Antecedents and correlates of alcohol, cocaine, and alcohol-cocaine abuse in early adulthood

We used a fourfold substance abuse typology consisting of non-abusers, alcohol abusers, cocaine abusers, and joint alcohol and cocaine abusers with a nationally representative sample of young adults (aged 19-26 years) to investigate issues related to prevalence, antecedents, and correlates of substance abuse. The prevalence data indicate higher alcohol abuse among white males, but approximately equal proportions of cocaine abuse and joint alcohol and cocaine abuse across gender and ethnic/racial groups. A simplex-like ordering was found for the four abuse groups with regard to the degree of problem severity associated with most of the antecedents and correlates. Joint alcohol and cocaine abusers demonstrated the highest levels of previous thirty-day and lifetime drug use, high levels of delinquent activity, and the highest rates of unemployment and marital instability. Cocaine abusers demonstrated the second highest levels of problem severity, alcohol abusers the third highest levels, and non-abusers the lowest levels. An exception to the simplex-like pattern was found with respect to educational attainment and verbal intelligence. Joint alcohol and cocaine abusers reported the lowest high school dropout rate and scored the highest on a measure of verbal intelligence. We suggest that joint alcohol and cocaine abusers may be characterized as "non-strivers" or "underachievers," quite possibly as a consequence of substance abuse.     

Counseling for the Family: The Neglected Aspect of Addiction Treatment in Canada

ABSTRACT

There has been a historic neglect of both research and practice in the area of counselling for the family members of alcohol or other drug abusers by the addiction field in Canada. As a result, treatment for individual family members affected by alcoholism and other drug addiction remains a neglected component of the majority of Canadian addiction programs. When family involvement is incorporated, the tendency has been to concentrate on orientation and education rather than on the provision of counseling for the family members. This dearth of programming exists despite the knowledge that an active alcohol or drug abuser's behaviour disrupts the entire family system, including the functioning and development of children. Each family member is uniquely affected with negative outcomes ranging from economic hardship to violence being perpetrated against them to an increased risk among children of becoming alcohol or drug abusers themselves. Thus, treating only the active alcohol or other drug abuser is limiting and an overly narrow orientation for the enhancement of both family and community health.     

Obstacles to victims' cooperation with the criminal prosecution of their abusers: the role of social support

Over the last 20 years, diminishing tolerance for domestic violence has triggered significant criminal justice reforms designed to facilitate the prosecution of abusers. Prosecutors, for example, have adopted policies requiring that cases go forward even if the victim later has second thoughts. Although increasingly common, these "no drop" policies reflect a profound irony about domestic cases that is well known but little understood: the most formidable problem in prosecuting such cases is often the victim's own unwillingness to bring the abuser to justice. This prospective study explored a range of factors potentially predictive of domestic violence victims' cooperation with the prosecution of their abusers. Although the study focused on interpersonal and institutional social support, it also investigated the influence of violence severity, victim demographic factors, and victim mental health characteristics, including the presence of depressive symptoms, emotional dependence on the abuser, and substance abuse. Findings showed that tangible support, severity of violence in the relationship, and the presence of children in common with the abuser all significantly predicted victims' cooperation with the prosecution of their abusers. Substance abuse significantly predicted victims' noncooperation with prosecution. The research and policy implications of these findings are discussed.     

Clinical Treatment of Substance Abusers: Past, Present and Future

With an estimated 9?% of the population in the United States having a substance use disorder, it is a rare social worker that has not encountered a substance abuser or a family member of one in his or her clinical practice. This article provides a brief history of social workers?? role in the treatment of substance abusing clients, an overview of the current, evidence-based treatment approaches and some of the issues that will be impacting this field in the future. A case study is used to illustrate some of the dynamics of substance abusing individuals, the impact on the family and effective treatment approaches.     

Use of self-help manuals to treat problem drinkers

In spite of research findings indicating that alcohol abusers may benefit from self-help manuals, health care providers have been slow to recognize their potential usefulness. As self-care strategies grow more popular and funding for traditional forms of alcohol treatment diminish, health care providers need to look more seriously at these materials. They also need to be aware of new innovations such as self-help materials that can be purchased on diskette. It may not be long before computerized materials sit next to printed manuals on bookstore shelves, and nurses need to know which materials to recommend.     

Confronting abusers: the opinions of clinicians and survivors

Confrontation of an abuser is often regarded as a powerful process in clinical work with adult survivors of childhood sexual abuse. This paper explores direct and symbolic forms of survivors confronting their abusers via a review of the current literature and the self-report of 12 female survivors, post-therapy. Six of the survivors had chosen to directly confront their abusers and six had not. Their experiences and opinions are presented together with a discussion of important issues within this area and the need for further research.     

