Boles, Sharon M.; Joshi, Vandana; Grella, Christine; Wellisch, Jean
This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multisite study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Controlling for gender, compared to patients without CSA,…
Stanger, Catherine; Ryan, Stacy R.; Fu, Hongyun; Landes, Reid D.; Jones, Bryan A.; Bickel, Warren K.; Budney, Alan J.
The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (M =15.8; SD = 1.3) who enrolled in a clinical trial comparing three behavioral treatments for adolescent marijuana abuse or dependence. Participants completed a delay discounting task at treatment onset for $100 and $1,000 of hypothetical money and marijuana. Overall, smaller magnitude rewards were discounted more than larger magnitude rewards. Delay discounting rates were concurrently related to demographic variables (SES, race). Delay discounting of $1,000 of money predicted during treatment abstinence outcomes among adolescent marijuana abusers, over and above the effects of type of treatment received. Teens who show higher levels of discounting of the future may be an important subgroup to identify at treatment onset. Youth with a greater tendency to discount the future may require different intervention strategies that address their impulsivity (e.g., targeting executive function or inhibitory control) and/or different schedules of reinforcement to address their degree of preference for immediate rewards. PMID:22182419
Chartier, Karen G; Carmody, Tom; Akhtar, Maleeha; Stebbins, Mary B; Walters, Scott T; Warden, Diane
This study explored Hispanic subgroup differences in substance use treatment outcomes, and the relationship of acculturation characteristics to these outcomes. Data were from a multisite randomized clinical trial of motivational enhancement therapy versus treatment as usual in a sample of Spanish-speaking substance abusers. Participants were Cuban American (n=34), Mexican American (n=209), Puerto Rican (n=78), and other Hispanic American (n=54). Results suggested that Cuban Americans and individuals with more connection to Hispanic culture had lower treatment retention. Hispanics born in the U.S and those who spoke English at home had a lower percentage of days abstinent during weeks 5-16, although Puerto Ricans born in the U.S. and Cuban Americans living more years in the U.S. had a higher percentage of days abstinent in weeks 1-4 and 5-16, respectively. Results may inform future hypothesis-driven studies in larger Hispanic treatment seeking samples of the relationship between acculturation and treatment outcome.
Celentano, David D; Lucas, Greg
Drug abuse is associated with poorer virologic and clinical outcomes for patients with human immunodeficiency virus (HIV) infection. Limited evidence, primarily from in vitro and animal studies, shows that some abused drugs (e.g., opioids) may have direct effects on HIV pathology and the immune response to infection, but the clinical effects are not known. Clinical data indicate that the primary effect of drug abuse on HIV disease progression is mediated via factors that may limit access and/or adherence to highly active antiretroviral therapy (HAART). Drug abuse is associated with reduced adherence to HAART, which is strongly correlated with poorer virologic and clinical outcomes. However, the virologic and clinical effects of HAART are generally equivalent among drug abusers and non-drug abusers who adhere to therapy. These results underscore the importance of integrating medical and substance abuse interventions for HIV-positive drug abusers, to improve adherence to HAART and optimize outcomes of treatment for HIV infection.
Love, Arnold J.
Assesses the feasibility and effectiveness of the Sexual Abuse Treatment Project used in a child welfare setting in Canada. Also evaluates the therapeutic process, which was based on an intensive psychodynamic model, and assesses its effectiveness for child and adult clients. (RJC)
Sahker, Ethan; Acion, Laura; Arndt, Stephan
Objective: To discover differences between student and nonstudent substance abuse treatment demographics, treatment characteristics, and outcomes. Participants: Conducted February 2014, clients without prior treatment admissions, aged 18-24, not in methadone maintenance therapy, and in nonintensive and ambulatory intensive outpatient treatment…
Murphy, Debra A.; Brecht, Mary-Lynn; Herbeck, Diane; Evans, Elizabeth; Huang, David; Hser, Yih-Ing
Longitudinal trajectories for HIV risk were examined over 5 years following treatment among 1,393 patients who participated in the nationwide Drug Abuse Treatment Outcome Studies. Both injection drug use and sexual risk behavior declined over time, with most of the decline occurring between intake and the first-year follow-up. However, results of…
Garnick, Deborah W; Horgan, Constance M; Acevedo, Andrea; Lee, Margaret T; Panas, Lee; Ritter, Grant A; Dunigan, Robert; Bidorini, Alfred; Campbell, Kevin; Haberlin, Karin; Huber, Alice; Lambert-Wacey, Dawn; Leeper, Tracy; Reynolds, Mark; Wright, David
The relationship between engagement in outpatient treatment facilities in the public sector and subsequent arrest is examined for clients in Connecticut, New York, Oklahoma and Washington. Engagement is defined as receiving another treatment service within 14 days of beginning a new episode of specialty treatment and at least two additional services within the next 30 days. Data are from 2008 and survival analysis modeling is used. Survival analyses express the effects of model covariates in terms of "hazard ratios," which reflect a change in the likelihood of outcome because of the covariate. Engaged clients had a significantly lower hazard of any arrest than non-engaged in all four states. In NY and OK, engaged clients also had a lower hazard of arrest for substance-related crimes. In CT, NY, and OK engaged clients had a lower hazard of arrest for violent crime. Clients in facilities with higher engagement rates had a lower hazard of any arrest in NY and OK. Engaging clients in outpatient treatment is a promising approach to decrease their subsequent criminal justice involvement.
Cloitre, Marylene; Chase Stovall McClough,K.; Miranda, Regina; Chemtob, Claude M.
This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic…
Oser, Carrie B.; Biebel, Elizabeth P.; Pullen, Erin L.; Harp, Kathi L.H.
Focus group data was collected from 28 substance abuse treatment counselors employed in rural and urban areas to examine their perceptions of factors influencing treatment outcomes. The influence of the counselor characteristics (i.e., education, experience, and recovery status) on client outcomes and geographic differences are explored. Focus group data was analyzed by three raters using line-by-line coding, focused coding, and memoing. This analytic approach revealed geographic differences in the counselors' perceptions of the effect of counselor education, experience, and recovery status on client outcomes. Recommendations for treatment planning and future research are provided. PMID:21927521
Comfort, Marilee; Kaltenbach, Karol A.
This study examined whether client characteristics at admission predict Retention, Abstinence, and utilization of Required Services and Specialized Services for pregnant women in outpatient and residential substance abuse treatment. Retrospective data were collected with the Psychosocial History (PSH), a structured clinical interview that is an expansion of the Addiction Severity Index, designed specifically to assess substance abusing women. The PSH was administered at intake for 183 pregnant women admitted to outpatient (n = 133) or residential (n = 50) treatment. Factor analysis reduced predictors to five factors with composite scores, and multiple regression procedures determined client characteristics that predict treatment outcomes. The findings suggest the complexity of predicting treatment outcomes for pregnant women. Significant predictors were composites of variables that encompassed all aspects of women's personal and family lives including medical and psychiatric needs, family and parenting issues, housing, victimization, and clients' perceived needs for treatment and assistance in all of these areas. The results suggest the need for a holistic approach to substance abuse treatment and continued exploration of a broad range of psychosocial assessments at intake in order to develop substance abuse treatment programs that effectively address multiple aspects of women's lives. PMID:12466646
Green, Carla A; Polen, Michael R; Lynch, Frances L; Dickinson, Daniel M; Bennett, Marjorie D
This study examined gender differences in treatment outcomes and outcomes predictors among 155 men and 81 women attending a gender-sensitive substance abuse treatment program. Bivariate analyses indicated women improved more than men in social/family and daily functioning domains, but differences disappeared after controlling for baseline characteristics. Multivariate models predicting treatment outcomes revealed that, across Addiction Severity Index domains, outcomes for men were predicted primarily by mental health and medical conditions, severity of the substance abuse problem, and treatment com- pletion. For women, in addition to treatment completion, outcomes were more likely to be predicted by social, socio-demographic, and life-history characteristics. For abstinence outcomes, women who completed treatment were 9 times as likely to be abstinent at 7-month follow-up as other women; men who completed were 3 times more likely to be abstinent than other men. Women with more severe psychiatric status and those who felt their life was out of control were less likely to be abstinent, as were men who lived alone. Clinicians targeting such factors differentially for men and women may enhance the effectiveness of treatment. PMID:15132342
Duffany, Adrienne; Panos, Patrick T.
Objective: To determine the effectiveness of group therapy in treating sexually abused children to prevent recidivism (subsequently re-abused or becoming abusers themselves). Methods: Recidivism rates of 617 children were compared between sexually abused children who received group treatment with those whose parents refused treatment.…
Burke, Anna C.; Gregoire, Thomas K.
This study provides new evidence regarding the relation of coerced care to posttreatment substance use and addiction severity while controlling for two important factors: readiness to change and addiction severity at admission to treatment. The initial study sample consisted of 289 people who agreed to participate in a prospective study of…
Timko, Christine; Valenstein, Helen; Stuart, Gregory L.; Moos, Rudolf H.
The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. PMID:25470658
Greenfield, Shelly F.; Brooks, Audrey J.; Gordon, Susan M.; Green, Carla A.; Kropp, Frankie; McHugh, R. Kathryn; Lincoln, Melissa; Hien, Denise; Miele, Gloria M.
This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field. PMID:16759822
Phillips, Susan D.; Gleeson, James P.; Waites-Garrett, Melissa
The expansion of the criminal justice system over the last several decades helped to focus attention on children of incarcerated parents, many of whom have parents with substance abuse problems. Since the 1990's, a national grassroots campaign has been underway to make substance abuse treatment an alternative to incarceration for parents who…
Lipsky, Sherry; Krupski, Antoinette; Roy-Byrne, Peter; Lucenko, Barbara; Mancuso, David; Huber, Alice
This retrospective cohort study examined risk factors for co-occurring substance use and mental disorders (COD) and the effect of COD and intimate partner violence (IPV) victimization among women and IPV-related arrest among men on 1-year substance abuse treatment outcomes. The study sample included clients admitted to Washington State publicly funded substance abuse treatment facilities in 2004-2007. COD was associated with a high substance use and IPV risk profile at admission. Having a COD decreased the odds of completing treatment by 30% among men and women and increased the risk of treatment reentry by 9% and 12% among men and women, respectively. IPV also decreased the odds of completing treatment among women and increased the risk of treatment reentry among men. Men with COD were less likely than those without COD to be arrested for substance-related crimes but more likely to be arrested for violence-related crimes in the follow-up period. Implications of these findings are discussed.
Rohsenow, D J; Monti, P M; Martin, R A; Michalec, E; Abrams, D B
Patients (N = 108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation-relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment.
Saxena, Preeta; Messina, Nena; Grella, Christine E.
This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). In order to identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post- treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6- and 12-months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression (OR = .29, p < .05, 95% CI = .10 – .86) and lowered rates of number of substances used (IRR = .52, p < .05, 95% CI = 0.28–0.98), in comparison to those who reported abuse and were randomized to the non-GRT group. GRT for women offenders who have experienced prior abuse would maximize the benefits of the trauma-informed, gender-sensitive intervention. PMID:24910481
Brensilver, Matthew; Heinzerling, Keith G.; Swanson, Aimee-Noelle; Telesca, Donatello; Furst, Benjamin A.; Shoptaw, Steven J.
Introduction and Aims Cigarette smoking occurs frequently among individuals with methamphetamine dependence. Preclinical and clinical evidence has suggested that the common co-abuse of methamphetamine and cigarettes represents a pharmacologically meaningful pattern. Methods The present study is a secondary analysis of a randomised, placebo-controlled trial of bupropion treatment for methamphetamine dependence (bupropion n=36; placebo n=37). A hierarchical logistic modelling approach assessed the efficacy of bupropion for reducing MA use separately among smokers and non-smokers. Among smokers, relations between cigarettes smoked and MA use were assessed. Results Smoking status did not affect treatment responsiveness in either the bupropion condition or the placebo condition. In the placebo condition, increased cigarette use was associated with an increased probability of methamphetamine use during the same time period. This effect was not observed in the bupropion condition. Discussion and Conclusions Initial smoking status did not impact treatment outcomes. Among smokers, results suggest that bupropion may dissociate cigarette and methamphetamine use. The effect was modest and a precise pharmacologic mechanism remains elusive. Cholinergic systems may be relevant for methamphetamine use outcomes. Future studies should continue to assess the role of smoking in methamphetamine treatment outcomes. PMID:22385210
Kuper, Laura E.; Gallop, Robert; Greenfield, Shelly F.
In this secondary data analytic study we examined whether the relationship between changes in coping and treatment outcome differed between women enrolled in either the Women's Recovery Group (N=29), a new manualized group treatment for women with substance use disorders, or Group Drug Counseling (N=7), an empirically supported mixed-gender group treatment. We examined subscales of the Ways of Coping questionnaire and found that while changes in coping did not differ significantly across treatment groups, the association of changes in coping with substance abuse outcome was related to treatment condition. Increases in problem focused coping were associated with decreased drinking days in WRG, but paradoxically with increased drinking days in GDC. For both groups, increases in wishful thinking were associated with increases in substance use, and increases in social support coping associated with decreases in use, but these associations were greater GDC. Our results highlight the importance of examining the impact of treatment modality on coping, as well as contextual factors that may help to explain the specific pattern of results. PMID:20958851
Murphy, Debra A.; Brecht, Mary Lynn; Herbeck, Diane; Evans, Elizabeth; Huang, David; Hser, Yih-Ing
Longitudinal trajectories for HIV risk were examined over five years following treatment among 1,393 patients who participated in the nationwide Drug Abuse Treatment Outcome studies (DATOS). Both injection drug use and sexual risk behavior declined over time, with most of the decline occurring between intake and the first year follow-up. However, results of the application of growth mixture models for both sets of trajectories indicated a subgroup of individuals reverted to a high-risk behavior over time, with a higher level of risk at the 5-year follow-up than their original risk level at intake. Of clients who were engaged in regular injection drug use at intake, 76% continued to inject drug at a Moderate/stable or Increased rate over the 5-year follow-up. PMID:18198171
Liotta, Lindsay; Springer, Craig; Misurell, Justin R; Block-Lerner, Jennifer; Brandwein, David
A quasi-experimental design was used to compare the effectiveness of group (game-based cognitive behavioral) therapy to group-plus-individual therapy for child sexual abuse. The sample consisted predominantly of children from economically disadvantaged, African-American or Latino backgrounds. Pretreatment scores were examined in order to determine which factors influence treatment referral decisions. Results suggest that children who were referred for individual therapy in addition to group therapy report higher pretreatment levels of sexualized behavior. Posttreatment differences were also compared across therapy conditions. Results suggest that individual therapy is needed to address the sexual concerns of survivors but that it may not be needed to augment the effects of group therapy for other symptoms. Implications for treatment are discussed.
Kolko, David J; Baumann, Barbara L; Caldwell, Nicola
This study examines the correlates and impacts of child treatment in 68 cases referred to community agency providers after reports of child physical or sexual abuse. Standardized clinical assessments were conducted with child victims and their caregivers at intake and short-term follow-up (FUP-1), supplemented by official record reviews at a long-term follow-up (FUP-2). Child treatment was received by 19% and 50% of the children at FUP-1 and FUP-2, respectively. There were few correlates of initial child treatment involvement (sexual abuse or parent and family services received concurrently). Initial child treatment was not associated with significant gains in child outcomes. Child improvement in abuse-related outcomes was associated with post-traumatic stress disorder and lower adjustment at intake. Initial child treatment was unrelated to reabuse or out-of-home placement by FUP-2. Additional studies are needed to more fully evaluate the process and outcome of referral of child abuse victims to community-based services. PMID:14604175
Martin, Rosemarie A.; MacKinnon, Selene; Johnson, Jennifer; Rohsenow, Damaris J.
A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies, but has not been studied as a predictor of cocaine treatment outcome. This study examined pre-treatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p < .01) predicted relapse to any use of cocaine and to alcohol, and the number of days cocaine or alcohol was used in the six months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine dependent patients. PMID:21129893
Rowland, Melisa D.; Chapman, Jason E.; Henggeler, Scott W.
This study examined the substance use and delinquency outcomes for the nearest age siblings of substance abusing and delinquent adolescents that participated in a randomized clinical trial evaluating the effectiveness of integrating evidence-based practices into juvenile drug court. The sample of 70 siblings averaged 14.4 years of age, 50% were…
McClure, Erin A.; Campbell, Aimee N. C.; Pavlicova, Martina; Hu, Meichen; Winhusen, Theresa; Vandrey, Ryan G.; Ruglass, Lesia M.; Covey, Lirio S.; Stitzer, Maxine L.; Kyle, Tiffany L.; Nunes, Edward V.
Introduction The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. Methods In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (Aim #1), specifically among those in the experimental treatment group (Aim #2), and the moderating effect of being a smoker on treatment outcomes (Aim #3). Results Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. Conclusions This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients. PMID:25595301
Engle, Brett; Macgowan, Mark J.; Wagner, Eric F.; Amrhein, Paul C.
Objectives: Despite their popularity, little is known about what distinguishes effective from ineffective or even iatrogenic adolescent group interventions. Methods: Audio recordings and transcripts from 19, 8-10 session, school-based treatment groups comprised of 108, substance abusing 10- to 19-year olds were analyzed. "Group leader empathy" was…
Although perpetrators of child neglect often abuse illicit substances, treatment outcome evaluations in drug-abusing young mothers who have been found to neglect their children are conspicuously absent. Problem-solving interventions and family-based therapies that include skill acquisition components have demonstrated effectiveness in…
Lennox, Richard D.; Sternquist, Marie A.; Paredes, Alfonso
The routine collection of drug treatment outcomes to manage quality of care, improve patient satisfaction, and allocate treatment resources is currently hampered by two key difficulties: (1) problems locating clients once they leave treatment; and (2) the prohibitive cost of obtaining meaningful and reliable post-treatment data. This pilot describes precise methods for an economical staff-based routine outcome monitoring (ROM) system using an 18-item core measure telephone survey. As implemented at Narconon™ of Oklahoma, a behavioral and social skills based, residential drug rehabilitation program, the system was psychometrically adequate for aggregate reporting while providing clinically useful information. Standardized procedures for staff training, collecting client contact information, structuring exit interviews and maintaining post-treatment telephone contact produced follow-up rates that improved from 57.6% to 100% over the course of the project. Aggregate data was used to improve program delivery and thereby post-treatment substance use and social outcomes. These methods and use of data may contribute to the discussion on how to best monitor outcomes. PMID:24092985
Linhorst, Donald M.; Dirks-Linhorst, P. Ann; Groom, Ralph
This study compares the characteristics of two groups of probationers ordered to jail-based substance-abuse treatment as an intermediate sanction. It further reviews rearrest and probation failure outcomes of the two groups, along with the demographic, clinical, and criminal factors associated with those outcomes. Probationers jailed for probation…
Garner, Bryan R; Hunter, Brooke D; Smith, Douglas C; Smith, Jane Ellen; Godley, Mark D
Emerging adulthood is the period of greatest risk for problematic substance use. The primary aim of the current study was to examine the relationship between a broad measure of child maltreatment and several key outcomes for a large clinical sample of emerging adults (n = 858) and adolescents (n = 2,697). The secondary aim was to examine the extent to which the relationship between child maltreatment and treatment outcomes differed between emerging adults and adolescents. Multilevel latent growth curve analyses revealed emerging adults and adolescents who experienced child maltreatment reported significantly greater reductions over time on several treatment outcomes (e.g., substance use, substance-related problems, and emotional problems). Overall, analyses did not support differential relationships between child maltreatment and changes over time in these substance use disorder treatment outcomes for emerging adults and adolescents. The one exception was that although emerging adults with child maltreatment did reduce their HIV risk over time, their improvements were not as great as were the improvements in HIV risk reported by adolescents who had experienced child maltreatment.
Morse, Siobhan; MacMaster, Samuel
Opiate use patterns, user characteristics, and treatment response among young adults are of interest due to current high use prevalence and historical low levels of treatment engagement relative to older populations. Prior research in this population suggests that overall, young adults present at treatment with different issues. In this study the authors investigated potential differences between young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of differences relative to treatment motivation, length and outcomes. Data for this study was drawn from 760 individuals who entered voluntary, private, residential treatment. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and 6-month post-discharge. Results indicate that older adults with a history of opiate use present at treatment with higher levels of severity for alcohol, medical, and psychological problems and young adults present at treatment with greater drug use and more legal issues. Significant improvement for both groups was noted at 6 months post treatment; there were also fewer differences between the two age groups of opiate users. Results suggest different strategies within treatment programs may provide benefit in targeting the disparate needs of younger opiate users. Overall, however, results suggest that individualized treatment within a standard, abstinence-based, residential treatment model can be effective across opiate users at different ages and with different issues, levels of severity, and impairment at intake.
Morse, Siobhan; MacMaster, Samuel
Opiate use patterns, user characteristics, and treatment response among young adults are of interest due to current high use prevalence and historical low levels of treatment engagement relative to older populations. Prior research in this population suggests that overall, young adults present at treatment with different issues. In this study the authors investigated potential differences between young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of differences relative to treatment motivation, length and outcomes. Data for this study was drawn from 760 individuals who entered voluntary, private, residential treatment. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and 6-month post-discharge. Results indicate that older adults with a history of opiate use present at treatment with higher levels of severity for alcohol, medical, and psychological problems and young adults present at treatment with greater drug use and more legal issues. Significant improvement for both groups was noted at 6 months post treatment; there were also fewer differences between the two age groups of opiate users. Results suggest different strategies within treatment programs may provide benefit in targeting the disparate needs of younger opiate users. Overall, however, results suggest that individualized treatment within a standard, abstinence-based, residential treatment model can be effective across opiate users at different ages and with different issues, levels of severity, and impairment at intake. PMID:25879396
Evans, E.; Li, L.; Buoncristiani, S.; Hser, Y.I.
This study examines perceived neighborhood characteristics associated with successful outcome among mothers 10 years after being treated for substance use disorders. Data were obtained from 713 mothers first studied at admission to drug treatment in California in 2000-2002 and followed-up in 2009-2011. At follow-up, 53.6% of mothers had a successful outcome (i.e., no use of illicit drugs and not involved with the criminal justice system). Perceived neighborhood safety almost doubled the odds of success. Perceived neighborhood safety interacted with social involvement, decreasing the odds of success among mothers who reported more versus less neighborhood social involvement. Perceived neighborhood climate is associated with long-term outcomes among mothers with substance use disorders independent of individual-level characteristics, underscoring the need for further efforts to understand its interaction with recovery capital in ways that promote and impede health. PMID:24832914
Ulibarri, Monica D.; Ulloa, Emilio C.; Salazar, Marissa
This study examined self-reported sexually abusive experiences in childhood and adulthood as correlates of current drug use, alcohol abuse, and depression and posttraumatic stress disorder (PTSD) symptoms. Participants were 204 Latina women 18–34 years old. Results indicated significant relationships between history of sexual abuse (regardless of age of occurrence), depression symptoms, PTSD symptoms, alcohol abuse, and drug use. When examined separately, childhood sexual abuse was associated with symptoms of depression, PTSD, and substance use but not alcohol abuse behaviors. Experiencing sexual abuse in adulthood was associated with symptoms of depression, alcohol abuse behaviors, and substance use but not PTSD symptoms. Structural equation modeling showed that substance use partially mediated the relationship between sexual abuse and mental health outcomes. These findings suggest mental health and substance use services should incorporate treatment for trauma, which may be the root of comorbid mental health and substance use issues. PMID:25635897
Carroll, Kathleen M.; Ball, Samuel A.; Nich, Charla; Martino, Steve; Frankforter, Tami L.; Farentinos, Christiane; Kunkel, Lynn E.; Mikulich-Gilbertson, Susan K.; Morgenstern, Jon; Obert, Jeanne L.; Polcin, Doug; Snead, Ned; Woody, George E.
Despite recent emphasis on integrating empirically validated treatment into clinical practice, there are little data on whether manual-guided behavioral therapies can be implemented in standard clinical practice and whether incorporation of such techniques is associated with improved outcomes. The effectiveness of integrating motivational interviewing (MI) techniques into the initial contact and evaluation session was evaluated in a multisite randomized clinical trial. Participants were 423 substance users entering outpatient treatment in five community-based treatment settings, who were randomized to receive either the standard intake/evaluation session at each site or the same session in which MI techniques and strategies were integrated. Clinicians were drawn from the staff of the participating programs and were randomized either to learn and implement MI or to deliver the standard intake/evaluation session. Independent analyses of 315 session audiotapes suggested the two forms of treatment were highly discriminable and that clinicians trained to implement MI tended to have higher skill ratings. Regarding outcomes, for the sample as a whole, participants assigned to MI had significantly better retention through the 28-day follow-up than those assigned to the standard intervention. There were no significant effects of MI on substance use outcomes at either the 28-day or 84-day follow-up. Results suggest that community-based clinicians can effectively implement MI when provided training and supervision, and that integrating MI techniques in the earliest phases of treatment may have positive effects on retention early in the course of treatment. PMID:16169159
Tracy, James J.; Clark, Elizabeth H.
Staff of a child abuse program in a Philadelphia hospital worked with parents in their own homes to help them develop greater competence as adults and as parents. This article describes the use of social learning theory, with some techniques of behavior therapy, as the basis for treatment. (Author)
Schiff, Miriam; Katz, Katalin
Objective: This study is the first in a comprehensive examination of therapeutic components and outcome of interventions in a public, nonresidential service for drug addicts in Jerusalem (SHALEM). Method: Data were gathered from 153 clients (35 women, 128 men; 35 Arabs, 118 Jews; median age = 39) using clinical data mining. Results: Men who had…
Banyard, Victoria L.; Williams, Linda M.
Using an ecological model as a guiding framework, this article reviews key factors which put adolescent survivors of sexual abuse at risk for negative outcomes, as well as resources which might enhance positive outcomes and recovery. Throughout the article, quotes from women who experienced sexual abuse during their youth highlight opportunities…
Silverman, K; Svikis, D; Robles, E; Stitzer, M L; Bigelow, G E
This study evaluated a novel drug abuse treatment, the Therapeutic Workplace. In this treatment, patients are paid to perform jobs or to participate in job training. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplace. Pregnant and postpartum drug abuse patients (N = 40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants were invited to work 3 hr every weekday for 6 months and could earn up to $4,030 in vouchers for abstinence, workplace attendance, and performance. On average, 45% of participants attended the workplace per day. Relative to controls, the Therapeutic Workplace nearly doubled patients' abstinence from opiates and cocaine (33% vs. 59% of thrice-weekly urine samples drug negative, respectively, p < .05). The Therapeutic Workplace can effectively treat heroin and cocaine abuse in pregnant and postpartum women. PMID:11519628
Silverman, K; Svikis, D; Robles, E; Stitzer, M L; Bigelow, G E
This study evaluated a novel drug abuse treatment, the Therapeutic Workplace. In this treatment, patients are paid to perform jobs or to participate in job training. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplace. Pregnant and postpartum drug abuse patients (N = 40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants were invited to work 3 hr every weekday for 6 months and could earn up to $4,030 in vouchers for abstinence, workplace attendance, and performance. On average, 45% of participants attended the workplace per day. Relative to controls, the Therapeutic Workplace nearly doubled patients' abstinence from opiates and cocaine (33% vs. 59% of thrice-weekly urine samples drug negative, respectively, p < .05). The Therapeutic Workplace can effectively treat heroin and cocaine abuse in pregnant and postpartum women.
Thurstone, Chris; Lajoie, Travis
Strategies are needed to improve adolescent substance abuse treatment outcomes. For example, during outpatient substance abuse treatment, up to 80% of adolescents continue to use.(1),(2) Following residential substance abuse treatment, 88% of adolescents relapse within 6 months.(3.) PMID:24381821
Rohsenow, Damaris J; Martin, Rosemarie A; Monti, Peter M
This study investigated specific coping techniques for effectiveness in reducing cocaine use after treatment. The urge-specific strategies questionnaire-cocaine (USS-C) assessed frequency of use of 21 strategies for coping with urges. The general change strategies questionnaire-cocaine (GCS-C) assessed frequency of use of 21 lifestyle change strategies designed to maintain abstinence. Cocaine-dependent patients were assessed at follow-up after residential treatment for USS-C (n=59 at 3 months, 84 at 6 months), GCS-C (n=89 at 3 months, 120 at 6 months) and substance use. Less cocaine use was associated with urge coping by thinking about negative or positive consequences, alternative behaviors, distraction, relaxation/meditation, escape, offer refusal, spiritual methods, behavior chains, mastery messages, problem-solving, meeting or sponsor, or seeking social support. The lifestyle change strategies of thinking about consequences, working toward goals, thinking of oneself as sober, clean recreation, regular relaxation, avoiding temptations, not carrying much money, living with clean people, seeking social support, spiritual involvement, keeping busy, and health activities were also associated with less cocaine use. Results suggest focusing coping skills training on these potentially effective strategies.
Background The rise of authorized marijuana use in the U.S. means that many individuals are using cannabis as they concurrently engage in other forms of treatment, such as substance abuse counseling and psychotherapy. Clinical and legal decisions may be influenced by findings that suggest marijuana use during treatment serves as an obstacle to treatment success, compromises treatment integrity, or increases the prevalence or severity of relapse. In this paper, the author reviews the relationship between authorized marijuana use and substance abuse treatment utilizing data from a preliminary pilot study that, for the first time, uses a systematic methodology to collect data examining possible effects on treatment. Methods Data from the California Outcomes Measurement System (CalOMS) were compared for medical (authorized) marijuana users and non-marijuana users who were admitted to a public substance abuse treatment program in California. Behavioral and social treatment outcomes recorded by clinical staff at discharge and reported to the California Department of Alcohol and Drug Programs were assessed for both groups, which included a sample of 18 reported medical marijuana users. Results While the findings described here are preliminary and very limited due to the small sample size, the study demonstrates that questions about the relationship between medical marijuana use and involvement in drug treatment can be systematically evaluated. In this small sample, cannabis use did not seem to compromise substance abuse treatment amongst the medical marijuana using group, who (based on these preliminary data) fared equal to or better than non-medical marijuana users in several important outcome categories (e.g., treatment completion, criminal justice involvement, medical concerns). Conclusions This exploratory study suggests that medical marijuana is consistent with participation in other forms of drug treatment and may not adversely affect positive treatment outcomes
Prendergast, Michael L.; Pearson, Frank S.; Podus, Deborah; Hamilton, Zachary K.; Greenwell, Lisa
Objectives The purpose of the present meta-analysis was to answer the question: Can the Andrews principles of risk, needs, and responsivity, originally developed for programs that treat offenders, be extended to programs that treat drug abusers? Methods Drawing from a dataset that included 243 independent comparisons, we conducted random-effects meta-regression and ANOVA-analog meta-analyses to test the Andrews principles by averaging crime and drug use outcomes over a diverse set of programs for drug abuse problems. Results For crime outcomes, in the meta-regressions the point estimates for each of the principles were substantial, consistent with previous studies of the Andrews principles. There was also a substantial point estimate for programs exhibiting a greater number of the principles. However, almost all of the 95% confidence intervals included the zero point. For drug use outcomes, in the meta-regressions the point estimates for each of the principles was approximately zero; however, the point estimate for programs exhibiting a greater number of the principles was somewhat positive. All of the estimates for the drug use principles had confidence intervals that included the zero point. Conclusions This study supports previous findings from primary research studies targeting the Andrews principles that those principles are effective in reducing crime outcomes, here in meta-analytic research focused on drug treatment programs. By contrast, programs that follow the principles appear to have very little effect on drug use outcomes. Primary research studies that experimentally test the Andrews principles in drug treatment programs are recommended. PMID:24058325
Lee, Shawna J.; Tolman, Richard M.
The authors explored the relationship among childhood sexual abuse (CSA), physical and mental health work barriers, and employment outcomes using a large panel study of current and former welfare recipients. Controlling for human capital and demographic characteristics, they found CSA was associated with significantly fewer months worked over the…
Blome, Wendy Whiting; Shields, Joseph; Verdieck, Mary Jeanne
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…
Meara, Ellen; Frank, Richard G.
Aim To describe a framework that can be used to determine optimal spending on substance abuse treatment in the United States. Methods Selective review of the literature on spending for substance abuse treatment combined with an economic analysis of how to determine when spending is optimal, defining optimal spending as that which minimizes the social costs of substance use disorders. Results In 1997, only $11.9 billion of the $294 billion estimated social costs of substance abuse was spent on treatment. The discrepancy between the high indirect costs of illness relative to the level of spending on treatment of addictive disorders leads many to believe that the United States spends too little on treatment. In this paper, we argue that information on the social costs of substance abuse disorders and the level of spending on treatment is insufficient to determine whether current spending is optimal. We develop a framework that could be used to determine optimal spending on substance abuse treatment in the United States. We develop this framework in four steps. First, we provide background on the unique financial and delivery features of substance abuse treatment. Secondly, we outline the points raised by advocates of expanded substance abuse treatment: substance abuse has high social costs, yet few people receive the many effective treatments available partly because of financial barriers to treatment. Thirdly, we provide a framework that can be used to judge the additional benefits of alternative levels and types of spending on substance abuse treatment. Finally, we discuss the distinction between the potential impact of spending on substance abuse treatment and its actual impact, using productivity as an example of one significant portion of the costs of substance abuse. Conclusion To determine optimal spending on substance abuse treatment, research should describe who receives treatment, the quality of treatment received, and how treatments relate to outcomes that
Lucas, Gregory M.
Substance abuse and addiction are highly prevalent in HIV-infected individuals. Substance abuse is an important comorbidity that affects the delivery and outcomes of HIV medical management. In this paper I will review data examining the associations between substance abuse and HIV treatment and potential strategies to improve outcomes in this population that warrant further investigation. Current - but not past - substance abuse adversely affects engagement in care, acceptance of antiretroviral therapy, adherence with therapy, and long-term persistence in care. Substance abuse treatment appears to facilitate engagement in HIV care, and access to evidence-based treatment for substance abuse is central to addressing the HIV epidemic. Strategies that show promise for HIV-infected substance abusers include integrated treatment models, directly observed therapy, and incentive-based interventions. PMID:20888839
Plummer, Carol A.
This study of 125 mothers examined the role of rumination in maternal emotional and behavioral outcomes subsequent to discovery of the sexual abuse of their children. Abuse severity, a maternal history of child abuse experiences, and life hassles were examined as predictors of negative outcomes. The central finding was that these factors, many of…
Mimiaga, Matthew J.; White, Jaclyn M.; Pinkston, Megan M.; Baden, Rachel P.; Mitty, Jennifer A.
