title: Betting on change: modeling transitional probabilities to guide therapy development for opioid dependence.
abstract: This study investigated the process of change by modeling transitions among four clinical states encountered in 64 detoxified opiate-dependent individuals treated with daily oral naltrexone: no opiate use, blocked opiate use (i.e., opiate use while adhering to oral naltrexone), unblocked opiate use (i.e., opiate use after having discontinued oral naltrexone), and treatment dropout. The effects of baseline characteristics and two psychosocial interventions of differing intensity, behavioral naltrexone therapy (BNT) and compliance enhancement (CE), on these transitions were studied. Participants using greater quantities of opiates were more likely than other participants to be retained in BNT relative to CE. Markov modeling indicated a transition from abstinence to treatment dropout was approximately 3.56 times greater among participants in CE relative to participants in BNT, indicating the more comprehensive psychosocial intervention kept participants engaged in treatment longer. Transitions to stopping treatment were more likely to occur after unblocked opiate use in both treatments. Continued opiate use while being blocked accounted for a relatively low proportion of transitions to abstinence and may have more deleterious effects later in a treatment episode. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
authors.affiliation: Division on Substance Abuse, New York State Psychiatric Institute, USA. carpent@pi.cpmc.columbia.edu
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Carpenter
authors.forename: Huiping
authors.initials: H
authors.lastname: Jiang
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
authors.forename: Adam
authors.initials: A
authors.lastname: Bisaga
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Comer
authors.forename: Wilfrid Noel
authors.initials: WN
authors.lastname: Raby
authors.forename: Adam C
authors.initials: AC
authors.lastname: Brooks
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010349:Patient Compliance; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone