1. CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ CJDATS is funded by NIDA in collaboration with SAMHSA and DOJ Medication Assisted Treatment: Examining Criminal Justice Client Outcomes Kevin Knight, Ph.D. 1, Julie Gray, Ph.D. 1, Amy Cohn, Ph.D. 2, Sarah Desmarais, Ph.D. 3, Jennifer Pankow, Ph.D. 1, Grace Rowan-Szal Ph.D. 1, Stephen Doherty, M.Ed. 4, & Pat Flynn, Ph.D. 1 1 Texas Christian University 2 University of South Florida 3 North Carolina State University 4 Gateway Foundation

2. Problem Background  Persistent skepticism exists within the criminal justice (CJ) system – including among criminal justice partner agencies – about the feasibility and impact of promoting medication ‐ assisted treatment (MAT).  Substantial evidence suggests MAT helps patients reduce opioid and alcohol use (Amato et al., 2005; Johnson, 2008), criminal behavior and arrest (Schwartz et al., 2009), and HIV risk behavior and infection (Metzger et al., 1993).

3. Specific Aim of This Study  Aim: To identify MAT clinic visit predictors based on patient self-report the day prior to the visit. Sub-Aim: Assess relationship of Violence and Victimization on patient participation in MAT.

4. Study Design  Recruit a minimum of 75 “MAT eligible” parolees & probationers participating in a community- based treatment program in the greater St. Louis area.  As part of the study, participants call into an interactive voice response (IVR) survey system daily over a 2-week period. The survey asks questions about previous day events, including stressors, psychological functioning, substance use, and problems attending treatment.

5. Data Collection  Baseline survey conducted in face-to-face interview after client is referred to MAT.  IVR training conducted with clients at baseline. The expectation for each participant is 2 weeks of consecutive daily calls (14 total).  Follow-up survey conducted as face-to-face interview with each participant after 90 days. Baseline assessment 2 weeks of daily IVR assessments 10 weeks of MAT treatment as usual Follow-up assessment

6.  Interactive Voice Response (IVR) Technology affordable and easy to use automated survey technology uses recorded voice prompts to ask questions that clients answer by using the touchtone keypad on the telephone or by speaking open ended responses.  Software: SmartQ by TeleSage (www.telesage.com/SmartQ.html) Measures: IVR Daily Interview

7. Today, please rate how strong is your craving to drink or use drugs? 0 = not at all 1 = slightly 2 = moderately 3 = very 4 = extremely For the next several questions, I'm going to ask you about things that you've done since this time yesterday. Answer each questions using a scale of 0 to 3 where: 0 = no, 1 = yes, but yesterday only 2 = yes, but today only, or 3 = yes, both yesterday & today. Did you have stress about an argument with someone? Did you have any stress about work or unemployment? Did you have any stress about money problems? Did you have any stress about your health? Did you have any stress about probation or parole?

8. Measures: Victimization & Violence In 3 months prior to incarceration, VictimizationViolence has anyone…have you… 1. thrown something at you?1. thrown something at someone? 2. pushed, grabbed, or shoved you?2. pushed, grabbed or shoved anyone? 3. slapped you?3. slapped anyone? 4. kicked, bitten, or choked you?4. kicked, bitten or choked anyone? 5. hit you with a fist or object or beaten you up? 5. hit anyone with a fist or object or beaten up anyone? 6. tried to physically force you to have sex against your will? 6. tried to physically force anyone to have sex against their will? 7. threatened you with a knife or gun or other lethal weapon? 7. threatened anyone with a knife or gun or other lethal weapon? 8. used a knife or fired a gun at you?8. used a knife or fired a gun at anyone? Adapted from MacArthur Community Violence Inventory (Steadman et al., 1998 )

9. Demographic Characteristics  Mean age = 35.5 years (SD = 10.2) Range = 20 to 66 years  Race/ethnicity 78.4% African American/Black 18.9% Caucasian/White 2.7% Other  Relationship status 37.3% living with a spouse/partner  Children 29.3% have children that live with them  Education 22.7% graduated from high school, 37.3% completed GED Study Sample (n=75)

