Nicotine and other substance interaction expectancies questionnaire: relationship of expectancies to substance use

Smoking and substance abuse co-occur at high rates and substance abusers are less likely to quit smoking than are smokers in general. Therefore, more information about the beliefs substance abusers have about the role of smoking in substance use and in recovery would be useful when designing interventions to impact smoking among substance abusing patients. The present study developed a Nicotine and Other Substance Interaction Expectancies Questionnaire (NOSIE) to investigate the expectancies held by substance abusers in treatment about the effects of smoking on substance use, the effects of substance use on smoking, smoking to cope with recovery, and receptivity to smoking cessation during substance abuse treatment. The 29 items were Likert-rated by 160 substance dependent patients in an inner-city residential substance abuse treatment program and participating in a larger study of smoking at this site. Four components were derived and reduced to a 20-item measure with good reliability. No differences by gender or age were found. On average, the patients reported that substance use almost always increases their smoking or urges to smoke but that smoking only increased substance use or urges about half of the time, that they use smoking to cope with urges to use substances about half of the time, and that they generally agreed that smoking cessation or treatment should be tried during substance abuse treatment and would not harm recovery efforts. Three of the scales correlated with smoking dependence while one scale correlated with drug use severity and heavy drinking days. The scale of receptivity to smoking cessation correlated significantly with measures of motivation and barriers and predicted 1-month smoking cessation outcomes. However, scale scores on smoking to cope with recovery did not significantly predict 3-month relapse to substance use. Implications for theory and clinical interventions with substance abusers who smoke were discussed.     

Gender differences in problem severity at assessment and treatment retention

Women in treatment for substance abuse have been reported to have more severe problems at assessment than men but not to differ in treatment retention. To examine gender differences in problems at assessment, 30-day retention, and treatment completion, data from Detroit's publicly funded substance abuse treatment system were used. Women had significantly more severe problems at assessment, lower 30-day retention, and lower treatment completion rates than men. These gender differences in retention remained significant even after controlling for problem severity, primary drug of abuse, and referred treatment setting. There was no evidence of improvements in women's problems at assessment or retention over time during this period. Women presented with more severe problems at assessment and were less likely to stay in treatment for 30 days or to complete treatment than men. Monitoring gender differences in problems at presentation and retention outcomes is recommended to assess local need for interventions.     

Children of substance abusers: a review of the literature

The proportion of women in substance abuse treatment programs or in need of substance abuse treatment has been increasing. Concern with female substance abusers has led to increased attention on identifying the problems and needs of children of substance abusers, particularly on neonates. This literature review summarizes the contents of the research on children of substance abusers (COSAs) available through 1985. Areas requiring further research and methodological problems in the research are identified. The literature has been organized into several areas: estimates of the numbers of COSAs, and research on pregnant addicts, neonates, infants, older children, and parenting issues.     

Substance Abuse in an Urban Aboriginal Population

Abstract

This work is the result of a research program developed from a research partnership between the Native Mental Health Research Team of McGill University and the Native Friendship Centre of Montreal, a Native-run urban community-based service organization. The aims of the study were to examine substance abuse as well as physical and mental health among an urban Aboriginal population. The nature and severity of drug or alcohol problems in this population were explored. Data was collected through structured interviews with urban Aboriginal people in the greater Montreal area (n = 202). Results indicate that the majority of the sample were single, unemployed, and had lived in the urban area for a long time (mean of 9.96 V .76 years). Approximately two thirds of the sample were current alcohol drinkers and cigarette smokers and one third of the sample reported having a current drug or alcohol problem. Results indicate that individuals who abused substances were more likely to live with someone who had a drug or alcohol problem. Substance abusers also had a greater history of legal problems with more convictions, time spent in jail, and were more likely to be on probation or parole. A large proportion of the sample reported having significant medical problems that required treatment, and substance abusers were less likely to have identification needed to access medical services. Results indicated high levels of psychological distress in the general sample (depression, anxiety, suicidal ideation, attempted suicide). These phenomena were augmented by substance abuse problems. In particular, substance abusers had a history of more suicide attempts, and were more likely to have been the victims of abuse.     

