Treatment provider awareness of the possible impact of the internet on the treatment of sex offenders: an alert to a problem

This study evaluated treatment providers' perceptions of the impact of the Internet on the treatment of sex offenders. This study surveyed all of the agencies in South Carolina that provide treatment services for sex offenders. Analysis indicated that (a) most treatment providers were unaware of the potential negative impact of the Internet on their treatment efforts with clients, (b) most treatment providers had no policy restricting their clients' Internet use, (c) the overwhelming majority of treatment providers felt that they were poorly equipped to deal with this issue, and (d) almost all of the treatment providers felt that probation and parole would be of little assistance in helping them monitor their clients' use of the Internet. Implications of the findings for improving treatment services for sex offenders were explored and discussed.     

Client and program factors associated with dropout from court mandated drug treatment

To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.     

The Involvement of a Concerned Significant Other in Gambling Disorder Treatment Outcome

Interpersonal distress is a common feature in gambling disorder and adding a concerned significant other (CSO) to the recovery process could be an effective tool for improving treatment outcome. However, little empirical evidence is available regarding the effectiveness of including a CSO to interventions. We aimed to compare treatment outcomes (i.e. compliance with therapy guidelines, dropout from treatment, and relapse during treatment) in a CBT program involving a CSO to CBT treatment as usual (TAU) without a CSO. The sample comprised male gambling disorder patients (N = 675). The manualized CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. Patient CSOs attended a predetermined number of sessions with the patient and were provided with resources to acquire a better understanding of the disorder, to manage risk situations, and to aid patients in adhering to treatment guidelines. Patients with a CSO had significant higher treatment attendance and reduced dropout compared to patients receiving TAU. Moreover, patients whose spouse was involved in the treatment program were less likely to relapse and adhered to the treatment guidelines more than those with a non-spousal CSO. Our results suggest that incorporating interpersonal support to gambling disorder interventions could potentially improve treatment outcomes.     

THERAPIST-CONDUCTED CONSULTATION: USING CLIENTS AS CONSULTANTS TO THEIR OWN THERAPY

Using qualitative research methodology, the authors developed an in-session therapeutic procedure called the therapist-conducted consultation (TCC) which is designed to enhance the therapist-client collaborative relationship. In the TCC, the therapist and client(s) relinquish their traditional roles and discuss the client's treatment. During this process, clients are invited to (a) share their perspective of treatment, (b) assess whether treatment is meeting their goals, and (c) suggest how treatment could change to improve their experience. The three-stage model of the TCC that resulted from the research is presented with a case example.     

Sibling group treatment

This paper examines a model of treatment for working with sibling groups. It is suggested that the sibling group is rarely considered as a viable treatment entity, yet siblings potentially exert a powerful influence within the family system. Assumptions underlying this model of treatment are examined. As a unit of treatment, sibling groups can be worked with in three ways: (1) as an adjunct to family or adult treatment, (2) as an adjunct to individual child therapy, and (3) by itself. Treatment objectives are described and a case illustration is provided. Finally, limitations and benefits of sibling group treatment are discussed.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.     

Social Work Roles in Drug Treatment with Youth

ABSTRACT

Social workers working with youth, who are prescribed psychotropic medication, are routinely faced with tasks pertaining to psychopharmacologic treatment. Little is known, however, about how these workers contribute to the medication treatment process or the impact of their contributions. The purpose of this national survey of social workers practicing with youth was to explore three areas: (1) the frequency of medication-related functions with adolescent clients; (2) the worker, client, and contextual factors associated with greater involvement; and (3) social workers' perceptions of the effects of greater involvement on treatment processes and outcomes. Our findings suggested that in relation to medication treatment, social workers more frequently interfaced with clients than physicians, and that various treatment context and individual factors are associated with greater involvement. Social workers also perceived their involvement as associated with some desirable treatment processes/outcomes, especially the inclusion of adolescents in decision-making.     

Alcohol abuse

We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.     

Community-based addiction treatment staff attitudes about the usefulness of evidence-based addiction treatment and CBO organizational linkages to research institutions

This national study of community-based addiction-treatment organizations' (CBOs) implementation of evidence-based practices explored CBO Program Directors' (n=296) and clinical staff (n=518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical factors were associated with directors, and staff attitudes about the usefulness of science-based addiction treatment. For both directors and staff working in an organization that was affiliated with a research institution, working in an organization with better internet technology (measured through TCU-ORC scores) and having higher levels of education were all significantly associated with having more positive attitudes regarding science-based addiction treatment. Implications: government policy that promotes the hiring of addiction treatment clinical staff with professional degrees and encourages the development of linkages between addiction treatment researchers and treatment staff may positively impact attitudes and use of evidence-based addiction treatment practices (EBPs) in CBOs.     

