Childhood Abuse History and Substance Use Among Men and Women Receiving Detoxification Services

According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.     

Integration of Alcohol and Other Drug,Trauma and Mental Health Services

SUMMARY

The Franklin County Women's Research Project is a collaboration among the Western Massachusetts Training Consortium, the Franklin Medical Center, three Women's Resource Centers located across the county, and local consumer/survivor/recovering women (CSRs). This project is unusual in two ways: (1) it is a rural site, and (2) the project was designed, implemented and evaluated by CSRs. The program model integrates services at the person level and at the system level. The Women's Resource Centers are the focal points for the individual level services integration offering women support through their peers, including AA/NA meetings, trauma recovery groups using the Addiction and Trauma Recovery Model (ATRIUM), Peer Resource Advocates, writing, art, and body awareness programs, and a variety of opportunities. The guiding principle is that women heal when they find the resources within themselves to define their lives and engage in activities and work that is meaningful to them. These Centers work in conjunction with the formal treatment systems. Services integration is accomplished through the Services Integration Committee comprised of the mental health, AOD and domestic violence providers, the Community Coordination Council comprised of a wider network of service and support providers, and through the activities of the Trauma Liaison, an employee of Franklin Medical Center who chairs the committees and provides consultation on women with trauma histories.     

Substance Use and High Risk Sexual Behaviors among Women in Psychosocial Outpatient and Methadone Maintenance Treatment Programs

Objectives: The purpose of the present study was to assess the association between substance use/diagnosis and sexual risk behaviors among women enrolled in both psychosocial outpatient (PS) and methadone maintenance (MM) treatment and involved in a HIV prevention intervention study within the National Institute for Drug Abuse Clinical Trials Network. Methods: 515 sexually active women reported on unprotected sexual occasions (USO), anal sex, sex trading, sex with drug occasions, and multiple male sex partners at the baseline assessment. Results: Within the PS sample, cocaine use diagnosis was associated with more than twice the risk of having multiple partners, trading sex for drugs, having anal sex, or having sex with drugs; alcohol or opioid use diagnosis was associated with fewer risk behaviors. Within the MM sample, cocaine use, alcohol use and opiate use diagnoses were each associated with one to two risk behaviors. Associations between sexual risk and substance using days were less frequent in both samples. Conclusions: These findings highlight the need for integration of HIV sexual prevention interventions that address the relationship between sexual risk behavior and substance use diagnoses into substance abuse treatment programs.     

Improving Health and Social Outcomes with Targeted Services in Comprehensive Substance Abuse Treatment

Background: Improved life functioning along with substance use reduction is increasingly recognized as the definition of effective addiction treatment. Objectives: To assess whether targeted health and social services contribute to improved physical/mental health and employment. Methods: This study used data from the National Treatment Improvement Evaluation Study (N = 3027) and modeled the improvement in physical/mental health and employment at discharge or 12 months after discharge compared with intake measures as a function of receipts of matched services. Results: Receiving matched medical service improves physical health only at treatment discharge; receiving matched mental health services improves mental health at discharge and 12 months after discharge; receiving matched vocational services improves employment only 12 months after discharge. Conclusions: Need–service matching contributes to improved health and social outcomes when longitudinal assessments of treatment outcomes are used to evaluate treatment effectiveness. Scientific Significance: Study findings document the value of targeted services for achieving success in health and social functioning in comprehensive substance abuse treatment.     

Interpersonal Violence,Substance Use,and HIV-Related Behavior and Cognitions: A Prospective Study of Impoverished Women in Los Angeles County

In a sample of 810 women residing in shelters and low-income housing, this 6-month prospective study investigated associations of recent violence and substance use withHIV-related sexual behaviors and cognitions. Controlling for baseline sexual behavior, partner violence at baseline was associated with less sexual activity and unprotected sex at follow-up. Non-partner violence at baseline was associated with a higher likelihood of being sexually active at follow-up (housed women), but less frequent sexual activity. Drinking to intoxication at baseline was associated with less ability to refuse unwanted sex (sheltered women) and higher perceived susceptibility to HIV at follow-up, whereas baseline drug use was associated with greater perceived ability to refuse unwanted sex and condom use self-efficacy. These findings differed in important ways from cross-sectional associations, emphasizing the need for additional prospective research to fully understand the impact of violence and substance use on womens HIV-related behaviors and cognitions.     

