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Abstract: Background and aims: Despite similar substance use levels, Black adults experience greater family, legal, employment and other social-contextual challenges related to recovery than other groups. Substance use treatments that address both substance use and social-contextual factors are uniquely positioned to address these substance-related problems and produce more sustainable improvements in social functioning than treatment as usual (TAU) or behavioral controls (Control). The aim of this study was to evaluate changes in substance-related problems among Black adults, focusing on the comparative effectiveness between social-contextual treatments and TAU/Control. Design: Individual-level data synthesis based on secondary analysis of Black adults enrolled in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN). Setting: All data were collected in the primary studies between 2001 and 2008 at clinics across the United States. Participants: Black adults who reported cocaine and/or opioid use across nine studies within the NIDA CTN. The sample used herein consisted of individuals from five of these studies who provided data on substance-related problems (n=532; mean age=39.34; standard deviation=9.6). Measurements: There were two treatment conditions: Social-contextual (e.g. Motivational Interviewing, Seeking Safety, STAGE 12) and TAU/Control. Moderated nonlinear factor analysis estimated latent scores for substance-related problems, using subscales from the Addiction Severity Index, while accounting for measurement noninvariance across studies, time and covariates. Linear mixed models estimated latent score differences over time between social-contextual treatments and TAU/Control during treatment and from the end of treatment through 12-month follow-up. Findings: Both treatment groups improved across substance-related problem areas from baseline to the end-of-treatment (Cohen’s d = -0.10 to d = -0.47), with effects maintained at 12-month follow-up. Although social-contextual treatments did not statistically significantly outperform TAU/Control from baseline to end-of-treatment, they showed greater effects from end of treatment to 12-month follow-up in family/social [Cohen’s d difference ( d) = -0.47, 95% confidence interval (CI) = -0.57 to -0.38], legal ( d = -0.20, 95% CI = -0.31 to -0.10) and psychiatric problems ( d = 0.29, 95% CI = -0.38 to -0.20) than TAU/Control. Sensitivity analyses indicated that Seeking Safety and STAGE 12 predominantly drove post-treatment improvements in family/social problems. Conclusions: Substance use treatment may yield broader, delayed benefits beyond substance use reduction among Black adults in the United States. Compared with treatment-as-usual, social-contextual treatments can yield more sustainable effects in legal, family and psychiatric areas among Black adults, with interventions such as Seeking Safety and STAGE 12 showing particular benefits in addressing family-related challenges. Related protocols: CTN-0125

Abstract:

Psychosocial support is recommended in conjunction with medication for opioid use disorder (MOUD), although optimal “dose,” modality, and timing of participation is not established. This study used data from CTN-0051 to examine counseling and 12-Step attendance and subsequent opioid use in a MOUD randomized clinical trial.

The parent study randomly assigned 570 participants to receive buprenorphine-naloxone (BUP-NX, n=287) or extended-release injectable naltrexone (XR-NTX, n=283). Mixed-effects logistic regression models were fit with opioid use as the response variable, and a counseling/12-Step attendance predictor. Differences by treatment assignment were examined.

Any counseling or 12-Step attendance was associated with reduced odds of opioid use at the subsequent visit, whether considered individually or aggregated across type. A continuous relationship was observed for 12-Step attendance (F(1,5083)=5.01, p=.025); with each additional hour associated with 13% (95% CI: 0.83, 0.90) reduction in odds of opioid use. The strength of this association grew over time. In the BUP-NX arm, group counseling was associated with a greater reduction in odds of opioid use than for XR-NTX, (OR=0.32 (95% CI: .22, 0.48) vs. OR=0.69 (95% CI: 0.43, 1.08)). For XR-NTX, 12-Step was associated with a greater reduction in odds of opioid use (OR=0.35 (95% CI: 0.22, 0.54) vs. OR=0.65 (95% CI: 0.47, 0.89) for BUP-NX)).

