The Portal Project

SUMMARY

Palladia, Inc. is a not-for-profit, multi-service agency, located in New York City, serving primarily African-American and Latino communities. Palladia's Portal Project, in collaboration with the evaluation team from Hunter College School of Social Work (HCSSW), participated in the national Women, Co-Occurring Disorders and Violence study. We studied 270 women with co-occurring issues of alcohol and other drug (AOD) problems and mental illness, who had histories of violence, and were high end users of service. Palladia built an integrated system of care and implemented a comprehensive trauma-informed intervention that is designed to put trauma and safety first to assist women in remaining in treatment. Primacy of trauma in the early stages of treatment constitutes a major philosophical shift within the traditional residential drug treatment setting. The focus of the engagement and treatment process is on the role of trauma in the woman's life and its relationship to patterns of AOD abuse and mental illness. Another key feature of the Portal model is the emphasis on normalizing the adaptations which the women have made in response to interpersonal traumatic life events. The women feel less stigmatized and isolated. They are encouraged to see their former coping and adaptive behaviors as strengths rather than maladaptive weaknesses, deficiencies or character flaws. Support for the women in their parenting and family roles and attention to their individual perceptions of culture are also part of the intervention. Portal blends service intervention, policy development, research, and evaluation for effective service delivery. The collaborative work of this project has produced a replicable model that configures specific direct service enhancements and service system improvements, using the active involvement of consumers, practitioners, service providers and policy makers.     

Helping Clients Feel Welcome: Principles of Adapting Treatment Cross-Culturally

ABSTRACT

Empirically supported interventions (ESIs) for treating substance problems have seldom been made available to or tested with minority populations. Dissemination of ESIs may help reduce the disproportionate health disparities that exist. However, ESIs may require some adaptation to be effective with minority populations. One ESI, motivational interviewing (MI), appears to be particularly culturally congruent for Native American communities. We worked with Native American community members and treatment providers to adapt MI for Native communities. Reflecting their feedback and suggested amendments, we created and disseminated an intervention manual to improve the accessibility of MI within Native communities. To help guide practitioners working with Native American clients, we used focus-group methodology to explore communication patterns for negotiating change. Native American treatment providers expressed comfort with and enthusiasm for integrating MI into their current practices. Recommendations for adaptations ranged from simple to complex changes. The unique value and challenges of collaboration between academic and community members are presented from each author's perspective. This culturally adapted MI manual will likely improve the accessibility and adoption of MI practices as well as encourage controlled, clinical trials with Native communities.     

Child Abuse and Disability in an Ontario Community Sample: Does Social Capital Matter?

Researchers have established a link between abuse and disability, but most abused individuals do not experience disability. While some survivors are severely harmed by their experiences of abuse, other survivors of similar exposure appear to have no long-term health problems. Can the presence of social capital account for these differences? Cross-sectional data from the Ontario Health Supplement were used to assess the association between child abuse, age, social capital (social connections and disruptions in living circumstances and relationships), cultural capital (education and occupation) and financial capital (money) and disability in a female community sample (n=4238). The results suggest that abuse (physical and sexual) and financial capital are associated with disability, but not social capital.     

Substance abuse risk reduction: Verbal mediational training for children by parental and nonparental models

Little is known regarding the etiology and maintenance of substance abuse, especially factors which place children at higher risk for later drug use. The present study evaluated the impact of a 12‐week verbal mediational program (Think Aloud), which teaches children and parents cognitive and social problem‐solving skills and addresses early childhood risk factors related to the onset of drug use in adolescence. Fifty children and parents were included in the present study and were randomly divided into four groups: two groups received either a verbal mediation condition comprising the Think Aloud training or time to complete homework assignments. Each of the topic groups was subdivided into two groups, one in which the parents served as models and one in which the experimenter served as the model. Measures of family cohesion, expressiveness, and conflict, family organization and control, social skills, level of disruptiveness of the child's peer choice, academic competence, and the child's problem behaviors were administered to the parents and the teachers pre‐ and postinterventivefy. Children in the verbal mediation condition with parental models were expected to show the greatest reduction in risk factor scores, and children in the verbal mediation condition with the experimenter model were predicted to show the second greatest reduction in risk factor scores at posttest. Results of the study demonstrated partial support for experimental hypotheses in that the children involved in the Think Aloud program showed improvement on four of the six factors on posttest measures. The superiority of the parental model was not found.     

