Administrative Appointments

  • Member, Provost's Task Force on Binge Drinking on Campus (2011 - 2013)
  • Acting Director, VA Center for Health Care Evaluation (2010 - 2011)
  • Senior Policy Advisor, White House Office of National Drug Control Policy (2009 - 2010)
  • Chairman, Faculty Advisory Committee, Stanford Health Policy Forum (2007 - Present)
  • Director, VA Program Evaluation and Resource Center (2001 - 2009)
  • Affiliate, Center for Health Policy, Stanford University (2003 - Present)

Honors & Awards

  • Honorary Professor of Psychiatry, Institute of Psychiatry at the Maudsley, King's College London (2009-)
  • Public Health Book of the Year, British Medical Association (2010)
  • Honorary Member, Psychiatry Journal Club, Ibn Rushd Hospital, Baghdad (2008)
  • Distinguished Contribution to the Public Interest, American Psychological Association (2009)

Boards, Advisory Committees, Professional Organizations

  • Member, Advisory Board, Recovery Research Institute, Harvard University (2012 - Present)

Professional Education

  • Ph.D., University of Illinois, Psychology (1993)
  • A.M., University of Illinois, Clinical/Community Psychology (1991)
  • B.A., Michigan State University, Psychology (1988)

Community and International Work

  • Reconstruction of Iraq's mental health care system, Throughout Iraq


    Addictive and Psychiatric Disorders

    Partnering Organization(s)

    World Health Organization, UK, US and Japanese governments

    Populations Served




    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

Dr. Humphreys researches interventions for substance abuse and psychiatric disorders. He focuses particularly on evaluating the outcomes of professionally-administered treatments and peer-operated self-help groups (e.g., Alcoholics Anonymous), developing health services research-related applications for innovative qualitative and quantitative research techniques, and analyzing national mental health policy.


Graduate and Fellowship Programs


Journal Articles

  • Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Blodgett, J. C., Wagner, T. H. 2014; 38 (11): 2688-2694


    Observational studies of Alcoholics Anonymous' (AA) effectiveness are vulnerable to self-selection bias because individuals choose whether or not to attend AA. The present study, therefore, employed an innovative statistical technique to derive a selection bias-free estimate of AA's impact.Six data sets from 5 National Institutes of Health-funded randomized trials (1 with 2 independent parallel arms) of AA facilitation interventions were analyzed using instrumental variables models. Alcohol-dependent individuals in one of the data sets (n = 774) were analyzed separately from the rest of sample (n = 1,582 individuals pooled from 5 data sets) because of heterogeneity in sample parameters. Randomization itself was used as the instrumental variable.Randomization was a good instrument in both samples, effectively predicting increased AA attendance that could not be attributed to self-selection. In 5 of the 6 data sets, which were pooled for analysis, increased AA attendance that was attributable to randomization (i.e., free of self-selection bias) was effective at increasing days of abstinence at 3-month (B = 0.38, p = 0.001) and 15-month (B = 0.42, p = 0.04) follow-up. However, in the remaining data set, in which preexisting AA attendance was much higher, further increases in AA involvement caused by the randomly assigned facilitation intervention did not affect drinking outcome.For most individuals seeking help for alcohol problems, increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high preexisting AA involvement, further increases in AA attendance may have little impact.

    View details for DOI 10.1111/acer.12557

    View details for Web of Science ID 000345620400001

    View details for PubMedID 25421504

  • Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate PAIN MEDICINE Hah, J. M., Mackey, S., Barelka, P. L., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F. M., Schmidt, P. C., Carroll, I. R. 2014; 15 (6): 954-964

    View details for DOI 10.1111/pme.12439

    View details for Web of Science ID 000338025900009

  • Representativeness of Patients Enrolled in Influential Clinical Trials: A Comparison of Substance Dependence With Other Medical Disorders JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Humphreys, K., Maisel, N. C., Blodgett, J. C., Finney, J. W. 2013; 74 (6): 889-893


    ABSTRACT. Objective: The purpose of this study was to determine whether randomized trials of treatments for substance dependence differ from those for other medical disorders on quality of enrollment information reporting and sample representativeness. Method: Twenty highly cited clinical trials (publication date 2002-2010) of treatments for each of 14 prevalent disorders were identified by structured literature search. The disorders were alcohol dependence, drug dependence, nicotine dependence, Alzheimer's disease, breast cancer, colorectal cancer, chronic obstructive pulmonary disease, depression, diabetes, HIV/AIDS, hypertension, ischemic heart disease, lung cancer, and schizophrenia. The 280 clinical trials were coded for number of individuals screened for eligibility, number of screened individuals meeting eligibility criteria, and number of eligible individuals refusing to participate. Results: Substance-dependence treatment trials were significantly more likely to track and report enrollment information (75% vs. 45% of clinical trials for other disorders, p < .001). Substance-dependence trials did not differ from trials focused on other disorders on mean rate of non-enrollment. Across disorders, the primary driver of non-enrollment appeared to be clinical trial exclusion criteria rather than eligible patients refusing to enroll. Conclusions: Relative to other disorders, trials in the substance-dependence field do a better (although imperfect) job of tracking and reporting enrollment information. Low enrollment rates and unrepresentative samples are not challenges unique to treatment outcome studies in the substance-dependence field. Across a range of disorders, clinical trials that use eligibility criteria judiciously are more likely to produce findings that generalize to front-line clinical practice than are trials that restrict enrollment to a small and unrepresentative subset of patients. (J. Stud. Alcohol Drugs, 74, 889-893, 2013).

    View details for Web of Science ID 000326768500008

    View details for PubMedID 24172115

  • Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services? JOURNAL OF SUBSTANCE ABUSE TREATMENT Laudet, A. B., Humphreys, K. 2013; 45 (1): 126-133


    As both a concept and a movement, "recovery" is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform.

    View details for DOI 10.1016/j.jsat.2013.01.009

    View details for Web of Science ID 000318755400016

    View details for PubMedID 23506781

  • Extent and reporting of patient nonenrollment in influential randomized clinical trials, 2002 to 2010. JAMA internal medicine Humphreys, K., Maisel, N. C., Blodgett, J. C., Fuh, I. L., Finney, J. W. 2013; 173 (11): 1029-1031

    View details for DOI 10.1001/jamainternmed.2013.496

    View details for PubMedID 23608926

  • Commentary on Gustafson et?al. (2013): Can we know that addiction treatment has been improved without evidence of better patient outcomes? Addiction Humphreys, K. 2013; 108 (6): 1158-1159

    View details for DOI 10.1111/add.12144

    View details for PubMedID 23659846

  • Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? ADDICTION Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., Finney, J. W. 2013; 108 (2): 275-293


    Although debates over the efficacy of oral naltrexone and acamprosate in treating alcohol use disorders tend to focus on their global efficacy relative to placebo or their efficacy relative to each other, the underlying reality may be more nuanced. This meta-analysis examined when naltrexone and acamprosate are most helpful by testing: (i) the relative efficacy of each medication given its presumed mechanism of action (reducing heavy drinking versus fostering abstinence) and (ii) whether different ways of implementing each medication (required abstinence before treatment, detoxification before treatment, goal of treatment, length of treatment, dosage) moderate its effects.A systematic literature search identified 64 randomized, placebo-controlled, English-language clinical trials completed between 1970 and 2009 focused on acamprosate or naltrexone.Acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence, and naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving. For naltrexone, requiring abstinence before the trial was associated with larger effect sizes for abstinence maintenance and reduced heavy drinking compared with placebo. For acamprosate, detoxification before medication administration was associated with better abstinence outcomes compared with placebo.In treatment for alcohol use disorders, acamprosate has been found to be slightly more efficacious in promoting abstinence and naltrexone slightly more efficacious in reducing heavy drinking and craving. Detoxification before treatment or a longer period of required abstinence before treatment is associated with larger medication effects for acamprosate and naltrexone respectively.

    View details for DOI 10.1111/j.1360-0443.2012.04054.x

    View details for Web of Science ID 000313746200011

    View details for PubMedID 23075288

  • A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery ANESTHESIA AND ANALGESIA Carroll, I., Barelka, P., Wang, C. K., Wang, B. M., Gillespie, M. J., McCue, R., Younger, J. W., Trafton, J., Humphreys, K., Goodman, S. B., Dirbas, F., Whyte, R. I., Donington, J. S., Cannon, W. B., Mackey, S. C. 2012; 115 (3): 694-702


    Determinants of the duration of opioid use after surgery have not been reported. We hypothesized that both preoperative psychological distress and substance abuse would predict more prolonged opioid use after surgery.Between January 2007 and April 2009, a prospective, longitudinal inception cohort study enrolled 109 of 134 consecutively approached patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain. The primary end point was time to opioid cessation. All analyses were controlled for the type of surgery done.Overall, 6% of patients continued on new opioids 150 days after surgery. Preoperative prescribed opioid use, depressive symptoms, and increased self-perceived risk of addiction were each independently associated with more prolonged opioid use. Preoperative prescribed opioid use was associated with a 73% (95% confidence interval [CI] 0.51%-87%) reduction in the rate of opioid cessation after surgery (P = 0.0009). Additionally, each 1-point increase (on a 4-point scale) of self-perceived risk of addiction was associated with a 53% (95% CI 23%-71%) reduction in the rate of opioid cessation (P = 0.003). Independent of preoperative opioid use and self-perceived risk of addiction, each 10-point increase on a preoperative Beck Depression Inventory II was associated with a 42% (95% CI 18%-58%) reduction in the rate of opioid cessation (P = 0.002). The variance in the duration of postoperative opioid use was better predicted by preoperative prescribed opioid use, self-perceived risk of addiction, and depressive symptoms than postoperative pain duration or severity.Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.