Conclusions: Psychosocial engagement has a proximal association with opioid use and the strength of that association may grow with dose and time. Alternatively, more motivated individuals may both attend more counseling/12-Step and have better treatment outcomes, or the relationship may be reciprocal. While the results of the present study suggest that when it comes to psychosocial support, “more is better,” the present findings also suggest that “any is better than none.” Future research could expand upon the present study by examining the contributions of different psychosocial treatment modalities to opioid use and relapse.

Related protocols: CTN-0051

Abstract:

This is the primary outcomes article for CTN-0085.

Twelve-step mutual help groups are widely accessed by people with drug use disorder but infrequently subjected to rigorous evaluation. Pooling randomized trials containing a condition in which mutual help group attendance is actively facilitated presents an opportunity to assess the effectiveness of 12 step groups in large, diverse samples of drug use disorder patients.

As part of CTN-0085 (Selection Bias Free Estimation of the Impact of Drug-Focused Twelve Step Mutual Help Groups Using the VA Database), data from six federally-funded randomized trials were pooled (n=1730) and subjected to two-stage instrumental variables modelling and fixed and random effects regression models. All trials included a 12 step group facilitation condition and employed the Addiction Severity Index as a core measure.

The ability of 12 step facilitation to increase mutual help group participation among drug use disorder patients was minimal, limiting ability to employ two-stage instrumental variable models that correct for selection bias. However, traditional fixed and random effects regression models found that greater 12 step mutual help group attendance by drug use disorder patients predicted reduced use of and problems with illicit drugs and alcohol with alcohol.

Conclusions: Facilitating significant and lasting involvement in 12 step groups may be more challenging for drug use disorder patients than for alcohol use disorder patients, which has important implications for clinical work and for effectiveness evaluations. Though selection bias could explain part of the results of traditional regression models, the finding that participation in 12 step mutual help groups predicts lower illicit drug and alcohol use and problems in a large, diverse sample of drug use disorder patients is encouraging.

Related protocols: CTN-0085

Abstract:

There are several relatively safe and effective FDA-approved medications for opioid use disorder (OUD). Despite the existence of these medications, the rate of returning to opioid use after treatment is relatively high, underscoring the need for continued enhancement of treatments. Adjunctive psychosocial interventions paired with medication have been shown to improve OUD treatment outcomes. However, studies have yet to conclusively examine the distinct effects of the most widely utilized psychosocial treatment modalities.

The current study investigated the relationship between individual counseling, group therapy, and 12-step participation and illicit opioid abstinence at the end of treatment, and at 1 and 3 months after treatment.

A secondary analysis was conducted with data from CTN-0051 (“Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment”), which used a sample of 570 individual diagnosed with OUD recruited from 8 substance use disorder treatment centers in the U.S. Participants were enrolled in a two-group randomized, controlled trial testing buprenorphine-naloxone versus extended-release naltrexone for OUD. A two-level hierarchical linear growth model was used to examine the effects of individual counseling, group therapy, and 12-step participation on illicit opioid abstinence (urinalyses) 1- and 3-months post-treatment.

Hours of individual counseling and 12-step participation significantly predicted abstinence at follow-up. There was a significant interaction between individual counseling and 12-step participation. Additionally, participant age and employment status were significant predictors of illicit opioid abstinence. Hours of group therapy was not found to significantly predict illicit opioid abstinence.

Conclusions: This is the only known study to examine the effects of the 3 most widely used psychosocial intervention modalities in a multisite and diverse sample of individuals receiving mediation for OUD. Findings suggest that greater levels of individual therapy and 12-step participation may be beneficial for individuals receiving medication treatment for opioid use disorder. The relatively low percentage of individuals who achieve long-term abstinence suggests there is room for improvement in OUD treatment outcomes, and findings can be used to guide the selection and use of adjunctive psychosocial interventions during medication treatment for OUD.