Abstract Men who have sex with men (MSM) have the highest incidence of HIV infection in the United States. One of the contributing factors to HIV spread among this group is the use of crystal methamphetamine (“meth”). The objective was to review the behavioral impact of crystal meth use in HIV-infected MSM and potential treatment options. A systematic review of MEDLINE identified studies that evaluated the clinical effects of crystal meth on the HIV-infected MSM population. Search terms included HIV, methamphetamine, MSM, antiretroviral therapy, adherence, resistance, and treatment. U.S. citations in the English language in peer-reviewed journals until December 2010 were included. The primary author reviewed eligible articles, and relevant data including study design, sample, and outcomes were entered into an electronic data table. The 61 included studies highlight that HIV-infected MSM who use crystal meth are more likely to report high-risk sexual behaviors, incident sexually transmitted infections, and serodiscordant unprotected anal intercourse, compared to HIV-infected MSM who do not use crystal meth. Medication adherence in this population is notably low, which may contribute to transmission of resistant virus. No medications have proven effective in the treatment of crystal meth addiction, and the role of behavioral therapies, such as contingency management are still in question. HIV-infected MSM who abuse crystal meth have worse HIV-related health outcomes. Behavioral interventions have shown variable results in treating crystal meth addiction, and more investigation into rehabilitation options are needed. The results presented support efforts to develop and implement novel interventions to reduce crystal meth use in HIV-infected MSM. PMID:22070609
Saywitz, Karen J.; Mannarino, Anthony P.; Berliner, Lucy; Cohen, Judith A.
Reviews research demonstrating the variable effects of childhood sexual abuse, need for intervention, and effectiveness of available treatment. Proposes extending and modifying treatment from mainstream clinical child psychology to sexually abused children. Interventions range from psychoeducation and screening, to short-term, abuse-focused…
Little, B B; Snell, L M; Gilstrap, L C
Methamphetamines are a popular class of recreational drugs sometimes abused by women of childbearing age. The effects of methamphetamine abuse on pregnancy outcome and embryofetal development are not known. In this study, we compared pregnancy and fetal outcome in 52 women who abused methamphetamines with a randomly selected control group of 52 non-drug-abusing women. Body weight, length, and head circumference were significantly decreased in neonates born to mothers who abused methamphetamines during pregnancy. However, the frequency of congenital anomalies was not significantly increased in this group.
Shillington, Audrey M.; Clapp, John D.
Analyses of study on adolescents in publicly funded treatment programs present sex and ethnic differences. Among some of the findings: females were more likely to report methamphetamine use, males reported marijuana use; Hispanics and African Americans were referred to treatment from criminal justice; reported marijuana as primary drug; mandated…
O'Donohue, W; Letourneau, E
We investigated whether brief structured group treatment could produce a reduction of denial of sexual offenses in males convicted of sexually offending against children. Such denial can additionally harm victims and often precludes admission into sex offender treatment programs, thus ruling out an opportunity to decrease the potential of reoffending. The group treatment contained elements of victim empathy, cognitive restructuring, sex education, assertiveness and social skills, education about sex offender therapy, and a discussion of the possible consequences of continued denial. Seventeen child sexual offenders in denial were run in two groups. Despite an average length of denial of nearly two years, by post-treatment the majority of offenders had come out of denial. Moreover, follow-up denial data indicated continued admission, and above-average compliance with subsequent sex offender therapy. Although the lack of an experimental design precludes causal inference, these results are suggestive of an effective method for modifying denial in sex offenders against children.
Silverman, Kenneth; Svikis, Dace; Wong, Conrad J; Hampton, Jacqueline; Stitzer, Maxine L; Bigelow, George E
Long-term Therapeutic Workplace effects were evaluated in heroin- and cocaine-dependent, unemployed, treatment-resistant young mothers. Participants were paid to work or to train in the Therapeutic Workplace but had to provide drug-free urine samples to gain daily access. Participants (N = 40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants could work for 3 years. Relative to controls, Therapeutic Workplace participants increased cocaine (28% vs. 54% negative; p = .04) and opiate (37% vs. 60% negative; p = .05) abstinence on the basis of monthly urine samples collected until 3 years after intake. The Therapeutic Workplace can be an effective long-term treatment of cocaine and heroin addiction in poor and chronically unemployed young mothers. PMID:12233983
Silverman, Kenneth; Svikis, Dace; Wong, Conrad J; Hampton, Jacqueline; Stitzer, Maxine L; Bigelow, George E
Long-term Therapeutic Workplace effects were evaluated in heroin- and cocaine-dependent, unemployed, treatment-resistant young mothers. Participants were paid to work or to train in the Therapeutic Workplace but had to provide drug-free urine samples to gain daily access. Participants (N = 40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants could work for 3 years. Relative to controls, Therapeutic Workplace participants increased cocaine (28% vs. 54% negative; p = .04) and opiate (37% vs. 60% negative; p = .05) abstinence on the basis of monthly urine samples collected until 3 years after intake. The Therapeutic Workplace can be an effective long-term treatment of cocaine and heroin addiction in poor and chronically unemployed young mothers.
Carroll, K M; Schottenfeld, R
Familiarity with nonpharmacologic approaches to substance abuse treatment is critical for medical practitioners to act effectively to prevent the progression of substance use to medically harmful use, abuse, or dependence; to identify patients with substance use disorders and motivation behavioral changes; and to maximize the likelihood of successful treatment. At their most basic level, these nonpharmacologic approaches involve components of practice that are requisite to the successful management of any medical disorder: fostering an empathic, supportive relationship; routinely evaluating the system or problem area; providing accurate medical information about diagnosis, natural history, and treatment; and following up on identified problems to improve compliance, evaluate the impact of treatment, and modify treatment as indicated. Because of the nature of substance use disorders, their impact on multiple areas of functioning, and the conditioned craving that occurs following repeated substance use, nonpharmacologic treatments can improve outcome, even when effective pharmacologic treatments are also employed. Treatment of nicotine dependence provides a useful example. Physician advice to stop smoking substantially increases the likelihood of smoking cessation and long-term abstinence. Combined with physician advice, nicotine replacement therapies, using nicotine gum or transdermal preparations, approximately double the rate of long-term abstinence, compared with physician advice alone. Providing behavioral treatment in addition to physician advice and nicotine replacement treatment leads to the highest rates of sustained abstinence, significantly higher than advice alone or rates associated with nicotine replacement alone. Nonpharmacologic treatments complement pharmacologic approaches often by addressing different target symptom and problem areas. In the case of nicotine dependence, nicotine replacement ameliorates withdrawal symptoms and craving associated
Buckingham, E Taylor; Daniolos, Peter
Childhood abuse and neglect (child maltreatment) represent a common and significant public health burden. The consequences of maltreatment can be seen immediately, in the short term and in the long term. Determination of the exact prevalence of childhood maltreatment is difficult, as many cases go unreported; however in reported cases there is an estimated $124 billion annual burden on the US health-care system. The evaluation of potential maltreatment is difficult as many of the initial symptoms are subtle and can be explained with alternative illnesses or injuries. Potential immediate and short-term effects include brain injury, shaken baby syndrome and behavioral regression. The potential long-term sequelae of child maltreatment are explored in detail here and include increased risks of the development of mental health disorders, substance use disorders and chronic physical complaints during development and adulthood. Lastly, the review provides an overview of current treatment approaches for victims of childhood maltreatment. PMID:23307564
Heinrich, Carolyn J; Fournier, Elizabeth
Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.
Brucker, Debra L.; Stewart, Maureen
To explore whether the implementation of performance-based contracting (PBC) within the State of Maine’s substance abuse treatment system resulted in improved performance, one descriptive and two empirical analyses were conducted. The first analysis examined utilization and payment structure. The second study was designed to examine whether timeliness of access to outpatient (OP) and intensive outpatient (IOP) substance abuse assessments and treatment, measures that only became available after the implementation of PBC, differed between PBC and non-PBC agencies in the year following implementation of PBC. Using treatment admission records from the state treatment data system (N=9,128), logistic regression models run using generalized equation estimation techniques found no significant difference between PBC agencies and other agencies on timeliness of access to assessments or treatment, for both OP and IOP services. The third analysis, conducted using discharge data from the years prior to and after the implementation of performance-based contracting (N=6,740) for those agencies that became a part of the performance-based contracting system, was designed to assess differences in level of participation, retention, and completion of treatment. Regression models suggest that performance on OP client engagement and retention measures was significantly poorer the year after the implementation of PBC, but that temporal rather than a PBC effects were more significant. No differences were found between years for IOP level of participation or completion of treatment measures. PMID:21249461
Shakespeare-Finch, Jane; de Dassel, Therese
There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results…
Cortes, Dharma E.; Ja, Davis; Noboa, Abdin; Perry, Vincent; Robinson, Robert; Rodriguez, Domingo; Stubben, Jerry
This monograph provides a tool to help providers and other substance abuse treatment professionals gain a greater understanding of the cultural, social, political, and economic forces affecting substance abuse treatment among Hispanic Americans, African Americans, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives. An…
... Abuse Treatment: Know What To Ask » Introduction Seeking Drug Abuse Treatment: Know What To Ask Email Facebook Twitter Introduction The goal of drug abuse treatment is to stop drug use and allow ...
Berry, Stacey L.; Crowe, T. P.; Deane, F. P.; Billingham, M.; Bhagerutty, Y.
This paper describes psychosocial outcomes of an Indigenous residential substance abuse rehabilitation centre in Australia, examines the sensitivity to change of the new Growth and Empowerment Measure (GEM), and explores the degree to which service users value cultural components of the treatment program. Participants were 57 Indigenous and 46…
Isaacs, C D
Child abuse has probably existed as a social problem as long as parents and children have lived under the same roof, and in recent years it has received tremendous attention. Most of the research has focused on etiology rather than treatment, leaving large gaps in our knowledge about remediating abuse. Behavioral scientists have only begun to formulate a conceptual framework from which to work. Many theoretical questions are yet unanswered, particularly the question of what constitutes abuse. Burgess (1978) believes that conceptual problems exist because abuse falls along a continuum of parent-child relationships--a continuum that at one end might include verbal punishment (e.g., threats, ridicule) or milder forms of physical punishment (e.g., slap on the hand, spanking), and at the other end include extreme forms of physical punishment that exceed community mores (for example, hitting a child with a closed fist, scalding a child in hot water, torturing or killing a child). Thus, the question-- where does discipline stop and abuse begin?-- faces every researcher who must operationally define abuse. Identifying the consequences of abuse in a child's development is another area of inquiry that remains untreated. Most of the literature is filled with the subjective impressions of professionals speculating that abused children become the juvenile delinquents and the child abusers of the future; however, as yet no longitudinal studies have been conducted that compare the developmental outcomes of abused and non-abused children from early childhood to later adulthood. What if there were no differences? How might this influence our approaches to the treatment of abuse? Answers to these and other questions will take years of study. Increased awareness of the problem of child abuse has led to greater efforts to remediate the problem. Treatment efforts with abusive families are still in the initial stages, but, undoubtedly, information from these early programs can be the
Myers, Bronwyn; Fakier, Nuraan
To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services…
Alvarez, Josefina; Jason, Leonard A.; Olson, Bradley D.; Ferrari, Joseph R.; Davis, Margaret I.
SUMMARY Substance abuse prevalence rates for Latinos/as generally mirror those of the general U.S. population; however, a number of indicators of assimilation to U.S. culture as well as sociodemographic variables predict substance use and abuse among this group. Latinos/as have poorer outcomes in substance abuse treatment programs. Yet there is little empirical evidence that explains the problems these individuals experience in treatment, and there are few studies on the use and effectiveness of mutual help groups among this population. New developments in the conceptualization and measurement of acculturation will lead to a greater understanding of the role of culture in the prevalence and treatment of substance-related problems. PMID:18192207
Amaro, Hortensia; Chernoff, Miriam; Brown, Vivian; Arevalo, Sandra; Gatz, Margaret
This article presents findings from a quasi-experimental, nonrandomized group design study that explored whether trauma-enhanced substance abuse treatment results in longer residential treatment stays and improved outcomes compared with treatment-as-usual. We used a subsample (N = 461) of participants in the Women, Co-Occurring Disorders and…
Alexander, Jeffrey A.; Lemak, Christy Harris
Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey (n=571 in 1999/2000, n=566 in 2005). Analyses were conducted separately for methadone and non-methadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the non-methadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accreditation were related to longer duration. Study findings suggest evidence for how external relationships related to resources, treatment constraints, and legitimacy may influence women's treatment duration. Methadone programs may be more vulnerable to external influences. PMID:19038526
... nbspMilitary insurance (e.g., TRICARE)   IHS/Tribal/Urban (ITU) funds   Access to recovery (ATR) voucher & ... abuse   Persons who have experienced intimate partner violence, domestic violence   Children with serious emotional disturbance ( ...
Oliveros, Arazais; Kaufman, Joan
The goal of this paper is to synthesize available data to help guide policy and programmatic initiatives for families with substance abuse problems who are involved with the child welfare system, and identify gaps in the research base preventing further refinement of practices in this area. To date, Family Treatment Drug Court and newly developed home-based substance abuse treatment interventions appear the most effective at improving substance abuse treatment initiation and completion in child welfare populations. Research is needed to compare the efficacy of these two approaches, and examine cost and child well-being indicators in addition to substance abuse treatment and child welfare outcomes.
National Inst. for Advanced Studies, Washington, DC.
This report, based on a 1979 national survey of drug abuse treatment programs in the prisons of the 50 states and the District of Columbia, presents data on 160 operational programs. Descriptive information on the identification of drug-dependent inmates and the provision of drug abuse treatment by state adult correctional institutions is…
Tyler, A H
This paper examines the effects of current practice in the investigation and treatment of documented incest abusers on the offenders and families involved. Fifteen offenders attending the Utah Parents United group completed a questionnaire on the sequence of events in the investigation and prosecution of their cases and the concomitant results of the investigation on their job status, living and financial situations, family and social relationships, and media reporting of the abuse. Results indicate that there is great variability in the investigation and prosecution of incest cases and the public announcement of abuse convictions. The consequences of the abuse investigation are devastating for offender and his family in terms of job loss; need for public assistance; family disbandonment through removal of the offender, victim, or both from the family, marital separation, and foster care for nonabused siblings; changes of residence, and the public announcement of the abuse in the media. Results also show that offenders receive little, if any, social support from family or friends. Changes in the current approach to the investigation and prosecution of incest offenders are proposed and include the following: banning the publication of convictions for child abuse; streamlining the legal process so that it is consistent from case to case; and developing diversion programs as alternatives to prison for offenders. Suggested are self-help, court-ordered therapeutic programs, such as Parents United, that are designed for the treatment of families involved in child sexual abuse and incest. The desired outcomes of such a diversion program are low offender recidivism, avoidance of the offender's family being placed on welfare, less reliance on foster care placement for the offender's children, involvement of the offender's family in moving toward reunion when feasible, and the use of existing half-way houses in lieu of incarceration when necessary.
Reviews literature on prenatal drug abuse to (1) estimate mothers' drug use and exposure of infants; (2) document the relationship between prenatal drug use and adverse birth outcomes; and (3) examine effects of maternal drug use on birth defects. Argues for more treatment facilities and greater prevention efforts. (SLD)
Machlan, Bonna; Brostrand, H. L.; Benshoff, John J.
Research indicates that those who undergo treatment for alcohol and other drug abuse largely have poor work histories and low employment rates, regardless of their education. Relapse rates for individuals in recovery increase when unemployment remains a constant in their lives. Consequently, providing vocational services during treatment may be a…
Mulder, C. L.; Roosenschoon, B. J.; Wiersma, D.
In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT. PMID:19847646
Stitzer, M L; Bigelow, G E; McCaul, M E
The goal of drug abuse treatment is to decrease the dominance of drug-related behaviors while enhancing the dominance of alternative socially acceptable behaviors. The behavioral techniques of extinction, satiation, and punishment can be used to suppress undesirable behaviors, and reinforcement can be used to enhance desirable behaviors. Methadone maintenance offers unique advantages for treatment of opiate abuse since methadone satiates the drug abuser, thereby reducing the reinforcing efficacy of illicit opiate drugs, while also serving as a reinforcer whose delivery in the treatment setting can be used in contingent arrangements. Short-term efficacy has been demonstrated in studies that used contingent treatment termination or contingent dose decreases as punishing events and contingent dose increases or contingent take-home privileges as reinforcing events to promote reductions in drug use and cooperation with clinic rules. Systematic use of dose adjustments and take-home privileges may be a useful adjunct to methadone maintenance treatment, having a positive impact both on client outcomes and clinic operation. Rehabilitation efforts might also benefit if delivery of reinforcers available at the clinic is contingent upon participation in skills training and therapy programs or community activities outside the drug abuse clinic. PMID:3929125
Hansen, Lene Aagaard; Mikkelsen, Søren Johan; Sabroe, Svend; Charles, Annie Vesterby
A previous study published in 2000 on a small group of children concluded that the medical examination in cases of sexual child abuse seldom provided legal proof of sexual abuse [J Forensic Sci 45(2000):115-7]. The present consecutive study included children referred to the police for a forensic medical examination. A colposcope was used to evaluate the anogenital findings which were classified as normal, nonspecific, and abnormal. Four hundred and eighty-two children were included. Abnormal anogenital findings were found in 38% of the girls and 20% of the boys, but there was no relation between abnormal anogenital findings and the two legal outcomes: "appearing in court" and "being convicted." However, the age of the child turned out to be a more important factor in relation to legal outcome than the physical findings. The results of this study suggest that the child's statement and not the physical findings were important for legal outcome.
Glassmire, David M.; Welsh, Robert K.; Clevenger, Jeanne K.
The Substance Abuse and Mental Illness (SAMI) program combines cognitive rehabilitation and dual-diagnosis substance abuse treatment within a stages of change context. This article describes the development, implementation, and preliminary outcome analysis of the SAMI program in a forensic hospital.
Shin, Hee-Choon; Marsh, Jeanne C; Cao, Dingcai; Andrews, Christina M
As the substance abuse service system shifts from primarily residential to primarily nonresidential settings, it becomes important to understand how substance abuse treatment processes and outcomes may vary across service setting. Research increasingly indicates that, along with specific treatment and service strategies, client-provider relationship is an important ingredient in effective substance abuse treatment. This study uses a moderator-mediator analysis of a comprehensive service model to examine how the relation between client-provider relationship and substance abuse treatment outcomes may differ in residential and nonresidential settings. The study used data collected for the National Treatment Improvement Evaluation Study, a prospective, cohort-based study of U.S. substance abuse treatment programs and their clients, with an analytic sample of 59 publicly funded service delivery units and 3,027 clients. Structural equation modeling is used to assess the structural relations and causal connections between treatment process and treatment outcome variables. Results indicate that for nonresidential settings, a better client-provider relationship is directly related to improved outcomes of treatment duration and reduced posttreatment substance use and is indirectly related to both outcomes through provision of services matched to client needs. In residential settings, the quality of the client-provider relationship is unrelated to process or outcome variables. The findings point to the importance of the client-provider relationship in all settings but particularly in outpatient settings where there are limited physical constraints on the treatment process.
Campbell, Kevin M; Deck, Dennis; Krupski, Antoinette
Administrative data from Washington State's Division of Alcohol and Substance Abuse drive this three-year prospective study of the impact of substance abuse treatment on arrests among 12,962 opiate users receiving publicly funded substance abuse services. Using survival analysis, the risk of arrest among opiate users who receive substance abuse treatment is compared to those who do not receive treatment. Propensity scores control for client characteristics associated with admission to substance abuse treatment. Overall, a reduction in the risk of arrest was found among subjects in treatment (Hazard Ratio = 0.59-0.78, p < .05) and subjects successfully completing treatment (Hazard Ratio = 0.75, p < .05). Risk of arrest was elevated among those with a negative outcome to treatment (Hazard Ratio = 1.23, p < .05).
Yancey, C. Thresa; Hansen, David J.; Naufel, Karen Z.
The current study examined children and families who presented for treatment through Project SAFE (Sexual Abuse Family Education) following childhood sexual abuse. Pretreatment assessment data were used to develop clusters of participants with significantly differing presentation of symptom outcome following abuse. Four clusters were discovered:…
Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie
Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…
Flippen-Anderson, Judith L.; George, Clifford; Deschamps, Jeffrey R.
Cocaine is a potent stimulant of the central nervous system with severe addiction potential. Its abuse is a major problem worldwide. The exact mechanism of action of cocaine is still uncertain but it is known that its reinforcing and stimulant effects are related to its ability to inhibit the membrane bound dopamine transporter (DAT). This paper discusses efforts that are underway to identify ligands for possible use in the treatment of cocaine abuse. Much of this effort has been focussed on understanding cocaine interactions at DAT receptor sites.
Peltan, Jessica R; Cellucci, Tony
Incarcerated women have high rates of substance abuse problems and trauma. A variety of variables may influence whether these women seek help or are referred for substance abuse problems. This study reports an exploratory project on service utilization among incarcerated substance-dependent women (N = 40) in southeastern Idaho. Using self-report and interview tools, most participants reported some substance abuse treatment history, although extent and types of treatment varied. Most of the women also reported some type of childhood abuse. Age, income, and consequences of alcohol and other drug use related positively to substance abuse treatment. However, severity of childhood sexual abuse and current trauma symptoms were negatively correlated with substance abuse treatment episodes. These women may use substances to cope with childhood trauma or may not perceive the substance abuse system as responsive to their co-occurring trauma symptoms.
Ting, Laura; Jordan-Green, Lisa; Murphy, Christopher M.; Pitts, Steven C.
Objectives: This study examined predictive associations of substance abuse with treatment engagement variables and partner abuse outcomes and explored the extent to which treatment engagement and ongoing alcohol consumption mediated the association between pretreatment substance use and posttreatment abuse. Method: Data were collected from 145…
Plakun, E M
Regardless of the approach employed, treatment of patients with histories of sexual or other abuse is a formidable challenge. One reason for this is the vulnerability to "enactment" inherent in therapeutic work with such patients. Enactment is a recently elaborated psychoanalytic notion, defined as a pattern of nonverbal interactional behavior between the two parties in a therapeutic situation, with unconscious meaning for both. It involves mutual projective identification between therapist and patient. This paper clarifies the nature of enactment (conceptualized here as involving either refusal or actualization of the transference by the therapist) and its treatment implications. Transference-countertransference enactment paradigms encountered in work with survivors of abuse are presented. The therapeutic consequences of failing to recognize and respond to such enactments in work with these patients are explored. Unrecognized enactments may lead therapists unwittingly to abdicate the therapeutic role by becoming abusive, abused or vicariously traumatized, excessively guilty, seductive, overinvolved, and/or exhortatory or to implant false memories. Ways of utilizing enactment to advance treatment are also described and illustrated.
Plakun, E M
Regardless of the approach employed, treatment of patients with histories of sexual or other abuse is a formidable challenge. One reason for this is the vulnerability to "enactment" inherent in therapeutic work with such patients. Enactment is a recently elaborated psychoanalytic notion, defined as a pattern of nonverbal interactional behavior between the two parties in a therapeutic situation, with unconscious meaning for both. It involves mutual projective identification between therapist and patient. This paper clarifies the nature of enactment (conceptualized here as involving either refusal or actualization of the transference by the therapist) and its treatment implications. Transference-countertransference enactment paradigms encountered in work with survivors of abuse are presented. The therapeutic consequences of failing to recognize and respond to such enactments in work with these patients are explored. Unrecognized enactments may lead therapists unwittingly to abdicate the therapeutic role by becoming abusive, abused or vicariously traumatized, excessively guilty, seductive, overinvolved, and/or exhortatory or to implant false memories. Ways of utilizing enactment to advance treatment are also described and illustrated. PMID:9559350
Janikowski, T P; Glover, N M
Seventy-seven volunteer participants enrolled in eight substance abuse treatment facilities were surveyed using the Substance Abuse and Incest Survey. Of the sample, 36 (48%) reported histories of incest. For participants reporting incest, data on substance abuse history, perceptions of the relationship between incest and substance abuse, and opinions regarding incest-related counseling in the context of substance abuse treatment are presented. Recommendations for substance abuse professionals and facilities are made, including intake screening, barriers to treatment, counselor education, and future research.
... HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse... Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT.... Committee Name: Substance Abuse and Mental Health Services Administration's CSAT National Advisory...
Lofwall, Michelle R.; Schuster, Alyson; Strain, Eric C.
This study evaluated whether there were increasing admissions for illicit drug abuse treatment among older persons from 1992 to 2005 in the United States and describes the characteristics, number, and type of substances most commonly abused in this population over this 14-year period. Analyses used public data files from the Treatment Episode Data Set, which tracks federally and state funded substance abuse treatment admissions. From 1992 to 2005, admissions for illicit drug abuse increased significantly; in 2005, 61% of admissions age 50 to 54 years old and 45% of admissions age 55 years and older reported some type of illicit drug abuse, most commonly heroin or cocaine abuse. Criminal justice referrals for drug abuse admissions have increased over time and daily substance use remains high. Efforts to determine best practices for prevention, identification, and treatment of illicit drug abuse in older persons are indicated. PMID:19077857
Hébert, Martine; Collin-Vézina, Delphine; Daigneault, Isabelle; Parent, Nathalie; Tremblay, Caroline
Children who report sexual abuse (SA) have been found to display a range of internalizing and externalizing behavior problems. In the present study, a tree-based analysis was used to derive models predicting the variability of internalizing and externalizing behavior problems as well as dissociation symptoms in SA girls. Participants were 150 girls aged 4 to 12 years referred to a specialized pediatric clinic after disclosure of SA. The potential predictors taken into account included sociodemographic and abuse-related variables as well as maternal and family characteristics. The models obtained point to prior abuse as a salient variable in predicting outcomes of SA girls. Implications for the treatment for children disclosing SA are discussed.
Mueser, Kim T.; And Others
Reviews substance abuse disorders in schizophrenia patients, including prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and clinical effects of abuse on course of illness and cognitive functioning. Outlines principles of treatment for dual-diagnosis schizophrenia patients, noting limitations of existing…
Kemp, Donna R.; And Others
Child abuse is a major problem in the United States. Policy concerning child abuse involves a criminal justice approach, a treatment approach, and a prevention approach. Prevention programs have focused on identifying and serving high-risk groups and on preventive education. A study was conducted to examine issues related to child abuse. Four…
McNamara, S; Stokes, S; Kilduff, R; Shine, A
Pregabalin (Lyrica®) is used in treating epilepsy, nerve pain and anxiety. Pregabalin was initially thought to have a low misuse potential however there are emerging reports of Pregabalin being abused. A study was commenced at the National Drug Treatment Centre's (NDTC) Drug Analysis Laboratory to determine the level of usage of Pregabalin within the addiction services population in Ireland. A total of 498 urine samples representing samples from 440 individual opioid substitution patients, initially screened by immunoassay for drugs of abuse, were subjected to further analysis for Pregabalin by Liquid Chromatography/Mass Spectrometry (LC/MS). Of 440 patients tested, 39 tested positive for Pregabalin (9.2%). Only 10 patients from this group were prescribed this drug to our knowledge thus giving an estimated rate of misuse of 7.0%. Other drugs detected in the Pregabalin positive patients were Opiates (31.8%), Cocaine (11.4%), Benzodiazepines (79.5%) and Cannabis (77.8%). Our study confirms that Pregabalin abuse is taking place amongst the addiction services population. We believe that misuse of this prescription drug is a serious emerging issue which should be monitored carefully.
McNamara, S; Stokes, S; Kilduff, R; Shine, A
Pregabalin (Lyrica®) is used in treating epilepsy, nerve pain and anxiety. Pregabalin was initially thought to have a low misuse potential however there are emerging reports of Pregabalin being abused. A study was commenced at the National Drug Treatment Centre's (NDTC) Drug Analysis Laboratory to determine the level of usage of Pregabalin within the addiction services population in Ireland. A total of 498 urine samples representing samples from 440 individual opioid substitution patients, initially screened by immunoassay for drugs of abuse, were subjected to further analysis for Pregabalin by Liquid Chromatography/Mass Spectrometry (LC/MS). Of 440 patients tested, 39 tested positive for Pregabalin (9.2%). Only 10 patients from this group were prescribed this drug to our knowledge thus giving an estimated rate of misuse of 7.0%. Other drugs detected in the Pregabalin positive patients were Opiates (31.8%), Cocaine (11.4%), Benzodiazepines (79.5%) and Cannabis (77.8%). Our study confirms that Pregabalin abuse is taking place amongst the addiction services population. We believe that misuse of this prescription drug is a serious emerging issue which should be monitored carefully. PMID:26817289
Brown, Sandra A.; Berger, Barry
Research in the field of alcohol abuse evidences a long history of attempts to predict outcome from alcohol treatment programs using situational and intrapsychic factors. To investigate whether alcohol reinforcement expectancies are related to drinking behavior, 42 male veteran graduates of an inpatient alcohol treatment program were interviewed 1…
Mann, N; Bitsios, P
Substance abuse is a frequent co-morbid condition of adult attention deficit hyperactivity disorder (ADHD). Treatment with conventional psychostimulants in adult ADHD with co-morbid stimulant abuse may be problematic. In this study, we report the case of a patient with adult ADHD with co-morbid amphetamine abuse who was treated successfully with the non-stimulant alertness-promoting drug modafinil. The drug resolved both the inattention/hyperactivity symptoms as well as the amphetamine abuse. Modafinil may be a suitable candidate treatment for adults with ADHD and stimulant abuse.
Sperry, Debbie M.; Gilbert, Brenda O.
Objective: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. Method: An archival data set containing retrospective reports of childhood…
Hser, Yih-Ing; Teruya, Cheryl; Evans, Elizabeth A.; Longshore, Douglas; Grella, Christine; Farabee, David
Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system…
Clark, K A; Dee, D L; Bale, P L; Martin, S L
There is an insufficient number of substance abuse treatment programs available to pregnant women; however, even when women do enroll in treatment, they often choose not to comply with particular components of their treatment. To better understand what factors are associated with a woman's likelihood of compliance with treatment, this study assesses 244 pregnant, substance-using women enrolled in a specialized substance abuse treatment program. Women who complied with treatment referrals are compared with those who did not comply with referrals on various factors including their sociodemographic characteristics, types of substance use before and during pregnancy, experiences of violence before and during pregnancy, and prior substance use treatment. Bivariate analysis found that outpatient treatment compliance was more likely among women who smoked cigarettes before pregnancy, women who had received previous substance abuse treatment, and women whose partner had received previous substance abuse treatment. Outpatient treatment compliance did not vary by sociodemographic characteristics, any other type of substance use, or the women's experiences of violence. Inpatient treatment compliance was more likely among women who received prior substance abuse treatment; however, no other characteristic was found to be associated with inpatient treatment compliance. Logistic regression analyses, which controlled for various factors, suggested that past experiences with substance abuse treatment by the woman or her partner were significantly associated with treatment referral compliance. These findings suggest that the previous treatment experiences of women and their partners are important factors in shaping a successful substance abuse treatment program for pregnant women.
Shorter, Daryl; Kosten, Thomas R
Reconceptualizing drugs as toxins allowed an important shift in the approach to the treatment of substance abuse, because it ushered in consideration of immunological methods of pharmacotherapy. This paradigm shift represented a dramatic departure from previously considered approaches to pharmacotherapy for substance use disorders (SUDs), which had up until that time focused predominantly on either agonist and/or antagonist medications meant to block drug effects or to decrease reward, reinforcement, or craving. Use of immunological theory in SUD treatment also meant that 1) a potentially addicting medication would not be administered as part of therapy and 2) side effects could be limited, because the individual's immune system would be responsible for delivering treatment.
Luchansky, Bill; Nordlund, Dan; Estee, Sharon; Lund, Peter; Krupski, Antoinette; Stark, Kenneth
This study examined the association between receiving substance abuse treatment and subsequent criminal justice involvement. The sample consisted of Supplemental Security Income (SSI) recipients in the state of Washington that were determined to be in need of treatment. Fifty-two percent of those clients entered substance abuse treatment during the study period, while 48% did not. Arrests, felony convictions and convictions for less serious crimes were tracked for 8343 adults for one year following the end of an index treatment episode. Results showed that entering treatment was associated with reduced risks for each outcome. In addition, further analyses were conducted just on those entering treatment. Among that subset of the study population, the completion of treatment and having an episode of treatment lasting at least 90 days were both associated with reduced criminal justice risks. These results suggest that efforts to provide substance abuse treatment for SSI recipients have the potential to provide substantial public benefits.
Khodakarami, N; Naji, H; Dashti, M G; Yazdjerdi, M
We carried out a descriptive analysis on the pregnancy outcome in 313 pregnant women abused, 160 non-abused). Abuse was statistically significantly correlated with mean weight gain during pregnancy, mean frequency of the prenatal care, prolonged labour (dystocia), premature rupture of membrane, low mean birth weight and mean gestational age at birth. Given the high likelihood that a woman will access health care services during her pregnancy, physicians providing prenatal care are in a strategic position to screen for partner abuse.
Chevignard, Mathilde P; Lind, Katia
Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15-64%); epilepsy, often intractable (11-32%); microcephaly with corticosubcortical atrophy (61-100%); visual impairment (18-48%); language disorders (37-64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23-59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child's impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. PMID:25501726
Drapeau, Martin; Körner, Annett; Granger, Luc; Brunet, Louis; Caspar, Franz
Many authors have suggested adapting treatment programs to the specific needs of sexual abusers. However, little research has been conducted to understand what these patients seek in therapy or what elements play a key role in keeping them in treatment. In this pilot study, fifteen (N=15) pedophile sexual abusers from La Macaza clinic for sexual abusers were interviewed. Plan analysis was used to investigate the most prevalent components involved in staying in or leaving therapy. Results suggest that many components involved in the plans leading to doing and to avoiding treatment were similar. Differences were found in regards to the outcome of confrontations with the therapists, a tendency to isolate and overcomply, guilt related to the abuse, a need for a stable environment, and a need to be accepted. These results are discussed along with possible ways to improve the patients' involvement in treatment.
Join Together, Boston, MA.
The issue of quality in substance abuse treatment is often complicated due to persistent discrimination against people with drug and alcohol disease. The result is a self-perpetuating cycle of poor outcomes and misperceptions about the disease. However, research shows that treatment for drug and alcohol conditions, when properly delivered, can…
Matta Oshima, Karen M; Jonson-Reid, Melissa; Seay, Kristen D
Research on child sexual abuse has focused on adult revictimization and outcomes. This article examines the rate of child maltreatment revictimization among male and female children reported to child protective services for child sexual abuse and whether revictimization impacts outcomes. Using longitudinal administrative data, Cox regressions were used to examine relationships between initial report of child sexual abuse, maltreatment revictimization, and adolescent outcomes among children from poor and nonpoor families. Despite no significant differences in child sexual abuse rates between poor and nonpoor families, poor child sexual abuse victims were significantly more likely to have re-reports for maltreatment. Children with multiple reports were more likely to have negative outcomes. Interventions for child sexual abuse survivors should focus on preventing maltreatment recurrence generally and not ignore needs of male victims.