Severity of impairment in dually addicted gamblers

While much information about pathological gamblers has been gathered from clinical observations, few data exist from systematic, objective studies. Furthermore, still less is known about that subset of pathological gamblers who are also chemically dependent and/or substance abusers. Previous studies (e.g., McCormick et al., 1984) report that up to 45% pathological gamblers are substance abusers. The present study hypothesizes that inpatient chemically dependent pathological gamblers will exhibit greater impairment on a variety of life-functioning measures than a comparable group of chemically dependent psychiatric inpatient. Twelve chemically dependent pathological gamblers were matched on the basis of age, sex, alcohol/drug history and occupational status with twelve chemically dependent persons with no pathological gambling history. All study members were inpatients in an addictions program at a private psychiatric hospital. Each patient was administered the Addiction Severity Index (ASI) to assess impairment in seven problem areas: medical, employment/support, alcohol, drug, legal, family/social, and psychological/psychiatric functioning. The following findings emerged: 1) Chemically dependent (CD) gamblers report more chronic medical problems than CD psychiatric patients; 2) CD gamblers report more frequent conflicts with relatives and family members than CD psychiatric patients; 3) CD gamblers report more psychiatric symptoms both in amount and duration; Although not reaching statistical significance, 42% of the CD gamblers had made a previous suicide attempt as compared to 8% of the CD psychiatric patients; 4) CD gamblers and CD psychiatric patients appear comparable with regard to employment functioning and amount of legal problems. The clinical and theoretical implications of these findings are discussed further.     

Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.     

Oxford house: a review of research and implications for substance abuse recovery and community research

After treatment for substance abuse, whether it is in hospital-based treatment programs, therapeutic communities, or recovery homes, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of a relapse. As a consequence, substance abuse recidivism following treatment is high for both men and women. Alternative approaches need to be explored, and there are some promising types of recovery homes. From a public health perspective, a series of studies conducted at DePaul University suggests that one type of recovery home for alcohol abuse recovery has much potential. For example, within this self-help communal living setting, recovering alcoholics were able to maintain employment, thereby reducing their need for government subsidies. Maintaining employment for recovering alcoholics may promote increased personal responsibility, which may impact self-efficacy beliefs. These pilot studies, then, raised both theoretical and practical issues needing further evaluation.     

Substance Use and Mental Health Severity Among LGBTQ Individuals Attending Minnesota Model-Based Residential Treatment

This administrative data analysis examined substance use and mental health severity among a sample of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals receiving residential treatment for an alcohol or drug use disorder. LGBTQ were statistically compared to heterosexual patients on a number of variables, including frequency and amount of pretreatment alcohol use, frequency of pretreatment illicit drug use, co-occurring Axis I mental health diagnoses, and past history of physical or sexual abuse. LGBTQ patients exhibited significantly greater severity on nearly all variables, suggesting a strong relationship between clinical severity and being a sexual minority. This study also found a relationship between patient gender and the pattern of differences between LGBTQ and heterosexual patients. These results replicate and extend those of studies examining LGBTQ in the general population and suggest opportunities for development of alcohol/drug treatment approaches that address the unique needs of LGBTQ.     

Psychological treatment of adolescent substance abusers:: A review

Alcohol and drug abuse among youth has become a major national concern. Psychological treatment strategies reported in the literature that have been used with adolescent substance abusers include five approaches: (a) behavior therapy, (b) skills training, (c) reality therapy, (d) psychodynamic therapy, and (e) family therapy. A limited number of studies have evaluated these treatments. Behavior therapy, skills training, and family therapy approaches show some evidence of effectiveness. However, most studies had methodological flaws.     

Friends don't let friends ...or do they? Developmental and gender differences in intervening in friends' ATOD use

This study focused on the strategies adolescents endorsed for situations in which friends were experimenting with alcohol, tobacco, and other drugs. Four hypothetical vignettes (concerning a friend smoking, using drugs, getting drunk at a party, or deciding whether to attend a party with alcohol and drugs) were presented to 2697 5th-12th graders. Whereas younger students were more likely to choose proactive strategies (talking to the friend or an adult or ending the friendship), older students were more inclined to say they would ignore a friend's smoking and drug use although they would take the car keys away from a friend drinking alcohol. Among those 13 years old and older, the more dangerous the substance, the more inclined the youth were to intervene. Females were more inclined than males to talk to friends about smoking, drinking, and drugs and less inclined to ignore the behaviors or stop being a friend.     