Related protocols: CTN-0051

Abstract:

The natural course of prescription opioid use disorder has not been examined in longitudinal studies. This study examined correlates of opioid abstinence over time after completing a treatment trial for prescription opioid dependence.

The multi-site Prescription Opioid Addiction Treatment Study (POATS) examined different durations of buprenorphine-naloxone and different intensities of counseling to treat prescription opioid dependence. Following the clinical trial, a longitudinal study was conducted from March 2009-January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N=375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help (i.e., 12-step programs)) and opioid abstinence rates at the follow-up assessments.

At the three follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47-50%). The most common treatments were buprenorphine maintenance (27-35%) and mutual-help group attendance (27-30%), followed by outpatient counseling (18-23%) and methadone maintenance (4%).

In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (ORs=5.4, 4.6, and 2.8 at the three assessments), followed by current mutual-help attendance (ORs=2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models.

Conclusions: This study, using long-term follow-up data from the largest randomized trial of treatment for prescription opioid dependence to date, found that ongoing treatment was strongly associated with odds of opioid abstinence up to 42 months following the trial. Although current opioid agonist treatment had the strongest association with abstinence, mutual-help attendance was also significantly associated with abstinence. Critically, mutual-help attendance was associated with an additive benefit among those receiving opioid agonist treatment and was also associated with abstinence in those not receiving agonist treatment. Adults with prescription opioid dependence appear to benefit from continued medication and mutual-help participation as part of long-term, ongoing care.

Related protocols: CTN-0030, CTN-0030-A-3

Abstract:

Emerging adults (roughly 18-29 years) with substance use disorders can benefit from participation in twelve-step mutual-help organizations (TSMHO), however, their attendance and participation in such groups is relatively low. Twelve-step facilitation therapies, such as the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12), may increase attendance and involvement, and lead to decreased substance use.

This study used data from the NIDA Clinical Trials Network STAGE-12 protocol (CTN-0031), a multisite randomized controlled trial, to examine whether age moderated the STAGE-12 effects on substance use and TSMHO meeting attendance and participation, The original STAGE-12 study involved assessments at baseline, mid-treatment (week 4), end-of-treatment (week 8), and 3- and 6-months post-randomization; participants were adults with DSM-IV diagnosed stimulant abuse or dependence (N=450) enrolling in 10 intensive outpatient substance use treatment programs across the U.S. A zero-inflated negative binomial random-effects regression model was utilized to examine age-by-treatment interactions on substance use and meeting attendance and involvement.

Analyses found that younger age was associated with larger treatment effects for stimulant use. Specifically, younger age was associated with greater odds of remaining abstinent from stimulants in STAGE-12 versus Treatment-as-Usual; however, among those who were not abstinent during treatment, younger age was related to greater rates of stimulant use at follow-up for those in STAGE-12 compared to TAU. There was no main effect of age on stimulant use. Younger age was also related to somewhat greater active involvement in different types of TSMHO activities among those in STAGE-12 versus TAU. There were no age-by-treatment interactions for other types of substance use or for treatment attendance, however, in contrast to stimulant use; younger age was associated with lower odds of abstinence from non-stimulant drugs at follow-up, regardless of treatment condition.

Conclusions: These results suggest that STAGE-12 can be beneficial for some emerging adults with stimulant use disorder, and ongoing assessment of continued use is of particular importance. More targeted research addressing the differences between younger and older adults and their unique responses to treatment is needed, so that developmental variations can be considered in the provision of substance abuse treatment. Age-appropriate treatment could have considerable effects on clinical outcomes and public health.