Tang, Zhiqun; Claus, Ronald E.; Orwin, Robert G.; Kissin, Wendy B.; Arieira, Carlos
Background Gender-sensitive (GS) substance abuse treatment services have emerged in response to the multidimensional profile of problems that women display upon admission to substance abuse treatment. The present study examines the extent to which treatment programs vary in GS programming for women in real-world mixed-gender treatment settings, where most women are treated. Methods Data were collected through site visits using semi-structured interviews with program directors, clinical directors, and counselors in 13 mixed-gender treatment programs from Washington State. Rasch modeling techniques were used to analyze the data. Results Naturally occurring variation was revealed within and across the treatment programs, and demonstrated that reliable measures of three GS domains (Grella, 2008) can be constructed despite a small number of programs. Conclusions This is the first study to quantify GS treatment for substance abusing women. The identified treatment services and practices and the way they clustered together to form scales have practical implications for researchers, service providers, clinicians, and policy makers. The scales can be used to study treatment outcomes and to evaluate the effectiveness, cost-effectiveness, and cost-benefit of GS programming for women. PMID:22138537
Gregoire, Thomas K.; Snively, Carol
Explores outcomes for 59 women who attended long term substance abuse treatment in a women's facility that emphasized employment and economic self sufficiency. Results revealed that reductions in substance abuse were associated with an increase in economic self sufficiency. Additionally, women living in drug free social environments had high rates…
Leahy, M M
This article is intended as an overview of the current literature on child sexual abuse. There are some patterns of psychopathology seen in both the abused and the abusers that warrant further scrutiny. The presence of narcissistic pathology in both groups is interesting, particularly in light of the generationality of child sexual abuse. This finding raises the issue of the nature of psychic injury incurred by some of the victims and places it at the level of early self development.
Chandy, Joseph M.; And Others
Examined the school performance, suicidal involvement, disordered eating behaviors, pregnancy risk, and chemical use of female teenagers with a history of sexual abuse. Found that they reported higher rates of adverse outcomes than did teenagers without a background of abuse. Lists protective factors and risk factors that influenced outcomes. (RJM)
Metzger, D S; Navaline, H; Woody, G E
OBJECTIVE: As the acquired immunodeficiency syndrome (AIDS) epidemic among drug users enters its third decade in the United States, it is important to consider the role playing by substance abuse treatment in the prevention of human immunodeficiency virus (HIV) infection. METHODS: The authors review the research literature, examining findings from studies with behavioral and serologic measures on the association among treatment participation, HIV risk reduction, and HIV infection. RESULTS: Numerous studies have now documented that significantly lower rates of drug use and related risk behaviors are practiced by injecting drug users (IDUs) who are in treatment. Importantly, these behavioral differences, based primarily on self-report, are consistent with studies that have examined HIV seroprevalence and seroincidence among drug users. CONCLUSION: The underlying mechanism of action suggested by the collective findings of the available literature is rather simple-- individuals who enter and remain in treatment reduce their drug use, when leads to fewer instances of drug-related risk behavior. This lower rate of exposure results in fewer infections with HIV. The protective effects of treatment, however, can only be achieved when programs are accessible and responsive to the changing needs of drug users. Future research needs to be directed at developing a better understanding of the factors that enhance treatment entry and retention. PMID:9722815
This paper presents a theory and model for treating adolescent victims of physical and sexual abuse and neglect. The theory examines issues related to abuse or neglect and the effect that an abusive history has on adolescent development. Specific issues noted are depression, anger, low self-esteem, self-shame, lack of trust, a sense of…
Olmstead, Todd; White, William D; Sindelar, Jody
Objective To examine the impact of managed care on the number and types of services offered by substance abuse treatment (SAT) facilities. Both the number and types of services offered are important factors to analyze, as research shows that a broad range of services increases treatment effectiveness. Data Sources The 2000 National Survey of Substance Abuse Treatment Services (NSSATS), which is designed to collect data on service offerings and other characteristics of SAT facilities in the United States. These data are merged with data from the 2002 Area Resource File (ARF), a county-specific database containing information on population and managed care activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. Study Design We estimate the impact of managed care (MC) on the number and types of services offered by SAT facilities using instrumental variables (IV) techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. Due to limitations of the NSSATS data, MC and specific services are modeled as binary variables. Principal Findings We find that managed care causes SAT facilities to offer, on average, approximately two fewer services. This effect is concentrated primarily in medical testing services (i.e., tests for TB, HIV/AIDs, and STDs). We also find that MC increases the likelihood of offering substance abuse assessment and relapse prevention groups, but decreases the likelihood of offering outcome follow-up. Conclusion Our findings raise policy concerns that managed care may reduce treatment effectiveness by limiting the range of services offered to meet patient needs. Further, reduced onsite medical testing may contribute to the spread of infectious diseases that pose important public health concerns. PMID:15032957
Shin, Hee-Choon; Marsh, Jeanne C.; Cao, Dingcai; Andrews, Christina M.
As the substance abuse service system shifts from primarily residential to primarily non-residential settings, it becomes important to understand how substance abuse treatment processes and outcomes may vary across service setting. Research increasingly indicates that, along with specific treatment and service strategies, client-provider relationship is an important ingredient in effective substance abuse treatment. This study uses a moderator-mediator analysis of a comprehensive service model to examine how the relation between client-provider relationship and substance abuse treatment outcomes may differ in residential and non-residential settings. The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort-based study of U.S. substance abuse treatment programs and their clients with an analytic sample of 59 publicly-funded service delivery units and 3,027 clients. Structural equation modeling (SEM) is used to assess the structural relations and causal connections between treatment process and treatment outcome variables. Results indicate that for non-residential settings, a better client-provider relationship is directly related to improved outcomes of treatment duration and reduced post-treatment substance use and indirectly related to both outcomes through provision of services matched to client needs. In residential settings, the quality of the client-provider relationship is unrelated to process or outcome variables. The findings point to the importance of the client-provider relationship in all settings but particularly in outpatient settings where there are limited physical constraints on the treatment process. PMID:21871770
Meis, Laura A.; Murphy, Christopher M.; Winters, Jamie J.
Concerns about low motivation to change among perpetrators of intimate partner violence (IPV) have heightened interest employing behavior change models with this population. In the present investigation, a new scale was developed, the Outcome Expectancies for Partner Abuse (OEPA) Scale, assessing the negative and positive outcome expectancies of…
Fassler, I.R.; Amodeo, M.; Griffin, M.L.; Clay, C.M.; Ellis, M.A.
Objective:: Child sexual abuse (CSA) has been associated with adverse adult psychosocial outcomes, although some reports describe minimal long-term effects. The search for explanations for the heterogeneous outcomes in women with CSA has led to an examination of a range of CSA-related factors, from the severity of individual CSA incidents to the…
Griffin, Margaret L.; Amodeo, Maryann
Objective: Child physical abuse (CPA) has been associated with adverse adult psychosocial outcomes, although some reports describe minimal long-term effects. The search for the explanation for heterogeneous outcomes in women with CPA has led to an examination of a range of CPA-related factors, from the severity of CPA incidents to the childhood…
Wechsberg, Wendee M; Zule, William A; Riehman, Kara S; Luseno, Winnie K; Lam, Wendy KK
Background Individual and sociocultural factors may pose significant barriers for drug abusers seeking treatment, particularly for African-American crack cocaine abusers. However, there is evidence that pretreatment interventions may reduce treatment initiation barriers. This study examined the effects of a pretreatment intervention designed to enhance treatment motivation, decrease crack use, and prepare crack abusers for treatment entry. Methods Using street outreach, 443 African-American crack users were recruited in North Carolina and randomly assigned to either the pretreatment intervention or control group. Results At 3-month follow-up, both groups significantly reduced their crack use but the intervention group participants were more likely to have initiated treatment. Conclusion The intervention helped motivate change but structural barriers to treatment remained keeping actual admissions low. Policy makers may be interested in these pretreatment sites as an alternative to treatment for short term outcomes. PMID:17394653
Earles, Jay E.
The widespread problem of substance abuse negatively affects users and their families. This paper provides a methodological review of empirical studies that focused on systemic interventions (particularly marital and family therapy) in the treatment of substance abuse. The articles examined here focused on engaging the addict in treatment,…
Jackson, Afton; Shannon, Lisa
Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.
Slesnick, Natasha; Prestopnik, Jillian L
Runaway youth report a broader range and higher severity of substance-related, mental health and family problems relative to non-runaway youth. Most studies to date have collected self-report data on the family and social history; virtually no research has examined treatment effectiveness with this population. This study is a treatment development project in which 124 runaway youth were randomly assigned to (1) ecologically based family therapy (EBFT) or (2) service as usual (SAU) through a shelter. Youth completed an intake, posttreatment, 6 and 12 months follow-up assessment. Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions. Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth.
Simpson, D. Dwayne; Sells, S. B.
The Drug Abuse Reporting Program (DARP) was initiated in 1969 as a federally supported client reporting system for community-based drug abuse treatment programs. Posttreatment follow-up interviews were conducted with over 4,000 persons from 34 treatment agencies to describe major findings from the drug abuse treatment research of the DARP relating…
Wells, Rebecca; Harris Lemak, Christy; Alexander, Jeffrey A; Roddy, Brian L; Nahra, Tammie A
Despite high levels of unmet need for outpatient substance abuse treatment, a significant percentage of outpatient units have closed over the past several years. This study drew on 1999-2000 and 2005 national surveys to determine if managed care was associated with outpatient substance abuse treatment units' likelihood of surviving. Each substance abuse unit director was asked about the presence of any managed care contracts, percentage revenues from managed care, percentage of clients for whom prior authorization was required, and percentage of clients for whom concurrent review was required. A multiple logistic regression revealed that none of these factors was associated with substance abuse treatment unit survival. At this point, neither the presence nor the structure of managed care appears to affect the survival of outpatient substance abuse treatment units. Given the need for these facilities, however, and their vulnerability to closure, continued attention to managed care's potential influence is warranted. PMID:17458479
Ball, S A
The presence of an untreated personality disorder may be associated with worse compliance and outcome in substance abuse treatment. Therapeutic attention to the symptoms of personality disorder may reduce the severity of substance abuse and other Axis I symptoms which potentially contribute to relapse. A 24-week manual-guided individual cognitive-behavioral therapy approach has been developed that integrates relapse prevention with targeted intervention for early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. This Dual Focus Schema Therapy is being compared to 12-Step Drug Counseling for opioid-dependent individuals with personality disorders in an ongoing study funded by the National Institute on Drug Abuse. This article reviews Young's (1994) schema-focused theory and approach and summarizes the treatment manual, which integrates relapse prevention for substance abuse.
DeFulio, Anthony; Stitzer, Maxine; Roll, John; Petry, Nancy; Nuzzo, Paul; Schwartz, Robert P.; Stabile, Patricia
A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from a large (N=415) multi-site trial of a prize-based abstinence incentive intervention (Petry et al., 2005) examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n=138) were more likely than those not CJ referred (n=277) to provide stimulant negative urine samples whether missing samples were counted as positive (50 versus 41%, p=.016) or as missing (96 versus 91%, p<.001). A significant interaction term was found only for percentage of treatment completers (p=.027). However, on that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. The study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can be considered for use with CJ-referred stimulant users based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program. PMID:23433822
Watson, Donnie W.
The literature provides ample evidence of the relationship of substance abuse to crime. Research over the last 20 years has established a strong correlation between substance abuse and juvenile delinquency (held, 1998). Currently, there are more than 350,000 juveniles on probation and in continuing care programs in the U.S. who have substance…
Black, John L.; And Others
Intravenous (IV) drug abusers are at risk for contracting transmittable diseases such as acquired immunodeficiency syndrome (AIDS) and hepatitis B. This study was conducted to investigate the prevalence of risk behaviors for acquiring and transmitting AIDS and hepatitis B among treatment-seeking drug abusers (N=168). Subjects participated in a…
McKay, James R.; Buka, Stephen L.
Presents findings from research programs: first on substance abuse in juvenile offenders/adolescents with psychiatric/behavioral disorders focused on treatment issues (attributions for substance use, beliefs about effects of drugs, perceptions of family functioning); and second on psychiatric disorders in adolescent substance abuse patients…
Zaidi, Lisa Y.; Gutierrez-Kovner, Victoria M.
Describes a pilot group developed to address the traumagenic stigmatization, powerlessness, betrayal, and sexualization that characterize victims of sexual abuse. Treatment modules developed within this framework focused on: group cohesiveness, discussion of specific abuse experiences, coping strategies, sexuality, victimization prevention, and…
Burnhams, Warren; Remmert, Jocelyn E.; Myers, Bronwyn; Joska, John A.; Carrico, Adam W.
Aims This study documented the treatment cascade for engagement in care and abstinence at treatment exit as well as examined correlates of these outcomes for the first certified Matrix Model® substance abuse treatment site in Sub-Saharan Africa. Design This retrospective chart review conducted at a resource-limited community clinic in Cape Town, South Africa, assessed treatment readiness and substance use severity at treatment entry as correlates of the number of sessions attended and biologically confirmed abstinence at treatment exit among 986 clients who initiated treatment from 2009–2014. Sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately. Results Of the 2,233 clients who completed screening, approximately 44% (n = 986) initiated treatment. Among those who initiated treatment, 45% completed at least four group sessions, 30% completed early recovery skills training (i.e., at least eight group sessions), and 13% completed the full 16-week program. Approximately half (54%) of clients who provided a urine sample had negative urine toxicology results for any substance at treatment exit. Higher motivation at treatment entry was independently associated with greater odds of treatment completion and negative urine toxicology results at treatment exit. Conclusions Findings provide initial support for the successful implementation the Matrix Model in a resource-limited setting. Motivational enhancement interventions could support treatment initiation, promote sustained engagement in treatment, and achieve better treatment outcomes. PMID:26816208
Johnson, S H
The purpose of this paper is to compare two forms of treatment for heroin abusers in Malaysia--traditional medicine and institutional--and to evaluate which form of treatment the drug abusers consider more effective. The study involved interviewing 100 male drug abusers in Malaysia who had had treatment from an institution and from a traditional healer. The data revealed that traditional medicine was better for some abusers, but institutional treatment was better for others, depending upon an individual's own needs and personality. Advantages and disadvantages of both forms of treatment were given by those interviewed. The data can be used as guidelines for the development of a more flexible, individualized program within an institutional setting in Malaysia. PMID:6642801
Oser, Carrie B; Leukefeld, Carl G; Tindall, Michele Staton; Garrity, Thomas F; Carlson, Robert G; Falck, Russel; Wang, Jichuan; Booth, Brenda M
The purpose of this study is to use a modified version of Andersen's Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users' substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users.
Johnson, S H
The purpose of this paper is to compare two forms of treatment for heroin abusers in Malaysia--traditional medicine and institutional--and to evaluate which form of treatment the drug abusers consider more effective. The study involved interviewing 100 male drug abusers in Malaysia who had had treatment from an institution and from a traditional healer. The data revealed that traditional medicine was better for some abusers, but institutional treatment was better for others, depending upon an individual's own needs and personality. Advantages and disadvantages of both forms of treatment were given by those interviewed. The data can be used as guidelines for the development of a more flexible, individualized program within an institutional setting in Malaysia.
Shemesh, Eyal; Annunziato, Rachel A.; Yehuda, Rachel; Shneider, Benjamin L.; Newcorn, Jeffrey H.; Hutson, Carolyn; Cohen, Judith A.; Briere, John; Gorman, Jack M.; Emre, Sukru
Objective: The study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant. Method: Abuse history for children and adolescents ages 8 to 21 who underwent a liver transplantation at Mount Sinai Medical Center in New York was obtained in interviews in 2002.…
Slesnick, Natasha; Bartle-Haring, Suzanne; Gangamma, Rashmi
There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment…
Ferguson, Kristin M.
This article explores the psychosocial and behavioral adjustment outcomes associated with verbal, emotional, physical, and sexual abuse among homeless young adults as well as the associations among abuse types. Convenience sampling was used to select 28 homeless young adults (ages 18 to 24) from one drop-in center. Overall, subjects experienced…
Pechtel, Pia; Evans, Ian M.; Podd, John V.
Eighty-five New Zealand based practitioners experienced in treating adults with a history of child sexual abuse participated in an online judgment study of child sexual abuse outcomes using signal detection theory methodology. Participants' level of sensitivity was assessed independent of their degree of response bias when discriminating (a) known…
Horan, Jacqueline M; Widom, Cathy Spatz
Child maltreatment has been linked with a number of risk behaviors that are associated with long-lasting maladaptive outcomes across multiple domains of functioning. This study examines whether the ages of onset of four risk behaviors-sexual intercourse, alcohol use, drug use, and criminal behavior-mediate the relationship between child maltreatment and outcomes in middle adulthood among a sample of court-documented victims of child abuse/neglect and matched controls (N = 1,196; 51.7% female; 66.2% White, 32.6% Black). Adult outcomes included employment status, welfare receipt, internalizing symptoms of anxiety and depressive symptoms, substance use problems, and criminal arrests. The results indicated gender differences in these relationships. For females, age of onset of sexual intercourse mediated the relationship between child abuse/neglect and both internalizing symptoms and substance use problems in middle adulthood. For males, age at first criminal arrest mediated the relationship between child abuse/neglect and extensive involvement in the justice system in middle adulthood. Age of onset of alcohol use and drug use did not mediate the relationship between child abuse/neglect and middle adult outcomes. This study expands current knowledge by identifying associations between early initiation of risk behavior in one domain and later, continuing problems in different domains. Thus, early initiation of specific risk behaviors may have more wide-ranging negative consequences than are typically considered during intervention or treatment and strategies may need to target multiple domains of functioning.
... breadcrumb navigation Substance Abuse Treatment For Children And Adolescents: Questions To Ask Quick Links Facts For Families ... No. 41; Reviewed July 2013 Many children and adolescents use alcohol and other drugs. Some develop serious ...
Spas, Jayson; Ramsey, Susan; Paiva, Andrea L.; Stein, L.A.R.
Considerable evidence from the literature on treatment outcomes indicates that substance abuse treatment among adolescents with conduct problems varies widely. Treatments commonly used among this population are cognitive-behavioral therapy (CBT), 12-step facilitation, multisystemic therapy (MST), psychoeducation (PE), and motivational interviewing (MI). This manuscript thoroughly and systematically reviews the available literature to determine which treatment is optimal for substance-abusing adolescents with conduct problems. Results suggest that although there are several evidence-based and empirically supported treatments, those that incorporate family-based intervention consistently provide the most positive treatment outcomes. In particular, this review further reveals that although many interventions have gained empirical support over the years, only one holds the prize as being the optimal treatment of choice for substance abuse treatment among adolescents with conduct problems. PMID:23170066
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services,...
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services,...
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services,...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services,...
Amaro, Hortensia; Nieves, Rita; Johannes, Sergut Wolde; Cabeza, Nirzka M. Labault
Among 66 Latina mothers in a residential substance abuse treatment program, 80% reported childhood experiences of abuse. Compared to other female participants, women abused as children were more likely to be predominantly Spanish speakers, to have health problems, to have had children removed from their custody, and to drop out quickly from…
Cretzmeyer, Margaret; Sarrazin, Mary Vaughan; Huber, Diane L; Block, Robert I; Hall, James A
Over the past few years, methamphetamine has appeared in mass quantities, in part, because of the ease and cost efficiency of manufacturing. With this increase in availability, the use of methamphetamine has increased significantly. The purpose of this article is to describe the existing treatment options for methamphetamine abuse and provide recommendations for practitioners and researchers. Methamphetamine abuse adversely impacts physical functioning, brain functioning and cognition, social support and social networks, and behavioral functioning. Negative consequences have also been documented to the environment and communities. In the studies reviewed on effective treatments, interventions consisted of aversion therapy, medication, psychosocial treatment, and case management. Each specific treatment is described as connected with an overall drug treatment program. If methamphetamine abuse continues to increase and the consequences continue to be so devastating, researchers and clinicians could advance the field by particular focus on the treatment of this type of drug use.
Ibabe, Izaskun; Stein, Judith A; Nyamathi, Adeline; Bentler, Peter M
The current study focuses on the relationships among a trauma history, a substance use history, chronic homelessness, and the mediating role of recent emotional distress in predicting drug treatment participation among adult homeless people. We explored the predictors of participation in substance abuse treatment because enrolling and retaining clients in substance abuse treatment programs is always a challenge particularly among homeless people. Participants were 853 homeless adults from Los Angeles, California. Using structural equation models, findings indicated that trauma history, substance use history and chronicity of homelessness were associated, and were significant predictors of greater recent emotional distress. The most notable result was that recent emotional distress predicted less participation in current substance abuse treatment (both formal and self-help) whereas a substance use history alone predicted significantly more participation in treatment. Implications concerning treatment engagement and difficulties in obtaining appropriate dual-diagnosis services for homeless mentally distressed individuals are discussed. PMID:24238716
Haraldsson, Haraldur M.; Rafnar, Bjarni O.; Sigurdsson, Engilbert; Steingrimsson, Steinn; Johannsson, Magnus; Bragadottir, Helena; Magnusson, Andres
Objectives: Prescription rates of methylphenidate (MPH) are sharply rising in most Western countries. Although it has been reported that MPH has abuse potential, little is known about the prevalence of intravenous (IV) abuse of MPH. The aim of the study was to investigate the prevalence of IV MPH abuse among treatment-seeking IV substance abusers in Iceland. Methods: This is a descriptive population-based study using a semistructured interview assessing sociodemographics, substance abuse history, and the method of administration of 108 IV substance abusers. During 1 year, consecutively admitted adult inpatients with substance use disorder at any detoxification center in Iceland that reported any IV substance abuse in the past 30 days were invited to participate. Abuse was defined as nontherapeutic use of a substance to gain psychological or physiological effect. Results: Prevalence of any IV MPH abuse among participants was 88% in the last 30 days (95% confidence interval [CI], 0.82-0.94) and MPH was the most commonly abused substance (65%) and the preferred substance (63%). Around one third (30%) reported MPH as the first IV substance ever abused. However, among those reporting a shorter history than 10 years of IV abuse, 42% reported MPH as the first IV substance ever abused. Conclusions: This first nationwide study on IV abuse of MPH shows that it is common among treatment-seeking IV abusers in Iceland and suggests that MPH has high abuse potential. Therefore, both the use and possible abuse of MPH in those with high abuse potential should be monitored, especially in countries where MPH prescriptions rates are on the rise. PMID:25748561
Kuehnle, Kathryn; Connell, Mary
This article addresses what, if any, psychotherapeutic interventions should be provided to meet the emotional and clinical needs of alleged child victims of sexual abuse while they await judicial determinations from the family, dependency, or criminal courts. The discussion emphasizes that to minimize iatrogenic outcomes, professionals involved in…
McKendrick, Karen; Sullivan, Christopher; Banks, Steven; Sacks, Stanley
Treatment outcomes 1 year after release from prison were compared for two subgroups of male inmates with co-occurring serious mental illness and chemical abuse (MICA) disorders, those with a diagnosis for Antisocial Personality Disorder (APD), and those without a diagnosis of APD. The foundation study had randomly assigned inmates to either…
Sorenson, James L.; Masson, Carmen L.; Delucchi, Kevin; Sporer, Karl; Barnett, Paul G.; Mitsuishi, Fumi; Lin, Christine; Song, Yong; Chen, TeChieh; Hall, Sharon M.
A clinical trial contrasted 2 interventions designed to link opioid-dependent hospital patients to drug abuse treatment. The 126 out-of-treatment participants were randomly assigned to (a) case management, (b) voucher for free methadone maintenance treatment (MMT), (c) case management plus voucher, or (d) usual care. Services were provided for 6…
Heinrich, Carolyn J.; Fournier, Elizabeth
Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership…
Romans, S E; Martin, J L; Anderson, J C; O'Shea, M L; Mullen, P E
The psychological outcome for a random community sample of women who had experienced significant childhood sexual abuse was assessed, using two outcome measures: (i) psychiatric morbidity (measured with the short PSE); (ii) self-esteem. Sexual abused women with a good outcome, i.e. who were not a PSE 'case' or who had high self-esteem were compared with abused women with a poor outcome. This paper describes the post-abuse factors that modified the two outcomes. In general, a range of variables, all correlated with each other in a complex manner, distinguished good outcome subjects from poor outcome subjects. Post-abuse adolescent variables included family factors (poor mother-father and parent-child relationships), high school factors (poor academic, sporting and social performance) and early pregnancy. Women who had a good adolescent relationship with their father did better than expected statistically. Sport emerged as an alternative at secondary school to academic achievement in catalysing a good psychological outcome. Adult factors included the quality of relationship with partner, which was associated with a good outcome on both measures. Current paid employment was linked to high self-esteem but not to lowered psychiatric morbidity, while the converse applied for high socio-economic status. These findings imply that different processes operate for each outcome measure. A clear recognition by the school of childhood sexual abuse may help to provide the opportunity for the girl to experience success in some arena; this in turn may protect her against the likely adult consequences of low self-esteem and increased psychiatric morbidity.
Klajner, F; Hartman, L M; Sobell, M B
The efficacy of relaxation training as a treatment for alcohol and drug abuse is reviewed, and directions for future research derived. Such use of relaxation procedures, notably progressive muscular relaxation and meditation, has been widespread and is premised on the assumptions that substance abuse is causally linked to anxiety and that anxiety can be reduced by relaxation training. However, the evidence suggests that such precipitating anxiety is limited to interpersonal-stress situations involving diminished perceived personal control over the stressor, and that alcohol and other drugs are often consumed for their euphoric rather than tranquilizing effects. Consequently, the empirical support for the effectiveness of relaxation training as a treatment for substance abuse in general is equivocal. As well, the existing outcome studies suffer from numerous methodological and conceptual inadequacies. In cases of demonstrated effectiveness, increased perceived control is a more plausible explanation than is decreased anxiety.
Luchansky, Bill; Krupski, Antoinette; Stark, Kenneth
The purposes of this study were to examine the outcomes of a sample of patients receiving publicly funded substance abuse treatment in Washington State and to compare the outcomes of those using methamphetamine (MA) with patients using other drugs of abuse. All data for this study came from administrative systems in Washington State, and the outcomes included completion of and readmission to treatment, employment, and various forms of criminal justice involvement. Treatment records were linked to outcome data using both deterministic and probabilistic matching techniques. Patients were tracked for 1 year following their discharge, and analyses were performed separately on a study population of adults and a study population of youth. For both adults and youth, the results showed that across outcomes, there were few differences between MA users and users of other hard drugs, whereas there were consistent differences between MA users and users of alcohol and marijuana. Alcohol and marijuana users tended to have more positive outcomes than the other groups. Future research should focus on more detailed analyses of the type of treatment received by patients, particularly for MA users.
Substance Abuse and Mental Health Services Administration, 2005
Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS), are best-practice guidelines for the treatment of substance use disorders. CSAT draws on the experience…
Marcenko, M O; Kemp, S P; Larson, N C
Relationships among childhood abuse, subsequent adult functioning (with a focus on severity of substance abuse), and child placement were explored in an urban sample of low-income, African-American mothers. Childhood sexual trauma and age were found to be correlated with severity of later drug use; history of physical or sexual abuse was significantly related to psychological distress in adulthood; and addiction was highly correlated with child placement. Implications of the findings are discussed, with particular reference to collaborations between child welfare and substance abuse treatment. PMID:10953778
Nuttbrock, Larry A
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.
Vaillancourt-Morel, Marie-Pier; Godbout, Natacha; Sabourin, Stéphane; Briere, John; Lussier, Yvan; Runtz, Marsha
This study tested a moderation model in which the association between child sexual abuse severity and negative sexual outcomes (i.e., sexual avoidance and compulsivity) differed as a function of relationships status (i.e., single, cohabiting, and married individuals). A sample of 1,033 adults completed self-report questionnaires online, and 21.5% reported childhood sexual abuse. Path analyses indicated that child sexual abuse severity was associated with higher sexual compulsivity in single individuals, both higher sexual avoidance and compulsivity in cohabiting individuals, and higher sexual avoidance in married individuals. The moderation model was invariant across men and women. These results suggest that the time course of negative sexual outcomes associated with child sexual abuse may follow distinct patterns of expression according to relationship status. PMID:26804731
Calhoun, Stacy; Conner, Emma; Miller, Melodi; Messina, Nena
Substance abuse is a major public health concern that impacts not just the user but also the user’s family. The effect that parental substance abuse has on children has been given substantial attention over the years. Findings from the literature suggest that children of substance-abusing parents have a high risk of developing physical and mental health and behavioral problems. A number of intervention programs have been developed for parents who have a substance abuse problem. There have also been a number of interventions that have been developed for children who have at least one parent with a substance abuse problem. However, it remains unclear how we can best mitigate the negative effects that parental substance abuse has on children due to the scarcity of evaluations that utilize rigorous methodologies such as experimental designs. The purpose of this study is to review randomized controlled trials of intervention programs targeting parents with substance abuse problems and/or children with at least one parent with a substance abuse problem in order to identify programs that show some promise in improving the behavioral and mental health outcomes of children affected by parental substance abuse. Four randomized controlled trials that met our eligibility criteria were identified using major literature search engines. The findings from this review suggest that interventions that focus on improving parenting practices and family functioning may be effective in reducing problems in children affected by parental substance abuse. However, further research utilizing rigorous methodologies are needed in order to identify other successful interventions that can improve the outcomes of these children long after the intervention has ended. PMID:25670915
Striley, Catherine W.; Nattala, Prasanthi; Ben Abdallah, Arbi; Dennis, Michael L.; Cottler, Linda B.
This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to…
Baker, Juanita N.; Tanis, Heyley J.; Rice, Jennifer B.
Describes the necessity of including siblings in the treatment of victims of child sexual abuse. Theoretical and practical reasons to include siblings in treatment are discussed. Case examples using a particular intervention approach and results of client satisfaction surveys are described. (Contains 18 references.) (GCP)
Sodano, Ruthlyn; Watson, Donnie W.; Rataemane, Solomon; Rataemane, Lusanda; Ntlhe, Nomvuyo; Rawson, Richard
The purpose of this paper is to describe characteristics of substance abuse treatment counselors in the Republic of South Africa, including demographics, education, training, and job duties. Counselors recruited from 24 treatment centers completed a survey after signing informed consent. Counselors were primarily female (75%), racially diverse…
Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart
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…
McPherson, Paul; Scribano, Philip; Stevens, Jack
Child sexual abuse (CSA) often requires psychological treatment to address the symptoms of victim trauma. Barriers to entry and completion of counseling services can compromise long-term well-being. An integrated medical and mental health evaluation and treatment model of a child advocacy center (CAC) has the potential to reduce barriers to mental…
Kresina, Thomas F; Sylvestre, Diana; Seeff, Leonard; Litwin, Alain H; Hoffman, Kenneth; Lubran, Robert; Clark, H Westley
Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful
National Inst. on Drug Abuse (DHEW/PHS), Rockville, MD. National Clearinghouse for Drug Abuse Information.
This report presents a brief review of the development of methods and programs for treatment of drug abusers in the United States. In order to limit the scope of the report, discussion of the treatment of alcohol abuse and alcoholism is excluded. The report focuses primarily on the treatment of opiate dependence, since most of the experience on…
Chandy, Joseph M.; And Others
A study of 370 male and 2,681 female adolescents with a history of sexual abuse found that males were at higher risk than females for poor school performance, delinquent activities, extreme use of alcohol and marijuana, and sexual risk taking. Female victims showed higher risk for suicidal ideation and behavior, frequent use of alcohol, and…
Higgins, Stephen T; Alessi, Sheila M; Dantona, Robert L
In this report we provide an overview of research on the voucher-based incentives approach to substance abuse treatment. This approach was originally developed as a novel method for improving retention and increasing cocaine abstinence among cocaine-dependent outpatients. The efficacy of vouchers for those purposes is now well established, and plans are underway to move the intervention into effectiveness testing in community clinics. The use of vouchers also has been extended to the treatment of alcohol, marijuana, nicotine, and opioid dependence. Particularly noteworthy is that vouchers hold promise as an efficacious intervention with special populations of substance abusers, including pregnant and recently postpartum women, adolescents, and those with serious mental illness. Overall, voucher-based incentives hold promise as an innovative treatment intervention that has efficacy across a wide range of substance abuse problems and populations.
Children exposed to abuse and neglect are at significantly higher risk of developing mental health conditions than are children who grow up in stable families. Multiple complexities arise in supporting the needs of these vulnerable children: complex family circumstances; the need to balance the goals of protecting the children and strengthening family connections; and the involvement of multiple players from biological families to foster parents to case workers to children's mental health professionals. This article draws on case studies, the literature and proven initiatives that have been implemented in a number of children's aid societies in Ontario to demonstrate four strategies that can improve mental health outcomes for children exposed to abuse and neglect. These strategies are increasing admission prevention and early intervention to support at-risk youth at home; supporting transitions from intensive residential treatment back to the community; ensuring youth transitioning to the adult system have the supports they need; and increasing integration in service delivery between children's mental health and child welfare.
Chung, Yida Y H; Shek, Daniel T L
This study examined fears about drug treatment among 300 young male heroin abusers in Hong Kong (172 newcomers and 128 repeaters) recruited from non-government treatment agencies. An indigenous 35-item Fears about Treatment Scale (Fears Scale) was developed to measure fears about treatment among the participants. Results showed that four factors (fear of failure, fear of labeling or disclosure, fear of maladaptation and fear of withdrawal) were abstracted from the scale. Reliability analyses showed that subscales based on these four factors and the total scale were internally consistent. The findings showed that treatment failure was the major fear in the respondents. The present findings suggest that drug treatment and rehabilitation services should help clients, particularly young substance abusers, mitigate their treatment fears.
Luiselli, J K
This case study describes the functional assessment and treatment of aggressive and destructive behaviors in a 14-year-old male child with a history of physical abuse. Evaluation was performed in a classroom within a residential school setting. Functional assessment in forms of indirect and descriptive methods was used to generate hypotheses regarding sources of behavioral control. A treatment plan that combined multi-level differential reinforcement of other behavior (DRO) and positive reinforcement for task completion was implemented based on the outcome of functional assessment. Treatment was associated with a gradual and steady reduction in challenging behaviors with near-zero rates achieved at follow-up. This case provides an example of clinical intervention for behavior disorders commonly observed in children who have been abused physically and a hypothesis-driven model of treatment formulation. PMID:8814520
Luiselli, J K
This case study describes the functional assessment and treatment of aggressive and destructive behaviors in a 14-year-old male child with a history of physical abuse. Evaluation was performed in a classroom within a residential school setting. Functional assessment in forms of indirect and descriptive methods was used to generate hypotheses regarding sources of behavioral control. A treatment plan that combined multi-level differential reinforcement of other behavior (DRO) and positive reinforcement for task completion was implemented based on the outcome of functional assessment. Treatment was associated with a gradual and steady reduction in challenging behaviors with near-zero rates achieved at follow-up. This case provides an example of clinical intervention for behavior disorders commonly observed in children who have been abused physically and a hypothesis-driven model of treatment formulation.
Berger, Lawrence M; Slack, Kristen S; Waldfogel, Jane; Bruch, Sarah K
The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers' perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes.The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. Moreover, these associations are equal in magnitude or larger than those between the other risk factors and the outcomes. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.
... also may fall prey to strangers who take advantage of their cognitive impairment. Types of abuse Signs ... property) to his or her disadvantage or the advantage of someone else Sexual abuse: touching, fondling or ...
