A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction

Opioid addiction has become a U.S. epidemic. It is important to determine whether psychosocial interventions help prevent relapse. A total of 14 studies were included in this systematic review. Most studies compared psychosocial interventions in conjunction with pharmacological maintenance. Only 2 studies found that psychosocial interventions led to statistically significant benefits for outcomes related to opioid abuse when compared to maintenance and less or no psychosocial intervention. Psychosocial interventions were not found to be additive to pharmacological treatments during induction or maintenance stages. Further research is needed to determine effectiveness of psychosocial interventions during dose reduction and long-term relapse prevention.     

Alcohol Problems,Marriage, and Treatment: Developing a Theoretical Timeline

SUMMARY

While research findings over the past twenty years have consistently supported the efficacy of couples work with people experiencing alcohol related problems, in the field of practice in Ireland there is little evidence of the development of interventions based on a couples/marital perspective. This paper examines the place of marital work in the alcohol field through a review of the literature from 1950s to the present in order to discover the limitations in theory and research that might explain the reluctance of practitioners to adopt this method of intervention.     

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.     

Characteristics of Gambling Helpline Callers with Self-Reported Gambling and Alcohol Use Problems

The characteristics of problem gamblers calling the Connecticut Council on Problem Gambling (CCPG) gambling helpline during the years 2000–2001 (n = 960) were examined based on the presence or absence of self-reported alcohol use problems. A relatively low proportion of callers reported a problem with alcohol use (173/960 or 18.0%), and of those acknowledging an alcohol use problem, the majority reported a past rather than current problem (143/173 or 82.7%). A logistic regression analysis found that, as compared with problem gamblers denying any alcohol use problems, those reporting past or current alcohol use problems were more likely to be male and more frequently acknowledged problems with more forms of gambling, suicide attempts related to gambling, arrests secondary to gambling, daily tobacco use, drug use problems, prior substance abuse treatment, and family histories positive for alcohol and drug use problems. The findings highlight the strong relationship between alcohol use problems and other substance use problems, and suggest that problem gamblers with as compared with those without alcohol use problems demonstrate greater problems in multiple areas (arrest, attempted suicide) linked by impaired impulse control.Please address correspondence to Marc N. Potenza, Director, Problem Gambling Clinic; Director, Women and Addictive Disorders Core, Women’s Health Research at Yale; Yale University School of Medicine, Connecticut Mental Health Center, Room S-104, 34 Park Street, New Haven, CT 06519. E-mail: marc.potenza@yale.edu.     

End‐of‐Life Treatment Preferences Among Older Adults: An Assessment of Psychosocial Influences1

We explore the content and correlates of older adults’ end‐of‐life treatment preferences in two hypothetical terminal illness scenarios: severe physical pain with no cognitive impairment, and severe cognitive impairment with no physical pain. For each scenario, we assess whether participants would reject life‐prolonging treatment, accept treatment, or do not know their preferences. Using data from the 2004 wave of the Wisconsin Longitudinal Study (N = 5,106), we estimate multinomial logistic regression models to evaluate whether treatment preferences are associated with direct experience with end‐of‐life issues, personal beliefs, health, and sociodemographic characteristics. Persons who have made formal end‐of‐life preparations, persons with no religious affiliation, mainline Protestants, and persons who are pessimistic about their own life expectancy are more likely to reject treatment in both scenarios. Women and persons who witnessed the painful death of a loved one are more likely to reject treatment in the cognitive impairment scenario only. Consistent with rational choice perspectives, our results suggest that individuals prefer treatments that they perceive to have highly probable desirable consequences for both self and family.     

Technology-Based Interventions and Trainings to Reduce the Escalation and Impact of Alcohol Problems

There has been a rapid increase in the development of technological innovations to reduce the escalation and impact of alcohol problems among adolescents and adults. Technology-based interventions offer the possibility of reaching individuals who otherwise might not seek treatment, (e.g., those in remote areas, those not perceiving a need for treatment, or others who might resist treatment). This article describes 4 case examples of technology-based interventions for risky drinking: (a) a freely available and interactive Web site that provides individualized feedback and information on risky drinking patterns; (b) a brief intervention for adolescents that provides individualized feedback to teens regarding their alcohol use; (c) a computer-delivered screening and brief intervention for alcohol use among pregnant women; and (d) a simulation program for training social workers in screening and brief intervention. These case examples highlight how technology could have a role in addressing the Alcohol Misuse Grand Challenge.     

Associations between Students’ Perceptions of the Psychosocial School Environment and Indicators of Subjective Health in Finnish Comprehensive Schools

The study examined how far students’ perceptions of the psychosocial school environment are associated with self‐rated health, life satisfaction and subjective health complaints. Students’ perceptions were associated with one or more indicators of subjective health. Perceived health was better in direct proportion to positive perceptions. Student relations and school strain were the factors that stood out in both genders, with regard to all the health indicators. School engagement, parental support and educational aspiration were found to be important for overall perceived health of the students. This study indicates the importance of the psychosocial school environment for students’ health.     

