Effects of gender and diagnosis on addiction history,treatment utilization,and psychosocial functioning among a dually-diagnosed sample in drug treatment

There has been increased recognition of the clinical treatment needs of patients with co-occurring mental and substance use disorders and the heterogeneity of this group with regard to types of substances used and mental disorders. This article examines differences between men and women diagnosed with mood or psychotic disorders at admission to residential drug treatment, specifically regarding their addiction history, treatment history, perceived service needs, and psychosocial functioning. Males initiated drug use at a younger age and had higher levels of dependence on alcohol, cannabis, and opioids. There were no differences among groups in treatment history, motivation, or initiation. Males had higher rates of being under legal supervision and engaging in property crime, whereas females had higher rates of prostitution. Females had greater needs for family- and trauma-related services, and females with psychotic disorders had the highest needs for basic services. There were no differences among groups in barriers to treatment, quality of life, self-efficacy, or family support. Individuals with psychotic disorders had more symptoms of psychological distress; females had higher rates of posttraumatic stress disorder. Differences among dually-diagnosed individuals related to gender and diagnosis need to be considered in treatment planning and in matching services to patient needs.     

The impact of HIV infection on medical services in drug abuse treatment programs

The HIV/AIDS epidemic has had a profound impact on the organization and delivery of clinical services in drug abuse treatment programs. The need for emphasis on HIV prevention vs. treatment services has varied with the geographic distribution of HIV infection among drug injectors. On-site primary medical care services have been developed in some treatment programs, whereas other programs have had to formalize arrangements for referral or contractual care with outside medical providers. No single model of care is necessarily appropriate for all drug treatment programs, and, along with the potential benefit, each may pose structural challenges that need to be addressed. The advent of the AIDS epidemic may have served, in an inadvertently positive way, to draw attention to the increasingly illogical separation between drug abuse treatment and the larger medical care system. This review will examine the epidemiologic, clinical, organizational, and policy issues generated by the increased medical needs of drug users with HIV infection in treatment program settings.     

Substance abuse treatment and HIV services: Massachusetts' policies and programs

States and communities use many strategies and policies to facilitate the integration of HIV and AIDS services with alcoholism and drug abuse treatment and prevention programs. Massachusetts' policy initiatives that promoted collaboration between substance abuse programs and AIDS services are outlined. The review begins with an overview of the HIV epidemic in Massachusetts and reflects on the initial challenges of building system capacity so that HIV and substance abuse services could become more closely integrated. The discussion summarizes specific policy strategies implemented to encourage system development and to develop program and staff skills for working with men and women with HIV/AIDS and at risk of infection. The initiatives included integration of alcoholism and drug abuse treatment programs, expansion of Medicaid reimbursement for substance abuse treatment, training and skills development for counselors, and coordinated service development and advocacy for substance abuse and AIDS/HIV services.     

Treating addictive behaviors in the employee assistance program: implications for brief interventions

Employee assistance programs (EAPs) are widely available to assist employees with a variety of problems. This research examined factors related to utilization and outcome by individuals with addictive behaviors (ABs) versus other problem areas. The specific aims of this study were to evaluate referral source and treatment outcome by gender and presenting problem. The sample included 3890 men and women who attended the EAP for a variety of concerns. Men were less likely than women to self-refer and more likely to be mandated to the EAP. Men were also much more likely to present with ABs. Relative to clients presenting with other issues, individuals with ABs were less likely to self-refer, have their problems resolved in the EAP, and were seen for fewer sessions. These results suggest that EAPs may be well suited for implementation of brief interventions (BIs) that have been empirically supported in other contexts.     

Women-only and mixed-gender drug abuse treatment programs: service needs, utilization and outcomes

OBJECTIVES: This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs. METHODS: The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients' problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records. RESULTS: Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric). CONCLUSIONS: The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.     

Behavioral,Emotional, and Psychological Outcomes Among Adolescents in a Drug Treatment Program:

The purpose of this study was to compare indices of behavioral, emotional, and psychological problems of maltreated and non-maltreated adolescents in a drug treatment program. Data were collected over a seven year period from intake interviews and Minnesota Multiphasic Personality Inventory (MMPI) scores of 522 adolescent patients at a drug treatment program. Maltreatment was self-reported by 43% of the females and 17% of the males. Results indicated that females had significantly more emotional and psychological problems than did males and that maltreated females had significantly higher levels of problems in these areas than any other group. Both maltreated males and females had significantly higher levels of behavioral problems than did their non-maltreated peers. The unique needs of maltreated adolescents in drug treatment programs are discussed.     