Gagała, Jacek; Tarczyńska, Marta; Kosior, Piotr
Background. The aim of the study was to analyze late outcomes of perilunar carpal dislocations, depending on the type of the injury, time of the diagnosis and the treatment methods. Material and methods. The material is constituted by 37 patients treated in our department between 1981-2004 because of perilunar dislocation. In group were 2 women and 35 men, aged 19-56 (mean 31 years). All patients were asked for control visit. DASH and Mayo score were used to evaluate the outcome. Range of wrist motion, its stability, grip strength and X-ray pictures were analyzed. Results. Better follow-up results were observed in persons with early diagnosed dislocations of the wrist. The best outcomes were observed in group with perilunar early diagnosed dislocations, which were treated by open reduction. Posttraumatic wrist instability often was diagnosed in patients with dislocation of lunar bone and late-diagnosed transscaphoid perilunar carpal dislocations. Conclusions. The data we obtained show, that the consequences of late-diagnosed and late-treated injuries of the wrist are instability, pain, decrease in range of motion and hand skills. PMID:17592406
Lisha, Nadra E.; Sun, Ping; Rohrbach, Louise A.; Spruijt-Metz, Donna; Unger, Jennifer B.; Sussman, Steve
The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n = 1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational…
Asen, Karl; And Others
An approach to the treatment of child abuse used in a British clinic involves interventions that block or change destructive family interaction patterns. Real life stress situations are recreated in a multifamily group so that families can find new, nonviolent solutions to everyday problems. (MSE)
Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian
Objective: To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method: This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age…
Schwartz, Jonathan P.; Waldo, Michael
Examines men's experiences in educational groups for batterers. Two factors, imparting of information and development of socializing techniques, were found to be predominant. Other factors thought to be important for abuse treatment (i.e. hope, family reenactment, and modeling) were found to be minimally present. Analysis demonstrates relationship…
Flentje, Annesa; Heck, Nicholas C; Sorensen, James L
Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n=199) and non-transgender (cisgender, n=13,440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007 to 2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use, and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications, but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment. PMID:24561017
Waldron, Holly Barrett; Turner, Charles W.
This review synthesized findings from 17 studies since 1998 regarding evaluation of outpatient treatments for adolescent substance abuse. These studies represented systematic design advances in adolescent clinical trial science. The research examined 46 different intervention conditions with a total sample of 2,307 adolescents. The sample included…
Agrawal, Shantanu; Everett, Worth W.; Sharma, Sonali
Purpose: This study examined the impact of medical education on students' views of substance abuse treatment, public policy options and training. Method: A longitudinal survey was conducted on a single-class cohort of 101 students in a major American, urban medical school. The survey was administered in the Spring semesters of the first to third…
Keeshin, Brooks R.; Campbell, Kristine
Objectives: To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse. Methods: Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in…
Fabino, Robert A.
Alcohol abuse is a serious problem affecting not only the individual abuser, but also family, friends and society. The effectiveness of contracts as positive tools in the treatment of alcohol abuse was investigated for 15 current abusers randomly assigned to individual therapy sessions. Each subject completed a Personal History Questionnaire, the…
Doerfler, Leonard A.; Toscano, Peter F., Jr.; Connor, Daniel F.
We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and "both" sexual and…
Straussner, S Lala A; Marcus, Marianne T; Brown, Richard L; Madden, Theresa; Graham, Antonnette V; Schoener, Eugene P
The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service- learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.
... Treatment; Notice of Meeting Pursuant to Public Law 92-463, notice is hereby given of the meeting of the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment...
... Treatment; Notice of Meeting Pursuant to Public Law 92-463, notice is hereby given of the meeting of the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment...
Evans, Suzette M; Reynolds, Brady
This special issue exemplifies one of the major goals of the current editor of Experimental and Clinical Psychopharmacology (Dr. Suzette Evans): to increase the number of manuscripts that emphasize females and address sex differences. Taken together, these articles represent a broad range of drug classes and approaches spanning preclinical research to treatment to better understand the role of sex differences in drug abuse. While not all studies found sex differences, we want to emphasize that finding no sex difference is just as important as confirming one, and should be reported in peer-reviewed journals. It is our intention and hope that this special issue will further advance scientific awareness about the importance of accounting for sex differences in the study of substance abuse. Participant sex is an essential variable to consider in developing a more comprehensive understanding of substance abuse. Rather than viewing investigating sex differences as burdensome, investigators should seize this opportune area ripe for innovative research that is long overdue.
Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian
Objective To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (N = 164), ages 14–18 (x□ age = 16.09, SD = 1.12), in substance abuse treatment in the Denver metropolitan area. Bivariate and multivariate analyses were completed to determine factors related to adolescents' use of medical marijuana. Results Approximately 74% of the adolescents had used someone else's medical marijuana and they reported using diverted medical marijuana a median of 50 times. After adjusting for gender and race/ethnicity, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms compared to those who did not use medical marijuana. Conclusions Medical marijuana use among adolescent patients in substance abuse treatment is very common, implying substantial diversion from registered users. These results support the need for policy changes that protect against diversion of medical marijuana and reduce adolescent access to diverted medical marijuana. Future studies should examine patterns of medical marijuana diversion and use in general population adolescents. PMID:22721592
Boden, Joseph M.; Horwood, L. John; Fergusson, David M.
Objective: This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25. Method: Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to…
Objectives: To describe the legal outcomes and factors associated with case reaching court and conviction for sexual abuse of children seen at the Philippine General Hospital Child Protection Unit (PGH-CPU) from 1997 to 2000. Methods: Mixed transdisciplinary research design combined longitudinal cohort with qualitative methods. Data were obtained…
Lian, Huiwen; Ferris, D. Lance; Brown, Douglas J.
We predicted that the effects of abusive supervision are likely to be moderated by subordinate power distance orientation and that the nature of the moderating effect will depend on the outcome. Drawing upon work suggesting that high power distance orientation subordinates are more tolerant of supervisory mistreatment, we posited that high power…
Schaubroeck, John M; Peng, Ann C; Hannah, Sean T
We develop a model in which abusive supervision undermines individuals' perceptions of the level of respect they are accorded by their group peers, which in turn reduces their performance and disconnects them psychologically from the organization. High group potency strengthens each of these connections. We studied the theorized relationships across 3 periods during a 10-week residential organizational entry program. Group potency, representing shared group perceptions, moderated relationships at the individual level. These included the negative relationship between abusive supervision (Time 1) and perceived peer respect (Time 2) and the relationship between perceived peer respect and organizational commitment, organizational identification, and turnover intention (Time 3). We found stronger relationships between abusive supervision and perceived peer respect--and between peer respect and the attitudinal outcomes and turnover intention--among groups with higher potency. Perceived peer respect was also positively related to followers' task performance. We discuss implications of the conceptual framework and findings for future research and theory development concerning how groups and individuals respond to abusive supervision and to treatment by their peers. PMID:26348478
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug...
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug...
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug...
... Treatment; Notice of Meeting Pursuant to Public Law 92-463, notice is hereby given that the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT... information below). Committee Name: SAMHSA's Center for Substance Abuse Treatment National Advisory...
... Treatment; Notice of Meeting Pursuant to Public Law 92-463, notice is hereby given that the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT... information below). Committee Name: SAMHSA's Center for Substance Abuse Treatment National Advisory...
... Treatment; Notice of Meeting Pursuant to Public Law 92-463, notice is hereby given that the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT... information below). Committee Name: SAMHSA's Center for Substance Abuse Treatment National Advisory...
Substance Abuse and Mental Health Services Administration, 2011
This report uses data from the Treatment Episode Data Set (TEDS) for 2008 to provide information on the characteristics of youths aged 12 to 14 admitted to substance abuse treatment. In 2008, approximately 23,770 substance abuse treatment admissions were adolescents aged 12 to 14. The two most frequently reported primary substances of abuse among…
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug...
Botzet, Andria M.; Fahnhorst, Tamara
Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed. PMID:21701838
Nava, Angeles; Gilroy, Heidi; Maddoux, John
Abstract Background: To determine the differential risk of behaviors associated with lethal violence and functioning outcomes for abused women with children who received an intervention of shelter or justice services and return to the abuser were compared with women who did not return. Methods: The study was carried out using a matched-pair analysis of 152 women. Measures of risk of behaviors associated with lethal violence, type, and severity of abuse, and poor mental health symptoms were measured every 4 months for 24 months. Results: Irrespective of service used, women returning to the abuser reported significantly (p<0.001) more risk of behaviors associated with lethal violence compared to women who did not return. Additionally, severity of physical abuse was significantly higher (p<0.01) for women returning to the abuser who had been in a shelter but not for women who received a protection order. Similarly, levels of depression, posttraumatic stress disorder, and anxiety were significantly higher (p<0.01) for sheltered women who returned to the abuser but not for women using a protection order who returned. Conclusions: Risk of behaviors associated with lethal violence increases when abused women return to live with the abuser. Abused women should be informed of the heightened risk and greater probability for poor mental health. PMID:25714332
Miller, John Clark
Approaches incorporating 12-Step beliefs and practices have dominated substance abuse treatment despite a lack of empirical support. Recent claims for effectiveness relying on results from a large, multisite research project in the U.S. were re-evaluated based on critical analysis of design, methodology, and construction of outcome measures.…
Sinha, Rajita; Easton, Caroline; Kemp, Kathleen
Although rates of substance abuse continue to rise among young adults ages 18-25, there is little information on the clinical characteristics of young adults referred to treatment, their readiness to change substance use behaviors, and treatment outcomes. These aspects were examined in young (18-25 years old) and older adult (26-45 years old) substance abusers entering treatment at a large, urban, outpatient substance abuse treatment facility. All clients were referred for outpatient treatment by the local Offices of Adult Probation during 1998-1999. The demographic and substance use characteristics, motivation level/readiness to change substance use behaviors, treatment attendance, completion, and "drug-free" status based on patient self-report and urine/breathalyzer data were assessed. Results. Substance-abusing young adult probationers were more likely to be African-American, with a significantly earlier age of onset of primary substance use. They were more likely to have a marijuana use disorder as compared with older adults, who in turn, were more likely to meet criteria for alcohol use disorders. Furthermore, as compared with older adults, young adults had significantly higher scores on precontemplation, and significantly lower scores on contemplation, determination, action, and maintenance subscales of motivation/change readiness. A significantly higher number of young adults did not complete outpatient treatment and were "drug-positive" at discharge, as compared with older adults. Conclusions. Young adult probationers referred to substance abuse treatment show significantly different substance abuse and treatment characteristics as compared with their older adult counterparts. The findings suggest that specialized treatment approaches that focus on enhancing treatment readiness and motivation to change substance use behaviors may be of particular benefit to substance abusing young adults. PMID:14510042
Min, Meeyoung O; Tracy, Elizabeth M; Kim, Hyunsoo; Park, Hyunyong; Jun, Minkyoung; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre
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.
Arfken, Cynthia L; Kubiak, Sheryl P; Farrag, Mohamed
Acculturation to U.S. culture by Latinos and Asian Americans has been associated with increased prevalence of substance abuse. However, little is known about the association between acculturation and substance use among Arab Americans, or more specifically, among Arab-American treatment clients. In 156 Arab-American male treatment clients, we found that higher levels of U.S. acculturation were positively associated with increased prevalence of polysubstance abuse. This first report on a large series of Arab-American clients also found considerable within-group variability. These results can be used to develop treatment plans and work-force training on the importance of U.S. acculturation and variability within Arab Americans.
The abuse of stimulants such as cocaine, amphetamine, and methamphetamine is a huge problem in many parts of the world. Abuse of these drugs does not ruin just the user's life, but also adversely affects those around them. Despite many years of research, there are no approved medications for stimulant dependence, and treatment is focused on psychotherapy and abstinence. Over the last 10 to 20 years, there have been some major changes in approach to medication development for stimulant dependence. These include assessing ligands for non-dopaminergic sites, atypical dopamine transporter ligands, blocking long-term potentiation and / or memory reconsolidation, vaccines against the stimulant, and molecular approaches including pharmacogenomics and gene silencing. Also included in this overview are non-drug treatments such as deep brain stimulation and psychosurgery. This overview highlights recent preclinical and clinical studies of treatment development for stimulant dependence. PMID:27377486
Knudsen, Hannah K; Studts, Christina R; Studts, Jamie L
Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors' implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors' knowledge of the Public Health Service's clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors' knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.
Hopwood, Christopher J; Schade, Nick; Matusiewicz, Alexis; Daughters, Stacey B; Lejuez, Carl W
Emotion regulation at treatment entry was evaluated among 115 patients in an inner-city substance use residential facility who either persisted (N = 94) or discontinued treatment (N = 21). Emotion regulation capacity including emotional clarity and the ability to engage in goal-directed behavior despite emotional distress, as well as lower scores on a measure of trait-negative emotionality, were associated with treatment persistence, whereas motivational variables were not. Findings indicate the importance of regulating negative emotions for treatment engagement among substance abusers. PMID:25404467
Hopwood, Christopher J; Schade, Nick; Matusiewicz, Alexis; Daughters, Stacey B; Lejuez, Carl W
Emotion regulation at treatment entry was evaluated among 115 patients in an inner-city substance use residential facility who either persisted (N = 94) or discontinued treatment (N = 21). Emotion regulation capacity including emotional clarity and the ability to engage in goal-directed behavior despite emotional distress, as well as lower scores on a measure of trait-negative emotionality, were associated with treatment persistence, whereas motivational variables were not. Findings indicate the importance of regulating negative emotions for treatment engagement among substance abusers.
Pullmann, Michael D; Ague, Starcia; Johnson, Tamara; Lane, Stephanie; Beaver, Kevon; Jetton, Elizabeth; Rund, Evangejalynn
Youth engagement in substance use treatment is an important construct for research and practice, but it has been thinly and inconsistently defined in the literature. Most research has measured engagement by initiation, attendance, and retention in treatment. Because youth generally enter substance use treatment as a result of compliance with external requirements, defining engagement in this way might be insufficient. This qualitative participatory research study describes five focus groups with 31 adults working with youth in substance use treatment. Focus groups were designed and conducted by youth researchers in collaboration with university-based partners. We categorized participants' descriptions of engagement into five domains, identified as "CARES": Conduct, Attitudes, Relationships, Empowerment, and Social Context. These domains represent a comprehensive and ecologically-based definition of engagement that situates engagement in the context and trajectory of youth development, has clear implications for assertive clinical practice, and provides a foundation for developing an operationalized measure. PMID:24046184
Subramaniam, Geetha A.; Stitzer, Maxine A.; Clemmey, Philip; Kolodner, Ken; Fishman, Marc J.
Objective: To characterize baseline depressive symptoms among substance-abusing adolescents and determine their association with post residential treatment substance use outcomes. Method: In total, 153 adolescents (mean age 6.6 years, plus or minus 0.11) entering residential treatment were assessed at intake and at 3, 6, 9, and 12 months. Beck…
Shelef, Karni; Diamond, Gary M.; Diamond, Guy S.; Liddle, Howard A.
In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent…
Logemann, Jeri A.
Introduces six articles which address treatment outcomes and efficacy in audiology and speech-language pathology in the schools. Stresses the importance of practitioners participating in studies of treatment outcomes and efficacy to demonstrate that their evaluations and treatments make a significant difference to individuals served. (DB)
Kraft, M. Katherine; Vicary, Judith R.; Henry, Kimberly L.
Introduces a collection of articles by adolescent treatment experts and leading thinkers in the juvenile, restorative, and community justice movements. Articles offer broad overviews of the state of the art within these areas; commentary on challenges, opportunities, and changes such programming would entail; and case examples showing real-world…
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components...
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components...
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components...
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Substance abuse prevention and treatment services... BLOCK GRANTS Direct Funding of Indian Tribes and Tribal Organizations § 96.46 Substance abuse prevention... organizations under the substance abuse prevention and treatment Block Grant. (b) For the purpose of...
... LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.119 Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the... 29 Labor 3 2013-07-01 2013-07-01 false Leave for treatment of substance abuse. 825.119......
... LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.119 Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the... 29 Labor 3 2014-07-01 2014-07-01 false Leave for treatment of substance abuse. 825.119......
... LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.119 Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the... 29 Labor 3 2012-07-01 2012-07-01 false Leave for treatment of substance abuse. 825.119......
... LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.119 Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the... 29 Labor 3 2010-07-01 2010-07-01 false Leave for treatment of substance abuse. 825.119......
... LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.119 Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the... 29 Labor 3 2011-07-01 2011-07-01 false Leave for treatment of substance abuse. 825.119......
... 45 Public Welfare 1 2014-10-01 2014-10-01 false Substance abuse prevention and treatment services... BLOCK GRANTS Direct Funding of Indian Tribes and Tribal Organizations § 96.46 Substance abuse prevention... organizations under the substance abuse prevention and treatment Block Grant. (b) For the purpose of...
... 45 Public Welfare 1 2013-10-01 2013-10-01 false Substance abuse prevention and treatment services... BLOCK GRANTS Direct Funding of Indian Tribes and Tribal Organizations § 96.46 Substance abuse prevention... organizations under the substance abuse prevention and treatment Block Grant. (b) For the purpose of...
... 45 Public Welfare 1 2011-10-01 2011-10-01 false Substance abuse prevention and treatment services... BLOCK GRANTS Direct Funding of Indian Tribes and Tribal Organizations § 96.46 Substance abuse prevention... organizations under the substance abuse prevention and treatment Block Grant. (b) For the purpose of...
Haynes, L. F.; Korte, J. E.; Holmes, B. E.; Gooden, L.; Matheson, T.; Feaster, D. J.; Leff, J. A.; Wilson, L.; Metsch, L. R.; Schackman, B. R.
The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial,…
... 45 Public Welfare 1 2012-10-01 2012-10-01 false Substance abuse prevention and treatment services... BLOCK GRANTS Direct Funding of Indian Tribes and Tribal Organizations § 96.46 Substance abuse prevention... organizations under the substance abuse prevention and treatment Block Grant. (b) For the purpose of...
Coplan, P M; Chilcoat, H D; Butler, S F; Sellers, E M; Kadakia, A; Harikrishnan, V; Haddox, J D; Dart, R C
An extended-release opioid analgesic (OxyContin, OC) was reformulated with abuse-deterrent properties to deter abuse. This report examines changes in abuse through oral and nonoral routes, doctor-shopping, and fatalities in 10 studies 3.5 years after reformulation. Changes in OC abuse from 1 year before to 3 years after OC reformulation were calculated, adjusted for prescription changes. Abuse of OC decreased 48% in national poison center surveillance systems, decreased 32% in a national drug treatment system, and decreased 27% among individuals prescribed OC in claims databases. Doctor-shopping for OC decreased 50%. Overdose fatalities reported to the manufacturer decreased 65%. Abuse of other opioids without abuse-deterrent properties decreased 2 years later than OC and with less magnitude, suggesting OC decreases were not due to broader opioid interventions. Consistent with the formulation, decreases were larger for nonoral than oral abuse. Abuse-deterrent opioids may mitigate abuse and overdose risks among chronic pain patients.
Saylors, Karen; Daliparthy, Nalini
Many mental health problems among substance abusing populations are directly linked to high rates of abuse and trauma. There is increasing evidence of associations between childhood physical and sexual abuse to adult substance use and HIV-risk behavior. The relationship of abuse, mental health problems, substance abuse, and high-risk sexual…
Stitzer, Maxine L; Petry, Nancy M; Peirce, Jessica
The purpose of this article is to review both main findings and secondary analyses from studies of abstinence incentives conducted in the National Drug Abuse Treatment Clinical Trials Network (CTN). Previous research has supported the efficacy of tangible incentives provided contingent on evidence of recent drug abstinence. CTN conducted the first multisite effectiveness trial of this novel intervention. Study participants were stimulant abusers (N = 803) participating in treatment at 14 clinical sites and randomly assigned to treatment as usual with or without a prize draw incentive program. Study participants could earn up to $400 over 3 months for submission of drug-free urine and breath (BAL) specimens. Three-month retention was significantly improved by incentives offered to psychosocial counseling clients (50% incentive vs. 35% control retained), whereas ongoing stimulant drug use was significantly reduced in methadone maintenance clients (54.4% incentive vs. 38.7% control samples testing stimulant-negative). In both settings, duration of continuous abstinence achieved was improved in the incentive condition. These studies support effectiveness of one abstinence incentive intervention and highlight the different outcomes that can be expected with application in methadone maintenance versus psychosocial counseling treatment settings. Secondary analyses have shown the importance of early treatment positive versus negative urine screens in moderating the outcome of abstinence incentives and have explored both safety and cost-effectiveness of the intervention. Implications for the use of motivational incentive methods in clinical practice are discussed.
Stitzer, Maxine L; Petry, Nancy M; Peirce, Jessica
The purpose of this article is to review both main findings and secondary analyses from studies of abstinence incentives conducted in the National Drug Abuse Treatment Clinical Trials Network (CTN). Previous research has supported the efficacy of tangible incentives provided contingent on evidence of recent drug abstinence. CTN conducted the first multisite effectiveness trial of this novel intervention. Study participants were stimulant abusers (N = 803) participating in treatment at 14 clinical sites and randomly assigned to treatment as usual with or without a prize draw incentive program. Study participants could earn up to $400 over 3 months for submission of drug-free urine and breath (BAL) specimens. Three-month retention was significantly improved by incentives offered to psychosocial counseling clients (50% incentive vs. 35% control retained), whereas ongoing stimulant drug use was significantly reduced in methadone maintenance clients (54.4% incentive vs. 38.7% control samples testing stimulant-negative). In both settings, duration of continuous abstinence achieved was improved in the incentive condition. These studies support effectiveness of one abstinence incentive intervention and highlight the different outcomes that can be expected with application in methadone maintenance versus psychosocial counseling treatment settings. Secondary analyses have shown the importance of early treatment positive versus negative urine screens in moderating the outcome of abstinence incentives and have explored both safety and cost-effectiveness of the intervention. Implications for the use of motivational incentive methods in clinical practice are discussed. PMID:20307797
Lian, Huiwen; Ferris, D Lance; Brown, Douglas J
We predicted that the effects of abusive supervision are likely to be moderated by subordinate power distance orientation and that the nature of the moderating effect will depend on the outcome. Drawing upon work suggesting that high power distance orientation subordinates are more tolerant of supervisory mistreatment, we posited that high power distance orientation subordinates would be less likely to view abusive supervision as interpersonally unfair. Drawing upon social learning theory suggestions that high power distance orientation subordinates are more likely to view supervisors as role models, we posited that high power distance orientation subordinates would be more likely to pattern their own interpersonally deviant behavior after that of abusive supervisors. Across 3 samples we found support for our predicted interactions, culminating in a mediated moderation model demonstrating that social learning mediates the interaction of abusive supervision and power distance on subordinate interpersonal deviance, while ruling out alternate self-regulation impairment or displaced aggression explanations. Implications for the abusive supervision literature are discussed.
Perry, Jennifer L.; Joseph, Jane E.; Jiang, Yang; Zimmerman, Rick S.; Kelly, Thomas H.; Darna, Mahesh; Huettl, Peter; Dwoskin, Linda P.; Bardo, Michael T.
Vulnerability to drug abuse is related to both reward seeking and impulsivity, two constructs thought to have a biological basis in the prefrontal cortex (PFC). This review addresses similarities and differences in neuroanatomy, neurochemistry and behavior associated with PFC function in rodents and primates. Emphasis is placed on monoamine and amino acid neurotransmitter systems located in anatomically distinct subregions: medial prefrontal cortex (mPFC); lateral prefrontal cortex (lPFC); anterior cingulate cortex (ACC); and orbitofrontal cortex (OFC). While there are complex interconnections and overlapping functions among these regions, each is thought to be involved in various functions related to health-related risk behaviors and drug abuse vulnerability. Among the various functions implicated, evidence suggests that mPFC is involved in reward processing, attention and drug reinstatement; lPFC is involved in decision-making, behavioral inhibition and attentional gating; ACC is involved in attention, emotional processing and self-monitoring; and OFC is involved in behavioral inhibition, signaling of expected outcomes and reward/punishment sensitivity. Individual differences factors (e.g., age and sex) influence functioning of these regions, which, in turn, impacts drug abuse vulnerability. Implications for the development of drug abuse prevention and treatment strategies aimed at engaging PFC inhibitory processes that may reduce risk-related behaviors are discussed, including the design of effective public service announcements, cognitive exercises, physical activity, direct current stimulation, feedback control training and pharmacotherapies. A major challenge in drug abuse prevention and treatment rests with improving intervention strategies aimed at strengthening PFC inhibitory systems among at-risk individuals. PMID:20837060
Muck, Randolph; Zempolich, Kristin A.; Titus, Janet C.; Fishman, Marc; Godley, Mark D.; Schwebel, Robert
Describes current approaches to adolescent substance abuse treatment, including the 12-step treatment approach, behavioral treatment approach, family-based treatment approach, and therapeutic community approach. Summarizes research that assesses the effectiveness of these models, offering findings from the Center for Substance Abuse Treatment's…
Walsh, Bart J
This article presents a substance abuse treatment method that acknowledges and accommodates the personal needs that are being addressed by substance. This method, Utilization Sobriety, bypasses perceived resistances and employs idiosyncratic psychobiological learning to achieve a body-mind gestalt that is complementary to the client's sobriety. It develops a safe framework for addressing any subsequent mental health themes directly or indirectly related to substance misuse. A treatment protocol for the use of Utilization Sobriety as well as relevant clinical material illustrating its application and a discussion of its implications are offered. PMID:12570092
Holmes, William C.
Objectives: To estimate how many heterosexual and gay/bisexual men self-define abusive childhood sexual experiences (CSEs) to be childhood sexual abuse (CSA) and to assess whether CSA self-definition is associated with risky behavioral and psychiatric outcomes in adulthood. Methods: In Philadelphia County, 197 (66%) of 298 recruited men…
Saunders, D G
At a community-based domestic violence program, 218 men with a history of partner abuse were randomly assigned to either feminist-cognitive-behavioral or process-psychodynamic group treatments. The treatments were not hypothesized to differ in outcome. However, men with particular characteristics were expected to have lower recidivism rates depending on the type of treatment received. Treatment integrity was verified through audio-taped codings of each session. The partners of 79% of the 136 treatment completers gave reports of the men's behavior an average of 2 years post-treatment. These reports were supplemented with arrest records and self-reports. Rates of violence did not differ significantly between the two types of treatment nor did reports from the women of their fear level, general changes perceived in the men, and conflict resolution methods. However, interaction effects were found between some offender traits and the two treatments. As predicted, men with dependent personalities had better outcomes in the process-psychodynamic groups and those with antisocial traits had better outcomes in the cognitive-behavioral groups. The results suggest that more effective treatment may occur if it is tailored to specific characteristics of offenders.
Choi, Sam; Adams, Susie M; MacMaster, Samuel A; Seiters, John
A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.
Bamatter, Wendy; Carroll, Kathleen M.; Añez, Luis M.; Paris, Manuel; Ball, Samuel A.; Nich, Charla; Frankforter, Tami L.; Suarez-Morales, Lourdes; Szapocznik, Jose; Martino, Steve
This study investigated the extent to which bilingual counselors initiated informal discussions about topics that were unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Institute on Drug Abuse Clinical Trial Network protocol examining the effectiveness of motivational enhancement therapy (MET). Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of informal discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin. Additionally, informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment. These results suggest that informal discussion may have adverse consequences on Hispanic clients’ motivation for change and substance abuse treatment outcomes and that maintaining a more formal relationship in early treatment sessions may work best with Hispanic clients. Careful counselor training and supervision in MET may suppress the tendency of counselors to talk informally in sessions. PMID:20817381
Aiken, Leona S.; And Others
Used structural equation modeling for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. Evaluated effect of early period of treatment on daily lives of 486 clients in 2 drug abuse treatment modalities (methadone maintenance and outpatient counseling).…
Evans, Suzette M; Reynolds, Brady
This special issue exemplifies one of the major goals of the current editor of Experimental and Clinical Psychopharmacology (Dr. Suzette Evans): to increase the number of manuscripts that emphasize females and address sex differences. Taken together, these articles represent a broad range of drug classes and approaches spanning preclinical research to treatment to better understand the role of sex differences in drug abuse. While not all studies found sex differences, we want to emphasize that finding no sex difference is just as important as confirming one, and should be reported in peer-reviewed journals. It is our intention and hope that this special issue will further advance scientific awareness about the importance of accounting for sex differences in the study of substance abuse. Participant sex is an essential variable to consider in developing a more comprehensive understanding of substance abuse. Rather than viewing investigating sex differences as burdensome, investigators should seize this opportune area ripe for innovative research that is long overdue. PMID:26237316
Marsh, Jeanne C.; Cao, Dingcai; Shin, Hee-Choon
Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women. PMID:21566721
Cormier, Stéphanie; Lavigne, Geneviève L; Choinière, Manon; Rainville, Pierre
Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.
Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: the National Drug Abuse Treatment Clinical Trials Network.
Brown, Lawrence S; Kritz, Steven Allan; Goldsmith, R Jeffrey; Bini, Edmund J; Rotrosen, John; Baker, Sherryl; Robinson, Jim; McAuliffe, Patrick
Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the "Infections and Substance Abuse" study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy. PMID:16716846
Matta Oshima, Karen M.; Jonson-Reid, Melissa; Seay, Kristen D.
Research on childhood sexual abuse (CSA) has focused on adult revictimization and outcomes. This article examines the rate of child maltreatment revictimization among male and female children reported to child protective services for CSA and whether revictimization impacts outcomes. Using longitudinal administrative data, Cox regressions were used to examine relationships between initial report of CSA, maltreatment revictimization, and adolescent outcomes among children from poor and non-poor families. Despite no significant differences in CSA rates between poor and non-poor families, poor CSA victims were significantly more likely to have re-reports for maltreatment. Children with multiple reports were more likely to have negative outcomes. Interventions for CSA survivors should focus on preventing maltreatment recurrence generally and not ignore needs of male victims. PMID:24641766
Crits-Christoph, Paul; Ring-Kurtz, Sarah; McClure, Bridget; Temes, Christina; Kulaga, Agatha; Gallop, Robert; Forman, Robert; Rotrosen, John
We report here on the results of a randomized, controlled trial evaluating the efficacy of a semi-automated performance improvement system (“Patient Feedback”) that enables real-time monitoring of patient outcomes in outpatient substance abuse treatment clinics. The study involved 118 clinicians working at 20 community-based outpatient substance abuse treatment clinics in the northeast United States. Ten clinics received 12 weeks of the Patient Feedback performance improvement intervention and ten clinics received no intervention during the 12 weeks. Over 1500 patients provided anonymous ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use. There was no evidence of an intervention effect on the primary drug and alcohol use scales. There was also no evidence of an intervention effect on secondary measures of therapeutic alliance. Clinician-rated measures of organizational functioning and job satisfaction also showed no intervention effect. Possible insights from these findings, and alternative methods of utilizing feedback reports to enhance clinical outcomes are proposed. PMID:20116964
Winters, Ken C.; Lee, Susanne; Botzet, Andria; Fahnhorst, Tamara; Nicholson, Ali
Two manually-guided brief interventions were evaluated with a randomized controlled trial. Adolescents (aged 13-17 years) suspected of abusing alcohol and other drugs and their parent were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Adolescents were identified in a school setting and the intervention was delivered by trained counselors. Outcome analyses (N=284; 90% of those enrolled) of relative change (from intake to 12-months) and absolute status (at 12-months) revealed a general pattern of reductions in drug use behaviors, particularly with the cannabis outcome measures, in both active conditions (BI-A and BI-AP). Students in the control condition showed worse outcome compared to the BI-A and BI-AP groups. Among the four mediating variables measured at 6-months, use of additional services, motivation to change and parenting practices had significant influences on 12-month outcome; problem solving skills approached significance as a mediator. The potential value of a brief intervention for drug abusing adolescents is discussed. PMID:24955669
Bartlett, Catalina; Dinsmore, Janet; Gilbert, J. Max; Kornblum, Annette; Latham, Joyce; Oliff, Helen; Paisner, Susan; Sutton, David
This Treatment Improvement Protocol (TIP) provides guidelines for counselors and criminal justice personnel who treat offenders with substance use disorders. TIPs are best-practice guidelines that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts in the…
Durvasula, Ramani; Miller, Theodore R
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 1990s, 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.
Although child sexual abuse (CSA) is recognized as a serious violation of human well-being and of the law, no community has yet developed mechanisms that ensure that none of their youth will be sexually abused. CSA is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races, ethnicities, and socioeconomic classes. Upon invitation, this current publication aims at providing a brief overview of a few lessons we have learned from CSA scholarly research as to heighten awareness of mental health professionals on this utmost important and widespread social problem. This overview will focus on the prevalence of CSA, the associated mental health outcomes, and the preventive strategies to prevent CSA from happening in the first place. PMID:23866106
Congress of the U.S., Washington, DC. Office of Technology Assessment.
This background paper examines evidence for the effectiveness of treatment for drug abuse and evaluates the role of drug abuse treatment as a strategy to prevent Human Immunodeficiency Virus (HIV) spread. Because most intravenous (IV) drug users are not in treatment, the study also examines other approaches to HIV prevention. The remainder of the…
Beschner, George; Thompson, Peggy
During the 1970s, several activities were initiated in response to concern about the quality of treatment services available to drug-abusing women. A comparison of services needed by women with services actually available to women found that special treatment services for drug-abusing women were needed in the areas of medical treatment,…
Chicharro, Juan; Pérez-García, Ana M; Sanjuán, Pilar
The emotions predispose to action providing information from both internal and external environment. There is evidence indicating that the emotional response in drugdependent patients is different from that of the not consuming population. The present work analyzed the emotions of drugdependent under ambulatory treatment (N=57), following the Lang's theory of emotion, considering the dimensions of valence, arousal and dominance or control, across the International Affective Picture System (IAPS), individually applied. The results were contrasted with a control group of not consuming persons (N=44) of similar age, since this variable concerns emotional experience. The influence of sex was also analyzed, considering the possible differences between men and women in emotional experience. The results can be summarized in the following points: (1) There were significant differences between substance abusers and not consumers in the dimension of valence, valuing the consumers the emotional stimuli of the most extreme form (the agreeable ones as better, and the disagreeable ones as worse); (2) there were no differences between both groups in the arousal and dominance dimensions; and (3) women reported more arousal before aversive images, and less before the sexual ones, than males, independently of they were or not substance abusers. Finally, it is suggested the need to deep into the analysis of sex differences and into the images selected, as well as into the usefulness of the emotion centred therapies for the treatment of drugdependency.