    View details for DOI 10.1213/ANE.0b013e31825c049f

    View details for Web of Science ID 000307942900028

    View details for PubMedID 22729963

  • Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence PSYCHIATRIC SERVICES Harris, A. H., Oliva, E., Bowe, T., Humphreys, K. N., Kivlahan, D. R., Trafton, J. A. 2012; 63 (7): 679-685


    This study assessed changes since 2007 at Veterans Health Administration (VHA) facilities (N=129) in use of the medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorders.VHA data from fiscal years (FYs) 2008 and 2009 were used to identify patients with a diagnosis of an alcohol use disorder who received oral or extended-release naltrexone, disulfiram, or acamprosate as well as the proportion of days covered (PDC) in the 180 days after initiation and the time to first ten-day gap in possession (persistence) for each medication. Multilevel, mixed-effects logistic regression models examined the association between patient and facility characteristics and use of medications.Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12%. In fully adjusted analyses, facilities offering evening and weekend services had higher rates of medication receipt, but other facility characteristics, such as having prescribers on the addiction program's staff or using medication to treat opioid or tobacco dependence, were unrelated to medication receipt. The mean PDC of acamprosate was significantly lower than mean PDCs of the other medications (p<.05), and persistence in use of naltrexone was significantly greater than use of acamprosate and significantly less than use of disulfiram (p<.05).Use of these medications is increasing but remains variable across the VHA system. Interventions are needed to optimize initiation of and persistence in use of these medications.

    View details for DOI 10.1176/

    View details for Web of Science ID 000305931900011

    View details for PubMedID 22549276

  • Scientific evidence alone is not sufficient basis for health policy BRITISH MEDICAL JOURNAL Humphreys, K., Piot, P. 2012; 344

    View details for DOI 10.1136/bmj.e1316

    View details for Web of Science ID 000301229800009

    View details for PubMedID 22371864

  • What can we learn from the failure of yet another miracle cure' for addiction? ADDICTION Humphreys, K. 2012; 107 (2): 237-239
  • Drug policy and the public good: evidence for effective interventions LANCET Strang, J., Babor, T., Caulkins, J., Fischer, B., Foxcroft, D., Humphreys, K. 2012; 379 (9810): 71-83


    Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.

    View details for Web of Science ID 000298913000039

    View details for PubMedID 22225672

  • A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients ADDICTION Humphreys, K., McLellan, A. T. 2011; 106 (12): 2058-2066


    To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers.? We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into 'process-focused quality improvement strategies' that attempt to change some aspect of treatment (e.g. increased retention, greater use of evidence-based practices) and 'patient-focused strategies' that attempt to reward outcomes directly (e.g. contingency management for patients, payment by results for providers).? Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.

    View details for DOI 10.1111/j.1360-0443.2011.03464.x

    View details for Web of Science ID 000296534200002

    View details for PubMedID 21631620

  • Cross-Level Bias and Variations in Care JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Finney, J. W., Humphreys, K., Harris, A. H. 2011; 306 (19): 2096-2097

    View details for Web of Science ID 000297013000014

    View details for PubMedID 22089717

  • If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Wagner, T. H., Gage, M. 2011; 41 (3): 243-251


    Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? This article attempts to explain this puzzling discrepancy by analyzing 1998-2006 data from the national Veterans Affairs (VA) health care system. The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.

    View details for DOI 10.1016/j.jsat.2011.04.006

    View details for Web of Science ID 000294982100004

    View details for PubMedID 21664790

  • Why Health Care Process Performance Measures Can Have Different Relationships to Outcomes for Patients and Hospitals: Understanding the Ecological Fallacy AMERICAN JOURNAL OF PUBLIC HEALTH Finney, J. W., Humphreys, K., Kivlahan, D. R., Harris, A. H. 2011; 101 (9): 1635-1642


    Relationships between health care process performance measures (PPMs) and outcomes can differ in magnitude and even direction for patients versus higher level units (e.g., health care facilities). Such discrepancies can arise because facility-level relationships ignore PPM-outcome relationships for patients within facilities, may have different confounders than patient-level PPM-outcome relationships, and may reflect facility effect modification of patient PPM-outcome relationships. If a patient-level PPM is related to better patient outcomes, that care process should be encouraged. However, the finding in a multilevel analysis that the proportion of patients receiving PPM care across facilities nevertheless is linked to poor hospital outcomes would suggest that interventions targeting the health care facility also are needed.

    View details for DOI 10.2105/AJPH.2011.300153

    View details for Web of Science ID 000294090500017

    View details for PubMedID 21778493

  • OUR MAP SHOULD CORRESPOND WITH THE TERRITORY ADDICTION Humphreys, K. 2010; 105 (12): 2054-2056
  • Brief Intervention, Treatment, and Recovery Support Services for Americans Who Have Substance Use Disorders: An Overview of Policy in the Obama Administration PSYCHOLOGICAL SERVICES Humphreys, K., McLellan, A. T. 2010; 7 (4): 275-284

    View details for DOI 10.1037/a0020390

    View details for Web of Science ID 000292529900006

  • Something Must Be Done!: But Is Moore Correct that Something Can Be Worse than Nothing in Alcohol Control Policy? ALCOHOL AND ALCOHOLISM Humphreys, K. 2010; 45 (5): 409-411

    View details for DOI 10.1093/alcalc/agq044

    View details for Web of Science ID 000281528300003

    View details for PubMedID 20705618

  • The cost of concordance with opiate substitution treatment guidelines JOURNAL OF SUBSTANCE ABUSE TREATMENT Barnett, P. G., Trafton, J. A., Humphreys, K. 2010; 39 (2): 141-149


    The Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

    View details for DOI 10.1016/j.jsat.2010.05.012

    View details for Web of Science ID 000280623600007

    View details for PubMedID 20598830

  • Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration PSYCHIATRIC SERVICES Harris, A. H., Kivlahan, D. R., Bowe, T., Humphreys, K. N. 2010; 61 (4): 392-398


    Acamprosate, oral and long-acting injectable naltrexone, and disulfiram are approved for treatment of alcohol dependence. Their availability and consideration of their use in treatment are now standards of high-quality care. This study determined rates of medication initiation among Veterans Health Administration (VHA) patients.VHA pharmacy and administrative data were used to identify patients with alcohol use disorder diagnoses in fiscal years (FY) 2006 and 2007 and the proportion (nationally and by facility) who received each medication. Patient characteristics associated with receipt were also examined.Among more than a quarter-million patients with alcohol use disorder diagnoses, the percentage receiving any of the medications increased from 2.8% in FY 2006 to 3.0% in FY 2007. Receipt of these medications was more likely among patients who received specialty addiction care, those with alcohol dependence (compared with abuse), those younger than 55 years, and females. In the patient subgroups examined, the largest proportion to receive any of the medications was 11.6%. Across 128 VHA facilities, rates of use among patients in the sample who had received past-year specialty addiction treatment ranged from 0% to 20.5%; rates ranged from 0% to 4.3% among those with no specialty treatment. Patient preferences and medical contraindications could not be determined from the data.Findings suggest the need to better understand systemwide variation in use of these medications and their use as a rough proxy for availability and consideration of pharmacotherapy--a standard of care with strong organizational support.

    View details for Web of Science ID 000276254200011

    View details for PubMedID 20360279

  • Does Meeting the HEDIS Substance Abuse Treatment Engagement Criterion Predict Patient Outcomes? JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH Harris, A. H., Humphreys, K., Bowe, T., Tiet, Q., Finney, J. W. 2010; 37 (1): 25-39


    This study examines the patient-level associations between the Health Plan Employer Data and Information Set (HEDIS) substance use disorder (SUD) treatment engagement quality indicator and improvements in clinical outcomes. Administrative and survey data from 2,789 US Department of Veterans Affairs SUD patients were used to estimate the effects of meeting the HEDIS engagement criterion on improvements in Addiction Severity Index Alcohol, Drug, and Legal composite scores. Patients meeting the engagement indicator improved significantly more in all domains than patients who did not engage, and the relationship was stronger for alcohol and legal outcomes for patients seen in outpatient settings. The benefit accrued by those who engaged was statistically significant but clinically modest. These results add to the literature documenting the clinical benefits of treatment entry and engagement. Although these findings only indirectly support the use of the HEDIS engagement measure for its intended purpose-discriminating quality at the facility or system level-they confirm that the processes of care captured by the measure are associated with important patient outcomes.

    View details for DOI 10.1007/s11414-008-9142-2

    View details for Web of Science ID 000273686300003

    View details for PubMedID 18770044

  • Developing and Validating Process Measures of Health Care Quality An Application to Alcohol Use Disorder Treatment MEDICAL CARE Harris, A. H., Kivlahan, D. R., Bowe, T., Finney, J. W., Humphreys, K. 2009; 47 (12): 1244-1250


    Health care process quality measures usually are designed by expert panels attempting to synthesize nuanced clinical evidence and subsequently operationalized using administrative data. Many quality measures are then adopted without directly validating their presumed links with outcomes. Later efforts to validate process measures often yield negative results, leaving policy makers without a defensible means of measuring quality. This article presents an alternative strategy for developing and validating process quality measures. The development of an alcohol use disorder (AUD) treatment quality measure is used as an example.An expert panel generated a range of candidate process quality measures of AUD treatment derivable from administrative data that were then tested to determine which had the strongest associations with facility- and patient-level outcomes. Outcome and process data were from 2701 US Veterans Health Administration patients starting a new episode of care at 54 VA facilities.Several of the candidate process-of-care quality measures predicted facility- and patient-level outcomes. Having at least 3 visits during the first month of specialty AUD treatment was correlated with improvement on the Addiction Severity Index Alcohol composite at the facility level, r = 0.41 (95% Confidence Interval 0.16-0.61), and at the patient level, r = 0.07 (CI: 0.03-0.11).These "prevalidated" quality measures can now be judged for the extent they map onto the extant clinical literature and other design requirements. The development and validation strategy we describe should aid in efficiently producing quality measures in other areas of health care.