Gender differences in hostility of opioid-dependent outpatients: role in early treatment termination

The purpose of this study was to evaluate gender differences in hostility and the role of hostility in predicting early treatment termination of opioid-dependent outpatients. Demographic characteristics and Addiction Severity Index (ASI) ratings were collected from 104 patients (68 males and 36 females) at intake to a buprenorphine treatment program. Hostility was assessed using the Buss-Durkee Hostility Scale. Compared to male opioid-dependent patients, females scored significantly higher on this scale. Early treatment termination was defined as remaining in treatment < 30 days, and 13% percent of males and 25% of females were classified as early terminators. Stepwise logistic regression identified predictors of early treatment termination. Severity of legal and employment problems and the interaction between hostility and gender predicted early treatment termination status. Patients with less severe legal problems and patients with greater employment problems were more likely to terminate early from treatment. Higher levels of hostility predicted early treatment termination of female patients, but hostility levels were not associated with treatment termination in male patients. Results from this study show that female heroin addicts have high levels of hostility and suggest that hostility may be an important predictor of premature discharge from opioid substitution programs, especially among women.     

Followup of cocaine-dependent men and women with antisocial personality disorder

Long-term outcomes following drug treatment were examined for cocaine-dependent men (N = 453) and women (N = 254) with and without antisocial personality disorder (ASP). In-depth assessments were conducted at treatment intake in 1991-93 and at 1 and 5 years following treatment discharge. Overall, 47.2% of the males and 34.3% of females were diagnosed with ASP using DSM-III-R criteria derived from the Diagnostic Interview Schedule. All groups reduced their cocaine, marijuana, and alcohol use; reduced their levels of psychological distress; and improved in functioning (e.g., employment, arrests, residential status). At Year 5 ASP was associated with an increased likelihood of heavy alcohol use and additional substance abuse treatment among men, whereas women with ASP were more likely to report psychological problems and to receive mental health treatment and other services than either women without ASP or men with ASP. The findings suggest the need to address the specific treatment needs of male and female cocaine abusers with ASP.     

Treatment needs and experiences of Australian women with alcohol and other drug problems

Two hundred and sixty-seven women were interviewed as part of a national survey examining the treatment needs and experiences of Australian women who had received assistance for their alcohol and other drug problems. The majority of women had previously received assistance for their substance use, and of these most had left alcohol and other drug treatment programs before completion. While the women cited a number of ways in which they were helped by such services, several areas were identified by the women as important and amenable to improvement. Among the service issues raised were access, models of service delivery, service structure and staffing, physical environment, physical and psychological safety and the handling of issues such as health status and sexual assault.     

HIV/AIDS and Native Americans: the health departments' response

For some time, state health department HIV/AIDS programs have worked with communities of color to address their unmet needs. Because of the need for a holistic approach to the multiple issues impacting these communities, efforts to address HIV/AIDS in Native American communities are often integrated into programs addressing related issues, such as substance abuse, mental health and other STDs. Building upon a recent report from the National Alliance of State and Territorial AIDS Directors (NASTAD), this article will review the numerous challenges state and local health departments face in supporting HIV/AIDS-focused health and human services in Native American communities and how some health departments have worked with Native American communities to respond to these challenges. A series of recommendations and next steps for health departments seeking to improve services in Native American communities will be offered.     

Preventing HIV transmission in drug treatment programs: what works?

The AIDS epidemic has dramatically affected drug treatment programs, creating both an epidemiological crisis and a psychological one. A paramount question for treatment program staff is how to prevent patients from acquiring or spreading HIV. The health belief model has been useful in generating prevention approaches, including programs that raise the threat of infection, provide alternative behaviors, and build social support. Some of these programs have been effective in changing attitudes and reducing the behaviors that put drug users at risk for acquiring or transmitting HIV. Future research will develop collaborative studies, disseminate techniques to drug treatment programs, and develop more powerful interventions for patients who continue with risky behaviors.     

Women in addictions treatment: comparing VA and community samples

Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.     

Assessment of an AIDS intervention program during drug abuse treatment

Since 1985, many drug abuse treatment centers and health care providers have implemented special education programs for individuals who inject drugs. They focus primarily on increasing awareness of the threat of the human immunodeficiency virus (HIV) being spread through drug injection equipment and by sexual activities. As part of the Drug Abuse Treatment for AIDS- Risk Reduction (DATAR) project, the AIDS/HIV Risk Reduction Module was designed to meet these special intervention needs. This study examined program impact on 110 methadone treatment clients. Results indicated that for those in treatment less than 4 months, the AIDS intervention program enhanced specialized knowledge about AIDS, aided in the reduction of AIDS-risky behaviors, and enhanced attitudes toward achieving and maintaining abstinence from drug use. Thus, AIDS education and intervention programs appear to be effective and should be emphasized in the early phase of drug abuse treatment.     