The DSM-V Committee plans to abolish the distinction between Alcohol Abuse and Alcohol Dependence (dsm5.org). The author presents a case report as a proof of concept that this distinction should be retained. The author has asserted that Alcohol Abuse is a purely psychological addiction, while Alcohol Dependence involves capture of the ventral tegmental dopaminergic SEEKING system (Johnson, 2003). In psychological addiction the brain can be assumed to function normally, and ordinary psychoanalytic technique can be followed. For the patient described, transference interpretation was the fundamental key to recovery. Alcoholic drinking functioned to prevent this man from remembering overwhelming childhood events; events that were also lived out in his current relationships. Murders that occurred when he was a child were hidden in a screen memory. The patient had an obsessional style of relating where almost all feeling was left out of his associations. After he stopped drinking compulsively, he continued to work compulsively. The maternal transference had to be enacted and then interpreted in order for overwhelming memories to be allowed into conscious thought. After psychoanalysis, the patient resumed drinking and worked a normal schedule that allowed more fulfilling relationships. He had no further symptoms of distress from drinking over a 9-year followup. This case illustrates that Alcohol Abuse is a purely psychological illness, that it does not have the brain changes typical of Alcohol Dependence. Combining epidemiological, neurobiological, longitudinal, and psychoanalytic observations would allow multiple sources of information to be used in creating diagnostic categories. Losing details of human behavior by relying only on epidemiological studies is likely to cause errors in categorization of disorders. In turn, having faulty categories as the basis of further research is likely to impair identification of specific effective treatments. PMID:22144975
The DSM-V Committee plans to abolish the distinction between Alcohol Abuse and Alcohol Dependence (dsm5.org). The author presents a case report as a proof of concept that this distinction should be retained. The author has asserted that Alcohol Abuse is a purely psychological addiction, while Alcohol Dependence involves capture of the ventral tegmental dopaminergic SEEKING system (Johnson, 2003). In psychological addiction the brain can be assumed to function normally, and ordinary psychoanalytic technique can be followed. For the patient described, transference interpretation was the fundamental key to recovery. Alcoholic drinking functioned to prevent this man from remembering overwhelming childhood events; events that were also lived out in his current relationships. Murders that occurred when he was a child were hidden in a screen memory. The patient had an obsessional style of relating where almost all feeling was left out of his associations. After he stopped drinking compulsively, he continued to work compulsively. The maternal transference had to be enacted and then interpreted in order for overwhelming memories to be allowed into conscious thought. After psychoanalysis, the patient resumed drinking and worked a normal schedule that allowed more fulfilling relationships. He had no further symptoms of distress from drinking over a 9-year followup. This case illustrates that Alcohol Abuse is a purely psychological illness, that it does not have the brain changes typical of Alcohol Dependence. Combining epidemiological, neurobiological, longitudinal, and psychoanalytic observations would allow multiple sources of information to be used in creating diagnostic categories. Losing details of human behavior by relying only on epidemiological studies is likely to cause errors in categorization of disorders. In turn, having faulty categories as the basis of further research is likely to impair identification of specific effective treatments.
Broome, K M; Flynn, P M; Simpson, D D
OBJECTIVE: To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices. DATA SOURCES/STUDY SETTING: The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities. STUDY DESIGN: The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility. DATA COLLECTION/EXTRACTION METHODS: Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records. PRINCIPAL FINDINGS: Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility. CONCLUSIONS: Assessment issues and stability of results across programs are important considerations for treatment research and practice. PMID:10445903
Yancey, C Thresa; Hansen, David J; Naufel, Karen Z
The current study examined children and families who presented for treatment through Project SAFE (Sexual Abuse Family Education) following childhood sexual abuse. Pretreatment assessment data were used to develop clusters of participants with significantly differing presentation of symptom outcome following abuse. Four clusters were discovered: (a) a Highly Distressed group, whose members had clinically elevated scores on all self- and parent-report measures; (b) a Problem Behaviors group, whose members had scores within the normal range for self-report measures and elevated scores on all parent-report measures; (c) a Subclinical group, whose participants had scores below the mean and below cutoff scores for all self- and parent-report measures; and (d) a Self-reported Distress group, whose members had elevated scores on self-report measures and scores below clinical cutoffs for all parent-report measures.
Fontes, Lisa Aronson, Ed.
Due to cultural and linguistic misunderstandings, racism, and even homophobia, sexual abuse is frequently mishandled by professionals working with minority populations. Research and multiculturalism have led to advances in understanding sexual abuse in its various contexts. The complicated issues which surround such abuse, in nine different…
Reid, Malcolm S; Fallon, Bryan; Sonne, Susan; Flammino, Frank; Nunes, Edward V; Jiang, Huiping; Kourniotis, Eva; Lima, Jennifer; Brady, Ron; Burgess, Cynthia; Arfken, Cynthia; Pihlgren, Eric; Giordano, Louis; Starosta, Aron; Robinson, James; Rotrosen, John
Nicotine dependence is highly prevalent among drug- and alcohol-dependent patients. A multisite clinical trial of smoking cessation (SC) treatment was performed at outpatient community-based substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment, Clinical Trials Network. Cigarette smokers (N=225) from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned in a 2:1 ratio to receive either (1) SC treatment as an adjunct to substance abuse treatment-as-usual (TAU) or (2) substance abuse TAU. Smoking cessation treatment consisted of 1 week of group counseling before the target quit date and 8 weeks of group counseling plus transdermal nicotine patch treatment (21 mg/day for Weeks 1-6 and 14 mg/day for Weeks 7 and 8) after the target quit date. Smoking abstinence rates in SC, 10%-11% during treatment and 5%-6% at the 13- and 26-week follow-up visits, were significantly better than those in TAU during treatment (p< .01). In addition, SC was associated with significantly greater reductions as compared with TAU in cigarettes smoked per day (75% reduction, p< .001), exhaled carbon monoxide levels (p< .001), cigarette craving (p< .05), and nicotine withdrawal (p< .05). Smoking cessation did not differ from TAU on rates of retention in substance abuse treatment, abstinence from primary substance of abuse, and craving for primary substance of abuse. Compliance with SC treatment, moderate at best, was positively associated with smoking abstinence rates. Smoking cessation treatment resulted in significant reductions in daily smoking and modest smoking abstinence rates without having an adverse impact on substance abuse rehabilitation when given concurrently with outpatient substance abuse treatment. Substance abuse treatment programs should not hesitate to implement SC for established patients.
van Roode, Thea; Dickson, Nigel; Herbison, Peter; Paul, Charlotte
Objectives: To determine the impact of child sexual abuse (CSA) on adult sexual behaviors and outcomes over three age periods. Methods: A longitudinal study of a birth cohort born in Dunedin, New Zealand in 1972/1973 was used. Information on CSA was sought at age 26, and on sexual behaviors and outcomes at ages 21, 26, and 32. Comparisons were…
Volkow, Nora D.; Montaner, Julio
Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. In this article we explain the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment—both for HIV and for substance abuse. We summarize evidence showing that injection drug users can successfully undergo HIV treatment; that many substance abusers adhere to antiretroviral therapy as well as do people who don’t inject drugs; and that injection drug users who undergo substance abuse treatment are more likely to obtain and stay in treatment for their HIV infection. This evidence makes a strong case for integrating substance abuse treatment with HIV treatment programs and providing substance abusers with universal access to HIV treatment. But an integrated strategy will require changes in the health care system to overcome lingering obstacles that inhibit the merging of substance abuse treatment with HIV programs. PMID:21821558
Petry, Nancy M.; Roll, John M.
Contingency management (CM) treatments that provide patients with the opportunity to earn chances of winning prizes of varying magnitudes are becoming increasingly popular. In the CM literature, magnitude of reinforcement is linked with effect sizes, such that CM treatments that provide larger magnitude reinforcement are more efficacious than those that provide lower magnitude reinforcement. With prize CM, even when magnitudes of overall expected prize earnings are constant, some patients win more prizes than others. Thus, patients who win larger overall amounts of prizes during treatment may have better outcomes than those who win fewer prizes. This study evaluated the impact of overall amounts of prizes won on long-term abstinence outcomes. The dollar amount of prizes won during prize CM treatments was determined from 78 cocaine abusing methadone maintenance patients who were randomized to prize CM treatments in three clinical trials. Abstinence three months following the end of the CM intervention was the primary dependent variable. The dollar amount of prizes won during CM treatment was a significant predictor of submission of cocaine-negative urine samples and self reports of cocaine abstinence at the follow-up evaluation, even after controlling for other variables associated with long-term abstinence such as pre-treatment urinalysis results and longest duration of abstinence achieved during treatment. These results suggest that magnitudes of earnings during prize CM may impact outcomes and call for further experimentation of parameters related to the efficacy of prize CM. PMID:21707189
Chu, Doris C; Sung, Hung-En
Many offenders participate in drug abuse treatment programs while in prison or on probation or parole. Among other benefits, this treatment may lessen the risk of recidivism. Thus, understanding counselor treatment philosophy is important as their attitudes toward treatment can be influential in the strategies they use and ultimately affect treatment outcomes. Analyzing data from 110 drug abuse treatment counselors, this study compared counselors' perceptions of causation of drug abuse and treatment strategy between faith-based and secular treatment programs. It was found that counselors from faith-based programs were more likely to endorse religious models and less prone to support disease models as an explanation of drug use. With regard to treatment strategy, counselor's group affiliation was not predictive of a focus on either a client religious need or a medical treatment model. Nevertheless, the extent of counselor's religiosity was correlated with tackling clients' religious needs as a treatment strategy. On the other hand, certified (licensed) counselors were found to be more supportive of the medical model as a treatment approach. Limitations of the current study and policy implications are discussed.
Sirey, Jo Anne; Berman, Jacquelin; Salamone, Aurora; DePasquale, Alyssa; Halkett, Ashley; Raeifar, Elmira; Banerjee, Samprit; Bruce, Martha L; Raue, Patrick J
The goal of this pilot program was to test the feasibility of mental health screening among elder abuse victims and of offering those victims a brief psychotherapy for depression and anxiety. Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomized to receive one of three different interventions concurrent with abuse resolution services. Staff were able to screen 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was successfully implemented in two different formats with collaboration between staff workers. These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice.
Wong, Eunice C; Longshore, Douglas
There is increasing concern over whether standard health care services, such as substance abuse treatment, adequately account for important cultural influences, yet studies focusing on the impact of cultural influences on substance abuse treatment continue to be limited. The current study prospectively examined the effects of two cultural factors (ethnic identity and spirituality) on substance abuse treatment outcomes among Hispanic American clients (N=114) enrolled in methadone maintenance treatment. In addition, this study examined whether a commonly studied treatment factor (i.e., self-efficacy) significantly influenced treatment outcomes. Higher levels of self-efficacy at intake were related to increased odds of reported heroin abstinence and a lower number of drugs used at 1-year follow-up. Greater levels of ethnic identity were related to a greater number of drugs used at follow-up. No significant effects were found for spirituality.
Background The importance of diagnosing and treating co-occurring psychiatric disorders among substance abusers in treatment has received much attention. The aim of this study was to investigate to which extent co-occurring psychiatric disorders are diagnosed in a clinical population of substance abusers, and which factors (including the use of MINI-Plus) that influence the diagnosing of co-occurring psychiatric disorders. Methods Patients (N = 275) who received inpatient substance use treatment in five different units in Northern Norway participated in the study. The patients’ clinicians gave information on diagnoses given during the stay in the units, and whether a systematic diagnostic tool was used for the diagnosing (MINI-Plus). Predictors of independent co-occurring psychiatric disorders were examined utilizing hierarchical regression analysis. Results One third of the patients were given an independent psychiatric diagnosis. Less than half of the patients were assessed using a diagnostic tool. The main predictor of diagnosing of independent psychiatric disorders was the use of the diagnostic tool MINI-Plus. Younger patients and patients that used less alcohol, were given independent psychiatric diagnoses more frequently. Conclusions The number of co-occurring independent psychiatric diagnoses was lower compared to other studies using standardized diagnostic tools. The low number of patients assessed by such a tool, and the strong relationship between the use of such a tool and the diagnosing of co-occurring psychiatric disorders, suggest that the implementation of standardized diagnostic tools should be addressed in the units. Generally, patients suffering from substance use disorders should be systematically screened for other psychiatric disorders, in order to improve their treatment and health. PMID:23742628
Tiffany, Stephen T.; Friedman, Lawrence; Greenfield, Shelly F.; Hasin, Deborah S.; Jackson, Ron
Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review articles. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of “other” measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research. PMID:21981638
This article examines the unique ethical considerations for the provision of family therapy as substance abuse treatment. Use of family therapy as substance abuse treatment has grown rapidly, but the ethical codes that guide clinical practice have not kept pace. Ethical pitfalls specific to family counseling within alcohol and drug treatment…
George Washington Univ. Medical Center, Washington, DC.
A survey sought to determine the nature and extent of family therapy practiced in treatment and rehabilitation agencies serving drug abuse clients. Questionnaire responses to a three-phase study were on a voluntary basis. Phase I, with a 60% response rate, gathered information on the number of drug abuse treatment agencies providing family…
As a valuable addition to substance abuse treatment, adventure programming can have positive impacts on clients' self-efficacy, social behavior, and problem solving. A study explored the extent to which traditional substance abuse treatment programs use adventure programming, the level of adventure training and experience among substance abuse…
Cook, Paddy; Gartner, Constance Grant; Markl, Lise; Henderson, Randi; Brooks, Margaret K.; Wesson, Donald; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayes, Elizabeth
The major goal of this TIP, on the best practice guidelines to improve the treatment of substance abuse, is to provide clinicians, educators, and paraprofessionals with the latest findings concerning domestic violence. The information is intended to educate providers about the needs and behaviors of batterers and survivors, and how to tailor…
Lo, Celia C.; Cheng, Tyrone C.
Using data from the 2007 National Survey on Drug Use and Health, this study examines whether several social exclusion and psychological factors affect adolescents' receipt of substance abuse treatment. Multinomial logistic regression techniques were used to analyze data. The study asked how the specified factors provide pathways to receipt of…
McCarty, Dennis; Fuller, Bret; Kaskutas, Lee Ann; Wendt, William W; Nunes, Edward V; Miller, Michael; Forman, Robert; Magruder, Kathryn M; Arfken, Cynthia; Copersino, Marc; Floyd, Anthony; Sindelar, Jody; Edmundson, Eldon
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.
McCarty, Dennis; Fuller, Bret; Kaskutas, Lee Ann; Wendt, William W.; Nunes, Edward V.; Miller, Michael; Forman, Robert; Magruder, Kathryn M.; Arfken, Cynthia; Copersino, Marc; Floyd, Anthony; Sindelar, Jody; Edmundson, Eldon
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed organizational (n = 106 of 112; 95% response rate) and treatment unit surveys (n = 348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to N-SSATS (National Survey of Substance Abuse Treatment Services), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services proved. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice. PMID:17875368
Coleman-Cowger, Victoria H
Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.
Wheeler, J R; Fadel, H; D'Aunno, T A
BACKGROUND. Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. METHODS. Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. RESULTS. Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. CONCLUSIONS. There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units. PMID:1314520
Kim, Tackeun; Oh, Chang Wan; Bang, Jae Seung; Kim, Jeong Eun; Cho, Won-Sang
Although the pathogenesis of moyamoya disease (MMD) has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. The main mechanism of surgical revascularization is augmenting the intracranial blood flow using an external carotid system by either direct bypass or pial synangiosis. This can improve resting cerebral blood flow as well as vascular reserve capacity. For direct revascularization, the superficial temporal artery is used as the donor artery in most cases, although the occipital artery may be used in limited cases. Usually, the cortical branch of the middle cerebral artery is selected as the recipient of direct anastomosis. As for indirect revascularization, various techniques using different kinds of connective tissues have been introduced. In some cases, reinforcing the anterior cerebral artery and the posterior cerebral artery territories can be considered. The effectiveness of surgical revascularization for preventing ischemic stroke had been generally accepted by many studies. However, for preventing hemorrhagic stroke, new evidence has been added by a recent randomized controlled trial. The incidence of peri-operative complications such as stroke and hyperperfusion syndrome seems to be high due to the nature of the disease and technical demands for treatment. Preventing and adequately managing these complications are essential for ensuring the benefits of surgery. PMID:26846757
Biswas, A; Ratnam, S S
Vaginismus is a condition of involuntary spasm of the muscles surrounding the outer third of the vagina that is brought about by real, imagined or anticipated attempts at vaginal penetration and often leads to non-consummation of marriage. It is a classic psychosomatic disorder where phobia of vaginal penetration often stems from sexual ignorance, previous traumatic experiences or religious orthodoxy. Management of vaginismus aims at helping the woman to regain voluntary control of her pelvic floor muscles. The treatment utilises a behavioural method aimed at teaching relaxation of pelvic floor muscles together with a systematic desensitization of the fear of vaginal penetration. There are two approaches to vaginal desensitization. The first is gradual desensitization using vaginal self-dilatation, and the second method utilises rapid desensitization brought about by vaginal mould insertion. Of these, the rapid method is preferred at our institution. Surgical correction is almost never required and may be detrimental to achieving success. Management of these conditions requires a warm, empathetic attitude and demands great patience and understanding on the part of the physician. Between 1985 and 1991, 19 patients with vaginismus were treated at the National University Hospital, with a rapid desensitization programme using vaginal moulds. All 19 women could achieve satisfactory vaginal intercourse within 2 to 6 weeks of commencement of therapy.
Myers, B; Parry, C D H; Plüddemann, M A
Few studies have investigated the demand for substance abuse treatment in South Africa. This article uses data collected from specialist substance abuse treatment centres to describe substance abuse treatment demand and patterns of service utilisation in Cape Town for the period January 1997 to December 2001. Findings suggest that although treatment demand for alcohol-related problems remains high, treatment demand for substances other than alcohol has increased over time. Patterns of treatment service utilisation suggest that women and black South Africans remain underserved. The need for comprehensive and accessible substance abuse treatment services in Cape Town is highlighted and recommendations are made for improving access to treatment services, and undertaking comprehensive evaluations of existing treatment facilities.
McElroy, Eoin; Shevlin, Mark; Elklit, Ask; Hyland, Philip; Murphy, Siobhan; Murphy, Jamie
Background Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes. Results There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses. Highlights of the article The prevalence of Axis I disorders were assessed in a large sample of sexual abuse and incest survivors. The impact of demographic and abuse characteristics were also examined. There was significant variation in the prevalence of disorders. Abuse characteristics were differentially associated with the disorders. Abuse from multiple perpetrators was the strongest overall predictor of psychopathology. PMID:27064976
Mitchell, Damon; Hirschman, Richard
This project examined the frequency of within treatment drinking and surreptitious drinking among patients who attended a brief substance abuse treatment program that mandated within treatment abstinence. We defined surreptitious drinking as within treatment drinking that is kept hidden from treatment staff. Data for this project came from the anonymous exit surveys of 275 patients. Forty-eight patients (17.45%) indicated that they engaged in within treatment drinking at least once. Forty-one of those patients (87%) kept the drinking hidden from treatment staff. The most common reason for patients keeping their drinking hidden was a fear of discharge from treatment. Within treatment drinkers were compared to within treatment abstainers in the extent to which their treatment was coerced, the extent to which treatment was perceived as helpful, and their posttreatment intentions for substance use and follow-up care. Differences between these two groups, and their implications, are discussed.
Shamseddeen, Wael; Asarnow, Joan Rosenbaum; Clarke, Gregory; Vitiello, Benedetto; Wagner, Karen Dineen; Birmaher, Boris; Keller, Martin B.; Emslie, Graham; Iyengar, Satish; Ryan, Neal D.; McCracken, James T.; Porta, Giovanna; Mayes, Taryn; Brent, David A.
Objective: We previously reported that a history of abuse was associated with a poorer response to combination treatment in the Treatment of Resistant Depression in Adolescents study (TORDIA). We now report on the nature and correlates of abuse that might explain these findings. Method: Youth who did not benefit from an adequate selective…
Crandal, Brent R.; Foster, Sharon L.; Chapman, Jason E.; Cunningham, Phillippe B.; Brennan, Patricia A.; Whitmore, Elizabeth A.
Effective evaluation of treatment requires the use of measurement tools producing reliable scores that can be used to make valid decisions about the outcomes of interest. Therapist-rated treatment outcome scores that are obtained within the context of empirically supported treatments (EST) could provide clinicians and researchers with data that are easily accessible and complimentary to existing instrumentation. We examined the psychometric properties of scores from the Therapist Perception of Treatment Outcome: Youth Antisocial Behavior (TPTO:YAB), an instrument developed to assess therapist judgments of treatment success among families participating in an EST, Multsystemic Therapy (MST), for youth with antisocial behavior problems. Data were drawn from a longitudinal study of MST. The initial 20-item TPTO was completed by therapists of 111 families at mid-treatment and 163 families at treatment termination. Rasch model dimensionality analyses provided evidence for two dimensions reflecting youth- and caregiver-related aspects of treatment outcome, although a bifactor analyses suggested that these dimensions reflected a single more general construct. Rasch analyses were also used to assess item and rating scale characteristics and refine the number of items. These analyses suggested items performed similarly across time and that scores reflect treatment outcome in similar ways at mid and post-treatment. Multilevel and zero-order analyses provided evidence for the validity of TPTO scores. TPTO scores were moderately correlated with scores of youth and caregiver behaviors targeted in treatment, adding support to its use as a treatment outcome measurement instrument. PMID:25642936
... 1 According to data from the Treatment Episode Data Set (TEDS), the proportion of female substance abuse treatment ... at time of admission is a TEDS Supplemental Data Set item. Thirty-four States and jurisdictions—AZ, CA, ...
Hingson, R; Zakocs, R; Heeren, T; Winter, M; Rosenbloom, D; DeJong, W
Objective: This analysis tested whether comprehensive community interventions that focus on reducing alcohol availability and increasing substance abuse treatment can reduce alcohol related fatal traffic crashes. Intervention: Five of 14 communities awarded Fighting Back grants by The Robert Wood Johnson Foundation to reduce substance abuse and related problems attempted to reduce availability of alcohol and expand substance abuse treatment programs (FBAT communities). Program implementation began on 1 January 1992. Design: A quasi-experimental design matched each program community to two or three other communities of similar demographic composition in the same state. Main outcome measures: The ratio of fatal crashes involving a driver or pedestrian with a blood alcohol concentration of 0.01% or higher, 0.08% or higher, or 0.15% or higher were examined relative to fatal crashes where no alcohol was involved for 10 years preceding and 10 years following program initiation. Results: Relative to their comparison communities, the five FBAT communities experienced significant declines of 22% in alcohol related fatal crashes at 0.01% BAC or higher, 20% at 0.08% or higher, and 17% at 0.15% or higher relative to fatal crashes not involving alcohol. Conclusions: Community interventions to reduce alcohol availability and increase substance abuse treatment can reduce alcohol related fatal traffic crashes. PMID:15805436
Dalton, Jarrod E; Dawson, Neal V; Sessler, Daniel I; Schold, Jesse D; Love, Thomas E; Kattan, Michael W
Randomized trials provide strong evidence regarding efficacy of interventions but are limited in their capacity to address potential heterogeneity in effectiveness within broad clinical populations. For example, a treatment that on average is superior may be distinctly worse in certain patients. We propose a technique for using large electronic health registries to develop and validate decision models that measure-for distinct combinations of covariate values-the difference in predicted outcomes among 2 alternative treatments. We demonstrate the methodology in a prototype analysis of in-hospital mortality under alternative revascularization treatments. First, we developed prediction models for a binary outcome of interest for each treatment. Decision criteria were then defined based on the treatment-specific model predictions. Patients were then classified as receiving concordant or discordant care (in relation to the model recommendation), and the association between discordance and outcomes was evaluated. We then present alternative decision criteria and validation methodologies, as well as sensitivity analyses that investigate 1) the imbalance between treatments on observed covariates and 2) the aggregate impact of unobserved covariates. Our methodology supplements population-average clinical trial results by modeling heterogeneity in outcomes according to specific covariate values. It thus allows for assessment of current practice, from which cogent hypotheses for improved care can be derived. Newly emerging large population registries will allow for accurate predictions of outcome risk under competing treatments, as complex functions of predictor variables. Whether or not the models might be used to inform decision making depends on the extent to which important predictors are available. Further work is needed to understand the strengths and limitations of this approach, particularly in relation to those based on randomized trials. PMID:25852080
Callaghan, Russell C; Brewster, Joan M; Johnson, Joy; Taylor, Lawren; Beach, Glenn; Lentz, Tim
Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population ( approximately 80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between cigarette-smoking bans and key clinical outcomes. The current study examined the medical charts of all adolescents (N = 520) admitted to the only adolescent hospital-based substance abuse treatment program in the northern two thirds of the province of British Columbia, Canada. During the span of the study period (March 2001-December 2005), the treatment site moved from a partial smoking ban to a total smoking ban, and then retreated to partial smoking ban. The total smoking ban was not associated with a lower proportion of adolescent smokers seeking treatment at the facility or a lower treatment completion rate among smokers. Total smoking bans do not appear to be an obstacle for adolescent smokers seeking residential substance abuse treatment, nor do total smoking bans appear to compromise the treatment completion rates of smokers in comparison to nonsmokers. Despite these null findings, the effective implementation of smoke-free policies in adolescent substance abuse treatment programs requires not only large-scale organizational change but also the transformation of current commonly held beliefs about tobacco dependence in addictions treatment and recovery communities.
Holdaway, I M; Rajasoorya, C R; Gamble, G D; Stewart, A W
A number of groups have developed guidelines to indicate whether an individual with acromegaly has been cured by treatment. However, studies to date do not provide a robust definition of biochemical remission of the disorder based on correlation with long-term outcome. Available data suggest that those with a random serum growth hormone (GH) level of <2.5 microg/l, or a glucose-suppressed GH level of <1 microg/l following treatment have mortality figures indistinguishable from the general population. However, the confidence limits for these mortality estimates are quite wide. It remains possible that growth hormone levels lower than 1 microg/l for random samples, or even lower when using ultrasensitive GH assays, may indicate superior outcome, but this remains to be confirmed. There are limited data relating serum insulin-like growth factor-I (IGF-I) levels to outcome, although normalisation of serum IGF-I clearly improves outcome compared with continued elevation of measurements after treatment. Current evidence suggests that a post-treatment random serum GH <2.5 microg/l and a normal serum IGF-I value defines biochemical cure. Available data suggest that achieving similar growth hormone levels after treatment also reduces the prevalence of chronic complications of the disorder, which is subsequently reflected in improved mortality. PMID:12914751
Pérez Gómez, Augusto; Sierra Acuña, Diana Raquel
This study examines the concept of natural recovery (without formal treatment) from problems associated with alcohol, marijuana, cocaine and heroin abuse, each one alone or in any combination. Two groups of males (40 Ss between 18 and 60 years of age) and two groups of females (19 Ss between 18 and 55 years of age) with at least one year of abstinence were studied. The main issues considered were: reason for attending treatment or ceasing the use of substances, factors related to maintenance of abstinence, and difficulties and threats associated with abstinence. Several significant differences were found between groups with and without treatment, as well as between males and females, particularly regarding factors related to the maintenance of abstinence. In both cases family and affective links appear as the most relevant factors in the decision to stop using substances. On the other hand, commitment to one's goals and life project are the principal motives for maintaining abstinence or moderate consumption. This reflects the progressive transition from cognitive and emotional processes with external referents to processes with internal referents, associated with personal achievement. PMID:18173103
Grella, Christine E.; Greenwell, Lisa; Prendergast, Michael; Sacks, Stanley; Melnick, Gerald
This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning. PMID:18683206
Parish, R A; Myers, P A; Brandner, A; Templin, K H
Few objective measures of the efficacy of intervention programs in the treatment of child abuse exist. One such measure may be improvement in the developmental delays often seen in abused children. Using the Learning Assessment Profile, we tested 53 abused children, ages 2.5-5 years, just before and after involvement in our Family Development Center Program (FDC). The FDC emphasizes therapy-group-interaction for parents, where alternative ways of expressing anger are explored. Children attend daily preschool classes, and take occasional outside field trips. Of the 53 children tested 42 (79%) showed greater than expected developmental skills gains. Six children demonstrated no improvement in developmental skills, four of whom had severe developmental delays in one or two areas. Fine motor and language skills were significantly delayed for the group as a whole; these areas showed the greatest improvement after FDC. There did not appear to be an overall association between increased improvement in developmental skills and length of time in the FDC program, although certain subgroups of children appeared to improve with time while others appeared to lose ground. A five-year follow-up study of these children is presently underway. We conclude that a program which involves both parent and child, and focuses on their interaction, appears to be effective in dealing with abusive families; monitoring developmental levels in the abused children is one means of assessing their progress in such a program. Further controlled prospective trials are needed in this area.
Campbell, Aimee N. C.; Nunes, Edward V.; Matthews, Abigail G.; Stitzer, Maxine; Miele, Gloria M.; Polsky, Daniel; Turrigiano, Eva; Walters, Scott; McClure, Erin A.; Kyle, Tiffany L.; Wahle, Aimee; Van Veldhuisen, Paul; Goldman, Bruce; Babcock, Dean; Stabile, Patricia Quinn; Winhusen, Theresa; Ghitza, Udi E.
Objective Drug and alcohol abuse constitutes a major public health problem. Computer-delivered interventions have potential to improve access to quality care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System, an internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders. Method Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to 12-weeks of treatment-as-usual (n=252) or treatment-as-usual + Therapeutic Education System, whereby the intervention substituted for 2 hours of standard care per week (n=255). Therapeutic Education System consists of 62 computer-interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment-as-usual consisted of individual and group counseling at the participating programs. Primary outcomes were (1) abstinence from drugs and heavy drinking measured by twice weekly urine drug screens and self-report, and (2) time to drop-out from treatment. Results Compared to treatment-as-usual, those receiving Therapeutic Education System reduced dropout from treatment (Hazard Ratio=0.72 [95% CI, 0.57-0.92], P=.010), and increased abstinence (Odds Ratio=1.62 [95% CI: 1.12-2.35], P=.010), an effect that was more pronounced among patients with a positive urine drug and/or breath alcohol screen at the point of study entry (n=228) (Odds Ratio=2.18 [95% CI: 1.30-3.68], P=.003). Conclusion Internet-delivered interventions, such as Therapeutic Education System, have the potential to expand access and improve addiction treatment outcomes; additional research is needed to assess effectiveness in non-specialty clinical systems and to differentiate the effect of Community Reinforcement Approach and Contingency Management. PMID:24700332
Gruber, K; Chutuape, M A; Stitzer, M L
We evaluated 3-month outcomes for reinforcement-based intensive outpatient treatment (RBT), a new relapse prevention behavior therapy for inner city opiate abusers. The therapy provides abstinence-contingent partial support of housing, food and recreational activities, abstinence-contingent access to social skills and job finding group therapy and non-contingent individual counseling, all in the context of a day treatment program. Heroin abusers (n = 52), contacted at a 3-day detoxification unit, were randomly assigned to RBT (n = 28) or referred to community treatment resources (n = 24) after a staff escort from the detoxification unit. For RBT patients, treatment began on the day of discharge; 61% received partial rent support in a recovery house based on the need for drug-free housing; the remainder were eligible for partial support of utility payments where they lived. Abstinence-based contingencies were in effect for 1 month with three times per week counseling available for an additional 2 months. One month after detoxification, 61% of RBT versus 17% of referral patients were enrolled in outpatient treatment (P < 0.01); RBT patients were significantly less likely than controls to have returned to any drug use; and 50% of RBT versus 21% of controls reported 30 days of abstinence from heroin and cocaine with confirmatory negative urine (P < 0.05). RBT patients had significantly lower scores on the Beck Depression Inventory at 1 month (M = 9.0 versus 17.6 for controls; P < 0.05) and showed evidence of less alcohol use and higher rates of employment. These results establish the short-term efficacy for RBT and support continued development and evaluation of this new outpatient behavioral treatment. PMID:10661672
Neumann, Anne; Ojong, Tambetta N.; Yanes, Paula K.; Tumiel-Berhalter, Laurene; Daigler, Gerald E.; Blondell, Richard D.
This study examined the admission characteristics associated with failure to complete residential substance abuse treatment among male adolescents. Of 160 admissions, 48 (30%) completed treatment. Having commercial health insurance (P = 0.005), having a family history of a substance use disorder (P = 0.05), and living with only one biological parent (P = 0.015) were admission characteristics associated with non-completion. Those reporting a history of physical or sexual abuse also appeared to be at risk for non-completion (P = 0.014); none of these patients completed the treatment. Interventions that improve residential substance abuse treatment retention for adolescents are needed. PMID:20924878
This article provides a comprehensive review of research studies that have examined the diffusion of evidence-based treatments (EBTs) within the field of substance abuse treatment. Sixty-five research studies were identified and were grouped into one of three major classifications: attitudes toward EBTs, adoption of EBTs, and implementation of EBTs. This review suggests significant progress has been made with regard to the advancement of the fields’ knowledge about attitudes toward and the extent to which specific EBTs have been adopted in practice, as well as with regard to the identification of organizational factors related to EBT adoption. In an effort to advance the substance abuse treatment field towards evidence-based diffusion practices, recommendations are made for greater use of methodologically rigorous experimental or quasi-experimental designs, psychometrically sound instruments, and integration of quantitative and qualitative data collection. PMID:19008068
Fernández-Montalvo, Javier; López-Goñi, José J; Arteaga, Alfonso
This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed.
Holt, Richard L; Montesinos, Sylvia; Christensen, Richard C
The rate of lifetime exposure to physical and/or sexual abuse among homeless women is very high, and the prevalence of depression, anxiety, and substance abuse is greater in this population than in the general population. The relationship between abuse and mental illness in homeless women is incompletely understood. Using multivariable logistic regression, the present study examines this relationship in a retrospective study of women seeking treatment at a psychiatric clinic for the homeless in Jacksonville, Florida. The results of this study indicate a strong association between abuse history and anxiety disorders, especially posttraumatic stress disorder. PMID:17242595
Kearney-Cooke, A; Striegel-Moore, R H
In this article a parallel is drawn between the psychological problems experienced by victims of childhood sexual abuse and by clients with eating disorders. In particular, we describe how sexual abuse has a significant and lasting effect on body image, identity, self-regulation, and interpersonal functioning. Treatment issues are outlined including the nature of the healing relationship, assessment of abuse, development of capacity for self-soothing, techniques for assisting in memory recall, sculpting of images, description and reenactment of abuse, dealing with shame, and ending the cycle of repeated victimization.
Leister, Sandra C.
Little information is available on therapeutic interventions or counseling techniques used with sexually abused children. Many experts consider parental and family support to be the single most important factor in preventing abuse from becoming a life destroying event. The goals of therapy are to make the child and family feel better about…
Seligson, Anne Glinert
Object relations theory offers the most viable explanation of the dynamics of sexually abused individuals by allowing for the conceptualization of an individual, whose earlier object relations left him barren, lonely, or neglected, as having a predisposition or vulnerability to abuse. Children with adequate nurturing experiences react negatively…
King, H. Elizabeth; And Others
These papers on child and adolescent sexual abuse address the psychological consequences, psychological assessment techniques, and clinical issues in group therapy with sexually abused girls. In the first paper. H. Elizabeth King discusses the psychological consequences of sexual assault and incest on minors particularly in regard to family…
Chong, Jenny; Lopez, Darlene
The objective of this study was to describe the predictors of substance use relapse of American Indian (AI) women up to one year following substance abuse treatment. Relapse is defined as any use of alcohol or drugs in the past 30 days at the follow-up points. Data were collected from AI women in a 45-day residential substance abuse treatment…
Latimer, William W.; Ernst, Jenna; Hennessey, Jodi; Stinchfield, Randy D.; Winters, Ken C.