Related protocols: CTN-0031

Abstract:

This secondary data analysis explored predictors and outcomes of having a 12-step sponsor among individuals receiving treatment for stimulant use disorders, inclusive of four types of 12-step groups (Narcotics Anonymous, Alcoholics Anonymous, Cocaine Anonymous, and Crystal Meth Anonymous). For the CTN Stimulant Abuse Groups to Engage in 12-Step (STAGE-12) protocol (CTN-0031), a multisite randomized trial, participants (N=471, 59% women) were recruited among adult patients in 10 U.S. community treatment programs. Participants were randomized into treatment as usual (TAU) or a 12-step facilitation (TSF) intervention (STAGE-12). Logistic regression analyses explored the extent to which participants obtained sponsors, including the extent to which treatment condition and other predictors (12-step experiences, expectations, and beliefs) were associated with having a sponsor. The relationship between end-of-treatment sponsorship and follow-up substance use outcomes was also tested.

Results found that participants were more likely to have a sponsor at the end of treatment and 3-month follow-up, with the STAGE-12 condition having higher sponsorship rates. Twelve-step meeting attendance and literature reading during the treatment period predicted having a sponsor at the end of treatment. Sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant user and having no drug-related problems at follow-up.

Conclusions: This study extends previous research on sponsorship, which has mostly focused on alcohol use disorders, by indicating that sponsorship is associated with positive outcomes for those seeking treatment from stimulant use disorders. It also suggests that sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF intervention.

Related protocols: CTN-0031

Abstract:

Engagement in 12-step meetings and activities has been shown to be a powerful aid to recovery from substance use disorders. However, only limited attention has been given to ethnic and racial differences in attitudes toward 12-step and involvement. This study utilized data from CTN-0031, “Stimulant Abuser Groups to Engage in 12-Step (STAGE-12),” a large multisite trial testing the effectiveness of a 12-step facilitation therapy (Twelve-Step Facilitation (TSF)) with stimulant-dependent treatment seekers. It compared baseline differences and treatment outcomes between African American and Caucasian participants. Results of the analysis found select few baseline differences (i.e., African Americans reported higher levels of spirituality than Caucasians; African American participants indicated more perceived benefits of 12-step involvement; Caucasians were more likely to endorse future involvement in 12-step). However, there were no outcome differences (e.g., substance use outcomes, 12-step meeting attendance).

Conclusions: The tested intervention, TSF, produced similar outcomes for both groups, indicating that it may be useful across racial categories. This finding is promising, given that much of the previous research on TSF treatments has focused on alcohol, and stimulant use may present unique problem profiles for African American and Caucasian individuals. That TSF performed equally well among the two study groups is important information for clinicians deciding which evidence-based practice might be best applied to a particular client.

Related protocols: CTN-0031

Abstract:

Few studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs). The NIDA Clinical Trials Network study, STAGE-12, was a clinical trial of 12-step facilitation (N=471) focusing on individuals with cocaine or methamphetamine use disorders. It allowed for examination of four questions:

1. To what extent do treatment-seeking stimulant users use 12-step programs and which ones?
2. Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users?
3. What specific baseline “12-step readiness” factors predict subsequent 12-step participation and attendance?
4. Does stimulant drug of choice differentially predict 12-step participation and attendance?

The four outcome variables, attendance, speaking, duties and 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity. Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3-, and 6-month follow-ups than did methamphetamine users. Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment self-help activities at end-of-treatment and 3-month follow-up/ Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all times points by pre-randomization in self-help activities.

Conclusions: The primary finding of this study is one of continuity: both readiness to engage in 12-step content and specific prior attendance and active participation (defined as speaking, having duties at, or engaging in related activities) with 12-step programs were the main signs pointing to future involvement in these same areas. Based on these findings, there may be little value in continuing to explore demographic characteristics as predictors of 12-step involvement, and instead future research should focus on measures of perceptions and behaviors that are 12-step specific.

Related protocols: CTN-0031

Abstract:

Decision-making processes have been posited to affect treatment outcome in addiction patients. This multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients. A total of 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (NIDA Clinical Trials Network protocol CTN-0031, STAGE-12) were assessed. Decision-making processes of risk and delay (Iowa Gambling Task (IGT)) and response reversal (Wisconsin Card Sorting Task (WCST)) were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the period following post-randomization were evaluated.

Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, worse performance on the IGT was associated with fewer number of stimulant use days (p=0.001). In contrast, worse performance on the WCST (fewer perseverative errors) was associated with a greater number of stimulant use days (p=0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and minority participants.

Conclusions: Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of non-drug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use.

Related protocols: CTN-0031

Abstract:

This study examined associations of therapeutic alliance and treatment delivery fidelity with treatment retention in Stimulant Abusers to Engage in Twelve-Step (STAGE-12), a community-based trial of 12-Step Facilitation (TSF) conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). The STAGE-12 trial randomized 234 stimulant abusers enrolled in 10 outpatient drug treatment programs to an eight-session, group and individual TSF intervention. During the study, TSF participants rated therapeutic alliance using the Helping Alliance questionnaire-II (HAq-II). After the study, independent raters evaluated treatment delivery fidelity of all TSF sessions on adherence, competence, and therapist empathy. Poisson regression modeling examined relationships of treatment delivery fidelity and therapeutic alliance with treatment retention (measured by number of sessions attended) for 174 participants with complete fidelity and alliance data. Therapeutic alliance (p=.005) and therapist competence (p=.010) were significantly associated with better treatment retention. Therapist adherence was associated with poorer retention in a nonsignificant trend (p=.061).

Conclusions: Stronger therapeutic alliance and higher therapist competence in the delivery of TSF intervention were associated with better treatment retention whereas treatment adherence was not. Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention. This is the first study to show a relationship between therapeutic alliance and retention in TSF with substance abusers, and to identify a significant fidelity-retention relationship for manual-guided TSF treatment, a finding that has important implications for treatment delivery.

Related protocols: CTN-0031

Abstract:

This ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (“Stimulant Abuser Groups to Engage in 12-Step (STAGE 12)”) investigated the correspondence among four groups of raters on adherence to STAGE-12, a manualized 12-step facilitation (TSF) group and individual treatment targeting stimulant abuse. The four rater groups included the study therapists, supervisors, study-related (“TSF expert”) raters, and non-project-related (“external”) raters. Results indicated that external raters rated most critically Mean Adherence — the mean of all the adherence items — and global performance. External raters also demonstrated the highest degree of reliability with the designated expert. Therapists rated their own adherence lower, on average, than did supervisors and TSF expert raters, but therapist ratings also had the poorest reliability.

Conclusions: Findings highlight the challenges in developing practical, but effective methods of fidelity monitoring for evidence-based practice in clinical settings. While funding and licensing agencies increasingly call for use of evidence-based treatments, community-based organizations implementing them will seek the simplest, most reliable and cost-effective ways of monitoring their delivery. These results suggest that there may be a role for on-site therapists or supervisors rating adherence, and that raters unaffiliated with the treatment being tested may provide the most objective ratings. Future research should examine the impact of training therapists on self-rating to determine whether this group and achieve acceptable reliability and objectivity in ratings.

Related protocols: CTN-0031

Abstract:

Given that treatment dropout among stimulant abusers has been found in prior research to be associated with relapse and continued substance use, identifying variables that best predict treatment completion for particular subgroups among stimulant abusers may aid clinicians in targeting dropout prevention strategies. The purpose of this study was to explore the selection of predictor variables in the evaluation of drug treatment completion using an ensemble approach with classification trees. The basic methodology is reviewed and the subagging procedure of random subsampling is applied. Among 234 individuals with stimulant use disorders randomized to a 12-step facilitative intervention shown to increase stimulant use abstinence (National Drug Abuse Treatment Clinical Trials Network study CTN-0031, “STAGE-12”), 67.52% were classified as treatment completers. A total of 122 baseline variables were used to identify factors associated with completion. The number of types of self-help activity involvement prior to treatment was the predominant predictor. Other effective predictors included better coping self-efficacy for substance use in high-risk situations, more days of prior meeting attendance, greater acceptance of the disease model, higher confidence for not resuming use following discharge, lower ASI Drug and Alcohol composite scores, negative urine screens for cocaine or marijuana, and fewer employment problems.

