Women's Experience of Co-Occurring Substance Abuse and Mental Health Conditions

ABSTRACT

This study explored the relationship between gender and co-occurring substance abuse and mental health conditions among a sample of 754 consumers of behavioral health services in the southwest U.S. Logistic regression was used to determine factors that would predict women's unique experience of dual diagnosis. Women were almost seven times more likely than men in this sample to have a diagnosis of posttraumatic stress disorder in conjunction with substance abuse. Women were also significantly more likely to experience anxiety and mood disorders and to have been married. Implications of these findings for social work practice are suggested.     

Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

Another Way of Talking About Substance Abuse: Substance Abuse Screening and Brief Intervention in a Mental Health Clinic

This article provides experiential evidence on the transportability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) screening tool and brief intervention in a mental health clinic. There is very little published information on implementing screening and brief intervention (SBI) in a mental health setting. Moreover, few SBI projects have reported on clinicians' experiences using the ASSIST. The article documents a successful attempt at implementing the ASSIST and discusses the benefits and challenges of doing SBI in a mental health setting.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

Personal Social Networks of Women with Co-Occurring Substance Use and Mental Disorders

ABSTRACT

There has been relatively little examination of the social network resources of women with substance use disorder, and even fewer explorations of women with co-occurring mental disorders, such as anxiety, depression, and posttraumatic stress disorder. This study explores the nature of co-occurring mental disorders, social network characteristics and perceived social support in 136 women with substance use disorders. Respondents reported small personal networks that contained both supportive and non-supportive people. Relatives did provide social support, but those who used alcohol/drugs were viewed as tending to interact negatively. Women with dual disorders perceived less concrete, emotional, and sobriety support from some network relationships than the women with substance use disorders only. Implications for research and practice are presented.     

Experiences of Drug Use and Parenting among Women in Substance Abuse Treatment: An Exploratory Study

The purpose of this exploratory study was to explore the multiple contexts of vulnerability, drug use and parenting for women in substance abuse treatment. Nineteen purposively sampled women provided qualitative data through semi-structured interviews. Findings revealed that adverse childhood experiences and intimate partners were important pathways into drug use initiation. Identities as mothers emerged as a key finding, intimately linked to women's motivation to seek and complete treatment. Understanding the challenges to recovery among mothers in treatment is an important priority for social workers. This study highlights the complexity of women's experiences and suggests implications for future practice and research.     

Correlates of Race and Substance Abuse with Religious Support Systems: A Study of Pregnant Substance Abusers

Women who misuse substances may have decreased connections with community structures, including religious support systems. This study examined the correlates of race, age, socioeconomic status, and drug use status on 1,116 pregnant women's connections with religious support structures. Data were derived from the 2002 National Survey of Drug Abuse and the 2003 National Survey of Drug Use and Health and were used to perform a secondary analysis of the variables. Results of the analyses revealed that race is not an indicator of social connectivity; while drug use, age, and socioeconomic status are indicators.     

The Role of Hawaiian Elders in Substance Abuse Treatment Among Asian/Pacific Islander Women

SUMMARY

The elders of a culture are often the designated transmitters of long-standing values and ways that define the unique essence of a people. Küpuna (elders) teachings are especially important to Native Hawaiians who have experienced the cumulative effects of cultural imperialism, which has taken their lands, discouraged use of their language and cultural ways, damaged their identity as a people and destroyed their sovereignty.

Modern day cultural imperialism, which universalizes the dominant group's experience and culture, renders minority groups as invisible while marginalizing them (Young, 1990). The chronic stress of this insidious form of oppression can translate into physical, mental health problems which lead to decreased life expectancy (McEwen, 1998; Schulkin, Gold & McEwen, 1998). Statistics on Hawaiians and other Asian/Pacific Islanders in Hawaiì indicate these groups have high rates of health problems and increasing rates of substance abuse (Office of Hawaiian Affairs, 1998).

This article describes the roles and Hawaiian practices of küpuna who acted as facilitators in the healing of Asian/Pacific Islander pregnant and postpartum women who participated in a culturally based substance abuse treatment program (CBSATP). The findings of a qualitative study, which examined the effectiveness of küpuna in these roles and their implications for practice are discussed.     

The Impact of Caregiver-Care Recipient Relationship Quality on Family Caregivers of Women With Substance-Use Disorders or Co-Occurring Substance and Mental Disorders

This cross-sectional study utilized a stress-process model to examine the impact of caregivers' (N = 82) perceptions of their relationship quality with a female family member (i.e., care-recipient) with substance-use or co-occurring substance and mental disorders on caregivers' perceived burden. Regression findings indicate that relationship quality impacts both subjective and objective burden. Higher levels of emotional support given to the care recipient by the caregiver predicted lower levels of caregiver displeasure; whereas higher levels of undermining of the care recipient by the caregiver predicted higher levels of caregiver stigma. Higher levels of emotional support received by the caregiver from the care recipient were associated with lower levels of caregiver displeasure and lower objective burden; higher levels of undermining of the caregiver by the care recipient predicted higher objective burden. Implications for practice and service delivery are presented.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco account for the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Women with Disabilities and Experiences of Abuse

Abstract

A qualitative study of disabled and non-disabled professionals and survivors of abuse revealed a range of types of abuse endured by disabled women, some of which were unique to that population. Two major themes emerged from data analysis: vulnerable beginnings and complexity of abuse. Three sub-themes are encompassed within complexity of abuse: active abuse, abuse through image, and contextual abuse by social service/legislative systems. The authors present data essential to an informed assessment and analysis of abuse that considers the person-in-environment circumstances of women with disabilities. Implications for future research and the human behavior in the social environment curriculum are discussed.     

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.     

TANF Recipients' Barriers to Employability: Substance Abuse and Domestic Violence

Recipients of temporary assistance for needy families (TANF) encounter a variety of expectations and sanctions. Recipients face work requirements, limited resources, and barriers to employability, including the barrier of substance use. This article addresses the sanctions that are applied to clients who do not meet expectations of the policy, barriers to employability, disparities in resources, and factors influencing referrals for substance abuse treatment for TANF clients.     

Interpersonal Dependency Among Adult Survivors of Childhood Sexual Abuse in Therapy

ABSTRACT

This study investigated dependency in survivors of childhood sexual abuse (CSA). The Interpersonal Dependency Inventory (IDI) was administered at intake to 24 men and 85 women seen in therapy at a university-based community mental health clinic. In contrast to findings from earlier studies, no significant gender differences were obtained for IDI whole-scale or subscale scores. Analyses comparing CSA IDI scores with the IDI scores of previously studied groups indicated that among women, CSA survivors obtained higher dependency scores than non-CSA psychiatric patients, community adults, and college students. Findings for men were less consistent. Follow-up analyses revealed that commonly investigated CSA characteristics were unrelated to survivors' dependency scores. Implications of these findings for future research and clinical practice are explored.     

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.