This is a report on a sample of adolescent drug abusers in treatment (N = 220) to estimate the degree to which probable ADHD status increases the odds of posttreatment alcohol, marijuana, and other drug relapse during the initial 6 months following discharge. Drug abusing youth with probable ADHD status exhibited 2.5 times the risk of…
Wentzer, Carol; Dhir, Annie
Guidelines for working with the hearing impaired in an inpatient substance abuse treatment program include recognition of the deaf culture, use of a qualified sign language interpreter, fluency in American Sign Language and deaf culture by the primary substance abuse counselor, and patient contact with recovering deaf persons. (DB)
Stohr, Mary K.; Hemmens, Craig; Baune, Diane; Dayley, Jed; Gornik, Mark; Kjaer, Kirstin; Noon, Cindy
This Research for Practice examines the Residential Substance Abuse Treatment (RSAT) program at the South Idaho Correctional Institution. The program targets parole-violating inmates with substance abuse problems in an effort to reduce recidivism. Researchers conducted a 15-month evaluation of the program's process to identify strengths and…
Maine State Dept. of Mental Health and Mental Retardation, Augusta.
The document presents Maine's model for providing substance abuse treatment to the client with mental retardation. Introductory information on retardation and substance abuse is followed by a discussion of this population's unique problems. Services offered in the Mental Retardation Alcoholism project are reviewed, and contracts and cooperative…
Grella, Christine E.; Hser, Yih-Ing; Huang; Yu-Chuang
Problem: Greater awareness of the role of parental substance abuse in child maltreatment makes it imperative that the substance abuse treatment and child welfare systems coordinate services for these parents. Yet little is known about the characteristics of child-welfare involved parents (primarily mothers) who enter into substance abuse…
West, Paul L.; Hamm, Terri
Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors. (Contains 3…
Stahmer, Aubyn C.; Sutton, Danielle Thorp; Fox, Lise; Leslie, Laurel K.
Each year nearly 900,000 cases of child abuse and neglect are substantiated in the United States, with the highest rates of maltreatment occurring among infants and toddlers. Children exposed to maltreatment are at increased risk of developmental delay. The Child Abuse Prevention and Treatment Act specifies that children under age 3 with…
National Center for Child Advocacy (DHEW/OHD), Washington, DC.
The two reports reprinted here address prevention and treatment of child abuse and neglect in rural areas through self-help programs. The larger report, that of the Appalachian Citizens for Children's Rights (ACCR) Project, describes project purposes: to develop a community development model for child abuse/neglect using resources already existing…
Ong, Lee Za; Lee, Dal-Yob; Cha, Grace; Arokiasamy, Charles
One hundred rehabilitation counselors in California reported that about 90% of consumers with whom they worked with had substance abuse and cooccurring issues, yet about half rated their graduate training in substance abuse treatment and assessment as poor and their practices as marginally proficient. The correlation analysis revealed that…
Broadhurst, Diane D.
The manual delineates the roles of the educator in child abuse and neglect identification, treatment, and prevention. Chapter I addresses the nature, extent, causes, and effects of child abuse and neglect. Chapter II explains why educators should be involved with discussion of legal and ethical issues relating to the problem. A third chapter…
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community... RDAP, they must participate in TDAT in the community. If inmates refuse or fail to complete TDAT,...
Turner, Win C; Muck, Randolph D; Muck, Rebekah J; Stephens, Robert L; Sukumar, Bhuvana
This article explores the rates of co-occurring disorders in two large federally-funded programs that target youth. In the mental health treatment system, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) supports the Comprehensive Community Mental Health Services for Children and Their Families Program. SAMHSA's Center for Substance Abuse Treatment (CSAT) supports a number of grant programs providing substance abuse treatment for adolescents. The data from these programs underscores the need for the use of systematic, validated, biopsychosocial assessment instruments for all youth entering either the substance abuse or mental health treatment systems. The current evidence base for models of co-occurring treatment for youth is discussed and recommendations made for future activity related to adolescent co-occurring treatment.
Smith, Brenda D; Liu, Junqing
As more substance abuse treatment counselors begin to use evidence-based treatment techniques, questions arise regarding the continued use of traditional techniques. This study aims to (1) assess whether there are meaningful practice profiles among practitioners reflecting distinct combinations of cognitive-behavioral and traditional treatment techniques; and (2) if so, identify practitioner characteristics associated with the distinct practice profiles. Survey data from 278 frontline counselors working in community substance abuse treatment organizations were used to conduct latent profile analysis. The emergent practice profiles illustrate that practitioners vary most in the use of traditional techniques. Multinomial regression models suggest that practitioners with less experience, more education, and less traditional beliefs about treatment and substance abuse are least likely to mix traditional techniques with cognitive-behavioral techniques. Findings add to the understanding of how evidence-based practices are implemented in routine settings and have implications for training and support of substance abuse treatment counselors.
Murrell, William D; Anz, Adam W; Badsha, Humeira; Bennett, William F; Boykin, Robert E; Caplan, Arnold I
In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair.
Brown, Lawrence S; Kritz, Steven; Goldsmith, R Jeffrey; Bini, Edmund J; Robinson, Jim; Alderson, Donald; Rotrosen, John
The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments. Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor. These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections. PMID:17639646
Carrico, Adam W; Flentje, Annesa; Gruber, Valerie A; Woods, William J; Discepola, Michael V; Dilworth, Samantha E; Neilands, Torsten B; Jain, Jennifer; Siever, Michael D
Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment. PMID:24744105
Winters, Ken C.; Fahnhorst, Tamara; Botzet, Andria; Lee, Susanne; Lalone, Britani
This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12–18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parent (N = 315) were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6-months) and absolute (status at 6-months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared to the CON group. Also, youth receiving the BI-AP condition showed significantly better outcomes compared to the BI-A group on several variables. Problem-solving skills and utilization of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed. PMID:22000326
Cohen, Lisa R.; Greenfield, Shelly F.; Gordon, Susan; Killeen, Therese; Jiang, Huiping; Zhang, Yulei; Hien, Denise
A strong association between substance use disorders (SUD) and eating disorders (ED) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multi-site clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD. The Eating Disorder Examination-self report (EDE-Q), and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD and depression symptoms at baseline than those in the No Binge group. Though all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a sub-group of women with co-occurring PTSD and SUDs who endorsed binge ED symptoms responded differently to SUD/PTSD group treatment. Identification of eating disorder symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes. PMID:20525031
Kyei-Aboagye, K.; Acker, D. B.; MacBain, D.
The birth outcome for pregnant drug abusers is complicated by polydrug use, neonatal withdrawal symptoms, and low birth weight. To improve birth outcome, in-hospital detoxification and stabilization from drug use followed by drug-free residential living with prenatal care were provided for patients committed to cessation of illicit drug use. Pregnant heroin or cocaine abusers with significant drug use were eligible for the study. The birth outcome for the 30 term singletons born to the mothers in the program was statistically compared with respect to low birth weight, mean birth weight and length of stay in the nursery to that for 44 term singleton infants of a similar group of drug-abusing ambulatory pregnant women in our aftercare clinic, not in the residential program. Twenty percent of 152 patients evaluated were found suitable for admission to the program. Numerical data for term singletons were as follows: weights (g +/- SD), 3218 +/- 596 (30) vs control 2806 +/- 317 (44); low birth weights; 1/30 vs control 12/44; and length of stay in the nursery (days +/- SD), 3 +/- 0.5 (30) vs control 5.5 +/- 2.5 (44). For the pregnant drug abuser committed to cessation of drug use, detoxification followed by drug free living leads to a statistically significant improvement in birth outcome.
Lee, Anselm C. W.; Li, C. H.; So, K. T.
Objective: To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. Study period: Two 2-year periods before (1994-1995) and after (2002-2003) the implementation of the protocol in 1998. Methods: This is a retrospective hospital chart review in…
Tolliver, Bryan K; Anton, Raymond F
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
Tolliver, Bryan K; Anton, Raymond F
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients. PMID:26246792
... CONTROL POLICY Technology Innovations for Substance Abuse and Mental Health Treatment Conference & Related Health Information Technology (HIT) Meeting AGENCY: Office of National Drug Control Policy. ACTION... (SAMHSA) in partnership with the Office of the National Coordinator for Health Information Technology,...
Slesnick, Natasha; Prestopnik, Jillian L.
Runaway youth report a broader range and higher severity of substance-related, mental health and family problems relative to non-runaway youth. Most studies to date have collected self-report data on the family and social history; virtually no research has examined treatment effectiveness with this population. This study is a treatment development project in which 124 runaway youth were randomly assigned to 1) Ecologically-Based Family Therapy (EBFT) or 2) Service as Usual (SAU) through a shelter. Youth completed an intake, posttreatment, 6 and 12 month follow-up assessment. Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions. Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth. PMID:15878048
Howell, Leonard L.; Negus, S. Stevens
The acute and chronic effects of abused psychostimulants on monoamine transporters and associated neurobiology have encouraged development of candidate medications that target these transporters. Monoamine transporters in general, and dopamine transporters in particular, are critical molecular targets that mediate abuse-related effects of psychostimulants such as cocaine and amphetamine. Moreover, chronic administration of psychostimulants can cause enduring changes in neurobiology reflected in dysregulation of monoamine neurochemistry and behavior. The current review will evaluate evidence for the efficacy of monoamine transporter inhibitors and substrates to reduce abuse-related effects of stimulants in preclinical assays of stimulant self-administration, drug discrimination and reinstatement. In considering deployment of monoamine transport inhibitors and substrates as agonist-type medications to treat stimulant abuse, the safety and abuse liability of the medications are an obvious concern, and this will also be addressed. Future directions in drug discovery should identify novel medications that retain efficacy to decrease stimulant use but possess lower abuse liability, and evaluate the degree to which efficacious medications can attenuate or reverse neurobiological effects of chronic stimulant use. PMID:24484977
Howell, Leonard L; Negus, S Stevens
The acute and chronic effects of abused psychostimulants on monoamine transporters and associated neurobiology have encouraged development of candidate medications that target these transporters. Monoamine transporters, in general, and dopamine transporters, in particular, are critical molecular targets that mediate abuse-related effects of psychostimulants such as cocaine and amphetamine. Moreover, chronic administration of psychostimulants can cause enduring changes in neurobiology reflected in dysregulation of monoamine neurochemistry and behavior. The current review will evaluate evidence for the efficacy of monoamine transporter inhibitors and substrates to reduce abuse-related effects of stimulants in preclinical assays of stimulant self-administration, drug discrimination, and reinstatement. In considering deployment of monoamine transport inhibitors and substrates as agonist-type medications to treat stimulant abuse, the safety and abuse liability of the medications are an obvious concern, and this will also be addressed. Future directions in drug discovery should identify novel medications that retain efficacy to decrease stimulant use but possess lower abuse liability and evaluate the degree to which efficacious medications can attenuate or reverse neurobiological effects of chronic stimulant use. PMID:24484977
Sirey, Jo Anne; Berman, Jacquelin; Salamone, Aurora; DePasquale, Alyssa; Halkett, Ashley; Raeifar, Elmira; Banerjee, Samprit; Bruce, Martha L.; Raue, Patrick J.
Objective The goal of this pilot program was to test the feasibility of mental health screening among elder abuse victims and enrolling those victims into a brief psychotherapy useful with both depression and anxiety. Methods Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomized to receive one of three different mental health interventions concurrent with abuse resolution services. This design helped determine the acceptability of each intervention offered and thus the optimal format for service delivery. Results Staff were able to integrate mental health screening for 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was able to be implemented in two different formats, with collaboration between elder abuse and mental health staff workers. Discussion These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice. PMID:25611116
Schultz, Nicole R; Blonigen, Daniel; Finlay, Andrea; Timko, Christine
Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild-(78.9%), moderate (13.6%), and severe (7.5%)-distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.
This research deals primarily with an overview of drug use and/or abuse, with specific discussion of the halfway house concept of treatment, including definition, historical framework, rationales, and inherent problems of halfway houses as modalities of treatment (i.e., economics of the treatment modality). Other special treatment modalities are…
McNeese-Smith, Donna K
Alcohol and drug abuse is a major problem in Australia and caused over 4000 deaths in 1998 alone. The national policy for reducing the harmful consequences of drug and alcohol use focuses on decreasing the production and supply of drugs, reducing the demand for drugs including a focus on abstinence in treatment, and minimizing the harm to individuals and communities. This research examines substance abuse treatment in Australia, and identifies similarities and differences in funding, philosophy, purpose, and strategies between public and private treatment programs. Interviews of 21 treatment program directors in Sydney and Melbourne were done, using a valid and reliable semi-structured interview guide. Nine public, not-for-profit programs primarily focused on consultation to medical providers, detoxification, outpatient counseling, and harm minimization including methadone treatment and needle exchange. Rehabilitation, prevention, and/or research were objectives of a limited number. Twelve private, non-governmental programs primarily provided abstinence-based treatment in a variety of settings. Some for-profit programs, funded by insurance, provided three to four weeks inpatient care, usually with outpatient follow-up. Not-for-profit programs provided residential treatment in a therapeutic community over a period of 6 months to 2 years. Still others (both profit and not-for-profit) provided methadone treatment or outpatient treatment. Four were church related and six received funding through government contracts, social security illness benefits, and housing assistance. The general lack of structured rehabilitation programs seemed to be the greatest weakness of the Australian public programs. A low percentage of patients completing detoxification entered counseling, and studies were not available to show the outcomes of detoxification without follow-up. The availability of consultations to hospitals and health care practitioners seemed to be an excellent advantage
Onyeka, Ifeoma N; Uosukainen, Hanna; Korhonen, Maarit Jaana; Beynon, Caryl; Bell, J Simon; Ronkainen, Kimmo; Föhr, Jaana; Tiihonen, Jari; Kauhanen, Jussi
The epidemiological part of the Huume tietokanta (HUUTI) consortium research project is the first large-scale longitudinal study of treatment-seeking illicit drug abusers in Finland. The objective of this report was to describe the sociodemographic characteristics and drug abuse patterns of treatment-seeking clients at their first visit. This study analysed baseline data of 4817 clients (3365 men and 1452 women) aged 11-65 years who sought treatment for drug abuse between 1997 and 2008 at Helsinki Deaconess Institute. Data were collected using a structured questionnaire. The majority (56%) of clients were between 15 and 24 years, educated at elementary school level (75%), and unemployed (57%). Opiates (30%) were the primary drugs of abuse. The primary drugs were mostly injected (45%) and were abused daily during the past month (44%). Cannabis was the most common secondary drug of abuse (34%). The secondary drugs were predominantly smoked (39%) or taken orally (38%) and were abused once per week or less frequently during the past month (33%). Age at initiation of illicit drug abuse ranged from 5 to 49 years. Polydrug abuse was common, with a mean consumption of 3.5 concurrent polydrug use, which were combined from 3 or more drug classes. The prevalence of lifetime/ever intravenous drug abuse was 64% and past month intravenous drug abuse was 64%, respectively, and 13% reported sharing injecting equipment during the past month. Early initiation, polydrug abuse, and risky consumption of illicit drugs were major areas of concern among the study population. Injecting drug use could place considerable burden on health services in view of complications and transmission of infectious diseases.
Belitz, J; Schacht, A
Male youths from abusive family environments may be particularly vulnerable to recruitment into satanic cults. Families that are abusive, devalue or invalidate the abused child's feelings, blame the child for the family's problems, and view the world in rigidly moralistic terms create environments in which the youths are likely to identify with the aggressor and label themselves as evil. These youths, who may have poor social skills and feelings of anger, low self-esteem, self-blame, depression, powerlessness, and isolation as a result of the abuse, may use satanic involvement as a means of legitimizing their experience and differentiating from a negatively enmeshed and/or abusive family system. In this paper, the etiological factors and treatment approaches of ten hospitalized boys who had voluntarily involved themselves in repeated group satanic activities during their adolescence are described, and two case illustrations are given. Recommendations for understanding and treating such cases are provided. PMID:1471565
Belitz, J; Schacht, A
Male youths from abusive family environments may be particularly vulnerable to recruitment into satanic cults. Families that are abusive, devalue or invalidate the abused child's feelings, blame the child for the family's problems, and view the world in rigidly moralistic terms create environments in which the youths are likely to identify with the aggressor and label themselves as evil. These youths, who may have poor social skills and feelings of anger, low self-esteem, self-blame, depression, powerlessness, and isolation as a result of the abuse, may use satanic involvement as a means of legitimizing their experience and differentiating from a negatively enmeshed and/or abusive family system. In this paper, the etiological factors and treatment approaches of ten hospitalized boys who had voluntarily involved themselves in repeated group satanic activities during their adolescence are described, and two case illustrations are given. Recommendations for understanding and treating such cases are provided.
Peles, Einat; Potik, David; Schreiber, Shaul; Bloch, Miki; Adelson, Miriam
The aim of this study was to assess the prevalence of a history of sexual abuse and its relation to psychiatric comorbidity among former opiate addicts currently on methadone maintenance treatment (MMT). We evaluated the history of sexual abuse and current clinical obsessive compulsive disorder (OCD), dissociative identity disorder (DID), and complex posttraumatic distress disorder (cPTSD), and administered the Life Events Inventory Questionnaire among 125 MMT patients (76 females and 49 males). Eighty (64%) patients had experienced sexual abuse, 69 (55.2%) met the criteria for clinical OCD, 20 (16.0%) for cPTSD and 13 (10.4%) for DID. More females had clinical OCD than males (63.2% vs. 42.9%, respectively, p=0.03). Sexually abused patients had higher rates of clinical OCD than their non-abused counterparts (67.5% vs. 33.3%, respectively, p<0.0005) and a higher mean number of negative life events (8.0±2.0 vs. 7.1±1.8, p=0.01). Sexually abused patients showed a trend towards a higher Dissociative Experiences Scale score (17.6±10.1 vs. 14.6±8.1, p=0.08) and rate of DID (13.8% vs. 4.4%, p=0.1), but no significant difference in the rate of cPTSD (17.5% vs. 13.3%, p=0.6) compared to non-abused subjects. The 80 sexually abused patients were mostly female (85%), and 57.5% of them were abused by a family member. In summary, more sexually abused MMT patients were diagnosed with clinical OCD and fewer with cPTSD and DID. Those with cPTSD were characterized by more negative life events, higher dissociation scores, and assaults by a family member. We conclude that sexually abused MMT patients should be screened for clinical OCD.
Acevedo, Andrea; Garnick, Deborah W.; Lee, Margaret T.; Horgan, Constance M.; Ritter, Grant; Panas, Lee; Davis, Steve; Leeper, Tracy; Moore, Rebecca; Reynolds, Mark
This study examined variations by race/ethnicity in initiation and engagement, two performance measures of treatment for substance use disorders, which focus on the timely receipt of services during the early stage of treatment. Administrative data from the Oklahoma Department of Mental Health and Substance Abuse Services were linked with facility-level information from the National Survey of Substance Abuse Treatment Services. We found that Black clients were less likely to initiate treatment, but we found no differences in treatment engagement by race/ethnicity. Most client and facility characteristics’ association with initiation or engagement did not differ across racial/ethnic groups. Increased attention is needed to understand what may contribute to the differences found and how to address them. This study also offers an approach that state agencies may implement for monitoring treatment quality and examining racial/ethnic disparities in substance abuse treatment services. PMID:22381120
Choi, Sam; Ryan, Joseph P
A significant number of substance-abusing parents in the child welfare system do not complete substance abuse treatments. Consequently, their children experience longer stays in substitute care settings, and the risk of the termination of parental rights is increased. This study identifies and determines the specific factors that explain the completion of substance abuse treatment for substance-abusing caregivers in child welfare. The sample includes 871 caregivers enrolled in the Illinois Alcohol and Other Drug Abuse waiver demonstration. Approximately 22% of these caregivers successfully completed all required levels of substance abuse treatment. The multivariate models indicate that age, employment status, and legal involvement were significantly associated with the likelihood of completing substance abuse treatment. Heroin users were significantly less likely to complete treatment as compared with alcohol, cocaine, and marijuana users. The findings are discussed in terms of policy and practice implications for public child welfare systems.
Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam
Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p < 0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study. PMID:25605438
Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam
Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p < 0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study.
Resnick, Heidi S; Walsh, Kate; Schumacher, Julie A; Kilpatrick, Dean G; Acierno, Ron
To inform intervention approaches, the current study examined prevalence and comorbidity of recent use and history of abuse of alcohol, marijuana, and other illicit drugs as well as history of substance treatment among a sample of female victims of sexual assault seeking post-assault medical care. Demographic variables and prior history of assault were also examined to further identify factors relevant to treatment or prevention approaches. Participants were 255 women and adolescent girls seeking post sexual assault medical services who completed an initial follow-up assessment on average within 3 months post-assault. The majority (72.9%) reported recent substance use prior to assault, approximately 40% reported prior substance abuse history, and 12.2% reported prior substance treatment history. Prior history of assault was associated with recent drug use and history of drug abuse as well as substance treatment. Among those with prior histories of substance abuse and assault, assault preceded substance abuse onset in the majority of cases. Almost all those with prior treatment history reported recent drug or alcohol use. A portion of sexual assault survivors seen for acute medical services may benefit from facilitated referral for substance abuse treatment in addition to counseling at the time of screening. Assessment and intervention approaches should target alcohol, marijuana, and other illicit drug use and abuse. Substance use and associated impairment may serve as a rape tactic by perpetrators of assault. Substance use at the time of assault does not imply blame on the part of assault victims. Previous findings indicate that rape poses high risk of PTSD particularly among women with prior history of assault. Screening and intervention related to substance abuse should be done with recognition of the increased vulnerability it may pose with regard to assault and the high risk of PTSD within this population.
Peles, Einat; Seligman, Zivya; Bloch, Miki; Potik, David; Sason, Anat; Schreiber, Shaul; Adelson, Miriam
To determine the effect of sexual abuse history on chronic pain and its relation to opioid addiction and methadone maintenance treatment (MMT), we studied current women MMT patients, and women patients from a sexual abuse treatment center with no history of opioid addiction. Questionnaires included Chronic Pain, Chronic Severe Pain, the Yale-Brown Obsessive Compulsive Scale, the Dissociative Experiences Scale (DES), and the Structured Interview for Disorders of Extreme Stress (complex-PTSD). Chronic severe pain was most prevalent among sexually abused women with no history of opioid addiction (64% of 25), followed by sexually abused MMT women (30.9% of 68), and MMT women with no history of sexual abuse (25% of 8, p = 0.01). Pain severity correlated with dissociation and complex-PTSD scores. The sexually abused non-MMT women had higher rates of high dissociation scores (DES ≥ 30) and complex-PTSD, but fewer obsessive-compulsive disorder symptoms (scored ≥16) than the MMT sexually abused women. Chronic pain was found to be highly prevalent among sexually abused women, independent of being methadone-maintained with an addiction history. The high known prevalence of chronic pain among MMT patients, which may be attributable to opioid-induced hyperalgesia, may partially reflect the sexual abuse history, and should be targeted in future studies evaluating pain indices. PMID:27430532
Peles, Einat; Seligman, Zivya; Bloch, Miki; Potik, David; Sason, Anat; Schreiber, Shaul; Adelson, Miriam
To determine the effect of sexual abuse history on chronic pain and its relation to opioid addiction and methadone maintenance treatment (MMT), we studied current women MMT patients, and women patients from a sexual abuse treatment center with no history of opioid addiction. Questionnaires included Chronic Pain, Chronic Severe Pain, the Yale-Brown Obsessive Compulsive Scale, the Dissociative Experiences Scale (DES), and the Structured Interview for Disorders of Extreme Stress (complex-PTSD). Chronic severe pain was most prevalent among sexually abused women with no history of opioid addiction (64% of 25), followed by sexually abused MMT women (30.9% of 68), and MMT women with no history of sexual abuse (25% of 8, p = 0.01). Pain severity correlated with dissociation and complex-PTSD scores. The sexually abused non-MMT women had higher rates of high dissociation scores (DES ≥ 30) and complex-PTSD, but fewer obsessive-compulsive disorder symptoms (scored ≥16) than the MMT sexually abused women. Chronic pain was found to be highly prevalent among sexually abused women, independent of being methadone-maintained with an addiction history. The high known prevalence of chronic pain among MMT patients, which may be attributable to opioid-induced hyperalgesia, may partially reflect the sexual abuse history, and should be targeted in future studies evaluating pain indices.
McAllister, B B; Kiryanova, V; Dyck, R H
During and following pregnancy, women are at considerable risk of experiencing depression. For treatment, selective serotonin reuptake inhibitor drugs, such as fluoxetine, are commonly prescribed, yet the potential effects of perinatal exposure to these drugs on the brain and behaviour have not been examined in humans beyond childhood. This is despite abundant evidence from studies using rodents indicating that altered serotonin levels early in life affect neurodevelopment and behavioural outcomes. These reported effects on behaviour are inconsistent, however, and the testing of females has often been overlooked. In the present study, the behavioural outcomes of female mice perinatally (embryonic day 15 to postnatal day 12) treated with fluoxetine (25mg/kg/day) via a non-stressful method of maternal administration were assessed using a battery of tests. Maternal treatment resulted in subtle alterations in anxiety-like and depression-like behaviour in early adulthood, with a decrease in both types of behaviour as well as body weight. Though altered anxiety and depression have previously been reported in this area of research, decreased anxiety is a novel finding. While there was little effect of perinatal maternal fluoxetine treatment on many of the behaviours assessed, the capacity to alter "emotional" behaviours in mice has implications with regard to research on human infant fluoxetine exposure.
Lee, A James
This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.
Meikle, M B; Stewart, B J; Griest, S E; Martin, W H; Henry, J A; Abrams, H B; McArdle, R; Newman, C W; Sandridge, S A
There is a wide range of assessment techniques for tinnitus, but no consensus has developed concerning how best to measure either the presenting features of tinnitus or the effects of tinnitus treatments. Standardization of reliable and valid tinnitus measures would provide many advantages including improving the uniformity of diagnostic and screening criteria between clinics and facilitating comparison of treatment outcomes obtained at different sites. This chapter attempts to clarify issues involved in developing self-report questionnaires for the assessment of tinnitus. While the tinnitus questionnaires that are currently available provide valuable information on which to base diagnostic and screening decisions, they were not originally developed in such a way as to maximize their sensitivity to treatment-related changes in tinnitus. As a result, their construct validity for measuring treatment benefit has not received appropriate attention. In this paper, special emphasis is devoted to the use of effect sizes as an estimate of the ability of questionnaires (and their individual items) to measure changes associated with treatment. We discuss the criteria relevant to evaluating the effectiveness of a questionnaire for diagnostic purposes vs. for treatment-evaluation purposes, and we present a detailed illustration of how the various criteria have been applied in a recent questionnaire development effort. PMID:17956815
Chung, Yida Y H; Shek, Daniel T L
This study examined the reasons for seeking treatment among 300 male young heroin abusers in Hong Kong (172 newcomers and 128 repeaters) recruited from non-government drug treatment agencies. A 55-item Reasons for Seeking Treatment Scale (Reasons Scale) was developed to measure the participants' reasons for seeking treatment. The results showed that the scale was internally consistent and six factors with reliable related subscales were extracted. The findings are generally consistent with the "hitting of the bottom" hypothesis, which posits that drug abusers will seek help only when they perceive that their addicted life is out of control. The results suggest that drug treatment and rehabilitation services should target the reasons for seeking treatment among young drug abusers.
Richter, Kimber P; Arnsten, Julia H
Most persons in drug treatment smoke cigarettes. Until drug treatment facilities systematically treat their patients' tobacco use, millions will flow through the drug treatment system, overcome their primary drug of abuse, but die prematurely from tobacco-related illnesses. This paper reviews the literature on the health benefits of quitting smoking for drug treatment patients, whether smoking causes relapse to other drug or alcohol abuse, the treatment of tobacco dependence, and good and bad times for quitting smoking among drug treatment patients. It also presents a conceptual model and recommendations for treating tobacco in substance abuse treatment, and provides references to internet and paper-copy tools and information for treating tobacco dependence. At present, research on tobacco treatment in drug treatment is in its infancy. Although few drug treatment programs currently offer formal services, many more will likely begin to treat nicotine dependence as external forces and patient demand for these services increases. In the absence of clear guidelines and attention to quality of care, drug treatment programs may adopt smoking cessation services based on cost, convenience, or selection criteria other than efficacy. Because research in this field is relatively new, substance abuse treatment professionals should adhere to the standards of care for the general population, but be prepared to update their practices with emerging interventions that have proven to be effective for patients in drug treatment. PMID:16907984
Montgomery, LaTrice; Carroll, Kathleen M.; Petry, Nancy M.
Objective Limited research has evaluated African American substance users’ response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. Method A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. PMID:25798729
Le Fauve, Charlene E; Litten, Raye Z; Randall, Carrie L; Moak, Darlene H; Salloum, Ihsan M; Green, Alan I
This article represents the proceedings of a symposium at the 2003 annual meeting RSA in Fort Lauderdale, FL. It was organized and cochaired by Charlene E. Le Fauve and Carrie L. Randall. The presentations were (1) Introduction, by Charlene E. Le Fauve and Raye Z. Litten; (2) Treatment of co-occurring alcohol use and anxiety disorders, by Carrie L. Randall and Sarah W. Book; (3) Pharmacological treatment of alcohol dependent patients with comorbid depression, by Darlene H. Moak; (4) Efficacy of valproate in bipolar alcoholics: a double blind, placebo-controlled study, by Ihsan M. Salloum, Jack R. Cornelius, Dennis C. Daley, Levent Kirisci, Johnathan Himmelhoch, and Michael E. Thase; (5) Alcoholism and schizophrenia: effects of antipsychotics, by Alan I. Green, Robert E. Drake, Suzannah V. Zimmet, Rael D. Strous, Melinda Salomon, and Mark Brenner; and (6) Conclusions, by Charlene E. Le Fauve; discussant, Raye Z. Litten. Alcohol-dependent individuals have exceptionally high rates of co-occurring psychiatric disorders. Although this population is more likely to seek alcoholism treatment than noncomorbid alcoholics, the prognosis for treatment is often poor, particularly among patients with more severe psychiatric illnesses. Development of effective interventions to treat this population is in the early stages of research. Although the interaction between the psychiatric condition and alcoholism is complex, progress has been made. The NIAAA has supported a number of state-of-the-art pharmacological and behavioral trials in a variety of comorbid psychiatric disorders. Some of these trials have been completed and are presented here. The symposium presented some new research findings from clinical studies with the aim of facilitating the development of treatments that improve alcohol and psychiatric outcomes among individuals with alcohol-use disorders and co-occurring psychiatric disorders. The panel focused on social anxiety disorder, depression, bipolar disorder, and
Robbins, Cynthia A.; Martin, Steven S.; Surratt, Hilary L.
This article reports analyses of recidivism and relapse experiences of substance-abusing women inmates as they reenter the community. Outcomes are compared for women who completed a work-release therapeutic community program, women who entered but did not complete the program, and those who did not receive work-release therapeutic community…
Bowles, Steven; Louw, Johann; Myers, Bronwyn
Directors' and treatment staff's perceptions of organizational functioning within substance abuse treatment facilities in four provinces in South Africa were examined via the Texas Christian University's Organizational Readiness for Change instrument. Forty-four treatment facilities (out of 89) participated in the study. Results indicated that…
Taxman, Faye S.; Walters, Scott T.; Sloas, Lincoln B.; Lerch, Jennifer; Rodriguez, Mayra
Background Motivational interviewing (MI) is a promising practice to increase motivation, treatment retention, and reducing recidivism among offender populations. Computer-delivered interventions have grown in popularity as a way to change behaviors associated with drug and alcohol use. Methods/Design Motivational Assistance Program to Initiate Treatment (MAPIT) is a three arm, multisite, randomized controlled trial, which examines the impact of Motivational Interviewing (MI), a Motivational Computer Program (MC), and Supervision as Usual (SAU) on addiction treatment initiation, engagement, and retention. Secondary outcomes include drug/alcohol use, probation progress, recidivism (i.e., criminal behavior) and HIV/AIDS testing and treatment among probationers. Participant characteristics are measured at baseline, 2, and 6 months after assignment. The entire study will include 600 offenders, with each site recruiting 300 offenders (Baltimore City, Maryland and Dallas, Texas). All participants will go through standard intake procedures for probation and participate in probation requirements as usual. After standard intake, participants will be recruited and screened for eligibility. Discussion The results of this clinical trial will fill a gap in knowledge about ways to motivate probationers to participate in addiction treatment and HIV care. This randomized clinical trial is innovative in the way it examines the use of in-person vs. technological approaches to improve probationer success. Trial Registration NCT01891656 PMID:26009023
Doyle, William W., Jr.
This presentation by a practicing marital therapist describes how exercise behavior can be used as a preventive measure against spouse abuse. This crisis intervention approach is intended to help couples develop stopgap techniques to prevent physical violence; it is one segment of a more comprehensive approach which might include contingency…
The paper describes a federally funded project of the University of Alberta (Canada) addressing sexual assault and sexual abuse of people with disabilities. Written in outline style, the paper briefly describes project activities and general conclusions. Phase I of the project documented the nature and extent of the problem. It was concluded that…
... consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press. 3. Pinto, S. M., Dodd, S., Walkinshaw, S. A., ... Health, 22 (1), 50-55. 6. Office on Child Abuse and Neglect, Children’s Bureau, ICF International. (2009). Protecting ...
Leukefeld, Carl G.; Godlaski, Ted; Clark, James; Brown, Cynthia; Hays, Lon
Describes how structured stories can be used as a part of a therapy for rural substance abusers and discusses how this approach can complement social skills training. Presents an example of a structured story focused on negative thinking and concludes with a discussion of the possibilities of using structured stories and implications for social…
Saleh, Shadi S.; Vaughn, Thomas; Levey, Samuel; Fuortes, Laurence; Uden-Holmen, Tanya; Hall, James A.
Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management…
Horton, Evette; Murray, Christine
Maternal substance abuse is a risk factor for child maltreatment, child attachment insecurity, and maladaptive social information processing. The aim of this study was to conduct a quantitative exploratory evaluation of the effectiveness of an attachment-based parent program, Circle of Security-Parenting (COS-P; G. Cooper, K. Hoffman, & B. Powell, 2009), with a community sample of 15 mothers in residential treatment for substance abuse. Participants attended nine weekly group sessions and were given three measures at pretest and posttest: the Emotion Regulation Questionnaire (J.J. Gross & O.P. John, 2003), the Parent Attribution Test (D. Bugental, ), and the Parenting Scale (D.S. Arnold, S.G. O'Leary, L.S. Wolff, & M.M. Acker, 1993). The results indicate that mothers who attended the majority of group sessions showed greater improvements on all three variables. Participants who attended some of the sessions showed some improvements on the measures, but participants who did not attend the group sessions had no improvements, and on some measures, declined significantly. Further analyses of demographic data indicates that participants with more education, no personal history of child maltreatment, less time in the residential program, and lower social desirability scores demonstrated more positive outcomes. These findings suggest that the COS-P may positively impact parental risk factors associated with child maltreatment and maladaptive social information processing in the context of residential substance-abuse treatment.