    View details for Web of Science ID 000272488100008

    View details for PubMedID 19786908

  • Responding to the Psychological Impact of War on the Iraqi People and US Veterans: Mixing Icing, Praying for Cake AMERICAN PSYCHOLOGIST Humphreys, K. 2009; 64 (8): 712-723


    The psychological impact of the war in Iraq stimulated major initiatives to build a modern mental health care system for the Iraqi people and to improve mental health services for U.S. veterans of the Iraq war. Although these two initiatives differ in important respects, they are both informed by general principles of psychology concerning the nature of social problem definition, the process of human adaptation to extreme stress and its aftermath, and the role and limits of mental health services. Building on these common themes and my own experiences, I describe how two nations are trying to address the colossal psychological damage wrought by the war in Iraq.

    View details for Web of Science ID 000271875300016

    View details for PubMedID 19899875

  • How Internet technology can improve the quality of care for substance use disorders. Current drug abuse reviews Cucciare, M. A., Weingardt, K. R., Humphreys, K. 2009; 2 (3): 256-262


    By allowing for the efficient delivery of instructional content and the secure collection of self-report data regarding substance use and related problems, the Internet has tremendous potential to improve the effectiveness and accessibility of addiction treatment services. This article discusses some of the ways in which Internet technology can facilitate, complement and support the process of traditional clinician-delivered treatment for individuals with substance use disorders. Internet applications are being used to support a range of activities including (a) the assessment and feedback process that constitutes a central feature of brief motivational interventions, (b) the concurrent monitoring of individual level outcomes among patients who are currently enrolled in addiction treatment programs, (c) the continuing care and ongoing recovery of patients who have completed treatment, and (d) the delivery of clinical training in evidence based practices for addiction treatment providers. This emerging body of literature suggests that addiction counselors and program administrators can enhance the quality of clinician-delivered treatment by incorporating internet applications into existing processes of care. Internet applications provide an unparalleled opportunity to engage patients in the treatment process, incorporate real-time data into treatment planning, prevent relapse, and promote evidence-based treatment approaches.

    View details for PubMedID 20443772

  • HEDIS Initiation and Engagement Quality Measures of Substance Use Disorder Care: Impact of Setting and Health Care Specialty POPULATION HEALTH MANAGEMENT Harris, A. H., Bowe, T., Finney, J. W., Humphreys, K. 2009; 12 (4): 191-196


    Many health care systems track the HEDIS measures of initiation and engagement in substance use disorder (SUD) care. However, the impact of setting of care (inpatient vs. outpatient) and health care specialty (SUD, psychiatric, other) on the likelihood of patients meeting the initiation and engagement criteria are unknown. If the vast majority of initiation and engagement occurs within SUD specialty clinics, then these quality measures could be used to discriminate among and incentivize SUD clinic managers. However, if these criteria are satisfied in different settings and specialties, then they should be considered characteristics of the entire facility, rather than just specialty SUD units. Using a Markov model, the probabilities of advancing to treatment initiation and engagement given initial setting and specialty of care were estimated for 320,238 SUD-diagnosed Veterans Health Affairs (VA) patients. Patients in SUD specialty units progressed more often (diagnosis to initiation, initiation to engagement) than patients in other specialties. Progression through the criteria differed for inpatients vs. outpatients. Approximately 25% of initiation and over 40% of engagement occurred outside of SUD specialty care. VA patients who have contact with SUD specialty treatment have higher rates of advancing to initiation, and from initiation to engagement, compared to SUD-diagnosed patients in psychiatric or other medical locations. Even so, a substantial portion of initiation and engagement occurs outside of SUD specialty units. Therefore, these quality measures should be considered measures of facility performance rather than measures of the quality of SUD specialty care. The usual combining of inpatient and outpatient performance on these measures into overall facility scores clouds measurement and interpretation.

    View details for DOI 10.1089/pop.2008.0028

    View details for Web of Science ID 000268811100004

    View details for PubMedID 19663621

  • Datapoints: Iraqi psychiatrists' perceptions of substance use disorders among patients. Psychiatric services Al-Hasnawi, S. M., Aqrawi, R., Sadik, S., Humphreys, K. 2009; 60 (6): 728-?

    View details for DOI 10.1176/

    View details for PubMedID 19487343

  • Measuring the quality of substance use disorder treatment: Evaluating the validity of the Department of Veterans Affairs continuity of care performance measure JOURNAL OF SUBSTANCE ABUSE TREATMENT Harris, A. H., Humphreys, K., Bowe, T., Kivlahan, D. R., Finney, J. W. 2009; 36 (3): 294-305


    This study examined the patient- and facility-level associations between the continuity of care performance measure adopted by the Department of Veterans Affairs (VA) and improvements in self-administered Addiction Severity Index (ASI) composites and other indicators of problematic substance use. Up to 50 patients from each of a nationally representative sample of 109 VA substance use disorder (SUD) treatment programs at 73 VA facilities were assessed at intake and posttreatment. The continuity of care performance measure specifies that patients should receive at least two SUD outpatient visits in each of the three consecutive 30-day periods after they qualify as new SUD patients. In analyses adjusting for baseline characteristics, meeting the continuity of care performance measure was not associated with patient-level improvements in the ASI alcohol or drug composites, days of alcohol intoxication, or days of substance-related problems. Facility-level rates of continuity of care were negatively associated with improvements in ASI alcohol and drug composites. The continuity of care performance measure derived from prior patient-level evidence did not discriminate facility-level performance as predicted. Translating research into process-of-care quality measures requires postconstruction validation.

    View details for DOI 10.1016/j.jsat.2008.05.011

    View details for Web of Science ID 000264510000006

    View details for PubMedID 18835678

  • Searching Where the Light Is Worse: Overemphasizing Genes and Underplaying Environment in the Quest to Reduce Substance Misuse CLINICAL PHARMACOLOGY & THERAPEUTICS Humphreys, K. 2009; 85 (4): 357-358

    View details for DOI 10.1038/clpt.2008.263

    View details for Web of Science ID 000264455300007

    View details for PubMedID 19295533

  • Performance Monitoring of Substance Use Disorder Interventions in the Veterans Health Administration AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Humphreys, K., Harris, A. H., Kivlahan, D. R. 2009; 35 (3): 123-127


    Measuring and improving the quality of treatment for patients with substance use disorders are enduring challenges.This article describes how the Veterans Affairs health care system is using incentivized performance measures to promote more effective delivery of interventions for nicotine, illegal drug, and alcohol disorders.The monitoring and incentive system has increased the delivery of evidence-based services, including screening for alcohol use disorders.Further work remains to be done to strengthen the connection between process-based measures and longer-term patient outcomes.

    View details for DOI 10.1080/00952990802707042

    View details for Web of Science ID 000266277700002

    View details for PubMedID 19462294

  • Responding to Rising Substance Misuse in Iraq SUBSTANCE USE & MISUSE Aqrawi, R., Humphreys, K. 2009; 44 (12): 1744-1748


    We present an overview of the current substance misuse situation in Iraq. Numerous indicators as well as first-hand observations of the authors, suggest that substance misuse is increasing in Iraq. Violence, economic uncertainty, poorly monitored borders, and a porous pharmacy system, all appear to be contributing to the problem. Yet, Iraq also has significant features that put some restraints on the size of the problem, most notably highly cohesive families and prevalent religiosity. The Iraqi Ministry of Health is leading an international effort to respond to rising substance misuse and associated mental and physical health conditions.

    View details for DOI 10.3109/10826080902963415

    View details for Web of Science ID 000272093000007

    View details for PubMedID 19895304

  • Assessing spirituality/religiosity in the treatment environment: The Treatment Spirituality/Religiosity Scale JOURNAL OF SUBSTANCE ABUSE TREATMENT Lillis, J., Gifford, E., Humphreys, K., Moos, R. 2008; 35 (4): 427-433


    There has been much interest in measuring and evaluating the role of spirituality/religiosity (S/R) in substance use disorder (SUD) treatment. This study presents the initial evaluation of a new measure of S/R in the treatment environment: the Treatment Spirituality/Religiosity Scale (TSRS). The TSRS has 10 items and can be completed by both patient and staff to measure the emphasis on S/R in a given treatment program, which may have important implications for patient-program fit. Data on the TSRS were gathered from 3,018 patients and 329 staff members from 15 residential SUD treatment programs within the Department of Veterans Affairs Health Care System. The TSRS showed good internal consistency (alpha = .77), a single-factor structure, close agreement between patients and staff members (r = .93), and good discriminant validity. The TSRS appears to be a brief, easily administered, and potentially useful measure of the emphasis on S/R in residential SUD treatment programs.

    View details for DOI 10.1016/j.jsat.2008.02.002

    View details for Web of Science ID 000260800700009

    View details for PubMedID 18424049

  • Subject eligibility criteria can substantially influence the results of alcohol-treatment outcome research JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Humphreys, K., Harris, A. H., Weingardt, K. R. 2008; 69 (5): 757-764


    Most alcohol-treatment studies exclude some patients from participation based on particular criteria (e.g., comorbid illegal drug abuse, homelessness). The current study evaluated whether such eligibility criteria can change the outcome results a study obtains.Five widely used treatment research eligibility criteria--(1) psychiatric problems, (2) medical problems, (3) social-residential instability, (4) low motivation/noncompliance, and (5) drug problems--were applied to two samples of real-world alcohol patients whose outcomes were known. Comparing outcomes of the samples with and without the application of eligibility criteria produced estimates of bias in outcome results, as well as an assessment of change in statistical power.Medical and psychiatric eligibility criteria produced a moderate bias in outcome estimates (e.g., a 10% or less change in outcome results). In contrast, social-residential instability, low motivation/noncompliance, and drug use produced a large (e.g., up to an 18% change) to a very large (e.g., up to a 51% change) bias in outcome estimates. Sensitivity analyses showed that these biases are even larger if eligibility criteria are operationalized in a broad rather than a narrow fashion. Contrary to expectation, eligibility criteria did not produce their theoretically expected benefit of increased statistical power.Researchers who use eligibility criteria should do so judiciously and interpret outcome results in light of potential bias introduced by the ineligibility of some patients for study enrollment. Efforts to integrate findings across treatment outcome studies should also consider how conclusions might be affected by the eligibility criteria used in different research areas.

