Managing MICA Clients in a Modified Therapeutic Community with Enhanced Staffing

To determine how effective a modified therapeutic community (TC) with enhanced mental health staffing would be in treating mentally ill chemical abusing (MICA) clients in a “mainstream” program, Project Return Foundation, Inc. (PRF) conducted a treatment outcome evaluation study involving 438 residents. Client admissions were screened by mental health specialists for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnoses and then placed into one of three diagnostic groups: non-MICA; general MICA (not requiring psychotropic medication); and, severe MICA (requiring psychotropic medication). Clients were administered the Tennessee Self-Concept Scale (TSCS; Roid & Fitts, 1991) after admission and at 6-month intervals thereafter. Results indicated that: (a) the three diagnostic groups were significantly different at initial TSCS testing, with the non-MICA group evidencing the least lowest measures of self-esteem and lesser degrees of psychopathology; the severe MICA group had the lowest psychological scores; (b) all three diagnostic groups showed significant improvement in their TSCS scores after 6 to 7 months of treatment; (c) covariance analyses observed that the three diagnostic groups did not significantly differ at 6 month testing when the initial TSCS testing was taken into account; and, (d) significant gender differences on several TSCS scales were noted, in that women scored lower than men in self-esteem and higher than men in psychopathology. Research limitations and clinical observations are considered.     

Female Physicians and Substance Abuse: Comparisons with Male Physicians Presenting for Assessment

As with women in general, the vicissitudes of the female physician who suffers from a substance use disorder have been understudied, and such persons remain underrepresented in treatment. The purpose of the present study is to describe the similarities and differences between female and male physicians presenting for assessment; 108 physicians in total were included in the study, 10 of whom were female. Demographically, we found that the female physicians were more likely to be single and younger than their male counterparts. On clinical indices, females showed less impairment on legal and medical functioning, and better capability in sustaining abstinence and eliminating environmental cues to relapse. Of the women with substance use disorders, higher rates of comorbidity were found than with males. Although there were no significant differences in overall severity, males were more likely to be recommended to more intensive levels of care for either substance use or psychiatric disorders. The female physicians were recommended to a level of care of a lower intensity, but more often to a treatment with a dual-diagnosis focus. These findings are discussed in terms of the vulnerabilities of the female physician, barriers to treatment, tailoring treatment to female needs, and opportunities for prevention and further research.     

Drug Abuse and Incarcerated Women: A Research Review

Drug abuse is the primary reason women enter prison and is the primary health problem of women in prison. There has been little research conducted specifically with this population; information must be drawn from studies with nonincarcerated addicted women and incarcerated addicted men. The purpose of this paper is to review what is known about the treatment and aftercare needs of this group (including relapse and recidivism prevention) and to propose an agenda for future research.     

Untreated Symptoms of PTSD Among Cocaine-Dependent Individuals: Changes Over Time

Changes over time in posttraumatic stress disorder (PTSD) symptoms during periods when individuals with substance use disorders remain abstinent has not received much attention. PTSD symptomatology over a 36-month period was studied in cocaine-dependent individuals (N = 34) who entered a pharmacologic trial targeting cocaine use and depression, but did not include any treatment for PTSD. All participants reported at least one PTSD Criterion A event, and 17.6% had current PTSD at baseline (Base PTSD+). Significant improvements in PTSD symptoms were observed on global measures of PTSD, but not on the Impact of Events Intrusion subscale. Significant improvement in drug use severity also was observed. Compared with participants who were negative for PTSD at baseline, Base PTSD+ participants were significantly more likely to: (a) meet criteria for current PTSD at follow-up and (b) have been re-victimized over the time period of the study. Careful evaluation of intrusive symptoms may be particularly important when diagnosing PTSD in individuals with SUDs, and repeated assessment of traumatic experiences may be necessary in longitudinal studies.