Hikitsuchi, Emi; Matsumoto, Toshihiko; Wada, Kiyoshi; Tanibuchi, Yuko; Takano, Ayumi; Imamura, Fumi; Kawachi, Hiraku; Wakabayashi, Asako; Kato, Takashi
In this study, we compared the efficacy of a group relapse prevention program using the cognitive behavioral therapy-based workbook, Serigaya Methamphetamine Relapse Prevention Program (SMARPP), between patients abusing the so-called "dappou drugs" (designer drug in Japan, and those abusing methamphetamine (MAP). Both groups participated in the SMARPP at the Center Hospital, National Center of Neurology and Psychiatry. Results showed that, no significant differences were found in the rates of participation in the program or self-reported frequency of drug or alcohol use between the patients abusing "dappou drugs" or MAP. However, patients using "dappou drugs" reported no significant increase in their confidence in their ability to resist the temptation to use drugs on the self- report drug abuse scales after the SMARPP intervention, while patients abusing MAP reported a significant positive difference in their ability to resist temptation. In addition, insight into substance abuse problems and motivation to participate in further treatment slightly declined in those using "dappou drugs," while there was a significant increase reported by the patients using MAP. These results suggested that the SMARPP might not be as effective for patients abusing "dappou drugs" as for those abusing MAP. The development of a relapse prevention program specifically designed for patients abusing "dappou drugs" is required. PMID:25831947
Lamoureux, Brittain E.; Palmieri, Patrick A.; Jackson, Anita P.; Hobfoll, Stevan E.
We examined a dual pathway, longitudinal mediational model in which child sexual abuse (CSA) influences adulthood interpersonal functioning and sexual risk through its impact on resiliency resources and psychological distress. Women were recruited from two obstetrics and gynecological clinics serving primarily low-income, inner-city women (N = 693) and interviewed at pretest (Time 1) and 6-month follow-up (Time 2). The proposed mediators were resiliency resources (i.e., self-esteem and self-efficacy) and psychological distress (i.e., depressive and posttraumatic stress symptoms). The interpersonal outcomes were general interpersonal problems (measured via recent loss of interpersonal resources, lack of perceived current social support, and recent social conflict) and HIV/sexual risk (measured via lack of confidence asserting safe sex practices, intimate partner risk, and perceived barriers to safe sex). A respecified partial structural equation model implying full mediation supported our hypotheses (CFI = .96, RMSEA = .05, SRMR = .04). The impact of CSA on interpersonal problems was mediated through its effect on psychological distress, whereas the impact of CSA on HIV/sexual risk was mediated through its effect on resiliency resources. Implications for intervention are discussed. PMID:23543033
Lund, Jessie I; Day, Kimberly L; Schmidt, Louis A; Saigal, Saroj; Van Lieshout, Ryan J
The high prevalence of child sexual abuse (CSA) is concerning, particularly as survivors are at increased risk for multiple adverse outcomes, including poor mental health across the lifespan. Children born at an extremely low birth weight (ELBW; <1000g) and who experience CSA may be a group that is especially vulnerable to psychopathology later in life. However, no research has considered the mental health risks associated with being born at ELBW and experiencing CSA. In this study, we investigated the mental health of 179 ELBW survivors and 145 matched normal birth weight (NBW; >2500g) participants at ages 22-26 and 29-36. At age 22-26, CSA was associated with increased odds of clinically significant internalizing (OR=7.32, 95% CI: 2.31-23.23) and externalizing (OR=4.65, 95% CI: 1.11-19.51) problems among ELBW participants exposed to CSA compared to those who did not, though confidence intervals were wide. At age 29-36, CSA was linked to increased odds of any current (OR=3.43, 95% CI: 1.08-10.87) and lifetime (OR=7.09, 95% CI: 2.00-25.03) non-substance use psychiatric disorders, however, this did not hold after adjustment for covariates. Statistically significant differences in mental health outcomes were not observed in NBW participants exposed to CSA compared to NBW participants who were not exposed. Survivors of significant perinatal adversity who are also exposed to CSA may be at higher risk for psychopathology through the fourth decade of life. PMID:27500386
Merrill, Jeffrey C
This paper explores results of a program for substance-abusing welfare recipients in New Jersey. New Jersey hired an outside contractor, placed them in the welfare offices and proactively identified recipients with problems, assessed and placed them in appropriate treatment and then managed their care. The program eased the burden on welfare caseworkers who had had little motivation to help these recipients obtain treatment. While the initiative started slowly, because of concerns of the caseworkers and the recipients, recruitment, assessment and placement rates have continued to grow. In addition, those getting into treatment now appear to be receiving more treatment services as opposed to only detox (which was what they primarily received in the past) with no additional costs to the program. Finally, some preliminary outcomes data indicates improvements in the population in terms of both less drug use and increased employment. PMID:15201116
Calsyn, R J; Winter, J P; Morse, G A
This study used a non-equivalent control group design to investigate the effect of consumer choice of treatment on both process and outcome variables. All study participants suffered from severe mental illness, were homeless at baseline, and were enrolled in a modified Assertive Community Treatment (ACT) program. Consumers in the choice condition had selected the ACT program from a menu of five treatment programs; clients in the no-choice condition were simply assigned to the ACT program by an intake worker. Results found that consumers in the choice condition visited the ACT staff at their offices more than consumers in the no-choice condition, but there were no significant differences between groups on the other treatment process variables. Although consumers in the choice condition increased their income more than consumers in the no-choice condition, there were no significant differences between groups on the other outcome variables (stable housing, psychotic symptoms, depression, and substance abuse). PMID:10800864
Joe, George W; Knight, Danica Kalling; Becan, Jennifer E; Flynn, Patrick M
Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
Krüger, Antje; Ehring, Thomas; Priebe, Kathlen; Dyer, Anne S.; Steil, Regina; Bohus, Martin
Background Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD). However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD. Objective The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined. Methods Female participants (N=74) were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS). Sudden changes were computed as suggested by the literature on sudden gains. Results During treatment, only one participant (3%) experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments. Conclusions Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome. PMID:25317254
Ozbaran, Burcu; Erermis, Serpil; Bukusoglu, Nagehan; Bildik, Tezan; Tamar, Muge; Ercan, Eyyup Sabri; Aydin, Cahide; Cetin, Saniye Korkmaz
Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M…
Lynch, Christina Olenik; Davis, Stephanie Rice
This paper discusses the development of evaluation strategies for a nonprofit child abuse prevention agency in Maryland. The Family Tree, an organization associated with National Parents Anonymous and the National Exchange Club Foundation for the Prevention of Child Abuse, serves more than 15,000 people per year through community training,…
The condition widely known as Munchausen syndrome by proxy comprises both physical abuse and medical neglect and is also a form of psychological maltreatment. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable findings or treatment failures. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. In this statement, factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a medical setting, and recommendations are provided for physicians regarding when to report a case to their state's child protective service agency.
... as drugged driving, violence, stress, and child abuse. Drug abuse can lead to homelessness, crime, and missed work or problems with keeping a job. It harms unborn babies and destroys families. There are different types of treatment for drug abuse. But the best is to prevent drug ...
Paris, Ruth; Herriott, Anna; Holt, Melissa; Gould, Karen
This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent-child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social-emotional development. Additionally, clinicians provided assessments of the parent-child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal-Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent-child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social-emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress.
Paris, Ruth; Herriott, Anna; Holt, Melissa; Gould, Karen
This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent-child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social-emotional development. Additionally, clinicians provided assessments of the parent-child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal-Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent-child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social-emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress. PMID:26455262
Taymoori, Parvaneh; Pashaei, Tahereh
Background This study investigated the correlation between risk-taking and relapse among methamphetamine (MA) abusers undergoing the Matrix Model of treatment. Methods This cross-sectional study was conducted on male patients who were stimulant drug abusers undergoing the matrix treatment in the National Center for Addiction Research. A sampling was done using the availability method including 92 male patients. Demographic questionnaires and drug abuse related questionnaire were completed for each patient. Then, Bart’s balloon risk-taking test was administered to the patients. Findings Participants had a mean age ± standard deviation (SD) of 27.59 ± 6.60 years with an age range of 17-29 years. Unemployment, unmarried status, criminal offense, and also addiction family history increased the probability of relapse. In addition, a greater adjusted score of the risk-taking test increased the odds of relapse by more than 97%. The simultaneous abuse of opium and stimulants compared to the abuse of stimulants only, revealed no statistically significant differences for relapse. Patients with higher risk-taking behavior had a more probability of relapse. Conclusion This finding indirectly implies the usefulness of Bart’s risk-taking test in assessing risk-taking behavior in stimulant drug abusers. PMID:27274793
Cunningham, John A.; Herie, Marilyn; Martin, Garth; Turner, Bonnie J.
The results of field-testing a substance-abuse treatment protocol are reported. Ten probation and parole officers were trained in Structured Relapse Prevention, and 55 clients were treated. Incentives and barriers to treatment are highlighted. The use of this type of field test as a dissemination technique is discussed. (EMK)
In this study, the social network characteristics of 102 urban adolescents in brief substance abuse treatment are described and analyzed longitudinally to examine risk and protective mechanisms. The treatment intervention had one session devoted to social support and networks. Social networks were conceptualized and measured along two dimensions…
Ong, Lee Za; Cardoso, Elizabeth; Chan, Fong; Chronister, Julie; Chou, Chih Chin
Forty-two rehabilitation counselors participated in a study regarding perceived training needs concerning alcohol and other drug abuse (AODA) treatment and assessment. Participants reported that 85% of consumers with whom they worked had AODA issues, yet over half rated their graduate training in AODA treatment and assessment as poor, and their…
Cook, Paddy; Davis, Carolyn; Howard, Deborah L.; Kimbrough, Phyllis; Nelson, Anne; Paul, Michelle; Shuman, Deborah; Brooks, Margaret K.; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayws, Elizabeth
As alcohol and other drug disorders become acknowledged as major problems, the need increases for current information on the scope of the problem and appropriate treatment. This TIP serves to educate treatment providers with information about older adults who, in general, are more likely to hide their substance abuse, less likely to seek…
Teater, Barbra; Hammond, Gretchen Clark
Survey research was used to explore the beliefs of 963 staff members regarding the myths to treating tobacco dependence and the integration of tobacco dependence into substance abuse treatment programs. The staff represented a mixture of residential, outpatient, and prevention-based gender-specific (women only) treatment centers throughout Ohio.…
Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri
Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…
Alexandre, Pierre K.; Beulaygue, Isabelle C.; French, Michael T.; McCollister, Kathryn E.; Popovici, Ioana; Sayed, Bisma A.
Objective: Public and private stakeholders of substance abuse treatment services require economic cost data to guide program evaluations and funding decisions. Background: Rigorous cost assessments have been conducted for several treatment programs across the United States, but a systematic and comprehensive evaluation of programs in a particular…
This document reports on an exhaustive study into the large-scale treatment of drug abuse in New Jersey. Seeking to assess the impact of these programs, the state provided money to cover the cost of this comprehensive, year-long survey of both methadone maintenance and drug-free treatment projects. The findings generally supported the New Jersey…
Mason, Michael J.; Posner, Michael A.
The purpose of this translational research study was to test a brief, manualized adolescent substance abuse treatment protocol's effects in an urban community setting compared to a sample in an experimental study from which the treatment was first employed. One hundred two adolescents who were treated with a manualized protocol of five sessions of…
Murphy, Glynis; Powell, Simon; Guzman, Ana-Maria; Hays, Sarah-Jane
Background: Cognitive-behaviour therapy (CBT) seems to be becoming the treatment of choice for non-disabled sex offenders. Nevertheless, there have been relatively few evaluations of such treatment for men with intellectual disabilities (ID) and sexually abusive behaviour. Method: A pilot study providing CBT for two groups of men with ID is…
Voluse, Andrew C; Gioia, Christopher J; Sobell, Linda Carter; Dum, Mariam; Sobell, Mark B; Simco, Edward R
The psychometric properties of the Drug Use Disorders Identification Test (DUDIT), an 11-item self-report questionnaire developed to screen individuals for drug problems, are evaluated. The measure, developed in Sweden and evaluated there with individuals with severe drug problems, has not been evaluated with less severe substance abusers or with clinical populations in the United States. Participants included 35 drug abusers in an outpatient substance abuse treatment program, 79 drug abusers in a residential substance abuse treatment program, and 39 alcohol abusers from both treatment settings who did not report a drug abuse problem. The DUDIT was found to be a psychometrically sound drug abuse screening measure with high convergent validity (r=.85) when compared with the Drug Abuse Screening Test (DAST-10), and to have a Cronbach's alpha of .94. In addition, a single component accounted for 64.91% of total variance, and the DUDIT had sensitivity and specificity scores of .90 and .85, respectively, when using the optimal cut-off score of 8. Additionally, the DUDIT showed good discriminant validity as it significantly differentiated drug from alcohol abusers. These findings support the DUDIT as a reliable and valid drug abuse screening instrument that measures a unidimensional construct. Further research is warranted with additional clinical populations. PMID:21937169
McClure, Erin A; Acquavita, Shauna P; Dunn, Kelly E; Stoller, Kenneth B; Stitzer, Maxine L
The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.
Gurganus, Kelsey M; Butt, Amir L; Kirchenbauer, Christin M; Melkvik, Chelsie; Piatt, Jamie; Hawkins, Jessica; U'Ren, Stephanie; Onuorah, Young
With substance abuse being a significant problem in Oklahoma, the Oklahoma Department of Mental Health and Substance Abuse Services aimed to address these problems using the Strategic Prevention Framework to empower local communities and to assist in implementing prevention strategies based on epidemiological data by establishing the Regional Epidemiological Outcomes Workgroup (REOW) network. Seventeen REOWs across the state helped identify and use community resources to collect, analyze, and interpret epidemiological data to measure the burden of substance abuse problems and the associated intermediate variables. The REOWs prioritized the needs of each community based on the data, identified the gaps and limitations in available community-level data, and helped find solutions. The REOWs serve as a permanent resource for the communities to establish a sustainable and ongoing monitoring system. With this comprehensive network, prevention providers and coalitions have a partner to assist in strategically allocating resources to address substance abuse and other emerging public health issues. The issues identified among different public health areas can help different community sectors formulate their strategy and address key problems in their areas. The REOW network brings awareness more effectively and efficiently to communities about eminent dangers posed by different health-related problems and behaviors. PMID:25536944
Gurganus, Kelsey M; Butt, Amir L; Kirchenbauer, Christin M; Melkvik, Chelsie; Piatt, Jamie; Hawkins, Jessica; U'Ren, Stephanie; Onuorah, Young
With substance abuse being a significant problem in Oklahoma, the Oklahoma Department of Mental Health and Substance Abuse Services aimed to address these problems using the Strategic Prevention Framework to empower local communities and to assist in implementing prevention strategies based on epidemiological data by establishing the Regional Epidemiological Outcomes Workgroup (REOW) network. Seventeen REOWs across the state helped identify and use community resources to collect, analyze, and interpret epidemiological data to measure the burden of substance abuse problems and the associated intermediate variables. The REOWs prioritized the needs of each community based on the data, identified the gaps and limitations in available community-level data, and helped find solutions. The REOWs serve as a permanent resource for the communities to establish a sustainable and ongoing monitoring system. With this comprehensive network, prevention providers and coalitions have a partner to assist in strategically allocating resources to address substance abuse and other emerging public health issues. The issues identified among different public health areas can help different community sectors formulate their strategy and address key problems in their areas. The REOW network brings awareness more effectively and efficiently to communities about eminent dangers posed by different health-related problems and behaviors.
Kelley, Michelle L; D'Lima, Gabrielle M; Henson, James M; Cotten, Cayla
The purpose of this study was to examine attitudes of substance-abusing mothers and fathers entering outpatient treatment toward allowing their children to participate in individual- or family-based interventions. Data were collected from a brief anonymous survey completed by adults at intake into a large substance abuse treatment program in western New York. Only one-third of parents reported that they would be willing to allow their children to participate in any form of mental health treatment. Results of chi-square analyses revealed that a significantly greater proportion of mothers reported that they would allow their children to participate in mental health treatment (41%) compared to fathers (28%). Results of logistic regression analyses revealed even after controlling for child age, mothers were more likely than fathers to indicate their willingness to allow their children to receive mental health treatment; however, type of substance abuse (alcohol versus drug abuse) was not associated with parents' willingness to allow their children to receive treatment. Parental reluctance to allow their children to receive individual or family-based treatment is a significant barrier in efforts to intervene with these at-risk children. PMID:24680218
Virmani, Ashraf; Binienda, Zbigniew; Ali, Syed; Gaetani, Franco
Nutritional deficiency in combination with drug abuse may increase risk of developing the metabolic syndrome by augmenting cell damage, excitotoxicity, reducing energy production, and lowering the antioxidant potential of the cells. We have reviewed here the following points: effects of drugs of abuse on nutrition and brain metabolism; effects of nutrition on actions of the drugs of abuse; drug abuse and probability of developing metabolic syndrome; role of genetic vulnerability in nutrition/drug abuse and brain damage; and the role of neuroprotective supplements in drug abuse. Nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. The strategies available, in particular the nutritional approach to protect the drug abusers from the metabolic syndrome and other diseases are discussed.
Titus, Janet C.; Dennis, Michael L.; Diamond, Guy; Godley, Susan H.; Babor, Thomas; Donaldson, Jean; Herrell, James; Tims, Frank; Webb, Charles
The Cannabis Youth Treatment (CYT) study is a multi-site randomized field experiment examining five outpatient treatment protocols for adolescents who abuse or are dependent on marijuana. The purpose of the CYT project is twofold: (a) to test the relative clinical effectiveness and cost-effectiveness of five promising interventions targeted at…
Koenig, Lane; Denmead, Gabrielle; Nguyen, Robert; Harrison, Margaret; Harwood, Henrick
This study seeks to quantify the costs and benefits of alcohol and drug abuse treatment and the resulting economic benefits to society. Using data from the National Treatment Improvement Evaluation Study (NTIES), and client questionnaires, estimates were made of the average costs per client in terms of crime-related costs, health care costs, and…
Dell, Colleen Anne; Seguin, Maureen; Hopkins, Carol; Tempier, Raymond; Mehl-Madrona, Lewis; Dell, Debra; Duncan, Randy; Mosier, Karen
First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.
Tracy, Elizabeth M.; Munson, Michelle R.; Peterson, Lance T.; Floersch, Jerry E.
Using a personal social network framework, this qualitative study sought to understand how women in substance abuse treatment describe their network members' supportive and unsupportive behaviors related to recovery. Eighty-six women were interviewed from residential and outpatient substance abuse treatment programs. Positive and negative aspects of women's social networks were assessed via open-ended questions. Analysis was guided by grounded theory techniques using three coders. The findings extend classic social support concepts such as emotional, tangible, and informational support. Practice implications are presented in light of the potential roles network members may play in substance use and recovery. PMID:20953326
Greenfield, Shelly F; Back, Sudie E; Lawson, Katie; Brady, Kathleen T
Gender differences in substance use disorders (SUDs) and treatment outcomes for women with SUDs have been a focus of research in the last 15 years. This article reviews gender differences in the epidemiology of SUDs, highlighting the convergence of male/female prevalence ratios of SUDs in the last 20 years. The telescoping course of SUDs, recent research on the role of neuroactive gonadal steroid hormones in craving and relapse, and sex differences in stress reactivity and relapse to substance abuse are described. The role of co-occurring mood and anxiety, eating, and posttraumatic stress disorders is considered in the epidemiology, natural history, and treatment of women with SUDs. Women's use of alcohol, stimulants, opioids, cannabis, and nicotine are examined in terms of recent epidemiology, biologic and psychosocial effects, and treatment. Although women may be less likely to enter substance abuse treatment than men over the course of the lifetime, once they enter treatment, gender itself is not a predictor of treatment retention, completion, or outcome. Research on gender-specific treatments for women with SUDs and behavioral couples treatment has yielded promising results for substance abuse treatment outcomes in women.
Drug Abuse Office, Prevention, and Treatment Amendments of 1978. Hearing Before the Subcommittee on Alcoholism and Drug Abuse of the Committee on Human Resources, United States Senate, Ninety-Fifth Congress, Second Session on S. 2916.
Congress of the U.S., Washington, DC. Senate Committee on Human Resources.
The purpose of the testimony presented before the Subcommittee on Alcoholism and Drug Abuse in April, 1978 was to amend the drug abuse office and treatment act of 1972, thereby extending assistance programs for drug abuse prevention, education, treatment, rehabilitation and other purposes. Speakers represented such organizations as National…
Traube, Dorian E; He, Amy S; Zhu, Limei; Scalise, Christine; Richardson, Tyrone
To date, few studies have examined the effect of interagency collaboration on substance abuse assessment ity of Southern California and treatment completion for parents who are involved in child welfare. The purpose of this paper is to: (1) describe a statewide, interagency collaborative program aimed at providing targeted substance abuse assessment and treatment to parents engaged in the child welfare system; (2) document the specialized assessment and treatment outcomes for parents engaged through this collaborative program; and (3) determine factors related to successful treatment completion for parents involved in the child welfare system. This is a retrospective study of an open cohort of 13,829 individuals admitted to the New Jersey Child Protection Substance Abuse Initiative (CPSAI) program from October 1, 2009, through September 30, 2010. Data were drawn from two unique administrative data sources. Multivariate Cox regression models were used to explore factors related to successfil treatment completion for parents involved in the child welfare system. Trend analysis for the total sample in the CPSAI program revealed that, of the 10,909 individuals who received a CPSAI assessment, 59% were referred to treatment. Of those referred to treatment, 40% enrolled in a treatment program. Once enrolled in a treatment program, 55% completed or were in the process of completing substance abuse treatment. These findings suggest that when adequate screening and treatment is available through a streamlined process, many of the ethnic and gender disparities present among other populations of individuals seeking treatment are minimized. Utilizing inherent child welfare case factors appears to be an important motivating element that aids parents during the assessment and treatment process.
Lincoln, Alisa K; Liebschutz, Jane M; Chernoff, Miriam; Nguyen, Dana; Amaro, Hortensia
Background Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374). Results Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. Conclusion Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment PMID:16959041
Williams, O J; Becker, R L
Partner abuse literature reveals that treatment is less effective with minorities than with their white counterparts. Our survey of partner abuse programs (N = 142) indicates that, for the most part, little or no special effort is being made to understand or accommodate the needs of minority populations. This colorblind approach lacks the effectiveness of a culturally competent approach, which fosters an environment that helps minority groups succeed in treatment. Do partner abuse programs make efforts to be culturally competent? The major characteristics of an organizational transformation towards cultural competence occur when these programs do the following: (a) network with the minority community, (b) locate outside consultants with expertise in working with minority clients, (c) obtain information concerning service delivery and programming for minority clients, and (d) have at least one bilingual counselor. These four characteristics accounted for .58 of the variance in the minority-focused activities. PMID:7647049
Ducharme, Lori J; Chandler, Redonna K; Harris, Alex H S
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.
Davies, Michelle; Rogers, Paul; Hood, Paul A
This study investigated perceptions of child sexual abuse in a hypothetical cybersexploitation case. Men were predicted to be more negative toward the victim than were women. Victims were predicted to be more negatively judged when they consented to sex than when they did not and when they were lied to than when they were not. Two hundred and seventy-six respondents read a sexual abuse depiction in which the perpetrator's disclosure about his age (being honest from the outset, lying, or refusing to disclose when questioned) and the final outcome of the meeting (consensual verses nonconsensual sexual intercourse) were varied between subjects. Respondents then completed a 17-item attribution scale. ANOVAs revealed broad support for the predictions. Results have implications for education about cybercrime.
Jiménez-Murcia, Susana; Del Pino-Gutiérrez, Amparo; Fernández-Aranda, Fernando; Granero, Roser; Hakänsson, Anders; Tárrega, Salomé; Valdepérez, Ana; Aymamí, Neus; Gómez-Peña, Mónica; Moragas, Laura; Baño, Marta; Sauvaget, Anne; Romeu, Maria; Steward, Trevor; Menchón, José M.
Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment. PMID:27065113
Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey A
The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment. PMID:21184286
Blum, Terry C.; Roman, Paul M.
Boards of directors are the ultimate governing authorities for most organizations providing substance abuse treatment. A governing board may establish policies, monitor and improve operations, and represent a treatment organization to the public. This paper explores alternative configurations of governing boards in a national sample of 500 substance abuse treatment centers. The study proceeds from the premise that boards may be configured with varying levels of engagement in five aspects of internal management and external connections in treatment center operating environments. Based on interviews with treatment center administrative directors, four clusters emerge, describing boards that are: (1) active and balanced across internal and external domains; (2) active boundary spanners concentrating primarily on external relationships; (3) focused primarily on internal organizational management; and (4) relatively inactive. In post hoc analysis, we found that placement in these clusters is associated with treatment center attributes such as rate of growth and financial results, use of evidence based practices and provision of integrated care. PMID:21489737
Fields, Dail; Blum, Terry C; Roman, Paul M
The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBPs) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations.
Blum, Terry C.; Roman, Paul M.
The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBP) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities, and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations. PMID:24722825
Cochran, Bryan N; Cauce, Ana Mari
Previous research has suggested that lesbian, gay, bisexual, and transgender (LGBT) individuals enter treatment for substance abuse with more severe problems than heterosexual individuals. However, methodological difficulties, particularly the difficulty of obtaining a representative sample, have limited the ability to draw conclusions about LGBT individuals who receive services for substance abuse. This study took advantage of a unique opportunity to examine a representative sample of openly LGBT clients receiving publicly funded substance abuse treatment by using data gathered by treatment providers in Washington State. Baseline differences between openly LGBT and heterosexual clients were compared in a variety of domains. Results demonstrated that openly LGBT clients enter treatment with more severe substance abuse problems, greater psychopathology, and greater medical service utilization when compared with heterosexual clients. When the analyses were stratified based on sex, different patterns of substance use and associated psychosocial characteristics emerged for the LGBT clients. Implications for provision of appropriate services and recommendations to treatment agencies are discussed in this article. PMID:16490677
Amaro, Hortensia; Larson, Mary Jo; Zhang, Annie; Acevedo, Andrea; Dai, Jianyu; Matsumoto, Atsushi
Women in substance abuse treatment often have co-occurring mental health disorders and a history of trauma; they are also at high risk for HIV infection and other sexually transmitted diseases via unprotected sex. A quasi-experimental study evaluated the effectiveness of trauma-enhanced substance abuse treatment combined with HIV/AIDS prevention…
Prather, Walter; Golden, Jeannie A.
Attachment theory provides a useful conceptual framework for understanding trauma and the treatment of children who have been abused. This article examines childhood trauma and attachment issues from the perspective of behavior analysis, and provides a theoretical basis for two alternative treatment models for previously abused children and their…
... of Services of Other Federal Agencies § 17.80 Alcohol and drug dependence or abuse treatment and... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Alcohol and drug dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract....
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Limitations on payment for alcohol and drug dependence or abuse treatment and rehabilitation. 17.83 Section 17.83 Pensions... Agencies § 17.83 Limitations on payment for alcohol and drug dependence or abuse treatment...
... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Limitations on payment for alcohol and drug dependence or abuse treatment and rehabilitation. 17.83 Section 17.83 Pensions... Agencies § 17.83 Limitations on payment for alcohol and drug dependence or abuse treatment...
Minugh, P. Allison; Janke, Susan L.; Lomuto, Nicoletta A.; Galloway, Diane K.
Context: Rural and frontier states are significantly affected by substance abuse and poverty. The high rate of substance abuse coupled with high levels of dependence on state-funded treatment systems places a burden on rural treatment systems and makes resource allocation a central planning issue. Purpose: The goal of this study was to combine…
Husky, Mathilde M; Mazure, Carolyn M; Carroll, Kathleen M; Barry, Danielle; Petry, Nancy M
Contingency management (CM) treatments have been shown to be effective in reducing substance use. This manuscript illustrates how the experience sampling method (ESM) can depict behavior and behavior change and can be used to explore CM treatment mechanisms. ESM characterizes idiosyncratic patterns of behavior and offers the potential to determine how behavioral patterns are affected by the operant conditioning principles that drive CM. It may also lead to the identification of new target behaviors for CM in the context of substance abuse treatment.
Slesnick, Natasha; Prestopnik, Jillian L
Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents (N = 119) and their primary caretakers from two runaway shelters and assigned them to (a) home-based ecologically based family therapy (EBFT), (b) office-based functional family therapy (FFT), or (c) service as usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared with SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome.
Masson, Carmen L; Shopshire, Michael S; Sen, Soma; Hoffman, Kim A; Hengl, Nicholas S; Bartolome, John; McCarty, Dennis; Sorensen, James L; Iguchi, Martin Y
This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population.
Ozechowski, Timothy J.; Waldron, Holly Barrett
In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse can have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders, and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered. PMID:18690540
Background Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue. Methods This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes. Results We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services. Conclusions Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings. PMID:24938281
Higgs, A. Catherine
Presented are federal standards designed to synthesize and describe the knowledge available on the prevention and treatment of child abuse and negect. A summary chapter (Chapter I) covers background information, organization and content of the standards, and utilization of the standards. Chapter II discusses the relationships among children,…
Anderson, Lorna M.; Shafer, Gretchen
A collaborative approach to treating sexually abusive families is described, in which such families are viewed as analogous to "character-disordered" individuals. This model, unlike traditional voluntary treatment models, is explained to assume that effective intervention requires authoritative control and careful coordination of all professional…
Aiken, Liona S.; And Others
Volunteers have made significant contributions to mental health by assisting with institutional care, outpatient counseling, aftercare, and research. To describe the use of volunteers in drug abuse treatment programs, volunteers were studied by a telephone survey of administrators in 123 programs that had at least five volunteers and a single…
Van Hasselt, Vincent B.; Schlessinger, Kari M.; DiCicco, Tina M.; Anzalone, William F.; Leslie, Tricia L.; George, John A.; Werder, Edward J.; Massey, Larry L.
The present study provides preliminary data concerning the efficacy of the Adolescent Drug Abuse Prevention and Treatment (ADAPT) Program, a collaborative effort involving mental health and law enforcement. ADAPT is a multi-component, cognitive-behavioral outpatient intervention serving children and youth referred directly from local police…
Morral, Andrew R.; McCaffrey, Daniel F.; Ridgeway, Greg; Mukherji, Arnab; Beighley, Christopher
Each year, substance abuse treatment programs in the United States record approximately 150,000 admissions of youths under the age of 18. Nevertheless, little is known about the effectiveness of the types of community-based services typically available to youths and their families. Recognizing the need for better information on the effectiveness…
... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Community Transitional Drug Abuse Treatment Program (TDAT). 550.56 Section 550.56 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF... condition of participation in a community-based program, with the approval of the Transitional Drug...
Coons, Philip M.
Multiple personality disorder is associated with a high incidence of physical and sexual abuse during childhood. While difficult to diagnose, multiple personality is easier to treat if diagnosed early in childhood or adolescence. Treatment for multiple personality focuses on establishing trust and communicating with and integrating the…
Titus, Janet C.; Schiller, James A.; Guthmann, Debra
The purpose of this study is to provide a profile of youths with hearing loss admitted to substance abuse treatment facilities. Intake data on 4,167 youths (28% female; 3% reporting a hearing loss) collected via the Global Appraisal of Individual Need-I assessment was used for the analyses. Information on demographics, environmental…
Titus, Janet C.
The author profiles the prevalence, severity, and characteristics of victimization among a group of youths with hearing loss presenting to substance abuse treatment. Intake data on 111 deaf and hard of hearing youths (42% female) were analyzed and compared with data from a weighted, gender-matched sample of hearing youths. After gender is…
Diamond, G.M.; Izzard, M.C.; Kedar, T.; Hutlzer, A.; Mell, H.
The objective of this study was to assess the rates of externalizing and internalizing symptoms, and the relation between psychological symptoms and drug use severity, among 117 Israeli adolescents presenting for outpatient drug abuse treatment. Psychological symptoms were assessed via both adolescent self-report and parent report. Drug use was…
Clark, James J.; Leukefeld, Carl; Godlaski, Theodore; Brown, Cyndy; Garrity, John; Hays, Lon
Evaluation of an innovative substance abuse treatment program designed for rural areas involved 45 clients, 10 clinicians, and 2 program directors from three sites. Most clients felt the program was beneficial, but stressful. Clinicians found the program demanding to learn and adopt. Program directors liked the rural-specific design and the…
Faw, Leyla; Hogue, Aaron; Liddle, Howard A.
The authors applied contemporary methods from the evaluation literature to measure implementation in a residential treatment program for adolescent substance abuse. A logic model containing two main components was measured. Program structure (adherence to the intended framework of service delivery) was measured using data from daily activity logs…
Florsheim, Paul; Heavin, Sarah; Tiffany, Stephen; Colvin, Peter; Hiraoka, Regina
This paper describes an experiment designed to test an imagery-based craving management technique with a sample of adolescents diagnosed with substance-use disorders. Seventy adolescents between the ages of 14 and 18 (41 males) were recruited through two substance-abuse treatment programs. The experimental procedure involved stimulating craving…
Glover, Noreen M.; And Others
Volunteer participants (n=77) enrolled in 8 substance abuse treatment facilities were surveyed in order to examine the prevalence and nature of incest contacts among the group. Results indicated that approximately 49 percent of the participants had reported histories of incest. Data are presented under various parameters. Also gives comparisons by…
Ledgerwood, David M.; Alessi, Sheila M.; Hanson, Tressa; Godley, Mark D.; Petry, Nancy M.
Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were…
MacMaster, Samuel A.; Ellis, Rodney A.; Cooper, Lyle
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…
Simons, Lori; Jacobucci, Raymond; Houston, Hank
A quasi-experimental research design with quantitative and qualitative methodologies was conducted to explore reactions of 21 students to treatment manuals for substance abuse. Students were randomized to experimental (n = 11) and attention-control (n = 10) groups involving exposure to one of two manual-based therapy interventions. Quantitative…
Dietz, Tracy J.; Davis, Diana; Pennings, Jacquelyn
This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child…
Belitz, Jerald; Schacht, Anita
Asserts that male youths from abusive family environments may be particularly vulnerable to recruitment into satanic cults. Describes etiological factors and treatment approaches of 10 hospitalized boys who voluntarily involved themselves in repeated group satanic activities during their adolescence. Includes two case illustrations. Provides…
Oliveros, Arazais; Kaufman, Joan
The goal of this paper is to synthesize available data to help guide policy and programmatic initiatives for families with substance abuse problems who are involved with the child welfare system, and identify gaps in the research base preventing further refinement of practices in this area. To date, Family Treatment Drug Court and newly developed…
Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.
