institute on Drug Abuse, Grant 5 P30 DA016383 (September 2005 through August 2010).

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Treatment System Impact and
Outcomes of Proposition 36

Yih-Ing Hser, Ph.D., Principal Investigator
(yhser@ucla.edu)
Christine E. Grella, Ph.D., David Farabee, Ph.D., &
M. Douglas Anglin, Ph.D., Co-Investigators
Cheryl Teruya, Ph.D., & Elizabeth Evans, M.A.,
Project Directors

Approved by California voters in 2000, the Substance Abuse and Crime Prevention Act (or “Proposition 36”) allows adult drug offenders to receive community-based drug treatment in lieu of incarceration. This study investigates the impact of Proposition 36 on the treatment service delivery system and treatment outcomes.  Specifically, the project aims to:

  • Describe counties’ plans and strategies for implementing Proposition 36 in their drug treatment systems as well as the characteristics of drug offenders diverted to treatment;
  • Assess the treatment system impact of and response to Proposition 36, including changes in clinical practices and organizational adaptations;
  • Assess the influence of program and staff characteristics on Proposition 36 client treatment retention and completion;
  • Assess services received by Proposition 36 clients;
  • Assess client self-reported treatment outcomes (e.g., drug use, criminal involvement); and
  • Assess client treatment outcomes in other health/social data systems.

Participating in the project are approximately 10,000 Proposition 36 clients recruited by 36 treatment agencies in seven counties (Kern, Los Angeles, Riverside, Sacramento, San Diego, San Francisco, Shasta). Study findings will elucidate the effects of implementing this new drug policy on the treatment service delivery system, identify factors that influence the treatment outcomes among drug-abusing offenders, and provide information crucial to understanding how the implications of the act on the treatment system may affect future strategies for treating California’s large drug-abusing offender population. (Additional information is available at www.uclaisap.org/Prop36/tsi/index.html.)

Treatment System Impact and Outcomes of Proposition 36 was funded by the National Institute on Drug Abuse, Grant 5 R01 DA15431 (July 2002 through June 2007). 

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Factors Associated with Help-Seeking
and Change in Substance Use

Mitchell Karno, Ph.D., Principal Investigator
(karno@ucla.edu)
Alison Moore, M.D., M.P.H., Christine Grella, Ph.D., &
M. Douglas Anglin, Ph.D., Co-Investigators

This project uses cross-sectional and longitudinal data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to identify the factors associated with why people with an alcohol or drug use disorder improve and maintain improvement in their substance use. The first objective of this project is to identify the factors associated with changes in substance use among individuals with a lifetime diagnosis of abuse or dependence on either alcohol, drugs, or both alcohol and drugs. The second objective of this project is to identify the factors associated with help-seeking among these same individuals. The third objective is to identify the factors associated with maintaining improvement from Wave 1 to Wave 2 of NESARC among individuals who had a lifetime substance use disorder but who no longer met criteria for diagnosis in the year preceding Wave 1. The results of this study will provide new information about the initiation and maintenance of behavior change. This information may contribute significantly to informing public policy, prevention, and treatment efforts.

Factors Associated with Help-Seeking and Change in Substance Use was funded by the National Institute on Alcohol Abuse and Alcoholism, Grant 1 R01 DA020944 (September 2005 through August 2008).

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Psychotherapy Process in
Alcohol Treatment Matching

Mitchell Karno, Ph.D., Principal Investigator
(karno@ucla.edu)
Richard Longabaugh, Ed.D. (Brown University),
Co-Investigator
Diane Herbeck, M.A., Project Director

This project examines interactions between therapist behaviors and patient attributes in behavioral treatment for alcoholism. The project uses causal chain analysis to identify the mechanisms underlying these interaction effects, hence providing insight into why and how alcohol treatments work. A multi-dimensional matching typology will be developed based on the study’s findings to provide treatment providers with practical guidelines to improve the drinking outcomes of patients with alcoholism. 

Psychotherapy Process in Alcohol Treatment Matching was funded by the National Institute on Alcohol Abuse and Alcoholism, Grant 2 R01 AA12155 (September 2004 through July 2008).