A Study of Criminal History among Young Adults with Co-occurring Mental Health and Substance Use Disorders in Psychiatry Outpatient

ABSTRACT

The goal of this study was to examine risk/protective factors to criminality in an adolescent population. Retrospective chart review was utilized to gather data on psychiatric history, substance use, and criminality among adolescent patients within a psychiatric outpatient clinic at a university school of medicine. An earlier age of psychiatric diagnosis and comorbid substance use was found to be a marked risk factor for criminality, whereas female gender and education were shown to be protective factors. These findings can aid in intervention strategies targeted at adolescents who are most at risk for criminality.     

Dual Taboos: Sexuality and Women with Severe Mental Illness in South Africa. Perceptions of Mental Health Care Providers

The AIDS epidemic in South Africa is among the fastest growing in the world. While much of the population is at risk for infection, marginalized groups such as women with severe mental illness (SMI) are often neglected in prevention efforts. A qualitative study of mental health care providers' perceptions of HIV risk and sexuality among women with SMI was conducted in four provinces of South Africa. Semistructured qualitative interviews explored providers' views on the impact of mental illness on sexuality and reproductive health for women with SMI. Providers described their perceptions of the role of psychiatric symptoms in sexual behavior, the kinds of sexual behavior engaged in, and the quality of sexual relationships for women with SMI. Providers prioritized family planning and prevention of pregnancy for women with SMI over HIV prevention. The findings suggest that mental health care providers' ambivalence about sexual expression in women with SMI may be a barrier to complete care as well as effective HIV prevention for this population.     

Prevention of Mental and Substance Use and Abuse Disorders and Comorbidity in African Americans

Regrettably for African Americans, research has rarely addressed issues that affect their health and well-being. This lack of attention manifests itself in the dearth of literature available while doing literature reviews on prevention of comorbid mental illness and substance abuse (MISA) and substance use and abuse disorders in African Americans. However, there are a few studies on the prevention of substance use and abuse disorders alone and the prevention of relapse in African Americans with MISA problems. These articles form the basis of our proposal to prevent co-morbidity of mental and substance use and abuse disorders in African Americans.     

The role of general family environment and sexual and physical abuse in the origins of eating disorders

This paper reviews the role of childhood family functioning and of sexual and physical abuse in eating disorders. Bearing in mind the huge methodological differences across studies the following tentative conclusions can be reached: there is evidence of more family pathology in eating disorder families than in normal control families. Those with bulimic disorders seem to have poorer family functioning than restrictors. Different eating disorder subgroups show less or comparable levels of family pathology compared to psychiatric or other medical controls depending on the comparison group. In bulimia nervosa high levels of family disturbance seem to be associated with greater severity and chronicity of bulimic symptomatology. There is some suggestion that family functioning may have more of an effect on Axis II than on Axis I disorders. Rates of sexual abuse appear to be higher in bulimia nervosa than in normal controls. Depending on which psychiatric control groups are chosen, eating disorder patients may have similar, higher or lower rates of contact sexual abuse. The majority of studies fails to find differences between eating disorder subtypes in terms of rates of sexual abuse. The evidence on whether there is any link between abuse characteristics and the severity of eating disorder is inconclusive. On balance, childhood sexual abuse does not seem to be a specific risk factor for eating disorders. Physical abuse is more common in bulimic than in restricting disorders and usually occurs in the context of a disturbed family environment. The clinical implications of these findings are discussed. Future research in the area of family factors or childhood trauma in eating disorders needs to get away from mere ‘head counts’ and needs to focus more strongly on the mediators between abuse and neglect and the development of eating disorders and also on the relative importance of family factors compared with other aetiological factors. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.     

