Substance Use by Persons with Recent Spinal Cord Injuries.

ERIC Educational Resources Information Center

Heinemann, Allen W.; And Others

Substance use histories were obtained from 103 persons (16 to 63 years of age) with recent spinal cord injuries (SCI). Lifetime exposure to and current use of substances with abuse potential were substantially greater in this sample compared to a like-age national sample. Exposure to and recent use of substances with abuse potential was…

Personality Disorders, Narcotics, and Stimulants; Relationship in Iranian Male Substance Dependents Population.

PubMed

Noorbakhsh, Simasadat; Zeinodini, Zahra; Khanjani, Zeynab; Poorsharifi, Hamid; Rajezi Esfahani, Sepideh

2015-06-01

Individuals with certain personality disorders, especially the antisocial and borderline personality disorders, are more prone to substance use disorders. Regarding the importance of substance use disorders, this study aimed to explore the association between personality disorders and types of used drugs (narcotics and stimulants) in Iranian male substance users. The current study was a correlation study. We evaluated 285 male substance users and excluded 25 according to exclusion criteria. A total of 130 narcotic users and 130 stimulant users were recruited randomly in several phases from January 2013 to October 2013. All participants were referred to Substance Dependency Treatment Clinics in Tehran, Iran. Data collection process was accomplished by means of clinical interview based on DSM-V criteria for substance use disorders, Iranian version of addiction severity index (ASI), and Millon clinical multi-axial inventory-III (MCMI-III). Data were analyzed by SPSS 21 using Pearson correlation coefficient and regression, the. There was a significant correlation between stimulant use and histrionic personality disorder (P < 0.001) and antisocial and narcissistic personality disorders (P < 0.05). In addition, correlation between avoidant, histrionic, and narcissistic personality disorders (P < 0.05) and depressed, antisocial, and borderline personality disorders (P < 0.001) with narcotics consumption were significant. In clusters, there was a significant correlation between cluster B personality disorders, and narcotic and stimulants consumption (P < 0.001). In addition, this association was explored between cluster C personality disorder and narcotics (P < 0.001). The results of this study in terms of personality disorders and types of used drugs were in accordance with the previous studies results. It is necessary to design appropriate treatment plans for medical treatment of those with personality disorders.

European laws on compulsory commitment to care of persons suffering from substance use disorders or misuse problems- a comparative review from a human and civil rights perspective.

PubMed

Israelsson, Magnus; Nordlöf, Kerstin; Gerdner, Arne

2015-08-28

Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. The study raises questions concerning whether various European CCC laws in relation to substance use disorder or misuse problems

Personality risk profile for conduct disorder and substance use disorders in youth.

PubMed

Anderson, Kristen G; Tapert, Susan F; Moadab, Ida; Crowley, Thomas J; Brown, Sandra A

2007-10-01

The five factor model of personality is a useful metric to describe personality profiles associated with maladaptive functioning. Using the NEO-Five Factor Inventory (NEO-FFI), we examined a conceptually based profile of high neuroticism, low agreeableness and low conscientiousness among 243 youth (aged 13-18 years) with varying degrees of conduct disorder (CD) and substance use disorders (SUD). Comparisons of the NEO-FFI personality dimensions between CD/SUD youth and adolescent siblings (N=173), and relations between the personality dimensions and behavioral indicators of conduct disorder and substance involvement were examined. Youth with CD and SUD had greater neuroticism, lower agreeableness, and lower conscientiousness than siblings of a similar age. The NEO-FFI scales predicted aggression and substance involvement for both probands and siblings in this cross-sectional investigation. These findings support the role for personality in models of the etiology and persistence of conduct disorder and substance use disorders.

Personal networks of women in residential and outpatient substance abuse treatment.

PubMed

Kim, HyunSoo; Tracy, Elizabeth; Brown, Suzanne; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung; McCarty, Chris

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t -tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse.

Personal networks of women in residential and outpatient substance abuse treatment

PubMed Central

Kim, HyunSoo; Tracy, Elizabeth; Brown, Suzanne; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung; McCarty, Chris

2015-01-01

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse. PMID:27011762

[Substance use, affective problems and personality traits: test of two association models].

PubMed

Chakroun, N; Doron, J; Swendsen, J

2004-01-01

The International Consortium of Psychiatric Epidemiology has confirmed the high comorbidity in community-drawn samples between substance use disorders and anxiety or depression. In the same way, associations between substance use and specific personality traits (such as novelty seeking, harm avoidance or antisocial personality) have also been extensively documented. Self-medication and social deviance are among the most commonly evoked explanatory models for these forms of comorbidity, and are based on findings that affective disorders and specific personality traits often precede the onset of substance use disorders. The self-medication model postulates that an individual chooses a specific substance according to its psychopharmacologic action on the given psychological state of the person. By contrast, the social deviance model posits that this form of comorbidity is due to the fact that persons consuming certain substances may have affective or personality characteristics that are more severe or more deviant than non-consumers (or than consumers of socially well-accepted substances). In this way, the individual does not use a particular substance to assuage pre-existing disorders but, due to a more deviant personality, is less influenced by social norms and may more easily turn to using illicit substances or to polyconsumption. However, a major limitation of the current scientific literature concerning tests of these models is that previous investigations have been based in overwhelming majority on clinical populations. The examination only of clinical samples renders difficult the identification of causal (or primary) risk factors for the emergence of substance use disorders from the potential consequences of substance use itself. The goal of the current study was therefore to simultaneously compare both models of association using a non clinical population of substance users. In addition to selecting subjects based on use (rather than abuse or dependence

Offenders with mental health problems and problematic substance use: affective psychopathic personality traits as potential barriers to participation in substance abuse interventions.

PubMed

Durbeej, Natalie; Palmstierna, Tom; Berman, Anne H; Kristiansson, Marianne; Gumpert, Clara Hellner

2014-01-01

Substance abuse is related to re-offending, and treatment of substance abuse may reduce criminal recidivism. Offender characteristics including problem severity, violence risk and psychopathic personality traits may be positively or negatively associated with participation in substance abuse treatment. We explored the relationships between such characteristics and participation in substance abuse interventions among Swedish offenders with mental health problems and problematic substance use. Our analyses revealed that problem severity regarding drugs, employment, and family/social situations predicted intervention participation, and that affective psychopathic personality traits were negatively associated with such participation. Thus, affective psychopathic personality traits could be considered as potential barriers to participation in substance abuse interventions. Among offenders with mental health problems and problematic substance use, such personality traits should be taken into account in order to optimize treatment participation and treatment outcome. Approaches used in cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) could be applicable for these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Social problem-solving abilities and personality disorder characteristics among dual-diagnosed persons in substance abuse treatment.

PubMed

Herrick, S M; Elliott, T R

2001-01-01

We examined the relation of self-appraised social problem-solving abilities and personality-disorder characteristics to the adjustment and compliance of persons with dual diagnoses in substance-abuse treatment. It was hypothesized that elements of the problem-orientation component would remain predictive of depressive behavior and distress after considering personality-disorder characteristics among 117 persons receiving inpatient-substance-abuse treatment. Furthermore, self-appraised problem-solving abilities were expected to predict the occurrence of "dirty" drug and alcohol screens during treatment and compliance with the first scheduled community follow-up visit. Results supported predictions concerning the relation of problem-solving confidence to depressive behavior, distress, and substance-use screens; however, a paradoxical relation was observed between the problem-orientation variables and compliance with the first outpatient visit. The results are interpreted within the context of contemporary models of social problem solving and the implications for cognitive-behavioral assessment and intervention are considered.

Substance use in young persons in Ireland, a systematic review.

PubMed

Murphy, Kevin; Sahm, Laura; McCarthy, Suzanne; Lambert, Sharon; Byrne, Stephen

2013-08-01

Adolescence is a time of physical and mental development when small changes can impact on the rest of a person's life. Substance use in this crucial period can have long-lasting consequences for the individual and for society. The prevalence of substance use in young people is an area of concern for policy makers and health workers. This systematic review looked at prevalence for four substances: alcohol, tobacco, cannabis, and benzodiazepines, across the Republic of Ireland for persons between the ages of 13 and 24, and compared usage between 2000 and 2012. Eighteen articles were included in the review. It was seen that tobacco, alcohol, and cannabis use has fallen in the lifetime and previous month use. The level of benzodiazepine use has remained similar in the period of study. Future work should redress the imbalance in substance use research that sees the majority of researchers looking at a few substances while little work is done on the others. Copyright © 2013 Elsevier Ltd. All rights reserved.

Illicit substance use among university students from seven European countries: a comparison of personal and perceived peer use and attitudes towards illicit substance use.

PubMed

Helmer, S M; Mikolajczyk, R T; McAlaney, J; Vriesacker, B; Van Hal, G; Akvardar, Y; Guillen-Grima, F; Salonna, F; Stock, C; Dempsey, R C; Bewick, B M; Zeeb, H

2014-10-01

To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes. This study used baseline data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online survey which included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances. 8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53-2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73-4.41). Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/attitudes. Copyright © 2014 Elsevier Inc. All rights reserved.

Dialectical Behavior Therapy for Substance Abusers Adapted for Persons Living with HIV/AIDS with Substance Use Diagnoses and Borderline Personality Disorder

ERIC Educational Resources Information Center

Wagner, Elizabeth E.; Miller, Alec L.; Greene, Lori I.; Winiarski, Mark G.

2004-01-01

The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad…

Do Substance Use Risk Personality Dimensions Predict the Onset of Substance Use in Early Adolescence? A Variable- and Person-Centered Approach

ERIC Educational Resources Information Center

Malmberg, Monique; Kleinjan, Marloes; Vermulst, Ad A.; Overbeek, Geertjan; Monshouwer, Karin; Lammers, Jeroen; Engels, Rutger C. M. E.

2012-01-01

Various studies found personality to be related to substance use, but little attention is paid to the role of personality risk dimensions with regard to an early onset of alcohol, tobacco, and marijuana use. Therefore, the current study used a variable-centered approach to examine whether anxiety sensitivity, hopelessness, sensation seeking, and…

Personal network structure and substance use in women by 12 months post treatment intake

PubMed Central

Tracy, Elizabeth M.; Min, Meeyoung O.; Park, Hyunyong; Jun, MinKyoung; Brown, Suzanne; Francis, Meredith W.

2015-01-01

Introduction Women with substance use disorders enter treatment with limited personal network resources and reduced recovery support. This study examined the impact of personal networks on substance use by 12 months post treatment intake. Methods Data were collected from 284 women who received substance abuse treatment. At six month follow up, composition, support availability and structure of personal networks were examined. Substance use was measured by women’s report of any use of alcohol or drugs. Hierarchical multivariate logistic regression was conducted to examine the contribution of personal network characteristics on substance use by 12 months post treatment intake. Results Higher numbers of substance using alters (network members) and more densely connected networks at six month follow-up were associated with an increased likelihood of substance use by 12 months post treatment intake. A greater number of isolates in women’s networks was associated with decreased odds of substance use. Women who did not use substances by 12 months post treatment intake had more non-users among their isolates at six months compared to those who used substances. No association was found between support availability and likelihood of substance use. Conclusions Both network composition and structure could be relevant foci for network interventions e.g. helping women change network composition by reducing substance users as well as increasing network connections. Isolates who are not substance users may be a particular strength to help women cultivate within their network to promote sustained sobriety post treatment. PMID:26712040

Development of a personalized bidirectional text messaging tool for HIV adherence assessment and intervention among substance abusers.

PubMed

Ingersoll, Karen; Dillingham, Rebecca; Reynolds, George; Hettema, Jennifer; Freeman, Jason; Hosseinbor, Sharzad; Winstead-Derlega, Chris

2014-01-01

We describe the development of a two-way text messaging intervention tool for substance users who are non-adherent with HIV medications, and examine message flow data for feasibility and acceptability. The assessment and intervention tool, TxText, is fully automated, sending participants mood, substance use, and medication adherence queries by text message. Participants respond, the tool recognizes the category of response, and sends the personalized intervention message that participants designed in return. In 10months, the tool sent 16,547 messages (half initial, half follow-up) to 31 participants assigned to the TxText condition, who sent 6711 messages in response to the initial messages. Response rates to substance use (n=2370), medication (n=2918) and mood (n=4639) queries were 67, 69, and 64%, respectively. Responses indicating medication adherence, abstinence from substances, and good moods were more common than negative responses. The TxText tool can send messages daily over a 3month period, receive responses, and decode them to deliver personalized affirming or intervention messages. While we await the outcomes of a pilot randomized trial, the process analysis shows that TxText is acceptable and feasible for substance abusers with HIV, and may serve as a complement to HIV medical care. © 2013.

Development of a Personalized Bidirectional Text Messaging Tool for HIV Adherence Assessment and Intervention among Substance Abusers

PubMed Central

Ingersoll, Karen; Dillingham, Rebecca; Reynolds, George; Hettema, Jennifer; Freeman, Jason; Hosseinbor, Sharzad; Winstead-Derlega, Chris

2013-01-01

We describe the development of a two-way text messaging intervention tool for substance users who are non-adherent with HIV medications, and examine message flow data for feasibility and acceptability. The assessment and intervention tool, TxText, is fully automated, sending participants mood, substance use, and medication adherence queries by text message. Participants respond, the tool recognizes the category of response, and sends the personalized intervention message that participants designed in return. In 10 months, the tool sent 16,547 messages (half initial, half follow-up) to 31 participants assigned to the TxText condition, who sent 6711 messages in response to the initial messages. Response rates to substance use (n=2370), medication (n=2918) and mood (n=4639) queries were 67%, 69%, and 64%, respectively. Responses indicating medication adherence, abstinence from substances, and good moods were more common than negative responses. The TxText tool can send messages daily over a 3 month period, receive responses, and decode them to deliver personalized affirming or intervention messages. While we await the outcomes of a pilot randomized trial, the process analysis shows that TxText is acceptable and feasible for substance abusers with HIV, and may serve as a complement to HIV medical care. PMID:24029625

Validation of vocational assessment tool for persons with substance use disorders.

PubMed

Sethuraman, Lakshmanan; Subodh, B N; Murthy, Pratima

2016-01-01

Work-related problems are a serious concern among persons with substance use but due to lack of a standardized tool to measure it; these problems are neither systematically assessed nor appropriately addressed. Most existing measures of work performance cater to the needs of the workplace rather than focusing on the workers' perception of the difficulties at work. To develop a standardized instrument to measure work-related problems in persons with substance use disorders. Qualitative data obtained from interviews with substance users were used to develop a scale. The refined list of the scale was circulated among an expert panel for content validation. The modified scale was administered to 150 cases, and 50 cases completed the scale twice at the interval of 2 weeks for test-retest reliability. Items with a test-retest reliability kappa coefficient of 0.4 or greater were retained and subjected to factor analysis. The final 45-item scale has a five-factor structure. The value of Cronbach's alpha of the final version of the scale was 0.91. This self-report questionnaire, which can be completed in 10 min, may help us in making a baseline assessment of the work-related impairment among persons with substance use and the impact of substance use on work.

21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons not...

21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons not...

Not only biocidal products: Washing and cleaning agents and personal care products can act as further sources of biocidal active substances in wastewater.

PubMed

Wieck, Stefanie; Olsson, Oliver; Kümmerer, Klaus

2018-06-01

The emission sources of biocidal active substances in households have been under discussion since these substances have been detected frequently in municipal wastewater and receiving surface water bodies. Therefore, the goal of this study was to investigate the products responsible for the emission of these substances to wastewater. We analysed the wastewater of two streets for a set of biocidal active substances. Time-proportional sampling was conducted for one week of each season during one year in each street. The 14 substances analysed with liquid chromatography coupled with tandem mass spectrometry were 1,2-benzisothiazol-3(2H)-one (BIT), C 12 -benzalkonium chloride, carbendazim, 5-chloro-2-methyl-2H-isothiazol-3-one (CMIT), dichlorooctylisothiazolinone (DCOIT), N,N-diethyl-meta-toluamide (DEET), diuron, icaridine, 2-octyl-2H-isothiazol-3-one (OIT), piperonyl butoxide (PBO), triclosan, tebuconazole, terbutryn and tetramethrin. Using data available from household product inventories of the two streets, we searched the lists of ingredients for the products possibly being responsible for the emissions. Except for four substances, all substances have been detected in at least 10% of the samples. Highest concentrations were measured for C 12 -benzalkonium chloride with an average concentration in the daily samples of 7.7 μg/L in one of the streets. Next to C 12 -benzalkonium chloride, BIT, DEET and icaridine were detected in all samples in average concentrations above 1 μg/L in at least one street. The results show that washing and cleaning agents were important sources for preservatives such as BIT and OIT, while triclosan was apparently mainly emitted through personal care products. The mosquito repelling substances DEET and icaridine were found throughout the year, with highest emissions in summer and autumn. In conclusion, the results demonstrate that the sources of biocidal active substances in municipal wastewater are complex and that measures for the

Using the tidal model of mental health recovery to plan primary health care for women in residential substance abuse recovery.

PubMed

Young, Brenda B

2010-09-01

Women currently are 30% of the substance abuse recovery population in North America and have gender specific treatment needs as they enter the difficult work of recovery. Important among women's specific needs as they enter recovery is the need for a focus on primary health care. Few models designed to guide the provision of health care for this population are available in the literature. The Tidal Model of Mental Health Recovery and Reclamation is based on the concept of nursing as "caring with" persons in the experience of distress. Given the emphasis in this model on developing a partnership between caregiver and client, it is especially appropriate for women in recovery for substance abuse. The Tidal Model, integrated with the United States Substance Abuse and Mental Health Services' CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment, is used to guide planning for delivery of primary health care in a residential women's substance abuse recovery center in the Midwest. This article describes the Tidal Model, and identifies how the model can improve the delivery of primary care to women in residential substance abuse treatment. Strategies for implementation of the model are proposed. Evaluation and outcome criteria are identified.

Balancing personalized medicine and personalized care.

PubMed

Cornetta, Kenneth; Brown, Candy Gunther

2013-03-01

The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

Considerations for the Development of a Substance-Related Care and Prevention Continuum Model

PubMed Central

Perlman, David C.; Jordan, Ashly E.

2017-01-01

There are significant gaps in the identification and engagement in care and prevention services of people who use illicit substances. Care continuum models have proven to be useful tools in the evaluation of care for HIV and other conditions; numerous issues in substance-related care and prevention resemble those identified in other continua models. Systems of care for substance misuse and substance use disorders (SUDs) can be viewed as consisting of a prevention and care continuum, reflecting incidence and prevalence of substance misuse and SUDs, screening and identification, medical and psychosocial evaluation for treatment, engagement in evidence-based treatment, treatment retention, relapse prevention, timeliness of step completion, and measures of overall and substance use-related specific morbidity and mortality. Care and prevention continuum models could potentially be applied at program, local, regional, state, and national levels. We discuss important lessons that can be drawn from applications of continuum models in other fields. The development and use of a substance-related care and prevention continuum may yield significant patient care, program evaluation and improvement, and population-level benefits. PMID:28770195

Unhealthy Substance Use Behaviors as Symptom-Related Self-Care in HIV/AIDS

PubMed Central

Brion, John M.; Rose, Carol Dawson; Nicholas, Patrice K.; Sloane, Rick; Voss, Joachim G.; Corless, Inge B.; Lindgren, Teri G.; Wantland, Dean J.; Kemppainen, Jeanne K.; Sefcik, Elizabeth F.; Nokes, Kathleen M.; Kirksey, Kenn M.; Eller, Lucille Sanzero; Hamilton, Mary Jane; Holzemer, William L.; Portillo, Carmen J.; Mendez, Marta Rivero; Robinson, Linda M.; Moezzi, Shanaz; Rosa, Maria; Human, Sarie; Maryland, Mary; Arudo, John; Ros, Ana Viamonte; Nicholas, Thomas P.; Cuca, Yvette; Huang, Emily; Bain, Catherine; Tyer-Viola, Lynda; Zang, Sheryl M.; Shannon, Maureen; Peters-Lewis, Angelleen

2014-01-01

The prevalence of symptoms in HIV disease can be associated with HIV disease itself, comorbid illness, and/or antiretroviral therapy. Unhealthy substance use behaviors, particularly substance-use behaviors including heavy alcohol intake, marijuana use, other illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage disease-related symptoms. This study is a secondary data analysis of baseline data from a larger randomized-controlled trial of an HIV/AIDS Symptom Management Manual. In the present study, the prevalence and characteristics of unhealthy substance use behaviors in relation to HIV/AIDS symptoms are examined. Subjects were recruited from a variety of settings which provide HIV/AIDS care and treatment. The mean age of the sample (n=775) was 42.8 years (SD=9.6) and nearly thirty-nine percent (38.5%) of the sample was female. The racial demographics of the sample were: 28% African American, 28% Hispanic, 21% White/Caucasian, 16% African from Kenya or South Africa, 1% Asian, and 5% self-described as “Other.” The mean number of years living with HIV was reported to be 9.1 years (SD=6.6).Specific self-reported unhealthy substance-use behaviors were use of marijuana (n= 111; 14.3%), cigarette smoking (n=355; 45.8%), heavy alcohol use (n= 66; 8.5%), and illicit drugs (n= 98; 12.6%). A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance use behaviors including amphetamine and injection drug use in addition to heavy alcohol use, cigarette smoking, and marijuana use. Implications for clinical practice include assessment of self-care behaviors, screening for substance abuse, and education of persons related to self-management across the trajectory of HIV disease. PMID:21352430

Co-occurrence of addictive behaviours: personality factors related to substance use, gambling and computer gaming.

PubMed

Walther, Birte; Morgenstern, Matthis; Hanewinkel, Reiner

2012-01-01

To investigate co-occurrence and shared personality characteristics of problematic computer gaming, problematic gambling and substance use. Cross-sectional survey data were collected from 2,553 German students aged 12-25 years. Self-report measures of substance use (alcohol, tobacco and cannabis), problematic gambling (South Oaks Gambling Screen - Revised for Adolescents, SOGS-RA), problematic computer gaming (Video Game Dependency Scale, KFN-CSAS-II), and of twelve different personality characteristics were obtained. Analyses revealed positive correlations between tobacco, alcohol and cannabis use and a smaller positive correlation between problematic gambling and problematic computer gaming. Problematic computer gaming co-occurred only with cannabis use, whereas problematic gambling was associated with all three types of substance use. Multivariate multilevel analyses showed differential patterns of personality characteristics. High impulsivity was the only personality characteristic associated with all five addictive behaviours. Depression and extraversion were specific to substance users. Four personality characteristics were specifically associated with problematic computer gaming: irritability/aggression, social anxiety, ADHD, and low self-esteem. Problematic gamblers seem to be more similar to substance users than problematic computer gamers. From a personality perspective, results correspond to the inclusion of gambling in the same DSM-V category as substance use and question a one-to-one proceeding for computer gaming. Copyright © 2012 S. Karger AG, Basel.

Validation of vocational assessment tool for persons with substance use disorders

PubMed Central

Sethuraman, Lakshmanan; Subodh, B. N.; Murthy, Pratima

2016-01-01

Background: Work-related problems are a serious concern among persons with substance use but due to lack of a standardized tool to measure it; these problems are neither systematically assessed nor appropriately addressed. Most existing measures of work performance cater to the needs of the workplace rather than focusing on the workers' perception of the difficulties at work. Aim: To develop a standardized instrument to measure work-related problems in persons with substance use disorders. Methods: Qualitative data obtained from interviews with substance users were used to develop a scale. The refined list of the scale was circulated among an expert panel for content validation. The modified scale was administered to 150 cases, and 50 cases completed the scale twice at the interval of 2 weeks for test–retest reliability. Results: Items with a test–retest reliability kappa coefficient of 0.4 or greater were retained and subjected to factor analysis. The final 45-item scale has a five-factor structure. The value of Cronbach's alpha of the final version of the scale was 0.91. Conclusions: This self-report questionnaire, which can be completed in 10 min, may help us in making a baseline assessment of the work-related impairment among persons with substance use and the impact of substance use on work. PMID:28163409

Genetic variation in personality traits explains genetic overlap between borderline personality features and substance use disorders.

PubMed

Few, Lauren R; Grant, Julia D; Trull, Timothy J; Statham, Dixie J; Martin, Nicholas G; Lynskey, Michael T; Agrawal, Arpana

2014-12-01

To examine the genetic overlap between borderline personality features (BPF) and substance use disorders (SUDs) and the extent to which variation in personality traits contributes to this covariance. Genetic structural equation modelling was used to partition the variance in and covariance between personality traits, BPF and SUDs into additive genetic, shared and individual-specific environmental factors. All participants were registered with the Australian Twin Registry. A total of 3127 Australian adult twins participated in the study. Diagnoses of DSM-IV alcohol and cannabis abuse/dependence (AAD; CAD) and nicotine dependence (ND) were derived via computer-assisted telephone interview. BPF and five-factor model personality traits were derived via self-report questionnaires. Personality traits, BPF and substance use disorders were partially influenced by genetic factors with heritability estimates ranging from 0.38 (neuroticism; 95% confidence interval: 0.30-0.45) to 0.78 (CAD; 95% confidence interval: 0.67-0.86). Genetic and individual-specific environmental correlations between BPF and SUDs ranged from 0.33 to 0.56 (95% CI = 0.19-0.74) and 0.19-0.32 (95% CI = 0.06-0.43), respectively. Overall, there was substantial support for genetic influences that were specific to AAD, ND and CAD (30.76-68.60%). Finally, genetic variation in personality traits was responsible for 11.46% (extraversion for CAD) to 59.30% (neuroticism for AAD) of the correlation between BPF and SUDs. Both genetic and individual-specific environmental factors contribute to comorbidity between borderline personality features and substance use disorders. A substantial proportion of this comorbidity can be attributed to variation in normal personality traits, particularly neuroticism. © 2014 Society for the Study of Addiction.

Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders.

PubMed

Mueser, Kim T; Crocker, Anne G; Frisman, Linda B; Drake, Robert E; Covell, Nancy H; Essock, Susan M

2006-10-01

Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.

A Two Year Longitudinal Outcome Study of Addicted Health Care Professionals: An Investigation of the Role of Personality Variables

PubMed Central

Angres, Daniel; Bologeorges, Stephanie; Chou, Jessica

2013-01-01

The co-morbidity of personality disorders (PDs) and other dysregulatory personality patterns with addiction have been well-established, although few studies have examined this interplay on long-term sobriety outcome. In addition, health care professionals suffering from addiction have both a significant public health impact and a unique set of treatment and recovery challenges. The aim of this study was to investigate if personality variables differentiated sobriety outcome in this population over a two year interval. A clinical sample of health care professionals participated in a substance abuse hospital treatment program individually tailored with respect to personality. Participants took the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory at intake, and were tracked two years post-discharge to determine sobriety status. Univariate analyses showed antisocial personality, female gender, and alcohol dependence were independent predictors of relapse, however a significant relationship between personality and substance use did not exist in multivariate analysis when controlling for demographic variables The lack of multivariate relationships demonstrates the heterogeneity in self-report measures of personality, which suggests the interplay of personality and addiction is complex and individualized. PMID:23531922

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

EPA Pesticide Factsheets

The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the documented or potential hazards associated with trace exposure to these anthropogenic substances, many of which are highly bioactive and perpetually present in many aquatic locales. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized.Of the many facets involved in this complex issue, that of sources/origins and environmental occurrence is the better understood end of the larger spectrum. The potential for adverse ecological or human health effects (especially from long-term, combined exposure to multiple xenobiotics at low concentrations) is the

Nurse practitioners and controlled substances prescriptive authority: improving access to care.

PubMed

Ambrose, Michelle A; Tarlier, Denise S

2013-03-01

In 2007, Health Canada proposed a new framework to regulate prescriptive authority for controlled substances, titled New Classes of Practitioners Regulations (NCPR). The new regulatory framework was passed in November 2012; it gives nurse practitioners (NPs), midwives and podiatrists the authority to prescribe controlled medications under the Controlled Drugs and Substances Act. It is expected that authorizing NPs to write prescriptions for certain controlled substances commonly used in primary care will enhance flexibility and timeliness in primary care service delivery. Studies from the United States have shown positive outcomes in primary care access, decreased healthcare costs and the evolution and advancement of the NP role when prescriptive authority was expanded to include controlled substances. The purpose of this paper is to examine how NPs' prescriptive authority for controlled substances affects access to primary care and NP role development. Three key issues identified from the experience of one group of NPs in the United States (access to care, professional autonomy and prescriber knowledge) offer insight into the practice changes that may be anticipated for NPs in Canada now that they have acquired prescriptive authority for controlled substances. Recommendations are offered to assist nurse leaders and educators to best support NPs as they take on this new and important role responsibility.

Integrated EAP/Managed Behavioral Health Plan Utilization by Persons with Substance Use Disorders

PubMed Central

Levy Merrick, Elizabeth S.; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Greenfield, Shelly F.; McCann, Bernard

2011-01-01

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral healthcare organization's integrated EAP/managed behavioral health care product (N=1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. PMID:21185684

Electronic health records: essential tools in integrating substance abuse treatment with primary care

PubMed Central

Tai, Betty; Wu, Li-Tzy; Clark, H Westley

2012-01-01

While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted. PMID:24474861

The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

PubMed

Elfstrand Corlin, Tinna; Kajonius, Petri J; Kazemi, Ali

2017-06-01

In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. © 2016 John Wiley & Sons Ltd.

21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

Code of Federal Regulations, 2013 CFR

2013-04-01

... either a DEA Form 222 or an electronic order may return the substance to the supplier of the substance with either a DEA Form 222 or an electronic order from the supplier. (c) A person registered to... person registered or authorized to conduct chemical analysis or research with controlled substances may...

21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

Code of Federal Regulations, 2014 CFR

2014-04-01

... either a DEA Form 222 or an electronic order may return the substance to the supplier of the substance with either a DEA Form 222 or an electronic order from the supplier. (c) A person registered to... person registered or authorized to conduct chemical analysis or research with controlled substances may...

21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

Code of Federal Regulations, 2012 CFR

2012-04-01

... either a DEA Form 222 or an electronic order may return the substance to the supplier of the substance with either a DEA Form 222 or an electronic order from the supplier. (c) A person registered to... person registered or authorized to conduct chemical analysis or research with controlled substances may...

Distinguishing General and Specific Personality Disorder Features and Implications for Substance Dependence Comorbidity

PubMed Central

Jahng, Seungmin; Trull, Timothy J.; Wood, Phillip K.; Tragesser, Sarah L.; Tomko, Rachel; Grant, Julia D.; Bucholz, Kathleen K.; Sher, Kenneth J.

2014-01-01

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities. PMID:21604829

Substance Use among Young People Living in Residential State Care

ERIC Educational Resources Information Center

McCrystal, Patrick; Percy, Andrew; Higgins, Kathryn

2008-01-01

Existing empirical evidence on substance use among young people living in residential state care during adolescence is comparatively limited. This paper reports on substance use trends of young people living in residential state care during three annual data-sweeps when aged 14, 15 and 16 years. A repeated cross-sectional research design was…

Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders.

PubMed

Hudziak, J J; Boffeli, T J; Kreisman, J J; Battaglia, M M; Stanger, C; Guze, S B; Kriesman, J J

1996-12-01

The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders. Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity. Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, or substance abuse disorders. Patterns of comorbidity for panic (51%), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies. The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the

Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse.

PubMed

Dimaggio, Giancarlo; D'Urzo, Maddalena; Pasinetti, Manuela; Salvatore, Giampaolo; Lysaker, Paul H; Catania, Dario; Popolo, Raffaele

2015-02-01

Many patients with substance abuse problems present with co-occurrent cluster C personality disorders. Focusing on both disorders disrupts the maintenance mechanisms and the vicious cycle between the 2 conditions; however, treatment teams often neglect this issue. In this work, we describe the features of metacognitive interpersonal therapy as applied to a man with avoidant and depressive personality disorders and heroin, cocaine, and alcohol abuse. Psychotherapy proceeded through the following steps: (a) conducting drug therapy to deal with symptoms of abstinence from heroin; (b) forming a therapeutic bond to overcome the patient's severe emotional withdrawal; (c) fostering basic metacognitive capacities such as awareness of emotions and their triggers; (d) sharing formulations of maladaptive interpersonal schemas and descriptions of the associated states of mind; (e) conveying an understanding of the link between interpersonal events (recent ones and traumatic memories) and substance abuse; (f) facilitating the acquisition of critical distance from maladaptive schemas; and (g) promoting the use of adaptive coping skills instead of resorting to substance abuse. Implications for generalizing these procedures to the treatment of other patients with co-occurrent personality disorders and substance abuse are described. © 2014 Wiley Periodicals, Inc.