    View details for Web of Science ID 000259205200015

    View details for PubMedID 18781251

  • The underrepresentation of African Americans in online cancer support groups JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Fogel, J., Ribisl, K. M., Morgan, P. D., Humphreys, K., Lyons, E. J. 2008; 100 (6): 705-712


    The Internet is increasingly important for many cancer survivors because it provides access to the latest information on cancer treatments and also allows them to receive support by participating in online cancer support groups. Unfortunately, little is known about why African-American cancer survivors are underrepresented in online cancer support groups. This article reviews the relevant literature and discusses three possible explanations for why African Americans are underrepresented in online cancer support groups: the digital divide/digital inequality, preferences for face-to-face support or culture-specific online support, and trust concerns. We conclude that a health inequity exists with regard to the utilization of information that can be obtained from online cancer support groups. However, with regard to the potential benefits of the psychosocial and emotional support aspect of online cancer support groups, a health inequity may not exist, as African Americans have other preferred avenues for obtaining needed support, and there is no evidence that this is detrimental to their health.

    View details for Web of Science ID 000256771200007

    View details for PubMedID 18595573

  • Does following research-derived practice guidelines improve opiate-dependent patients' outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Trafton, J. A., Oliva, E. M. 2008; 34 (2): 173-179


    The Multisite Opiate Substitution Treatment study evaluated whether adhering to clinical-trial-derived practice guidelines improves treatment outcomes of unselected opiate-dependent patients seen in everyday practice. Clinics that were relatively concordant (n = 4) or nonconcordant (n = 4) with guidelines concerning medication dose levels and psychosocial service provision were identified. Staff interviewed 256 patients at intake and 6-month follow-up regarding past month heroin use, criminal activities, and mental health. To represent real-world practice conditions, clinics provided care in accordance with their usual approach, and no patient exclusion criteria were employed. Patients in each type of clinic were similar at baseline, but by follow-up, heroin use and mental health outcomes were significantly better in guideline-concordant clinics than in guideline-discordant clinics. Notably, 60.6% of patients in concordant clinics had urinalysis-confirmed heroin abstinence versus only 40.0% in nonconcordant clinics. Following research-derived practice guidelines seems to increase opiate substitution treatment effectiveness for opiate-dependent patients in the real world.

    View details for DOI 10.1016/j.jsat.2007.03.001

    View details for Web of Science ID 000253222900004

    View details for PubMedID 17499955

  • Veterans affairs facility performance on Washington circle indicators and casemix-adjusted effectiveness JOURNAL OF SUBSTANCE ABUSE TREATMENT Harris, A. H., Humphreys, K., Finney, J. W. 2007; 33 (4): 333-339


    Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in 1 of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.

    View details for DOI 10.1016/j.jsat.2006.12.015

    View details for Web of Science ID 000251110700001

    View details for PubMedID 17400416

  • Improving medicare coverage of psychological services for older Americans AMERICAN PSYCHOLOGIST Karlin, B. E., Humphreys, K. 2007; 62 (7): 637-649


    Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.

    View details for DOI 10.1037/0003-066X.62.7.637

    View details for Web of Science ID 000250131700002

    View details for PubMedID 17924748

  • Consistent adherence to guidelines improves opioid dependent patients' first year outcomes JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH Trafton, J. A., Humphreys, K., Harris, A. H., Oliva, E. 2007; 34 (3): 260-271


    Clinical practice guidelines for opioid substitution treatment (OST) for opioid dependence recommend that patients receive at least 60 mg daily methadone and have access to a broad array of psychosocial services. However, there is still wide variation in clinical practice in OST clinics. In real-world settings, patients could receive lower methadone doses and less psychosocial care because they require less intensive care for recovery; alternatively, barriers to delivery of guideline concordant care could limit treatment received and impair recovery. The Multisite Opioid Substitution Treatment (MOST) study examines the impact of more consistent adherence to guideline recommendations in eight Veterans Affairs OST clinics. While patients at all clinics demonstrated improvements in substance use over the first year in treatment, patients at clinics that more consistently adhered to guidelines had greater reductions in heroin and cocaine use and greater improvement in mental health. These results suggest that efforts to increase guideline adherence in OST will improve patient outcomes.

    View details for DOI 10.1007/s11414-007-9074-2

    View details for Web of Science ID 000249225600003

    View details for PubMedID 17610159

  • Influence of subject eligibility criteria on compliance with national institutes of health guidelines for inclusion of women, minorities, and children in treatment research ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Weingardt, K. R., Harris, A. H. 2007; 31 (6): 988-995


    Many alcohol treatment outcome studies exclude some patients with particular problems, such as psychiatric disorders, noncompliance, and homelessness. Such criteria may increase the likelihood of a study being successfully conducted, but may also have the unintended consequence of reducing a study's ability to comply with National Institutes of Health guidelines for inclusion of racial minorities, women, and children in treatment research.This paper examined this issue empirically using 5 prior studies of treatment systems enrolling over 100,000 alcohol patients. Widely used eligibility criteria in the alcohol treatment field typically exclude between one-fifth to one-third of patients from enrolling in research. Under several eligibility criteria, most notably those for drug use and social/residential instability, women and African-American patients are substantially more likely to be excluded than are men and non-African-American patients, respectively.In designing treatment studies with many eligibility criteria, researchers may therefore inadvertently be thwarting their own good faith efforts to ensure that a range of vulnerable populations are able to participate in research. We analyze the implications of this dilemma for the generalizability of treatment results and for research design, and provide data that may help researchers working in different treatment systems estimate the impact of various eligibility criteria.

    View details for DOI 10.1111/j.1530-0277/2007.00391.x

    View details for Web of Science ID 000246576500009

    View details for PubMedID 17428295

  • Different components of opioid-substitution treatment predict outcomes of patients with and without a parent with substance-use problems JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Trafton, J. A., Tracy, S. W., Oliva, E. M., Humphreys, K. 2007; 68 (2): 165-172


    The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems.This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined.Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use.The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.

    View details for Web of Science ID 000248712700001

    View details for PubMedID 17286334

  • The psychological science of addiction ADDICTION Gifford, E., Humphreys, K. 2007; 102 (3): 352-361


    To discuss the contributions and future course of the psychological science of addiction.The psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory through increasingly broad relational contexts, including patient-practitioner interactions, families, social networks, institutional settings, economics and culture. Some of the contributions discussed here include applications of behavioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment. Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context, psychology is an integrated discipline using diverse methods well-suited to capture the multi-dimensional nature of addictive behavior.Psychology has a unique ability to integrate basic experimental and applied clinical science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of addiction.

    View details for DOI 10.1111/j.1360-0443.2006.01706.x

    View details for Web of Science ID 000244098000005

    View details for PubMedID 17298641

  • How are substance use disorders addressed in VA psychiatric and primary care settings? Results of a national survey PSYCHIATRIC SERVICES Tracy, S. W., Trafton, J. A., Weingardt, K. R., Aton, E. G., Humphreys, K. 2007; 58 (2): 266-269


    This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings.National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders.Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs.Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

    View details for Web of Science ID 000244070800018

    View details for PubMedID 17287386

  • Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Moos, R. H. 2007; 31 (1): 64-68


    Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients' health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients' substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

    View details for DOI 10.1111/j.1530-0277.2006.00273.x

    View details for Web of Science ID 000243022200009

    View details for PubMedID 17207103

  • Inquirers, triers, and buyers of an alcohol harm reduction self-help organization ADDICTION RESEARCH & THEORY Klaw, E., Horst, D., Humphreys, K. 2006; 14 (5): 527-535
  • Closing remarks: Swimming to the horizon-reflections on a special series ADDICTION Humphreys, K. 2006; 101 (9): 1238-1240
  • Predictors of retention in methadone programs: A signal detection analysis DRUG AND ALCOHOL DEPENDENCE Villafranca, S. W., McKellar, J. D., Trafton, J. A., Humphreys, K. 2006; 83 (3): 218-224


    Retention in Opioid Agonist Therapy (OAT) is associated with reductions in substance use, HIV risk behavior, and criminal activities in opioid dependent patients. To improve the effectiveness of treatment for opioid dependence, it is important to identify predisposing characteristics and provider-related variables that predict retention in OAT. Participants include 258 veterans enrolled in 8 outpatient methadone/l-alpha-acetylmethadol (LAAM) treatment programs. Signal detection analysis was utilized to identify variables predictive of 1-year retention and to identify the optimal cut-offs for significant predictors. Provider-related variables play a vital role in predicting retention in OAT programs, as higher methadone dose (> or =59 mg/day) and greater treatment satisfaction were among the strongest predictors of retention at 1-year follow-up.

    View details for DOI 10.1016/j.drugalcdep.2005.11.020

    View details for Web of Science ID 000239081300005

    View details for PubMedID 16384657

  • Rebuilding Iraq's mental health system. Behavioral healthcare Humphreys, K., Sadik, S. 2006; 26 (7): 34-35

    View details for PubMedID 16915888

  • Response to methadone maintenance treatment of opiate dependent patients with and without significant pain DRUG AND ALCOHOL DEPENDENCE Ilgen, M. A., Trafton, J. A., Humphreys, K. 2006; 82 (3): 187-193


    Both clinicians and researchers have expressed doubt that opiate dependent patients with significant pain can be effectively treated in methadone maintenance treatment (MMT) programs; however, little research exists on this topic. Patients who report significant pain in the month preceding entry to MMT present with a distinct and more severe pattern of polysubstance use, medical and psychosocial problems than do those without pain. The present study investigated the 1-year treatment outcomes of MMT patients with opiate dependence and pain.Analyses were based on a national sample of 200 patients presenting in MMT programs for treatment of opiate dependence. Substance use and related problems were measured at treatment entry and 12 months later. Patients reported pain severity over the month preceding treatment entry.Compared to patients without significant pain, patients who reported significant pain at baseline (n = 103) showed similar substance-related functioning, but poorer psychosocial functioning at 1 year.Patients with and without significant pain experience comparable reductions in substance use when provided with standard care in MMT programs. However, additional medical and/or mental health treatment is needed for their pain and other problems.

