Bridging Psychosocial Research and Treatment in Community Substance Abuse Programs

Bridging the gap between substance abuse research and treatment has received extensive attention in recent years. The Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA) have implemented major initiatives to establish partnerships between researchers and practitioners. The objective is to study promising treatments under real-world conditions and then facilitate their use in treatment programs if they are found to be effective. However, many considerations for implementing substance abuse research in community treatment have not received sufficient attention. This article addresses issues relevant to implementing psychosocial research protocols in community substance abuse programs. Building a stronger bridge between research and treatment could be achieved by considering issues heretofore neglected, such as the lack of communication between treatment staff and researchers in the development and implementation of studies. In addition, the pitfalls of applying U.S. Food and Drug Administration (FDA) standards to psychosocial substance abuse studies in community setting needs more attention. The article includes specific suggestions for substance abuse researchers, treatment staff, and funding sources for producing high-quality psychosocial research in community-based programs.     

An Effective Web Presence for Substance Abuse Treatment Facilities

Background: Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page. Objectives: The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry. Methods: This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score. Results: The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites. Conclusions: The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.     

A Comparison of Problems-of-Life for Blacks and Whites Entering Substance Abuse Treatment Programs

Abstract

Blacks in the general population experience alcohol-related health problems to a greater extent than Whites, even though surveys of drinking behavior find that Blacks generally drink no more than Whites and, in fact, at younger ages Blacks actually drink less than Whites. In this study, Blacks and Whites entering randomly selected state-supported substance abuse treatment programs within a given period of time were interviewed and administered a battery of assessment instruments; results are derived from the Addiction Severity Index. A major research question was whether the higher rates of alcohol-related problems for Blacks in the general population were matched by greater severity of life-problems for Blacks in a clinical treatment population. Blacks had more severe problems than Whites in two problem areas: employment support and other drug use. Results point to socioeconomic factors as well as combined alcohol and other drug use as potential contributors to the greater alcohol-related health problems for Blacks in the general population. Comprehensive study of alcohol and other drug use norms and customs within the Black community is recommended to aid in the development of prevention and treatment strategies for alcohol-related problems among Blacks.     

Treatment refusal/attrition among adults randomly assigned to programs at a drug treatment campus: The New Jersey Substance Abuse Treatment Campus, Seacaucus, NJ

The New Jersey Substance Abuse Treatment Campus was funded to assess the feasibility of establishing a new model for delivering substance abuse treatment services and to serve as a research laboratory for conducting comparative evaluations of those services. The 350-bed campus was designed to improve treatment effectiveness by providing special services needed by underserved populations, and reduce treatment costs by serving large numbers of clients, centralizing services, and sharing facilities. First-time clients who met preliminary eligibility requirements during phone screening were randomly assigned to therapeutic community and chemical dependency programs. We used data collected on 1,573 adults who were ultimately accepted for admission to analyze treatment refusals and attrition during the 25 days after admission. Only 6.4% of the clients refused admission when informed of their treatment assignment. Planned duration of the residential phase of treatment, gender, and language spoken (English/Spanish) interacted with one another and differentially predicted treatment refusal/attrition. These findings may be useful for understanding treatment refusal and attrition in substance abuse treatment programs.     

An Adolescent with a Different Substance Abuse

Abstract

From the beginning of history, it is a well known fact that some people admire to substances making them tipsy and stories about them were told and heard in everywhere and in every time. As shown in several studies, psychiatric disorders related to substance abuse especially in adolescents are becoming more prevalent in all countries including Turkey every year and this is another well-known reality of our time. There are many known psychoactive substances affecting the mental well being of young people and disturbing their social adaptation skills. Inhalants are the preferred psychoactive substances between the young people because of the factors making their abuse become widespread such as cheapness, ease of availability and frequent use in daily life. Here we report an adolescent with a different substance abuse.     

Differences Between Adolescents Who Complete and Fail to Complete Residential Substance Abuse Treatment

ABSTRACT

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= .005), having a family history of a substance use disorder (P= .05), and living with only one biological parent (P= .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= .014); none of these participants completed the treatment. Interventions that improve residential substance abuse treatment retention for adolescents are needed.     

Finding the Common Ground: Contemporary Psychoanalysis and Substance Abuse Treatment

ABSTRACT

Recent changes in psychoanalysis and substance abuse treatment are healing long-standing rifts that had kept these two fields apart. This article elaborates the historical positions that contributed to the schism and describes how the harm reduction model of substance abuse treatment and the relational orientation in psychoanalysis can bring them together. Three clinical examples illustrate how integrating these methods can offer an approach that is effective and comprehensive.     

An In-Depth Survey of the Screening and Assessment Practices of Highly Regarded Adolescent Substance Abuse Treatment Programs

Aims: To examine the quality of screening and assessment practices at some of the most highly regarded adolescent substance use treatment programs in the United States.