Pathways to Preventing Substance Use Among Youth in Foster Care.

PubMed

Kim, Hyoun K; Buchanan, Rohanna; Price, Joseph M

2017-07-01

Substance use problems are highly prevalent among youth in foster care. Such problems in adolescence have long-lasting implications for subsequent adjustment throughout adulthood and even across generations. Although several programs have demonstrated positive results in reducing substance use in at-risk youth, few studies have systemically examined how such programs work for foster youth and whether they are effective for both genders. This study examined the efficacy of KEEP SAFE, a family-based and skill-focused program designed to prevent substance use and other related health risking behaviors among youth in foster care. We hypothesized that improving the caregiver-youth relationship would lead to later reductions in youths' involvement with deviant peers, which subsequently would lead to less substance use, and that this mechanism would work comparably for both genders. A sample of 259 youth (154 girls, ages 11-17 years) in foster care and their caregivers participated in a randomized controlled trial and was followed for 18 months post-baseline. Results indicated that the intervention significantly reduced substance use in foster youth at 18 months post-baseline and that the intervention influenced substance use through two processes: youths' improved quality of relationships with caregivers at 6 months post-baseline and fewer associations with deviant peers at 12 months post-baseline. This suggests that these two processes may be fruitful immediate targets in substance use prevention programs for foster youth. We also found little gender differences in direct and mediating effects of the intervention, suggesting KEEP SAFE may be effective for both genders in foster care.

Prevention of adolescent substance abuse through the development of personal and social competence.

PubMed

Botvin, G J

1983-01-01

The initiation of substance use typically begins during adolescence and appears to be the result of the complex interplay of social, personality, cognitive, attitudinal, behavioral, and developmental factors. Traditional smoking, alcohol, and drug education programs have attempted to increase students' knowledge of the risks associated with using these substances in the hope that this would deter use. Other programs have attempted to enrich the personal and social development of students through what has been referred to as "affective" education. Unfortunately, the inescapable conclusion to be drawn from the substance abuse prevention literature is that few of these programs have demonstrated any degree of success in terms of the actual prevention of substance use/abuse. Traditional educational approaches to substance abuse prevention appear to be inadequate because they are based on faulty assumptions and are too narrow in their focus. The "affective" education approaches, on the other hand, appear to have placed too little emphasis on the acquisition of the kind of skills that are likely to increase general personal competence and enable students to cope with the various interpersonal and intrapersonal pressures to begin using tobacco, alcohol, or drugs. From the perspective of social learning theory (Bandura 1977) and problem behavior theory (Jessor and Jessor 1977), substance use is conceptualized as a socially learned, purposive, and functional behavior which is the result of the interplay of social (environmental) and personal factors. One potentially effective approach to substance abuse prevention might involve enhancing general personal competence and teaching adolescents the kind of problem-specific skills and knowledge which will increase their ability to resist the various forms of pro-substance-use social pressure. Brief reviews of the social skills training literature and the literature related to techniques for coping with anxiety not only provide

Changes in personal networks of women in residential and outpatient substance abuse treatment.

PubMed

Min, Meeyoung O; Tracy, Elizabeth M; Kim, Hyunsoo; Park, Hyunyong; Jun, Minkyoung; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre

2013-10-01

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment. Copyright © 2013 Elsevier Inc. All rights reserved.

Changes in Personal Networks of Women in Residential and Outpatient Substance Abuse Treatment

PubMed Central

Min, Meeyoung O.; Tracy, Elizabeth M.; Kim, Hyunsoo; Park, Hyunyong; Jun, MinKyong; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre

2013-01-01

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment. PMID:23755971

Parity for mental health and substance abuse care under managed care.

PubMed

Frank, Richard G.; McGuire, Thomas G.

1998-12-01

BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less

Enhancing Readiness-to-Change Substance Abuse in Persons with Schizophrenia

PubMed Central

Carey, Kate B.; Purnine, Daniel M.; Maisto, Stephen A.; Carey, Michael P.

2008-01-01

This article describes a four-session intervention designed for persons with co-occurring substance abuse and schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing mental health treatment in an outpatient setting. The intervention targets those dually diagnosed individuals with low readiness-to-change as indicated by current use, and/or low level of engagement in treatment for substance abuse. The intervention is designed to increase problem recognition, to enhance motivation to change maladaptive patterns of substance use, and to facilitate engagement in substance abuse. To achieve these goals, we have adopted constructs from the Transtheoretical Model of Change and utilize principles of motivational and harm reduction interventions, and tailored them to the target population. PMID:11428245

Personality traits and illicit substances: the moderating role of poverty.

PubMed

Sutin, Angelina R; Evans, Michele K; Zonderman, Alan B

2013-08-01

Illicit substances increase risk of morbidity and mortality and have significant consequences for society. Personality traits are associated with drug use; we test whether these associations vary by socioeconomic status. Participants (N=412) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study completed the Revised NEO Personality Inventory and self-reported use of opiates and cocaine. 50% of participants were living below 125% of the federal poverty line. Mean-level personality differences across never, former, and current opiate/cocaine users were compared. Logistic regressions compared never versus current users and interactions between personality traits and poverty status tested whether these associations varied by socioeconomic status. High Neuroticism and low Agreeableness increased risk of drug use. The association between low Conscientiousness and drug use was moderated by poverty, such that low Conscientiousness was a stronger risk factor for illicit substance use among those with relatively higher SES. For every standard deviation decrease in Conscientiousness, there was a greater than 2-fold increase in risk of illicit substance use (OR=2.15, 95% CI=1.45-3.17). Conscientiousness was unrelated to drug use among participants living below 125% of the federal poverty line. Under favorable economic conditions, the tendency to be organized, disciplined, and deliberate is protective against drug use. These tendencies, however, matter less when financial resources are scarce. In contrast, those prone to emotional distress and antagonism are at greater risk for current drug use, regardless of their economic situation. Published by Elsevier Ireland Ltd.

Prenatal and postpartum care of women with substance use disorders.

PubMed

Gopman, Sarah

2014-06-01

The incidence of substance abuse in pregnancy is substantial and affects pregnancy health and outcomes. Multiple challenges exist in the identification of women with substance abuse disorders in pregnancy and the provision of care. A multidisciplinary approach has been shown to be most successful in providing comprehensive and effective care. This article outlines key aspects of prenatal and postpartum care, with a brief overview provided of intrapartum care. Issues covered include screening, opioid replacement therapy, comorbid medical and psychiatric conditions, environmental stressors, parenting preparation, pain management in labor and postpartum, breastfeeding guidance, prevention of relapse, and assistance with postpartum transition to primary care. Copyright © 2014 Elsevier Inc. All rights reserved.

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

EPA Pesticide Factsheets

The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the documented or potential hazards associated with trace exposure to these anthropogenic substances, many of which are highly bioactive and perpetually present in many aquatic locales. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized.Of the many facets involved in this complex issue, that of sources/origins and environmental occurrence is the better understood end of the larger spectrum. The potential for adverse ecological or human health effects (especially from long-term, combined exposure to multiple xenobiotics at low concentrations) is the l

Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial.

PubMed

Watson, Dennis P; Ray, Bradley; Robison, Lisa; Xu, Huiping; Edwards, Rhiannon; Salyers, Michelle P; Hill, James; Shue, Sarah

2017-01-01

There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana's Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients' recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention. The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT's impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences. Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration. ClinicalTrials.gov (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.

The Standardized Assessment of Personality-Abbreviated Scale as a screening instrument for personality disorders in substance-dependent criminal offenders.

PubMed

Jansen, Brigitte P M; Damen, Katinka F M; Hoffman, Tonko O; Vellema, Sietske L

2013-05-01

Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted. Copyright © 2012 John Wiley & Sons, Ltd.

Individualized population care: linking personal care to population care in general practice.

PubMed

Buetow, Stephen; Getz, Linn; Adams, Peter

2008-10-01

General practice is increasingly expected to deliver population care to individual patients. The feasibility and ethics of this policy shift have been challenged. Our aim is to suggest how to deliver population care while protecting personal care. We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for individualized population care. Individualized population care can enable general practice to meet the health targets of individual patients in the light of population-based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the individual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the individuality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of individualized population care. We advocate a constructive but critical attitude towards the idea of population-based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into individualized population care. However, this presupposes clinical-epidemiological expertise and moral awareness in practising clinicians.

The Association between Personality Factors and Self-Reported Substance Use in Adolescents.

ERIC Educational Resources Information Center

Chambliss, Catherine

High school and college students (N=321) completed the Mini Markers Five Factors Personality Scale (MMFFPS) and items assessing recent substance use, in order to permit an assessment of the relationship between five basic personality factors and reported use of cigarette, alcohol, and marijuana. A 2 x 2 MANOVA (personality factors; low and high;…

Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorders.

PubMed

Ritsher, Jennifer Boyd; McKellar, John D; Finney, John W; Otilingam, Poorni G; Moos, Rudolf H

2002-11-01

In a cohort of 2,595 male patients in VA intensive treatment programs for substance use disorders (SUD), we tested whether psychiatric comorbidity, outpatient care and mutual help group attendance during the first two follow-up years predicted remission status at Year 5, controlling for covariates. Logistic regression modeling of longitudinal data was used to test the hypotheses. Dual diagnosis patients were less likely to be in remission at Year 5 than SUD-only patients. Outpatient care was at best only weakly related to Year 5 remission status. By contrast, mutual help involvement substantially improved the chances of substance use remission at Year 5 for both SUD-only and dual diagnosis patients. Mutual help involvement did not, however, offset the poorer prognosis for dual diagnosis patients. Because mutual help groups specifically targeted to individuals with comorbid substance use and psychiatric disorders are currently rare, further research is recommended to investigate whether they are more effective than standard SUD mutual help groups in facilitating the recovery of persons with dual diagnoses.

Psychiatric severity and HIV-risk sexual behaviors among persons with substance use disorders.

PubMed

Majer, John M; Komer, Anne C; Jason, Leonard A

2015-01-01

The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well-established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use), and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity) to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110), while 27.8% reported using cocaine (n = 74) and 12.8% reported using alcohol (n = 34). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not frequency of unprotected behavior), such that those higher

Psychiatric Severity and HIV-Risk Sexual Behaviors among Persons with Substance Use Disorders

PubMed Central

Majer, John M.; Komer, Anne C.; Jason, and Leonard A.

2014-01-01

Objective The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use) and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity), to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Methods Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110, 110/266), while 27.8% reported using cocaine (n = 74, 74/266) and 12.8% reported using alcohol (n = 34, 34/266). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Results Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not

Co-Occurring Disorders: A Challenge for Mexican Community-Based Residential Care Facilities for Substance Use.

PubMed

Marín-Navarrete, Rodrigo; Medina-Mora, María Elena; Horigian, Viviana E; Salloum, Ihsan M; Villalobos-Gallegos, Luis; Fernández-Mondragón, José

2016-01-01

In Mexico, specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. More than 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however, suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high-quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology, and other health risks. This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology, and psychiatric disorder diagnostic criteria. The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%), followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73]; p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78]; p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). Co-occurring disorders are highly

Relational Care for Perinatal Substance Use: A Systematic Review.

PubMed

Kramlich, Debra; Kronk, Rebecca

2015-01-01

The purpose of this systematic review of the literature is to highlight published studies of perinatal substance use disorder that address relational aspects of various care delivery models to identify opportunities for future studies in this area. Quantitative, qualitative, and mixed-methods studies that included relational variables, such as healthcare provider engagement with pregnant women and facilitation of maternal-infant bonding, were identified using PubMed, Scopus, and EBSCO databases. Key words included neonatal abstinence syndrome, drug, opioid, substance, dependence, and pregnancy. Six studies included in this review identified statistically and/or clinically significant positive maternal and neonatal outcomes thought to be linked to engagement in antenatal care and development of caring relationships with healthcare providers. Comprehensive, integrated multidisciplinary services for pregnant women with substance use disorder aimed at harm reduction are showing positive results. Evidence exists that pregnant women's engagement with comprehensive services facilitated by caring relationships with healthcare providers may improve perinatal outcomes. Gaps in the literature remain; studies have yet to identify the relative contribution of multiple risk factors to adverse outcomes as well as program components most likely to improve outcomes.

Improving substance abuse screening and intervention in a primary care clinic.

PubMed

Neushotz, Lori A; Fitzpatrick, Joyce J

2008-04-01

Despite recent efforts to educate primary care providers in the identification and management of patients presenting with substance abuse problems, many opportunities to identify and intervene with these patients are overlooked. This project was designed to identify factors that interfere with rates of screening and brief intervention (SBI) of substance abuse problems in a primary care clinic in a major academic medical center in New York City. Six informants representing the disciplines of medicine, nursing, and social work in the primary care clinic provided information regarding SBI. Analysis was focused on substantiation of the need for enhanced diffusion of knowledge related to screening for substance abuse problems to improve rates of SBI in primary care. Recommendations for improvement included continued promotion of SBI by influential role models and opinion leaders, improvement in primary care providers' perceptions of the perceived characteristics of SBI to improve rates of adoption, implementation of interdisciplinary educational initiatives toward the goal of improving rates of SBI in the primary care clinic, and initiation of translational research at the clinic supporting SBI in primary care.

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons.

PubMed

Marques, Tais Cristina Nascimento; Sarracini, Karin Luciana Migliato; Cortellazzi, Karine Laura; Mialhe, Fábio Luiz; de Castro Meneghim, Marcelo; Pereira, Antonio Carlos; Ambrosano, Glaucia Maria Bovi

2015-03-20

The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil. A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05. The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life. This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls

PubMed Central

Forns, Maria; Goti, Javier; Castro-Fornieles, Josefina

2015-01-01

Substance use is a risk behavior that tends to increase during adolescence, a time when part of the personality is still in development. Traditionally, personality psychopathology has been measured in terms of categories, although dimensional models have demonstrated better consistency. This study aimed to analyze differences in personality profiles between adolescents with substance use disorders (SUD n = 74) and matched community controls (MCC n = 74) using the Personality Psychopathology Five (PSY-5) dimensional model. Additionally, we compared age at first drug use, level of drug use and internalizing and externalizing symptoms between the groups. In this study, the PSY-5 model has proved to be useful for differentiating specific personality disturbances in adolescents with SUD and community adolescents. The Disconstraint scale was particularly useful for discriminating adolescents with substance use problems and the Delinquent Attitudes facet offered the best differentiation. PMID:26082873

Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders.

PubMed

Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard

2011-04-01

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. Copyright © 2011 Elsevier Inc. All rights reserved.

Substance abuse intervention for health care workers: a preliminary report.

PubMed

Lapham, S C; Chang, I; Gregory, C

2000-05-01

The Workplace Managed Care Cooperative Agreement project targets 3,300 health care professionals in hospital, specialty clinic, and primary care settings located in metropolitan New Mexico communities. This project will evaluate whether enhancements to existing substance abuse prevention/early intervention programs can prevent the onset of risky drinking, reduce prevalence of risky drinking, better identify employees who abuse alcohol and drugs, and improve employee wellness. This article describes one such enhancement (Project WISE [Workplace Initiative in Substance Education]), implemented at Lovelace Health Systems. Project WISE includes relatively low-cost elements such as substance abuse awareness training, information on how to reduce drinking, and brief motivational counseling. Evaluation will consist of baseline comparisons of the intervention and comparison sites, a process evaluation, a qualitative analysis using focus groups, and an outcome evaluation using health and work records. Methodological challenges, solutions, and implications for researchers undertaking similar projects are presented.

PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders.

PubMed

Mansfield, Alyssa J; Greenbaum, Mark A; Schaper, Kim M; Banducci, Anne N; Rosen, Craig S

2017-06-01

This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy. Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010. Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units. Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD treatment or of sufficient psychotherapy among VHA-enrolled veterans.

The Relation Between Antisocial and Borderline Personality Symptoms and Early Maladaptive Schemas in a Treatment Seeking Sample of Male Substance Users

PubMed Central

Shorey, Ryan C.; Anderson, Scott; Stuart, Gregory L.

2014-01-01

Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. PMID:23650153

Personal and Social Motivations as Predictors of Substance Use among College Students.

ERIC Educational Resources Information Center

Hadan, Tony L.; Edmundson, Elizabeth W.

1991-01-01

Administered Drug Use Survey to 1,013 college students to determine predictability of self-reported drug use utilizing motivations (social and personal) commonly reported by substance users. Results indicated that personal motivations subscale was stronger predictor in every model examined with exception of model that predicted alcohol use index.…

Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use.

PubMed

Jarlenski, Marian; Hogan, Caroline; Bogen, Debra L; Chang, Judy C; Bodnar, Lisa M; Van Nostrand, Elizabeth

State policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients' care seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes. This study sought to characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws. We conducted a systematic content analysis of statutes in all U.S. states that mentioned reporting by health care providers of substance use by pregnant women or infants exposed to substances in utero; inter-rater reliability was high. We calculated the number of states, and proportion of U.S. births occurring in states, with processes for mandatory reporting of perinatal substance use to authorities, and substance use disorder treatment provision for individuals who are reported. Twenty states (corresponding with 31% of births) had laws requiring health care providers to report perinatal substance use to child protective authorities, and four states (18% of births) had laws requiring reporting only when a health care provider believed the substance use was associated with child maltreatment. About one-half of states (13) with any reporting law had a provision promoting substance use disorder treatment in the perinatal period. Findings inform the ongoing debate about how health policies may be used to reduce the population burden of perinatal substance use. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Managed care, networks and trends in hospital care for mental health and substance abuse treatment in Massachusetts: 1994-1999.

PubMed

Fleming, Elaine; Lien, Hsienming; Ma, Ching-To Albert; McGuire, Thomas G

2003-03-01

Rates of inpatient care for mental health and substance abuse treatment have been reported to fall after the introduction of managed care, but the actual decline may be overstated. Almost all managed care impact studies are based on pre-post comparisons, which have two drawbacks: secular downward trends may be attributed to a managed care effect and self-selection may exaggerate the impact of managed care. Therefore it is useful to examine long-term population-based trends in use associated with the growth of managed care. This paper examines trends in inpatient care for mental health and substance abuse treatment in Massachusetts between 1994 and 1999 by service provider and payer. We analyze how managed care impacts the trends in mental health and substance abuse care. We provide an overview of the health market in Massachusetts and compare trends in mental health and substance abuse services with all inpatient services. To analyze the impact of managed care, we compare the per discharge cost of managed care and fee for service plans in Medicare and Medicaid. Finally, we examine the role played by hospital networks in managed care. The reduction in service costs for mental health and substance abuse, about 25% in six years, is mostly due to the decline in the average cost per inpatient episode. This is only slightly greater than the decline in costs for all inpatient care. Managed care has reduced both the quantity (average length of stay) and intensity of health care (expenditure per day). Simulations suggest that the creation of hospital networks by managed care accounts for around 50% of the differential between the average costs of the HMO and FFS sectors. We find that the cost reductions in mental health and substance abuse services are larger than for physical health, but not by much. The average length of stay and average day cost is lower for managed care plans than for FFS plans, and much of this difference is attributable to the hospitals managed care

Official conceptualizations of person-centered care: which person counts?

PubMed

O'Dwyer, Ciara

2013-08-01

Numerous studies have indicated that a "psycho-social" person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a "consumer-based" rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the "Fourth Age". This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia. Copyright © 2013 Elsevier Inc. All rights reserved.

21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

Code of Federal Regulations, 2010 CFR

2010-04-01

... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or if...

21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

Code of Federal Regulations, 2011 CFR

2011-04-01

... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or if...

Genetic variation in personality traits explains genetic overlap between borderline personality features and substance use disorders

PubMed Central

Few, Lauren R.; Grant, Julia D; Trull, Timothy J.; Statham, Dixie J.; Martin, Nicholas G.; Lynskey, Michael T.; Agrawal, Arpana

2014-01-01

Aims To examine the genetic overlap between borderline personality features (BPF) and substance use disorders (SUDs) and the extent to which variation in personality traits contributes to this covariance. Design Genetic structural equation modelling was used to partition the variance in and covariance between personality traits, BPF, and SUDs into additive genetic, shared, and individual-specific environmental factors. Setting All participants were registered with the Australian Twin Registry. Participants A total of 3,127 Australian adult twins participated in the study. Measurements Diagnoses of DSM-IV alcohol and cannabis abuse/dependence (AAD; CAD), and nicotine dependence (ND) were derived via computer-assisted telephone interview. BPF and five-factor model personality traits were derived via self-report questionnaires. Findings Genetic factors were responsible for 49% (95%CI: 42%–55%) of the variance in BPF, 38–42% (95%CI range: 32%–49%) for personality traits and 47% (95%CI: 17%–77%), 54% (95%CI: 43%–64%), and 78% (67%–86%) for ND, AAD and CAD, respectively. Genetic and individual-specific environmental correlations between BPF and SUDs ranged from .33–.56 (95%CI range: .19–.74) and .19–.32 (95%CI range: .06–.43), respectively. Overall, there was substantial support for genetic influences that were specific to AAD, ND and CAD (31%–69%). Finally, genetic variation in personality traits was responsible for 11% (Extraversion for CAD) to 59% (Neuroticism for AAD) of the correlation between BPF and SUDs. Conclusions Both genetic and individual-specific environmental factors contribute to comorbidity between borderline personality features and substance use disorders. A substantial proportion of this comorbidity can be attributed to variation in normal personality traits, particularly Neuroticism. PMID:25041562

Reframing Person-Centered Nursing Care for Persons With Dementia

PubMed Central

Penrod, Janice; Yu, Fang; Kolanowski, Ann; Fick, Donna M.; Loeb, Susan J.; Hupcey, Judith E.

2010-01-01

Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia. PMID:17378465

Perspectives and strategies of alternative methods used in the risk assessment of personal care products.

PubMed

Quantin, P; Thélu, A; Catoire, S; Ficheux, H

2015-11-01

Risk assessment for personal care products requires the use of alternative methods since animal testing is now totally banned. Some of these methods are effective and have been validated by the "European Union Reference Laboratory for alternatives to animal testing"; but there is still a need for development and implementation of methods for specific endpoints. In this review, we have focused on dermal risk assessment because it is the prime route of absorption and main target organ for personal care products. Within this field, various areas must be assessed: irritation, sensitisation and toxicokinetic. Personal care product behaviour after use by the consumer and potential effects on the environment are also discussed. The purpose of this review is to show evolution and the prospects of alternative methods for safety dermal assessment. Assessment strategies must be adapted to the different chemical classes of substances studied but also to the way in which they are used. Finally, experimental and theoretical technical parameters that may impact on measured effects have been identified and discussed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Re-offending in forensic patients released from secure care: the role of antisocial/borderline personality disorder co-morbidity, substance dependence and severe childhood conduct disorder.

PubMed

Howard, Rick; McCarthy, Lucy; Huband, Nick; Duggan, Conor

2013-07-01

Research suggests that a particular externalising phenotype, manifested in a developmental trajectory from severe childhood conduct disorder through early-onset substance abuse to adult antisocial/borderline personality disorder co-morbidity, may increase risk of antisocial behaviour in general and criminal recidivism in particular. This study aims to test the hypothesis that antisocial/borderline co-morbidity together with the triad of substance dependence, severe conduct disorder and borderline pathology would result in an increased risk of criminal recidivism. Fifty-three men who had been assessed and treated in a secure hospital unit were followed up after they had returned to the community. They were assessed for severity of the following: (i) antisocial personality disorder; (ii) borderline personality disorder; (iii) drug/alcohol dependence; and (iv) high Psychopathy Checklist Revised scores (factors 1 and 2). Patients with antisocial/borderline co-morbidity took significantly less time to re-offend compared with those without such co-morbidity. Both Psychopathy Checklist Revised factor 2 and the tripartite risk measure significantly predicted time to re-offence; the former largely accounted for the predictive accuracy of the latter. Risk of criminal recidivism can be adequately assessed without recourse to the pejorative term 'psychopath'. It is sufficient to assess the presence of the three elements of our risk measure: borderline and antisocial personality disorders in the context of drug/alcohol dependence and severe childhood conduct disorder. Practical implications of the study are as follows. (i) Sound assessment of personality, inclusive of a detailed history of childhood conduct disorder as well as adolescent and adult substance misuse, yields good enough information about risk of recidivism without recourse to the pejorative concept of 'psychopathy'. (ii) Given the high risk of alcohol-related violence in individuals with antisocial/borderline co

A systematic review of interventions for co-occurring substance use and borderline personality disorders.

PubMed

Lee, Nicole K; Cameron, Jacqui; Jenner, Linda

2015-11-01

The aim of this study was to undertake a systematic review on effective treatment options for co-occurring substance use and borderline personality disorders to examine effective treatments for this group. A systematic review using a narrative analysis approach was undertaken as there were too few studies within each intervention type to undertake a meta-analysis. The inclusion criteria comprised of English language studies (between 1999 and 2014) and a sample of >70% borderline personality disorder, with measurable outcomes for substance use and borderline personality disorder. All abstracts were screened (n = 376) resulting in 49 studies assessed for eligibility, with 10 studies, examining three different treatment types, included in the final review. There were four studies that examined dialectical behaviour therapy (DBT), three studies that examined dynamic deconstructive psychotherapy (DDP) and three studies that examined dual-focused schema therapy (DFST). Both DBT and DDP demonstrated reductions in substance use, suicidal/self-harm behaviours and improved treatment retention. DBT also improved global and social functioning. DFST reduced substance use and both DFST and DPP improved treatment utilisation, but no other significant positive changes were noted. Overall, there were a small number of studies with small sample sizes, so further research is required. However, in the absence of a strong evidence base, there is a critical need to respond to this group with co-occurring borderline personality disorder and substance use. Both DBT and DPP showed some benefit in reducing symptoms, with DBT the preferred option given its superior evidence base with women in particular. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model.

PubMed

Loonen, Jacqueline J; Blijlevens, Nicole Ma; Prins, Judith; Dona, Desiree Js; Den Hartogh, Jaap; Senden, Theo; van Dulmen-Den Broeder, Eline; van der Velden, Koos; Hermens, Rosella Pmg

2018-01-16

Survivors of childhood and adult-onset cancer are at lifelong risk for the development of late effects of treatment that can lead to serious morbidity and premature mortality. Regular long-term follow-up aiming for prevention, early detection and intervention of late effects can preserve or improve health. The heterogeneous and often serious character of late effects emphasizes the need for specialized cancer survivorship care clinics. Multidisciplinary cancer survivorship care requires a coordinated and well integrated health care environment for risk based screening and intervention. In addition survivors engagement and adherence to the recommendations are also important elements. We developed an innovative model for integrated care for cancer survivors, the "Personalized Cancer Survivorship Care Model", that is being used in our clinic. This model comprises 1. Personalized follow-up care according to the principles of Person Centered Care, aiming to empower survivors and to support self management, and 2. Organization according to a multidisciplinary and risk based approach. The concept of person centered care is based on three components: initiating, integrating and safeguarding the partnership with the patient. This model has been developed as a universal model of care that will work for all cancer survivors in different health care systems. It could be used for studies to improve self efficacy and the cost-effectiveness of cancer survivorship care.

Reliability of self-reported antisocial personality disorder symptoms among substance abusers.

PubMed

Cottler, L B; Compton, W M; Ridenour, T A; Ben Abdallah, A; Gallagher, T

1998-02-01

It is estimated that from 20 to 60% of substance abusers meet criteria for Antisocial Personality Disorder (APD). An accurate and reliable diagnosis is important because persons meeting criteria for APD, by the nature of their disorder, are less likely to change behaviors and more likely to relapse to both substance abuse and high risk behaviors. To understand more about the reliability of the disorder and symptoms of APD, the Diagnostic Interview Schedule Version III-R (DIS) was administered to 453 substance abusers ascertained from treatment programs and from the general population (St Louis Epidemiological Catchment Area (ECA) follow-up study). Estimates of the 1 week, test-retest reliability for the childhood conduct disorder criterion, the adult antisocial behavior criterion, and APD diagnosis fell in the good agreement range, as measured by kappa. The internal consistency of these DIS symptoms was adequate to acceptable. Individual DIS criteria designed to measure childhood conduct disorder ranged from fair to good for most items; reliability was slightly higher for the adult antisocial behavior symptom items. Finally, self-reported 'liars' were no more unreliable in their reports of their behaviors than 'non-liars'.

Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care

PubMed Central

Entwistle, Vikki A.; Watt, Ian S.

2013-01-01

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. PMID:23862598

Relationship between craving and personality in treatment-seeking women with substance-related disorders

PubMed Central

Zilberman, Monica L; Tavares, Hermano; el-Guebaly, Nady

2003-01-01

Background Individual differences may impact susceptibility to addiction. The impact of personality features on drug craving, however, has not been studied, particularly in women. Methods Ninety-five treatment-seeking women with substance dependence, abstinent for at least 5 and no more than 21 days, were investigated regarding the correlation between personality factors and craving. Personality was assessed using the Temperament and Character Inventory (TCI), the NEO Personality Inventory Revised (NEO-PI-R), and the Barratt Impulsiveness Scale version 11 (BIS-11). Cravings were assessed through the Pennsylvania Craving Scale (PCS), and the Craving Questionnaire (CQ). Anxiety and depressive symptomatology were also recorded. Results Craving scores were positively correlated with depression and negatively correlated with number of days abstinent from substance use. Also, craving scores were positively associated with the novelty-seeking factor from the TCI and the total score on the BIS-11, and negatively associated with the conscientiousness and agreeableness facets of the NEO-PI-R. Conclusion Findings suggest that personality features, particularly impulsiveness, can be important predictors of craving in women, which has important implications for treatment planning. PMID:12525264

Hospital care for mental health and substance abuse conditions in Parkinson's disease.

PubMed

Willis, Allison W; Thibault, Dylan P; Schmidt, Peter N; Dorsey, E Ray; Weintraub, Daniel

2016-12-01

The objective of this study was to examine mental health conditions among hospitalized individuals with Parkinson's disease in the United States. This was a serial cross-sectional study of hospitalizations of individuals aged ≥60 identified in the Nationwide Inpatient Sample dataset from 2000 to 2010. We identified all hospitalizations with a diagnosis of PD, alcohol abuse, anxiety, bipolar disorder, depression, impulse control disorders, mania, psychosis, substance abuse, and attempted suicide/suicidal ideation. National estimates of each mental health condition were compared between hospitalized individuals with and without PD. Hierarchical logistic regression models determined which inpatient mental health diagnoses were associated with PD, adjusting for demographic, payer, geographic, and hospital characteristics. We identified 3,918,703 mental health and substance abuse hospitalizations. Of these, 2.8% (n = 104, 437) involved a person also diagnosed with PD. The majority of mental health and substance abuse patients were white (86.9% of PD vs 83.3% of non-PD). Women were more common than men in both groups (male:female prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34), psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse control disorders (adjusted odds ratio 1.51, 1.31-1.75), and mania (adjusted odds ratio 1.43, 1.18-1.74) were more likely among PD patients, alcohol abuse was less likely (adjusted odds ratio 0.26, 0.25-0.27). We found no PD-associated difference in suicide-related care. PD patients have unique patterns of acute care for mental health and substance abuse. Research is needed to guide PD treatment in individuals with pre-existing psychiatric illnesses, determine cross provider reliability of psychiatric diagnoses in PD patients, and inform efforts to improve psychiatric outcomes. © 2016 International Parkinson and

Attitude to substance abuse: do personality and socio-demographic factors matter?

PubMed

Rahimian Boogar, Isaac; Tabatabaee, Sayed Mosa; Tosi, Jalileh

2014-09-01

Substance abuse is a serious global problem that is affected by multiple psychosocial and socio-demographic factors. This study aimed to investigate the leading factors in positive attitude and tendency toward substance abuse in terms of personality, socio-economic, and socio-demographic factors. In a cross-sectional study, 200 college students (105 females and 95 males) residing in Damghan University dormitory in northeast of Iran were recruited by random sampling from March to July 2013. The participants were instructed and asked to complete the NEO FIVE-factor Inventory, the attitude to substance abuse scale, and the demographic questionnaire. Then data were analyzed by stepwise multiple regression employing PASW 18. Being male sex and neuroticism had a significant positive role in predicting positive attitude toward substance abuse in university students. In addition, agreeableness, conscientiousness, openness, and socio-economic status had a significant negative role in predicting tendency toward substance abuse (P < 0.001). Extraversion had no significant role in prediction of positive attitude to substance abuse (P > 0.05). Lower agreeableness, decreased conscientiousness, higher neuroticism, diminished openness, low socio-economic status, and male sex might make university students more inclined to substance abuse. Thus, it is reasonable to show the importance of these factors in tailored prevention programs.