Traumatic Experiences in Childhood and Adult Substance Use in a Nonclinical Sample: The Mediating Role of Arousal/Reactivity

The vast majority of adults in the United States experience at least one traumatic event during childhood. According to the self‐medication hypothesis of substance use disorders, adult survivors of childhood trauma may cope with trauma‐related symptoms via alcohol or drug use. The purpose of this study is to identify through which specific PTSD symptom clusters childhood trauma exposure are associated with adult substance use. Participants of this study (N = 627) were not recruited based on substance use or traumatic exposure. Results of this study demonstrate that arousal/reactivity partially mediates the association between childhood trauma and current substance use. Implications for treatment include recommendations for trauma‐informed approaches that aim to decrease arousal/reactivity and subsequently substance use.     

Family Therapy and Substance Abuse

The approaches of family therapies to substance abuse are reviewed and evaluated. Questions from a systemic perspective are raised about the therapeutic efficacy of the structural/strategic family therapies which predominate in the literature. Consideration is given to certain clinical issues and to the place of a systemic perspective in a drug and alcohol service.     

Natural Recovery from Substance Dependency

Abstract

The literature on cessation of drug and alcohol dependency without benefit of treatment or participation in self-help groups spans nearly forty years. While this literature is substantial and analyses of the processes of natural recovery well-developed, discussions directed at treatment providers around the value of these analyses for practice has been sparse. Drawing on our study as well as the research of others, this paper explores two dimensions of natural recovery that hold important implications for treatment providers who work with substance dependent clients. These include the common strategies used by remitters and the concept of recovery capital as a way to capture the embeddedness of these natural recovery strategies within a unique structural context of personal attributes and social environments.     

Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.     

Effectiveness of continuing care interventions for substance abusers. Implications for the study of long-term treatment effects

Substance-abusing patients are frequently urged to participate in lower intensity continuing care interventions, also known as "stepdown care" or "aftercare," following an initial phase of treatment. Since 1988, 15 controlled studies of continuing care for alcohol or drug abuse have been published, with follow-up data on substance use presented in 14 of these studies. In the studies that featured an active control condition, only 1 of 7 yielded positive findings. In the studies that featured a minimal- or no-treatment control, 3 of 7 studies yielded positive findings. The relative paucity of continuing care studies, coupled with the lack of stronger evidence of clinical effectiveness, provides a convincing rationale for conducting evaluations of continuing interventions, as well as evaluations of combinations of various primary and continuing interventions. Methodological issues in the evaluation of continuing care and potential research questions that could be addressed in long-term follow-up studies are outlined and discussed.     

Physical fitness effects on substance abuse risk factors and use patterns

In this study, seventy-four adolescents in either a school, community or hospital based drug intervention program received and eight to nine week structured fitness activity class as an integrated element of their respective prevention or treatment program. Prepost assessments indicated significant gains in the field fitness tests of one mile run, 1 minute situp, 1 minute pushup, percent fat and flexibility for the total sample. Based upon prepost change on the one mile run time (less than 1:00) subjects were categorized as improvers (n = 38) and non-improvers (n = 36). Improvers demonstrated a significant increase in the self concept risk factor (Piers Harris Self Concept Scale) and a significant decrease in anxiety and depression risk factors (General Well-Being Scale) compared to the non-improvers. At posttest, the improvers self reported substance use patterns were significantly lower compared to the non-improvers for percentage of the sample who were multiple drug users and alcohol uses per week and were significantly higher for the percentage of the sample demonstrating total abstinence. These findings are suggestive of the usefulness of physical training as a supplemental intervention for adolescent substance abusers.     

Mental health and criminal justice issues among perpetrators of elder abuse

ABSTRACT Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

Child abuse: differential diagnosis, differential treatment

This study assessed the relationship between treatment intensity and rehabilitation at discharge of child abusers whose MMPI profiles revealed high levels of psychological distress. It should be noted that this sample does not represent the child abuser who requires only a support group or outpatient counseling. Because of repeated failures at other social service agencies coupled with the court selection process, this sample may be described as having been screened for intransigence, severity of symptomatology, and resistance to previous attempts at treatment. It is noteworthy that participation in treatment was court-ordered, thereby diminishing the possibility of improvement because of subject characteristics, emotional availability or stamina in the treatment process. In this exploratory study, the association between treatment intensity and assessed rehabilitation yielded a positive and statistically significant relationship. The client who received intense weekly treatment for longer durations was assessed as having a higher degree of rehabilitation. This finding is important particularly for a population that exhibited an abnormally high degree of psychological distress. As an initial investigation, results support the need for differential diagnosis and subsequent differential treatment of child abusers. Without differential diagnosis, treatment needs may go unrecognized; without intense and sustained treatment, the needs of the highly distressed child abuser may go unmet.