Examination of the Inventory of Drug Use Consequences with Individuals with Serious and Persistent Mental Illness and Co-Occurring Substance Use Disorders

Background: The Inventory of Drug Use Consequences (InDUC) () is a 50-item measure that evaluates lifetime and recent consequences of substance use. Objectives: This study examined the psychometric properties of a modified version of the Inventory of Drug Use Consequences (InDUC-M) in individuals with serious and persistent mental illness (SPMI) and co-occurring substance use disorders (SUDs). Methods: We examined self-reported consequences in the sample, evaluated internal consistency, identified items for a brief form of the InDUC-M, and explored relationships with indicators of substance use severity. Results: InDUC-M Lifetime and Recent subscales showed good internal consistency and were related to other measures of substance use and problems. A brief version of the InDUC-M Recent (SIP-M) showed excellent internal consistency and was highly correlated with both Lifetime and Recent subscales. Conclusion: The InDUC-M and the SIP-M performed well in individuals with SPMI and SUDs. Conclusion and Scientific Significance: Overall, these findings are a useful first step in determining the utility of the InDUC-M in people with SPMI and SUDs.     

Personal Adjustment and Substance Abuse Problems in a Longitudinal Study of TANF Recipients and the Potential Need for Treatment

Objective: This study assessed the need over time for treatment of personal adjustment and substance abuse problems among chronic drug using and other recipients of Temporary Assistance for Needy Families (TANF). Methods: Participants were administered the personal adjustment problems and substance abuse problems scales contained in the Multidimensional Addictions and Personality Profile (MAPP) at intake, one‐year, and two‐year interviews. Results: Most participants who were not chronic users had total scale scores that would indicate no recommended referral or a referral to outpatient treatment. Approximately one‐third of chronic users had scores that would indicate referral to inpatient treatment. Many chronic users had comorbid conditions but reported receiving no psychological or substance abuse treatment. Conclusions: Many TANF recipients may be experiencing coexisting personal and substance abuse related problems that are going untreated.     

Patients with Substance Use and Personality Disorders: A Comparison of Patient Characteristics,Treatment Process,and Outcomes in Swiss and U.S. Substance Use Disorder Programs

Background: Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients’ characteristics, treatment conditions, and outcomes. Objectives: The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U.S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes. Methods: A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U.S. male patients drawn from a sample of 10 Swiss and 15 U.S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up. Results: Compared to Swiss SUD-PD patients, U.S. SUD-PD patients had more severe substance use and psychosocial problems at admission and follow-up. More intensive treatment and a stronger emphasis on patients’ involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. Conclusion: There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients’ outcomes. Scientific Significance: Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients’ outcomes.     

Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic

This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.     

Characteristics of Opioid-Using Pregnant Women Who Accept or Refuse Participation in a Clinical Trial: Screening Results from the MOTHER Study

Background: Although concerns arise about the generalizability of results from Randomized Controlled Trials (RCTs), few studies systematically examine this issue. Objectives: This study compared the characteristics of 427 opioid-using pregnant women who did (n = 208) and did not consent (n = 219) to enrollment in a multicenter clinical trial of agonist medications (i.e., the MOTHER study). Methods: Logistic regression models were used to compare consenters and non-consenters to examine the effect of screening variables on the likelihood of consenting. Results: Of nine characteristics examined, most differences did not reach statistical significance. Consenting participants were less likely than non-consenting women to be currently enrolled in a methadone maintenance program (74.5% vs. 84.5%, p =.01). Conclusion and Scientific Significance: These data show that the recruited sample of drug-dependent pregnant women enrolled in an intensive RCT is representative of the larger population of treated opioid-dependent patients and supports the generalizability of randomized controlled trials in this population.     

