Factors that Affect Treatment Expectations of Outpatients with Substance Use Problems

The study assessed treatment expectations (TE) of outpatients with substance use problems as well as factors that affect their TE. Participants were 200 outpatients presenting at three community based substance abuse treatment services. Results of general linear modelling analyses showed that outpatients with substance use problems have higher expectations about their personal contribution to the counseling process (i.e., expected to be motivated, open and responsible in counseling) and the facilitative conditions that exist in the counseling environment. In comparison, they had significantly lower expectations about clinicians?? expertise (m diff?=?.75 and .58, p?<?.001 compared to personal contribution and facilitative conditions, respectively) and clinicians?? nurturance (warmth and comfort) levels (m diff?=?.73 and .57, p?<?.001 compared to personal contribution and facilitative conditions, respectively). Females had significantly higher TE in relation to personal contribution, F(1,184)?=?20.76, p?<?.001 and facilitative conditions, F(1,184)?=?7.76, p?<?.01 than males. Males, individuals reporting more than one substance of concern, younger clients and individuals reporting no previous substance abuse treatment tend to underestimate level of motivation needed to contribute to counseling outcome. Individuals with extremely severe stress levels had higher clinician related expectations which include clinician expertise, genuineness, and warmth than those without such stress levels. These findings identify groups of clients that may need to be educated about specific aspects of the process of counseling early in the therapy process.     

Relationships Between Suicide Risk,Traumatic Experiences,and Substance Use Among Juvenile Detainees

Youth suicide ideation in juvenile justice settings is a phenomenon with multiple determinants. This article examines relationships among determinants of suicidal ideation utilizing various screening instruments. Consecutive youth admitted to detention in Connecticut (N = 757) completed the Massachusetts Youth Screening Instrument 2 (MAYSI-2), the Suicidal Ideation Questionnaire (SIQ), measures of substance use, and risk and protective factors for violence during intake screening. In bivariate and multivariate analyses (controlling for demographic and MAYSI-2 sub-scale scores), relationships were found between the Traumatic Experiences and Alcohol and Drug Use subscales of the MAYSI-2 and the SIQ. The potential impact of traumatic stress and substance use symptoms in understanding and detecting youths who are at risk for suicide is discussed.     

Validation and Use of the Youth and Caregiver Treatment Outcome Expectations Scale (TOES) to Assess the Relationships Between Expectations, Pretreatment Characteristics, and Outcomes

This study introduces the youth and caregiver versions of the Treatment Outcome Expectations Scale (TOES) and presents the results of comprehensive psychometric analyses in a large sample of clinically-referred youth (N = 291) ages 11-18 and their caregivers (N = 268). This study also examines whether expectations are predictive of early or overall treatment change as measured by changes in youth symptom severity rated by multiple respondents (youth, caregiver, and clinician). Additionally, the relationship between treatment outcome expectations and several background, pretreatment, and clinical variables is explored. Finally, this study investigates the correspondence in outcome expectations between dyads of youth and caregivers. Results demonstrate the TOES is a psychometrically sound measure for use in this population. Findings also indicate that while higher youth outcome expectations significantly relate to higher youth-rated internalizing symptom severity at baseline, they also relate to a faster rate of reduction in internalizing symptom severity. Additionally, caregiver age and youth gender were significant predictors of youth-rated outcome expectations. Results also demonstrate a small, positive correlation between youth and caregiver ratings of outcome expectations. Implications, future directions, and limitations of the study are discussed.     

Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: Comparing Housing First with Treatment First Programs

The Housing First (HF) approach for homeless adults with serious mental illness has gained support as an alternative to the mainstream “Treatment First” (TF) approach. In this study, group differences were assessed using qualitative data from 27 HF and 48 TF clients. Dichotomous variables for substance use and substance abuse treatment utilization were created and examined using bivariate and logistic regression analyses. The HF group had significantly lower rates of substance use and substance abuse treatment utilization; they were also significantly less likely to leave their program. Housing First’s positive impact is contrasted with the difficulties Treatment First programs have in retaining clients and helping them avoid substance use and possible relapse.     