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Methamphetamine Abuse Treatment – Special Studies

Patricia Marinelli-Casey, Ph.D., Principal Investigator (pattymc@ucla.edu)
Richard A. Rawson, Ph.D., Co-Investigator
Florentina Marcu, M.S., Project Director,
Maureen Hillhouse, Ph.D., Study Director, &
Alison Hamilton Brown, Ph.D., Study Director

Methamphetamine Abuse Treatment – Special Studies (MAT-SS) is a collection of research studies that contributes to knowledge about the growing problem of methamphetamine (MA) abuse in the United States. The project examines the long-term consequences of MA dependence, the temporal trends in adherence to a manualized treatment model, and the costs of various treatment approaches. The MAT-SS project builds on the work conducted by the Methamphetamine Treatment Project (MTP), the largest randomized clinical trial of treatments for MA dependence to date. The MTP was conducted as an eight-site outpatient trial, with ISAP serving as the Coordinating Center. There are three separate studies included in the current MAT-SS project:

  • The Multiyear Follow-up Study assesses a cohort of participants who were enrolled in the MTP by conducting follow-up interviews at 3-years post-intake. The purpose of the study is to examine patterns and consequences of MA abuse over time.
  • The Treatment Adherence Study contributes to knowledge about integrating research-based therapies into practice by assessing adherence to a manualized treatment as a function of time.
  • The Cost Analysis Study evaluates and compares the cost of a manualized treatment approach (Matrix Model) to other locally available treatment approaches studied in the MTP.

Methamphetamine Abuse Treatment – Special Studies was funded by the Substance Abuse & Mental Health Services Administration/Center for Substance Abuse Treatment, Contract RFP 270-01-7089 (September 2001 through March 2007).

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Evidence-Based Principles of Treatment

Michael Prendergast, Ph.D., Principal Investigator
(mlp@ucla.edu)
Deborah Podus, Ph.D., & David Farabee, Ph.D.,
Co-Investigators
Deborah Podus, Ph.D., Project Director

The Evidence-Based Principles of Treatment project entails systematic reviews and meta-analyses of evaluations of substance abuse treatment programs in order to test prominent principles of treatment effectiveness. These include the 13 principles of effective treatment identified by the National Institute on Drug Abuse and the three principles of effective rehabilitative correctional treatment identified by the “Andrews Group.” The study, conducted in conjunction with researchers at the National Development and Research Institutes, Inc. (NDRI), builds and expands upon previous meta-analytic databases created both by ISAP and by NDRI. In addition, the project seeks to strengthen meta-analytic techniques and methodology. The project has implications for practice as it will provide researchers and practitioners substantially more knowledge about which principles of treatment are indeed effective in improving client outcomes and about the strengths and limitations of current meta-analysis protocols.

Evidence-Based Principles of Treatment was funded by the National Development and Research Institutes, Inc., Subcontract 116 (DA16600) (July 2004 through June 2008).

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Mechanisms Underlying Patient-Treatment Matches and
Mismatches in Alcohol Therapy

Mitchell Karno, Ph.D., Principal Investigator (karno@ucla.edu)
Diane Herbeck, M.A., Project Director

Evidence suggests that post treatment alcohol use is associated with the occurrence of a match or mismatch between the level of therapy structure in relation to the level of patient reactance (i.e., opposition to influence from others), and with mismatches between the level of therapist confrontation in relation to the level of patient reactance and patient trait anger. This project seeks to study potential mechanisms of action that underlie these effects. Drawing on both the theories behind these effects and the extant literature on purported mechanisms of action in behavioral therapies, this research is using observer-based ratings of alcohol treatment sessions to examine the roles of (1) cognitive change in beliefs about alcohol use, (2) change talk, and (3) in-session resistance as potential mechanisms. If positive, the results of this study will validate the importance of these patient-treatment match and mismatch effects, will provide valuable insights into the active ingredients of behavioral treatments, and will provide compelling evidence on which to base future clinical trials that examine these matching effects in treatments for alcoholism.

Mechanisms Underlying Patient-Treatment Matches and Mismatches in Alcohol Therapy was funded by the National Institute on Alcohol Abuse and Alcoholism, Grant 1 R21 AA017132 (September 2007 to August 2009).

Last Updated: 03/06/2009

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2016 ISAP Publications
2015 ISAP Publications