    View details for DOI 10.1016/j.drugalcdep.2005.09.005

    View details for Web of Science ID 000237317000002

    View details for PubMedID 16219429

  • Determining effective methadone doses for individual opioid-dependent patients PLOS MEDICINE Trafton, J. A., Minkel, J., Humphreys, K. 2006; 3 (3): 380-387


    Randomized clinical trials of methadone maintenance have found that on average high daily doses are more effective for reducing heroin use, and clinical practice guidelines recommend 60 mg/d as a minimum dosage. Nevertheless, many clinicians report that some patients can be stably maintained on lower methadone dosages to optimal effect, and clinic dosing practices vary substantially. Studies of individual responses to methadone treatment may be more easily translated into clinical practice.A volunteer sample of 222 opioid-dependent US veterans initiating methadone treatment was prospectively observed over the year after treatment entry. In the 168 who achieved at least 1 mo of heroin abstinence, methadone dosages on which patients maintained heroin-free urine samples ranged from 1.5 mg to 191.2 mg (median = 69 mg). Among patients who achieved heroin abstinence, higher methadone dosages were predicted by having a diagnosis of posttraumatic stress disorder or depression, having a greater number of previous opioid detoxifications, living in a region with lower average heroin purity, attending a clinic where counselors discourage dosage reductions, and staying in treatment longer. These factors predicted 42% of the variance in dosage associated with heroin abstinence.Effective and ineffective methadone dosages overlap substantially. Dosing guidelines should focus more heavily on appropriate processes of dosage determination rather than solely specifying recommended dosages. To optimize therapy, methadone dosages must be titrated until heroin abstinence is achieved.

    View details for DOI 10.1371/journal.pmed.0030080

    View details for Web of Science ID 000236897500018

    View details for PubMedID 16448216

  • Opioid substitution treatment reduces substance use equivalently in patients with and without posttraumatic stress disorder JOURNAL OF STUDIES ON ALCOHOL Trafton, J. A., Minkel, J., Humphreys, K. 2006; 67 (2): 228-235


    The purpose of this study was to determine whether opioid-dependent patients with diagnosed posttraumatic stress disorder (PTSD) have poorer long-term outcomes in opioid substitution treatment than do patients without PTSD.This prospective observational study examined outcomes of 255 opioid-dependent patients (men = 248) entering opioid substitution treatment at eight clinics in the Veterans Health Administration (VHA). Subjects were interviewed at treatment entry, 6 months, and 1 year about substance use and related problems, health status, treatment satisfaction, and non-VHA health care utilization. Medical records were reviewed to obtain toxicology results, health care utilization data, and diagnoses. Medical record review identified a diagnosis of PTSD in 71 (28%) patients. Substance-use and mental-health outcomes and health care utilization in the first year following treatment entry were compared between patients with and without a diagnosis of PTSD.Patients with and without PTSD had similar treatment responses. Although patients with PTSD had longer histories of drug use at intake, at 1-year follow-up they showed reductions in heroin, cocaine, and alcohol use, comparable to patients without the disorder. PTSD patients received higher doses of opiate medication, attended more psychosocial treatment sessions for substance-use disorder, and had better treatment retention. Psychiatric symptoms for patients with PTSD were more severe at intake and showed little improvement throughout treatment.Opioid substitution therapy is as effective at reducing substance use in PTSD patients as it is in patients without the disorder, but additional services are needed for treatment of psychological problems that are largely unchanged by treatment for addiction.

    View details for Web of Science ID 000235318900005

    View details for PubMedID 16562404

  • Prevalence and predictors of research participant eligibility criteria in alcohol treatment outcome studies, 1970-98 ADDICTION Humphreys, K., Weingardt, K. R., Horst, D., Joshi, A. A., Finney, J. W. 2005; 100 (9): 1249-1257


    To describe the eligibility criteria (i.e. study participant inclusion and exclusion rules) employed in alcohol treatment outcome research and to identify predictors of their use.The eligibility criteria of 683 alcohol treatment outcome studies conducted between 1970 and 1998 were coded reliably into 14 general categories. Predictors of the use of eligibility criteria were then examined.Patients were most often ruled ineligible for research studies because of their level of alcohol problems (39.1% of studies), comorbid psychiatric problems (37.8%), past or concurrent utilization of alcohol treatment (31.8%), co-occurring medical conditions (31.6%), and because they were deemed non-compliant and unmotivated (31.5%). The number of eligibility criteria employed in studies increased from the 1970s through the 1990s, and was positively associated with funding from the US National Institute of Alcohol Abuse and Alcoholism (NIAAA) and from the private sector, lack of an inpatient/residential treatment condition, presence of a pharmacotherapy, and use of a randomized, multiple-condition design. Principal investigators with doctoral degrees used more eligibility criteria than those with lower degrees.Participant eligibility criteria are extensively employed in alcohol treatment outcome research, and vary significantly across historical periods, funders and research designs. Researchers should report the details of subject eligibility criteria and excluded patients more fully, and, evaluate how eligibility criteria affect the cost, feasibility, and generalizability of treatment outcome research.

    View details for DOI 10.1111/j.1360-0443.2005.01175.x

    View details for Web of Science ID 000231505700014

    View details for PubMedID 16128714

  • Expanding self-help group participation in culturally diverse urban areas: Media approaches to leveraging referent power JOURNAL OF COMMUNITY PSYCHOLOGY Humphreys, K., Macus, S., Stewart, E., Oliva, E. 2004; 32 (4): 413-424

    View details for DOI 10.1002/jcop.20009

    View details for Web of Science ID 000222044700004

  • Depression increases diabetes symptoms by complicating patients' self-care adherence DIABETES EDUCATOR McKellar, J. D., Humphreys, K., Piette, J. D. 2004; 30 (3): 485-492


    This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen.Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations.An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year.Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health.

    View details for Web of Science ID 000223738100012

    View details for PubMedID 15208846

  • Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Klvlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morgenstern, J., Townsend, M., Weiss, R. 2004; 26 (3): 151-158


    This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse.

    View details for DOI 10.1016/S0740-5472(03)00212-5

    View details for Web of Science ID 000220939400002

    View details for PubMedID 15063905

  • A few apologies, but no regrets ADDICTION Humphreys, K. 2004; 99 (2): 155-156

    View details for Web of Science ID 000189144000008

    View details for PubMedID 14756704

  • Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment DRUG AND ALCOHOL DEPENDENCE Trafton, J. A., Oliva, E. M., Horst, D. A., Minkel, J. D., Humphreys, K. 2004; 73 (1): 23-31


    Although pain problems are prevalent in substance use disorder (SUD) patients, the special treatment needs of SUD patients with pain have not been investigated. This study examines the problems and behaviors associated with reported pain among veterans treated at eight opioid substitution treatment clinics. Patients reporting pain had more severe medical and psychiatric problems and greater health care utilization. Pain was associated with an increased propensity for misuse of substances with analgesic effects, suggesting that ongoing pain contributes to an altered and more severe pattern of drug-seeking behavior. Patients without pain rarely abused sedatives or opioid medication, indicating that misuse of these substances is unique to co-morbid pain and SUD patients. Patients reporting pain did not differ from patients without pain in use of heroin, alcohol, cocaine or in injection practices, demonstrating that they are truly SUD patients in need of SUD treatment. Pain complicates the treatment of SUD and should be addressed as an important co-morbidity during treatment.

    View details for DOI 10.1016/j.drugalcdep.2003.08.007

    View details for Web of Science ID 000188121900003

    View details for PubMedID 14687956

  • Circles of Recovery: Self-help organizations for addictions. Cambridge, UK: Cambridge University Press Humphreys, K. 2004
  • Datapoints: do participants in alcoholism treatment outcome studies resemble patients seen in everyday practice? Psychiatric services Humphreys, K. 2003; 54 (12): 1576-?

    View details for PubMedID 14645790

  • Characteristics and motives of problem drinkers seeking help from moderation management self-help groups COGNITIVE AND BEHAVIORAL PRACTICE Klaw, E., Luft, S., Humphreys, K. 2003; 10 (4): 384-389
  • Response: the marriage of drug abuse treatment and 12-step strategies. Science & practice perspectives / a publication of the National Institute on Drug Abuse, National Institutes of Health Forman, R. R., Humphreys, K., Tonigan, J. S. 2003; 2 (1): 52-54

    View details for PubMedID 18552723

  • The cost of institutional review board procedures in Multicenter Observational Research ANNALS OF INTERNAL MEDICINE Humphreys, K., Trafton, J., Wagner, T. H. 2003; 139 (1): 77-77

    View details for Web of Science ID 000183823200014

    View details for PubMedID 12834327

  • Alcohol & drug abuse: A research-based analysis of the Moderation Management controversy. Psychiatric services Humphreys, K. 2003; 54 (5): 621-622

    View details for PubMedID 12719491

  • Alcoholics anonymous involvement and positive alcohol-related outcomes: Cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY McKellar, J., Stewart, E., Humphreys, K. 2003; 71 (2): 302-308


    A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes.

