Abstracts of the AMERSA National Conference,November 1999: Empirical Studies

Abstract List

Abstracts of the AMERSA National Conference, November 1999: Empirical Studies     

Abstracts of the AMERSA National Conference,November, 2000: Empirical Studies

Abstract List

Abstracts of the AMERSA National Conference, November, 2000: Empirical Studies     

Abstracts of the AMERSA National Conference,November 2001: Looking Back Moving Forward

Abstract List

Abstracts of the AMERSA National Conference, November 2001: Looking Back Moving Forward     

Frontline counselors in organizational contexts: a study of treatment practices in community settings

This study addresses the challenge of implementing evidence-based treatment approaches in typical community settings. It identifies individual and organizational characteristics associated with two contrasting treatment approaches used by frontline practitioners. One treatment approach involves techniques supported by research; the other approach involves techniques primarily supported by experience and tradition. The study uses a nested probability sample of 45 organizations and 279 frontline practitioners. Multilevel (hierarchical linear modeling) regression models appropriately address the nested sample. The findings indicate that practitioner beliefs and components of organizational social contexts are associated with treatment approach. The use of an evidence-supported treatment approach is associated with opportunities to use training and with transformational leadership. A traditional treatment approach is more commonly used when practitioners have more positive perceptions of the organizational climate. The findings underscore the challenge of implementing evidence-based treatment techniques among counselors committed to traditional approaches.     

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.     

The Perceptions of White Clients in a Substance Abuse Program in Which They Are in the Minority

Background: There is a large body of literature regarding the need for culturally-informed practice with non-white populations in substance abuse treatment. Virtually nothing, however, has been written regarding the needs of white clients when they represent a small minority in treatment programs. Objectives: The primary purpose of this study is to compare perceptions of treatment and completion rates between white and nonwhite clients in a substance abuse treatment program where white clients represent a small minority. Methods: In New York City in 2009/2010, at a short-term inpatient program where white clients represented 12% of the population, 611 clients completed surveys that included scales measuring satisfaction, therapeutic alliance, social cohesion, and connection to the program. White and non-white clients were compared regarding results of these scales as well as program completion rates. Furthermore, demographic/background characteristics of the white and nonwhite clients obtained from the surveys were compared. Results: White clients reported lower levels of connection to the treatment program than non-white clients at levels that were statistically significant. However, there were no statistically significant differences between them for the other scales and program completion rates. Although white clients reported greater frequency and number of substances used, they were far less likely to have had felony convictions. Conclusions: Although differences were not extreme, there was evidence that greater sensitivity to the needs of white clients in programs in which they are in the minority is needed. Furthermore, this study demonstrates racial disparities in criminal justice involvement between white and non-white substance users.     

Latent practice profiles of substance abuse treatment counselors: Do evidence-based techniques displace traditional techniques?

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.     

Demarginalizing the marginalized in substance abuse treatment: Stories of homeless,active substance users in an urban harm reduction based drop-in center

This article reports stories of demarginalization in treatment as told by participants of a nonabstinence-based treatment program based on a harm reduction model targeting homeless active users. The stories told are ones where drug users–marginalized due to their drug and/or alcohol use–experienced the treatment setting in a destigmatizing, normalizing, humanizing and nonjudgmental manner. The purpose of this article is to describe the sense of demarginalization that participants experienced and to posit that demarginalization is a critical component in engaging “hard-to-reach” populations in substance abuse treatment. It assumes that listening to consumer voices about what is/is not meaningful to them in treatment can reveal much about program uptake or disconnect.     

Medicaid Coverage,Methadone Maintenance,and Felony Arrests: Outcomes of Opiate Treatment in Two States

ABSTRACT

A modest number of clinics in Oregon and Washington provide MMT maintenance treatment (MMT) services. More than 10,000 clients in each state were followed for 3 years after an initial admission for opiate use between 1993 and 2000. Medicaid clients in both states had far greater access to MMT than their non-Medicaid counterparts, controlling for differences in client characteristics using propensity scores. Months in MMT were associated with much lower arrest rates than time not in treatment, but unexpectedly this was only true for clients participating in MMT for many months. Despite differences in the treatment systems for opiate addiction in these two states observed in previous studies, the current findings generalized across both states.     

Relations among parental substance use, violence exposure and mental health: the national survey of adolescents

OBJECTIVE: To study the relations among parental substance use, violence exposure and psychopathology in a nationally representative sample of adolescents. METHOD: Random digit dialing methodology was used to obtain a nationally representative sample of 4023 adolescents, ages 12-17. Telephone surveys, conducted in 1995, assessed demographics, parental substance use, violence exposure, and three psychiatric disorders: major depressive disorder (MDE), posttraumatic stress disorder (PTSD), and substance abuse/dependence (SA/D). RESULTS: Obtained prevalence rates included: 8.2% for sexual assault, 22.5% for physical assault, and 39.7% for witnessing violence at home or in the community. Substance use by a family member was reported by 18.4% (n=721) of adolescents, with 50.6% reporting parental alcohol use and 19.1% (n=138) reporting parental drug use. Consistent with hypotheses, violence exposure and parental substance use, particularly parental alcohol abuse, were independently associated with outcomes. Additionally, parental substance use emerged as a moderator for MDE, PTSD, and SA/D; however, the moderating relations varied according to the outcome variable investigated. CONCLUSIONS: Violence-exposed adolescents reporting parental alcohol or drug use had the highest rates of psychiatric diagnoses.     