Conclusions: The application of an ensemble subsampling regressions tree method utilizes the fact that classification trees are unstable but, on average, produce an improved prediction of the completion of drug abuse treatment. The results support the notion that there are early indicators of treatment completion that may allow for modification of approaches more tailored to fitting the needs of individuals and potentially provide more successful treatment engagement and improved outcomes. Given these results, in addition to considering mostly static variables like race, gender, or marital status, researchers should attend to the selection of more dynamic variables, such as confidence and self-efficacy, that may have stronger implications in the development of treatment interventions.

Related protocols: CTN-0031

Abstract:

This ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (“Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)”), examined whether level of exposure to the STAGE-12 intervention, a 12-step facilitative therapy, is related to treatment outcome. The original study compared STAGE-12 combined with treatment-as-usual (TAU) to TAU alone. These analyses include only those randomized to STAGE-12 (n=234). Assessments occurred at baseline and 30, 60, 90, and 180 days following randomization. High-exposure patients (n=158; attended at least 2 of 3 individual and 3 of 5 group sessions), compared to those with less exposure (n=76), demonstrated: (1) higher odds of self-reported abstinence from, and lower rates of, stimulant and non-stimulant drug use; (2) lower probabilities of stimulant-positive urines; (3) more days of attending and lower odds of not attending 12-Step meetings; (4) greater likelihood of reporting no drug problems; (5) more days of duties at meetings; and (6) more types of 12-Step activities. Many of these differences declined over time, but several were still significant by the last follow-up.

Conclusions: Although outpatient substance use disorder treatment is thought to be characterized by high drop-out rates and low rates of treatment completion, exposure to STAGE-12 treatment was relatively high for this 8-session intervention embedded within intensive outpatient treatment as usual. Over two-thirds of patients met criteria for high exposure to the intervention, and there was relatively low early attrition. Those achieving high exposure to STAGE-12 demonstrated more positive outcomes, though the design of this secondary analysis cannot demonstrate a causal relationship between STAGE-12 exposure and positive outcomes. However, the current study demonstrates that it is feasible to interest people entering intensive outpatient treatment in a 12-Step oriented intervention and that individuals who agree to participate can be retained in the intervention at relatively high rates.

Related protocols: CTN-0031

Abstract:

This study describes early treatment drug use status and associated clinical characteristics in a diverse sample of patients entering outpatient substance abuse psychosocial counseling treatment. The goal was to more fully characterize those entering treatment with and without active use of their primary drug in order to better understand associated treatment needs and resilience factors. Using baseline data from the National Drug Abuse Treatment Clinical Trials Network (CTN) study CTN-0044 (Web-Delivery of Treatment for Substance Use, N=494), patients were categorized according to self-identified primary drug of abuse (alcohol, cocaine/stimulants, opioids, marijuana) and baseline drug use status (positive/negative) as measured by urine testing or self-report (alcohol). Characteristics were examined by primary drug and early use status.

Classified as drug-negative were 84%, 76%, 62%, and 33% of primary opioid, stimulant, alcohol, and marijuana users, respectively. Drug-positive versus -negative patients did not differ on demographics or rates of substance abuse/dependence diagnoses. However, those negative for active use had better physical and mental health profile, were less likely to be using a secondary drug, and were more likely to be attending 12-step self-help meetings.

Conclusions: Early treatment drug abstinence is common among substance users entering outpatient psychosocial counseling programs, regardless of primary abused drug. Abstinence is associated with better physical and mental health profiles, less secondary drug use, and more days of 12-step attendance. These findings provide important information for clinicians looking to better understand the health issues and substance use profiles among patients seeking treatment, and suggest that individual behavioral differences at treatment start can help inform treatment planning.

Related protocols: CTN-0044