Introducing and Negotiating the Use of Female Condoms in Sexual Relationships: Qualitative Interviews with Women Attending a Family Planning Clinic

Safe sex skills training often teach women to be assertive in condom use negotiations. However, it has been suggested that assertiveness training may be inappropriate for women who lack power in their sexual relationship. Our qualitative study of 62 women attending a family planning clinic explored various communication styles they used to introduce and negotiate female condom use in their sexual relationships. We further examined how different introduction and negotiation styles were related to actual use of the device. The device was introduced using a direct, semidirect, indirect, or nonverbal communication approach. Use of the female condom was negotiated by avoiding sex, using humor, discussing the possibility of using the condom, or being argumentative with partners. The outcome of introducing and negotiating female condom use was often mediated by other factors including partner characteristics, relationship power dynamics, situational context, and use of additional discourse strategies (e.g., describing the female condom as a sexual toy or taking the opportunity to educated partners about the female condom). Less direct approaches appeared to be as effective in facilitating use of the female condom as more direct approaches. Female condom introduction and negotiation styles that continued to engage their partners by using additional discourse strategies led to more frequent use of the device. Implications of our findings for HIV risk reduction program development are discussed.     

Isolating the Nexus of Substance Use,Violence and Sexual Risk for HIV Infection Among Young Adults in the United States

Adults aged 18 to 29 are at significant sexual risk for HIV infection. Substance use and violence are known to be associated with sexual risk in certain groups, but few studies have examined these relationships in the general population of young adults. No studies have tested whether the contributions of substance use and violence to sexual risk are independent, and few have looked at whether drug use associations with risk are specific to certain substances. Using structural modeling techniques, we examined data for 3,437 adults aged 23–24, testing for associations between three measures of sexual risk for HIV, various forms of substance use, victimization and partner violence. Alcohol use and victimization predicted high risk sex in independent samples of single and married/cohabiting adults. Marijuana use, problem drug use, and partner violence were inconsistently related to sexual risk across measures and subsamples. HIV-prevention interventions designed for young adults in the general population should target individuals who use alcohol frequently and who are victims of violence, and should address both factors, in addition to sexual risk behavior.     

A population-based study of HIV testing practices and perceptions in 4 U.S. states

OBJECTIVE: To evaluate testing practices and perceptions of HIV risk among a geographically diverse, population-based sample of sexually active adults who reported behaviors that could transmit HIV. DESIGN: Secondary analysis of the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System (BRFSS) 2000 survey. PATIENTS/PARTICIPANTS: Sexually active adults less than 50 years old, who completed the Sexual Behavior Module of the BRFSS 2000 survey administered in 4 U.S. states. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of the study population reported one or more behaviors in the past year that increased their risk of HIV infection (men 23%; women 15%). In this subgroup at any increased risk of HIV infection, 49% reported having had an HIV test in the past year. For 71% of those tested, the HIV test was self-initiated. Younger age was the only factor independently associated with whether or not individuals with behaviors that increased their risk of HIV infection had had a recent HIV test. Among the 51% of individuals at risk who reported no recent HIV test, 84% perceived their risk as low or none. CONCLUSIONS: In this study, about half of the individuals who reported behaviors that could transmit HIV had not been recently tested for HIV. Of those not tested, most considered their risk of HIV to be low or none. Interventions to expand HIV testing and increase awareness of HIV risk appear to be needed to increase early detection of HIV infection and to reduce its spread.     

Adherence to Medication Treatment: A Qualitative Study of Facilitators and Barriers Among a Diverse Sample of HIV+ Men and Women in Four U.S. Cities

Most studies examining HIV antiretroviral medication treatment adherence involve quantitative surveys. Although these studies have identified factors associated with medical adherence, no single variable or combination of variables is sufficiently consistent to apply to any individual or group of people. Using qualitative methods, an ethnically diverse sample (N = 110) of HIV+ women, men who have sex with men, and male injecting drug users in four U.S. cities were interviewed in depth to elicit their experiences, perspectives, and life contexts regarding knowledge, attitudes, beliefs, and experiences with HIV medication adherence. Most described multiple influences on medication-taking behavior, describing adherence as a dynamic phenomenon that changes over time with their changing beliefs, attitudes, emotions, and daily and larger life events. Prevalent themes include ambivalence toward HIV medication and intentional nonadherence, usually to address physical side effects. Factors from different domains (e.g., cognitive, emotional, interpersonal) can have compensatory influences on behavioral outcomes. Findings are discussed in terms of social action theory, contributing to our theoretical understanding of the phenomenon of adherence.