Substance Abuse Treatment Stage and Personal Networks of Women in Substance Abuse Treatment

PubMed Central

Tracy, Elizabeth M.; Kim, HyunSoo; Brown, Suzanne; Min, Meeyoung O.; Jun, Min Kyoung; McCarty, Christopher

2012-01-01

This study examines the relationship among 4 treatment stages (i.e., engagement, persuasion, active treatment, relapse prevention) and the composition, social support, and structural characteristics of personal networks. The study sample includes 242 women diagnosed with substance dependence who were interviewed within their first month of intensive outpatient treatment. Using EgoNet software, the women reported on their 25 alter personal networks and the characteristics of each alter. With one exception, few differences were found in the network compositions at different stages of substance abuse treatment. The exception was the network composition of women in the active treatment stage, which included more network members from treatment programs or 12-Step meetings. Although neither the type nor amount of social support differed across treatment stages, reciprocity differed between women in active treatment and those in the engagement stage. Networks of women in active treatment were less connected, as indicated by a higher number of components, whereas networks of women in the persuasion stage had a higher degree of centralization, as indicated by networks dominated by people with the most ties. Overall, we find social network structural variables to relate to the stage of treatment, whereas network composition, type of social support, and sociodemographic variables (with a few exceptions) do not relate to treatment stage. Results suggest that social context, particularly how social contacts are arranged around clients, should be incorporated into treatment programs, regardless of demographic background. PMID:22639705

Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis.

PubMed

Walley, Alexander Y; Paasche-Orlow, Michael; Lee, Eugene C; Forsythe, Shaula; Chetty, Veerappa K; Mitchell, Suzanne; Jack, Brian W

2012-03-01

Hospital discharge may be an opportunity to intervene among patients with substance use disorders to reduce subsequent hospital utilization. This study determined whether having a substance use disorder diagnosis was associated with subsequent acute care hospital utilization. We conducted an observational cohort study among 738 patients on a general medical service at an urban, academic, safety-net hospital. The main outcomes were rate and risk of acute care hospital utilization (emergency department visit or hospitalization) within 30 days of discharge. The main independent variable was presence of a substance use disorder primary or secondary discharge diagnosis code at the index hospitalization. At discharge, 17% of subjects had a substance use disorder diagnosis. These patients had higher rates of recurrent acute care hospital utilization than patients without substance use disorder diagnoses (0.63 vs 0.32 events per subject at 30 days, P < 0.01) and increased risk of any recurrent acute care hospital utilization (33% vs 22% at 30 days, P < 0.05). In adjusted Poisson regression models, the incident rate ratio at 30 days was 1.49 (95% confidence interval, 1.12-1.98) for patients with substance use disorder diagnoses compared with those without. In subgroup analyses, higher utilization was attributable to those with drug diagnoses or a combination of drug and alcohol diagnoses, but not to those with exclusively alcohol diagnoses. Medical patients with substance use disorder diagnoses, specifically those with drug use-related diagnoses, have higher rates of recurrent acute care hospital utilization than those without substance use disorder diagnoses.

The Relationship between Personality Disorders and the Type of Crime Committed and Substance Used among Prisoners.

PubMed

Fakhrzadegan, Shahin; Gholami-Doon, Hossein; Shamloo, Bagher; Shokouhi-Moqhaddam, Solmaz

2017-04-01

Prisoners are a vulnerable group within societies, and also threaten society due to their dangerous behavior. The objective of the present study was to evaluate the relationship between prisoners' personality disorders and their crime and substance use. This was a descriptive-correlational study. The statistical population consisted of all prisoners of Kerman, Iran. Through stratified random sampling, 228 prisoners (114 women and 114 men) were selected as the study subjects. Data were collected through clinical interviews by a psychiatrist [structured interviews based on the Diagnostic and Statistical Manual of Mental Disorders-4 th Edition (DSM-IV)], a social worker, and a physician and using a demographic characteristics questionnaire and the Millon Clinical Multiaxial Inventory-2 nd Edition (MCMI-II) (the 175-item Persian version). Data were analyzed using frequency, percentage, and Fisher's z-distribution in SPSS software. The results showed that 87.3% of women and 83.3% of men had a personality disorder at the time of committing the crime. Moreover, 46.5% of the target population had developed substance dependence at the time of committing the crime. The highest percentage of substance abuse in both women and men was related to opium, especially in the age group of 18-28 years. The highest rates of mental disorders were related to major depressive disorder (MDD), dependent personality disorder (DPD), borderline personality disorder (BPD), and antisocial personality disorder (ASPD), respectively. In these personality disorders, opium, methamphetamine, heroin, and alcohol, respectively, had the highest rates of use. The results of Fisher's z-distribution illustrated a significant relationship between personality disorders and type of crime committed and substance used. The total rate of substance abuse was lower in sexual offenses and fraud, but was the highest in theft and drug trafficking. The presence of personality disorders in the target population is

The Relationship between Personality Disorders and the Type of Crime Committed and Substance Used among Prisoners

PubMed Central

Fakhrzadegan, Shahin; Gholami-Doon, Hossein; Shamloo, Bagher; Shokouhi-Moqhaddam, Solmaz

2017-01-01

Background Prisoners are a vulnerable group within societies, and also threaten society due to their dangerous behavior. The objective of the present study was to evaluate the relationship between prisoners’ personality disorders and their crime and substance use. Methods This was a descriptive-correlational study. The statistical population consisted of all prisoners of Kerman, Iran. Through stratified random sampling, 228 prisoners (114 women and 114 men) were selected as the study subjects. Data were collected through clinical interviews by a psychiatrist [structured interviews based on the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV)], a social worker, and a physician and using a demographic characteristics questionnaire and the Millon Clinical Multiaxial Inventory-2nd Edition (MCMI-II) (the 175-item Persian version). Data were analyzed using frequency, percentage, and Fisher's z-distribution in SPSS software. Findings The results showed that 87.3% of women and 83.3% of men had a personality disorder at the time of committing the crime. Moreover, 46.5% of the target population had developed substance dependence at the time of committing the crime. The highest percentage of substance abuse in both women and men was related to opium, especially in the age group of 18-28 years. The highest rates of mental disorders were related to major depressive disorder (MDD), dependent personality disorder (DPD), borderline personality disorder (BPD), and antisocial personality disorder (ASPD), respectively. In these personality disorders, opium, methamphetamine, heroin, and alcohol, respectively, had the highest rates of use. The results of Fisher's z-distribution illustrated a significant relationship between personality disorders and type of crime committed and substance used. The total rate of substance abuse was lower in sexual offenses and fraud, but was the highest in theft and drug trafficking. Conclusion The presence of personality

Storytelling in person-centred care.

PubMed

Chu, Elizabeth

2006-01-01

Storytelling is a powerful tool that can be used successfully to pass on knowledge, wisdom and expertise from educators to students. A story is more easily remembered and new concepts in nursing taught in story form are understood more readily. By the same token, the story of a resident's history allows caregivers to really understand who that person is and was, and in turn provide the care that will suit the unique needs of that resident. The person-centered care concept revolves around this uniqueness of person and the process of storytelling serves the understanding of the resident, the crafting of the care package itself, and communicating that knowledge to other caregivers.

Accounting for intended use application in characterizing the contributions of cyclopentasiloxane (D5) to aquatic loadings following personal care product use: antiperspirants, skin care products and hair care products.

PubMed

Montemayor, Beta P; Price, Bradford B; van Egmond, Roger A

2013-10-01

Decamethylcyclopentasiloxane, commonly known as D5 (cyclopentasiloxane) has a wide application of use across a multitude of personal care product categories. The relative volatility of D5 is one of the key properties attributed to this substance that provide for the derived performance benefits from the use of this raw material in personal care formulations. On this basis, rapid evaporative loss following use of many products comprising D5 is expected following typical use application and corresponding wear time. Studies were conducted on three key product categories containing D5 (antiperspirants, skin care products and hair care products) to characterize the amount of D5 that may be destined to 'go down the drain' following simulated typical personal care use scenarios. Marketed antiperspirants and skin care products were applied to human subjects and hair care products were applied to human hair tressesand subsequently rinsed off at designated time points representative of typical consumer cleansing and personal hygiene habits. Wash water was collected at 0, 8 and 24h (antiperspirant and hair care analysis) and additionally at 4h (skin care analysis) post product application and samples were analyzed by isotope dilution headspace gas chromatography/mass spectrometry (GC/MS) to quantify the concentration of D5 destined to be available to go down the drain in captured wash water. It is demonstrated that significant amounts of D5 in 'leave-on' application products evaporate during typical use and that the concentration of D5 available to go down the drain under such conditions of use is only a very small (negligible) fraction of that delivered immediately upon product application. Copyright © 2012 Elsevier Ltd. All rights reserved.

Job satisfaction amongst aged care staff: exploring the influence of person-centered care provision.

PubMed

Edvardsson, David; Fetherstonhaugh, Deirdre; McAuliffe, Linda; Nay, Rhonda; Chenco, Carol

2011-10-01

There are challenges in attracting and sustaining a competent and stable workforce in aged care, and key issues of concern such as low staff job satisfaction and feelings of not being able to provide high quality care have been described. This study aimed to explore the association between person-centered care provision and job satisfaction in aged care staff. Residential aged care staff (n = 297) in Australia completed the measure of job satisfaction and the person-centered care assessment tool. Univariate analyses examined relationships between variables, and multiple linear regression analysis explored the extent to whichperceived person-centredness could predict job satisfaction of staff. Perceived person-centred care provision was significantly associated with job satisfaction, and person-centred care provision could explain nearly half of the variation in job satisfaction. The regression model with the three person-centered care subscales as predictor variables accounted for 40% of the variance in job satisfaction. Personalizing care had the largest independent influence on job satisfaction, followed by amount of organizational support and degree of environmental accessibility. Personalizing care and amount of organizational support had a statistically significant unique influence. As person-centered care positively correlated with staff job satisfaction, supporting staff in providing person-centered care can enhance job satisfaction and might facilitate attracting and retaining staff in residential aged care. The findings reiterate a need to shift focus from merely completing care tasks and following organizational routines to providing high quality person-centered care that promotes the good life of residents in aged care.

Personalized health care: from theory to practice.

PubMed

Snyderman, Ralph

2012-08-01

The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual's specific health needs. Personalized health care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized health care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of personalized health care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

HIV Risk, Substance Use, and Personality Characteristics among Adults with History of Serious Mental Illness.

PubMed

Mainville, Cathryn H; Richardson, Mark A; Brady, Stephen M; Berger-Greenstein, Jori; Bacic, Janine

2017-01-01

The present study examined the relationship between characteristics associated with personality disorders, substance use, and HIV risk among adults with a history of serious mental illness. Participants included 103 adults with antisocial or borderline personality disorder, serious mental illness, and recent HIV risk behavior. The sample was predominately male (64%), diverse (42% African American and 13% Hispanic), and homeless/marginally housed (76%). In order to examine the relationship between personality characteristics and risk we constructed a risk index comprising key symptoms of antisocial and borderline personality disorders, namely; impulsivity, affective instability, and disregard for safety of self/others. Contrary to our primary hypotheses, risk index scores did not predict HIV risk behavior and substance abuse did not mediate this risk. Exploratory analyses did reveal that women engaged in significantly more risk behaviors than their male counterparts and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Finally, recent alcohol use and increased impulsivity was associated with more condomless oral sex for men and women. These results suggest the relationship among serious mental illness, personality disorder, substance abuse, and gender is complex and merits further study.

Attitude to Substance Abuse: Do Personality and Socio-Demographic Factors Matter?

PubMed Central

Rahimian Boogar, Isaac; Tabatabaee, Sayed Mosa; Tosi, Jalileh

2014-01-01

Background: Substance abuse is a serious global problem that is affected by multiple psychosocial and socio-demographic factors. Objectives: This study aimed to investigate the leading factors in positive attitude and tendency toward substance abuse in terms of personality, socio-economic, and socio-demographic factors. Patients and Methods: In a cross-sectional study, 200 college students (105 females and 95 males) residing in Damghan University dormitory in northeast of Iran were recruited by random sampling from March to July 2013. The participants were instructed and asked to complete the NEO FIVE-factor Inventory, the attitude to substance abuse scale, and the demographic questionnaire. Then data were analyzed by stepwise multiple regression employing PASW 18. Results: Being male sex and neuroticism had a significant positive role in predicting positive attitude toward substance abuse in university students. In addition, agreeableness, conscientiousness, openness, and socio-economic status had a significant negative role in predicting tendency toward substance abuse (P < 0.001). Extraversion had no significant role in prediction of positive attitude to substance abuse (P > 0.05). Conclusions: Lower agreeableness, decreased conscientiousness, higher neuroticism, diminished openness, low socio-economic status, and male sex might make university students more inclined to substance abuse. Thus, it is reasonable to show the importance of these factors in tailored prevention programs. PMID:25593892

Personality assessment of substance-dependent patients in a therapeutic community.

PubMed

Moffett, L A; Steinberg, S L; Rohde, P

1996-01-01

The design and implementation of a personality assessment system for severely substance-dependent men in a therapeutic community (TC) are described. The system was designed from a treatment utility perspective (Hayes, Nelson, & Jarrett, 1987) and uses the Personality Research Form E (Jackson, 1984) to provide each patient with feedback (a) describing his normal personality traits, (b) predicting his probable pattern of adjustment to the treatment setting, and (c) prescribing specific actions he can take to address potentially problematic behaviors. Discussing the the results with the patient helps him cope with the TC. Reviewing the assessment results with the staff promotes their empathy for the patient as a person whose behavior can be understood as an interaction of his personality with the specific demands of the TC rather than seeing the patient in exclusively pathological terms. Specific suggestions for behavior change guide both the patient and the staff and are potentially useful in various treatment settings.

Comparisons of substance abuse, high-risk sexual behavior and depressive symptoms among homeless youth with and without a history of foster care placement.

PubMed

Hudson, Angela L; Nandy, Karabi

2012-10-01

The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. The design is descriptive and cross-sectional. A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. It is important that nurses, who serve homeless

Clinical outcomes of a stepped care program for borderline personality disorder.

PubMed

Laporte, Lise; Paris, Joel; Bergevin, Tanya; Fraser, Ronald; Cardin, Jean-François

2018-04-30

This study examines the clinical outcomes of two clinics for borderline personality disorder (BPD) in a naturalistic setting, offering a stepped care model with both short-term (ST) treatment lasting 12 weeks and extended care (EC) up to 24 months. A total of 479 patients attending the ST clinic and 145 attending the EC clinic were assessed on depression, impulsivity, self-esteem, emotion dysregulation, substance abuse, self-harm and suicidality. There were significant reductions in all symptoms in both clinics with the exception that substance abuse was only reduced in the EC clinic. On all symptoms, no significant differences in magnitude of changes were observed between patients who stayed in EC clinic for 6-12 months in comparison to those who stayed for 18-24 months. These results support the concept that for the majority of patients with BPD, brief treatment can be effective. While some patients still need longer treatment, the results are encouraging for brief treatment as a first step for the majority of patients with BPD. While this study adds to the weight of evidence to support ST interventions for patients with BPD, further research using a control group is needed. Copyright © 2018 John Wiley & Sons, Ltd. Copyright © 2018 John Wiley & Sons, Ltd.

Association of housing first implementation and key outcomes among homeless persons with problematic substance use.

PubMed

Davidson, Clare; Neighbors, Charles; Hall, Gerod; Hogue, Aaron; Cho, Richard; Kutner, Bryan; Morgenstern, Jon

2014-11-01

Housing First is a supportive housing model for persons with histories of chronic homelessness that emphasizes client-centered services, provides immediate housing, and does not require treatment for mental illness or substance abuse as a condition of participation. Previous studies of Housing First have found reduced governmental costs and improved personal well-being among participants. However, variations in real-world program implementation require better understanding of the relationship between implementation and outcomes. This study investigated the effects of Housing First implementation on housing and substance use outcomes. Study participants were 358 individuals with histories of chronic homelessness and problematic substance use. Clients were housed in nine scatter-site Housing First programs in New York City. Program fidelity was judged across a set of core Housing First components. Client interviews at baseline and 12 months were used to assess substance use. Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at follow-up. Consistently implemented Housing First principles related to consumer participation were associated with superior housing and substance use outcomes among chronically homeless individuals with a history of substance use problems. The study findings suggest that program implementation is central to understanding the potential of Housing First to help clients achieve positive housing and substance use outcomes.

Delineating selection and mediation effects among childhood personality and environmental risk factors in the development of adolescent substance abuse.

PubMed

Hicks, Brian M; Johnson, Wendy; Durbin, C Emily; Blonigen, Daniel M; Iacono, William G; McGue, Matt

2014-01-01

Utilizing the large, longitudinal Minnesota Twin Family Study (N = 2510; 96 % European American ancestry), we examined the influence of several person-environment transactions on adolescent substance abuse. We focused on the two childhood personality traits found to be most predictive of substance abuse in this sample-socialization (willingness to follow rules and endorse conventional values) and boldness (social engagement and assurance, stress resilience, thrill seeking)-and the environmental variables of antisocial and prosocial peers, academic engagement, parent-child relationship quality, and stressful life events. Path analysis revealed that low socialization had a selection effect for each environmental risk factor, that is, socialization at age 11 predicted environmental risk at age 14, after controlling for the stability of the environmental variables from ages 11 to 14. Antisocial peers and academic engagement at age 14 then mediated some of the risk of low socialization on substance abuse at age 17, but the majority of risk for substance abuse was accounted for by the stability of socialization from age 11 to 14. Boldness at age 11 also increased risk for substance abuse, but did so primarily via a direct effect. The findings help to parse the nature of person-environment transactions across multiple personality traits and contextual risk factors that contribute to adolescent substance abuse.

Delineating Selection and Mediation Effects among Childhood Personality and Environmental Risk Factors in the Development of Adolescent Substance Abuse

PubMed Central

Hicks, Brian M.; Johnson, Wendy; Durbin, C. Emily; Blonigen, Daniel M.; Iacono, William G.; McGue, Matt

2014-01-01

Utilizing the large, longitudinal Minnesota Twin Family Study (N = 2510; 96% European American ancestry), we examined the influence of several person-environment transactions on adolescent substance abuse. We focused on the two childhood personality traits found to be most predictive of substance abuse in this sample—socialization (willingness to follow rules and endorse conventional values) and boldness (social engagement and assurance, stress resilience, thrill seeking)—and the environmental variables of antisocial and prosocial peers, academic engagement, parent-child relationship quality, and stressful life events. Path analysis revealed that low socialization had a selection effect for each environmental risk factor, that is, socialization at age 11 predicted environmental risk at age 14, after controlling for the stability of the environmental variables from ages 11 to 14. Antisocial peers and academic engagement at age 14 then mediated some of the risk of low socialization on substance abuse at age 17, but the majority of risk for substance abuse was accounted for by the stability of socialization from age 11 to 14. Boldness at age 11 also increased risk for substance abuse, but did so primarily via a direct effect. The findings help to parse the nature of person-environment transactions across multiple personality traits and contextual risk factors that contribute to adolescent substance abuse. PMID:24337735

Substance use and violent behavior in women with antisocial personality disorder.

PubMed

Lewis, Catherine F

2011-01-01

The purpose of this study was to examine the relationship between substance abuse and dependence and violent behavior in a sample of incarcerated women with antisocial personality disorder (ASPD). Among male populations, substance dependence is associated with aggression and criminal behavior. Individuals with ASPD have more severe substance dependence, including higher symptom counts, earlier age of onset, and more frequent co-morbidity. Incarcerated women have a high prevalence of ASPD and substance dependence, but there has been little detailed work regarding addiction severity. Similarly, work on association of substance abuse and dependence with specific violent behaviors has been limited. This study examined a group of 41 mid-sentence female felons with a diagnosis of ASPD to determine associations with substance abuse and dependence. Data were gathered through administration of the Semi-Structured Assessment of the Genetics of Alcoholism II (SSAGA II). Substance dependence was highly prevalent (i.e., alcohol dependence, 56.1%; opiate dependence, 48.8%; cocaine dependence, 61.0%). While specific diagnoses were not associated with violent behavior and offending, symptom severity (i.e., age of onset, symptom count, co-morbidity) was associated with violent behavior in women dependent on opiates, alcohol, and cocaine. Arrest for an assault 1 was associated with alcohol dependence and opiate dependence. These data suggest that measurement of symptom severity and co-morbidity is important in assessing violent behavior in incarcerated women with ASPD. These findings are potentially important in examining non-incarcerated, substance-dependent women. Copyright © 2011 John Wiley & Sons, Ltd.

Continuing Care and Trauma in Women Offenders’ Substance Use, Psychiatric Status, and Self-Efficacy Outcomes

PubMed Central

Saxena, Preeta; Grella, Christine E.; Messina, Nena P.

2015-01-01

Using secondary data analysis of 3 separate trauma-informed treatment programs for women offenders, we examine outcomes between those who received both prison and community-based substance abuse treatment (i.e., continuing care; n = 85) and those who received either prison or community aftercare treatment (n = 108). We further account for differences in trauma exposure to examine whether continuing care moderates this effect on substance use, psychiatric severity, and self-efficacy outcomes at follow-up. The main effect models of continuing care showed a significant association with high psychiatric status and did not yield significant associations with substance use or self-efficacy. However, the interaction between trauma history and continuing care showed significant effects on all 3 outcomes. Findings support the importance of a continuing care treatment model for women offenders exposed to multiple forms of traumatic events, and provide evidence of the effectiveness of integrating trauma-informed treatment into women’s substance abuse treatment. PMID:26924891

Emotion Regulation and Substance Use Frequency in Women with Substance Dependence and Borderline Personality Disorder Receiving Dialectical Behavior Therapy

PubMed Central

Axelrod, Seth R.; Perepletchikova, Francheska; Holtzman, Kevin; Sinha, Rajita

2011-01-01

Background Dialectical Behavior Therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. Objective Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. Method Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. Conclusions This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. Significance and Future Research Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dyregulation such as BPD and substance dependence, and to further explore emotion regulation as a potential mechanism of change for clinical interventions. PMID:21091162

Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of forensic mental health services.

PubMed

Ogloff, James R P; Talevski, Diana; Lemphers, Anthea; Wood, Melisa; Simmons, Melanie

2015-03-01

Despite the number of studies investigating co-occurring disorders, and more recently, co-occurring disorders and criminal offending, few studies have considered samples from forensic mental health services. The present study was conducted to investigate the relationship between mental illness, substance use disorders, antisocial personality disorder, and offending. The prevalence of co-occurring disorders was investigated in 130 male offenders who had contact with the statewide forensic mental health service in Victoria, Australia. Offense histories and severity of offending were compared among participants diagnosed with a single mental illness (or no mental illness), co-occurring mental illness and substance use, and co-occurring disorders plus antisocial personality disorder. The majority of participants had co-occurring mental and substance use disorders; a significant minority met the criteria for antisocial personality disorder. Participants with co-occurring mental illness and substance use disorders, and those who had an additional diagnosis of antisocial personality disorder, were responsible for more serious and frequent offending than those with mental illness alone. Forensic mental health services must take into account the effect that co-occurring disorders have on clients' functioning and offending. Those who work with people with psychiatric disabilities and co-occurring substance use disorders must ensure that the substance disorders are addressed to help ensure recovery from the mental illness and to reduce the likelihood of offending. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Inter-rater agreement of comorbid DSM-IV personality disorders in substance abusers.

PubMed

Hesse, Morten; Thylstrup, Birgitte

2008-05-17

Little is known about the inter-rater agreement of personality disorders in clinical settings. Clinicians rated 75 patients with substance use disorders on the DSM-IV criteria of personality disorders in random order, and on rating scales representing the severity of each. Convergent validity agreement was moderate (range for r = 0.55, 0.67) for cluster B disorders rated with DSM-IV criteria, and discriminant validity was moderate for eight of the ten personality disorders. Convergent validity of the rating scales was only moderate for antisocial and narcissistic personality disorder. Dimensional ratings may be used in research studies and clinical practice with some caution, and may be collected as one of several sources of information to describe the personality of a patient.

Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting.

PubMed

Rushton, Carole; Edvardsson, David

2017-07-01

Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the 'acute care space' as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person-centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person-centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of 'person-centred space' helps to crystallize the relationship between space and person-centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them. © 2016 John Wiley & Sons Ltd.

Personality and substance use: psychometric evaluation and validation of the Substance Use Risk Profile Scale (SURPS) in English, Irish, French, and German adolescents.

PubMed

Jurk, Sarah; Kuitunen-Paul, Sören; Kroemer, Nils B; Artiges, Eric; Banaschewski, Tobias; Bokde, Arun L W; Büchel, Christian; Conrod, Patricia; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Jürgen; Garavan, Hugh; Heinz, Andreas; Mann, Karl F; Nees, Frauke; Paus, Tomáš; Pausova, Zdenka; Poustka, Luise; Rietschel, Marcella; Schumann, Gunter; Struve, Maren; Smolka, Michael N

2015-11-01

The aim of the present longitudinal study was the psychometric evaluation of the Substance Use Risk Profile Scale (SURPS). We analyzed data from N = 2,022 adolescents aged 13 to 15 at baseline assessment and 2 years later (mean interval 2.11 years). Missing data at follow-up were imputed (N = 522). Psychometric properties of the SURPS were analyzed using confirmatory factor analysis. We examined structural as well as convergent validity with other personality measurements and drinking motives, and predictive validity for substance use at follow-up. The hypothesized 4-factorial structure (i.e., anxiety sensitivity, hopelessness, impulsivity [IMP], and sensation seeking [SS]) based on all 23 items resulted in acceptable fit to empirical data, acceptable internal consistencies, low to moderate test-retest reliability coefficients, as well as evidence for factorial and convergent validity. The proposed factor structure was stable for both males and females and, to lesser degree, across languages. However, only the SS and the IMP subscales of the SURPS predicted substance use outcomes at 16 years of age. The SURPS is unique in its specific assessment of traits related to substance use disorders as well as the resulting shortened administration time. Test-retest reliability was low to moderate and comparable to other personality scales. However, its relation to future substance use was limited to the SS and IMP subscales, which may be due to the relatively low-risk substance use pattern in the present sample. Copyright © 2015 by the Research Society on Alcoholism.

Personal Network Recovery Enablers and Relapse Risks for Women With Substance Dependence

PubMed Central

Brown, Suzanne; Tracy, Elizabeth M.; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung O.

2015-01-01

We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women’s intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships. PMID:25231945

Longitudinal associations between depression and problematic substance use in the Youth Partners in Care study.

PubMed

McKowen, James W; Tompson, Martha C; Brown, Timothy A; Asarnow, Joan R

2013-01-01

Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.

Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs.

PubMed

Timko, Christine; Lesar, Michelle; Calvi, Noël J; Moos, Rudolf H

2003-01-01

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (e.g., by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).

Challenges in using opioids to treat pain in persons with substance use disorders.

PubMed

Savage, Seddon R; Kirsh, Kenneth L; Passik, Steven D

2008-06-01

Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist's efficacy with many patients, both in the substance abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

EPA Pesticide Factsheets

While the point-source emissions of pollutants from manufacturing waste streams have long been monitored and subject to controls, the environmental impact of the public's (i.e., the individual's) activities regarding the use of chemicals is more difficult to assess. Of particular question is the widespread release to sewage and surface/ground waters of pharmaceuticals and personal care products after their ingestion, external application, or disposal. Certain pharmaceutically active compounds (e.g., caffeine, nicotine, and aspirin) have been known for over 20 years to enter the environment by a variety of routes - primarily via treated and untreated sewage effluent. A larger picture, however, has emerged only more recently, where it is evident that numerous personal care products (such as fragrances and sunscreens) and drugs from a wide spectrum of therapeutic classes can occur in the environment and drinking water (albeit at very low concentrations), especially in natural waters receiving sewage. Nearly all ecological monitoring studies for pharmaceuticals and personal care products (informally referred to as

Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

PubMed

Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

2016-02-01

Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

Personal care assistants' experiences of caring for people on home mechanical ventilation.

PubMed

Israelsson-Skogsberg, Åsa; Lindahl, Berit

2017-03-01

The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations. © 2016 Nordic College of Caring Science.

The longitudinal associations between substance use, crime, and social risk among emerging adults: A longitudinal within and between-person latent variables analysis.

PubMed

Merrin, Gabriel J; Davis, Jordan P; Berry, Daniel; D'Amico, Elizabeth J; Dumas, Tara M

2016-08-01

The reciprocal relationship between crime and substance use is well known. However, when examining this relationship, no study to date has disaggregated between- and within-person effects, which represents a more methodologically sound and developmentally-appropriate analytic approach. Further, few studies have considered the role of social risk (e.g., deviant peers, high-risk living situations) in the aforementioned relationship. We examined these associations in a group of individuals with heightened vulnerability to substance use, crime and social risk: emerging adults (aged 18-25 years) in substance use treatment. Participants were 3479 emerging adults who had entered treatment. We used auto-regressive latent growth models with structured residuals (ALT-SR) to examine the within-person cross-lagged association between crime and substance use and whether social risk contributed to this association. A taxonomy of nested models was used to determine the structural form of the data, within-person cross-lagged associations, and between-person associations. In contrast to the extant literature on cross-lagged relations between crime and substance use, we found little evidence of such relations once between- and within-person relations were plausibly disaggregated. Yet, our results indicated that within-person increases in social risk were predictive of subsequent increases in crime and substance use. Post-hoc analyses revealed a mediation effect of social risk between crime and substance use. Findings suggest the need to re-think the association between crime and substance use among emerging adults. Individuals that remain connected to high-risk social environments after finishing treatment may represent a group that could use more specialized, tailored treatments. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective.

PubMed

Thibodeau, Eric L; August, Gerald J; Cicchetti, Dante; Symons, Frank J

2016-03-01

Preventive interventions that target high-risk youth, via one-size-fits-all approaches, have demonstrated modest effects in reducing rates of substance use. Recently, substance use researchers have recommended personalized intervention strategies. Central to these approaches is matching preventatives to characteristics of an individual that have been shown to predict outcomes. One compelling body of literature on person × environment interactions is that of environmental sensitivity theories, including differential susceptibility theory and vantage sensitivity. Recent experimental evidence has demonstrated that environmental sensitivity (ES) factors moderate substance abuse outcomes. We propose that ES factors may augment current personalization strategies such as matching based on risk factors/severity of problem behaviors (risk severity (RS)). Specifically, individuals most sensitive to environmental influence may be those most responsive to intervention in general and thus need only a brief-type or lower-intensity program to show gains, while those least sensitive may require more comprehensive or intensive programming for optimal responsiveness. We provide an example from ongoing research to illustrate how ES factors can be incorporated into prevention trials aimed at high-risk adolescents.

Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

PubMed Central

Tai, Betty; Volkow, Nora D.

2016-01-01

Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites.

PubMed

Mays, Vickie M; Jones, Audrey L; Delany-Brumsey, Ayesha; Coles, Courtney; Cochran, Susan D

2017-02-01

Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early. Fifteen percent of California adults reported discrimination during a health care visit and 4% specifically during mental health/substance abuse visits. Latinos, the uninsured, and those with past year mental disorders were twice as likely as others to report health care discrimination [adjusted odds ratio (AORs)=2.08, 2.77, and 2.51]. Uninsured patients were 7 times more likely to report discrimination in mental health/substance abuse visits (AOR=7.27, P<0.01). The most commonly reported reasons for health care discrimination were race/ethnicity for blacks (52%) and Latinos (31%), and insurance status for whites (40%). Experiences of discrimination in mental health/substance abuse visits were associated with less helpful treatment ratings for Latinos (AOR=0.09, P<0.05) and whites (AOR=0.25, P<0.01), and early treatment termination for blacks (AOR=13.38, P<0.05). Experiences of discrimination are associated with negative mental health/substance abuse treatment experiences and stopped treatment, and could be a factor in mental health outcomes.

Personal support networks, social capital, and risk of relapse among individuals treated for substance use issues.