Methods: Between March and September 2005, telephone surveys were administered to directors of highly regarded programs. Several different publications and databases were then used to measure the quality of the screening and assessment instruments described by programs.

Results: For the 120 programs responding, 77 distinctly named instruments developed by outside sources were used at some point in the screening and assessment process, and the majority of programs also used instruments developed in-house. Fewer than half of these instruments were mentioned in the Substance Use Screening & Assessment Instruments Database. We were able to confirm that 87% of the instruments developed by others have a published manual, and 74% have been described in an article appearing in a peer-reviewed publication. Sixty-two percent were designed to be used with adolescents or adults and adolescents, while 19% were designed for adults only.

Conclusion: Although adolescent substance abuse treatment programs recognized the importance of screening and assessment, the quality of such practices varied significantly. A large number of different tools were used by some of the most highly regarded programs in the country, and many used questionnaires developed in-house that may not have had high standards of reliability and validity. Furthermore, numerous programs were using assessment instruments that were not uniquely designed for adolescents. Encouraging the adoption of standardized assessment practices would help those involved in treatment to evaluate programs and to understand the assessment process.     

Availability of Outpatient Substance Use Disorder Treatment Programs in the United States

The purpose of this study was to examine the availability of outpatient substance use disorder (SUD) treatment programs in the United States. A geographic information system (GIS) was used to spatially locate outpatient SUD treatment programs, calculate areas, and determine population density within specific areas. Urban areas were mapped using data from the US Census (2000). Addresses of outpatient SUD treatment programs were obtained from the Facility Locator Web site of the Substance Abuse and Mental Health Services Administration. A 15-mile service catchment around each outpatient SUD treatment program was drawn. The amount of urban area not covered by the service catchment represents the underserved. Total underserved urban area and population without access was computed for each state. Significant variability of underserved urban area and population was observed across the states. Moderate correlations among area and population suggest that some states are more effective in locating SUD treatment programs than other states.     

Assessing Adolescent Substance Abuse Programs With Updated Quality Indicators: The Development of a Consumer Guide for Adolescent Treatment

When adolescent substance abuse requires treatment, few parents know which treatment features are important and which treatment programs are effective. There are few resources to help them select appropriate care. We describe early work on an evaluation method and comparative treatment guide for parents based upon the premise that the quality of a program and its potential effectiveness is a function of the number and frequency of evidence-based treatment practices (EBPs) delivered. Thus, we describe the development of and measurement approach for a set of EBPs toward the goal of developing a Consumer Guide to Adolescent Substance Abuse Treatment.     

American Indians/Alaska Natives and Substance Abuse Treatment Outcomes: Positive Signs and Continuing Challenges

ABSTRACT

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.     

An Holistic Approach to Substance Abuse Treatment

Abstract

The purpose of this article is to describe a model outpatient substance abuse treatment program. This program is designed to provide patients with not only traditional modalities of treatment such as individual, group, and family therapy, but also to provide an opportunity for patients to express thoughts and feelings through holistic modalities. These modalities include dance/movement therapy, Tai Chi, art therapy, leisure and recreational skills, spiritual growth and development, cultural awareness and appreciation, vocational services, psychiatric care and physical health. The authors describe features of this program that they believe to be unique and that focus on ways to help patients develop a stronger sense of self-identity, self-esteem and self-confidence.     

Drug-Abusing Homeless Clients in California's Substance Abuse Treatment System

Abstract

As many as one-half to three-fourths of homeless persons have diagnoses of alcohol or other drug dependence. Rates of alcohol and other drug use disorders, and the social costs associated with untreated substance disorder, are higher among homeless than nonhomeless persons. Despite the high level of need for treatment, relatively few substance-abusing homeless individuals receive treatment for their drug problems, suggesting difficulties in accessing treatment. This study addresses access by focusing on the select group of homeless drug users who have overcome barriers to enter the substance abuse treatment system in California and by examining differences between these homeless treatment clients and nonhomeless drug-using clients. Major findings from bivariate and logistic regression analyses performed on 187 homeless and 1,820 nonhomeless treatment clients are that homeless clients were more likely than nonhomeless clients to have a primary drug problem of cocaine/crack and to be injecting methamphetamine and other amphetamines, and that they were no less likely to complete their treatment program. An implication of this study is that homeless persons with primary drug problems appear to have no less commitment to achieving treatment goals than their nonhomeless counterparts.