Substance Use Trends and Treatment Among Israeli School Dropouts

Widespread international concern exists about school dropout and substance use among high risk youth. This article examines the issue in Israel and the impact of a 90 day treatment program on a prospective sample of youth. A cohort of 77 youths completed a self-report questionnaire prior to receiving substance abuse treatment. These youth were compared to those attending and disengaged from school. With the exception of inhalants that tend to be a substance more commonly used by youth in school, dropouts report much higher rates of substance use especially those referred to treatment. For this population, the impact of a 90 day residential treatment program was evaluated. Results show the potential such treatment has on reducing substance use. Given the paucity of literature on this topic, this paper makes an initial contribution to understanding a growing problem of youth who have dropped out of school and who are substance users.     

Treatment Issues for Aboriginal Mothers with Substance Use Problems and Their Children

In many cultures, approximately one third of people with drug dependence are women of child-bearing age. Substance use among pregnant and parenting women is a major public health concern. Aboriginal people have some of the highest rates of substance abuse in Canada, increasing concern for detrimental health impacts, including those for women and their children. For many women, substance abuse offers a means of coping with trauma, such as childhood abuse, partner violence, and, for Aboriginal women, the intergenerational effects of colonization. In this paper, we review treatment issues for Aboriginal mothers with substance use problems and their children. We discuss gender-specific issues in substance abuse, the need for women-specific treatment, the impact of substance abuse on children and parenting, the additional risks for Aboriginal women and children, and the need for integrated programs (those that integrate pregnancy-, parenting-, and child-related services with women-specific addiction treatment). We describe New Choices as an example of an integrated program, review research on existing treatment for Aboriginal mothers with substance use issues, and describe Sheway as a promising integrated program for Aboriginal women with substance abuse issues and their young children. There are few treatment programs specifically for Aboriginal mothers with substance use issues and their children and very little research on their effectiveness. Based on our review of existing evidence, we offer recommendations for future research and practice.     

Racial/Ethnic Match and Treatment Outcomes for Women with PTSD and Substance Use Disorders Receiving Community-Based Treatment

This study examined the relationship between racial/ethnic match and treatment outcomes for 224 women who participated in a clinical trial of group treatments for posttraumatic stress disorder (PTSD) and substance use disorders. Generalized estimating equations were used to examine the effect of client–therapist racial/ethnic match on outcomes. Results revealed racial/ethnic match was not significantly associated with session attendance. There was a significant three-way interaction between client race/ethnicity, baseline level of PTSD symptoms, and racial/ethnic match on PTSD outcomes. White clients, with severe PTSD symptoms at baseline, who attended treatment groups where they were matched with their therapist, had greater reductions in PTSD symptoms at follow-up than their counterparts who were racially/ethnically mismatched with their group therapist. Racial/ethnic match did not confer additional benefits for Black clients in terms of PTSD outcomes. Racial/ethnic match interacted with baseline substance use to differentially influence substance use outcomes at follow-up for all women. Clinical implications are discussed.     

Older Adult Substance Use Treatment First-Time Admissions Between 2008 and 2018

ObjectivesTo see whether the percentage of older adults entering substance use treatment for their first time continued to increase and whether there were changes in the use patterns leading to the treatment episode, particularly an increase in illicit drugs.DesignPublic administrative health record study.SettingThe Treatment Episode Data Sets publicly available from the Substance Abuse Mental Health Services Administration from 2008 to 2018.ParticipantsYoung adults age 30–54 years (N = 3,327,903) and older adults age 55 years and older (N = 453,598) with a first-time admission for a publicly funded substance use treatment.MeasurementsDemographic and substance use history variables at admission.ResultsThe proportion of older adults going for substance use treatment for the first time continued to increase between 2008 and 2018 relative to younger adults, continuing the trend of increasing first-time admission between 1998 and 2008. For the first time, the primary substance at admission for older adults was an illicit substance only, surpassing alcohol only and the combination of alcohol and illicit drug use. In this period, use of opioids, particularly heroin, and methamphetamine increased among older adults entering treatment.ConclusionsAs our population ages and substance use trends change, healthcare providers that take care of older adults must have skills to prevent, screen for, diagnose, and treat substance use disorders. Given recent trends in substance use and treatment among older adults, substance use treatment programs must adapt to meet the needs of an older population.     