PubMed

Panebianco, Daria; Gallupe, Owen; Carrington, Peter J; Colozzi, Ivo

2016-01-01

The success of treatment for substance use issues varies with personal and social factors, including the composition and structure of the individual's personal support network. This paper describes the personal support networks and social capital of a sample of Italian adults after long-term residential therapeutic treatment for substance use issues, and analyses network correlates of post-treatment substance use (relapse). Using a social network analysis approach, data were obtained from structured interviews (90-120 min long) with 80 former clients of a large non-governmental therapeutic treatment agency in Italy providing voluntary residential treatments and rehabilitation services for substance use issues. Participants had concluded the program at least six months prior. Data were collected on socio-demographic variables, addiction history, current drug use status (drug-free or relapsed), and the composition and structure of personal support networks. Factors related to risk of relapse were assessed using bivariate and multivariate logistic regression models. A main goal of this study was to identify differences between the support network profiles of drug free and relapsed participants. Drug free participants had larger, less dense, more heterogeneous and reciprocal support networks, and more brokerage social capital than relapsed participants. Additionally, a lower risk of relapse was associated with higher socio-economic status, being married/cohabiting, and having network members with higher socio-economic status, who have greater occupational heterogeneity, and reciprocate support. Post-treatment relapse was found to be negatively associated with the socioeconomic status and occupational heterogeneity of ego's support network, reciprocity in the ties between ego and network members, and a support network in which the members are relatively loosely connected with one another (i.e., ego possesses "brokerage social capital"). These findings suggest the

Randomized Trial of Dual-Focused versus Single-Focused Individual Therapy for Personality Disorders and Substance Dependence

PubMed Central

Ball, Samuel A.; Maccarelli, Lisa M.; LaPaglia, Donna M.; Ostrowski, Mark J.

2011-01-01

We conducted a randomized comparison of Dual Focus Schema Therapy with Individual Drug Counseling as enhancements to residential treatment for 105 substance dependent patients with versus without specific personality disorders. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using Cox Proportional Hazards, we found no psychotherapy differences in retention (days in treatment). Hierarchical Linear Modeling indicated that personality disordered participants started with higher psychiatric, interpersonal, and dysphoria symptoms, and both therapies reduced symptoms over 6 months. Contrary to predictions, Individual Drug Counseling resulted in more sustained reductions than Dual Focus Schema Therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms. PMID:21543951

Internal and external factors in professional burnout of substance abuse counsellors in Croatia.

PubMed

Tatalović Vorkapić, Sanja; Mustapić, Jelena

2012-01-01

In this study, burnout and its internal and external factors were investigated among substance abuse counsellors (no. = 68) who worked in Centres for Prevention and Substance Abuse Treatment (no. = 18) in Croatia. Maslach Burnout Inventory was used which measured three burnout dimensions: emotional exhaustion, depersonalization and personal accomplishment; and questionnaire of internal and external burnout factors. The higher levels of emotional exhaustion and depersonalization, and the higher level of personal accomplishment were determined. Factors such as work conditions, emotions about us and work, work organization and certain personality traits showed significant relationship with three burnout dimensions. Overall, findings implicated a certain specificity of professional burnout in substance abuse counsellors, and the need for specific design of mental health care for them.

Impulsivity and negative emotionality associated with substance use problems and Cluster B personality in college students.

PubMed

James, Lisa M; Taylor, Jeanette

2007-04-01

The co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) can be partially attributed to shared underlying personality traits. This study examined the role of negative emotionality (NEM) and impulsivity in 617 university students with self-reported substance use problems and Cluster B PD symptoms. Results indicated that NEM was significantly associated with drug and alcohol use problems, antisocial PD, borderline PD, and narcissistic PD. Impulsivity was significantly associated with drug use problems, antisocial PD, and histrionic PD. Only NEM mediated the relationship between alcohol use problems and symptoms of each of the Cluster B PDs while impulsivity mediated only the relationship between drug use problems and histrionic PD. These results suggest that NEM may be more relevant than impulsivity to our understanding of the co-occurrence between substance use problems and Cluster B PD features.

Using drama to improve person-centred dementia care.

PubMed

Kontos, Pia C; Mitchell, Gail J; Mistry, Bhavnita; Ballon, Bruce

2010-06-01

We implemented a 12-week drama-based educational intervention to introduce to dementia practitioners person-centred care that emphasizes the notion of embodied selfhood (defined as non-verbal self-expression). Person-centred dementia care guidelines emphasize the assessment of individual needs, and where appropriate, the use of non-pharmacological interventions before resorting to pharmacological management. However, dementia care is not consistent with these guidelines suggesting conceptual limitations and reliance on passive knowledge translation strategies. Focus groups and semi-structured interviews with practitioners (n = 24) in two nursing homes in central Canada were undertaken to assess the effectiveness of the drama-based components of the intervention. Our findings suggest that drama was effective as an educational modality, and helped implement the person-centred approach into practice. Significant practice outcomes included: new awareness that residents' body movements and dispositions can convey meaning; seeking biographical information from families; increased time efficiency; and supporting residents' independence. Our findings make an important contribution to person-centred dementia care by broadening the notion of personhood, and by facilitating implementation using drama. As an enhancement of person-centred care, the support of embodied selfhood may significantly improve residents' quality of life, quality of care, and practitioners' care-giving experience. © 2010 Blackwell Publishing Ltd.

Social exclusion, personal control, self-regulation, and stress among substance abuse treatment clients.

PubMed

Cole, Jennifer; Logan, T K; Walker, Robert

2011-01-01

The purpose of this study was to examine the relationship of social exclusion, personal control, and self-regulation to perceived stress among individuals who participated in publicly funded substance abuse treatment. Participants entered treatment between June 2006 and July 2007 and completed a 12-month follow-up survey by telephone (n=787). The results of the OLS regression analysis indicate that individuals with greater social exclusion factors (e.g. greater economic hardship, lower subjective social standing, greater perceived discrimination), lower perceived control of one's life, and lower self-regulation had higher perceived stress. Furthermore, a significant interaction was found suggesting a stress-buffering effect of personal control between subjective social standing and perceived stress. Interestingly, income status was not significantly related to perceived stress, while economic hardship, which assesses participants' inability to meet basic expenses, was significantly associated with perceived stress. Future research should examine how to integrate the AA/NA teaching about powerlessness and its role in recovery with the importance of increased personal control and self-control in decreasing perceived stress. Implications for future research and substance abuse treatment are discussed. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Where Personalized Medicine, Patient Engagement, and Primary Care Collide.

PubMed

Bell, Megan

2017-01-01

Personalized medicine and patient engagement have become common buzzwords in the context of health care reform. Independently both concepts have showed some promise in impacting health outcomes, but when synergistically applied, they have more power, as both are critical pieces of personalized health care (PHC). PHC is a health care model that embraces the need for patient engagement along with personalized medicine technologies to make the health care process more personalized, patient-driven, and proactive. Primary care presents an ideal setting for the application of PHC through the use of patient engagement techniques such as patient portals, patient-generated health data, and self-management programs, with the goal of supporting a preventative proactive health care approach. Copyright© South Dakota State Medical Association.

A model of integrated primary care for HIV-positive patients with underlying substance use and mental illness.

PubMed

Zaller, N; Gillani, F S; Rich, J D

2007-10-01

There is a high burden of underlying substance use and mental illness in HIV-infected populations. HIV-care settings provide an important opportunity to assess substance and mental health needs among HIV-positive patients and to provide or make referrals for appropriate treatment services. In 2003, with funding from the Center for Substance Abuse Treatment (CSAT), we developed a model of integrated substance-use counselling and referral for treatment within a primary care HIV-care setting at The Miriam Hospital in Providence, Rhode Island. The project uses a multidisciplinary approach to provide linkage to treatment services for substance use and mental illness as well as to help participants with social service needs, such as housing and medical coverage, to ensure continuity of care and optimal HIV treatment adherence. Twelve percent of the 965 HIV-infected patients in care at our center have been enrolled in the project. Of these, all have a current substance-use disorder and 79.3% have been diagnosed with a mental illness. In addition, most participants are hepatitis C-positive (HCV) (65.5%). The majority of participants are on antiretroviral therapy (76.7%). Participants have been referred for the following treatment modalities: intensive outpatient services, methadone, buprenorphine, outpatient services and residential as well as individual and group counselling. Our model has been successful in assessing the substance-use and mental health needs of HIV-infected individuals with numerous co-morbidities and referring them for ancillary medical and social services.

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

Substance Abuse Treatment in Persons with HIV/AIDS: Challenges in Managing Triple Diagnosis

PubMed Central

Durvasula, Ramani; Miller, Theodore R.

2014-01-01

This paper provides a review of the current literature addressing substance abuse treatment in persons living with HIV/AIDS. Clinical management of HIV must account for the “triple diagnosis” of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990's, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention. PMID:24274175

Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

PubMed Central

Beckwith, Curt; Castonguay, Breana Uhrig; Trezza, Claudia; Bazerman, Lauri; Patrick, Rudy; Cates, Alice; Olsen, Halli; Kurth, Ann; Liu, Tao; Peterson, James; Kuo, Irene

2017-01-01

Background HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender. Methods We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender. Results Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender

Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection

PubMed Central

Gonzalez, Stevan A.; Fierer, Daniel S.

2017-01-01

Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy. PMID:28701904

Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: Results from a national telephone household probability sample

PubMed Central

McCauley, Jenna L.; Kilpatrick, Dean G.; Walsh, Kate; Resnick, Heidi S.

2013-01-01

Objective To examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape. Method Using a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident. Results One-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use. Conclusions Substance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed. PMID:23380490

Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: results from a national telephone household probability sample.

PubMed

McCauley, Jenna L; Kilpatrick, Dean G; Walsh, Kate; Resnick, Heidi S

2013-04-01

To examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape. Using a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident. One-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use. Substance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Training substance abuse treatment staff to care for co-occurring disorders.

PubMed

Hunter, Sarah B; Watkins, Katherine E; Wenzel, Suzanne; Gilmore, Jim; Sheehe, John; Griffin, Belle

2005-04-01

Although co-occurring disorders have been associated with poorer substance abuse treatment outcomes and higher costs of care, few individuals with co-occurring disorders receive appropriate mental health care. This article describes the design and implementation of an intervention to improve the quality of mental health care provided in outpatient substance abuse treatment programs without requiring new treatment staff. The intervention focuses on individuals with affective and anxiety disorders and consists of three components: training and supervising staff, educating and activating clients, and linking with community resources. We evaluated three treatment programs (one intervention and two comparison) for the first component by having program staff complete both self-administered questionnaires and semistructured interviews. Staff knowledge and attitudes about co-occurring disorders, job satisfaction, and morale all indicated an improvement at the intervention relative to the comparison sites. The evaluation is still under way; results for implementation of the other two components and for outcomes will be reported later.

Patient experiences of caring and person-centredness are associated with perceived nursing care quality.

PubMed

Edvardsson, David; Watt, Elizabeth; Pearce, Frances

2017-01-01

To explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Self-reported patient experiences have had limited attention in conceptualizations of healthcare quality as described in policy and national standards, as well as in health and nursing care practice. The impact of central nursing concepts such as caring and person-centredness on patient ratings of nursing care quality is largely unknown. A descriptive non-experimental correlational design was used to collect and analyse data from a sample of Australian acute hospital inpatients (n = 210) in December 2012. The study collected self-report patient data through a study survey including demographic data and the Caring Behaviours Inventory, the Person-centred Climate Questionnaire, the SF-36 and the Distress thermometer. Descriptive statistics together with Pearson correlation and hierarchical linear regression were used. Perceived caring behaviours of staff and the person-centredness of wards were significantly associated with nursing care quality as evidenced by Pearson correlations being significant and exceeding the pre-set cut-off of r > 0·5. Staff caring behaviours and ward person-centredness also accounted for more than half of the total variance in perceived nursing care quality as evidenced by the final regression model. Knowledgeable and communicable staff, timeliness of assistance and environmental support stood out as most significantly related to patient perceived nursing care quality. Patient experiences of caring and person-centredness seem to have an influential role in the extent to which patients experience the quality of nursing care. Knowledgeable and communicable staff, timeliness of assistance and environmental support stand out as most significantly related to patient-perceived nursing care quality. © 2016 John Wiley & Sons Ltd.

Case-mix tool, costs and effectiveness in improving primary care mental health and substance abuse services.

PubMed

Riihimäki, Kirsi; Heiska-Johansson, Ainomaija; Ketola, Eeva

2018-02-01

Despite its importance in improving care and developing services, high-quality data evaluating cost-effectiveness and services in different case-mix populations is scarce in primary care. The objective was to investigate the service use of those mental health and substance abuse patients, who use lots of services. Primary health care diagnosis-related groups (pDRG) is a tool to evaluate service provider system and improve efficiency, productivity and quality. We viewed all pDRG results available from the year 2015 concerning municipal mental health and substance abuse services. In primary care mental health and substance abuse services, the most common ICD-10-codes were depression and substance abuse. One-fifth of patients produced 57% of costs. Their medium of appointments was 16 per year versus 6 per year of all patients. Only 54% of their diagnoses were recorded in the electronic health records versus 75% of all patients. They made 5.7 different pDRG episodes, including 1.8 episodes of depression, per patient. The average episode cost for this patient group was 301€. pDRG makes health care production transparent also in mental health and substance abuse services. It is easy to identify patients, who use a lot of services and thus induce the majority of costs, and focus on their needs in managing and developing services.

Alcohol and substance use history among ADHD adults: the relationship with persistent and remitting symptoms, personality, employment, and history of service use.

PubMed

Huntley, Zoe; Young, Susan

2014-01-01

To profile substance use, personality, service use, and employment in adults with ADHD. The sample consisted of 216 consecutive referrals to an adult ADHD service and classified with ADHD, partially or fully remitted ADHD, or no ADHD. Normal controls (n = 33) were recruited from a general practitioner's center. Participants completed measures of alcohol and illicit substance use, employment, service use, ADHD symptoms, and personality. High rates of substance use were found in participants with current ADHD diagnoses. ADHD participants showed increased rates of personality trait or disorder scores and unemployment. There was some indication that those with ADHD and substance-related impairment place higher demand on services. Individuals with partially remitted ADHD showed similar substance use to those with current ADHD, whereas those in full remission were comparable with normal controls. Although ADHD symptoms may remit with time, individuals retaining persisting or partial symptoms have substantial needs in adulthood.

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

ERIC Educational Resources Information Center

Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

2011-01-01

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

Towards person-centredness in aged care - exploring the impact of leadership.

PubMed

Backman, Annica; Sjögren, Karin; Lindkvist, Marie; Lövheim, Hugo; Edvardsson, David

2016-09-01

To explore the association between leadership behaviours among managers in aged care, and person-centredness of care and the psychosocial climate. Theory suggests that leadership is important for improving person-centredness in aged care, however, empirical evidence is lacking. A cross-sectional design was used to collect data from Swedish aged care staff (n = 3661). Valid and reliable questionnaires assessing leadership behaviours, person-centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms. Leadership behaviours were significantly related to the person-centredness of care and the psychosocial climate. The level of person-centredness of care moderated the impact of leadership on the psychosocial climate. The leadership behaviour of managers significantly impacts person-centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person-centred care practice, thereby creating a positive psychosocial climate and high quality care. © 2016 John Wiley & Sons Ltd.

Comprehensive Substance Abuse Services for Homeless Persons with Alcohol and Other Drug Problems.

ERIC Educational Resources Information Center

Kirby, Michael W., Jr.; Braucht, G. Nicholas

Homeless people with alcohol and other drug problems present the traditional substance abuse services delivery provider with special challenges. This paper discusses the optimal designs of comprehensive treatment services for homeless persons with alcohol and other drug problems. Most importantly, the homeless must have immediate access to a safe…

A Research Agenda to Advance the Coordination of Care for General Medical and Substance Use Disorders.

PubMed

Quinn, Amity E; Rubinsky, Anna D; Fernandez, Anne C; Hahm, Hyeouk Chris; Samet, Jeffrey H

2017-04-01

The separation of addiction care from the general medical care system has a negative impact on patients' receipt of high-quality medical care. Clinical and policy-level strategies to improve the coordination of addiction care and general medical care include identifying and engaging patients with unhealthy substance use in general medical settings, providing effective chronic disease management of substance use disorders in primary care, including patient and family perspectives in care coordination, and implementing pragmatic models to pay for the coordination of addiction and general medical care. This Open Forum discusses practice and research recommendations to advance the coordination of general medical and addiction care. The discussion is based on the proceedings of a national meeting of experts in 2014.

Person-Centered Care: A Definition and Essential Elements.

PubMed

2016-01-01

Improving healthcare safety, quality, and coordination, as well as quality of life, are important aims of caring for older adults with multiple chronic conditions and/or functional limitations. Person-centered care is an approach to meeting these aims, but there are no standardized, agreed-upon parameters for delivering such care. The SCAN Foundation charged a team from the American Geriatrics Society (AGS) in collaboration with a research and clinical team from the Keck School of Medicine of the University of Southern California to provide the evidence base to support a definition of person-centered care and its essential elements. An interprofessional panel of experts in person-centered care principles and practices that the AGS convened developed this statement. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Elaboration of the Gothenburg model of person-centred care.

PubMed

Britten, Nicky; Moore, Lucy; Lydahl, Doris; Naldemirci, Oncel; Elam, Mark; Wolf, Axel

2017-06-01

Person-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals. In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings. We conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects. Interviewees' accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships. This study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Clinical Utility of the Cross-Cultural (Chinese) Personality Assessment Inventory (CPAI-2) in the Assessment of Substance Use Disorders among Chinese Men

ERIC Educational Resources Information Center

Cheung, Fanny M.; Cheung, Shu Fai; Leung, Freedom

2008-01-01

This study examined the clinical utility of the Cross-Cultural (Chinese) Personality Inventory (CPAI-2) in differentiating the personality characteristics of Chinese men with substance use disorders from other psychiatric patients and normal control participants. The CPAI-2 profile of 121 Chinese men with substance use disorders was contrasted…

Initiation of Substance Use by Adolescents after One Year in Residential Youth Care

ERIC Educational Resources Information Center

Monshouwer, Karin; Kepper, Annelies; van den Eijnden, Regina; Koning, Ina; Vollebergh, Wilma

2015-01-01

Background: Several studies have shown that substance use levels among adolescents living in residential youth care are high. However, it is not clear to what extent adolescents initiate (heavy) substance during their stay and to what extent these rates are higher than would be expected based on their risk profile. Objective: The aim of the…

Workforce development to provide person-centered care

PubMed Central

Austrom, Mary Guerriero; Carvell, Carly A.; Alder, Catherine A.; Gao, Sujuan; Boustani, Malaz; LaMantia, Michael

2018-01-01

Objectives Describe the development of a competent workforce committed to providing patient-centered care to persons with dementia and/or depression and their caregivers; to report on qualitative analyses of our workforce’s case reports about their experiences; and to present lessons learned about developing and implementing a collaborative care community-based model using our new workforce that we call care coordinator assistants (CCAs). Method Sixteen CCAs were recruited and trained in person-centered care, use of mobile office, electronic medical record system, community resources, and team member support. CCAs wrote case reports quarterly that were analyzed for patient-centered care themes. Results Qualitative analysis of 73 cases using NVivo software identified six patient-centered care themes: (1) patient familiarity/understanding; (2) patient interest/engagement encouraged; (3) flexibility and continuity of care; (4) caregiver support/engagement; (5) effective utilization/integration of training; and (6) teamwork. Most frequently reported themes were patient familiarity – 91.8% of case reports included reference to patient familiarity, 67.1% included references to teamwork and 61.6% of case reports included the theme flexibility/continuity of care. CCAs made a mean number of 15.7 (SD = 15.6) visits, with most visits for coordination of care services, followed by home visits and phone visits to over 1200 patients in 12 months. Discussion Person-centered care can be effectively implemented by well-trained CCAs in the community. PMID:26666358

Addressing the service linkage problem. Increasing substance abuse treatment engagement using personalized feedback interventions in heavy-using female domestic violence shelter residents.

PubMed

Ogle, Richard L; Baer, John S

2003-11-01

Two personalized substance abuse assessment and feedback interventions were tested for effectiveness in engaging female domestic violence shelter residents in substance abuse treatment. One hundred forty-seven residents were assessed for quantity andfrequency of substance use, negative consequences due to use, motivation to change substance use behavior, and psychopathological symptoms related to substance abuse. Assessment identified (33) 22% of participants as heavy substance users. Twenty of the 33 heavy-using residents received one of two personalized substance use feedback interventions:face-to-face feedback or writtenfeedbackplaced in shelter mailboxes. Treatment engagement was defined as attending at least one substance abuse treatment session within 30 days after the intervention. Results showed a significant difference in treatment engagement rates in favor of the face-to-face feedback group (60% vs. 0%). The results provide preliminary data suggesting that substance abuse assessment can be effectively accomplished in the shelter environment and that the face-to-face feedback procedure may be an effective intervention to bridge the service linkage problem between domestic violence services and substance abuse treatment.

Relations of Personality to Substance Use Problems and Mental Health Disorder Symptoms in Two Clinical Samples of Adolescents

ERIC Educational Resources Information Center

Battista, Susan R.; Pencer, Alissa; McGonnell, Melissa; Durdle, Heather; Stewart, Sherry H.

2013-01-01

There is a high overlap between substance misuse and mental health disorders in adolescents. Certain personality traits (i.e., sensation seeking, impulsivity, hopelessness, and anxiety sensitivity) may be related to increased risk for mental health symptoms and/or substance misuse. The current study examined the relationships between personality…

The need for substance abuse after-care: longitudinal analysis of Oxford House.

PubMed

Jason, Leonard A; Davis, Margaret I; Ferrari, Joseph R

2007-04-01

There is a need to explore the processes of social support and self-efficacy change over time among individuals in recovery homes, and to assess the extent to which residents remain abstinent, obtain and maintain employment, refrain from criminal activity, and utilize health care systems both while within the and after leaving such settings. Residents were recruited and interviewed at an initial baseline phase and then re-interviewed at three subsequent 4-month intervals. Oxford Houses are recovery home residences for individuals with substance abuse and dependence problems who seek a supportive, democratic, mutual-help setting. A national US sample of Oxford House residents (n=897: 604 men, 293 women). Information was gathered on abstinence, social support, self-efficacy, employment, criminal history, and medical care utilization. Change in cumulative abstinence was predicted by support for alcohol use, abstinence self-efficacy, and length of residency in OH (i.e., less than versus >or=6 months), even after controlling for initial time spent in OH. Results suggest that receiving abstinence support, guidance, and information from recovery home members committed to the goal of long-term sobriety may enhance residents' abstinence self-efficacy and enable persons recovering from alcohol and other drug addiction to reduce the probability of a relapse.

Compulsory commitment to care of substance misusers: international trends during 25 Years.

PubMed

Israelsson, Magnus; Gerdner, Arne

2012-01-01

The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes - civil CCC and CCC within criminal justice legislation - as well as maximum length and amount of applications of such care. The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002-2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. There is a risk that the shift from civil CCC to penal CCC implies more focus on young out-acting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected. Copyright © 2012 S. Karger AG, Basel.

Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders.

PubMed

Outcalt, Jared; Dimaggio, Giancarlo; Popolo, Raffaele; Buck, Kelly; Chaudoin-Patzoldt, Kelly A; Kukla, Marina; Olesek, Kyle L; Lysaker, Paul H

2016-01-01

Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery. Published by Elsevier Inc.

Primary care and care for older persons: position paper of the European Forum for Primary Care.

PubMed

Boeckxstaens, Pauline; De Graaf, Pim

2011-01-01

This article explores how to address the needs of the growing number of older patients in primary care practice. Primary care is not a fixed organisational structure but a combination of functional characteristics which has developed variably in European countries with differing responses to the emerging needs of older persons. Multimorbidity, frailty, disability and dependence play out differently in older persons; a key challenge for primary care is to provide a response that is adapted to the needs of individuals - as they see them and not as the professional defines them. Indeed, growing experience shows how to involve older persons in taking decisions. Contrary to popular opinion, older persons often rate their quality of life as high. Indeed, comprehensive primary care offers health promotion and prevention: also older people may benefit from measures that support their health and independence and some case descriptions show this potential. Although most people prefer to be in their own environment (home, community) during the last stage of life, providing end-of-life care in the community is a challenge for primary care because it requires continuity and coordination with specialist care. Successful models of care however do exist. Delivering seamless integrated care to older persons is a central theme in primary care. Rather than disease management, in primary care, case management is the preferred approach. Proactive geriatric assessment of individual medical, functional and social needs, including loneliness and isolation, has been shown to be useful and its place in primary care is the subject of further research. Clinical practice guidelines for multimorbidity are badly needed. Non-adherence to medication, linked to multiple and uncoordinated prescriptions, is a widespread and costly problem. Successful approaches in primary care are being developed, including the use of electronic patient files. With the general practitioner (GP) as the central care

Assessment of primary care services and perceived barriers to care in persons with disabilities.

PubMed

Harrington, Amanda L; Hirsch, Mark A; Hammond, Flora M; Norton, H James; Bockenek, William L

2009-10-01

To determine what percentage of persons with disabilities have a primary care provider, participate in routine screening and health maintenance examinations, and identify perceived physical or physician barriers to receiving care. A total of 344 surveys, consisting of 66 questions, were collected from adults with disabilities receiving care at an outpatient rehabilitation clinic. A total of 89.5% (95% CI 86.3%-92.8%) of participants reported having a primary care physician. Younger persons (P < 0.0001), men (P < 0.02), persons with brain injury (P < 0.05), or persons with amputations (P < 0.05) were less likely to have a primary care physician. Participant report of screening for alcohol, nonprescription drug use, and safety with relationships at home ranged from 26.6% to 37.5% compared with screening for depression, diet, exercise, and smoking (64.5%-70%). Completion rates of age- and gender-appropriate health maintenance examinations ranged from 42.4% to 90%. A total of 2.67% of participants reported problems with physical access at their physician's office, and 36.4% (95% CI 30.8%-42.1%) of participants reported having to teach their primary care physician about their disability. Most persons with disabilities have a primary care physician. In general, completion rates for routine screening and health maintenance examinations were high. Perceived deficits in primary care physicians' knowledge of disability issues seem more prevalent than physical barriers to care.

Latent profiles of family background, personality and mental health factors and their association with behavioural addictions and substance use disorders in young Swiss men.

PubMed

Marmet, Simon; Studer, Joseph; Rougemont-Bücking, Ansgar; Gmel, Gerhard

2018-05-04

Recent theories suggest that behavioural addictions and substance use disorders may be the result of the same underlying vulnerability. The present study investigates profiles of family background, personality and mental health factors and their associations with seven behavioural addictions (to the internet, gaming, smartphones, internet sex, gambling, exercise and work) and three substance use disorder scales (for alcohol, cannabis and tobacco). The sample consisted of 5287 young Swiss men (mean age = 25.42) from the Cohort Study on Substance Use Risk Factors (C-SURF). A latent profile analysis was performed on family background, personality and mental health factors. The derived profiles were compared with regards to means and prevalence rates of the behavioural addiction and substance use disorder scales. Seven latent profiles were identified, ranging from profiles with a positive family background, favourable personality patterns and low values on mental health scales to profiles with a negative family background, unfavourable personality pattern and high values on mental health scales. Addiction scale means, corresponding prevalence rates and the number of concurrent addictions were highest in profiles with high values on mental health scales and a personality pattern dominated by neuroticism. Overall, behavioural addictions and substance use disorders showed similar patterns across latent profiles. Patterns of family background, personality and mental health factors were associated with different levels of vulnerability to addictions. Behavioural addictions and substance use disorders may thus be the result of the same underlying vulnerabilities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Managed care and the quality of substance abuse treatment.

PubMed

Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

2002-12-01

In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that

Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

ERIC Educational Resources Information Center

Stefansson, Ragnar; Hesse, Morten

2008-01-01

A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

Ethical Issues in mHealth Research Involving Persons Living with HIV/AIDS and Substance Abuse

PubMed Central

Labrique, Alain B.; Kirk, Gregory D.; Westergaard, Ryan P.; Merritt, Maria W.

2013-01-01

We aim to raise awareness and stimulate dialogue among investigators and research ethics committees regarding ethical issues that arise specifically in the design and conduct of mHealth research involving persons living with HIV/AIDS and substance abuse. Following a brief background discussion of mHealth research in general, we offer a case example to illustrate the characteristics of mHealth research involving people living with HIV/AIDS and substance abuse. With reference to a well-established systematic general ethical framework for biomedical research with human participants, we identify a range of ethical issues that have particular salience for the protection of participants in mHealth research on HIV/AIDS and substance abuse. PMID:24171110

Linking "Big" Personality Traits to Anxiety, Depressive, and Substance Use Disorders: A Meta-Analysis

ERIC Educational Resources Information Center

Kotov, Roman; Gamez, Wakiza; Schmidt, Frank; Watson, David

2010-01-01

We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66…

Aggression, impulsivity, and psychopathic traits in combined antisocial personality disorder and substance use disorder.

PubMed

Alcorn, Joseph L; Gowin, Joshua L; Green, Charles E; Swann, Alan C; Moeller, F Gerard; Lane, Scott D

2013-01-01

Aggression, impulsivity, and psychopathic traits are prominent in both antisocial personality disorder (ASPD) and substance use disorders (SUD), but have rarely been examined collectively. The authors' results show that all three variables were elevated in adults with comorbid ASPD/SUD, relative to SUD-only and control subjects.

[Conceptualizations on care for persons with dementia in nursing homes].

PubMed

Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente

2016-03-01

Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team.

Legal system involvement and costs for persons in treatment for severe mental illness and substance use disorders.

PubMed

Clark, R E; Ricketts, S K; McHugo, G J

1999-05-01

Persons with co-occurring severe mental illness and substance use disorders were followed for three years to better understand how they are involved with the legal system and to identify factors associated with different kinds of involvement. Data came from a three-year study of 203 persons enrolled in specialized treatment for dual disorders. Cost and utilization data were collected from multiple data sources, including police, sheriffs and deputies, officers of the court, public defenders, prosecutors, private attorneys, local and county jails, state prisons, and paid legal guardians. Over three years 169 participants (83 percent) had contact with the legal system, and 90 (44 percent) were arrested at least once. Participants were four times more likely to have encounters with the legal system that did not result in arrest than they were to be arrested. Costs associated with nonarrest encounters were significantly less than costs associated with arrests. Mean costs per person associated with an arrest were $2,295, and mean costs associated with a nonarrest encounter were $385. Combined three-year costs averaged $2,680 per person. Arrests and incarcerations declined over time. Continued substance use and unstable housing were associated with a greater likelihood of arrest. Poor treatment engagement was associated with multiple arrests. Men were more likely to be arrested, and women were more likely to be the victims of crime. Effective treatment of substance use among persons with mental illness appears to reduce arrests and incarcerations but not the frequency of nonarrest encounters. Stable housing may also reduce the likelihood and number of arrests.

Ability of Substance Abusers to Escape Detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a Juvenile Correctional Facility

ERIC Educational Resources Information Center

Stein, L. A. R.; Graham, John R.

2005-01-01

The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once…

Personal care workers in Australian aged care: retention and turnover intentions.

PubMed

Radford, Katrina; Shacklock, Kate; Bradley, Graham

2015-07-01

This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation. © 2013 John Wiley & Sons Ltd.

Personal Trainer Perceptions of Providing Nutrition Care to Clients: A Qualitative Exploration.

PubMed

Barnes, Katelyn; Ball, Lauren; Desbrow, Ben

2017-04-01

Personal trainers are well placed to provide basic nutrition care in line with national dietary guidelines. However, many personal trainers provide nutrition care beyond their scope of practice and this has been identified as a major industry risk due to a perceived lack of competence in nutrition. This paper explores the context in which personal trainers provide nutrition care, by understanding personal trainers' perceptions of nutrition care in relation to their role and scope of practice. Semistructured telephone interviews were conducted with 15 personal trainers working within Australia. Thematic analysis was used to identify key themes. All personal trainers reported to provide nutrition care and reported that nutrition care was an important component of their role. Despite this, many were unaware or uncertain of the scope of practice for personal trainers. Some personal trainers reported a gap between the nutrition knowledge they received in their formal education, and the knowledge they needed to optimally support their clients to adopt healthy dietary behaviors. Overall, the personal training context is likely to be conducive to providing nutrition care. Despite concerns about competence personal trainers have not modified their nutrition care practices. To ensure personal trainers provide nutrition care in a safe and effective manner, greater enforcement of the scope of practice is required as well as clear nutrition competencies or standards to be developed during training.