    View details for DOI 10.1037/0022-006X.71.2.302

    View details for Web of Science ID 000181602000009

    View details for PubMedID 12699024

  • Participation in alcoholics anonymous: Intended and unintended change mechanisms ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Owen, P. L., Slaymaker, V., Tonigan, J. S., McCrady, B. S., Epstein, E. E., Kaskutas, L. A., Humphreys, K., Miller, W. R. 2003; 27 (3): 524-532


    This article is a compilation of the information presented at a symposium at the 2001 RSA Meeting in Montreal, Canada. The presentations were: (1) Maintaining change after conjoint behavioral alcohol treatment for men: the role of involvement with Alcoholics Anonymous, by Barbara S. McCrady and Elizabeth E. Epstein; (2) Changing AA practices and outcomes: Project MATCH 3-year follow-up, by J. Scott Tonigan; (3) Life events and patterns of recovery of AA-exposed adults and adolescents, by Patricia L. Owen and Valerie Slaymaker; (4) Social networks and AA involvement as mediators of change, by Lee Ann Kaskutas and Keith Humphreys; and (5) What do we know about Alcoholics Anonymous? by William R. Miller, discussant.

    View details for DOI 10.1097/01.ALC.0000057941.57330.39

    View details for Web of Science ID 000181843000018

    View details for PubMedID 12658120

  • Alcoholics Anonymous and 12-step alcoholism treatment programs. Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism Humphreys, K. 2003; 16: 149-164


    Alcoholics Anonymous (AA) self-help groups are the most commonly accessed component of the de facto system of care for alcohol problems in the United States. Further, AA's concepts and approach have strongly influenced a significant number of professional treatment programs. Nevertheless, only a modest number of longitudinal, comparative outcome studies on AA and on professional 12-step treatment programs have been conducted, which has limited both the certainty and scope of conclusions that can be drawn about these interventions. Research indicates that participation in Alcoholics Anonymous and in 12-step treatment are associated with significant reductions in substance abuse and psychiatric problems. Further, such interventions, it has been found, reduce health care costs over time in naturalistic, quasi-experimental, and experimental studies. Evaluation studies have also begun to illuminate the processes through which self-help groups and 12-step treatment programs exert their effects. To build on this knowledge base, future research should (1) be methodologically flexible and well-matched to its phenomenon of interest, (2) include evaluation of the unique features of self-help organizations, (3) increase representation of African-Americans and women in research samples, and (4) increase statistical power through larger sample sizes and more reliable measurement. Key content areas for future enquiry include further longitudinal evaluation of the outcomes of participation in AA and 12-step treatment (particularly in outpatient samples); better specification of the aspects of AA that influence outcome; and individual-, community-, and health organization-level controlled studies of the health care cost consequences of 12-step interventions.

    View details for PubMedID 12638636

  • Datapoints: moving from inpatient to residential substance abuse treatment in the VA. Psychiatric services Humphreys, K., Horst, D. 2002; 53 (8): 927-?

    View details for PubMedID 12161662

  • Social networks as mediators of the effect of Alcoholics Anonymous ADDICTION Kaskutas, L. A., Bond, J., Humphreys, K. 2002; 97 (7): 891-900


    This study tested the hypothesis that the relationship between Alcoholics Anonymous (AA) involvement and reduced substance use is partially explained (or 'mediated') by changes in social networks.This is a naturalistic longitudinal study of the course of alcohol problems.Study sites were the 10 largest public and private alcohol treatment programs in a northern California county.Three hundred and seventy-seven men and 277 women were recruited upon seeking treatment at study sites.At baseline and 1-year follow-up, we assessed alcohol consequences and dependence symptoms, consumption, social support for abstinence, pro-drinking social influences and AA involvement.In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow-up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty-day abstinence was predicted by AA involvement (OR=2.9), not having pro-drinking influences in one's network (OR=0.7) and having support for reducing consumption from people met in AA (versus no support; OR=3.4). In contrast, having support from non-AA members was not a significant predictor of abstinence. For alcohol-related outcomes other than abstinence, significant relationships were found for both AA-based and non-AA-based support.The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on outcomes reflective of AA's goals (such as abstinence) when studying how AA works.

    View details for Web of Science ID 000176684600018

    View details for PubMedID 12133128

  • Pilot study of racial and geographic HIV risk among methadone patients XIV INTERNATIONAL AIDS CONFERENCE: SOCIAL SCIENCES Oliva, E., Horst, D., Trafton, J., Humphreys, K. 2002: 279-282
  • Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Mankowski, E. S., Humphreys, K., Moos, R. H. 2001; 29 (4): 537-563


    Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.

    View details for Web of Science ID 000170756300002

    View details for PubMedID 11554152

  • Can targeting nondependent problem drinkers and providing Internet-based services expand access to assistance for alcohol problems? A study of the moderation management self-help/mutual aid organization JOURNAL OF STUDIES ON ALCOHOL Humphreys, K., Klaw, E. 2001; 62 (4): 528-532


    Moderation Management (MM) is the only alcohol self-help organization to target nondependent problem drinkers and to allow moderate drinking goals. This study evaluated whether MM drew into assistance an untapped segment of the population with nondependent alcohol problems. It also examined how access to the organization was influenced by the provision of Internet-based resources.A survey was distributed to participants in MM face-to-face and Internet-based self-help groups. MM participants (N = 177, 50.9% male) reported on their demographic characteristics, alcohol consumption, alcohol problems and utilization of professional and peer-run helping resources.MM appears to attract women and young people, especially those who are nondependent problem drinkers. It was also found that a significant minority of members experienced multiple alcohol dependence symptoms and therefore may have been poorly suited to a moderate drinking program.Tailoring services to nondependent drinkers and offering assistance over the Internet are two valuable methods of broadening the base of treatment for alcohol problems. Although interventions like MM are unlikely to benefit all individuals who access them, they do attract problem drinkers who are otherwise unlikely to use existing alcohol-related services.

    View details for Web of Science ID 000170348900014

    View details for PubMedID 11513231

  • Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Moos, R. 2001; 25 (5): 711-716


    Twelve-step-oriented inpatient treatment programs emphasize 12-step treatment approaches and the importance of ongoing attendance at 12-step self-help groups more than do cognitive-behavioral (CB) inpatient treatment programs. This study evaluated whether this difference in therapeutic approach leads patients who are treated in 12-step programs to rely less on professionally provided services and more on self-help groups after discharge, thereby reducing long-term health care costs.A prospective, quasi-experimental comparison of 12-step-based (N = 5) and cognitive-behavioral (n = 5) inpatient treatment programs was conducted. These treatments were compared on the degree to which their patients participated in self-help groups, used outpatient and inpatient mental health services, and experienced positive outcomes (e.g., abstinence) in the year following discharge. Using a larger sample from an ongoing research project, 887 male substance-dependent patients from each type of treatment program were matched on pre-intake health care costs (N = 1774). At baseline and 1-year follow-up, patients' involvement in self-help groups (e.g., Alcoholics Anonymous), utilization and costs of mental health services, and clinical outcomes were assessed.Compared with patients treated in CB programs, patients treated in 12-step programs had significantly greater involvement in self-help groups at follow-up. In contrast, patients treated in CB programs averaged almost twice as many outpatient continuing care visits after discharge (22.5 visits) as patients treated in 12-step treatment programs (13.1 visits), and also received significantly more days of inpatient care (17.0 days in CB versus 10.5 in 12-step), resulting in 64% higher annual costs in CB programs ($4729/patient, p < 0.001). Psychiatric and substance abuse outcomes were comparable across treatments, except that 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB programs, p < 0.001).Professional treatment programs that emphasize self-help approaches increase their patients' reliance on cost-free self-help groups and thereby lower subsequent health care costs. Such programs therefore represent a cost-effective approach to promoting recovery from substance abuse.

    View details for Web of Science ID 000168773500012

    View details for PubMedID 11371720

  • Self-help group participation among substance use disorder patients with posttraumatic stress disorder JOURNAL OF SUBSTANCE ABUSE TREATMENT Ouimette, P., Humphreys, K., Moos, R. H., Finney, J. W., Cronkite, R., FEDERMAN, B. 2001; 20 (1): 25-32


    Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participation was similar for SUD patients with and without PTSD. PTSD patients with worldviews (e.g., holding disease model beliefs) that more closely matched 12-step philosophy participated more in 12-step activities. Although greater participation was associated with better concurrent functioning, participation did not prospectively predict outcomes after case mix adjustment. An exception was that greater participation predicted decreased distress among PTSD patients whose identity was more consistent with 12-step philosophy. In summary, PTSD patients participate in and benefit from 12-step participation; continuing involvement may be necessary to maintain positive benefits.

    View details for Web of Science ID 000167491300005

    View details for PubMedID 11239725

  • A comparative, process-effectiveness evaluation of VA substance abuse treatment. Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism Finney, J. W., Ouimette, P. C., Humphreys, K., Moos, R. H. 2001; 15: 373-391


    Over 3,000 patients from 15 VA inpatient, substance abuse treatment programs showed considerable improvement from intake to a one-year follow-up. Patients in 12-step programs, as opposed to cognitive-behavioral (CB) or eclectic programs, and those with more extended continuing outpatient mental health care and 12-step self-help group involvement, were more likely to be abstinent and free of substance use problems at follow-up. Consistent with their better one-year outcomes, patients in 12-step programs improved more between intake and discharge than CB patients on proximal outcomes assumed to be specific to 12-step treatment (e.g., disease model beliefs) and as much or more on CB proximal outcomes. Proximal outcomes assessed at treatment discharge and follow-up were, at best, modestly related to one-year substance use and other outcomes. No evidence was found that CB or 12-step treatment is more beneficial for certain types of patients.

    View details for PubMedID 11449754

  • Assessing readmission to substance abuse treatment as an indicator of outcome and program performance PSYCHIATRIC SERVICES Humphreys, K., Weingardt, K. R. 2000; 51 (12): 1568-1569


    Managed health care systems often use treatment readmission data as an indicator of psychiatric patient outcome and program performance. This study of 3,018 inpatients being treated for substance abuse in Department of Veterans Affairs medical centers found that across a range of measures and patient subpopulations, patient outcomes and program performance were virtually independent of treatment readmission. These findings suggest that even though readmission for substance abuse treatment may have value as an easily obtainable measure of health care utilization and cost, it cannot serve as a valid substitute for direct assessment of patient outcome or program performance.