A prospective longitudinal survey of erectile function status in symptomatic benign prostatic hyperplasia patients treated with dutasteride

We prospectively evaluated erectile function (EF) using the Sexual Health Inventory for Men (SHIM) and the erectile hardness score (EHS) as well as urinary statuses using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) before and 3, 6, and 12 months after a daily treatment with 0.5?mg dutasteride (DUT). Significant improvements were observed in IPSS and OABSS in 98 patients with the DUT treatment, and the effects were similar between 28 patients with potency with baseline SHIM of 8 or greater and 70 severe erectile dysfunction (ED) patients at baseline. In the 28 patients with potency, significant decreases were observed in SHIM and EHS after 3, 6, and 12 months of the DUT treatment, with the severity of ED according to SHIM deteriorating in half of these patients after 12 months of the DUT treatment. Eighteen out of 28 patients (64.3%) with potency at baseline had awareness of the occurrence of ED before the DUT treatment, were younger, and had higher SHIM and EHS just before the DUT treatment than their counterparts. Regular assessments of EF may be needed, especially in younger patients and those with higher levels of EF before the administration of DUT.     

Treatment outcomes among adolescents with substance abuse problems: the relationship between comorbidities and post-treatment substance involvement

This study examines comorbid mental disorders in relation to post-treatment outcomes (12 months post-intake) among adolescents (N=419) who entered three residential drug treatment programs. When contrasted with youths who had no comorbid mental disorders or youths with a single comorbid condition, those with combined internalizing and externalizing disorders (mixed comorbidity) had higher levels of substance-related problems and poly-drug use at entry to treatment, and poorer outcomes, e.g. relapse, particularly evident for drugs other than alcohol or marijuana. A significantly higher proportion of those with mixed comorbidity were admitted to short term residential treatment, as compared to long term residential care. However, the effects of comorbidity were independent of both planned and actual length of stay, suggesting that comorbidities can negatively impact treatment outcome in multiple ways, apart from length of stay. Since co-occurring problems appear to profoundly limit treatment effectiveness, treatment strategies that address comorbidity are needed to improve outcomes.     

Women in Substance Use Treatment

Abstract

The objective of this study was to examine the differences between women with children in substance use treatment who are involved in Child Protective Services (CPS+) and those who are not involved (CPS-). Using a sample of all alcohol and other drug (AOD) clients (N = 6,023) receiving substance use treatment over a three-year period (1997-99), the study found that CPS+ women were more likely to be younger, have more children, have been arrested less often, be mandated to receive treatment, to have an unsatisfactory exit status or be transferred to another treatment program at discharge. CPS+ women were also more likely to have attended outpatient or day treatment for the AOD treatment. This study points out that there may be specific risk factors in place for a subgroup of women with children in AOD treatment.     

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.     

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.     

Individual treatment of intimate partner violence perpetrators

This article outlines a rationale for investigating the individual (one-on-one) treatment format and individualized (case-tailored) services for partner abuse perpetrators. Many state standards caution against or prohibit individual services in abuser intervention. However, initial research indicates that motivational interviewing, conducted individually, can increase abusive clients' engagement in the change process. Challenges of using the group format in treatment development are discussed along with potential benefits of individual treatment for this population. Notably, individual treatment can be adapted to the client's stage of change, can address a range of presenting concerns (such as substance abuse and mood disorders) that may influence outcome, and can be used to focus clinical attention on case-specific change targets while avoiding potentially negative and antisocial peer influences in the group format. Nevertheless, individual treatment has been almost entirely ignored to date in clinical research with this population.     

Parents’ Decision Making and Their Information Needs Concerning Treatments for Child Anxiety: Implications for Family-Centered Practice

Collaborative decision making is a central feature of family-centered practice and is important to families in treatment planning. This study explored parents’ preferences for decision making involvement and their information needs regarding treatment for child anxiety. Qualitative interviews conducted with 19 parents revealed four main themes: (1) parents regard themselves as protectors, (2) parents desire involvement in decision making, (3) information is key in decision making, and (4) not all treatments are perceived as equal. Parents reported a strong desire to maintain control over the final treatment decision. They preferred a wide range of information about treatment and the health-care provider. Implications for implementing family-centered practice are discussed.     

Combined physical and psychosexual therapy for provoked vestibulodynia-an evaluation of a multidisciplinary treatment model

Our objective is to standardize and evaluate a combined physical and psychosexual therapy for women with provoked vestibulodynia. Twenty-four patients underwent the treatment program. Sessions with a psychosexual counselor included issues on sexual functioning, psychological adjustments, and stress elimination. Exercises for mucosal desensitization and reestablishment of pelvic floor function were supervised by a midwife. A questionnaire was used for evaluation at a minimum of 6 months after the treatment. The mean number of appointments to the counselor was 12 (4-24) and 15 (9-26) to the midwife during a mean period of 53 weeks (19-92). Nineteen women (79%) considered themselves to be cured or having greatly improved. Intercourse frequency was increased (p = 0.001) and coital pain was reduced (p = 0.02) after completing the treatment. Improvements in sexual functioning and coping strategies for psychological impairment and stress were reported. Women with provoked vestibulodynia benefit from a multidisciplinary treatment model including desensitization of the vestibular mucosa, rehabilitation of the pelvic floor, and psychosexual adjustments.     

Effects of Aerobic Training on Primary Dysmenorrhea Symptomatology in College Females

Abstract

“Single-Dose Therapy for Cystitis in Women: A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin,” Thomas M. Hooton et al. We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of the 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy. (Journal of the American Medical Association 1985;253:387-390.)