Treatment Outcome as a Function of Treatment Attendance with Homeless Persons Abusing Cocaine

This research examines the influence of treatment attendance at two substance abuse outpatient treatment programs of the Birmingham Substance Abuse Homeless Project on substance abuse, homelessness, and unemployment outcomes with homeless persons abusing primarily crack cocaine. Results revealed that significant reductions across a one year period in alcohol use, cocaine use, and homelessness were more likely to occur in clients who attended an average of 4.1 treatment days per week (High attendance or Enhanced Care group) than clients who attended less than one day a week on average (Low attendance or Usual Care and Medium attendance groups). These results are consistent with the literature suggesting that more intensive contact early in treatment results in better long-term outcome with cocaine abusers, but has now been demonstrated with homeless cocaine abusers who additional problems associated with housing and employment.     

Herbal Therapy in the Treatment of Drug Use

The use of herbs in the treatment of substance abuse is a relatively new phenomenon, although the practice of herbalism goes back to the dawn of humanity. Herbs are natural botanical substances which have noticeable effects on the human organism. Throughout history man has used herbs for nutritional and healing purposes as well as for getting highMost current treatment programs for substance abusers take into account only a small portion of the healing spectrum (e.g., psychological counseling, methadone, self-help, therapeutic community). There is a growing awareness of and concern to develop programs for substance abusers which utilize a holistic approach to deal with the mental, physical, emotional, and spiritual problems accompanying substance abuse. The purpose of this article is to review the use of herbal therapy in the treatment of drug abusers. An annotated bibliography is provided.     

Does centralized intake improve drug abuse treatment outcomes?

This study was designed to assess whether centralized intake and assessment in a drug abuse treatment system would lead to improved outcomes. Clients entering treatment through a centralized intake unit (CIU) or through individual programs (non-CIU) were interviewed at admission, and at 1 month and 1 year postadmission. Interviews included measures of treatment access and satisfaction, psychiatric symptoms, social support, and Addiction Severity Index composite scores. At treatment entry, CIU participants had more employment and psychological problems and lower social support, were more often required to be in treatment, and were more often placed on a waiting list. In analyses controlling for baseline differences between groups, there were main effects of time, but no CIU status effects or CIU status by time interactions. The CIU may have improved access to treatment for a more disabled population; however, clients entering treatment through the CIU did not have better outcomes than those entering treatment directly.     

Women's steps of change and entry into drug abuse treatment. A multidimensional stages of change model

The Transtheoretical, or Stages of Change Model, has been applied to the investigation of help-seeking related to a number of addictive behaviors. Overall, the model has shown to be very important in understanding the process of help-seeking. However, substance abuse rarely exists in isolation from other health, mental health, and social problems. The present work extends the original Stages of Change Model by proposing "Steps of Change" as they relate to entry into substance abuse treatment programs for women. Readiness to make life changes in four domains-domestic violence, HIV sexual risk behavior, substance abuse, and mental health-is examined in relation to entry into four substance abuse treatment modalities (12-step, detoxification, outpatient, and residential). The Steps of Change Model hypothesizes that help-seeking behavior of substance-abusing women may reflect a hierarchy of readiness based on the immediacy, or time urgency, of their treatment issues. For example, women in battering relationships may be ready to make changes to reduce their exposure to violence before admitting readiness to seek substance abuse treatment. The Steps of Change Model was examined in a sample of 451 women contacted through a substance abuse treatment-readiness program in Los Angeles, California. A series of logistic regression analyses predict entry into four separate treatment modalities that vary. Results suggest a multidimensional Stages of Change Model that may extend to other populations and to other types of help-seeking behaviors.     

Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout

High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.     

Treating adolescents for substance abuse and comorbid psychiatric disorders

Recent research has identified a cluster of standardized approaches that effectively treat adolescents with substance abuse disorders. Many of these approaches share elements that may be adopted to improve outcomes in substance treatment programs. In adolescents, treatment goals should be informed by a comprehensive assessment that includes the adolescent patient's developmental history and evaluation of psychiatric comorbidity. Treatment for behavioral, psychosocial, and psychiatric problems should be integrated with substance abuse interventions. The author describes practical clinical guidelines, grounded in current research, for providing integrated treatment services. Special emphasis is given to strategies for integrating the treatment of comorbid psychiatric disorders with substance use disorders in adolescents.     