[Talk to them: Narrative care within a person-centered care framework].

PubMed

Villar, Feliciano; Serrat, Rodrigo

The aim of this paper is to highlight the importance of narrative care in the attention of older people who receive care in institutions, underlining how its use provides a better understanding of the Person Centered Care (PCC) model and valuable strategies to put it into practice. To achieve this goal, firstly, we describe the relevance of a narrative approach for understanding the experience of the old person who receive care in institutions, with regards to individual aspects as well as to her/his relationships with professionals and the institutional discourse which contextualize these relationships. Secondly, we specify different ways in which the use of narratives could have an impact on the improvement of the quality of attention and well-being of older people receiving care in institutions. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Personality traits and career satisfaction of health care professionals.

PubMed

Richardson, John D; Lounsbury, John W; Bhaskar, Tripti; Gibson, Lucy W; Drost, Adam W

2009-01-01

Based on Holland's theorizing that vocational satisfaction arises from a good match between one's personality and career choice, one purpose of the study was to examine broad and narrow personality traits that characterize health care workers in comparison with professionals from other occupations. Also investigated were ways in which characteristic traits of health care workers were related to career satisfaction. Professionals utilizing the services of eCareerfit.com responded to online surveys that have been demonstrated to produce reliable and valid measures of broad and narrow personality traits and levels of career satisfaction. An independent sample t test was used to compare means of health care workers with those from other occupations. Pearson product-moment correlations were then computed to assess relationships between the traits and career satisfaction of health care professionals. Two traits that were particularly strong among health care workers were also significantly correlated with career satisfaction: work drive and conscientiousness. Other traits were found to be significantly related to career satisfaction in health care but were not uniquely high in the sample of health care professionals. To increase career satisfaction of health care professionals and thus to improve retention rates, administrators should consider focusing on recruiting and selecting individuals with higher levels of key personality traits.

Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience.

PubMed

Edvardsson, David; Sandman, P O; Borell, Lena

2014-07-01

Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear - targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.

Personal Health Care Expenditures by State, Selected Years 1966-1978

PubMed Central

Levit, Katharine R.

1982-01-01

In 1966, spending for personal health care in the U.S. was $39 billion. By 1978, these expenditures had grown to $166 billion. Among regions and states, different patterns and levels of spending emerged, along with different rates of growth. Some of the highlights from the accompanying report which pinpoint personal health care spending differences among regions and states are listed below. In 1978, $745 per person was spent for personal health care services within the U.S. Massachusetts led the nation in spending with $935 per person. The lowest spending for personal health—$521 per capita—occurred in South Carolina.Expenditures for hospital care ranged from a high of $490 per capita in Massachusetts to a low of $197 per capita in Idaho, with the U.S. expenditure level at $337 per person.Spending for physician services in 1978 was $161 per person nationwide. The highest level of spending—$238—was in California, and the lowest—$90—was in Vermont. Florida, with the largest proportion of aged residents in the U.S., registered expenditure levels of $208 per person for physician services. Despite a 29.5 percent increase nationwide in the number of physicians from 1969 to 1978, little change has occurred in the rank of states and regions in their physician-to-population concentrations.Minnesota led the nation in nursing home care expenditures, spending $126 per person for this service in 1978. Minnesota's high per capita spending for nursing home care correlates with its large number of nursing home beds per 65 years of age and over population. In 1978, the 96 beds per 1000 elderly residents which were maintained in Minnesota contrasted sharply with the 56 beds maintained per 1000 elderly residents nationwide.Personal health care expenditures per capita grew an average of 11.6 percent per year between 1966 and 1978. Growth was most dramatic in the Southeast, where expenditures per capita more than quadrupled, growing 12.6 percent per year. Mississippi

Psychopathological features in a sample of substance-abusing individuals with criminal history: Towards a definition of a personality prototype of an 'Addict with Criminal Conduct'.

PubMed

Gori, Alessio; Ponti, Lucia; Tani, Franca; Iraci Sareri, Giuseppe; Giannini, Marco; Meringolo, Patrizia; Craparo, Giuseppe; Bruschi, Angelo; Caretti, Vincenzo; Cacioppo, Marco; Paterniti, Rolando; Schuldberg, David

2017-10-01

The relationship between substance use disorders and criminal activity is strong, and one that is not easily resolved in the criminal justice system. A better understanding of personality traits among substance misusers who commit offences could support better treatment efforts. The aim of this study is to explore associations between the psychopathology of people addicted to substances who have also committed crimes. We recruited 263 substance-dependent individuals (80% male, 20% female) from a cohort of people attending regional community services in Italy. They all completed an extensive evaluation of their current mental health and personality traits. Their official criminal records were obtained, and the psychopathology of those who had a criminal record compared with those who did not. The criminal group was more likely to perceive the external world as hostile and to consider others as responsible for their own problems and difficulties; in addition, substance-dependent individuals with criminal records showed more personality traits within the psychopathy range and fewer in the dependent personality range than the substance abusers who had never committed crimes. These findings allow us to hypothesise that substance abusers who also have criminal convictions may have a specific personality profile. If further research were to confirm this, then it could have important implications for identifying people for particular treatment pathways and developing more effective treatments. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Psycho-education for substance use and antisocial personality disorder: a randomized trial.

PubMed

Thylstrup, Birgitte; Schrøder, Sidsel; Hesse, Morten

2015-11-14

Antisocial personality disorder often co-exists with drug and alcohol use disorders. This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure. Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up. Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder. ISRCTN registry, ISRCTN67266318 , 17/7/2012.

TRAJECTORIES OF SUBSTANCE USE FREQUENCY AMONG ADOLESCENTS SEEN IN PRIMARY CARE: IMPLICATIONS FOR SCREENING

PubMed Central

Hadland, Scott E.; Copelas, Sarah H.; Harris, Sion K.

2017-01-01

Objective Anticipating how adolescents’ substance use may escalate is critical for primary care clinicians. We identified trajectories of use in a prospective cohort of adolescent primary care patients one year after a clinic visit. Study Design We recruited 12- to 18-year-olds from 9 New England practices between 2005–2008 and identified 5 trajectories of substance use. We first distinguished adolescents with no past-year use at a baseline clinic visit and at 12-month follow-up (trajectory A). For adolescents who used substances, we assessed past-90-day use at both timepoints, and identified the remaining 4 trajectories based on frequency of use. Trajectories included: substance-involved parents, siblings, and peers. Results Among 860 adolescents (mean age 15.4 years; 60.9% female; 65.6% white non-Hispanic), more than half (52.7%) abstained (trajectory A). The remainder were classified into trajectories B (23.8%), C (9.5%), D (5.7%), and E (8.3%). Those who abstained were least likely to have substance-involved parents (adjusted odds ratio [AOR]=0.58; 95% confidence interval [95%CI]=0.46–0.72), siblings (AOR=0.49; 95%CI=0.40–0.60), or peers (AOR=0.44; 95%CI=0.37–0.52). Those increasing from substance-involved siblings (AOR=1.58; 95%CI=1.23–2.03) or peers (AOR=1.51; 95%CI=1.06–2.17). Conclusions Most adolescent primary care patients remained abstinent or infrequent users over one year, but 1 in 5 showed frequent use, with substance-involved siblings, and peers predicting escalation of use. PMID:28196680

Telephone-based continuing care counseling in substance abuse treatment: economic analysis of a randomized trial

PubMed Central

Daley, Marilyn C.; Neuman, Matthew J.; Blaakman, Aaron P.; McKay, James R.

2016-01-01

Purpose To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse. Methods Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes. Results The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1,684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (−$1,400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. Conclusions TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered. PMID:26718395

Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial.

PubMed

Shepard, Donald S; Daley, Marilyn C; Neuman, Matthew J; Blaakman, Aaron P; McKay, James R

2016-02-01

To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse. Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes. The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (-$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Substance related disorder in emergency services: Which attitudes?

PubMed

Rica, M; Principe, A; Le Reste, J-Y; Guillou Landreat, M

2017-02-01

Substance related disorders are more prevalent in emergency services than in the general population, about 20% of individuals in emergency care test positive for alcohol. Emergency services are strategic places to identify alcohol misuse. Attitudes to individuals presenting substance related disorders are important in developing therapeutic relationships and applying interventions. This study explores the attitudes of an emergency staff to these individuals across a range of roles, and evolution in face of an addictology care improvement. Data were gathered from an emergency service sample from the emergency department of a general hospital in Morlaix (France). We used a short questionnaire, adapted from previous similar French studies. Twenty-five persons answered the first questionnaire and 18 the second. A self-administrated attitudes questionnaire showed its interest in our study and helped us to identify attitudes and to initiate a reflection on behaviours in emergency care. Moreover, it helped to change attitudes towards individuals presenting substance related disorders. The daily setting of an addictive disorders specialized unit in emergency changed the point of view on addictive disorders of both physicians and nurses. We showed differences in addictive related disorders prevalence perception among patients attending emergency care between the two evaluations. But we also showed that physicians and nurses stressed that it was more difficult to ask patients in emergency care on the second evaluation, after and despite a daily addictive disorders specialized setting. We showed several limits in emergency staff care relationship with patients with substance related disorders. They identified difficulties to talk about addictive disorders, especially in younger and older patients. Regarding literature, we discuss our study limits and different ways of improving addictology care in emergency services. Copyright © 2015 L'Encéphale, Paris. Published by

Addressing the critical health problem of adolescent substance use through health care, research, and public policy.

PubMed

Feinstein, Emily C; Richter, Linda; Foster, Susan E

2012-05-01

The use of addictive substances-tobacco, alcohol, and other drugs-during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: America's #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Demographic Characteristics and Rates of Progress of Deaf and Hard of Hearing Persons Receiving Substance Abuse Treatment

ERIC Educational Resources Information Center

Moore, Dennis; McAweeney, Mary

2007-01-01

A lack of demographic information and data related to the achievement of short-term goals during substance abuse treatment among persons who are deaf or hard of hearing dictated the need for the study. New York State maintains a database on all individuals who participate in treatment. Within this database, 1.8% of persons in treatment for…

Mental health, substance abuse, and health behavior services in patient-centered medical homes.

PubMed

Kessler, Rodger; Miller, Benjamin F; Kelly, Mark; Graham, Debbie; Kennedy, Amanda; Littenberg, Benjamin; MacLean, Charles D; van Eeghen, Constance; Scholle, Sarah Hudson; Tirodkar, Manasi; Morton, Suzanne; Pace, Wilson D

2014-01-01

The purpose of this study was to understand mental health, substance use, and health behavior activities within primary care practices recognized by the National Committee for Quality Assurance as patient-centered medical homes (PCMHs). We identified 447 practices with all levels of National Committee for Quality Assurance PCMH recognition as of March 1, 2010. We selected the largest practice from multisite groups, and 238 practices were contacted. We received 123 responses, for a 52% response rate. A 40-item web-based survey was collected. Of PCMH practices, 42% have a behavioral health clinician on site; social workers were the most frequent category of provider delivering behavioral services. There are also were care managers-distinct from behavioral health clinician-at 62% of practices. Surveyed practices were less likely to have procedures for referrals, communication, and patient scheduling for responding to mental health and substance use services than for other medical subspecialties (50% compared with 73% for cardiology and 69% for endocrinology). More than half of practices (62%) reported using electronic, standardized depression screening and monitoring; practices were less likely to screen for substance use than mental health. Among the practices, 54% used evidence-based health behavior protocols for mental health and substance use conditions. Practices reported that lack of reimbursement, time, and sufficient knowledge were obstacles. Practices serving a higher proportion of low-income patients performed more mental health organizational and clinical activities. In PCMHs, practice organization and response to behavioral issues seem to be less well developed than other types of medical care. These results support further efforts to develop whole-person care in the PCMH, with greater emphasis on access to and coordination of mental health, substance abuse, and health behavior services. Focusing primary care practices on this aspect of whole-person care

Primary care providers’ experiences with and perceptions of personalized genomic medicine

PubMed Central

Carroll, June C.; Makuwaza, Tutsirai; Manca, Donna P.; Sopcak, Nicolette; Permaul, Joanne A.; O’Brien, Mary Ann; Heisey, Ruth; Eisenhauer, Elizabeth A.; Easley, Julie; Krzyzanowska, Monika K.; Miedema, Baukje; Pruthi, Sandhya; Sawka, Carol; Schneider, Nancy; Sussman, Jonathan; Urquhart, Robin; Versaevel, Catarina; Grunfeld, Eva

2016-01-01

Abstract Objective To assess primary care providers’ (PCPs’) experiences with, perceptions of, and desired role in personalized medicine, with a focus on cancer. Design Qualitative study involving focus groups. Setting Urban and rural interprofessional primary care team practices in Alberta and Ontario. Participants Fifty-one PCPs. Methods Semistructured focus groups were conducted and audiorecorded. Recordings were transcribed and analyzed using techniques informed by grounded theory including coding, interpretations of patterns in the data, and constant comparison. Main findings Five focus groups with the 51 participants were conducted; 2 took place in Alberta and 3 in Ontario. Primary care providers described limited experience with personalized medicine, citing breast cancer and prenatal care as main areas of involvement. They expressed concern over their lack of knowledge, in some circumstances relying on personal experiences to inform their attitudes and practice. Participants anticipated an inevitable role in personalized medicine primarily because patients seek and trust their advice; however, there was underlying concern about the magnitude of information and pace of discovery in this area, particularly in direct-to-consumer personal genomic testing. Increased knowledge, closer ties to genetics specialists, and relevant, reliable personalized medicine resources accessible at the point of care were reported as important for successful implementation of personalized medicine. Conclusion Primary care providers are prepared to discuss personalized medicine, but they require better resources. Models of care that support a more meaningful relationship between PCPs and genetics specialists should be pursued. Continuing education strategies need to address knowledge gaps including direct-to-consumer genetic testing, a relatively new area provoking PCP concern. Primary care providers should be mindful of using personal experiences to guide care. PMID:27737998

Primary care providers' experiences with and perceptions of personalized genomic medicine.

PubMed

Carroll, June C; Makuwaza, Tutsirai; Manca, Donna P; Sopcak, Nicolette; Permaul, Joanne A; O'Brien, Mary Ann; Heisey, Ruth; Eisenhauer, Elizabeth A; Easley, Julie; Krzyzanowska, Monika K; Miedema, Baukje; Pruthi, Sandhya; Sawka, Carol; Schneider, Nancy; Sussman, Jonathan; Urquhart, Robin; Versaevel, Catarina; Grunfeld, Eva

2016-10-01

To assess primary care providers' (PCPs') experiences with, perceptions of, and desired role in personalized medicine, with a focus on cancer. Qualitative study involving focus groups. Urban and rural interprofessional primary care team practices in Alberta and Ontario. Fifty-one PCPs. Semistructured focus groups were conducted and audiorecorded. Recordings were transcribed and analyzed using techniques informed by grounded theory including coding, interpretations of patterns in the data, and constant comparison. Five focus groups with the 51 participants were conducted; 2 took place in Alberta and 3 in Ontario. Primary care providers described limited experience with personalized medicine, citing breast cancer and prenatal care as main areas of involvement. They expressed concern over their lack of knowledge, in some circumstances relying on personal experiences to inform their attitudes and practice. Participants anticipated an inevitable role in personalized medicine primarily because patients seek and trust their advice; however, there was underlying concern about the magnitude of information and pace of discovery in this area, particularly in direct-to-consumer personal genomic testing. Increased knowledge, closer ties to genetics specialists, and relevant, reliable personalized medicine resources accessible at the point of care were reported as important for successful implementation of personalized medicine. Primary care providers are prepared to discuss personalized medicine, but they require better resources. Models of care that support a more meaningful relationship between PCPs and genetics specialists should be pursued. Continuing education strategies need to address knowledge gaps including direct-to-consumer genetic testing, a relatively new area provoking PCP concern. Primary care providers should be mindful of using personal experiences to guide care. Copyright© the College of Family Physicians of Canada.

Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain.

PubMed

Hilarion, Pilar; Groene, Oliver; Colom, Joan; Lopez, Rosa M; Suñol, Rosa

2010-10-23

The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector

Use of psychoactive substances in persons with spinal cord injury: a literature review.

PubMed

Tétrault, M; Courtois, F

2014-12-01

To undertake a critical review of literature on use of legal and illegal psychoactive substances (PAS) in persons with spinal cord injury (SCI) before and after trauma. Hundred and five articles published between 1980 and 2014 on alcohol and drug use in persons with SCI before and after trauma were retrieved from the PubMed and PsycInfo search engines. Before injury, 25% to 96% of people with SCI reported using alcohol, while 32% to 35% had used illegal drugs. At the time of injury, 31% to 50% of individuals with SCI were intoxicated with alcohol, 16% to 33% with drugs and 26% with a combination of drugs and alcohol. Among those reporting PAS use before injury, up to 50% stated that they had reduced their use during active rehabilitation, during which time only 6% consumed psychoactive substances for the first time. A variety of risk factors are associated with consumption subsequent to spinal cord injury: personality alteration (impulsiveness, aggressiveness), posttraumatic depression, poor coping skills, lack of social support and pain. PAS use can affect the process of rehabilitation, diminish the effectiveness of medication and result in various medical complications. Few studies have explored the use of alcohol, drugs and psychoactive medications before SCI and during active rehabilitation. To our knowledge, no study has analyzed the evolution of PAS use after hospital discharge, even though return home is associated with new stressors that may trigger risky behaviors. It should be a priority, as early as possible during rehabilitation, to detect persons at risk of developing PAS abuse. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A global framework to model spatial ecosystems exposure to home and personal care chemicals in Asia.

PubMed

Wannaz, Cedric; Franco, Antonio; Kilgallon, John; Hodges, Juliet; Jolliet, Olivier

2018-05-01

This paper analyzes spatially ecosystem exposure to home and personal care (HPC) chemicals, accounting for market data and environmental processes in hydrological water networks, including multi-media fate and transport. We present a global modeling framework built on ScenAT (spatial scenarios of emission), SimpleTreat (sludge treatment plants), and Pangea (spatial multi-scale multimedia fate and transport of chemicals), that we apply across Asia to four chemicals selected to cover a variety of applications, volumes of production and emission, and physico-chemical and environmental fate properties: the anionic surfactant linear alkylbenzene sulphonate (LAS), the antimicrobial triclosan (TCS), the personal care preservative methyl paraben (MeP), and the emollient decamethylcyclopentasiloxane (D5). We present maps of predicted environmental concentrations (PECs) and compare them with monitored values. LAS emission levels and PECs are two to three orders of magnitude greater than for other substances, yet the literature about monitored levels of LAS in Asia is very limited. We observe a good agreement for TCS in freshwater (Pearson r=0.82, for 253 monitored values covering 12 streams), a moderate agreement in general, and a significant model underestimation for MeP in sediments. While most differences could be explained by uncertainty in both chemical/hydrological parameters (DT50 water , DT50 sediments , K oc , f oc , TSS) and monitoring sites (e.g. spatial/temporal design), the underestimation of MeP concentrations in sediments may involve potential natural sources. We illustrate the relevance of local evaluations for short-lived substances in fresh water (LAS, MeP), and their inadequacy for substances with longer half-lives (TCS, D5). This framework constitutes a milestone towards higher tier exposure modeling approaches for identifying areas of higher chemical concentration, and linking large-scale fate modeling with (sub) catchment-scale ecological scenarios; a

Borderline personality disorder in the primary care setting.

PubMed

Dubovsky, Amelia N; Kiefer, Meghan M

2014-09-01

Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Communicative challenges in the home care of older persons - a qualitative exploration.

PubMed

Sundler, Annelie J; Eide, Hilde; van Dulmen, Sandra; Holmström, Inger K

2016-10-01

To explore communicative challenges in encounters between nurse assistants and older persons during home care visits. The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication. A descriptive observational design with a qualitative approach was used. The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. A hermeneutic phenomenological analysis was conducted. Communicative challenges were identified: (a) in situations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility and worries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges. The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level. © 2016 John Wiley & Sons Ltd.

Substance use and its implications for the critical care nurses: a literature review.

PubMed

Brotto, Vanessa; Lee, Geraldine

2007-04-01

Illicit drug use in Australia has been increasing and studies indicate that illicit drug users have a higher risk of accidents which may result in the user needing critical care. However, there is a significant gap in the literature specifically pertaining to the implications of drug use in critical care. The primary objective was to examine the literature for the physiological effects of methylenedioxymethamphetamine (MDMA), cocaine and amphetamines in critically ill patients. A comprehensive literature review was undertaken and a body systems framework was used to categorise the effects of these illicit drugs. The illicit substances addressed have potentially fatal and long-term side effects. For those users involved in accidents or trauma requiring intensive or critical care nursing, the mortality and co-morbidity risks are increased significantly. It is, therefore, important that nurses are able to recognise the specific physiological effects and possible complications that can occur with the use of each illicit drug. Both nursing and medical staff need to have a thorough understanding of how illicit substances work and how they can affect the critical care patient and the care they are given.

Residential Treatment of Substance Abusing Adolescents: Trends in the Post-Managed Care Era

ERIC Educational Resources Information Center

MacMaster, Samuel A.; Ellis, Rodney A.; Cooper, Lyle

2005-01-01

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis…

Examining the Role of Personality, Peers, and the Transition to College on Substance Use

ERIC Educational Resources Information Center

Bailey, Ursula Louise

2011-01-01

It is well established that there is an increase in substance use among college students. In the literature, this increase in use has been attributed to different personality factors, such as sensation seeking. However, what has not received sufficient attention is the possibility that the new peer groups, afforded by the transition to college,…

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal

Do Personality Traits Moderate the Impact of Care Receipt on End-of-Life Care Planning?

PubMed Central

Ha, Jung-Hwa; Pai, Manacy

2012-01-01

Purpose of the Study: This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP. Design and Methods: Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school graduates from 1957 to 2004. We used data on EOLCP among older adults in the most recent (2003–2004) wave of this survey. Hierarchical logistic regression models are used to estimate the effects of care receipt and the moderating effects of personality. Results: Compared with their peers who are not receiving care, care recipients are more likely to engage in informal discussion on EOLCP. This association between care receipt and informal EOLCP is strengthened when the individual scores high on openness. Implications: Health practitioners should take into account older adults’ care needs and differing personality traits while helping older adults make successful EOLCP. PMID:22459693

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

PubMed Central

Ghitza, Udi E.; Tai, Betty

2014-01-01

Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care. PMID:24583486

Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems.

PubMed

Suarez, Liza M; Belcher, Harolyn M E; Briggs, Ernestine C; Titus, Janet C

2012-06-01

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

Substance Use Stigma: Reliability and validity of a theory-based scale for substance-using populations*

PubMed Central

Smith, Laramie R.; Earnshaw, Valerie A.; Copenhaver, Michael M.; Cunningham, Chinazo O.

2016-01-01

Background Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized substance use stigma mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population. Methods This study was a cross-sectional evaluation of the validity, reliability, and generalizability of the SU-SMS across two independent samples with diverse substance use and treatment histories. Results Findings support the structural and construct validity of the SU-SMS, suggesting the scale was able to capture enacted, anticipated, and internalized stigma as distinct stigma experiences. It also further differentiated between two distinct stigma sources (family and healthcare providers). Analysis of these mechanisms and psychosocial metrics suggests that the scale is also associated with other health-related outcomes. Furthermore, the SU-SMS demonstrated high levels of internal reliability and generalizability across two independent samples of persons with diverse substance use disorders and treatment histories. Conclusion The SU-SMS may serve as a valuable tool for better understanding the processes through which substance use stigma serves to undermine key health behaviors and outcomes among persons with substance use disorders. PMID:26972790

Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

PubMed

Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

2017-01-01

Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

Personality disorders in early adolescence and the development of later substance use disorders in the general population

PubMed Central

Cohen, Patricia; Chen, Henian; Crawford, Thomas N.; Brook, Judith S.; Gordon, Kathy

2007-01-01

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention. PMID:17227697

Personality disorders in early adolescence and the development of later substance use disorders in the general population.

PubMed

Cohen, Patricia; Chen, Henian; Crawford, Thomas N; Brook, Judith S; Gordon, Kathy

2007-04-01

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.

Guidance on maintaining personal hygiene in nail care.

PubMed

Malkin, Bridget; Berridge, Pat

Nail care is important in the maintenance of personal hygiene and is an essential aspect of patient care. Confusion about who should perform nail care for patients has resulted in poor practice and cycles of non-activity. This article provides guidance for nurses on performing routine nail care.

A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action

PubMed Central

Glynn, Tiffany R.; van den Berg, Jacob J.

2017-01-01

Abstract Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work. PMID:28861547

Depression care among adults with co-occurring major depressive episodes and substance use disorders in the United States.

PubMed

Han, Beth; Olfson, Mark; Mojtabai, Ramin

2017-08-01

We examined 12-month prevalence and correlates of receiving depression care and perceiving helpfulness of depression care among U.S. adults with major depressive episodes (MDE) and substance use disorders (SUD). Data were from 325,800 adults who participated in the 2008-2014 National Surveys on Drug Use and Health (NSDUH). Descriptive analyses and bivariable and multivariable logistic regression models were applied. In the U.S., 3.3 million adults (1.4% of the adult population) had co-occurring MDE and SUD in the past year. Among adults with both disorders, 55.4% reported receiving past-year depression care. Among those with past-year depression care, 36.1% perceived it as helpful. Compared with adults who did not receive substance use treatment in the past year, those who received substance use treatment were significantly more likely to receive depression care, and those who received treatment of both disorders were more likely to perceive their depression care as helpful (adjusted risk ratios (ARRs) = 1.5-1.6). Compared with adults who received depression care only from general medical providers, those who received depression care from specialty mental health providers were more likely to report that their care was helpful (ARRs = 1.4-1.6). Receipt of prescription medication for MDE was associated with perceived helpfulness of depression care (ARR = 1.3, 95% CI = 1.05-1.73). Almost half of adults with co-occurring MDE and SUD did not receive past-year depression care. Among those who received depression care, most did not perceive it as helpful. Substance use treatment, specialty mental health treatment, and antidepressant medications were perceived as helpful aspects of depression care. Published by Elsevier Ltd.

Co-occurrence of substance use related and mental health problems in the Finnish social and health care system.

PubMed

Kuussaari, Kristiina; Hirschovits-Gerz, Tanja

2016-03-01

Many studies have noted that substance abuse and mental health problems often occur simultaneously. The aim of the work reported here was to study the co-occurrence of mental health problems and problems related to substance use in a sample of clients visiting the Finnish social and health care services for issues related to substance use. We collected background information on the clients and considered the parts of the treatment system in which these clients were treated. Survey data on intoxicant-related cases in the Finnish health care and social services were gathered on a single day in 2011. During the 24 hours of data collection, all intoxicant-related cases were reported and data were obtained for 11,738 intoxicant-related cases. In this analysis we took into account the clients' background variables, mental health variables, information on the treatment type and the main reasons for the client being in treatment. The χ(2) test, Fisher's exact test and binary logistic regression analysis were used. Half of the visiting clients had both substance use related and mental health problems. The strongest factors associated with the co-occurrence of substance use related and mental health problems were female sex, younger age and single marital status. Clients with co-occurring problems were more often treated in the health care services, whereas clients with only substance use related problems were primarily treated in specialized services for the treatment of substance abuse. It is important to identify clients with co-occurring substance use related and mental health problems. In this study, half of the clients presenting to the Finnish social and health care treatment system had both these problems. © 2015 the Nordic Societies of Public Health.

Characteristics of U.S. Substance Abuse Treatment Facilities Offering HIV Services: Results From a National Survey.

PubMed

Cohn, Amy; Stanton, Cassandra; Elmasry, Hoda; Ehlke, Sarah; Niaura, Ray

2016-06-01

Substance use disorders are common among persons with HIV/AIDS. This study examined the prevalence and correlates of the provision of four HIV services in a national sample of substance abuse treatment facilities. Data were from the 2011 National Survey of Substance Abuse Treatment Services. Prevalence estimates indicated that 28% of facilities offered HIV testing, 26% early intervention, 58% HIV/AIDS education, and 8% special programs for HIV/AIDS. Facilities offering inpatient substance abuse care were more than six times as likely to offer HIV testing but not more likely to offer any other type of HIV service. Facilities offering methadone treatment were 2.5 times more likely to offer HIV services. Given the high rates of substance use among persons with HIV, the prevalence of facilities offering HIV services was low in most domains, with different barriers identified in multivariable models. Integrating comprehensive HIV prevention, testing, and support services into programs that address substance abuse is needed.

Medicaid-financed residential care for persons with mental retardation.

PubMed

Lakin, K C; Hall, M J

1990-12-01

Two sources of Medicaid support for persons with mental retardation and related conditions (MR/RC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States.

Medicaid-financed residential care for persons with mental retardation

PubMed Central

Lakin, K. Charlie; Hall, Margaret Jean

1990-01-01

Two sources of Medicaid support for persons with mental retardation and related conditions (MRIRC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States. PMID:10113489

Service use and costs for persons experiencing chronic homelessness in Philadelphia: a population-based study.

PubMed

Poulin, Stephen R; Maguire, Marcella; Metraux, Stephen; Culhane, Dennis P

2010-11-01

This study is the first to examine the distribution of service utilization and costs with a population-based sample that experienced chronic homelessness in sheltered and unsheltered locations in a large U.S. city. This study used shelter and street outreach records from a large U.S. city to identify 2,703 persons who met federal criteria for chronic homelessness during a three-year period. Identifiers for these persons were matched to administrative records for psychiatric care, substance abuse treatment, and incarceration. Twenty percent of the persons who incurred the highest costs for services accounted for 60% of the total service costs of approximately $20 million a year (or approximately $12 million). Most of the costs for this quintile were for psychiatric care and jail stays. Eighty-one percent of the persons in the highest quintile had a diagnosis of a serious mental illness, and 83% of the persons in the lowest quintile had a history of substance abuse treatment without a diagnosis of a serious mental illness. Supportive housing models for people with serious mental illness who experience chronic homelessness may be associated with substantial cost offsets, because the use of acute care services diminishes in an environment of housing stability and access to ongoing support services. However, because persons with substance use issues and no recent history of mental health treatment used relatively fewer and less costly services, cost neutrality for these persons may require less service-intensive programs and smaller subsidies.

Insecure Attachment Styles and Increased Borderline Personality Organization in Substance Use Disorders.

PubMed

Hiebler-Ragger, Michaela; Unterrainer, Human-Friedrich; Rinner, Anita; Kapfhammer, Hans-Peter

Previous research has linked insecure attachment styles and borderline personality organization to substance use disorder (SUD). However, it still remains unclear whether those impairments apply to different kinds of SUDs to the same extent. Therefore, in this study we sought to investigate potential differences regarding attachment deficits and borderline personality organization in two different SUD inpatient groups and furthermore in comparison to healthy controls. A total of 66 (24 female) inpatients diagnosed with alcohol use disorder (AUD), 57 (10 female) inpatients diagnosed with polydrug use disorder (PUD), and 114 (51 female) healthy controls completed the Borderline Personality Inventory and the Attachment Style Questionnaire. Compared to healthy controls, AUD and PUD inpatients showed significant deficits in all attachment parameters (p < 0.01) as well as a significantly increased amount of borderline personality organization (p < 0.01). No differences between AUD and PUD inpatients were observed (p > 0.05). Our results indicate that the drug(s) of choice cannot be regarded as an indicator for the extent of attachment deficits or personality pathology. These initial findings are mainly limited by the rather small sample size as well as just a single point of measurement. Future research might also consider further covariates such as comorbidity or psychotropic medication. © 2016 S. Karger AG, Basel.