A Short Psychosocial History of British Child Abuse and Protection: Case Studies in Problems of Mourning in the Public Sphere

This paper offers a historical and psychosocial account of ‘moral panics’ about child maltreatment in England over the last four decades, and proposes this perspective as additional to Munro's more systemic account of the same history. The formal child protection system is theorised in terms of an explicit and a covert dual primary task. The overt task is to actually protect vulnerable children and prevent abuse; the covert task is to protect the remainder of society from exposure to anxiety provoking ‘dangerous knowledge’ about the prevalence of child maltreatment. Episodes of public and political moral panic occur when the boundaries of containment provided by the official system and its processes are breached, propelling debate and contestation about child maltreatment into the public sphere, where public enquiries and other social mechanisms are called upon to ‘settle’ the contested issues. Sometimes these social settlements appear to be successful in resolving conflicts about the reality or otherwise of specific forms of abuse; in other cases, especially child deaths, the controversial and anxiety-laden nature of the problem is recurrently projected back into the public domain. The paper suggests that this may be associated with a difficulty about establishing a secure symbolic framework or discourse in society for the emotionally indigestible facts of child torture and murder. In turn, this may be associated with problems about the decline of public mourning rituals and the failure of the public enquiry format to facilitate this. In line with Munro, the paper argues for the importance of a tragic perspective on child maltreatment, to counter idealisations of the capacity of the formal system to protect children.     

Effects of Family Involvement on Length of Stay and Treatment Completion Rates with Cocaine and Alcohol Abusers

SUMMARY

Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and that family involvement may influence continuation in and completion of treatment for both cocaine and alcohol abusers.

A sample of 99 primary cocaine abusers and 105 primary alcohol abusers in outpatient treatment were followed during the course of their treatment. Results indicated primary alcohol abusers were significantly more successful in completing treatment than primary cocaine abusers. Family involvement in treatment significantly increased the likelihood that cocaine and alcohol abusers would complete the full course of treatment.

It is possible that treatment could be improved and completion rates increased by coordinating the involvement of the family.     

Pilot Testing a Cognitive-Behavioral Protocol on Psychosocial Predictors of Exercise,Nutrition, Weight,and Body Satisfaction Changes in a College-Level Health-Related Fitness Course

Abstract

Objective: Small-scale pilot testing of supplementing a required college health-related fitness course with a cognitive-behavioral exercise-support protocol (The Coach Approach). Participants: Three classes were randomly assigned to Usual processes (n = 32), Coach Approach–supplemented: Mid-size Groups (n = 32), and Coach Approach–supplemented: Small Groups (n = 34) conditions. Methods: Repeated-measures analyses of variance (ANOVAs) assessed overall and between-class changes in the behavioral/physiological factors of exercise, fruit/vegetable intake, and body mass index (BMI); and the psychosocial factors of self-regulation, exercise self-efficacy, mood, and body satisfaction. Dependent t tests evaluated within-class changes. Multiple regression analyses tested prediction of exercise by changes in self-regulation, self-efficacy, and mood. Results: Significant improvements in self-regulation and fruit/vegetable intake were found in all classes. The Coach Approach–supplemented classes demonstrated significant increases in exercise. Significant improvements in BMI, self-efficacy, and body satisfaction were found in only The Coach Approach–supplemented: Small Groups class. Psychosocial changes predicted increased exercise. Self-regulation was the strongest contributor. Conclusions: Overall, results were positive and warrant more comprehensive testing.     

Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

ABSTRACT

Current attempts to address the high burden of sexual health morbidity and mortality in developing countries remain limited in scale due to a range of health system constraints. We conducted a literature review of the policy and programmatic issues that influence the integration of sexual health into primary care services in developing countries. Forty-seven reports were identified from a search of both peer-reviewed and gray literature. Key issues identified were intersectoral and intergovernmental coordination; management and organizational issues including decentralization, health sector reform, logistics, and referral systems; human resources, including training and support required to increase service scope; relationships between the public and private sectors; and scaling-up and financing issues.     

Adolescents in Treatment: Effects of Parental Substance Abuse on Treatment Entry Characteristics and Outcomes

SUMMARY

Research strongly supports an increased risk of substance use disorders among the adolescent children of addicted parents. However, little documentation exists of how these adolescents fare when they present for treatment. This article uses data taken from a two-state study on the effects of adolescent substance abuse treatment to examine the characteristics of adolescents with substance-abusing parents and their outcomes following an episode of outpatient treatment. Although such adolescents enter treatment with greater problem severity in a range of areas, outcomes appear similar to adolescents with no substance-abusing parents. The impact of family and individual counseling on outcomes was also examined, demonstrating mixed results for adolescents with substance-abusing parents.     

