Natural History/Treatment Process and Outcomes Projects


Methamphetamine Abuse: Long-Term Trajectories, Correlates, Treatment Effects
Mary-Lynn Brecht, Ph.D., Principal Investigator (lbrecht@ucla.edu)
Diane Herbeck, MA, Project Director

 The project is a follow-up of 596 previously studied methamphetamine (meth) users, half recruited from drug treatment participation in Los Angeles County and half with no prior meth treatment at recruitment. The project uses the Natural History Interview to collect detailed histories of substance use, treatment, and criminal careers; these new data combined with previously collected data will produce life course trajectories averaging at least 28 years in duration, covering teen and adult periods. Additional data will come from administrative records from several state agencies. The sample is 35% female/65% male, 33% Hispanic/38% non-Hispanic White/17% African-American/12% other ethnicity, and will be 28-74 years of age (average 42) at beginning of the follow-up study. Analyses will describe the current status and extended patterns of meth and other substance use including escalation, deceleration, and possible cessation and recovery; examine drug treatment utilization patterns and relationship to meth use patterns; describe health morbidity and mortality; assess long-term outcomes (14 or more years) of a previously identified drug treatment episode (for the subsample recruited from treatment); and estimate cumulative social costs of meth abuse for the sample in terms of criminal activity, incarceration, and drug treatment, health, and mental health services utilization. Analysis methods will include growth models and growth mixture models.

Methamphetamine Abuse: Long-Term Trajectories, Correlates, Treatment Effects was funded by the National Institute on Drug Abuse, grant 1 R01 DA025113-01A1, from July 2009 to May 2013.


Four Models of Telephone Support for Stimulant Recovery
David Farabee, Ph.D., Principal Investigator (dfarabee@ucla.edu)
Richard Rawson, Ph.D., & Mitchell Karno, Ph.D, Co-Investigators
Valerie Pearce, MPH, Project Director
Sarah Cousins, B.S., B.A., Project Coordinator

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 = 300) who have successfully completed a Primary 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 3 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.

Four 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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Research on Racial and Ethnic Disparities in Access to Mental Health Care and Addiction-Related Outcomes among Clients of Public Sector Substance Abuse Treatment Programs in California
Kevin Heslin, Ph.D., Principal Investigator
Yih-Ing Hser, Ph.D., Co-Investigator
Elizabeth Evans, M.A., Project Director

 Psychiatric comorbidity is highly prevalent among persons with substance abuse problems.  Unfortunately, many substance abusers with psychiatric symptoms do not receive mental health services.  Racial/ethnic minorities are much less likely than are whites to use mental health or substance abuse treatment; however, the reasons for these disparities are not well understood.  Previous work has not determined whether the geographic maldistribution of providers and other characteristics of poor, predominantly minority neighborhoods has an effect on mental health service use and addiction-related outcomes. This represents a considerable gap in the literature, given the continued need to explain and reduce persistent racial/ethnic health disparities in the U.S. 

The general aim of this study is to identify individual- and community-level determinants of mental health service use and treatment outcomes among clients of publicly funded substance abuse programs.  We will examine the extent to which racial/ethnic disparities in mental health service use and addiction-related outcomes are a function of community-level characteristics.  To accomplish this goal, we will conduct a secondary analysis of existing data from the California Treatment Outcome Project (CalTOP), a computer-based system developed for California to standardize assessment, monitor use of services, and support outcomes evaluation of publicly funded substance abuse treatment programs throughout the state.

Research on Racial and Ethnic Disparities in Access to Mental Health Care and Addiction-Related Outcomes among Clients of Public Sector Substance Abuse Treatment Programs in California was funded by the National Institute on Drug Abuse, grant R03 DA018762 to Drew University, with a subcontract between ISAP (Yih-Ing Hser) and Drew University, from November 2008 to August 2010. 


Center for Advancing Longitudinal Drug Abuse Research (CALDAR)
Yih-Ing Hser, Ph.D., Principal Investigator (yhser@ucla.edu)
Mary-Lynn Brecht, Ph.D., Christine E. Grella, Ph.D., Debra A. Murphy, Ph.D.,
Michael Prendergast, Ph.D., & Constance Weisner, Dr.P.H., M.S.W., Co-Investigators
Cheryl Teruya, Ph.D., Project Director

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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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).


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: 06/27/2011

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2016 ISAP Publications
2015 ISAP Publications