• Covariates Associated with Completing Short-Term Residential Treatment for a Substance Use Disorder Among Adults in the U.S.

      Ware, Orrin; Sacco, Paul; 0000-0002-3269-5324 (2021)
      Substance use disorders (SUDs) are associated with harmful outcomes across the biopsychosocial spectrum. Although completion of treatment for SUDs is associated with beneficial outcomes such as improved well-being and reduced mortality, premature treatment termination remains high in the United States. Short-term residential treatment is brief and for more severe SUD. This 3-paper dissertation focuses on exploring covariates of treatment completion in a short-term residential setting for adults with an SUD. Secondary data include the Treatment Episode Data Set Discharges 2017 and the Short-Term Residential Treatment Dataset, which contains data gathered from a Mid-Atlantic treatment facility’s electronic medical records. Paper 1 examines the associations of sociodemographic and substance use characteristics with completion of short-term residential treatment. This paper also has a primary focus on observing sex differences in treatment completion. Results from logistic regression models indicated that men were more likely to complete treatment than were women, nonpolysubstance users were more likely to complete treatment than were polysubstance users, and individuals with alcohol identified as their primary substance were more likely to complete treatment than were individuals with other primary substances. Paper 2 examines the associations between perceived stress, distress tolerance, and treatment completion in the short-term residential SUD treatment setting. Perceived stress and distress tolerance were negatively associated. Men had lower perceived stress and higher distress tolerance than did women. Those who completed treatment had lower perceived stress and higher distress tolerance than did those who were discharged from treatment prematurely. Lower perceived stress was found to predict treatment completion conditional to including a Perceived Stress × Distress Tolerance interaction variable. Distress tolerance did not moderate the relationship between perceived stress and treatment completion. Paper 3 examines a scale based on the theory of planned behavior to predict treatment completion in the short-term residential SUD treatment setting. In a path model, the theory of planned behavior’s constructs attitude and perceived behavioral control positively predicted greater intention to complete treatment. Intention to complete treatment and perceived behavioral control did not have a direct effect on treatment completion.
    • An Evaluation of the Effectiveness of Extended-Release Naltrexone

      Hochheimer, Martin; Sacco, Paul; Unick, George Jay; 0000-0001-6644-4841 (2022)
      Medications for the treatment of opioid use disorder (MOUDs) are considered the gold standard form of treatment for this condition. There are two forms of MOUD treatment, agonist, and antagonist. Agonist treatment has the medical system provide people with opioid use disorder methadone or buprenorphine which are long lasting opioids that do not produce a euphoric reaction with the goal of alleviating cravings and mitigating illicit use of opioids. Conversely, antagonist treatment blocks opioid absorption in the brain. Extended-release naltrexone (XR-NTX) is the most common antagonist treatment it is administered as a once-monthly injection. During the month after injection, patients who use opioids will not experience their effect and by negating the reward of opioid use the treatment discourages continued use. This study evaluated the effectiveness of buprenorphine and XR-NTX treatment on three characteristics: treatment retention, risk of opioid related acute care incidents, and changes in healthcare costs during treatment. Data from the Truven Health MarketScan® databases which records the date, type of interaction, and cost of every interaction that a person insured privately with one of over 250 insurance providers has with the healthcare system was used to identify a sample of approximately 30,000 people who were treated with buprenorphine or and 617 who were treated with XR-NTX for opioid use disorder. Treatment episodes were constructed based on filled prescription information and a frailty model survival analysis was fit both to a matched sample and the whole sample to length of treatment for each medication. The risk of acute care incidents was evaluated using a generalized estimating equation, and healthcare costs were evaluated using fixed-effects regression models. The study found that there are no significant differences in treatment retention between the MOUDS. Treatment with either medication was associated with an approximately 10% reduction, per day in treatment, of the odds of experiencing an acute care incident during one month. Healthcare costs increased while people were in treatment, with either MOUD, between approximately 0.85% and 1.5% for both opioid related and non-opioid related services.
    • Healthcare Provider Communication with Young Adults: Patient-Centered Communication, Patient Satisfaction, Patient Trust, Social Support, Self-Care Skills, and Emotional Well-Being