    View details for Web of Science ID 000165681400017

    View details for PubMedID 11097655

  • Psychologists' ethical responsibilities in Internet-based groups: Issues, strategies, and a call for dialogue PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Humphreys, K., Winzelberg, A., Klaw, E. 2000; 31 (5): 493-496


    How can psychologists participate ethically as facilitators, advisers, and peer members in Internet-based groups? The astonishing growth of Internet technology and on-line groups has outpaced the development of formal ethical guidelines for psychologists involved in on-line groups. This article provides an initial appraisal of psychologists' ethical responsibilities in discussion, support, and self-help groups that operate on the Internet and offers practical strategies for avoiding ethical problems. By presenting initial strategies and guidelines for ethical behavior in Internet-based groups, the authors hope to stimulate the field to further discuss and analyze these issues.

    View details for Web of Science ID 000089750800008

    View details for PubMedID 14621714

  • Communication patterns in an on-line mutual help group for problem drinkers JOURNAL OF COMMUNITY PSYCHOLOGY Klaw, E., Huebsch, P. D., Humphreys, K. 2000; 28 (5): 535-546
  • Use of exclusion criteria in selecting research subjects and its effect on the generalizability of alcohol treatment outcome studies AMERICAN JOURNAL OF PSYCHIATRY Humphreys, K., Weisner, C. 2000; 157 (4): 588-594


    Researchers have not systematically examined how exclusion criteria used in selection of research subjects affect the generalizability of treatment outcome research. This study evaluated the use of exclusion criteria in alcohol treatment outcome research and its effects on the comparability of research subjects with real-world individuals seeking alcohol treatment.Eight of the most common exclusion criteria described in the alcohol treatment research literature were operationalized and applied to large, representative clinical patient samples from the public and private sectors to determine whether the hypothetical research samples differed substantially from real-world samples. Five hundred ninety-three consecutive individuals seeking alcohol treatment at one of eight treatment programs participated. A trained research technician gathered information from participants on demographic variables and on alcohol, drug, and psychiatric problems as measured by the Addiction Severity Index.Large proportions of potential research subjects were excluded under most of the criteria tested. The overall pattern of results showed that African Americans, low-income individuals, and individuals who had more severe alcohol, drug, and psychiatric problems were disproportionately excluded under most criteria.Exclusion criteria can result in alcohol treatment outcome research samples that are more heavily composed of white, economically stable, and higher-functioning individuals than are real-world samples of substance abuse patients seen in clinical practice, potentially compromising the generalizability of results. For both scientific and ethical reasons, in addition to studies that use exclusion criteria, outcome research that uses no or minimal exclusion criteria should be conducted so that alcohol treatment outcome research can be better generalized to vulnerable populations.

    View details for Web of Science ID 000086232300014

    View details for PubMedID 10739418

  • Alcohol & drug abuse: the transformation of the Veterans Affairs substance abuse treatment system. Psychiatric services Humphreys, K., Huebsch, P. D., Moos, R. H., Suchinsky, R. T. 1999; 50 (11): 1399-1401

    View details for PubMedID 10543846

  • Alcoholics anonymous affiliation at treatment intake among white and black Americans JOURNAL OF STUDIES ON ALCOHOL Kaskutas, L. A., Weisner, C., Lee, M. J., Humphreys, K. 1999; 60 (6): 810-816


    Black Americans are overrepresented in the public alcohol treatment system, but may be less likely to use informal services such as Alcoholics Anonymous (AA). Some commentators perceive AA as a white, middle-class organization that is unlikely to appeal to blacks. This epidemiological study considers prior attendance and engagement in AA among 791 black and white men and women entering treatment in public, private and HMO substance abuse programs.Clients were interviewed in-person within the first 3 days of inpatient treatment or the first 3 weeks of outpatient treatment.Black clients dominate public detoxification programs and report more drug and employment problems than whites (who report more family problems). Those with prior treatment experiences and those reporting they had gone to AA as part of treatment reported overall higher rates of AA affiliation, with blacks more likely to say they felt like a member of AA (64% vs 54% of whites), had a spiritual awakening as a result of AA (38% vs 27%) and had done service at AA meetings in the last year (48% vs 37%); whites were more likely to have had a sponsor (23% vs 14%) and to have read program literature (77% vs 67%).Controlling for other effects such as prior inpatient or outpatient treatment, blacks are about twice as likely as whites to report having attended AA as part of treatment (OR = 1.70). More research is needed to understand referral pathways to AA among blacks, and the differential effect this may have on sustained participation in AA and on long-term sobriety.

    View details for Web of Science ID 000083530700012

    View details for PubMedID 10606493

  • Should patients' religiosity influence clinicians' referral to 12-step self-help groups? Evidence from a study of 3,018 male substance abuse patients JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Winzelberg, A., Humphreys, K. 1999; 67 (5): 790-794


    Twelve-step self-help organizations maintain that anyone, regardless of his or her religious beliefs, can benefit from participation in their groups. Yet many addiction professionals have reservations about referring nonreligious patients to 12-step groups. The present study examined the influence of patients' religiosity on whether they were referred to and benefited from 12-step groups. Participants were 3,018 male substance abuse inpatients. Individuals who engaged in fewer religious behaviors in the past year were referred to 12-step groups less frequently by clinicians. However, referrals to 12-step groups were effective at increasing meeting attendance, irrespective of patients' religious background, and all experienced significantly better substance abuse outcomes when they participated in 12-step groups. The viewpoint that less religious patients are unlikely to attend or benefit from 12-step groups may therefore be overstated.

    View details for Web of Science ID 000083117200018

    View details for PubMedID 10535246

  • The case for a partnership with self-help groups PUBLIC HEALTH REPORTS Humphreys, K., Ribisl, K. M. 1999; 114 (4): 322-?

    View details for Web of Science ID 000081929200014

    View details for PubMedID 10501131

  • A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-Step and cognitive-behavioral treatment to substance use outcomes ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Finney, J. W., Moos, R. H., Humphreys, K. 1999; 23 (3): 537-544


    This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment, traditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year follow-up. A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry, at or near discharge, and at a 1-year follow-up. Based on the results of factor analyses, composite proximal outcomes variables were constructed to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral beliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatment discharge were linked to 1-year outcomes, but the relationships were weak (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were stronger, but still modest in magnitude (r = .16 to .39). The weak predictive findings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved more frequently. In this regard, participation in continuing care was associated with enhanced maintenance of treatment gains on proximal outcomes. However, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficiently comprehensive.

    View details for Web of Science ID 000079269900025

    View details for PubMedID 10195830

  • Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? ANNALS OF BEHAVIORAL MEDICINE Humphreys, K., Mankowski, E. S., Moos, R. H., Finney, J. W. 1999; 21 (1): 54-60


    Self-help groups are the most commonly sought source of help for substance abuse problems, but few studies have evaluated the mechanisms through which they exert their effects on members. The present project evaluates mediators of the effects of self-help groups in a sample of 2,337 male veterans who were treated for substance abuse. The majority of participants became involved in self-help groups after inpatient treatment, and this involvement predicted reduced substance use at 1-year follow-up. Both enhanced friendship networks and increased active coping responses appeared to mediate these effects. Implications for self-help groups and professional treatments are discussed.

    View details for Web of Science ID 000085538800009

    View details for PubMedID 18425655

  • Evaluating and improving VA substance abuse patients ' care AMERICAN JOURNAL OF MEDICAL QUALITY Moos, R. H., Humphreys, K., Ouimette, P. C., Finney, J. 1999; 14 (1): 45-54


    The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.

    View details for Web of Science ID 000083697400007

    View details for PubMedID 10446663

  • The Alcoholics Anonymous affiliation scale: Development, reliability, and norms for diverse treated and untreated populations ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Humphreys, K., Kaskutas, L. A., Weisner, C. 1998; 22 (5): 974-978


    Affiliation with Alcoholics Anonymous (AA) is an important variable to measure in many clinical and research activities. This paper reports on the development of an AA affiliation scale, and demonstrates its utility in a sample of 927 alcohol treatment seekers and 674 untreated problem drinkers. The scale is short (9 items), covers a range of AA experiences, and is internally consistent across diverse demographic groups, multiple health services settings, and treated and untreated populations. The validity of the scale is supported by the findings that treatment seekers report significantly higher AA affiliation than do untreated problem drinkers, and inpatients report higher affiliation than outpatients. Potential clinical and research applications of the scale are proposed.

    View details for Web of Science ID 000075475100002

    View details for PubMedID 9726265

  • Treatment involvement and outcomes for four subtypes of homeless veterans AMERICAN JOURNAL OF ORTHOPSYCHIATRY Humphreys, K., Rosenheck, R. 1998; 68 (2): 285-294


    A longitudinal study examined treatment services and outcomes in a nationwide sample of 565 homeless veterans who were classified as alcoholic, psychiatrically impaired, multiproblem, or best-functioning. All four groups experienced some improvement in their primary problem area, in employment status, and in residential quality at eight-month follow-up, but there were significant differences in degree of improvement across groups. Implications for the design of homeless programs and policies are discussed.

    View details for Web of Science ID 000073293200013

    View details for PubMedID 9589766

  • The relationship of pre-treatment Alcoholics Anonymous affiliation with problem severity, social resources and treatment history DRUG AND ALCOHOL DEPENDENCE Humphreys, K., Kaskutas, L. A., Weisner, C. 1998; 49 (2): 123-131


    Little research has examined the relationship of substance abuse patients' prior Alcoholics Anonymous (AA) affiliation to important treatment-related variables. This study of 927 individuals seeking treatment in public, health maintenance organization (HMO) and private-for-profit medical programs, found that 82.8% of patients presented at treatment with a history of AA affiliation. Degree of prior AA affiliation was significantly associated with more extensive prior utilization of formal and informal helping resources, current seeking of treatment in the public sector, having low income, being divorced/separated and having more severe alcohol, employment/support and psychiatric problems. Implications for service delivery and future research are discussed.