Eighteen-Month Follow-Up Data on a Treatment Program for Homeless Substance Abusing Mothers

In response to the dearth of data on substance abuse treatment among homeless mothers, this study breaks new ground in presenting 18-month follow-up data on 149 homeless mothers with young children enlisted in a substance abuse treatment program. The effects of residential compared to nonresidential services were evaluated over the follow-up period. Although dropout rates were high, predictors of dropout were identified, and the residential had a lower dropout rate compared to the nonresidential comparison group. Members of both residential and nonresidential groups evidenced improvement in alcohol and drug problems and in housing stability, regardless of the amount of time they spent in the program. This project demonstrated that homeless mothers can be more successfully engaged in substance abuse programs with provisions of residential placement in addition to participation in a therapeutic community. Future interventions can take advantage of this knowledge in designing more effective programs.     

Alcohol and cocaine abusers 6 months after traditional treatment: Do they fare as well as problem drinkers?

Problem drinkers (N = 49) and individuals presenting with both alcohol and cocaine problems (N = 51) admitted to a traditional 28-day alcoholism treatment milieu were compared on their psychosocial, psychological, neuropsychological functioning and substance abuse at admission as well as at six months posttreatment follow-up. On admission, alcohol and cocaine patients were younger, more likely to live alone or with their family of origin, to report having started using alcohol at an earlier age, to have fewer alcohol-related problems and to have fewer years of but more diversity in their substance abuse than the alcohol-only patients. Otherwise both groups were more similar than different on psychosocial, psychological and neuropsychological dimensions. At six-months posttreatment, both groups showed similar improvement on most dimensions of functioning measured. However, a significantly greater proportion of the alcohol and cocaine abusers admitted to having relapsed in the previous six months, reported significantly fewer average days of abstinence than the alcohol group since terminating treatment, and were more likely to present urine specimens indicative of recent substance abuse at the six-month follow-up interview. Thus, traditional approaches to alcoholism treatment may be less effective in establishing abstinence for individuals with both alcohol and cocaine problems. Adaptations to treatment to reduce the risk for relapse faced by alcohol and cocaine abusers in such milieu are discussed.     

Consumer perceptions of trauma assessment and intervention in substance abuse treatment

Substance abuse treatment programs are increasing their use of integrated interventions for trauma and substance abuse. While positive behavioral outcomes have been associated with this model, the purpose of this study was to determine consumers' satisfaction with it. Participants were 51 men and 102 women who received trauma assessments and interventions through a drug treatment court. Satisfaction with treatment was measured through the Consumer Perception of Care (CPC). Participants were generally satisfied with the trauma assessments and interventions they received. Number of traumatic experiences, measured by the Adverse Childhood Experiences (ACE) scale, and level of distress, as assessed on the Trauma Symptom Inventory (TSI), were significantly associated with assessment and treatment satisfaction. Gender differences were noted, with men reporting fewer traumatic experiences and trauma-symptoms and less satisfaction with trauma assessment. Implications for the integration of trauma and substance abuse interventions in drug treatment courts and other programs are discussed.     

Single versus multiple drug focus in substance abuse clinical trials research

Complex patterns of multiple substance use pose clinical and methodological challenges for substance abuse clinical trials research. To increase measurement precision and internal validity, the modal approach has been to target both treatment interventions and outcome assessment to a single class of abused substance. This strategy warrants reconsideration because it entails limitations in recruitment feasibility and generalization of study findings. This report reviews pros and cons of single versus multiple targeted drugs, suggests guidelines for choosing between these strategies and outlines methods for broadening the scope of substance abuse clinical trails to take abuse of multiple substances into account. We recommend that investigators consider moving away from a single drug focus in three ways. First, include systematic assessment of a wide range of psychoactive substance use throughout the trial and evaluate the impact of study treatments on use of all classes of drugs. Second, except where contraindicated, include patients who use and abuse multiple classes of substances even in trials evaluating treatment of a single targeted drug. Third, consider inclusion of polysubstance abusers or those who primarily abuse multiple classes of substances in the same clinical trial. Although many treatment efficacy questions can best be answered by single focus studies, we recommend that such designs be adopted only after less restrictive designs are first considered.     