Special Issue: Using Drama to Improve Person-Centred Dementia Care

PubMed Central

Mitchell, Gail J.; Mistry, Bhavnita; Ballon, Bruce

2013-01-01

Background Person-centred dementia care guidelines emphasize the assessment of individual needs, and, where appropriate, the use of non-pharmacological interventions before resorting to pharmacological management. Yet dementia care is not consistent with these guidelines suggesting conceptual limitations and reliance on passive knowledge translation strategies. Aims and Objectives We implemented a 12-week drama-based educational intervention to introduce to dementia practitioners person-centred care that emphasizes the notion of embodied selfhood (defined as non-verbal self-expression). Design and Methods Focus groups and semi-structured interviews with practitioners (n=24) in two nursing homes in central Canada were undertaken to assess the effectiveness of the drama-based components of the intervention. Results Our findings suggest that drama was effective as an educational modality, and helped implement the person-centred approach into practice. Significant practice outcomes included: new awareness that residents’ body movements and dispositions convey meaning; seeking biographical information from families; increased time efficiency; and supporting residents’ independence. Conclusions Our findings make an important contribution to person-centred dementia care by broadening the notion of personhood, and by facilitating implementation using drama. Implications for Practice As an enhancement of person-centered care, the support of embodied selfhood may significantly improve residents’ quality of life, quality of care, and practitioners’ caregiving experience. PMID:20925717

Ability of Substance Abusers to Escape Detection on the Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A) in a Juvenile Correctional Facility

PubMed Central

Stein, L. A. R.; Graham, John R.

2010-01-01

The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once under instructions to fake good (FG). Under SI, substance scales correctly classified about 60% to 85% of adolescents. Under FG, substance- and non-substance-abusing juveniles produced lower scores on substance scales. However, the Lie Scale (L) was able to detect more than 75% of deceptive profiles and about 77% of honest profiles. When scale L and the best substance scale were used in combination, only about 18% of faking substance abusers were not identified as either substance abusers or as underreporting. For feigning substance abusers, only about 10% of substance abusers were detected, with about 72% being categorized as faking and needing further assessment. PMID:15695741

Comorbidity of mood and substance use disorders in patients with binge-eating disorder: Associations with personality disorder and eating disorder pathology.

PubMed

Becker, Daniel F; Grilo, Carlos M

2015-08-01

Binge-eating disorder (BED) is associated with elevated rates of mood and substance use disorders, but the significance of such comorbidity is ambiguous. We compared personality disorder and eating disorder psychopathology in four subgroups of BED patients: those with mood disorders, those with substance use disorders, those with both, and those with neither. Subjects were 347 patients who met DSM-IV research criteria for BED. Semistructured interviews evaluated lifetime DSM-IV axis I disorders, DSM-IV personality disorder features, and eating disorder psychopathology. Among these patients, 129 had co-occurring mood disorder, 34 had substance use disorder, 60 had both, and 124 had neither. Groups differed on personality disorder features, with those having mood disorder and both mood and substance use disorders showing the highest frequencies. Although groups did not differ in body mass index or binge eating frequency, they did differ on eating disorder psychopathology-with the groups having mood disorder and both comorbidities demonstrating higher eating, weight, and shape concerns. No differences were observed between groups with respect to ages of onset for specific eating behaviors, but some differences were observed for ages of disorder onset. Mood and substance use disorders co-occur frequently among patients with BED. Compared with a previous work, the additional comparison group (those with both mood and substance use disorders) and the control group (those with neither) afforded better discrimination regarding the significance of these comorbidities. Our findings suggest approaches to subtyping BED based on psychiatric comorbidity, and may also have implications for treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Substance use and drinking outcomes in Personalized Cognitive Counseling randomized trial for episodic substance-using men who have sex with men.

PubMed

Santos, Glenn-Milo; Coffin, Phillip O; Vittinghoff, Eric; DeMicco, Erin; Das, Moupali; Matheson, Tim; Raiford, Jerris L; Carry, Monique; Colfax, Grant; Herbst, Jeffrey H; Dilley, James W

2014-05-01

Non-dependent alcohol and substance use patterns are prevalent among men who have sex with men (MSM), yet few effective interventions to reduce their substance use are available for these men. We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM (SUMSM). 326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling (PCC) intervention with rapid HIV testing or to rapid HIV testing only control. Both arms followed over 6 months. Trends in substance use were examined using GEE Poisson models with robust standard errors by arm. Reductions in frequency of use were examined using ordered logistic regression. In intent-to-treat analyses, compared to men who received rapid HIV testing only, we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption (RR=0.93; 95% CI=0.89-0.97), marijuana use (RR=0.84; 95% CI=0.73-0.98), and erectile dysfunction drug use (EDD; RR=0.51; 95% CI=0.33-0.79) over the 6-month follow-up. PCC was also significantly associated with reductions in frequency of alcohol intoxication (OR=0.58; 95% CI=0.36-0.90) over follow-up. Furthermore, we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine (RR=0.26; 95% CI=0.08-0.84). The addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk, including alcohol and EDD; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

PubMed Central

Kuznetsova, Anna V.; Meylakhs, Anastasia Y.; Amirkhanian, Yuri A.; Kelly, Jeffrey A.; Yakovlev, Alexey A.; Musatov, Vladimir B.; Amirkhanian, Anastasia G.

2016-01-01

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one’s HIV status, fears of learning about one’s true health status, and substance abuse. Care facilitators were feeling responsible for one’s health and one’s family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one’s doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services. PMID:26767534

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia.

PubMed

Kuznetsova, Anna V; Meylakhs, Anastasia Y; Amirkhanian, Yuri A; Kelly, Jeffrey A; Yakovlev, Alexey A; Musatov, Vladimir B; Amirkhanian, Anastasia G

2016-10-01

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

Characteristics of private-sector managed care for mental health and substance abuse treatment.

PubMed

Garnick, D W; Hendricks, A M; Dulski, J D; Thorpe, K E; Horgan, C

1994-12-01

This study examined diversity during the late 1980s in managed care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on the effectiveness of utilization review programs. Telephone interviews were conducted with representatives of utilization review programs for employee health insurance plans in 31 firms that employed 2.1 million people in 1990. Questions addressed qualifications of personnel, clinical criteria to authorize care, integration with employee assistance plans, penalties for not complying with utilization review procedures, outpatient review, and carve out of mental health and substance abuse review. Large variations in utilization review programs were found. Programs employed a range of review personnel and used a variety of clinical criteria to authorize care. More than two-thirds did not carve out mental health and substance abuse review from medical-surgical review. Some firms' employee assistance plans were integrated with utilization review programs, while others remained unintegrated. Penalties for not following program procedures varied widely, as did review of outpatient services. Because of trends toward even more diversity in utilization review programs in the 1990s, research that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining quality of care will increasingly be needed.

Canadian Schizophrenia Guidelines: Schizophrenia and Other Psychotic Disorders with Coexisting Substance Use Disorders.

PubMed

Crockford, David; Addington, Donald

2017-09-01

Persons with schizophrenia and other psychotic disorders frequently have coexisting substance use disorders that require modifications to treatment approaches for best outcomes. The objectives of this review were to identify evidence-based practices best practices that improve outcomes for individuals with schizophrenia and substance used disorders. We reviewed guidelines that were published in the last 5 years and that included systematic reviews or meta-analyses. Most of our recommendations came from 2 publications from the National Institute for Health and Care Excellence (NICE): the 2011 guidance titled Coexisting Severe Mental Illness (Psychosis) and Substance Misuse: Assessment and Management in Healthcare Settings and the 2014 guidance titled Psychosis and Schizophrenia in Adults: Prevention and Management. We placed these recommendations into the Canadian context to create this guideline. Evidence supports the inclusion of individuals with coexisting substance use disorders in first-episode psychosis programs. The programs should integrate psychosis and substance use treatments, emphasizing ongoing monitoring of both substance use and patterns and symptoms. The best outcomes are achieved with combined use of antipsychotic medications and addiction-based psychosocial interventions. However, limited evidence is available to recommend using one antipsychotic medication over another or one psychosocial intervention over another for persons with schizophrenia and other psychotic disorders with coexisting substance use disorders. Treating persons who have schizophrenia and other psychotic disorders with coexisting substance use disorders can present clinical challenges, but modifications in practice can help engage and retain people in treatment, where significant improvements over time can be expected.

Canadian Schizophrenia Guidelines: Schizophrenia and Other Psychotic Disorders with Coexisting Substance Use Disorders

PubMed Central

Addington, Donald

2017-01-01

Objective: Persons with schizophrenia and other psychotic disorders frequently have coexisting substance use disorders that require modifications to treatment approaches for best outcomes. The objectives of this review were to identify evidence-based practices best practices that improve outcomes for individuals with schizophrenia and substance used disorders. Method: We reviewed guidelines that were published in the last 5 years and that included systematic reviews or meta-analyses. Most of our recommendations came from 2 publications from the National Institute for Health and Care Excellence (NICE): the 2011 guidance titled Coexisting Severe Mental Illness (Psychosis) and Substance Misuse: Assessment and Management in Healthcare Settings and the 2014 guidance titled Psychosis and Schizophrenia in Adults: Prevention and Management. We placed these recommendations into the Canadian context to create this guideline. Results: Evidence supports the inclusion of individuals with coexisting substance use disorders in first-episode psychosis programs. The programs should integrate psychosis and substance use treatments, emphasizing ongoing monitoring of both substance use and patterns and symptoms. The best outcomes are achieved with combined use of antipsychotic medications and addiction-based psychosocial interventions. However, limited evidence is available to recommend using one antipsychotic medication over another or one psychosocial intervention over another for persons with schizophrenia and other psychotic disorders with coexisting substance use disorders. Conclusions: Treating persons who have schizophrenia and other psychotic disorders with coexisting substance use disorders can present clinical challenges, but modifications in practice can help engage and retain people in treatment, where significant improvements over time can be expected. PMID:28886671

Factors associated with attrition rate in a supportive care service for substance using pregnant women in Brazil.

PubMed

Avilla, Rosa Marina; Surjan, Juliana; de Fátima Ratto Padin, Maria; Canfield, Martha; Laranjeira, Ronaldo Ramos; Mitsuhiro, SandroSendin

2017-10-01

Retaining substance using women in antenatal care remains a major challenge. This study explored factors associated with attrition rate among women with substance use problems attending a supportive care service during pregnancy and soon after the birth of the infant. Records of 166 women's antenatal consultations were analyzed. Attrition rate was high (75/166, 45.2%), and was associated with women having no schooling/primary schooling only, no family contact, having child(ren), crack-cocaine use, poly drug use, and substance use problems by the expected child's father. Attrition may be the outcome of socio-demographic, family, individual, and substance use issues not fully addressed in prenatal interventions. Identification of who are at risk for dropping out affords services with an opportunity to prevent its occurrence. (Am J Addict 2017;26:676-679). © 2017 American Academy of Addiction Psychiatry.

Substance Use in Adolescent Psychiatric Outpatients: Self-Report, Health Care Providers' Clinical Impressions, and Urine Screening

ERIC Educational Resources Information Center

Holzer, Laurent; Pihet, Sandrine; Passini, Christina Moses; Feijo, Isabelle; Camus, Didier; Eap, Chin

2014-01-01

Purpose: To determine the prevalence of substance use among adolescent psychiatric outpatients using a variety of data sources. Method: Using a questionnaire, 3-month prevalence of substance use data were obtained from 50 adolescents and their health care providers. Adolescents' self-reports and providers' clinical impressions were compared with…

Models of home care services for persons with dementia: a narrative review.

PubMed

Low, Lee-Fay; Fletcher, Jennifer

2015-10-01

Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

Resident Reactions to Person-Centered Communication by Long-Term Care Staff.

PubMed

Savundranayagam, Marie Y; Sibalija, Jovana; Scotchmer, Emma

2016-09-01

Long-term care staff caregivers who are person centered incorporate the life history, preferences, and feelings of residents with dementia during care interactions. Communication is essential for person-centered care. However, little is known about residents' verbal reactions when staff use person-centered communication. Accordingly, this study investigated the impact of person-centered communication and missed opportunities for such communication by staff on resident reactions. Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded for person-centered communication and missed opportunities. Resident utterances were coded for positive reactions, such as cooperation, and negative reactions, such as distress. Linear regression analyses revealed that the more staff used person-centered communication, the more likely that residents reacted positively. Additionally, the more missed opportunities in a conversation, the more likely that the residents reacted negatively. Conversation illustrations elaborate on the quantitative findings and implications for staff training are discussed. © The Author(s) 2016.

Person-Centredness and Fundamentals of Care - Dancing with Beauty Rather than Fighting Ugliness.

PubMed

McCormack, Brendan

2016-01-01

The fundamentals of care have re-emerged as an important consideration in nursing following a period when these role elements were predominantly "delegated tasks" delivered by other (usually unregistered/unregulated) members of the health and social care team. Contemporary critiques of nursing highlight the technical focus of nursing at the expense of its caring function. Person-centred nursing theory offers a way of reinstating the value of fundamental care as a core part of providing holistic nursing to persons as well as highlighting the importance of the nursing role in coordinating healthcare services in ways that are consistent with a person's beliefs and values. This paper argues that a focus on person-centredness enables the core function of nurses as providers and coordinators of holistic person-centred fundamental care to be revalued. It highlights the importance of nurses being clear about "what matters" in caring practices and suggests that nurses adopting a person-centred approach can achieve effective care coordination through the lens of the fundamentals of care. In reading this paper, a greater understanding of person-centredness in the context of the fundamentals of care can be achieved. Copyright © 2016 Longwoods Publishing.

[Treatment program for dual-diagnosis substance abusers].

PubMed

Kandel, Isack

2007-01-01

Dual-diagnosis mentally ill patients, i.e. those characterized with substance abuse problems combined with mental health problems, are a challenge both for systems treating substance abusers and for mental health services. These patients are not easily integrated in either of these healthcare systems and/or are treated only for one aspect of their problem by each of these systems. For such patients it is necessary to create a separate treatment model, combining care of the problem of substance abuse and attention to the patient's mental pathology, according to his individual personality traits. For purposes of this programme a treatment setting operating on the model of a therapeutic community is proposed. This setting will open an affiliated treatment programme for dual-diagnosed patients in a separate treatment programme that is not part of the therapeutic community but will be affiliated with it and will accept dual-diagnosis patients.

Health Care Finance Executive Personalities Revisited: A 10-Year Follow-up Study.

PubMed

Lieneck, Cristian; Nowicki, Michael

2015-01-01

A dynamic health care industry continues to call upon health care leaders to possess not one but multiple competencies. Inherent personality characteristics of leaders often play a major role in personal as well as organizational success to include those in health care finance positions of responsibility. A replication study was conducted to determine the Myers-Briggs personality-type differences between practicing health care finance professionals in 2014, as compared with a previous 2003 study. Results indicate a significant shift between both independent samples of health care finance professionals over the 10-year period from original high levels of introversion to that of extraversion, as well as higher sensing personality preferences, as compared with the original sample's high level of intuition preferences. Further investigation into the evolving role of the health care finance manager is suggested, while continued alignment of inherent, personal characteristics is suggested to meet ongoing changes in the industry.

Personality, Cognitive, and Interpersonal Factors in Adolescent Substance Use: A Longitudinal Test of an Integrative Model.

ERIC Educational Resources Information Center

Barnea, Zipora; And Others

1992-01-01

A test with 1,446 high school students in Israel of a multidimensional model of adolescent drug use that incorporates sociodemographic variables, personality variables, cognitive variables, interpersonal factors, and the availability of drugs validated the model longitudinally. Results suggest that different legal and illegal substances share a…

Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.

PubMed

Scales, Kezia; Bailey, Simon; Middleton, Joanne; Schneider, Justine

2017-02-01

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. © 2016 Foundation for the Sociology of Health & Illness.

The Relevance of the Affordable Care Act for Improving Mental Health Care.

PubMed

Mechanic, David; Olfson, Mark

2016-01-01

Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce.

Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program.

PubMed

Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine

2017-03-01

The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.

Personalization in the health care system: do personal health budgets have an impact on outcomes and cost?

PubMed

Jones, Karen; Forder, Julien; Caiels, James; Welch, Elizabeth; Glendinning, Caroline; Windle, Karen

2013-10-01

In England's National Health Service, personal health budgets are part of a growing trend to give patients more choice and control over how health care services are managed and delivered. The personal health budget programme was launched by the Department of Health in 2009, and a three-year independent evaluation was commissioned with the aim of identifying whether the initiative ensured better health- and care-related outcomes and at what cost when compared to conventional service delivery. The evaluation used a pragmatic controlled trial design to compare the outcomes and costs of patients selected to receive a personal health budget with those continuing with conventional support arrangements (control group). Just over 1000 individuals were recruited into the personal health budget group and 1000 into the control group in order to ensure sufficient statistical power, and followed for 12 months. The use of personal health budgets was associated with significant improvement in patients' care-related quality of life and psychological wellbeing at 12 months. Personal health budgets did not appear to have an impact on health status, mortality rates, health-related quality of life or costs over the same period. With net benefits measured in terms of care-related quality of life on the adult social care outcome toolkit measure, personal health budgets were cost-effective: that is, budget holders experienced greater benefits than people receiving conventional services, and the budgets were worth the cost. The evaluation provides support for the planned wider roll-out of personal health budgets in the English NHS after 2014 in so far as the localities in the pilot sample are representative of the whole country.

A person-centred segmentation study in elderly care: towards efficient demand-driven care.

PubMed

Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

2014-07-01

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals.

PubMed

Berntsen, Gro; Høyem, Audhild; Lettrem, Idar; Ruland, Cornelia; Rumpsfeld, Markus; Gammon, Deede

2018-06-20

Person-Centered Integrated Care (PC-IC) is believed to improve outcomes and experience for persons with multiple long-term and complex conditions. No broad consensus exists regarding how to capture the patient-experienced quality of PC-IC. Most PC-IC evaluation tools focus on care events or care in general. Building on others' and our previous work, we outlined a 4-stage goal-oriented PC-IC process ideal: 1) Personalized goal setting 2) Care planning aligned with goals 3) Care delivery according to plan, and 4) Evaluation of goal attainment. We aimed to explore, apply, refine and operationalize this quality of care framework. This paper is a qualitative evaluative review of the individual Patient Pathways (iPP) experiences of 19 strategically chosen persons with multimorbidity in light of ideals for chronic care. The iPP includes all care events, addressing the persons collected health issues, organized by time. We constructed iPPs based on the electronic health record (from general practice, nursing services, and hospital) with patient follow-up interviews. The application of the framework and its refinement were parallel processes. Both were based on analysis of salient themes in the empirical material in light of the PC-IC process ideal and progressively more informed applications of themes and questions. The informants consistently reviewed care quality by how care supported/ threatened their long-term goals. Personal goals were either implicit or identified by "What matters to you?" Informants expected care to address their long-term goals and placed responsibility for care quality and delivery at the system level. The PC-IC process framework exposed system failure in identifying long-term goals, provision of shared long-term multimorbidity care plans, monitoring of care delivery and goal evaluation. The PC-IC framework includes descriptions of ideal care, key questions and literature references for each stage of the PC-IC process. This first version of a PC

Theory-based processes that promote the remission of substance use disorders.

PubMed

Moos, Rudolf H

2007-06-01

Four related theories about the personal and social resources that shield individuals from developing substance use disorders and foster the process of remission from these disorders are described. These theories are social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. Next, the social processes specified by these theories are highlighted, including the provision of support, goal direction, and monitoring; engagement in rewarding activities other than substance use, exposure to abstinence-oriented norms and models, and attempts to build self-efficacy and coping skills. Then, a review of the literature considers evidence about the association between the personal and social resources specified by the four theories and remission from substance use disorders. The discussion highlights several issues that need to be addressed to enhance our understanding of the protective resources involved in stable remission, such as how to develop integrated measures of the key resources and specify their associations with substance use outcomes, the extent to which the resources amplify or compensate for the influence of treatment, and how treatment and continuing care can be tailored to strengthen the protective resources that promote remission.

Theory-Based Processes that Promote the Remission of Substance Use Disorders

PubMed Central

Moos, Rudolf H.

2007-01-01

Four related theories about the personal and social resources that shield individuals from developing substance use disorders and foster the process of remission from these disorders are described. These theories are social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. Next, the social processes specified by these theories are highlighted, including the provision of support, goal direction, and monitoring; engagement in rewarding activities other than substance use, exposure to abstinence-oriented norms and models, and attempts to build self-efficacy and coping skills. Then, a review of the literature considers evidence about the association between the personal and social resources specified by the four theories and remission from substance use disorders. The discussion highlights several issues that need to be addressed to enhance our understanding of the protective resources involved in stable remission, such as how to develop integrated measures of the key resources and specify their associations with substance use outcomes, the extent to which the resources amplify or compensate for the influence of treatment, and how treatment and continuing care can be tailored to strengthen the protective resources that promote remission. PMID:17254686

Person-centred care during prolonged weaning from mechanical ventilation, nurses' views: an interview study.

PubMed

Cederwall, Carl-Johan; Olausson, Sepideh; Rose, Louise; Naredi, Silvana; Ringdal, Mona

2018-06-01

To determine: 1) if the three elements of person-centred care (initiating, working and safeguarding the partnership) were present, and 2) to identify evidence of barriers to person-centred care during prolonged weaning from mechanical ventilation. Secondary analysis of semi structured interviews with 19 critical care nurses using theoretical thematic analysis. This study was conducted in three Swedish intensive care units, one in a regional hospital and two in a university hospital. Three themes and nine subthemes related to person-centred care were identified. The three themes included: 1) 'finding a person behind the patient' related to the 'initiating the partnership' phase, 2) 'striving to restore patient́s sense of control' related to 'working the partnership' phase and 3) 'impact of patient involvement' related to 'safeguarding the partnership' phase of person-centred care'. Additionally a further theme 'barriers to person-centred care' was identified. We found evidence of all three person-centred care routines. Barriers to person-centred care comprised of lack team collaboration and resources. Facilitating patients to actively participate in decision-making during the weaning process may optimise weaning outcomes and warrants further research. Copyright © 2017 Elsevier Ltd. All rights reserved.

The quality of asthma care among adults with substance-related disorders and adults with mental illness.

PubMed

Baxter, Jeffrey D; Samnaliev, Mihail; Clark, Robin E

2009-01-01

The purpose of this study was to investigate whether the presence of substance-related disorders or mental illness may affect the quality of medication management in asthma care. Claims from 1999 for adult Medicaid patients with persistent asthma from five states were analyzed. Sample sizes ranged from 1,207 to 5,815. The adjusted odds of meeting two quality-of-care measures for asthma were calculated: the Health Effectiveness Data and Information Set (HEDIS) measure of filling a single prescription for a controller medication and a non-HEDIS measure of achieving a ratio of long-term controller medications to total asthma medications of > or = .5. Odds of achieving the HEDIS measure were lower for patients with substance-related or schizophrenia disorders in two states (range of odds ratio [OR]=.69, 95% confidence interval [CI]=.53-.90, to OR=.81, 95% CI=.69-.96), but the odds increased for patients with depressive disorders in two states (OR=1.34, CI= 1.12-1.61; OR=1.37, CI=1.05-1.77) and for patients with bipolar disorder in one state (OR=1.69, CI=1.13-2.55). Odds of achieving the ratio measure were lower for patients with substance-related disorders in four states (range of OR=.63, CI=.47-.88, to OR=.75, CI=.62-.92) and higher for patients with depressive disorders, although only in one state (OR=1.25, CI=1.03-1.53). Patients with substance-related disorders and those with schizophrenia disorders may be receiving lower-quality asthma care, whereas patients with some other forms of mental illness may be receiving higher-quality care. Further studies are needed to identify the determinants of high-quality asthma care and the validity of quality measures based on administrative data in these populations.

Development and Initial Testing of a Measure of Person-Directed Care

ERIC Educational Resources Information Center

White, Diana L.; Newton-Curtis, Linda; Lyons, Karen S.

2008-01-01

Purpose: The purpose of the study was to empirically test items of a new measure designed to assess person-directed care (PDC) practices in long-term care. Design and Methods: After reviewing the literature, we identified five areas related to PDC: personhood, comfort care, autonomy, knowing the person, and support for relationships. We also…

Integrating Public Health and Personal Care in a Reformed US Health Care System

PubMed Central

Chernichovsky, Dov

2010-01-01

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access. Inefficiency is increased by the lack of an integrated system that could promote an optimal mix of personal medical care and population health measures. We advocate a health trust system to provide core medical benefits to every American, while improving efficiency and reducing redundancy. The major innovation of this plan would be to incorporate existing private health insurance plans in a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns. PMID:20019310

Change in neurocognition by housing type and substance abuse among formerly homeless seriously mentally ill persons.

PubMed

Caplan, Brina; Schutt, Russell K; Turner, Winston M; Goldfinger, Stephen M; Seidman, Larry J

2006-03-01

To test the effect of living in group housing rather than independent apartments on executive functioning, verbal memory and sustained attention among formerly homeless persons with serious mental illness and to determine whether substance abuse modifies this effect. In metropolitan Boston, 112 persons in Department of Mental Health shelters were randomly assigned to group homes ("Evolving Consumer Households", with project facilitator, group meetings, resident decision-making) or independent apartments. All were case managed. A neuropsychological test battery was administered at baseline, at 18 months (Time 2), with an 81% follow-up rate, and at 48 months (Time 3), with a 59% follow-up rate. Hierarchical Linear Modeling was applied to executive functioning--assessed with the Wisconsin Card Sorting Test (Perseverations)-Logical Memory story recall, and an auditory Continuous Performance Test (CPT) for sustained attention. Subject characteristics were controlled. When moved to group homes, subjects without a lifetime substance abuse history improved on Perseverations, while those who moved to independent apartments deteriorated on Perseverations. Across the two housing conditions, subjects showed no change in Perseverations, but improved on Logical Memory story recall and the CPT. Type of housing placement can influence cognitive functioning; notably, socially isolating housing is associated with weakened executive functioning. Substance abuse significantly diminishes environmental effects. These are important factors to consider in housing placement and subsequent treatment.

Sensitivity and specificity of a brief personality screening instrument in predicting future substance use, emotional, and behavioral problems: 18-month predictive validity of the Substance Use Risk Profile Scale.

PubMed

Castellanos-Ryan, Natalie; O'Leary-Barrett, Maeve; Sully, Laura; Conrod, Patricia

2013-01-01

This study assessed the validity, sensitivity, and specificity of the Substance Use Risk Profile Scale (SURPS), a measure of personality risk factors for substance use and other behavioral problems in adolescence. The concurrent and predictive validity of the SURPS was tested in a sample of 1,162 adolescents (mean age: 13.7 years) using linear and logistic regressions, while its sensitivity and specificity were examined using the receiver operating characteristics curve analyses. Concurrent and predictive validity tests showed that all 4 brief scales-hopelessness (H), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS)-were related, in theoretically expected ways, to measures of substance use and other behavioral and emotional problems. Results also showed that when using the 4 SURPS subscales to identify adolescents "at risk," one can identify a high number of those who developed problems (high sensitivity scores ranging from 72 to 91%). And, as predicted, because each scale is related to specific substance and mental health problems, good specificity was obtained when using the individual personality subscales (e.g., most adolescents identified at high risk by the IMP scale developed conduct or drug use problems within the next 18 months [a high specificity score of 70 to 80%]). The SURPS is a valuable tool for identifying adolescents at high risk for substance misuse and other emotional and behavioral problems. Implications of findings for the use of this measure in future research and prevention interventions are discussed. Copyright © 2012 by the Research Society on Alcoholism.

Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.

PubMed

Gryczynski, Jan; McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha A; Svikis, Dace S; Cathers, Lauretta A; Sharma, Gaurav; King, Jacqueline; Jelstrom, Eve; Nordeck, Courtney D; Sharma, Anjalee; Mitchell, Shannon G; O'Grady, Kevin E; Schwartz, Robert P

2017-09-01

The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. To validate the TAPS-1 in primary care patients. Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). Two thousand adult patients at five primary care sites. DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use. Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker. The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST.

PubMed

Schwartz, R P; McNeely, J; Wu, L T; Sharma, G; Wahle, A; Cushing, C; Nordeck, C D; Sharma, A; O'Grady, K E; Gryczynski, J; Mitchell, S G; Ali, R L; Marsden, J; Subramaniam, G A

2017-05-01

There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months. Copyright © 2017 Elsevier Inc. All rights reserved.

Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.

PubMed

McKernan, Lindsey Colman; Nash, Michael R; Gottdiener, William H; Anderson, Scott E; Lambert, Warren E; Carr, Erika R

2015-06-01

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and

[Household care for ill and disabled persons: challenges for the Mexican health care system].

PubMed

Nigenda, Gustavo; López-Ortega, Mariana; Matarazzo, Cecilia; Juárez-Ramírez, Clara

2007-01-01

To identify the pattern of time devoted by members of Mexican households to providing care to ill and disabled family members. To analyze the mechanisms used by families to provide care to an ill or disabled member. The database of the 2002 National Survey of Time Use was explored to accomplish the first objective. The second objective was accomplished by collecting primary data through in-depth interviews and focal groups in Coahuila, Sinaloa, Zacatecas, Jalisco, Oaxaca and Yucatán from June to December 2004. It was estimated that 1,738,756 persons spent time providing care to ill persons and 1,496,616 to disabled persons, over the reference period of the survey. There are important differences in the dedication of hours by gender and education level. Moreover, households tend to reorganize their structure to provide care to ill and disabled members. Women tend to have more responsibilities in the process. There are important differences in the care of ill and of the disabled in terms of the physical and emotional stress produced in the caregiver. The implications of results in the care of ill and disabled populations are highly relevant for the future of the Mexican health care system. Population aging and the increase of chronic diseases call for a reinforced relationship between institutional and household care so as to complement capacities, a situation already taking place in other countries.

The Ability of Individuals with Psychoactive Substance Use Disorders to Escape Detection by the Personality Assessment Inventory.

ERIC Educational Resources Information Center

Fals-Stewart, William

1996-01-01

The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI) was evaluated with 236 adults from treatment, nonclinical, control, and forensically referred groups. Findings indicate that the PAI scales measuring drug and alcohol problems are susceptible to…

Safety and efficacy of personal care products containing colloidal oatmeal.

PubMed

Criquet, Maryline; Roure, Romain; Dayan, Liliane; Nollent, Virginie; Bertin, Christiane

2012-01-01

Colloidal oatmeal is a natural ingredient used in the formulation of a range of personal care products for relief of skin dryness and itchiness. It is also used as an adjunctive product in atopic dermatitis. The safety of personal care products used on vulnerable skin is of particular importance and the risk of developing further skin irritations and/or allergies should be minimized. In a series of studies, we tested the safety of personal care products containing oatmeal (creams, cleansers, lotions) by assessing their irritant/allergenic potential on repeat insult patch testing, in safety-in-use and ocular studies using subjects with nonsensitive and sensitive skin. We also tested the skin moisturizing and repair properties of an oatmeal-containing skin care product for dry skin. We found that oatmeal-containing personal care products had very low irritant potential as well as a very low allergenic sensitization potential. Low-level reactions were documented in 1.0% of subjects during the induction phase of repeat insult patch testing; one of 2291 subjects developed a persistent but doubtful low-level reaction involving edema during the challenge phase in repeat insult patch testing. No allergies were reported by 80 subjects after patch testing after in-use application. Sustained skin moisturizing was documented in subjects with dry skin that lasted up to 2 weeks after product discontinuation. Our results demonstrate that colloidal oatmeal is a safe and effective ingredient in personal care products. No allergies were reported by consumers of 445,820 products sold during a 3-year period.

Safety and efficacy of personal care products containing colloidal oatmeal

PubMed Central

Criquet, Maryline; Roure, Romain; Dayan, Liliane; Nollent, Virginie; Bertin, Christiane

2012-01-01

Background Colloidal oatmeal is a natural ingredient used in the formulation of a range of personal care products for relief of skin dryness and itchiness. It is also used as an adjunctive product in atopic dermatitis. The safety of personal care products used on vulnerable skin is of particular importance and the risk of developing further skin irritations and/or allergies should be minimized. Methods In a series of studies, we tested the safety of personal care products containing oatmeal (creams, cleansers, lotions) by assessing their irritant/allergenic potential on repeat insult patch testing, in safety-in-use and ocular studies using subjects with nonsensitive and sensitive skin. We also tested the skin moisturizing and repair properties of an oatmeal-containing skin care product for dry skin. Results We found that oatmeal-containing personal care products had very low irritant potential as well as a very low allergenic sensitization potential. Low-level reactions were documented in 1.0% of subjects during the induction phase of repeat insult patch testing; one of 2291 subjects developed a persistent but doubtful low-level reaction involving edema during the challenge phase in repeat insult patch testing. No allergies were reported by 80 subjects after patch testing after in-use application. Sustained skin moisturizing was documented in subjects with dry skin that lasted up to 2 weeks after product discontinuation. Conclusion Our results demonstrate that colloidal oatmeal is a safe and effective ingredient in personal care products. No allergies were reported by consumers of 445,820 products sold during a 3-year period. PMID:23204849

Family Care for Persons with Developmental Disabilities: A Growing Commitment.

ERIC Educational Resources Information Center

Agosta, J. M., Ed.; Bradley, V. J., Ed.

The report presents findings from a study of family-based care for persons with developmental disabilities. The first of four parts introduces the problems of family-based care and presents perspectives of parents and of persons with developmental disabilities. Part 2, on responding to the needs of families, includes a review of historical and…

Robotic assistants in personal care: A scoping review.

PubMed

Bilyea, A; Seth, N; Nesathurai, S; Abdullah, H A

2017-11-01

The aim of this study is to present an overview of the technological advances in the field of robotics developed for assistance with activities of daily living (ADL), and to present areas where further research is required. Four databases were searched for articles presenting either a novel design of one of these personal care robotic system or trial results relating to these systems. Articles presenting nine different robotic personal care systems were examined, six of which had been developed after 2005. These six also all have publications relating to their trials. In the majority of trials, patient independence was improved with operation of the robotic device for a specific subset of ADL. A map of the current state of the field of personal care robotics is presented in this study. Areas requiring further research include improving feedback and awareness, as well as refining control methods and pre-programmed behaviors. Developing an affordable, easy to use system would help fill the current gap in the commercial market. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Substance Abuse Treatment for Persons with HIV/AIDS. Treatment Improvement Protocol (TIP) Series 37.

ERIC Educational Resources Information Center

CDM Group, Inc.

The role of substance abuse in the transmission of HIV and AIDS is clear, and the current trend in the pandemic shows that a disproportionate number of minorities in inner cities are affected or are at risk for contracting HIV. The recommendations and guidelines in this TIP support the creation of a comprehensive, integrated system of care for…

Substance abuse In Middle Eastern adolescents living in two different countries: spiritual, cultural, family and personal factors.

PubMed

Badr, Lina Kurdahi; Taha, Asma; Dee, Vivien

2014-08-01

It is estimated that the percentage of students using illicit substances by sixth grade has tripled over the last decade not only in developed countries but in developing countries as well probably due to the transition to a more Western society. Although much has been done to understand the mechanisms underlying substance abuse, few studies have been conducted with minority ethnic and religious groups such as Middle Eastern Youth. The primary goal of this study was to determine whether there are differences in factors contributing to substance abuse in adolescents from Lebanon versus the U.S.A. and to decipher the role of spirituality, religion, and culture among other factors that may influence substance abuse. A correlational cross-sectional design was used with adolescents living in two different countries: Los Angeles, California and Beirut, Lebanon. Muslim adolescents had significantly less rates of alcohol and substance use than Christians in both Lebanon and Los Angeles. More years lived in the U.S.A. increases the likelihood of abuse for both Muslims and Christians. Attachment to God and family was negatively associated with substance abuse. These results among others facilitate a better understanding of the influence of culture, religion, family and personal factors on substance abuse. Culturally sensitive interventions could benefit from the findings of this pilot study.

Why run the risk? Motivation for offences by patients with substance use and antisocial personality disorders which they rated as most risky to their own well-being.

PubMed

Thylstrup, Birgitte; Hesse, Morten

2018-04-01

Understanding motives for offending is important for the development and delivery of effective interventions. To explore associations between variables with motivational implications and the offence committed in the past year rated by people with antisocial personality disorder and substance use disorder as putting them and their status at most risk. Participants were 127 outpatients from a sample recruited for a pragmatic randomised controlled trial of an intervention for adults attending substance abuse treatment clinics in 13 municipalities in Denmark. Motives for offending were assessed on one occasion, using the Offending Motivation Questionnaire, aggression was assessed using the Buss-Perry Aggression Questionnaire and substance-related problems, including mental state difficulties, were assessed using the Substance Use Risk Profile. Attributing offending to provocation, excitement or financial gain differed substantially by type of offence, whereas attribution of offending to compliance did not. Personality scale scores were associated with attributing offences to provocation, excitement or compliance but not with financial gain. Motives for offending among substance users with antisocial personality disorder must be understood both in light of the type of offence and personality traits. Offending behaviour prevention strategies that draw on these distinctions, run in parallel to treatment for substance use, could improve reduction in recidivism. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Is Personality Associated with Health Care Use by Older Adults?

PubMed Central

Friedman, Bruce; Veazie, Peter J; Chapman, Benjamin P; Manning, Willard G; Duberstein, Paul R

2013-01-01

Context The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults’ use of acute and long-term care services. Methods Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the “Big Five” personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations. Findings Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services—probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users—but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits. Conclusions Personality traits are associated with Medicare beneficiaries’ use of many expensive health care services, findings that have implications for health services research and

Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

PubMed Central

D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

2016-01-01

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

Medical Records Flag for Suicide Risk: Predictors and Subsequent Use of Care Among Veterans With Substance Use Disorders.

PubMed

Berg, Joanna M; Malte, Carol A; Reger, Mark A; Hawkins, Eric J

2018-06-08

The U.S. Department of Veterans Affairs (VA) health care system established policies to include patient record flags (PRFs) for high suicide risk in the electronic medical record to alert providers and to increase health care contacts. This study identified predictors of new PRFs and described health care utilization before and after PRF initiation among VA patients with substance use disorders. The sample included patients ages ≥18 who received a substance use disorder diagnosis in 2012 (N=474,946). Demographic, clinical, and utilization predictors of PRFs were identified by multivariable logistic regression. Changes in short-term (three months) and longer-term (12 months) health care utilization before and after PRF initiation were compared by negative binomial regression. A total of 8,913 patients received PRFs. Demographic predictors of PRF initiation included being younger than 35, white, and homeless. Clinical predictors were cocaine, opioid, and sedative use disorders; posttraumatic stress, psychotic, bipolar, and depressive disorders; and diagnosis of a suicide attempt. Patients with PRFs averaged 1.33 (95% confidence interval [CI]=1.29-1.38) times more primary care visits, 2.29 (CI=2.24-2.34) times more mental health visits, 4.10 (CI=3.80-4.42) times more substance use visits, and fewer (incidence rate ratio=.55, CI=.53-.58) emergency department visits in the three months following compared with the three months before PRF initiation. Modest increases in mental health- and substance use--related days hospitalized were observed. Veterans received significantly more health care services after PRF initiation. Further research is warranted on the effects of PRFs on clinical outcomes, such as suicide behaviors.

The relationship between medical care costs and personal bankruptcy.

PubMed

Brotman, Billie Ann

2006-01-01

The number of personal bankruptcy filings has broken records over the last few years. Filings for nonbusiness bankruptcy protection totaled 1,650,279 in 2003, an increase of 9.6 percent between the years 2002 and 2003. This article examines the relationship in the United States between personal bankruptcy filings, and medical care costs and coverage. There seems to be a positive, statistically significant relationship between medical care costs and nonbusiness bankruptcy numbers; however, medical care coverage has limited or no explanatory value as a factor explaining total nonbusiness bankruptcy filings. The regression models suggest a weak or no relationship between the number of nonbusiness bankruptcy filings and health insurance coverage.

Passive sampling methods to determine household and personal care product use.

PubMed

Bennett, Deborah H; Wu, Xiangmei May; Teague, Candice H; Lee, Kiyoung; Cassady, Diana L; Ritz, Beate; Hertz-Picciotto, Irva

2012-01-01

Traditionally, use of household and personal care products has been collected through questionnaires, which is very time consuming, a burden on participants, and prone to recall bias. As part of the SUPERB Project (Study of Use of Products and Exposure-Related Behaviors), a novel platform was developed using bar codes to quickly and reliably determine what household and personal care products people have in their homes and determine the amount used over a 1-week period. We evaluated the acceptability and feasibility of our methodology in a longitudinal field study that included 47 California households, 30 with young children and 17 with an older adult. Acceptability was defined by refusal rates; feasibility was evaluated in terms of readable bar codes, useful product information in our database for all readable barcodes, and ability to find containers at both the start and end of the week. We found 63% of personal care products and 87% of the household care products had readable barcodes with 47% and 41% having sufficient data for product identification, respectively and secondly, the amount used could be determined most of the time. We present distributions for amount used by product category and compare inter- and intra-person variability. In summary, our method appears to be appropriate, acceptable, and useful for gathering information related to potential exposures stemming from the use of personal and household care products. A very low drop-out rate suggests that this methodology can be useful in longitudinal studies of exposure to household and personal care products.

Perceived Competency and Resolution of Homelessness Among Women with Substance Abuse Problems

PubMed Central

Finfgeld-Connett, Deborah; Bloom, Tina L.; Johnson, E. Diane

2011-01-01

Using a metasynthesis approach, our aim was to articulate new insights relating to the most efficient and effective means of helping homeless women with substance abuse problems to enhance their well-being and become more stably housed. Distorted perceptions of competency, which are shaped by dysfunctional relationships and mental health problems, make it challenging for women with substance abuse problems to resolve homelessness. Women with particularly low or high levels of perceived competency tend to grapple with challenges related to structure and control, trust, and hopelessness. Therapeutic strategies for approaching these women include careful assessment, caring, personalized structure and control, development of interpersonal trust, instillation of hope, and the targeted use of psychotherapeutic agents and counseling. Framing care for homeless women within the context of perceived competency offers a new way of understanding their plight and shaping interventions to more expeditiously move them toward healthy and stable lives. PMID:21890717

Perceived competency and resolution of homelessness among women with substance abuse problems.

PubMed

Finfgeld-Connett, Deborah; Bloom, Tina L; Johnson, E Diane

2012-03-01

Using a metasynthesis approach, our aim was to articulate new insights relating to the most efficient and effective means of helping homeless women with substance abuse problems to enhance their well-being and become more stably housed. Distorted perceptions of competency, which are shaped by dysfunctional relationships and mental health problems, make it challenging for women with substance abuse problems to resolve homelessness. Women with particularly low or high levels of perceived competency tend to grapple with challenges related to structure and control, trust, and hopelessness. Therapeutic strategies for approaching these women include careful assessment, caring, personalized structure and control, development of interpersonal trust, instillation of hope, and the targeted use of psychotherapeutic agents and counseling. Framing care for homeless women within the context of perceived competency offers a new way of understanding their plight and shaping interventions to more expeditiously move them toward healthy and stable lives.

Improving Care for Co-Occurring Psychological Health and Substance Use Disorders: An Implementation Evaluation of the Co-Occurring Disorders Clinician Training Program

DTIC Science & Technology

2015-01-01

Care for Co-Occurring Psychological and Substance Use Disorders sonnel to train staff from Navy Substance Abuse Rehabilitation Pro - grams (SARPs) to...for all SARP staff to receive some training in the pro - gram to increase service-wide buy-in and support for the CODP • a desire for more time...capable, while the other two were rated as pro - xviii Improving Care for Co-Occurring Psychological and Substance Use Disorders viding addiction-only

Prevalence of Contact Allergens in Personal Care Products for Babies and Children.

PubMed

Bonchak, Jonathan G; Prouty, Megan E; de la Feld, Salma F

Personal care products marketed for babies and children are often regarded as "safe" or "gentle." However, little is known about the prevalence of contact allergens in these types of products. This study assessed the prevalence of important sensitizers in personal care products marketed for babies and children. A secondary objective of this study was to determine whether a product's cost correlates with content of sensitizing ingredients. The ingredient lists of 533 unique personal care products were analyzed for presence of fragrance, betaines, propylene glycol, methylchloroisothiazolinone, methylisothiazolinone, formaldehyde, lanolin, and neomycin. Price per ounce was determined for each product as well. Most personal care products for babies and children contain 1 or more sensitizers. Products containing more sensitizers tend to cost less than those without any sensitizing ingredients.

POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

EPA Science Inventory

Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

EPA Science Inventory

Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

The Association between Foster Care and Substance Abuse Risk Factors and Treatment Outcomes: An Exploratory Secondary Analysis

ERIC Educational Resources Information Center

Blome, Wendy Whiting; Shields, Joseph; Verdieck, Mary Jeanne

2009-01-01

The child welfare and substance abuse systems are integrally linked through the children and families they both serve. There is a dearth of knowledge, however, on how children who have experienced foster care fare when they are treated for substance abuse issues as adults. This article presents an exploratory study using the Alcohol and Drug…

Barriers and facilitators to the implementation of person-centred care in different healthcare contexts.

PubMed

Moore, Lucy; Britten, Nicky; Lydahl, Doris; Naldemirci, Öncel; Elam, Mark; Wolf, Axel

2017-12-01

To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation. To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts. Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory. The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council. Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery. At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative

Aggregate exposure approaches for parabens in personal care products: a case assessment for children between 0 and 3 years old

PubMed Central

Gosens, Ilse; Delmaar, Christiaan J E; ter Burg, Wouter; de Heer, Cees; Schuur, A Gerlienke

2014-01-01

In the risk assessment of chemical substances, aggregation of exposure to a substance from different sources via different pathways is not common practice. Focusing the exposure assessment on a substance from a single source can lead to a significant underestimation of the risk. To gain more insight on how to perform an aggregate exposure assessment, we applied a deterministic (tier 1) and a person-oriented probabilistic approach (tier 2) for exposure to the four most common parabens through personal care products in children between 0 and 3 years old. Following a deterministic approach, a worst-case exposure estimate is calculated for methyl-, ethyl-, propyl- and butylparaben. As an illustration for risk assessment, Margins of Exposure (MoE) are calculated. These are 991 and 4966 for methyl- and ethylparaben, and 8 and 10 for propyl- and butylparaben, respectively. In tier 2, more detailed information on product use has been obtained from a small survey on product use of consumers. A probabilistic exposure assessment is performed to estimate the variability and uncertainty of exposure in a population. Results show that the internal exposure for each paraben is below the level determined in tier 1. However, for propyl- and butylparaben, the percentile of the population with an exposure probability above the assumed “safe” MoE of 100, is 13% and 7%, respectively. In conclusion, a tier 1 approach can be performed using simple equations and default point estimates, and serves as a starting point for exposure and risk assessment. If refinement is warranted, the more data demanding person-oriented probabilistic approach should be used. This probabilistic approach results in a more realistic exposure estimate, including the uncertainty, and allows determining the main drivers of exposure. Furthermore, it allows to estimate the percentage of the population for which the exposure is likely to be above a specific value. PMID:23801276

Ontological Security in Nursing Homes for Older Persons – Person-Centred Care is the Power of Balance

PubMed Central

James, Inger; Ardeman-Merten, Rebecka; Kihlgren, Annica

2014-01-01

Introduction: The Swedish national guidelines for elderly care describe how older persons should be able to trust that their care is permeated with security. Different theoretical perspectives can be found that describe what creates security. Many studies have been done about security. However, few studies have explicitly asked older persons what security in nursing homes means to them. Aim: The aim of the study was to describe how older persons in nursing homes talked and reflected about security in their daily lives. Method: Nine older persons were interviewed in, in-depth interviews one to three times and the resulting data was analysed using content analysis. Results: The older persons adapted to having their own needs and those of the other older persons met and to the staff routines which created a sense of security. At the same time, they longed for security in which they could trust themselves and create their own daily life. Further to have a sense of belonging and of being liked for created an internal, interpersonal and external security. This can be linked to an ontological security which means having a sense of confidence in the continuity of self-identity and order in events, a being in the world. Conclusion: Person-centred instead of institution- centred care can provide the balance of power that allows the older person to obtain ontological security in which the staff's ability to create a relationship with the older persons becomes crucial. PMID:25852785

Personal health care expenditures, by State: 1966-82

PubMed Central

Levit, Katharine R.

1985-01-01

Spending per capita for health care in the United States varies dramatically by State and region. In 1982, personal health care costs per capita ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. The focus of this article is State and regional variation in spending levels and the mix of health care services purchased. Possible causes for these differences are presented. PMID:10311335

Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings.

PubMed

Rushton, Carole; Edvardsson, David

2018-04-01

Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care

Is the Assessment of Personality Comparable in Persons Who Have and Have Not Experienced Depressive, Anxiety, and Substance Use Disorders? An Examination of Measurement Invariance.

PubMed

Olino, Thomas M; Benini, Laura; Icenogle, Grace; Wilson, Sylia; Klein, Daniel N; Seeley, John R; Lewinsohn, Peter M

2017-08-01

Numerous studies have focused on characterizing personality differences between individuals with and without psychopathology. For drawing valid conclusions for these comparisons, the personality instruments used must demonstrate psychometric equivalence. However, we are unaware of any studies that examine measurement invariance in personality across individuals with and without psychopathology. This study conducted tests of measurement invariance for positive emotionality, negative emotionality, and disinhibition across individuals with and without histories of depressive, anxiety, and substance use disorders. We found consistent evidence that positive emotionality, negative emotionality, and disinhibition were assessed equivalently across all comparisons with each demonstrating strict invariance. Overall, results suggest that comparisons of personality measures between diagnostic groups satisfy the assumption of measurement invariance and these scales represent the same psychological constructs. Thus, mean-level comparisons across these groups are valid tests.

Personality Correlates of the Common and Unique Variance across Conduct Disorder and Substance Misuse Symptoms in Adolescence

ERIC Educational Resources Information Center

Castellanos-Ryan, Natalie; Conrod, Patricia J.

2011-01-01

Externalising behaviours such as substance misuse (SM) and conduct disorder (CD) symptoms highly co-ocurr in adolescence. While disinhibited personality traits have been consistently linked to externalising behaviours there is evidence that these traits may relate differentially to SM and CD. The current study aimed to assess whether this was the…

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital...

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital...

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital...

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital...

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital...

Dimensions of personality structure among patients with substance use disorders and co-occurring personality disorders: a comparison with psychiatric outpatients and healthy controls.

PubMed

Di Pierro, Rossella; Preti, Emanuele; Vurro, Nicoletta; Madeddu, Fabio

2014-08-01

Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernberg's dimensional model of personality. Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients. Copyright © 2014 Elsevier Inc. All rights reserved.

Satisfaction in Older Persons and General Practitioners during the Implementation of Integrated Care

PubMed Central

Caljouw, Monique A. A.; de Waard, Claudia S.; Wind, Annet W.; Gussekloo, Jacobijn

2016-01-01

Background Integrated care for older persons with complex care needs is widely advocated. Particularly professionals and policy makers have positive expectations. Care outcome results are ambiguous. Receiver and provider satisfaction is relevant but still poorly understood. Methods During implementation of integrated care in residential homes (The MOVIT project), we compared general satisfaction and satisfaction with specific aspects of General Practitioner (GP) care in older persons and GPs before (cohort I) and after at least 12 months of implementation (cohort II). Results The general satisfaction score for GP care given by older persons does not change (Cohort I (n = 762) mean score 8.0 (IQR:7.0–9.0) vs. Cohort II (n = 505) mean score 8.0 (IQR:7.0–8.0);P = 0.01). Expressions of general satisfaction in GPs do not show consistent change (Cohort I (n = 87) vs Cohort II (n = 66), percentage satisfied about; role as GP, 56% vs 67%;P = 0.194, ability to provide personal care, 60% vs 67%;P = 0.038, quality of care, 54% vs 62%;P = 0.316). Satisfaction in older persons about some specific aspects of care do show change; GP-patient relationship, points 61.6 vs 63.3;P = 0.001, willingness to talk about mistakes, score 3.47 vs 3.73;P = 0.001, information received about drugs, score 2.79 vs 2.46;P = 0.002. GPs also report changes in specific aspects: percentage satisfied about multidisciplinary meetings; occurrence, 21% vs 53%;P = <0.001, GP presence, 12% vs 41%;P = <0.001, and participation, 29% vs.51%;P = 0.046. Conclusion General satisfaction about care received and provided shows no consistent change in older persons and GPs during the implementation of integrated care. Specific changes in satisfaction are found. These show an emphasis on inter-personal aspects in older persons and organizational aspects in GPs. PMID:27737012

Michigan Health Care Costs Review. Personal Health Care Expenditures, 1966-1981. Number 1.

ERIC Educational Resources Information Center

Michigan State Office of Health and Medical Affairs, Lansing.

Data are presented describing expenditures for personal health services in Michigan from 1977 to 1981. The rapid growth in expenditures is illustrated, as well as the rates of growth in expenditures, for major categories of health services. Personal health expenditures are defined as payments for care directly provided to patients: specifically,…

Access to health care for persons with disabilities in rural South Africa.

PubMed

Vergunst, R; Swartz, L; Hem, K-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M

2017-11-17

Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.

Personalizing health care: feasibility and future implications.

PubMed

Godman, Brian; Finlayson, Alexander E; Cheema, Parneet K; Zebedin-Brandl, Eva; Gutiérrez-Ibarluzea, Inaki; Jones, Jan; Malmström, Rickard E; Asola, Elina; Baumgärtel, Christoph; Bennie, Marion; Bishop, Iain; Bucsics, Anna; Campbell, Stephen; Diogene, Eduardo; Ferrario, Alessandra; Fürst, Jurij; Garuoliene, Kristina; Gomes, Miguel; Harris, Katharine; Haycox, Alan; Herholz, Harald; Hviding, Krystyna; Jan, Saira; Kalaba, Marija; Kvalheim, Christina; Laius, Ott; Lööv, Sven-Ake; Malinowska, Kamila; Martin, Andrew; McCullagh, Laura; Nilsson, Fredrik; Paterson, Ken; Schwabe, Ulrich; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Tomek, Dominik; Vlahovic-Palcevski, Vera; Voncina, Luka; Wladysiuk, Magdalena; van Woerkom, Menno; Wong-Rieger, Durhane; Zara, Corrine; Ali, Raghib; Gustafsson, Lars L

2013-08-13

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer's perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.

Personalizing health care: feasibility and future implications

PubMed Central

2013-01-01

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients. PMID:23941275

Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with antisocial personality disorder: A randomized study.

PubMed

Thylstrup, Birgitte; Hesse, Morten

2016-06-01

Patients with antisocial personality disorder in outpatient treatment for substance use disorders are at high risk of drop-out. Using a randomized design, this study tested the impact of adding a brief psycho-educational program, the Impulsive Lifestyle Counseling program, to outpatient substance abuse treatment in order to prevent treatment dropout. Patients (N=175) were recruited from 13 municipal treatment centers in Denmark, and assigned to treatment as usual or to the experimental condition. In all, 172 patients could be included in the analyses. In the intent-to-treat analysis, the risk of treatment dropout was reduced among patients randomized to the experimental program (hazard ratio=0.63, p=.031), after controlling for age, gender, and substitution treatment status. The study supported the efficacy of the Impulsive Lifestyle Counseling program as a method for preventing treatment dropout for patients with comorbid antisocial personality disorder in substance abuse treatment. Trial registration #ISRCTN67266318. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing person-centred practice in hip fracture care for older people.

PubMed

Christie, Jane; Macmillan, Maureen; Currie, Colin; Matthews-Smith, Gerardine

2016-12-14

To facilitate a multidisciplinary collaborative approach to developing person-centred practice in hip fracture care for older people. Collaborative inquiry, a form of action research, was used to collect data for this study. It involved exploration of dilemmas, questions and problems that are part of human experience. Clinical leaders from different disciplines (n=16), who work with older people with hip fractures at different stages of the care pathway, participated in a series of facilitated action meetings. The practice development techniques used in this study included: identifying the strengths and limitations of the current service, values clarification, creating a shared vision, sharing clinical stories, reviewing case records, and reflecting on the experiences of three older people and two caregivers. Hip fracture care was based on meeting service targets, national guidelines and audits. Care was fragmented across different service delivery units, with professional groups working independently. This resulted in suboptimal communication between members of the multidisciplinary group of clinical leaders and care that was process-driven rather than person-centred. Spending time away from clinical practice enabled the multidisciplinary group to collaborate to understand care from the patients' and caregivers' perspectives, and to reflect critically on the care experience as a whole. To develop a person-centred workplace culture, the multidisciplinary team requires facilitated time for reflection. Ongoing facilitative leadership would enable the multidisciplinary team to collaborate effectively to deliver safe, effective person-centred practice in hip fracture care for older people.

In-depth study of personality disorders in first-admission patients with substance use disorders

PubMed Central

2012-01-01

Background Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. Method A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. Conclusion The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients. PMID:23107025

Time spent on daytime direct care activities by personal carers in two Australian residential aged care facilities: a time-motion study.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David M; Zhang, Zhenyu; Davy, Pamela J; Nelson, Mark I

2014-05-01

To examine the time, frequency and duration of each direct care activity conducted by personal carers in Australian residential aged care homes. A time-motion study was conducted to observe 46 personal carers at two high-care houses in two facilities (14 days at Site 1 and 16 days at Site 2). Twenty-three direct care activities were classified into eight categories for analysis. Overall, a personal carer spent approximately 45% of their time on direct care, corresponding to 3.5h in an 8-h daytime shift. The two sites had similar ratios of personal carers to residents, and each resident received 30 min of direct care. No significant differences between the two sites were found in the time spent on oral communication, personal hygiene and continence activities. Personal carers at Site 1 spent significantly less time on toileting and mobility activities than those at Site 2, but more time on lunch activity. Although oral communication took the longest time (2h), it occurred concurrently with other activities (e.g. dressing) for 1.5h. The findings provide information that may assist decision makers in managing the operation of high-care residential aged care facilities, such as planning for task allocation and staffing. What is known about the topic? Overall, 30%-45% of the care staff's time is spent on direct care in residential aged care facilities. What does this paper add? This paper adds knowledge about how much time is required to conduct each direct care activity and the frequency and duration of conducting these activities to meet residents' day-to-day care needs in two high-care houses in two aged care facilities. What are the implications for practitioners? On average, a resident with high-care needs requires 30 min direct care. There may exist a basic minimum desirable ratio of personal carers to residents in high-care facilities. Residents' toileting needs are high after meals. Communication with residents represents an essential role in providing care.

The substance use risk profile scale: a scale measuring traits linked to reinforcement-specific substance use profiles.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woicik, P.A.; Stewart, S.H.; Pihl, R.O.

The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supportedmore » by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test-retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.« less

The Substance Use Risk Profile Scale: a scale measuring traits linked to reinforcement-specific substance use profiles.

PubMed

Woicik, Patricia A; Stewart, Sherry H; Pihl, Robert O; Conrod, Patricia J

2009-12-01

The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test-retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.

[Personal budget for persons in need of care. A socio-economic change with new perspectives for supply and demand].

PubMed

Meyer, Dirk

2005-11-01

In October 2004, in Germany a pre-operating study was started in order to prove the feasibility and consequences of the use of personal budgets by persons who are in need of nursing care. About 1000 care dependent persons living in seven regions are included in this triannual study. For three years they receive a budget amounting to 100 percent of their right of benefit in kind according to the German compulsory long-term care insurance. This budget has to be used exclusively for care-related services and must not be spent for assistance delivered by family members or neighbours. From socio-economic perspectives, the personal budget will result in a promotion of individuals instead of certain services or service institutions. An analysis shows, that the consequences might be an increased efficiency and effectiveness as well as structural changes within the supply of nursing care services. But to achieve these advantages, certain conditions must be provided. At first, the amount of the budget has to correspond to the individual need of care, which can change over time. Secondly, a misapplication of the personal fund has to be prevented without to exclude the potential of local or family dedication. And finally, new ways of quality assurance are requested due to the scope for development, which arises through deregulation.

Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs.

PubMed

Thylstrup, Birgitte; Schrøder, Sidsel; Fridell, Mats; Hesse, Morten

2017-01-09

People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder. Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175). Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month. Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction. ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

Disaster preparedness in home health and personal-care agencies: are they ready?

PubMed

Daugherty, Jill D; Eiring, Hilary; Blake, Sarah; Howard, David

2012-01-01

The use of home health care and personal-care agencies in the United States has increased by nearly 1,000% in less than 20 years. Despite the numerous advantages of keeping older and disabled people at home and fairly independent, new concerns have emerged about how to keep home health care and personal-care clients safe during emergencies and large-scale disasters. To date, little is known about the disaster preparedness activities of home health and personal-care agencies, including what oversight they have for their patients and what capabilities they sustain for preparing their clients for disasters. The purpose of this study was to explore the disaster preparedness policies and practices of these agencies and to identify opportunities for coordination with disaster preparedness officials. Semi-structured interviews were conducted by phone and in person with 21 home health and personal-care administrators across Georgia and Southern California. Transcripts from the interviews were analyzed for disaster preparedness themes. We found that most agencies have very limited disaster plans and capabilities. Despite this, most stated either their intentions or outlined past experience which demonstrated their commitment to provide services to clients on a case-by-case basis throughout a large-scale emergency or disaster. The findings from our study help to contribute to the growing interest in disaster preparedness among home health and personal-care agencies and point to the fact that these agencies need assistance to properly lay out their disaster preparedness plans. Copyright © 2012 S. Karger AG, Basel.

Care and Service at Home for Persons With Dementia in Europe.

PubMed

Bökberg, Christina; Ahlström, Gerd; Leino-Kilpi, Helena; Soto-Martin, Maria E; Cabrera, Esther; Verbeek, Hilde; Saks, Kai; Stephan, Astrid; Sutcliffe, Caroline; Karlsson, Staffan

2015-09-01

To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries. The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.

POLLUTION FROM PERSONAL ACTIONS AND ACTIVITIES - PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS)

EPA Science Inventory

The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

Preventing Child Behavior Problems and Substance Use: The Pathways Home Foster Care Reunification Intervention

PubMed Central

DeGarmo, David S.; Reid, John B.; Fetrow, Becky A.; Fisher, Philip A.; Antoine, Karla D.

2013-01-01

This paper evaluated the Pathways Home manualized selective preventive intervention designed to prevent reunification failures once children are returned home to their biological parent(s) after first time stays in foster care (n = 101). The theoretically based intervention focused on support and parent management practices designed to prevent the development of child behavior problems including internalizing and externalizing problems, and substance use. Intent to treat analyses employed probability growth curve approaches for repeated telephone assessments over 16 weeks of intervention. Findings showed that relative to services as usual reunification families, the Pathways Home families demonstrated better parenting strategies that were in turn associated with reductions in problem behaviors over time. Growth in problem behaviors in turn predicted foster care re-entry. Maternal substance use cravings were a risk factor for growth in problem behaviors that were buffered by participation in the Pathways Home intervention. PMID:23914130

Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey.

PubMed

D'Aunno, Thomas; Friedmann, Peter D; Chen, Qixuan; Wilson, Donna M

2015-08-01

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. Copyright © 2015 by Duke University Press.

Culturally competent substance abuse treatment with transgender persons.

PubMed

Nuttbrock, Larry A

2012-01-01

Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.

Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.

PubMed

Ondersma, Steven J; Gryczynski, Jan; Mitchell, Shannon Gwin; O'Grady, Kevin E; Schwartz, Robert P

2016-05-01

Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' ( N =178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss ( n = 114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use ( n = 108, 60.7%), but nearly a third of these ( n = 32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and-when addressing consequences-should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content.

The third person in the room: The needs of care partners of older people in home care services-A systematic review from a person-centred perspective.

PubMed

Anker-Hansen, Camilla; Skovdahl, Kirsti; McCormack, Brendan; Tønnessen, Siri

2018-04-01

To identify and synthesise the needs of care partners of older people living at home with assistance from home care services. "Ageing in place" is a promoted concept where care partners and home care services play significant roles. Identifying the needs of care partners and finding systematic ways of meeting them can help care partners to cope with their role. This study is based on the PRISMA reporting guidelines. The systematic review of qualitative and quantitative studies was guided by the Joanna Briggs Institute methodology. In total, 16 studies were included in the review, eleven qualitative and five quantitative. Three main categories were revealed in the analysis: the need for quality interaction, the need for a shared approach to care and the need to feel empowered. Care partners of older people have several, continuously unmet needs. A person-centred perspective can contribute new understandings of how to meet these needs. A knowledge gap has been identified regarding the needs of care partners of older people with mental health problems. There is a need to develop a tool for systematic collaboration between home care services and care partners, so that the identified needs can be met in a more thorough, systematic and person-centred way. The carers in home care services need competence to identify and meet the needs of care partners. The implementation of person-centred values in home care services can contribute to meet the needs of care partners to a greater extent than today. Future research on the needs of care partners of older people with mental health problems needs to be undertaken. © 2017 John Wiley & Sons Ltd.

Adaptive leadership and person-centered care: a new approach to solving problems.

PubMed

Corazzini, Kirsten N; Anderson, Ruth A

2014-01-01

Successfully transitioning to person-centered care in nursing homes requires a new approach to solving care issues. The adaptive leadership framework suggests that expert providers must support frontline caregivers in their efforts to develop high-quality, person-centered solutions.