Stepping Down and Stepping In: Youth's Perspectives on Making the Transition from Residential Treatment to Treatment Foster Care

Older youth preparing to emancipate from the foster care system are often served in residential treatment settings where they have limited opportunities to practice skills for independent living in a community setting. Stepping these youth down to less restrictive environments such as treatment foster care is a growing trend, especially for youth with mental health issues. Yet, few studies have explored the youth's perspective on making this transition. This study utilized qualitative interviews with youths who were participating in a treatment foster care intervention study (n = 8) to gain their perspectives on the process of transitioning from residential care. Youths were interviewed right before they exited residential care and two months after placement in the new foster home. Youths reported hopes for gaining family in the new home as well as fears of placement disruption. Findings point to the need to enlist youths in discussion and problem solving about difficulties they anticipate in the new home and expectations for their relationship with the new foster parents. In addition, the struggles described after two months in the home point to the need for youths to build specific skills to better manage ongoing relationships with foster parents and for foster parent training on how to help build these skills.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Supervision and Treatment of Juveniles with Sexual Behavior Problems

Responses to a survey, distributed at the 2005 Conference for Sex Offender Management, were studied to identify treatment theories, client behavior expectations, and level of interagency collaboration relied upon to produce positive outcomes for Juveniles with Sexual Behavior Problems (JSBP). Analysis of 112 responses to the 31-item survey identified three potential subscales (Integration of Theory, Readiness for Program Release, and Collaboration) and indicated support for an integrative approach to treatment. Clinicians were more likely than probation, institutional officers and caseworkers to use cognitive-behavioral approaches to enhance positive outcomes. Results are discussed regarding three controversial issues related to JSBP supervision and treatment: use of polygraphs with juvenile sex offenders, referrals to 12-Step Sexual Addiction programs, and victim/offender reunification.     

Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a literature review by emphasizing the perspective from which research was collected within the family system. Recognizing the impact of cancer on the lives of patients, their partners, children, and the family as a whole is an essential factor in providing appropriate and adequate psychosocial services to families facing cancer.     

Intimate Partnerships and Sexual Health in Gender-Dysphoric Individuals Before the Start of Medical Treatment

ABSTRACT

Objectives: This study focuses on sexual health aspects in partnered gender-dysphoric individuals at the start of medical treatment by examining their partnership constellations, sexual experiences, and reports of psychological problems. Methods: As part of the cross-national European Network for the Investigation of Gender Incongruence Study, 168 adult male-to-females (MFs) and female-to-males (FMs; MF:FM sex ratio = 1:1.2) were surveyed by means of self-administered questionnaires prior to any gender-confirming hormonal and surgical interventions. Results: MFs were often found to have androphilic (female) partners (sexually oriented toward males), noncomplementary with their female gender identity. In contrast, FMs frequently had androphilic (female) partners, complementary with their male gender identity and sexual orientations toward females. Conclusions: In both genders, complementary partnership constellations were associated with more avoidance of sexual experiences and more negative sexual experiences.     

Social and Health Service Use and Treatment Outcomes for Sexual Minorities in a National Sample of Substance Abuse Treatment Programs

This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.     

Denied Citizens of Turkey: Experiences of Discrimination Among LGBT Individuals in Employment,Housing and Health Care

The purpose of this article is to explore experiences of discrimination against lesbian, gay, bisexual and trans (LGBT) individuals in three domains of social policies: employment, housing and health care — domains in which LGBT individuals are not openly recognized as equal citizens and anti‐discrimination legislation is absent in Turkey. Drawing on qualitative content analysis of the data collected from 14 focus group interviews with 139 LGBT individuals conducted in ten provinces of Turkey in the first half of 2014, this article sheds light on diverse forms of discrimination facing LGBT individuals in employment, housing and health care in a largely under‐researched country. The article concludes that the contemporary understanding of Turkish citizenship and its practice are rooted in heterosexist universalism that does not recognize LGBTs as equal citizens, which, in turn, leads to systematic breaches of LGBTs' social rights in employment, housing and health care. The article shows that even strong and universalistic social policies fail to serve LGBTs on an equal footing with other citizens unless equal citizenship rights of LGBTs and anti‐discrimination principles are recognized and realized.     

Mindfulness and Alcohol Problems in College Students: The Mediating Effects of Stress

Abstract

Objective: To examine the relationship between mindfulness and alcohol problems in college students, as well as the role of stress as a mediator in this relationship. Participants: Participants were 310 students from a small, private college in the Northeast. Methods: Students completed self-report measures, including the Perceived Stress Scale, the Five Facet Mindfulness Questionnaire, and the Rutgers Alcohol Problems Index. Results: Mindfulness was negatively correlated with alcohol problems and stress, whereas stress positively correlated with alcohol problems. Results implicated stress as fully mediating the relationship between mindfulness and alcohol problems. Alcohol problems were negatively correlated with the Acting With Awareness and Describing Experience facets of mindfulness. Conclusion: Mindfulness-based stress reduction or other mindfulness programs may be useful in decreasing alcohol problems on college campuses via the effects on stress.