A new measure of substance abuse treatment. Initial studies of the treatment services review.

This paper describes the development and initial testing of the Treatment Services Review (TSR). The TSR is a 5-minute, technician-administered interview that provides a quantitative profile of the number and types of treatment services received by patients during alcohol and drug abuse rehabilitation. Test-retest studies indicated satisfactory reliability administered either in person or over the phone. Tests of concurrent validity showed the ability to discriminate different levels of treatment services and good correspondence with independent measures of treatment provided. While additional studies are still needed with this instrument, the data collected thus far suggest that the TSR may serve two types of needs. First, at the programmatic level, the TSR may prove useful in describing and comparing programs in terms of the nature and number of services actually delivered to patients. At the individual patient level, the TSR may offer a means of evaluating the "match" between a patient's needs and the services actually provided.     

Adolescent substance abuse treatment: evidence-based practice in outpatient services

Adolescent substance use disorder (SUD) is a serious public health concern. The majority of youth with SUD receive outpatient treatment. There is a pressing need to improve treatment outcome due to high rates of both premature treatment termination and relapse during and after treatment completion. Reviews of the latest innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials examining singular and integrative treatment modalities have established empiric support for the efficacy of adolescent treatment. Despite some prominent differences in treatment modalities, design, and methodology, recent studies have reported remarkably similar short-term outcomes. Taken together, the findings represent significant developments in treatment outcome research, and lay the foundation for continued future research addressing important challenges. Potential directions include improving short- and long-term outcomes, enhancing motivation for treatment, improving engagement strategies, identifying challenges associated with psychiatric comorbidity, addressing patient-treatment matching, and developing aftercare programs.     

Integrated services for treatment of schizophrenic substance abusers: Demographics,symptoms, and substance abuse patterns

We have previously described a model of outpatient integrated treatment for patients with comorbid psychoactive substance use disorders and schizophrenia (PSUD/S)(1). Here we review relevant literature on comorbidity and outline the rationale for integrated services. Further, we describe results from 3 related studies: First, we document the approximate incidence of PSUD among a heterogeneous group of 602 schizophrenic inpatient admissions to our hospital. Second, we describe in greater detail the psychiatric symptoms and patterns of substance abuse among a subsample of 106 inpatients with PSUD/S, contrasting them with 112 patients with PSUD and mixed psychotic disorders, but who are not schizophrenic. Third, we present a prospective research project and describe a sample of 30 patients with PSUD/S, detailing demographic characteristics, psychiatric symptoms and substance abuse history. Attention is given to current issues in the differential diagnosis of patients with PSUD/S using standardized instruments.     

Improving mental health and substance abuse services for adolescents

This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families. Depending on the state of knowledge of each topic, the authors either highlight the importance of the area or offer a specific position statement. It is intended that these statements be reviewed for possible endorsement by the American College of Mental Health Administration (ACMHA) and for transmission to other professional organizations, federal and state governmental agencies and the field in general.     

Changes in services and structure in community residential treatment facilities for substance abuse patients

OBJECTIVE: This study examined the extent to which community residential facilities that contract with the Department of Veterans Affairs (VA) to treat substance abuse patients are providing more services and structure to meet the needs of a client population with increasingly severe problems. METHODS: A nationwide sample of 249 community residential facilities with VA contracts was surveyed in 1995 and again in 1998. RESULTS: In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psychologists available to patients as well as specialized counseling and psychoeducational, rehabilitation, and medical services. Facilities also provided more social and recreational activities, and more structure was provided by discouraging patients' choice of individual daily living patterns. In 1998 the facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed toward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients. CONCLUSIONS: Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.     

Mental health and substance abuse services in HMOs

Managed Care, in health services in general and in mental health in particular, is the latest building block presented as necessary for the development of an organized human services system. HMOs represent the fastest growing element in such systems. This paper attempts to collate the latest information available as to how mental health and substance abuse care is being designed and provided in HMOs.Portions of this article have been taken from Managed Health Care Handbook, ed.: P.R. Kongstvedt, Aspen Publishers, Inc., 1988.     

Drug and alcohol treatment services effective for methamphetamine abuse.

BACKGROUND: Methamphetamine abuse has become a major public health problem as demonstrated by increases in the number of emergency room visits, substance abuse treatment episodes, and arrests attributable to methamphetamine manufacture and abuse. We examine the effectiveness of conventional substance abuse treatment in the recovery of individuals seeking voluntary treatment for methamphetamine abuse. METHODS: At the request of the Iowa Department of Public Health, the Iowa Consortium for Substance Abuse Research and Evaluation contacted clients who had been admitted to voluntary treatment for methamphetamine abuse. Staff from the Consortium asked subjects to volunteer for follow-up interviews at designated intervals following admission. Agency staff conducted interviews based on the Mini International Neuropsychiatric Interview (MINI) at admission and at designated intervals and reported results to the Consortium for analysis. RESULTS: Subjects were predominantly Caucasian and over one half were female with an average age of 30 years. The criminal justice system was a primary referral source. Reported psychiatric symptoms dropped substantially in the first 60 days following admission and appeared to remain low at 6 and 12 months. Most clients reported abstinence and employment and denied arrests at the 6-month interview. Outcomes were not correlated with psychiatric symptoms. CONCLUSIONS: Psychiatric symptoms improved over time with usual substance abuse treatment. There was no evidence that referral by the court system or symptoms of antisocial personality disorder affected outcome. Conventional treatment resulted in sobriety, employment, and fewer arrests at 6 and 12 months following treatment.     