      Nichols, Helen M.; Sacco, Paul; 0000-0002-6782-0869 (2018)
      Patient-centered communication is critical to the delivery of quality healthcare services. Although numerous health outcomes have been connected to patient-provider communication, there is limited research that has explored the processes and pathways between communication and health. Research among young adults (ages 26-39 years) is even more scarce, despite findings that health communication does vary with age. This study used data from the 2014 Health Interview National Trends Survey to (1) test a scale of seven items measuring patient-centered communication among young adults age 26 to 39 and (2) explore the relationship between patient-centered communication, patient trust, patient satisfaction, social support, self-care skills, and emotional well-being among young adults age 26 to 39. Exploratory and confirmatory factor analyses were conducted and results showed that a one-factor model of patient-centered communication among young adults fit the data well. In the final regression model, income, history of depression diagnosis, patient-centered communication, patient trust, social support, and patient self-efficacy (self-care skills) were all significantly related to emotional well-being. Post-hoc analyses showed that self-efficacy and patient trust modify the association between general health and emotional well-being. Among respondents who reported poor overall health, increases in self-efficacy and trust in their provider are associated with corresponding improvement in their predicted emotional well-being. This is in contrast to respondents who reported excellent overall health, for whom an improvements in self-efficacy and trust did not have the same effect on predicted emotional well-being. There was a significant interaction between depression and self-efficacy, as respondents who reported being diagnosed with depression showed a stronger relationship between self-efficacy and greater predicted well-being. Post-hoc analyses also showed significant interactions between patient-centered communication, satisfaction, and social support. Respondents who reported lower levels of PCC, showed decreased predicted emotional well-being as their satisfaction and perceived social support increased. These findings suggest the need to explore the means through which communication can impact emotional well-being, specifically among young adults who are in poor health or have a history of depression. Future research should also include longitudinal studies, in order to determine causality and directionality among constructs.
    • The Relationship Between Alcohol Use and Gambling in Emerging Adulthood

      Jun, Hyun-Jin; Harrington, Donna; Sacco, Paul (2017)
      Emerging adults (ages 18-29 years) display higher prevalence and co-occurrence of alcohol use and gambling than do adults over age 29, which may lead to negative psychological symptoms, behavioral problems, and socioeconomic and medical costs. However, nationally representative research focused on the developmental relationships across these behaviors is limited. This study used multiple waves of National Longitudinal Study of Adolescent to Adult Health (Add Health) data to examine the relationships between earlier depressive symptoms (Wave III), antisocial behaviors (Wave III), alcohol use (Wave III), and gambling behaviors (Wave III) as predictors of later gambling behaviors (Wave IV) in emerging adults ages 18-29 while adjusting for relevant sociodemographic characteristics ((Waves I, II, and IV). It also examined gender differences in those prospective links. Findings from the path analysis suggested that alcohol-use behaviors were associated with antisocial behaviors but not with depressive symptoms, and earlier gambling behaviors were the best predictors of later gambling behaviors. Earlier depressive symptoms and binge drinking were associated with decreased risk of later gambling participation. Interestingly, endorsement of earlier antisocial behaviors was indirectly associated with a decreased risk of later gambling participation through its effect on binge drinking. The findings from multigroup analyses identified significant gender differences in the relationships between past-year alcohol use and heavy drinking (Wave III), binge drinking (Wave III) and gambling problems (Wave IV), and alcohol-related problems and gambling participation (Wave III). However, the only parameter statistically significant in models for both gender groups was past-year alcohol use and heavy drinking, indicating that a stronger association for men than women. The results suggest the need to focus on multiple risk behaviors and support for screening and early intervention for these risk behaviors (i.e., alcohol use and gambling) as a means of secondary prevention in emerging adults. Future research should further investigate the roles of antisocial behaviors, binge drinking, and gambling during emerging adulthood in vulnerability for future alcohol and gambling problems and consider other confounding factors and gender-specific risk factors.