    View details for Web of Science ID 000072544800006

    View details for PubMedID 9543649

  • Policy-relevant program evaluation in a national substance abuse treatment system JOURNAL OF MENTAL HEALTH ADMINISTRATION Humphreys, K., Hamilton, E. G., Moos, R. H., Suchinsky, R. T. 1997; 24 (4): 373-385


    This article discusses recent trends in public and private substance abuse services and offers suggestions on how the evaluation of such services can inform clinical practice and policy making. This analysis focuses particularly on the Department of Veterans Affairs (VA), which operates the largest substance abuse treatment system in the United States. In recent years, there has been an erosion of services for substance abuse outside the VA. In contrast, due to increased funding from the U.S. Congress, the VA significantly expanded substance abuse treatment from 1990 to 1994. However, efforts to "reinvent" and downsize government initiated a reversal of this growth trend in 1994, and VA services may shrink further as the system becomes more decentralized and adopts managed care strategies from the private sector. Drawing from the VA Program Evaluation and Resource Center's (PERC) experience of evaluating the VA system and working with federal policy makers, this article presents examples and suggestions for making evaluations of substance abuse treatment systems more useful in policy discussions and in day-to-day clinical practice.

    View details for Web of Science ID 000070961800001

    View details for PubMedID 9364108

  • Treatment of VA inpatients with diagnoses of substance abuse PSYCHIATRIC SERVICES Humphreys, K., BAISDEN, K., Piette, J. D., Moos, R. H. 1997; 48 (2): 171-171

    View details for Web of Science ID A1997WG88400003

    View details for PubMedID 9021845

  • The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY Humphreys, K., Noke, J. M. 1997; 25 (1): 1-16


    The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement) and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.

    View details for Web of Science ID A1997XK42700001

    View details for PubMedID 9231993

  • Addressing self-selection effects in evaluations of mutual help groups and professional mental health services: An introduction to two-stage sample selection models EVALUATION AND PROGRAM PLANNING Humphreys, K., Phibbs, C. S., Moos, R. H. 1996; 19 (4): 301-308
  • Datapoints. Psychiatric services in VA substance abuse treatment programs. Psychiatric services Humphreys, K., Moos, R. H., Hamilton, E. G. 1996; 47 (11): 1203-?

    View details for PubMedID 8916236

  • Psychiatric services in VA substance abuse treatment programs PSYCHIATRIC SERVICES Humphreys, K., Moos, R. H., Hamilton, E. G. 1996; 47 (11): 1203-1203
  • Life domains, alcoholics anonymous, and role incumbency in the 3-year course of problem drinking JOURNAL OF NERVOUS AND MENTAL DISEASE Humphreys, K., Moos, R. H., Finney, J. W. 1996; 184 (8): 475-481


    This study examined the course of problem drinking among 439 individuals over 3 years, using a life domains perspective that distinguishes life stressors and social resources in different contexts. More severe chronic financial stressors both predicted and were predicted by more alcohol consumption and drinking-related problems. Among social resources, Alcoholics Anonymous was the most robust predictor of better functioning on multiple outcome criteria. Support from friends and extended family also predicted better outcomes; this effect was stronger for individuals who were low on primary role incumbency (i.e., who were unemployed and/or did not have a spouse/partner).

    View details for Web of Science ID A1996VD33100004

    View details for PubMedID 8752076

  • Reduced substance-abuse-related health care costs among voluntary participants in alcoholics anonymous PSYCHIATRIC SERVICES Humphreys, K., Moos, R. H. 1996; 47 (7): 709-713


    This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider.Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years.At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group.Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.

    View details for Web of Science ID A1996UV45800006

    View details for PubMedID 8807683

  • World view change in Adult Children of Alcoholics Al-Anon self-help groups: Reconstruction the alcoholic family INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY Humphreys, K. 1996; 46 (2): 255-263


    Although 12-step self-help groups have become extremely popular in U.S. society, clinicians and researchers have devoted little attention to how these groups affect members. This project used naturalistic and qualitative methods to examine the processes through which committed members of self-help groups for adult children of alcoholics experience alterations in their perceptions of family of origin. Results suggest that world view transformation in the family of origin domain involves learning to define the family as pathological, assigning responsibility for this pathology to a disease, forgiving oneself, accepting that one was adversely affected by the family's problem, and ultimately learning to accept one's parents' shortcomings.

    View details for Web of Science ID A1996UE73900007

    View details for PubMedID 8935765

  • Clinical psychologists as psychotherapists - History, future, and alternatives AMERICAN PSYCHOLOGIST Humphreys, K. 1996; 51 (3): 190-197


    As managed care and other cost-containment strategies become central features of the American health care system, doctoral-level clinical psychologists will be increasingly supplanted in the role of psychotherapist by lower cost providers such as social workers, marriage and family counselors, and masters-level psychologists. To provide one basis for clinical psychologists to make judgments about their role in psychotherapy; this article describes what the field was like before psychotherapy became a core activity and then compares the present transition with its historical counterpart: the opening up of the psychotherapy profession to doctoral-level clinical psychologists after World War II. History suggests that efforts to resist the current changes will be unsuccessful and that the most adaptive coping strategy for clinical psychologists is to take advantage of the transition by reenvisioning training and practice of clinical psychologists.

    View details for Web of Science ID A1996UB19800002

    View details for PubMedID 8881525

  • Reliability, validity, and normative data for a short version of the understanding of alcoholism scale PSYCHOLOGY OF ADDICTIVE BEHAVIORS Humphreys, K., Greenbaum, M. A., Noke, J. M., Finney, J. W. 1996; 10 (1): 38-44
  • Recovering substance abuse staff members' beliefs about addiction JOURNAL OF SUBSTANCE ABUSE TREATMENT Humphreys, K., Noke, J. M., Moos, R. H. 1996; 13 (1): 75-78


    This study of 329 substance abuse treatment staff assessed how recovery status, in combination with other variables, influences beliefs about the causes and treatment of substance abuse. About 15% (n = 47) of participants were "in recovery" from substance abuse problems; these staff members were not significantly different than nonrecovering staff members on education, age, race/ethnicity, years of clinical experience, or amount of client contact. When examined in a multiple regression equation that also included age, education, and treatment program goals and activities, staff members' recovery status was not associated with endorsement of disease and psychosocial models of substance abuse. However, being in recovery was associated with endorsing an eclectic approach to substance abuse treatment. The importance of recognizing the diversity of beliefs about substance abuse among recovering staff and of acknowledging that multiple influences affect all staff members viewpoints on treatment is discussed.

    View details for Web of Science ID A1996UD52700009

    View details for PubMedID 8699546



    This 3-year longitudinal study examined two recovery pathways among 135 problem drinking individuals who never received professional treatment. Almost half (48.3%) of those individuals for whom outcome could be clearly determined became moderate drinkers or stably abstinent. At baseline, individuals who subsequently became abstinent (n = 28) were of low socioeconomic status, had severe drinking problems, and believed their drinking was a very serious problem. Once they began their recovery, they relied heavily on Alcoholics Anonymous as a maintenance factor. In contrast, individuals who became moderate drinkers (n = 29) had higher socioeconomic status and more social support at baseline than did individuals who became abstinent or continued to have drinking problems. A logistic regression on baseline data showed that it was possible to predict which natural recovery pathway an individual drinker would follow. The implications of these findings for alcoholism treatment and policy are discussed.

    View details for Web of Science ID A1995RH48600002

    View details for PubMedID 7484324

  • World views of Alcoholics Anonymous, Women for Sobriety, and Adult Children of Alcoholics/Al-Anon mutual help groups ADDICTION RESEARCH Humphreys, K., Kaskutas, L. A. 1995; 3 (3): 231-243

Conference Proceedings

  • Analysis of preoperative measures that predict interference with sleep recovery after surgery Schmidt, P., Hah, J., Barelka, P., Wang, C., Wang, B., Gillespie, M., McCue, R., Younger, J., Trafton, J., Humphreys, K., Goodman, S., Dirbas, F., Whyte, R., Donington, J., Cannon, W., Mackey, S., Carroll, I. CHURCHILL LIVINGSTONE. 2013: S19-S19
  • A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups Humphreys, K., Huebsch, P. D., Finney, J. W., Moos, R. H. WILEY-BLACKWELL PUBLISHING, INC. 1999: 558-563


    Affiliation with Alcoholics Anonymous (AA) and other 12-Step self-help groups is becoming more common at the same time as professional substance abuse treatment services are becoming less available and of shorter duration. As a result of these two trends, patients' outcomes may be increasingly influenced by the degree to which professional treatment programs help patients take maximum advantage of self-help groups. The present study of 3018 treated veterans examined how the theoretical orientation of a substance abuse treatment program affects (1) the proportion of its patients that participate in self-help groups, and, (2) the degree of benefit patients derive from participation in self-help groups. Patients treated in 12-Step and eclectic treatment programs had higher rates of subsequent participation in 12-Step self-help groups than did patients treated in cognitive behavioral programs. Furthermore, the theoretical orientation of treatment moderated the outcome of self-help group participation: As the degree of programs' emphasis on 12-Step approaches increased, the positive relationships of 12-Step group participation to better substance use and psychological outcomes became stronger. Hence, it appears that 12-Step oriented treatment programs enhance the effectiveness of 12-Step self-help groups. Findings are discussed in terms of implications for clinical practice and for future evaluations of the combined effects of treatment and self-help groups.

    View details for Web of Science ID 000079269900028

    View details for PubMedID 10195833

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