Exploring the mediating role of baseline urinalysis results on demographic characteristics and stimulant use disorder treatment outcomes

Crystal L Smith; André Q Miguel; Abigail Keever; Theresa Bowden; Ekaterina Burduli; John Roll; Sterling M McPherson

doi:10.1016/j.josat.2023.208962

Exploring the mediating role of baseline urinalysis results on demographic characteristics and stimulant use disorder treatment outcomes

J Subst Use Addict Treat. 2023 Aug:151:208962. doi: 10.1016/j.josat.2023.208962. Epub 2023 Jan 26.

Authors

Crystal L Smith¹, André Q Miguel², Abigail Keever¹, Theresa Bowden³, Ekaterina Burduli³, John Roll⁴, Sterling M McPherson¹

Affiliations

¹ Washington State University, Program of Excellence in Addictions Research (PEAR), USA; Washington State University, Elson S. Floyd College of Medicine Department of Community and Behavioral Health, USA; Washington State University, Analytics and PsychoPharmacology Laboratory (APPL), USA.
² Washington State University, Program of Excellence in Addictions Research (PEAR), USA; Washington State University, Elson S. Floyd College of Medicine Department of Community and Behavioral Health, USA; Washington State University, Analytics and PsychoPharmacology Laboratory (APPL), USA. Electronic address: andre.miguel@wsu.edu.
³ Washington State University, Program of Excellence in Addictions Research (PEAR), USA; Washington State University, Analytics and PsychoPharmacology Laboratory (APPL), USA; Washington State University, College of Nursing, USA.
⁴ Washington State University, Program of Excellence in Addictions Research (PEAR), USA; Washington State University, Elson S. Floyd College of Medicine Department of Community and Behavioral Health, USA; Washington State University, Analytics and PsychoPharmacology Laboratory (APPL), USA; Washington State University, College of Nursing, USA.

PMID: 36801204
PMCID: PMC10313760 (available on 2024-08-01)
DOI: 10.1016/j.josat.2023.208962

Abstract

Introduction: Baseline stimulant urinalysis (UA) is one of the most reliable predictors of stimulant use disorder treatment outcomes. Yet we know little about the role of baseline stimulant UA mediating the effects of different baseline characteristics on treatment outcomes.

Objectives: This study aimed to explore the potential mediating role of baseline stimulant UA results on the relationship between baseline characteristics and total number of stimulant negative UAs submitted during treatment.

Methods: The study team conducted analyses on data from a multisite randomized clinical trial of contingency management (CM) targeting stimulant use among individuals enrolled in methadone maintenance treatment programs (n = 394). Baseline characteristics included trial arm, education, race, sex, age, and Addiction Severity Index (ASI) composite measures. Baseline stimulant UA was the mediator and total number of stimulant negative UAs provided during treatment was the primary outcome variable.

Results: The baseline characteristics of sex (OR = 1.85), ASI drug (OR = 0.01) and psychiatric (OR = 6.20) composites were directly associated with the baseline stimulant UA result (p < 0.05 for all). Baseline stimulant UA result (B = -8.24), trial arm (B = -2.55), ASI drug composite (B = -8.38) and education (B = -1.95) were directly associated with the total number of negative UAs submitted (p < 0.05 for all). The evaluation of indirect effects of baseline characteristics on the primary outcome through baseline stimulant UA revealed significant mediated effects for the ASI drug composite (B = -5.50) and age (B = -0.05; p < 0.05 for both).

Conclusions: Baseline stimulant UA is a strong predictor of stimulant use treatment outcomes and mediates the association of some baseline characteristics and a stimulant use treatment outcome.

Keywords: Baseline urinalysis; Clinical trials; Contingency management; Mediation; Stimulant use.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Behavior Therapy* / methods
Central Nervous System Stimulants* / adverse effects
Demography
Humans
Treatment Outcome
Urinalysis

Substances

Central Nervous System Stimulants

Abstract

Publication types

MeSH terms

Substances

Grants and funding