     

Gender-Sensitive Substance Abuse Treatment and Arrest Outcomes for Women

The present study links an empirically-developed quantitative measure of gender-sensitive (GS) substance abuse treatment to arrest outcomes among 5109 substance abusing women in mixed-gender short-term residential programs in Washington State. Frailty models of survival analysis and three-level hierarchical linear models were conducted to test the beneficial effects of GS treatment on decreasing criminal justice involvement. Propensity scores were used to control for the pre-existing differences among women due to the quasi-experimental nature of the study. Men's arrest outcomes were used to control for confounding at the program level. Results show that women in more GS treatment programs had a lower risk of drug-related arrests, and women in more GS treatment programs who also completed treatment had a significant reduction in overall arrests from 2 years before- to 2 years after treatment, above and beyond the reduction in arrests due to treatment alone. Implications and directions for future research are discussed.     

Interdisciplinary Service-Learning Substance Abuse Projects

Abstract

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.     

Skeptical Attunement: Modifying Psychodynamic Technique for Substance Abuse Treatment

ABSTRACT

Despite enormous advances in the field brought on by psychology's reintegration, modern substance abuse treatment fails to adequately treat substance abusers' emotional lives.

Objectives: Psychodynamic technique can fill this gap by addressing the emotional discomfort and disconnection that underlies much of substance abuse.

Methods: A new model of substance abuse treatment integrating psychodynamic technique with recent developments in addiction treatment (harm reduction, relapse prevention and cognitive-behavioral therapy, motivational interviewing/motivational enhancement) is described with examples from a clinic in the Bronx currently using this method with positive clinical results. A modified version of psychodynamic technique is described in which the clinician is more active and symptom focused, addressing both emotional issues and symptoms of ongoing drug use. Skeptical attunement is the use of healthy skepticism as a means of confronting the patient in a way that is experienced as empathic attunement, leading to more meaningful therapeutic work.

Results: This model has proven efficacious in a low-income community. Patients showed an increased awareness of their feelings, ability to identify how feelings can lead to action, and awareness of how physical and emotional reactions can trigger cravings and relapse.

Conclusions: This model has implications for full substance abuse programs as well as private practice settings.     

An Epidemiological and Clinical Analysis of Propylhexedrine Abuse in the United States

Abstract

A random survey of 1,200 psychologists (with a 62% response rate) indicated that most psychologists (91%) are to some degree involved in clinical practice with substance abusers, although most have no formal education (74%) or training (54%) in substance abuse. Relevant recommendations are made.     

Pubertal Timing and Substance Abuse Treatment Outcomes: An Analysis of Early Menarche on Substance Use Patterns

ABSTRACT

This article examines the influence of pubertal timing on substance use patterns, specifically the relationship between onset of menarche and onset of substance use and substance abuse treatment outcomes. Findings show a significant relationship between pubertal timing and age of onset of substance use and age of onset of substance use and substance use severity at intake into treatment. The article concludes with a call for further research into the possible relationship between pubertal timing and treatment outcomes as well as effective gender-specific interventions for prevention and treatment of substance abuse among adolescent girls.     

Adolescent Substance-Use Frequency Following Self-Help Group Attendance and Outpatient Substance Abuse Treatment

Despite the heterogeneity of posttreatment outcomes, the likelihood of relapse is often dependent on several factors, including participation in continuing care services such as self-help groups. However, few studies have examined the use of self-help groups among adolescent outpatients. Therefore, in this study, investigators examined self-help group attendance among male and female adolescents during the three-month time period immediately following outpatient substance abuse treatment. Gender differences were found in regard to self-efficacy, coping, and severity of substance-related problems. A path model indicated that environmental risk provided the greatest total effect on substance-use frequency. Implications for research and practice are reviewed.     

Predictors of Dyadic Relationship Quality of Women in Substance Abuse Treatment

ABSTRACT

Objectives: The quality of relationship between family caregivers and care recipients with dual disorders can impact care recipients' well-being and treatment outcomes as well as caregivers' well-being and involvement in care. This paper examines the impact of caregiver stressors and well-being on relationship quality of family caregivers of women with substance use disorders or co-occurring substance and mental disorders.

Methods: Eighty-two women receiving in-patient or out-patient substance abuse treatment and the family member/significant other, nominated by each woman, who provided her with the most social support, were interviewed in this nonexperimental cross-sectional study. A stress-coping model was utilized to identify the impact of family caregivers' stressors (care recipient behavioral, substance abuse, and mental health problems) and caregiver well-being (burden and depressive symptomatology) on caregivers' perceptions of the quality of their relationship with their care recipient.

Results: Findings from multiple regression analyses, across four types of caregiver well-being, show that greater perceived support to the caregiver was predicted by fewer perceived care recipient substance abuse problems, whereas higher levels of undermining of the caregiver was predicted by greater care recipient behavioral problems and by the family caregiver being a significant other of the care recipient. Care recipient classification as having a current dual disorder as compared to a current substance use disorder only was not a significant predictor of perceived support given to the caregiver or of perceived undermining of the family member.

Conclusions: The findings suggest interventions for family caregivers need to be tailored to address different and possibly multiple groups of caregivers, specific types of stressors, and care recipient behavioral problems.