Relating Substance Abuse Counselor Background to the Provision of Clinical Tasks

Abstract

This study examines the diverse academic and professional background characteristics of substance abuse treatment counselors, relating these characteristics to the work counselors are doing. Results indicate that while academic and professional background characteristics differentiate whether counselors perform certain clinical tasks or not, they do not differentiate the amount of time they spend doing them. In fact, regression analyses indicate that academic and professional background characteristics currently account for less than 10% of the total variability associated with how counselors spend their time. While meager, the best predictors of individual work tasks appear to be more contextual in nature. The fact that academic and professional background characteristics do not differentiate counselors in terms of time spent on specific clinical responsibilities raises some questions regarding the quality of client care. Results also indicate that the knowledge and skill sets needed for counselors to be effective may vary according to the treatment setting     

Development of the Pretreatment Readiness Scale for Substance Abusers: Modification of an Existing Motivation Assessment

ABSTRACT

The Texas Christian University–Treatment Motivation Assessment (TCU-TMA) was originally developed to assess motivation among in-treatment opiod users. Numerous studies of in-treatment substance abusers in a variety of settings have confirmed the three factors present in the scale, including Problem Recognition, Desire For Help, and Treatment Readiness. The goal of the present study was to examine the factor structure of the TCU-TMA in a sample of 367 pretreatment substance abusers assessed at a centralized intake unit who had not yet entered treatment. Exploratory and confirmatory factor analyses led to the development of the Pretreatment Readiness Scale (PRS) that, like the TCU-TMA, contained Problem Recognition and Treatment Readiness factors. Desire for Change replaced Desire for Help in the new scale and Treatment Reluctance indicated mixed feelings about entering treatment. The implications of these findings on developing interventions for the pretreatment group will be discussed.     

Measuring substance abuse treatment provider training needs: Developing an index of training need: Harvard Medical School, Division on Addictions Addiction Training Center of New England, Brown University

This article describes the development of the Index of Training Need (ITN), a new system for measuring levels of treatment training need. By incorporating self- reported measures of the adequacy of respondents' previous treatment training and respondents' interest in future training in core domains, the ITN system yields a practical guide for the allocation of training resources. In addition, by quantifying levels of training need, the ITN system permits comparisons of training need on a variety of levels. By using the ITN system, educators can identify the needs of substance abuse clinicians efficiently and apply resources cost-effectively. Although this study represents a new approach for assessing training need in the substance abuse treatment field, the ITN approach is not limited to this application. Researchers, policy makers, and educators in other areas can apply the ITN methodology to needs assessment studies in their areas, substituting the appropriate core domains for those used in this study.     

Slightly New Strokes for Different Folks: A National Overview of Nonopiate Treatment Facilities

Abstract

The central ideas of this article are the result of intensive discussions during a symposium that was organized following structural changes in European substance abuse treatment. Therapeutic communities were concerned about their approach being replaced by other treatment modalities. Participants focused on the question of whether the emerging harm reduction paradigm could be combined with the principle of recovery and how its integration in a comprehensive treatment system could be beneficial or detrimental to therapeutic communities. This article defines integrated treatment systems for substance abusers from a conceptual, etymological, ethical and ideological point of view. In addition, it focuses on old but ongoing contradictions and discussions between drug-free, methadone-maintenance and harm reduction approaches. Several prerequisites for the integration of treatment systems are discussed, and parallels and discrepancies between the American and European situation are explored. An integrated and comprehensive system of treatment services is put forward as an alternative to the present-day gap between conventional abstinence-oriented programs and harm reduction initiatives. Participants maintain that collaboration between these apparently incompatible treatment paradigms will depend on mutual respect, the introduction of a common language and a thorough analysis of clients' treatment demands.     

循证护理在老年人股骨骨折围术期中的应用研究

目的在老年人股骨骨折围术期中运用循证护理的原理,以寻找整合患者主、客观资料的护理方法,达到减轻患者痛苦,提高患者生活质量。方法本组12例患者在围术期护理从三方面进行临床护理研究,以循证护理实施的步骤方法为依据,通过提出问题、寻找和查阅有关临床实证对患者实施最佳护理。结果12例患者中2例术后出现泌尿道感染需进一步治疗,其余10例均无合并其他并发症治愈出院。通过分析临床实践资料和吸取实证资料的经验,实施最佳护理行为,评价它能否取得最佳成效,判断是否需要进一步修正措施,确保护理质量的持续改进。结论循证护理能提高护理实践的科学性,并促进护理理论的发展,指导护理实践,通过实践验证,它既能满足服务对象的需求,又能促进护理学的必然发展,对建立护理学科的科学性和提高护理服务的有效性有着积极的促进作用。     

Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers, reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care, warranting further study and policy support.