Meeting the need for personal care among the elderly: does Medicaid home care spending matter?

PubMed

Kemper, Peter; Weaver, France; Short, Pamela Farley; Shea, Dennis; Kang, Hyojin

2008-02-01

To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help.

Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City

PubMed Central

Sanchez, John P.; Danoff, Ann

2009-01-01

Objectives. We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. Methods. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. Results. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). Conclusions. Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals. PMID:19150911

The health encounter as a treatable moment for homeless substance-using adults: the role of homelessness, health seeking behavior, readiness for behavior change and motivation for treatment.

PubMed

O'Toole, Thomas P; Pollini, Robin A; Ford, Daniel E; Bigelow, George

2008-09-01

Substance-using homeless persons frequent emergency departments and hospitals often. However, little is known about how homelessness affects when they seek care and their motivation for substance abuse treatment (SAT). We surveyed homeless (N=266) and non-homeless (N=104) substance-using adults sequentially admitted to an urban hospital medicine service, comparing demographics, readiness for change (URICA), and motivating reasons for SAT. Homeless respondents were more likely to be younger, uninsured, have hepatitis B/C, and <12th grade education. The majority in both groups were in either a precontemplative or contemplative stage of change, although more homeless respondents were in an action stage. They also had similar motivating reasons for wanting SAT, although being homeless was an additional motivator for the majority of homeless respondents. Almost half reported that being homeless caused them to delay seeking health care; paradoxically those citing physical health as a SAT motivator were 3.4 times more likely to have delayed care. While acutely ill homeless persons were at least as motivated for SAT, these data suggest the challenge is getting them to care in a timely manner and tailoring interventions during the care episode to avail of this motivation.

The financial hazard of personalized medicine and supportive care.

PubMed

Carrera, Pricivel M; Olver, Ian

2015-12-01

Personalized medicine is revolutionizing the delivery of oncological care, promising benefits both at the patient and health system levels. The cost of targeted therapies, unfortunately, is becoming more expensive and unaffordable. Where supportive care in cancer concerns the prevention and management of the adverse effects of cancer and its treatment and is the thrust of the Multinational Association of Supportive Care in Cancer, financing of and value in personalized medicine is an important area of research and engagement for the association. Discussing patients' concerns with and identifying those at most risk for the financial hazard of cancer treatment and offering financial counseling and assistance and/or referral to support networks are potential key areas for (exploring and providing) better supportive care. The time is now to turn the concern of patients and their carers, providers, and other advocates regarding the affordability of cancer treatment into a collective cause towards coordinated action.

Multidimensional Predictors of Treatment Outcome in Usual Care for Adolescent Conduct Problems and Substance Use

PubMed Central

Hogue, Aaron; Henderson, Craig E.; Schmidt, Adam T.

2016-01-01

This study investigated baseline client characteristics that predicted long-term treatment outcomes among adolescents referred from school and community sources and enrolled in usual care for conduct and substance use problems. Predictor effects for multiple demographic (age, sex, race/ethnicity), clinical (baseline symptom severity, comorbidity, family discord), and developmental psychopathology (behavioral dysregulation, depression, peer delinquency) characteristics were examined. Participants were 205 adolescents (52% male; mean age 15.7 years) from diverse backgrounds (59% Hispanic American, 21% African American, 15% multiracial, 6% other) residing in a large inner-city area. As expected, characteristics from all three predictor categories were related to various aspects of change in externalizing problems, delinquent acts, and substance use at one-year follow-up. The strongest predictive effect was found for baseline symptom severity: Youth with greater severity showed greater clinical gains. Higher levels of co-occurring developmental psychopathology characteristics likewise predicted better outcomes. Exploratory analyses showed that change over time in developmental psychopathology characteristics (peer delinquency, depression) was related to change in delinquent acts and substance use. Implications for serving multiproblem adolescents and tailoring treatment plans in routine care are discussed. PMID:26884380

Perceptions of Elders' Substance Abuse and Resilience

ERIC Educational Resources Information Center

Kane, Michael N.; Green, Diane

2009-01-01

Human service students' (social work, criminal justice, public administration, psychology) were surveyed (N = 242). Their perceptions about older persons' resilience and recovery from substance abuse were investigated. Overall, respondents did not agree that treating older persons for a substance abuse problem was wasteful of resources or older…

75 FR 34140 - Establishment of the Personal Care Attendants Workforce Advisory Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Establishment of the Personal Care Attendants Workforce... Health and Human Services. ACTION: Notice. Authority: The Personal Care Attendants Workforce Advisory... formation and use of advisory committees. SUMMARY: The U.S. Department of Health and Human Services...

Safety assessment of personal care products/cosmetics and their ingredients.

PubMed

Nohynek, Gerhard J; Antignac, Eric; Re, Thomas; Toutain, Herve

2010-03-01

We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed, the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO(2) and ZnO in sunscreens. However

Safety assessment of personal care products/cosmetics and their ingredients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nohynek, Gerhard J., E-mail: gnohynec@rd.loreal.co; Antignac, Eric; Re, Thomas

2010-03-01

We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed,more » the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO{sub 2} and ZnO in

Latent Class Analysis of Gambling Activities in a Sample of Young Swiss Men: Association with Gambling Problems, Substance Use Outcomes, Personality Traits and Coping Strategies.

PubMed

Studer, Joseph; Baggio, Stéphanie; Mohler-Kuo, Meichun; Simon, Olivier; Daeppen, Jean-Bernard; Gmel, Gerhard

2016-06-01

The study aimed to identify different patterns of gambling activities (PGAs) and to investigate how PGAs differed in gambling problems, substance use outcomes, personality traits and coping strategies. A representative sample of 4989 young Swiss males completed a questionnaire assessing seven distinct gambling activities, gambling problems, substance use outcomes, personality traits and coping strategies. PGAs were identified using latent class analysis (LCA). Differences between PGAs in gambling and substance use outcomes, personality traits and coping strategies were tested. LCA identified six different PGAs. With regard to gambling and substance use outcomes, the three most problematic PGAs were extensive gamblers, followed by private gamblers, and electronic lottery and casino gamblers, respectively. By contrast, the three least detrimental PGAs were rare or non-gamblers, lottery only gamblers and casino gamblers. With regard to personality traits, compared with rare or non-gamblers, private and casino gamblers reported higher levels of sensation seeking. Electronic lottery and casino gamblers, private gamblers and extensive gamblers had higher levels of aggression-hostility. Extensive and casino gamblers reported higher levels of sociability, whereas casino gamblers reported lower levels of anxiety-neuroticism. Extensive gamblers used more maladaptive and less adaptive coping strategies than other groups. Results suggest that gambling is not a homogeneous activity since different types of gamblers exist according to the PGA they are engaged in. Extensive gamblers, electronic and casino gamblers and private gamblers may have the most problematic PGAs. Personality traits and coping skills may predispose individuals to PGAs associated with more or less negative outcomes.

Use-patterns of personal care and household cleaning products in Switzerland.

PubMed

Garcia-Hidalgo, E; von Goetz, N; Siegrist, M; Hungerbühler, K

2017-01-01

Reliable consumer use data are needed to determine health risks posed by chemicals contained in household cleaning and personal care products. Essential information includes the amount of product applied, the frequency of use, and the site of application. To obtain such data, a survey was conducted in Switzerland to assess consumer usage patterns. The use-patterns of 12 household care products, 5 laundry products, and 22 personal care products were collected among the Swiss population (N = 759; ages 0-91) by postal questionnaire, providing for the first time in Europe comprehensive information regarding use of household cleaning and personal care products for the same study population. Apart from the investigation of use frequency, quantity, duration, and habits, also co-use analysis was performed separately for household and personal care products. Use-patterns are presented for both genders and all age groups, including children below the age of 12, who may be more vulnerable to adverse effects attributed to certain chemicals. Also, the currently missing use factors for cosmetic/baby wet wipes were assessed. Stratification of the data by gender, age and other socio-demographic factors, such as region affiliation, allowed us to identify differences between population sub-groups, emphasizing the need for region-specific exposure factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Access to dental care for persons with developmental disabilities in Ontario.

PubMed

Koneru, Anjani; Sigal, Michael J

2009-03-01

This study was undertaken to determine the proportion of persons primarily with developmental disabilities who encounter difficulties accessing dental care in Ontario, to identify perceived barriers to accessing dental care and to determine if persons with disabilities and their caregivers believe that oral health is important. Community organizations providing services mainly to persons with developmental disabilities in Ontario were recruited to circulate a questionnaire to their members by mail or the Internet. Fourteen organizations mailed out a total of 1,755 paper questionnaires in autumn 2006, of which 420 (23.9%) were returned; in addition, 236 Internet questionnaires were returned. Of the 656 paper and Internet responses, 634 were deemed valid. Most of the respondents had developmental disabilities. Almost three-quarters of respondents (464 [73.2%] ) reported being able to access dental services in Ontario. Personal (internal) factors were more likely to represent barriers to dental care than external factors. The majority of persons with disabilities and most caregivers believed that oral health is important for overall health.

The Architecture of Recovery: Two Kinds of Housing Assistance for Chronic Homeless Persons with Substance Use Disorders.

PubMed

Wittman, Friedner D; Polcin, Douglas L; Sheridan, Dave

2017-01-01

Roughly half a million persons in the United States are homeless on any given night and over a third of those individuals have significant alcohol/other drug (AOD) problems. Many are chronically homeless and in need of assistance for a variety of problems. However, the literature on housing services for this population has paid limited attention to comparative analyses contrasting different approaches. We examined the literature on housing models for homeless persons with AOD problems and critically analyzed how service settings and operations aligned with service goals. We found two predominant housing models that reflect different service goals: Sober Living Houses (SLHs) and Housing First (HF). SLHs are communally based living arrangements that draw on the principles of Alcoholics Anonymous. They emphasize a living environment that promotes abstinence and peer support for recovery. HF is based on the premise that many homeless persons with substance abuse problems will reject abstinence as a goal. Therefore, the HF focus is providing subsidized or free housing and optional professional services for substance abuse, psychiatric disorders and other problems. If homeless service providers are to develop comprehensive systems for homeless persons with AOD problems, they need to consider important contrasts in housing models, including definitions of "recovery," roles of peer support, facility management, roles for professional service, and the architectural designs that support the mission of each type of housing. This paper is the first to consider distinct consumer choices within homeless service systems and provide recommendations to improve each based upon an integrated analysis that considers how architecture and operations align with service goals.

Validating Female Psychopathy Subtypes: Differences in Personality, Antisocial and Violent Behavior, Substance Abuse, Trauma, and Mental Health

PubMed Central

Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.

2010-01-01

Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems including symptoms of post-traumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to non-violent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. PMID:20582155

Towards personalized care for persons with spinal cord injury: a study on patients' perceptions

PubMed Central

Garrino, Lorenza; Curto, Natascia; Decorte, Rita; Felisi, Nadia; Matta, Ebe; Gregorino, Silvano; Actis, M. Vittoria; Marchisio, Cecilia; Carone, Roberto

2011-01-01

Objective/background A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled ‘Experimentation and evaluation of personalized healthcare for patients with spinal cord injury’, which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting. Design Qualitative research study. The interview format was based on a narrative approach. Methods Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data. Results Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition. Conclusions Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients

A National Survey of the Nursing Care of Infants With Prenatal Substance Exposure in Canadian NICUs.

PubMed

Marcellus, Lenora; Loutit, Tara; Cross, Shannon

2015-10-01

Many communities are reporting increases in the number of infants requiring NICU care. Practices continue to vary and there is limited available evidence about nursing care. The purpose of this study was to describe current nursing care practices for infants with prenatal substance exposure in the NICU setting and during transition to the community. Findings from this study were compared with an earlier Canadian survey (by Marcellus in 2002) to identify shifts in clinical nursing practice for this population. This was a cross-sectional descriptive survey design. A 68-item survey composed of multiple-choice and open-ended questions was administered through FluidSurveys online software. A convenience sample of 62 clinical managers or clinical educators in hospitals with active maternal-infant clinical units with 500 deliveries or more annually and/or pediatric hospitals with a separate designated neonatal service (ie, Level 2 and 3 units) was chosen. A greater number of NICUs are using clinical guidelines to support the standardization of quality care. Improvements in nursing practice were identified and these included the consistent use of a withdrawal scoring tool and provision of education for team members in orientation. A decline in routine discharge planning meetings and routine parent teaching plans was discovered. This survey has improved understanding of the current state of nursing care for infants with prenatal substance exposure and their families during this critical time of transition. The purpose of the survey was to compare findings with the 2002 study by Marcellus to identify any improved practices and describe current state nursing care practices in the NICU. Practice changes over the last decade have included keeping mothers and infants together, expanding concepts of the team, integrating programs and services across hospital and community settings, and creating opportunities for NICU teams to learn more about substance use, mental health

Fostering Humane Care of Dying Persons in Long-Term Care. Guidebook for Staff Development Instructors.

ERIC Educational Resources Information Center

Wilson, Sarah A.; Daley, Barbara

This guide is intended for staff development instructors responsible for inservice education on the topic of fostering humane care for dying persons in long-term care. The introduction discusses the guide's development based on input from administrators, staff, and families of residents in long-term care facilities and focus group interviews in…

A Guide for the Person with a Disability: Independent Living with Attendant Care.

ERIC Educational Resources Information Center

Board, Mary Ann; And Others

The final manual of a series on attendant care for severely disabled persons is intended to help persons with a disability to hire and manage personal care attendants (PCAs). Models--private and shared systems--are reviewed, and advantages and disadvantages of each noted. Suggestions for interviewing and hiring PCAs include guidelines for…

The relationship between burnout symptoms and Type D personality among health care professionals in Turkey.

PubMed

Tekin, Atilla; Karadağ, Hekim; Yayla, Sinan

2017-05-04

The aim of this study was to investigate the relationship between burnout and Type D personality in health care professionals. The study randomly included 120 health care professionals (73 nurses, 47 doctors). Sociodemographic data form, Maslach Burnout Inventory, and Type D Personality Scale were applied to each participant; 38.3% of the health care professionals (n = 46) had the Type D personality. Emotional exhaustion and depersonalization of health care professionals with Type D personality were higher than of those without Type D personality (p = .006 and p = .005). Stepwise regression analysis indicated that Type D personality was a predictor of emotional exhaustion and depersonalization (p = .005 and p = .001, respectively). Our results suggest that Type D personality is associated with higher burnout levels.

THE RELATIONSHIP BETWEEN DISTRESS TOLERANCE AND ANTISOCIAL PERSONALITY DISORDER AMONG MALE INNER-CITY TREATMENT SEEKING SUBSTANCE USERS

PubMed Central

Daughters, Stacey B.; Sargeant, Marsha N.; Bornovalova, Marina A.; Gratz, Kim L.; Lejuez, C. W.

2014-01-01

There is currently limited research on the potential mechanisms underlying the development of antisocial personality disorder (ASPD). One such mechanism, distress tolerance (defined as an individual’s behavioral persistence in the face of emotional distress) may underlie the development of ASPD and its associated behavioral difficulties. It was hypothesized that substance users with ASPD would evidence significantly lower levels of distress tolerance than substance users without ASPD. To test this relationship, we assessed 127 inner-city males receiving residential substance abuse treatment with two computerized laboratory measures of distress tolerance. The mean age of the sample was 40.1 years (SD = 9.8) and 88.2% were African American. As expected, multiple logistic regression analyses indicated that distress intolerance significantly predicted the presence of an ASPD diagnosis, above and beyond key covariates including substance use frequency and associated Axis I and II psychopathology. Findings suggest that distress tolerance may be a key factor in understanding the development of ASPD, setting the stage for future studies expanding on the nature of this relationship, as well as the development of appropriate interventions for this at-risk group. PMID:18834298

Mexican-American Males Providing Personal Care for their Mothers

PubMed Central

Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

2011-01-01

We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act “against taboo”; and this approach is a new way to fulfill family obligations. PMID:21643486

Privacy protection for patients with substance use problems.

PubMed

Hu, Lianne Lian; Sparenborg, Steven; Tai, Betty

2011-01-01

Many Americans with substance use problems will have opportunities to receive coordinated health care through the integration of primary care and specialty care for substance use disorders under the Patient Protection and Affordable Care Act of 2010. Sharing of patient health records among care providers is essential to realize the benefits of electronic health records. Health information exchange through meaningful use of electronic health records can improve health care safety, quality, and efficiency. Implementation of electronic health records and health information exchange presents great opportunities for health care integration, but also makes patient privacy potentially vulnerable. Privacy issues are paramount for patients with substance use problems. This paper discusses major differences between two federal privacy laws associated with health care for substance use disorders, identifies health care problems created by privacy policies, and describes potential solutions to these problems through technology innovation and policy improvement.

Privacy protection for patients with substance use problems

PubMed Central

Hu, Lianne Lian; Sparenborg, Steven; Tai, Betty

2011-01-01

Many Americans with substance use problems will have opportunities to receive coordinated health care through the integration of primary care and specialty care for substance use disorders under the Patient Protection and Affordable Care Act of 2010. Sharing of patient health records among care providers is essential to realize the benefits of electronic health records. Health information exchange through meaningful use of electronic health records can improve health care safety, quality, and efficiency. Implementation of electronic health records and health information exchange presents great opportunities for health care integration, but also makes patient privacy potentially vulnerable. Privacy issues are paramount for patients with substance use problems. This paper discusses major differences between two federal privacy laws associated with health care for substance use disorders, identifies health care problems created by privacy policies, and describes potential solutions to these problems through technology innovation and policy improvement. PMID:24474860

Health care as perceived by persons with inflammatory bowel disease - a focus group study.

PubMed

Lesnovska, Katarina Pihl; Hollman Frisman, Gunilla; Hjortswang, Henrik; Hjelm, Katarina; Börjeson, Sussanne

2017-11-01

The aim of this study was to explore the perceptions of health care among persons living with inflammatory bowel disease. The quality of care plays an important role in the life of persons with a chronic disease. To define what persons with inflammatory bowel disease perceive as high-quality care, greater focus must be placed on the individual's own perspective of living with the condition. A qualitative exploratory study was conducted based on focus groups. Five focus groups were conducted with adult persons living with inflammatory bowel disease, 14 men and 12 women aged 19-76 years. The interviews were performed between January-June 2014. The perceptions of health care from the perspective of persons living with inflammatory bowel disease were summarised in two categories: 'professional attitudes of healthcare staff' and 'structure of the healthcare organisation'. Persons with inflammatory bowel disease want to be encountered with respect, experience trust and obtain information at the right time. They also expect shared decision-making, communication and to encounter competent healthcare professionals. Furthermore, the expectations on and perceptions of the structure of the healthcare organisation comprise access to care, accommodation, continuity of care, as well as the pros and cons of specialised care. The findings show the importance of establishing a respectful and trusting relationship, facilitating healthcare staff and persons with inflammatory bowel disease to work as a team in fulfilling individual care needs - but there is room for improvement in terms of quality of care. A person-centred approach, which places the individual and her/his family at the centre, considering them experts on their own health and enabling them to collaborate with healthcare staff, seems important to reach a high-quality healthcare organisation for patients with Inflammatory bowel disease. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

D4 dopamine-receptor (DRD4) alleles and novelty seeking in substance-dependent, personality-disorder, and control subjects.

PubMed Central

Gelernter, J; Kranzler, H; Coccaro, E; Siever, L; New, A; Mulgrew, C L

1997-01-01

Two reports have been published suggesting an association between the personality trait of novelty seeking and the DRD4*7R allele at the D4 dopamine-receptor locus (with heterozygotes or homozygotes for DRD4*7R having higher novelty seeking). We studied novelty seeking and four coding-sequence polymorphisms affecting protein structure in the D4 dopamine-receptor gene (DRD4) in a sample of 341 American subjects, of whom 224 are of primarily European ancestry and 117 are of primarily African ancestry. These subjects had diagnoses of substance dependence or personality disorder (PD) or were screened to exclude major psychiatric diagnosis. We found that, although the substance-dependent subjects had significantly higher novelty seeking than the control and PD subjects, they did not differ in DRD4*7R allele frequency. There was no association between any DRD4 polymorphism and novelty seeking in any population or diagnostic group, except for a significant association between the DRD4*7R allele and lower novelty seeking among European American females and African American substance abusers. The novelty seeking of subjects heterozygous for a null mutation did not differ from that of subjects with two functional alleles. We conclude that the most likely explanation of these results is that the DRD4 VNTR does not influence directly the trait of novelty seeking, in these samples. PMID:9345090

Person-centered care planning and service engagement: a study protocol for a randomized controlled trial.

PubMed

Stanhope, Victoria; Tondora, Janis; Davidson, Larry; Choy-Brown, Mimi; Marcus, Steven C

2015-04-22

Service disengagement is a pervasive challenge the mental health care system faces. Mental health services are of little value should persons with mental illnesses continue to opt out of receiving them. Consumers attribute disengagement from care to an absence of choice in their treatment. In response, the mental health system is adopting a person-centered model, based upon recovery principles, to engage consumers more actively in their care. Person-centered care planning is a promising practice involving collaboration to develop and implement an actionable plan to assist the person in achieving personal recovery goals. This study design combines a parallel-group randomized controlled trial of community mental health organizations with qualitative methods to assess the effectiveness of person-centered care planning. Participants at 14 sites in Delaware and Connecticut will be randomized to treatment as usual or the person-centered care planning intervention. Participants will be in leadership (n = 70) or supervisory or direct care (n = 210) roles. The person-centered care planning intervention involves intensive staff training and 12 months of ongoing technical assistance. Quantitative survey data will be collected at baseline, 6 months and 12 months measuring person-centered care planning competency and organizational factors. Consumer outcomes (engagement, medication adherence, functioning and consumer satisfaction) will be assessed by Medicaid and state-level data. Qualitative data focused on process factors will include staff and consumer interviews and focus groups. In this intent-to-treat analysis, we will use mixed-effects multivariate regression models to evaluate the differential impact of the person-centered care planning intervention on each consumer and implementation outcome as well as the extent to which clinician assessments of organizational factors are associated with the implementation outcome. Mixed methods will triangulate and strengthen the

Sustainability of a person-centered ward atmosphere and possibility to provide person-centered forensic psychiatric care after facility relocation.

PubMed

Alexiou, Eirini; Wijk, Helle; Ahlquist, Gustaf; Kullgren, Anette; Degl' Innocenti, Alessio

2018-05-01

This longitudinal study aims to assess the sustainability of staff perceptions of ward atmosphere and their possibility to provide person-centered forensic psychiatric care after relocation to new hospitals that aimed to provide supportive work conditions for the staff to be able to perform care of high quality. In this study we only present the result for the repeated measures, that is, only the individuals that performed both the questionnaires at baseline and at the three follow-ups. Data were collected prospectively between 2010 and 2016; before (baseline) and after relocation of the forensic psychiatric clinics to new buildings, i.e., after six months (follow-up 1), after one year (follow-up 2) and after two years (follow-up 3), respectively. Data were obtained by employing structured validated questionnaires. The main findings of this study display an improvement in the staff assessment of a person-centered atmosphere from baseline to follow-up 3 in the domains of safety, everydayness and community where safety was evaluated the highest. No sustainable significant changes were found concerning staff's assessment of the support for them to provide person-centered care. The findings show sustainability of person-centered ward atmosphere in forensic psychiatric care according to staff's assessment after relocation from traditional health care facilities to evidence-based designed premises. In this study the increased staff perception of the possibility to provide person-centered care in the new facilities could not be revealed as sustainability over the two years of follow-up. Copyright © 2018. Published by Elsevier Ltd.

Reconciling conceptualizations of ethical conduct and person-centred care of older people with cognitive impairment in acute care settings.

PubMed

Rushton, Carole; Edvardsson, David

2018-04-01

Key commentators on person-centred care have described it as a "new ethic of care" which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person-centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person-centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person-centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses' ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person-centred care. We argue that nurses' responses to the ethical demand by way of parrhêsia can be an important feature of intra-organizational reflexivity and its transformation towards the delivery care that is more person-centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. © 2017 John Wiley & Sons Ltd.

Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial.

PubMed

Chambers, Jaclyn E; Brooks, Adam C; Medvin, Rachel; Metzger, David S; Lauby, Jennifer; Carpenedo, Carolyn M; Favor, Kevin E; Kirby, Kimberly C

2016-04-18

Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions. This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences. The ability of brief

How Community Efforts To Reduce Substance Abuse Have Affected Health Care. Lessons Learned Conferences Seminar Report (Washington, D.C., April 14-15, 1997).

ERIC Educational Resources Information Center

Johnson, Michelle; Smith, Steven Rathgeb

A conference in Washington, D.C., brought together health care professionals and people working on substance abuse issues to take a look at what four communities have done to use the health care system as part of a strategy to address substance abuse. The four communities are Vallejo (California), Santa Barbara (California), Little Rock…

Influence of worldview on health care choices among persons with chronic pain.

PubMed

Buck, Tina; Baldwin, Carol M; Schwartz, Gary E

2005-06-01

The aim of this research was to examine relationships between the Pepperian worldviews of people with chronic pain and the health care choices that they make. A convenience sample survey was done. University Medical Center Pain Clinic, Tucson, Arizona. Men and women patients (n = 96) with nonmalignant chronic pain. World Hypothesis Scale; Health Care Choice List. Findings indicate that the combination of age and formistic worldview are statistically significant predictors of conventional health care choices by participants in this study. Older patients and persons with a predominantly formistic worldview were less likely to use complementary and alternative medicine (CAM) as a choice among this sample with chronic nonmalignant pain. Borderline significant associations were noted between persons with formistic or mechanistic worldviews and conventional health care choices, and persons with contextualistic, organismic, or equal scores in two worldview categories and CAM health care choices. Although rates of CAM use did not significantly differ from conventional choices, the prevalence rate for CAM use was high (55.2%) based on national findings. Results of this study provide a link to understanding how underlying philosophies can contribute to the reasons people with chronic pain make health care decisions. Further exploration of worldviews might very well contribute to best practices for consumer health care by engaging in communication styles and belief systems consistent with consumers' personal schemas.

Person-Centered Care Practices in Long-Term Care in the Deep South: Consideration of Structural, Market, and Administrator Characteristics.

PubMed

Jacobs, M Lindsey; Snow, A Lynn; Parmelee, Patricia A; Davis, Jullet A

2018-03-01

The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCP'S) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

EPA Science Inventory

The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

EPA Science Inventory

The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typicall...

Prevalence and predictors of substance use disorders among homeless women seeking primary care: An 11 site survey.

PubMed

Upshur, Carole Christofk; Jenkins, Darlene; Weinreb, Linda; Gelberg, Lillian; Orvek, Elizabeth Aaker

2017-10-01

Homeless women have shown high rates of substance use disorders (SUD), but many studies are more than a decade old, limited in geographic location, or focus only on women living outdoors or in shelters. The purpose of this study was to obtain a more current and representative sample of homeless women and the prevalence and predictors of substance use disorders among women seeking primary care at Health Care for the Homeless clinics across the US. Eleven Health Care for the Homeless (HCH) clinics in nine states contributed proportionally to a sample of n = 780 female patients who completed a self-administered survey including demographics, housing history, health, mental health, and drug and alcohol use. Compared to the general population of women, rates were four times higher for an alcohol use disorder, and 12 times higher for a drug use disorder. The findings indicate a significant need for SUD services, with an equally high need for mental health services. In addition, high rates of victimization and use of tobacco, and overall poor health status, indicate overall health disparities. Addressing barriers to full integration of substance use and mental health services, such as improving screening, reimbursement, clinician training, and addressing biases about motivation of this population to engage in treatment, are necessary to improve the health of women seeking care in HCH settings. (Am J Addict 2017;26:680-688). © 2017 American Academy of Addiction Psychiatry.

Improving the Care of Individuals with Schizophrenia and Substance Use Disorders: Consensus Recommendations

PubMed Central

ZIEDONIS, DOUGLAS M.; SMELSON, DAVID; ROSENTHAL, RICHARD N.; BATKI, STEVEN L.; GREEN, ALAN I.; HENRY, RENATA J.; MONTOYA, IVAN; PARKS, JOE; D. WEISS, ROGER

2008-01-01

National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia. “Integrated treatment” is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (e.g., cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of

Epidemiology of substance abuse among migrants compared to native born population in primary care.

PubMed

Qureshi, Adil; Garcia Campayo, Javier; Eiroa-Orosa, Francisco Jose; Sobradiel, Natalia; Collazos, Francisco; Febrel Bordejé, Mercedes; Roncero, Carlos; Andrés, Eva; Casas, Miguel

2014-01-01

Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACAT cross-sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia. Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini-International Neuropsychiatric Interview. Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs. Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access. © American Academy of Addiction Psychiatry.

Substance Use in Women

MedlinePlus

... in Women Email Facebook Twitter Revised June 2018 Sex and Gender Differences in Substance Use Women may ... care provider about all of their substance use. Sex and Gender Differences in Drug Treatment It is ...

Personalized Colon Cancer Care in 2010

PubMed Central

Catenacci, Daniel V.T.; Kozloff, Mark; Kindler, Hedy L.; Polite, Blase

2011-01-01

Colon cancer therapies have improved patient outcomes significantly over the last decades in both the adjuvant and metastatic settings. With the introduction of a number of novel agents, both traditional chemotherapies and biologically targeted agents, the need to identify subgroups that are likely and not likely to respond to a particular treatment regimen is paramount. This will allow patients who are likely to benefit to receive optimal care, while sparing those unlikely to benefit from unnecessary toxicity and cost. With the identification of several novel biomarkers and a variety of technologies to interrogate the genome, we are already able to rapidly study patient tumor or blood samples and normal tissues to generate a large dataset of aberrations within the cancer. How to digest this complex information to obtain accurate, reliable, and meaningful results that will allow us to provide truly personalized care for colon cancer patients is just starting to be addressed. In this article, we briefly review the history of colon cancer treatment, with an emphasis on current clinical standards that incorporate a ‘personalized medicine’ approach. We then review strategies which will potentially improve our ability to individualize therapy in the future. PMID:21421118

PHARMACEUTICAL AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

EPA Science Inventory

Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

EPA Science Inventory

Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

Substance Abuse Screening and Treatment.

PubMed

Tenegra, Johnny C; Leebold, Bobby

2016-06-01

One of the more prevalent and often undiagnosed problems seen by primary care clinicians is substance misuse. Resulting in increased morbidity and mortality, loss of productivity, and increased health care costs, substance misuse in our society remains a significant public health issue. Primary care physicians are on the front lines of medical care, and as such, are in a distinctive position to recognize potential problems in this area and assist. This article outlines office-based screening approaches and strategies for managing and treating this complex issue confronting primary care. Copyright © 2016 Elsevier Inc. All rights reserved.

Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems

PubMed Central

LIEBSCHUTZ, J. M.; GEIER, J. L.; HORTON, N. J.; CHUANG, C. H.; SAMET, J. H.

2016-01-01

We examined interpersonal violence and its association with health care utilization and substance use severity among a cohort of 349 HIV-infected men and women with histories of alcohol problems assessed biannually up to 36 months. Data included demographics, lifetime interpersonal violence histories, age at first violence exposure, recent violence (prior six months), substance use severity and health care utilization (ambulatory visits, Emergency Department (ED) visits, hospitalizations) and adherence to HIV medication. Kaplan-Meier survival curves estimated the proportion of subjects experiencing recent violence. Generalized estimating equation regression models evaluated the relationship between recent violence, utilization and substance use severity over time, controlling for demographics, CD4 counts and depressive symptoms. Subject characteristics included: 79% male; mean age 41 years; 44% black, 33% white and 23% other. Eighty percent of subjects reported lifetime interpersonal violence: 40% physical violence alone, and 40% sexual violence with or without physical violence. First violence occurred prior to age 13 in 46%. Twenty-four (41%) of subjects reported recent violence by 24 and 36 months, respectively. In multivariate analyses, recent violence was associated with more ambulatory visits, ED visits and hospitalizations and worse substance use severity, but not medication adherence. Due to the high incidence and associated increased health care services utilization, violence prevention interventions should be considered for HIV-infected patients with a history of alcohol problems. PMID:16036243

OI Issues: Dental Care for Persons with OI

MedlinePlus

... Better Bones Upcoming Events Online Store OI Issues: Dental Care for Persons with OI Introduction Osteogenesis imperfecta ( ... jaws and may or may not affect the teeth. About half of the people who have OI ...