Psychometric properties of coping and self-efficacy scales related to substance use in a sample of Iranian adolescents

Abstract

Aim: This study aimed to investigate the cultural adaptation and psychometric properties of the Persian version of self-efficacy and coping skill scales (CSE) which are relevant to substance use in Iranian adolescents. Method: The method included a forward–backward translation with face and content validity in the first step and the psychometric properties were evaluated in the second step. The study used reliability and construct validity in a cross-sectional survey, in three steps, including: item analysis, explanatory and confirmatory factor analyses in 720 adolescents, aged from 14 to 18 years old in Isfahan. Findings: In the first step, three items were excluded because of low CVI and one item was deleted due to low CITC. EFA in the cross-sectional study showed appropriate loading items and revealed an 18-item scale with four factors including: refusal self-efficacy, decision making, assertiveness and communication skills. Results of the confirmatory factor analysis represented an acceptable fitness (CMIN/DF?=?3.6, NFI?=?0.90, TLI?=?0.92, CFI?=?0.93, PNFI?=?0.76, RMSEA?=?0.06). Internal consistency was found from 0.68 to 0.89 for the four subscales. Conclusion: Overall, the results of these studies indicate that the Persian version of coping and self-efficacy appears to be a psychometrically robust instrument and could significantly predict substance use behaviour in Iranian adolescents.     

Social Cognition and Revictimization Risk

ABSTRACT

The ability to accurately detect violations in social contracts likely helps people to avoid or to withdraw from relationships in which they are at risk of being cheated or harmed. Betrayal trauma theory argues that detecting violations of social contracts may be counter-productive to survival under certain conditions, such as when a victim is dependent on a perpetrator. When dependent on a perpetrator (as in the case of child abuse perpetrated by a caregiver), the victim may be better able to preserve the necessary attachment with the caregiver by remaining unaware of the abuse. Thus, the victim may develop a compromised capacity to detect violations of social contracts in the caregiving relationship. Over time, the victim may develop more generalized problems detecting violations in social exchange rules; in turn, generalized problems in detecting violations of social contracts may increase risk for later victimization. Participants in the current study were asked to detect violations in three types of conditional (if-then) rules: abstract, social contract (rules involving a social exchange), and precautionary (rules involving safety). Young adults who reported experiences of revictimization made more errors on social contract and precautionary problems than a no revictimization group; group performance did not differ for abstract problems, suggesting these findings are not explained by general deficits in conditional reasoning. Pathological dissociation significantly predicted errors on social contract and precautionary problems.     

Gastrointestinal Decontamination: Maybe We'Re Both Right (Commentary)

Context. Naphyrone (naphthylpyrovalerone) is a cathinone derivative and recreational drug related to mephedrone. Case. We report a 31-year-old man who ingested a dose of naphyrone (100 mg), which produced acute sympathomimetic toxicity with restlessness, insomnia, anxiety, and hallucinations lasting for 2 days. Naphyrone was detected in the patient's plasma by gas chromatography with mass spectrometry at concentrations of 0.03 and 0.02 mg/L, 40 and 60 h after drug intake, respectively. Discussion. Based on the present case report and user web-reports, as well as on the chemical structure and pharmacological characteristics, naphyrone produces stimulant-like psychotropic effects and sympathomimetic toxicity.     

About ISAM: Its Inception and Promises

Abstract

Faith-based substance abuse rehabilitation programs provide residential treatment for many substance abusers. To determine key governing concepts of such programs, we conducted semi-structured interviews with sample of eleven clinical and administrative staff referred to us by program directors at six, Evangelical Christian, faith-based, residential rehabilitation programs representing two large, nationwide networks. Qualitative analysis using grounded theory methods examined how spirituality is incorporated into treatment and elicited key theories of addiction and recovery. Although containing comprehensive secular components, the core activities are strongly rooted in a Christian belief system that informs their understanding of addiction and recovery and drives the treatment format. These governing conceptions, that addiction stems from attempts to fill a spiritual void through substance use and recovery through salvation and a long-term relationship with God, provide an explicit, theory-driven model upon which they base their core treatment activities. Knowledge of these core concepts and practices should be helpful to clinicians in considering referrals to faith-based recovery programs.