10. Service Use and System Contact Criminal Justice History  # of lifetime arrests M = 16.2 (SD = 15.1) Range = 1 – 85  # of arrests while using/seeking drugs M = 11.9 (SD = 13.8) Range = 0 – 85  Age at first arrest M = 16.9 years (SD = 3.8) Range = 11 – 32  # of times in jail, prison or juvenile lockup M = 11.3 (SD = 11.7) Range = 1 – 60 Study Sample

11. Service Use and System Contact Treatment History  # of times received treatment for substance use M = 3.6 (SD = 4.8) Range = 0 – 30  Drug of choice 82% Opiates, 8% Alcohol, 10% poly-drug use, other  # of times hospitalized for psychiatric problems (Range = 0 – 10) n = 68 (91%) never hospitalized for psychiatric problems n = 2 (3%) one time n = 5 ( 7%) 2 times or more  # of times hospitalized for other health problems M = 2.37 (SD = 3.3) Range 0 – 15 Study Sample

12. Participant Characteristics: IVR Responses From Call Prior to MAT Appointment CharacteristicN (%) or Mean Receiving medication for alcohol/drug use 35 (47%) Any alcohol use 18 (24%) Any illegal drug use 38 (51%) Any prescription drug use to get high 18 (24%) Any (other) illegal activities 4 (16%) Kept MAT appointment 50 (67%)

13. Using Alcohol or Drugs to Cope with Stress Preliminary Findings

14. Correlates of keeping MAT appointment Preliminary Findings (n=75) Correlates of Appointment KeptrSource Treatment Readiness.29**From TCU CEST Self-Esteem.04From TCU CEST Anxiety.03From TCU CEST Personal Irresponsibility -.29**From CTS Use of drugs for coping with Stress -.27*From IVR Craving for Alcohol, Illegal or Rx Drugs -.10From IVR *p <.05 **p <.01 ***p <.001

15. Correlates of Vivitrol prescription Preliminary Findings (n=75) Correlates of receiving VivitrolrSource Self-esteem.28**From TCU CEST Anxiety-.04From TCU CEST Expectancy to refrain from drug use - next 90 days.21*From TCU CEST Percentage of daily calls to IVR survey.33***From IVR Craving for Alcohol, Illegal or Rx Drugs-.20From IVR *p <.05 **p <.01 ***p <.001

16. Keeping Scheduled MAT Appointment and Previous Day’s Stressors Preliminary Findings No stress from Health Stress about Health yesterday, today, or both N (%) Missed scheduled MAT Appointment 16 (21%)9 (12%) Kept scheduled MAT Appointment 41 (55%)9 (12%) “Did you have any stress about your health?”

17. Keeping scheduled MAT appointment and Use of illegal Drugs to cope with Stress Preliminary Findings “Did you take illegal drugs because of stress” Did not use of illegal drugs because of stress Used illegal drugs because of stress yesterday, today, or both N (%) Missed scheduled MAT Appointment 9 (12%)16 (21%) Kept scheduled MAT Appointment 36 (48%)14 (19%) X 2 (1, n=75) = 9.0, p <.01

18. Associations between previous psychiatric hospitalizations and keeping MAT appointment Preliminary Findings No previous psychiatric hospitalizations One or more psychiatric hospitalizations N (%) Missed scheduled MAT Appointment 23 (31%)2 (3%) Kept scheduled MAT Appointment 45 (60%)5 (7%)

19. Prevalence and Co-occurrence of Violence & Victimization x 2 (1, n=75) = 18.62, p <.001 Preliminary Findings

20. Prevalence of violent outcomes reported at baseline (n = 75) & follow-up (n = 47) Preliminary Findings *p <.05.

21. Conclusions  Need to explore impact of MAT on violence and victimization.  Will continue to examine measurement of MAT treatment satisfaction, barriers to MAT treatment, and support for MAT treatment.

22. Questions and Comments The study team gratefully acknowledges the support of the following organizations: National Institute on Drug Abuse Department of Justice Substance Abuse and Mental Health Services Administration