Oxford Houses are self-run, abstinence-based recovery homes for individuals recovering from a substance use disorder (SUD). With over 2000 Oxford Houses in several different countries including the U.S., Australia, Canada, the UK, and Ghana, the Oxford House model is the largest network of abstinence-based recovery homes. The Houses rely on a democratic vote for resident matters like accepting prospective residents, establishing rules, and assigning chores. Any resident that is discovered repeatedly using substances is immediately evicted. The vast majority of residents attend 12-step groups, like Narcotics Anonymous, where an individual using Medication-Assisted Treatment (MAT) is not considered abstinent. The purpose of this study was to examine residents’ views on MAT.

The majority of the 87 participants were men. Fourteen percent of the residents reported they were receiving MAT and 32% stated they had previously been on MAT. The residents’ views on MAT often depended on their own drug of choice. None of the residents currently receiving MAT believed that someone who takes buprenorphine/naloxone was a “using addict”. However, 22% of current MAT patients believed that someone who takes methadone was still a “using addict”. Among non-MAT residents, nearly half (49%) reported that an individual who takes buprenorphine/naloxone was still a “using addict”, and 68% thought someone who takes methadone was also still an addict. None of the MAT group reported they would vote against a prospective resident for using buprenorphine/naloxone, but 50% would vote against someone taking methadone. Of the non-MAT residents, 38% stated that they would vote against a prospective resident taking buprenorphine/naloxone and 65% of this group reported they would vote against someone taking methadone. There were also gender differences in responses with 41% of men saying they would vote against a resident taking buprenorphine/naloxone, compared to only 13% of women. Interestingly, longer time in recovery was related to harsher attitudes towards MAT.

Findings suggest Oxford Houses may not be the best recovery model for individuals receiving MAT. However, residents of abstinence-based homes should be educated on the science and benefits of MAT, and the ways in which use of MAT differ from addiction. The results also show that further education is needed to address stigma associated with methadone use so individuals receiving MAT can stay in and benefit from supportive environments.

Majer, J. M., Beasley, C., Stecker, E., Bobak, T. J., Norris, J., Nguyen, H. M., Ogata, M., … Jason, L. A. (January 01, 2018). Oxford House Residents’ Attitudes Toward Medication Assisted Treatment Use in Fellow Residents. Community Mental Health Journal, 54, 5, 571-577.

In addition to their substance use disorders (SUD), women involved in Drug Treatment Court (DTC) face other obstacles that can influence their motivation and ultimately their success in DTC. These include isolation from family, inadequate physical and mental health care, lack of social support, and past trauma. To be successful, women must balance their own motivation against these obstacles. In this study, peer interventionists interviewed 15 women participating in the Women’s Initiative Supportive Health DTC program. The participants were asked about past trauma on the trauma they’d experienced, along with other family and social barriers that may affect success in the program.

The women ranged in age from 20-40+. Thirteen of the women had at least one child and 14 out of 15 participants had experienced incarceration. Nearly all of the women (14 out of the 15) had experienced past trauma, including homelessness, physical or emotional abuse, intimate partner violence, and sexual assault. The women also faced mental and physical health obstacles, as all of the 15 women had histories of chronic health conditions including Hepatitis and HIV. Participants reported their main motivation to maintain their sobriety and to become supportive parents was most influential in completing DTC despite additional obstacles. Accordingly, the women reported that their parenting skills were the most common changed behavior. Participants stated that the second motivation and a source of support to maintain their health and sobriety was their families. Families helped the women in their journey to recovery by encouraging their competence and supporting their autonomy. A third common motivating factor was related to overcoming past trauma.

What can be taken away from this study? First, one of the most important ways to assist women in DTC is to empower them to be autonomous and to support the decision they make in their recovery. Second, past trauma must be taken into account in SUD interventions and treatment. Almost all of the women interviewed had experienced trauma. Finally, family can be a powerful motivator for women to achieve recovery. A supportive family helps reduce SUD among women who are mentally ill and suffer from a SUD. Future interventions should incorporate family or family dynamics into the treatment of women with SUD.

Goldberg, Z. E., Chin, N. P., Alio, A., Williams, G., & Morse, D. S. (January 01, 2019). A Qualitative Analysis of Family Dynamics and Motivation in Sessions With 15 Women in Drug Treatment Court. Substance Abuse: Research and Treatment, 13.

Family Treatment Drug Court (FTDC) is one of the most promising interventions for families involved in the child welfare system because of parental substance abuse. However, there are mixed feelings on the efficacy of FTDC on child welfare outcomes. This 2019 examined seventeen FTDC interventions with a total of 3402 participants enrolled in FTDC and 3683 comparison participants.

Overall, the reunification rate of FTDC participants was nearly two times higher than non-FTDC participants. However, there was no difference between FTDC and non-FTDC participants when it came to the risk of foster care reentry or child maltreatment re-report. Additionally, reunification rates improved over time suggesting that FTDC programs have improved over time. Future studies should examine the risk of foster care reentry for FTDC participants. The child welfare system should also consider enhancing follow-up services for those who have graduated from FTDC to prevent reentry into foster care.

Zhang, S., Huang, H., Wu, Q., Li, Y., & Liu, M. (February 01, 2019). The impacts of family treatment drug court on child welfare core outcomes: A meta-analysis. Child Abuse & Neglect, 88, 1-14.

Substance Use Disorders (SUD) are increasing among older adults in the US. Compared to younger groups, older adults have an increased risk of overdose, falls, drug interactions, cognitive and psychomotor impairment, as well as an increased risk of mortality. Medication-Assisted Treatment (MAT) is an effective treatment for Opioid Use Disorders (OUD), but it is especially underused among older adults with an estimated 7.9-9.8% of older adults used MAT as part of their treatment.

It can be challenging treating older populations for OUD, as there can be physical limitations, comorbidities, and negative interactions with other medications. Methadone maintenance treatment requires counseling sessions, toxicology screens, and same-day screening which can be challenging for older adults with physical limitations and transportation issues. Methadone, in particular, may interact with other drugs that are common for older adults. Insurance coverage of MAT services is also a significant barrier for older adults, as Medicare does not cover methadone use for OUD. Primary care providers, and other physicians that treat older adults, should be trained on how to screen for OUD and refer them to treatment.

Joshi, P., Shah, N. K., & Kirane, H. D. (April 01, 2019). Medication-Assisted Treatment for Opioid Use Disorder in Older Adults: An Emerging Role for the Geriatric Psychiatrist. The American Journal of Geriatric Psychiatry, 27, 4, 455-457.