Neuropsychological assessment of substance abusers: review and recommendations

Neuropsychological assessment of substance abusers frequently proves useful for the evaluation of those aspects of cognitive functioning that may be relevant for optimal therapeutic management and treatment planning. Research has demonstrated the presence of neuropsychological impairment in chronic abusers of CNS depressants, including alcohol, as well as opiates and possibly cocaine, especially when such substances are combined in a polydrug pattern of abuse. Clinical neuropsychological evaluation of individual substance abusers should take into account the various personal, demographic and neuromedical background variables that can affect cognitive functioning. Efforts should be made to distinguish between acute drug effects and more longterm stable deficits that may not become apparent for some time. Neuropsychological referrals should be made, and measures selected to answer particular questions about neurocognitive functioning that are relevant to treatment and eventual overall adjustment. A neuropsychological review of systems is likely to show a pattern of impairment in substance abusers that involves the integration of different cognitive functions for effective problem solving. Strongly focal or lateralized deficit patterns are less likely to be the result of drug abuse alone, and should prompt the appropriate neuromedical follow-up.     

Predicting Drug Treatment Entry Among Treatment-Seeking Individuals

This study examined factors related to drug treatment program entry among 276 drug abusers seeking treatment referral. Six-month follow-up interviews determined that 171 (62.0%) followed through with the treatment referral. The analyses indicated that treatment-entry and non-entry subjects did not differ in predisposing factors (age, gender, race/ethnicity, education), type of drug use, or years of use. A logistic regression analysis indicated that characteristics at baseline predicting subsequent treatment entry include legal pressure, lower levels of psychological distress and family or social problems, and prior successful treatment experience. Legal coercion was an effective factor promoting treatment entry. Drug abusers having prior successful treatment experience were also more likely to reenter treatment. However, those with more severe problems (drug related and others) seemed less likely to enter treatment, indicating that psychological distress and family problems may undermine motivation to follow through on treatment referral.     

Primary heroin users + drug-free treatment: an equation for success?

This study of persons referred to publicly funded drug-free substance abuse treatment in Washington State compares 122 primary heroin users (those specifying heroin as a drug of choice) with 532 persons who preferred other substances. Information on treatment entry and completion was obtained through review of client charts at the referral agency. Follow-up interviews with 587 participants provided self-reports of substance use during a 90-day period 3-6 months following removal from the treatment waitlist. Primary heroin users were significantly less likely than others to enter the treatment programs to which they were referred. Among treatment entrants, primary heroin users were somewhat less likely than other users to complete inpatient programs but no less likely to complete outpatient programs. The heroin preference group reported less abstinence and greater frequency of use during the follow-up period than did other users, patterns that almost entirely coincided with the lower treatment compliance in the heroin group. The authors note the importance of investigating methods for increasing treatment entry rates for opiate users who desire drug-free treatment.     

Comparison of background characteristics and behaviors of African-American, Hispanic, and white substance abusers treated in Federal prison: results from the TRIAD Study

The lack of empirical literature describing minority substance abusers who seek treatment serves as an obstacle for providing empirically-driven, culturally-relevant substance abuse treatment to minorities in both prison-based and community-based programs. The purpose of this study was to address this gap in the literature by describing and comparing the background characteristics and preincarceration behaviors and social environments of adult African-American, Hispanic, and white substance abusers who were treated in Federal Bureau of Prisons' (BOP) residential drug abuse treatment programs. The study sample included 279 African-American, 72 Hispanic, and 512 white male substance abusers who were treated in 16 prison-based residential drug treatment programs from 1991 to 1995. Consistent with the limited literature, this study tested the hypothesis that there would be significant differences among the groups on most of the variables, with the greatest differences to be noted between African-American and white participants. The results indicated that there were numerous significant differences in demographic and background, family background and criminal history characteristics, but there were only a few differences in preincarceration behaviors and social environment among participants. The findings suggested that addressing participants' treatment needs within the context of their cultural characteristics would enhance treatment for participants.     

Factors that predict adolescent motivation for substance abuse treatment

Many adolescent substance abusers enter treatment because of external pressures and thus lack motivation to change their behavior and engage in treatment. Because an understanding of adolescent motivation may contribute to improved treatment, an investigation of factors that predict motivation was undertaken with youth admitted to an adolescent outpatient substance abuse treatment program (N=196). At admission, these subjects received a comprehensive biopsychosocial assessment. Using multiple regression analysis, factors considered to potentially predict motivation were assessed. Of the factors examined, those that involved experiencing various negative consequences of substance use emerged as important predictors of motivation, whereas severity of substance use did not. Diminished awareness of negative consequences of use was consonant with lower motivation, suggesting the importance of interventions to help youth recognize negative consequences of their substance use. Interventions to enhance motivation are likely to become more important as the juvenile justice system increasingly refers troubled youth to treatment.