The Division of State and Community Assistance of the Center for Substance Abuse Treatment (CSAT), in conjunction with the Administration on Children, Youth and Families (ACYF), held four, two-day State team-building workshops. These workshops were designed to help build the State infrastructure necessary to bring about coordinated delivery of…
Haboush, Karen L; Alyan, Hala
The literature on child sexual abuse reflects growing recognition of the manner in which culture impacts the conceptualization, experience, and treatment of such cases. Despite heightened visibility of Arab Americans within the United States, population due to recent media attention, little empirical research exists on the occurrence of child sexual abuse within this population. Arab culture is often characterized by an emphasis on collectivism and familial obligations, and such features may prove to either facilitate or impede assessment and treatment of child sexual abuse, depending on how they are manifested. In terms of reporting child sexual abuse, cultural values pertaining to shame and honor as well as the stigma attached to mental health problems may influence the response to abuse. As such, enhancing the cultural competence of the therapist is key to facilitating effective cultural practice. Empirical research is required to investigate and substantiate these concepts as they relate to child sexual abuse in Arab-American populations. PMID:23829830
Petry, Nancy M; Roll, John M
Contingency management (CM) treatments that provide patients with the opportunity to earn chances of winning prizes of varying magnitudes are becoming increasingly popular. In the CM literature, magnitude of reinforcement is linked with effect sizes, such that CM treatments that provide larger magnitude reinforcement are more efficacious than those that provide lower magnitude reinforcement. With prize CM, even when magnitudes of overall expected prize earnings are constant, some patients win more prizes than others. Thus, patients who win larger overall amounts of prizes during treatment may have better outcomes than those who win fewer prizes. This study evaluated the impact of overall amounts of prizes won on long-term abstinence outcomes. The dollar amount of prizes won during prize CM treatments was determined from 78 cocaine-abusing methadone-maintenance patients who were randomized to prize CM treatments in three clinical trials. Abstinence three months following the end of the CM intervention was the primary dependent variable. The dollar amount of prizes won during CM treatment was a significant predictor of submission of cocaine-negative urine samples and self-reports of cocaine abstinence at the follow-up evaluation, even after controlling for other variables associated with long-term abstinence, such as pretreatment urinalysis results and longest duration of abstinence achieved during treatment. These results suggest that magnitudes of earnings during prize CM may impact outcomes and call for further experimentation of parameters related to the efficacy of prize CM.
Nunes, Edward V.; Ball, Samuel; Booth, Robert; Brigham, Gregory; Calsyn, Donald A.; Carroll, Kathleen; Feaster, Daniel J.; Hien, Denise; Hubbard, Robert L.; Ling, Walter; Petry, Nancy M.; Rotrosen, John; Selzer, Jeffrey; Stitzer, Maxine; Tross, Susan; Wakim, Paul; Winhusen, Theresa; Woody, George
Multi-site effectiveness trials such as those carried out in the National Drug Abuse Treatment Clinical Trials Network (CTN) are a critical step in the development and dissemination of evidence-based treatments, because they address how such treatments perform in real-world clinical settings. As Brigham and colleagues summarized in a recent article (Brigham, Feaster, Wakim, & Dempsey, 2009), several possible experimental designs may be chosen for such effectiveness trials. These include: 1) A new treatment intervention (Tx) is compared to an existing mode of community based treatment as usual (TAU): Tx versus TAU; 2) A new intervention is added to TAU and compared to TAU alone: Tx + TAU versus TAU; or 3) A new intervention is added to TAU and compared to a control condition added to TAU: Tx + TAU versus control + TAU. Each of these designs addresses a different question and has different potential strengths and weaknesses. As of December 2009, the primary outcome paper had been published for 16 of the multi-site randomized clinical trials conducted in the CTN, testing various treatments for drug abuse, HIV risk behavior, or related problems. This paper systematically examines, for each of the completed trials, the experimental design type chosen and its original rationale, the main findings of the trial, and the strengths and weaknesses of the design in hindsight. Based on this review, recommendations are generated to inform the design of future effectiveness trials on treatments for substance abuse, HIV risk, and other behavioral health problems. PMID:20307801
Green, Carla A; Polen, Michael R; Dickinson, Daniel M; Lynch, Frances L; Bennett, Marjorie D
We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education. Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance. Clinical implications of results are discussed. PMID:12495790
Illicit drug use and substance abuse disorders have increased dramatically in developing countries during recent decades. Sadly, treatment for people diagnosed as manifesting and/or attributed with substance abuse disorders in developing countries is usually inadequate to meet demand, not evidence based, and of poor quality. In response, international health organizations have developed best-practice guidelines for substance user treatment in developing countries, although little research has evaluated their implementation. This opinion piece will examine one such effort to improve substance user treatment in El Salvador. It will be argued that the program failed (2007–2008) because of a lack of political will by the Salvadoran government through their Ministry of Health to effectively supervise, monitor, and subsidize substance user treatment. PMID:23186469
Wilson, Timothy L.-Y.
The purpose of this paper was to elaborate on the definitions of child abuse in order to improve the understanding of child abuse. The definitions given by the U.S. House Joint Committee on Child Abuse in the Child Abuse Prevention and Treatment Act, and in research by Holden (1984), are cited. These definitions refer to the nature of abusive acts…
Taylor, Steven; Woody, Sheila; McLean, Peter D.; Koch, William J.
The sensitivity of five measures of outcomes of treatment for generalized social phobia was studied with 60 people diagnosed with generalized social phobia. Outcome measures were completed before and after treatment and three months later, and effect sizes were computed. Results support the usefulness of the Social Phobia and Anxiety Inventory (S.…
Harrison, P A; Beebe, T J; Fulkerson, J A; Torgerud, C R
Minnesota's treatment outcomes monitoring system is a cooperative effort between the State alcohol and drug abuse agency and 366 licensed treatment providers. A minimum dataset is required on all treatment admissions to provide a state-wide system profile. In addition, data are being collected on a sample of 30 patients from each program to measure patient characteristics and severity of problems, patient perceptions of needed assistance, actual nature and amount of services received, patient satisfaction and patient functioning 6 months following discharge from treatment. The dimensions measured include alcohol and other drug use, physical health, psychological well-being, employment and financial status, family and social relationships and criminality. The aggregated data will be analysed to determine what types of services are associated with more favorable outcomes for different types of patients. The findings will be used to develop standards for treatment placement and service delivery based on individual patient profiles. This report provides an overview of the plan and an illustration of how patient profiles can be developed for purposes of treatment service matching and outcomes monitoring. PMID:8935253
Mustillo, Sarah A.; Dorsey, Shannon; Conover, Kate; Burns, Barbara J.
Using longitudinal data on 1,813 children and parents from a nationally representative child-welfare sample, National Survey of Child and Adolescent Well-Being (NSCAW), this study investigated physically abusive and neglectful parenting as mediating the effects of parent depression on child mental health by developmental stage. Findings from…
Libby, Anne M.; Orton, Heather D.; Beals, Janette; Buchwald, Dedra; Manson, Spero M.
Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n=3,084) were asked about traumatic events and…
Smock, Sara A.; Trepper, Terry S.; Wetchler, Joseph L.; McCollum, Eric E.; Ray, Rose; Pierce, Kent
The present study compared solution-focused group therapy (SFGT) with a traditional problem-focused treatment for level 1 substance abusers. Outcome research on the effectiveness of solution-focused group therapy is minimal, especially in treating substance abusers. In the present study, clients were measured before and after treatment to…
Gillespie, F J
Although various courses of treatment for paedophilia have been tried, there is little evidence of their effectiveness. Important factors that mitigate against success are the inability of paedophiles to see their sexual activity as warranting treatment and their reluctance to change their behaviour.
Gonzales, Rachel; Ang, Alfonso; McCann, Michael J.; Rawson, Richard A.
This study examined correlates of methamphetamine (MA) and marijuana (MJ) use and treatment response among treatment-involved youth (N = 4,430) in Los Angeles County, California treated between 2000 and 2005. Of the sample, 912 (21%) were primary MA and 3,518 (79%) were primary MJ users. Correlates of increased MA use included being female, White,…
Islam, Manirul; Hashizume, Masahiro; Yamamoto, Taro; Alam, Faruq; Rabbani, Golam
Drug use is an alarming issue in Bangladesh. Most drug users return to drugs after treatment, in what becomes a vicious cycle of treatment and relapse. This study explored why they return and what pathways they follow. We carried out 5 key informant interviews, 10 in-depth interviews, 2 focus group discussions, 3 case studies, 8 observations, and…
Research on the incidence, etiology and substance abuse treatment needs of lesbian, bisexual and transgender (LBT) women is limited. Most research indicates higher levels of alcohol and drug abuse among these populations compared to their heterosexual counterparts, with recent research indicating that substance abuse is a particular concern for transgender individuals and an increasing problem among younger LBT individuals. Risk factors and reasons for substance abuse among sexual minority women are similar to those of heterosexual women, yet are substantially complicated by issues of family rejection and lack of social support, stigma and minority stress, as well as abuse and harassment. Historically, substance abuse prevention, early intervention, and clinical treatment programs were designed to meet the needs of the sexual majority population with relatively few programs designed to incorporate the specific needs of sexual minorities. This article reviews findings from previous studies and utilizes new data collected from community-based and residential substance abuse treatment programs to (1) examine issues relevant to LBT women and substance use, and (2) make recommendations for tailoring substance abuse treatment programs to meet the needs of these populations. PMID:24474874
Research on the incidence, etiology and substance abuse treatment needs of lesbian, bisexual and transgender (LBT) women is limited. Most research indicates higher levels of alcohol and drug abuse among these populations compared to their heterosexual counterparts, with recent research indicating that substance abuse is a particular concern for transgender individuals and an increasing problem among younger LBT individuals. Risk factors and reasons for substance abuse among sexual minority women are similar to those of heterosexual women, yet are substantially complicated by issues of family rejection and lack of social support, stigma and minority stress, as well as abuse and harassment. Historically, substance abuse prevention, early intervention, and clinical treatment programs were designed to meet the needs of the sexual majority population with relatively few programs designed to incorporate the specific needs of sexual minorities. This article reviews findings from previous studies and utilizes new data collected from community-based and residential substance abuse treatment programs to (1) examine issues relevant to LBT women and substance use, and (2) make recommendations for tailoring substance abuse treatment programs to meet the needs of these populations.
Herman-Smith, Robert L.
Research Findings: A 2003 amendment to the Child Abuse Prevention and Treatment Act (CAPTA) required states to develop plans to ensure that children younger than the age of 3 years who are victims of substantiated abuse or neglect have access to developmental screenings. Programs authorized under Part C of the Individuals with Disabilities…
Ball, Samuel A; Carroll, Kathleen M; Canning-Ball, Monica; Rounsaville, Bruce J
Previous research has identified risk factors for early attrition from substance abuse treatment, but has not assessed reasons for dropout from the client's perspective. Interview and self-report assessment data were collected from 24 clients who prematurely terminated outpatient treatment to evaluate their subjective reasons for dropping out and the association of these reasons with demographic and clinical variables. Items from scales indicating problems with client motivation or conflicts with program staff were the most commonly endorsed. The severity of participant's symptoms and logistical problems interfering with appointments were less commonly reported as reasons for dropping out. Demographic, substance abuse, and motivational stage indicators were infrequently associated with subjective reasons for dropout. In contrast, indicators of maladaptive personality functioning were strongly associated with many reasons for dropping out, especially concerns about privacy and boundary issues within the program. Results from this preliminary evaluation will guide the development of an instrument and intervention focused on dropout risk factors and treatment reengagement.
Stewart, D E; Cecutti, A
OBJECTIVES: To determine the prevalence of physical abuse during late pregnancy and to investigate how abused and nonabused pregnant women differ in demographic characteristics, health habits, psychologic distress and attitudes about fetal health. DESIGN: Survey of women attending for prenatal health care or admitted to hospital for delivery. The information was obtained on one occasion from self-report questionnaires, completed with the option of anonymity. SETTINGS: Community-based prenatal clinic, private obstetricians' offices in a large city, private family physicians' offices in a large city, family physicians' offices in a small town, and a university teaching hospital. PATIENTS: English-speaking women at 20 weeks' or more gestation attending or admitted consecutively. INTERVENTIONS: Three self-report questionnaires: the General Health Questionnaire (GHQ), the Fetal Health Locus of Control (FHLC) and the study questionnaire. RESULTS: Thirteen women (2.4%) refused to participate in the survey. Of the 548 women who completed the questionnaires 36 (6.6%) reported physical abuse during the current pregnancy and 60 (10.9%) before it. There were no significant differences in rates of abuse between settings. Of the women abused during the pregnancy 23 (63.9%) reported increased abuse during the pregnancy, and 28 (77.8%) remained with the abuser. Twenty-four pregnant women (66.7%) received medical treatment for abuse, but only 1 (2.8%) told her prenatal care provider of the abuse. Factor analysis revealed three factors associated with physical abuse in pregnancy: "social instability" (comprising low age, unmarried status, lower level of education, unemployment and unplanned pregnancy), "unhealthy lifestyle" (comprising poor diet, alcohol use, illicit drug use and emotional problems) and "physical health problems" (comprising health problems and prescription drug use). The GHQ scores showed that the abused women were significantly more emotionally distressed than the
Bourne, P G
As a result largely of dissatisfaction with existing treatment methods for narcotic addiction, there has been considerable recent interest in various non-pharmacological approaches to treatment. Acupuncture, transcendental meditation, electrosleep, biofeedback and hypnotism all have generated considerable interest and seem to be effective in a number of cases. Although apparently quite different, all of these approaches seek to induce a state of relaxation which in turn appears to exert specific neurophysiological changes in the brain. These treatment methods not only help for some addicts, but should contribute to our overall understanding of the addiction process.
Gonzales, Rachel; Douglas Anglin, M.; Glik, Deborah C.
This exploratory study examined treatment involved youth opinions about (i) the utility of using text messaging to support recovery behaviors after treatment; (ii) important types of text messages that could help youth self-manage their substance use behaviors after treatment; and (iii) programmatic or logistical areas associated with text messaging programs. Eight focus groups were conducted with 67 youth (aged 12–24) enrolled in outpatient and residential publicly funded substance abuse treatment programs around Los Angeles County, California. Results highlight that 70% of youth positively endorsed text messaging as a viable method of intervention during aftercare, 20% expressed ambivalent feelings, and 10% conveyed dislike. Thematic data exploration revealed seven themes related to the types of text messages youth recommend for helping youth avoid relapse after treatment, including positive appraisal (90%), lifestyle change tips (85%), motivational reinforcing (80%), coping advice (75%), confidence boosters (65%), inspiration encouragement (55%), and informational resources (50%). Youth opinions about key logistical features of text messaging programs, including frequency, timing, sender, and length are also examined. Findings offer insight for the development and enhancement of recovery support interventions with substance abusing youth. Results imply text messaging may serve as a promising opportunity for recovery support for young people with substance abuse problems. PMID:24038196
Collins, Gregory B; McAllister, Mark S; Jensen, Mark; Gooden, Timothy A
Substance abuse is a potentially lethal occupational hazard confronting anesthesiology residents. We present the results of a survey sent to all United States anesthesiology training programs regarding experience with and outcomes of chemically dependent residents from 1991 to 2001. The response rate was 66%. Eighty percent reported experience with impaired residents and 19% reported at least one pretreatment fatality. Despite this familiarity, few programs required pre-employment drug testing or used substance abuse screening tools during interviews. The majority of impaired residents attempted reentry into anesthesiology after treatment. Only 46% of these were successful in completion of anesthesiology residency. Eventually, 40% of residents who underwent treatment and returned to medical training entered another specialty. The mortality rate for the remaining anesthesiology residents was 9%. Long-term outcome was reported for 93% of all treated residents. Of these, 56% were successful in some specialty of medicine at the end of the survey period. We hypothesize that specialty change afforded substantial improvement in the overall success rate and avoided significant mortality. Redirection of rehabilitated residents into lower-risk specialties may allow a larger number to achieve successful medical careers. PMID:16244010
Graziano, Anthony M.; Mills, Joseph R.
This paper argues that insufficient attention has been paid to the psychological needs of physically maltreated children, who often require direct treatment for such problems as aggressive behavior, low self-esteem, and cognitive limitations. (DB)
Sparks, Taylor E.; Evans, Elizabeth; Selzer, Jeffrey A.
Introduction: In 2008, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS) required all state-funded or state-certified addiction treatment programs to be 100% tobacco-free. The regulation prohibits the use or possession of all tobacco products by patients, employees, volunteers, and visitors. This includes exterior grounds and vehicles owned, leased, or operated by the facility. Addiction treatment centers are also required to screen patients for tobacco use and incorporate tobacco cessation into treatment programming. This study examined the perceived effectiveness of this regulation from the perspective of counselors and clinical supervisors. Methods: Qualitative data were collected from 261 counselors and 80 clinical supervisors working in 50 free-standing substance abuse treatment programs throughout NYS. Questions asked about the perceived positive and negative consequences of the OASAS regulation approximately 1 year after its implementation. Results: The findings indicate mixed reactions to the regulation. A wide range of positive and negative consequences were identified, which were generally consistent across counselor and clinical supervisor reports. The most commonly reported positive outcomes were positive behavior change (e.g., less smoking, increased intentions to quit) and increased awareness about smoking (e.g., dangers, available assistance to quit). The most commonly reported negative consequences were reinforcing addict behaviors among patients (e.g., lying, “dealing” cigarettes) and enforcement problems (e.g., difficulty enforcing, policing for compliance). Conclusion: Findings have implications for the implementation of tobacco-free regulations in substance abuse treatment programs. PMID:22416113
Sahker, Ethan; Toussaint, Maisha N; Ramirez, Marizen; Ali, Saba R; Arndt, Stephan
Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.
McFarlane, Judith; Symes, Lene; Maddoux, John; Gilroy, Heidi; Koci, Anne
To provide differential effectiveness on length of stay at a shelter and receipt versus non-receipt of a protection order (PO), and outcomes of violence, functioning, and resiliency, in 300 abused women (150 first-time users of a shelter and 150 first-time applicants for a PO) who participate in a 7-year study with outcomes measured every 4 months. Four months after a shelter stay or application for a PO, abused women staying 21 days or less at a shelter reported similar outcomes compared with women staying longer than 21 days. Similarly, women receiving and not receiving a PO reported overall equivalent outcomes. Seeking shelter or justice services results in similar improved outcomes for abused women 4 months later, regardless of length of stay at the shelter or receipt or no receipt of the PO. Contact with shelter and justice services results in positive outcomes for abused women and indicates the urgent need to increase availability, accessibility, and acceptability of shelter and justice services.
Laber, Eric B; Lizotte, Daniel J; Ferguson, Bradley
Dynamic treatment regimes (DTRs) operationalize the clinical decision process as a sequence of functions, one for each clinical decision, where each function maps up-to-date patient information to a single recommended treatment. Current methods for estimating optimal DTRs, for example Q-learning, require the specification of a single outcome by which the "goodness" of competing dynamic treatment regimes is measured. However, this is an over-simplification of the goal of clinical decision making, which aims to balance several potentially competing outcomes, for example, symptom relief and side-effect burden. When there are competing outcomes and patients do not know or cannot communicate their preferences, formation of a single composite outcome that correctly balances the competing outcomes is not possible. This problem also occurs when patient preferences evolve over time. We propose a method for constructing DTRs that accommodates competing outcomes by recommending sets of treatments at each decision point. Formally, we construct a sequence of set-valued functions that take as input up-to-date patient information and give as output a recommended subset of the possible treatments. For a given patient history, the recommended set of treatments contains all treatments that produce non-inferior outcome vectors. Constructing these set-valued functions requires solving a non-trivial enumeration problem. We offer an exact enumeration algorithm by recasting the problem as a linear mixed integer program. The proposed methods are illustrated using data from the CATIE schizophrenia study.
Bright, George M.
Objective The objective is to assess abuse of prescription and illicit stimulants among individuals being treated for attention-deficit/hyperactivity disorder (ADHD). Methods A survey was distributed to patients enrolled in an ADHD treatment center. It included questions designed to gain information about demographics; ADHD treatment history; illicit drug use; and misuse of prescribed stimulant medications, including type of stimulant medication most frequently misused or abused, and how the stimulant was prepared and administered. Results A total of 545 subjects (89.2% with ADHD) were included in the survey. Results indicated that 14.3% of respondents abused prescription stimulants. Of these, 79.8% abused short-acting agents; 17.2% abused long-acting stimulants; 2.0% abused both short- and long-acting agents; and 1.0% abused other agents. The specific medications abused most often were mixed amphetamine salts (Adderall; 40.0%), mixed amphetamine salts extended release (Adderall XR; 14.2%), and methylphenidate (Ritalin; 15.0%), and the most common manner of stimulant abuse was crushing pills and snorting (75.0%). Survey results also showed that 39.1% of respondents used nonprescription stimulants, most often cocaine (62.2%), methamphetamine (4.8%), and both cocaine and amphetamine (31.1%). Choice of illicit drug was based on rapidity of high onset (43.5%), ease of acquisition (40.7%), ease of use (10.2%), and cost (5.5%). Conclusions The risks for abuse of prescription and illicit stimulants are elevated among individuals being treated in an ADHD clinic. Prescription agents used most often are those with pharmacologic and pharmacokinetic characteristics that provide a rapid high. This suggests that long-acting stimulant preparations that have been developed for the treatment of ADHD may have lower abuse potential than short-acting formulations. PMID:18596945
Fox, Helen C.; Sinha, Rajita
Extensive research indicates that chronic substance abuse disrupts stress and reward systems of the brain. Gender variation within these stress-system alterations, including the impact of sex hormones on these changes, may influence sex-specific differences in both the development of, and recovery from, dependency. As such, gender variations in stress-system function may also provide a viable explanation for why women are markedly more vulnerable than men to the negative consequences of drug use. This article therefore initially reviews studies that have examined gender differences in emotional and biophysiological changes to the stress and reward system following the acute administration of drugs, including cocaine, alcohol, and nicotine. The article then reviews studies that have examined gender differences in response to various types of stress in both healthy and drug-abusing populations. Studies examining the impact of sex hormones on these gender-related responses are also reported. The implications of these sex-specific variations in stress and reward system function are discussed in terms of both comorbid psychopathology and treatment outcome. PMID:19373619
Lindholm, Torun; Sjöberg, Rickard L; Memon, Amina
Two studies provided evidence that a decision to report an ambiguous case of child abuse affected subsequent memory of the case information, such that participants falsely recognized details that were not presented in the original information, but that are schematically associated with child abuse. Moreover, post-decision information that the child had later died from abuse influenced the memory reports of participants who had chosen not to report the case, increasing their reports of false schema-consistent details. This suggests that false decision-consistent memories are primarily due to sense-making, schematic processing rather than the motivation to justify the decision. The present findings points to an important mechanism by which decision information can become distorted in retrospect, and emphasize the difficulties of improving future decision-making by contemplating past decisions. The results also indicate that decisions may generate false memories in the apparent absence of external suggestion or misleading information. Implications for decision-making theory, and applied practices are discussed.
Campbell-Heider, Nancy; Baird, Carolyn
Many nurses, especially those in addictions, work directly in the prison system and or relate to inmates before or after institutionalization for criminal activity. This connection led to the theme of the 2009 Annual Education Conference held in Albuquerque, New Mexico, entitled "Substance Abuse Prevention and Treatment: Working with the Criminal Justice Systems." The conference was partially funded through an award from the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (grant # SP015963) and focused on identifying the special risk factors for and barriers to the treatment of addictions for those who enter the criminal justice system. The conference, presented in collaboration with the American Association of Nurse Attorneys (AANA) highlighted the tremendous need for more access to addictions and mental health providers in the criminal justice system. Papers presented at that conference confirmed that nurses can make a real difference in the health of inmates, especially those of us engaged in addictions and mental health practices, and inspired this specially focused edition of the Journal of Addictions Nursing. The purpose of this editorial is to provide an overview of the addictions problems affecting individuals under supervision in the criminal justice system, barriers to treatment within this system, and the cost-benefits of evidence based treatment.
Background Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. Methods We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. Results Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program’s mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. Conclusions SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical
Sacks, Joann Y; McKendrick, Karen; Hamilton, Zachary; Cleland, Charles M; Pearson, Frank S; Banks, Steven
This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities. PMID:18683197
Lipton, Douglas S.
Discusses in-prison prevalence and transmission of Human Immunodeficiency Virus (HIV). Focuses on epidemiology in prison settings, the role of ethnicity and gender in transmission, screening for HIV, segregating the HIV-positive inmate, condom distribution, medical treatment for HIV-positive inmates, HIV education and prevention, and tuberculosis…
Walfish, Steven; And Others
Examined non-K-corrected Minnesota Multiphasic Personality Inventory profiles of 243 adolescents presenting themselves for chemical dependency treatment in a residential setting. Results suggest general lack of psychopathology in this population, although significant elevation on Pd scale did emerge. Compared data to findings of previous studies…
Compares a new approach to treatment using traditional social work. Reports on the therapeutic regimen and Results/Kinesiology (RK), which addresses body-mind control, brain hemispheric integration, energy balancing, and stress elimination. Examination of 40 women addicted to alcohol and/or drugs indicated that RK helped with anxiety,…
Bowser, Benjamin P; Jenkins-Barnes, Tazima; Dillard-Smith, Carla; Lockett, Gloria
MORE was a mobile outreach drug abuse prevention and HIV harm reduction program primarily for ex-offenders who are active drug users. Through case management, clients were provided substance abuse education, counseling, and referral. Long term goals of these services were to reduce their drug use and re-incarceration for drug related crimes. From January 2002 to May 2006, 487 unduplicated clients were recruited in year long cohorts and offered services. The program evaluation tool was the Federal Office of Budget and Management Government Performance and Results Act questionnaire. Government Performance and Results Act interviews were conducted at in-take into the program, approximately six months later and again approximately 12 months after their initial in-take. By the six and 12 month follow-up interviews, active drug using clients reported significant reductions in their use of alcohol, cocaine/crack, heroin, and fewer sex partners and crimes. Program completers reported significantly reduced cocaine/crack and heroin use as well as fewer days in jail and crimes than non-completers (p < .01 to .001). Six program components account for these reductions: case management, day-treatment, outpatient services, outreach, HIV/AIDS, and substance abuse education. The differences in program service intensity, income, and employment for program completers and non-completers were analyzed using logistic regression. The intensity of case management and all services received along with having higher income by month six were the most significant predictors of program completion.
Rigg, Khary K.; Murphy, John W.
Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously. PMID:23656723
Catalá, M; Domínguez-Morueco, N; Migens, A; Molina, R; Martínez, F; Valcárcel, Y; Mastroianni, N; López de Alda, M; Barceló, D; Segura, Y
This paper investigates the elimination of drugs of abuse from six different chemical classes and their metabolites in natural fluvial waters (nearby the output of a sewage system). Mineralization of these substances and toxicological characterization before and after treatment by a heterogeneous photo-Fenton system has been evaluated. This advanced oxidation technology was able to significantly reduce the concentration of the drugs of abuse in all the tested conditions (different hydrogen peroxide and catalyst loadings). However, toxicological analyses measured as inhibition of fern spore mitochondrial activity, showed only a complete elimination of acute and chronic toxicity when a higher solid catalyst loading was used (0.6 g/L). A lower catalyst loading of 0.2 g/L was not enough for toxicity elimination. These results evidence the need for combining toxicological tests and chemical analyses in order to establish the effectiveness of the water treatment technologies based on advanced oxidation processes. PMID:25817756
Onken, Lisa Simon; Blaine, Jack D.
This monograph is based on the papers from a technical review. These papers are included: (1) Psychotherapy and Counseling Research in Drug Abuse Treatment: Questions, Problems, and Solutions (Lisa Onken, Jack Blaine); (2) Psychotherapy and Counseling for Methadone-Maintained Opiate Addicts: Results of Research Studies (George Woody, A. T.…
Stuyt, Elizabeth B; Sajbel, Terrie A; Allen, Michael H
This retrospective study of patients treated in a ninety-day, inpatient, dual-diagnosis treatment program examined antipsychotic effectiveness in this population using length of stay in treatment and successful program completion as outcome measures. All patients with co-occurring substance dependence and schizophrenia or schizoaffective disorder treated with olanzapine, risperidone, ziprasidone, and typical depot neuroleptics from January 2001 to December 2003 (N = 55) are the subjects of this study. Patients stayed longer in treatment when taking risperidone (82 +/- 19 days) or ziprasidone (74 +/- 21 days) compared with olanzapine (44 +/- 30 days) or typicals (47 +/- 36 days). Eighty-eight percent of risperidone patients and 64% of ziprasidone patients successfully completed the program, while only 33% of olanzapine patients and 40% of patients on typicals successfully completed the program. Risperidone and ziprasidone were associated with significantly better program performance than olanzapine or depot typicals in this population. Possible reasons for this difference are discussed.
Rockhill, Anna; Green, Beth L; Newton-Curtis, Linda
The complex issues associated with barriers to treatment entry for parents who are involved with child welfare has not been well explored. Accessing timely treatment is now critical for these parents since the introduction of the Adoption and Safe Families Act of 1997, limiting the time until a permanency decision is made. Using a longitudinal, qualitative approach, substance-abusing parents from 15 families, their relevant family members, and service providers were interviewed approximately every 3 months over an 18-month period. The experiences of these parents add to our knowledge of the unique barriers this population faces, and expands our understanding of the mechanisms by which certain barriers may delay treatment.
Dolan, Mairead; Whitworth, Helen
There is little literature on childhood sexual abuse in women seen by forensic services. A cohort of 225 cases of women seen by forensic services in a medium secure unit in the UK were examined, and childhood sexual abuse and non-childhood sexual abuse cases were compared. Over half the sample had a history of childhood sexual abuse, and 5.6% of…
Fickenscher, Alexandra; Novins, Douglas K; Manson, Spero M
Few studies to date have addressed illicit (i.e., nonceremonial) peyote use among American Indians (AIs). Participants were 89 AI adolescents admitted to a tribally operated residential substance abuse treatment program (RSATP) between 1998 and 2001. The RSATP is designed to provide specialized treatment of patients with substance use and other comorbid psychiatric disorders and is infused with a culturally sensitive approach to treatment. The participants completed a series of interviews that collected information on psychiatric diagnostic status, history of substance use, and ethnic identity. The majority of participants were male (65%), did not come from a two-parent household (75%), reported a mean use of 5.4 substances, and met full criteria for a median of 2.9 substance use disorders. Of 89 clients, 10 (11.2%) reported illicit use of peyote. The vast majority of these youth (n = 8) reported using peyote only once or twice in their lifetime. Illicit peyote users did not differ from nonusers in terms of age, gender, other substance use, prevalence of either other substance abuse/dependence or other nonsubstance use psychiatric disorders. However, illicit peyote users were more likely to report low levels of social support, low levels of self-esteem, and low identification with AI culture yet comparable involvement in AI traditional practices. The results of this exploratory study suggest that illicit peyote use is uncommon among AI adolescents with serious substance abuse problems.
Meade, Christina S; Lion, Ryan R; Cordero, Daniella M; Watt, Melissa H; Joska, John A; Gouse, Hetta; Burnhams, Warren
South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.
Zemore, Sarah E.; Ajzen, Icek
We examined whether a 9-item scale based on the theory of planned behavior (TPB) predicted substance abuse treatment completion. Data were collected at a public, outpatient program among clients initiating treatment (N=200). Baseline surveys included measures of treatment-related attitudes, norms, perceived control, and intention; discharge status was collected from program records. As expected, TPB attitude and control components independently predicted intention (model R-squared=.56), and intention was positively associated with treatment completion even including clinical and demographic covariates (model R-squared=.24). TPB components were generally associated with the alternative readiness scales as expected, and the TPB remained predictive at higher levels of coercion. Meanwhile, none of the standard measures of readiness (e.g., the URICA and TREAT) or treatment coercion were positively associated with treatment participation. Results suggest promise for application of the TPB to treatment completion and support use of the intention component as a screener, though some refinements are suggested. PMID:23953167
Zemore, Sarah E; Ajzen, Icek
We examined whether a 9-item scale based on the theory of planned behavior (TPB) predicted substance abuse treatment completion. Data were collected at a public, outpatient program among clients initiating treatment (N=200). Baseline surveys included measures of treatment-related attitudes, norms, perceived control, and intention; discharge status was collected from program records. As expected, TPB attitude and control components independently predicted intention (model R-squared=.56), and intention was positively associated with treatment completion even including clinical and demographic covariates (model R-squared=.24). TPB components were generally associated with the alternative readiness scales as expected, and the TPB remained predictive at higher levels of coercion. Meanwhile, none of the standard measures of readiness (e.g., the URICA and TREAT) or treatment coercion were positively associated with treatment participation. Results suggest promise for application of the TPB to treatment completion and support use of the intention component as a screener, though some refinements are suggested. PMID:23953167
Beamish, Patricia M.; And Others
Reviews outcome studies in the treatment of panic disorder without agoraphobia for adults. Presents evidence supporting the efficacy of psychopharmacological and cognitive-behavioral interventions. Addresses the need for standards of care in counseling persons with panic disorder. (RB)
Eckhardt, Christopher I.; Crane, Cory A.
The present study examined the associations among implicit attitudes toward factors related to intimate partner violence (IPV) and objective, behavioral outcomes of participants legally mandated to attend partner violence interventions. Twenty-six male offenders, adjudicated within the past month on IPV charges, completed three sets of gender and violence themed implicit associations tests (IATs) to evaluate the relationships between implicit evaluations of women and violence and three key outcome measures assessed six months after enrollment in the study: self-reported prior year IPV perpetration, completion of a court-mandated partner abuse program, and criminal reoffending. IAT results indicated that more rapid associations between violence-related words and positive valences, rather than gender evaluations or associations between gender and violence, were associated with greater IPV perpetration during the year prior to involvement in the study as well as with poorer outcomes (i.e., greater treatment non-compliance and criminal recidivism) at the 6-month follow-up. Among explicit measures, only negative partner violence outcome expectancies were marginally associated with treatment compliance. None of the explicit measures predicted previous violence or recidivism. The findings are discussed in the context of reducing violence through promoting implicit cognitive change. PMID:25598562
Wells, Rebecca; Lemak, Christy Harris; D'Aunno, Thomas A
Background Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. Results A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and
Arfken, Cynthia L; Agius, Elizabeth; Dickson, Marcus W
Little is known about clinicians' information sources for new treatments or ways to improve dissemination of that information. We analyzed 163 clinicians' responses to a checklist of where and how frequently they obtain information on new treatment approaches. They reported at least yearly use of a median of four cosmopolite categories (e.g., journals or books, Internet) and a median of three local categories (e.g., co-workers, personal experience) with interpersonal contact with co-workers (89%) and seminars/conferences (86%) being the most frequently endorsed responses for at least yearly use. In response to the hypothetical scenario of receiving monthly e-mail summaries of journal articles, 59% of the clinicians rated the strategy as "very helpful". If continuing education credits were offered, more clinicians (from 50-80%) would read the relevant articles. Information dissemination may improve with expanded Internet access at programs and short e-mailed summaries carrying links to full articles coupled with the incentive of earning continuing education credits.
Rabinovitch, Sara M; Kerr, David C R; Leve, Leslie D; Chamberlain, Patricia
Childhood sexual abuse (CSA) histories are prevalent among adolescent girls in the juvenile justice system (JJS) and may contribute to their high rates of suicidal behavior. Among 166 JJS girls who participated in an intervention trial, baseline CSA and covariates were examined as predictors of suicide attempt and nonsuicidal self-injury (NSSI) reported at long-term follow-up (7-12 years later). Early forced CSA was related to lifetime suicide attempt and NSSI history and (marginally) to postbaseline attempt; effects were not mediated by anxiety or depressive symptoms. Findings suggest that earlier victimization and younger entry into JJS are linked with suicide attempt and NSSI. PMID:25370436