Legal challenges for substance abuse treatment during disasters

Certain groups with preexisting mental and behavioral health conditions, such as substance use disorders, may be especially vulnerable during and shortly after disasters. Researchers have found that substance abuse treatment programs and the individuals they serve experienced major disruptions after the September 11, 2001, attacks on the World Trade Center and the Pentagon and after Hurricane Katrina. This column considers legal challenges that may arise when a rapid influx of licensed providers is needed for substance abuse treatment during disasters and reviews specific legal issues that disasters may raise for opioid treatment programs. Opportunities to mitigate legal challenges and facilitate substance abuse treatment during disasters are discussed.     

Lifetime use of mental health and substance abuse treatment services by incarcerated women felons

OBJECTIVE: This study examined the lifetime use of alcohol, drug, and mental health treatment services by recently incarcerated women prison inmates. METHODS: A total of 805 women entering a North Carolina prison for new felony charges in 1991 and 1992 were interviewed in person shortly after incarceration. The women were assessed for psychiatric disorders and lifetime use of substance abuse and mental health treatment services. Rates of service use were analyzed by inmate characteristics and were compared with rates for a sample of women in the community in North Carolina. RESULTS: The majority of women inmates reported a history of using substance abuse services or mental health services or both. Those with psychiatric disorders and prison recidivists were the most likely to have used such services. Rates of service use were substantially higher for the inmates than for the women in the community, even when the effects of having a psychiatric or substance use disorder were controlled for. CONCLUSIONS: Many of the incarcerated women in the study met lifetime criteria for alcohol, drug, and mental health disorders that were significantly related to their use of substance abuse and mental health treatment services. The majority of the inmates met criteria for a current disorder despite past treatment. Further research is needed to help in developing programs to reduce women inmates' alcohol, drug, and mental health problems.     

Medicaid eligibility and access to mental health services among adolescents in substance abuse treatment

OBJECTIVE: The co-occurrence of a mental disorder is common among adolescents who present for substance abuse treatment. This study was conducted to determine whether Medicaid eligibility was associated with greater use of mental health services. METHODS: The study used administrative data for 25,813 adolescents in Oregon. Propensity score analysis was used to assess the likelihood that the adolescents would use mental health services, with group differences and mental health need controlled for. RESULTS: Medicaid-eligible youths were nearly five times as likely to receive mental health services in the year they entered substance abuse treatment compared with non-Medicaid-eligible youths. In both groups, there was evidence of racial disparities as well as factors such as foster care that may facilitate access. CONCLUSIONS: The fact that Medicaid-eligible youths have greater access to mental health services should be considered in both state policies and research design. States considering ways to better serve adolescents with co-occurring disorders would do well to examine ways to promote Medicaid enrollment or expand eligibility.     

Receipt of aftercare services by problem types: Psychiatric,psychiatric/substance abuse and substance abuse

In the present study, a cohort of patients discharged from two state psychiatric hospitals were categorized into three groups: psychiatric, psychiatric/substance abuse and substance abuse. Patterns of service receipt postdischarge and the differential impact of service use on rehospitalizations and community tenure were analyzed. The psychiatric group were more receptive to contacting community mental health aftercare agencies and when they did connect, they received, on the average, greater amounts of service than the other two groups.This study was funded by grants from the Ohio Department of Mental Health, Office of Program Evaluation and Research.     

Older offenders, substance abuse, and treatment.

OBJECTIVE: The adoption of more stringent truth-in-sentencing laws and the aging of the United States population in general has led to an increase in the proportion of prison inmates age 55 years and older. Recent judicial rulings require prisoners to receive adequate medical and mental health care. Care for substance abuse is often included to reduce recidivism. However, little systematic research has been conducted on the mental health and substance abuse treatment needs of older prisoners. METHODS: The authors examined age differences in substance abuse history provided by 10,952 offenders as part of their orientation and evaluation on entry into prison. Trained substance abuse counselors interviewed each offender and recorded data in an institutional database. RESULTS: Seventy-one percent of older inmates reported a substance abuse problem. When compared with younger inmates, older offenders were more likely to abuse alcohol only. Those older inmates with abuse problems had used substances for over 40 years, yet more than one-third had never received treatment. CONCLUSION: Like younger inmates, most older offenders would benefit from substance abuse treatment. The treatment may need to be tailored to age and lack of previous treatment experience and should be sensitive to this high-risk group's additional medical needs.     

Clozapine treatment in patients with prior substance abuse.

OBJECTIVE: This study examined outcomes following discharge on clozapine for treatment-resistant schizophrenia patients with and without diagnosed substance abuse histories. METHODS: Those discharged on clozapine from a research unit between April 1991 and March 1996 were followed with respect to hospitalization status. Of the treatment-resistant patients with schizophrenia, 19 were diagnosed as individuals with substance abuse, while 26 patients had no history of abuse. Patients were openly treated with clozapine and were included in the study if they were stabilized and discharged on the medication. RESULTS: Patients who had histories of abuse exhibited a better treatment response and a lower total Brief Psychiatric Rating Scale (BPRS) score at discharge, compared with the non-substance abuse group. One-year readmission rates were 21% and 23% in patients with and without prior substance abuse histories, respectively (P = ns). CONCLUSIONS: Clozapine may be a therapeutic option for the dually diagnosed population and may offer benefits to patients with schizophrenia who have a history of substance abuse.     

The cost-effectiveness of substance abuse treatment

Researchers have estimated the cost of treating substance abuse and its effects on medical care and social service expenses, but have rarely used the methods developed to evaluate medical care interventions. When outcomes are expressed as quality-adjusted life years, substance abuse treatment may be compared with other types of health care. This method has found smoking cessation and methadone maintenance to be highly cost-effective health care programs.