Preventing HIV Transmission in Drug Treatment Programs:

The AIDS epidemic has dramatically affected drug treatment programs, creating both an epidemiological crisis and a psychological one. A paramount question for treatment program staff is how to prevent patients from acquiring or spreading HIV. The health belief model has been useful in generating prevention approaches, including programs that raise the threat of infection, provide alternative behaviors, and build social support. Some of these programs have been effective in changing attitudes and reducing the behaviors that put drug users at risks for acquiring or transmitting HIV. Future research will develop collaborative studies, disseminate techniques to drug treatment programs, and develop more powerful interventions for patients who continue with risky behviors.     

Gender differences in HIV risk behaviors among young adults and adolescents entering a Massachusetts detoxification center

We examined gender differences in HIV risk behaviors among young substance abusers 17 through 25 years of age. A voluntary and confidential survey inquiring about HIV‐related risk behaviors was administered to clients (N = 200 respondents) on intake at a drug detoxification center in Massachusetts. Female respondents were more likely than males to report having shared their needles (p < 0.01), having had sex in exchange for drugs or money (p < 0.01), sex with an HIV‐infected partner (p < 0.01), and sex with an injection‐drug user (p < 0.01). They were also more likely to report having been diagnosed with an STD (p < 0.01). Nineteen percent of females (compared to 32% of males) reported always having used condoms for vaginal sex (p = 0.08), and 16% of females compared to 35% of males reported always having used condoms for anal sex (p = 0.06). In our cohort of substance‐abusing youth, adolescent and young adult females were more likely than males to report unsafe injection‐drug use and sexual practices. The results of this study suggest that programs designed to decrease HIV risk among high‐risk substance abusers in detoxification centers should be gender specific.     

Characteristics of transgender individuals entering substance abuse treatment

Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n = 199) and non-transgender (cisgender, n = 13,440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007 to 2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use, and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications, but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment.     

Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups

This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 Blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 Whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment.     

Hispanic parenting women in women-only versus mixed-gender drug treatment: a 10-year prospective study

The present study examined Hispanic substance-using parenting women treated in women-only (WO; n=126) versus mixed-gender (MG; n=853) programs and associated outcomes assessed 10 years after admission. Relative to other races/ethnicities of women admitted to the set of 40 California treatment programs in 2000-2002, Hispanic women were underrepresented in WO programs. Compared to those in MG programs, Hispanic women in WO programs demonstrated more severe treatment needs, indicated by their greater severity in drug and alcohol use, health and mental health problems, and criminal justice involvement at admission. They also had fewer economic resources (15% WO vs. 23% MG were employed, p<.05; 48% vs. 37% on public assistance, p<.05). Data based on administrative records covering 3 years pre-admission and 8 years post-admission showed that Hispanic women treated in WO programs had higher mental health service utilization over 8 years post-treatment admission, though no differences were found in trajectories of arrests and incarceration. In sum, long-term outcomes (in terms of criminal justice involvement) among Hispanic women in WO treatment were comparable to those in the MG treatment, despite greater service needs at admission. WO programs were able to engage more Hispanic women in use of mental health services. Future research should focus on factors limiting Hispanic women's participation in WO programs, which could suggest ways for improvement so as to benefit all Hispanic women in need of these special services.     

Substance Dependency Treatment for Adolescents: Practice and Research

This paper reviews the more common treatment approaches that address adolescent substance abuse and the spectrum of problems which often attend involvement with drugs. The most common outpatient treatment approaches for adolescents are 12-step based programs and family-based therapies which may be used separately or in conjunction with each other. The therapeutic community is a residential approach, characterized by the use of the peer community itself to facilitate social and psychological change in individuals. Both outpatient and residential modalities have demonstrated effectiveness in working with adolescents. Ideally, the type of intervention will depend upon the young person's needs, in particular the extent and effects of his/her drug use, as well as the level of other problems. Overall, treatment must address a range of concerns of special relevance to adolescents because of their age and dependency status; for example, developmental stage, cultural issues, and gender issues.     

AIDS prevention and chemical dependence treatment needs of women and their children

Female partners of male drug users may not recognize that they are endangered by sexual transmission of human immunodeficiency virus (HIV). However, even when women acknowledge this problem, there are multiple subsequent impediments to behavior change. Chemically dependent women also have specific additional needs. Most chemical dependence outreach and treatment programs are not yet designed to address the issues of contraception, pregnancy, motherhood, child rearing, and prevention of sexually transmitted diseases. Chemically dependent women may not only give birth to drug-affected infants but they may also perpetuate an intergenerational cycle of inadequate parenting. Most women at risk for HIV infection are in their childbearing years. Infection of either or both mother and infant further complicates an already complex problem. Multiple interdisciplinary resources are needed to integrate AIDS prevention and treatment with chemical dependence treatment for women and their children.