Unmet Need For Community-Based Mental Health and Substance Use Treatment Among Rural Adolescents

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (12–18 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n=177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care.     

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009–2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.     

Decisional Balance Regarding Substance Use Among Persons with Schizophrenia

State-of-the-science treatment of substanceabuse relies on decisional balance activities (weighingpros and cons of continued substance use) to enhancemotivation for change. Few data are available regarding the feasibility of these activities amongpersons dually diagnosed with schizophrenia andsubstance use disorder. To address this lacuna in theliterature, we completed focus groups with 21participants, all of whom had a schizophrenia-spectrumdiagnosis and lifetime substance abuse or dependence.These key informants discussed the pros and cons ofsubstance use as well as the pros and cons of quitting in response to a structured group interview.Our qualitative data indicate that persons living withschizophrenia can generate rich and diverse decisionalbalance information. We describe salient themes, contrast complementary perspectives (i.e., thepros of using and cons of quitting), and suggesttreatment implications based on thesefindings.     

The Relationship Between Case Manager Expectations and Outcomes of Persons Diagnosed with Schizophrenia

The present study examined the relationship between case managers’ expectations about the abilities of persons diagnosed with schizophrenia and the outcomes (as indicated via chart review) of a randomly selected sample of clients diagnosed with schizophrenia on their caseload. Results indicate that clients of case managers with higher expectations averaged significantly more months of progress in employment than clients of case managers with lower expectations. Case manager expectations were also better predictors of the number of days employed than other case manager and consumer characteristics, however the type of expectation was a critical determinant of the direction of the effect. Case manager expectations were not related to outcomes in living situation.     

A Comparison of Treatment Outcomes for Individuals with Substance Use Disorder Alone and Individuals with Probable Dual Diagnosis

The co-occurrence of substance use and mental health problems, often referred to as dual diagnosis (DD), is increasingly recognised as commonplace within substance abuse treatment programs. Two-hundred and thirty-four individuals from 9 Australian Salvation Army drug and alcohol rehabilitation programs completed a 3-month post-discharge telephone follow-up. Using a cut-off score from the Psychiatric Subscale of the Addiction Severity Index (5^th ed.), 66.7% were classified as likely to have DD and 33.3% as substance use disorder only (SUD). Both groups reported comparable and decreased substance use levels at follow-up, yet DD individuals perceived less improvement in substance use problems. Comparable improvements were reported in the areas of: symptom distress and recovery from symptoms. This was despite greater scope for improvement in individuals with DD. Duration of treatment and access to post treatment services were also assessed. Understanding factors effecting treatment outcomes is imperative for the implementation of effective, evidence based treatment programs.     

Assertive Community Treatment and Associations with Substance Abuse Problems

This study examined the associations between substance abuse problems in severely mentally ill patients, outcome and Assertive Community Treatment (ACT) model fidelity. In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams using the Health of the Nation Outcome Scales, Camberwell Assessment of Needs short appraisal schedule and measures of service use. Five hundred and thirty severely mentally ill patients participated in the study. Substance abuse problems were assessed three times during a 2-year follow-up period. This study found that among patients with severe mental illness, patients with an addiction problem had more serious psychosocial problems at baseline. Substance abuse problems showed improvement over time, but this was not associated with ACT model fidelity. The study indicates that investment by teams to improve a patient’s psychosocial situation can lead to improvements on substance problems.     

Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban,Low-Income Women

Community Mental Health Journal - This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age...