Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Adolescents in residential treatment: The prevalence of ACEs,substance use and justice involvement

Abstract

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.     

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.     

Nicotine addiction and substance use disorder treatment: The Philadelphia story

The Philadelphia Department of Behavioral Health and its leadership have a well‐deserved reputation for pioneering recovery‐oriented systems of care. Effective Jan. 1, 2019, the agency initiated an aggressive policy to address the problem of nicotine addiction among those receiving substance use disorder (SUD) services in contracted facilities. The policy covers nine detox facilities, 32 short‐term rehabilitation programs, 31 long‐term rehabilitation programs and eight halfway houses.     

Job demands,emotional dissonance and elderly abuse: The moderating role of organizational resources

ABSTRACT

The present study focuses on elderly abuse committed by caregivers in nursing homes. It aimed at a better understanding of neglect and abusive behaviors by considering the working context and the emotional dissonance of these professionals. To achieve this goal, direct effects of emotional dissonance, job demands (workload and emotional demands) and organizational resources (high-quality relationships with the colleagues and the supervisor) on neglect and abusive behaviors were analyzed. Moreover, the moderating role of organizational resources was explored. The study was conducted among 481 nurses and healthcare assistants from different French nursing homes. Overall, results contributed to the literature by pointing out the impact of emotional dissonance and caregivers’ working context on neglect and abusive behaviors. Moreover, results highlighted the moderating effect of high-quality relationships with the colleagues and the supervisor and give rise to potential implications in preventing elderly abuse in nursing homes.     

The Marihuana Perception Inventory: the effects of substance abuse instruction

This article reports the latest results of a continuing effort to develop a perceptual inventory of factors associated with the onset of marihuana use among youths and young people. In addition to better understanding why adolescents begin using marihuana, the inventory is intended to assist drug educators target their programs. This phase studied 617 students in three Midwest school districts prior to and after substance abuse instruction to determine the relationship between perceptions and demographic characteristics, and to learn if substance abuse instruction was related to changes in the student's perception of the relationships. Factor analysis again revealed a five-factor solution. All thirty-four inventory items were included in the final solution. Items appeared to group themselves among the scales in a fashion similar to that found in prior studies. However, the larger sample size permitted refinement of the scales: Maturational Difficulties; Excessive Pressure; Parental Failings; Rebelliousness; and Societal/Institutional Weaknesses. The inventory appears to be remarkably stable across demographic characteristics. Significant differences between pretest and posttest scores indicated that students perceived less of a relationship between Maturational Difficulties, Excessive Pressure, and Societal/Institutional Weaknesses and the onset of marihuana use after instruction, and more of a relationship between Parental Failings and the young person's decision to begin using marihuana. It appears that instructional programs can be expected to at least contribute to changes in perceptions concerning the relationship between societal and familial factors and the onset of marihuana use.     

Disability and abuse in relation to substance abuse: a descriptive analysis

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

Conformity, peer pressure, and adolescent receptivity to treatment for substance abuse: a research note.

To explore the possibility that peer influences not only contribute to adolescent substance abuse but shape feelings about being in treatment for substance abuse, forty adolescent inpatients were surveyed. Misconduct, including substance abuse, was predicted best by perceived peer pressure toward misconduct, low opinions of the value of treatment by disposition to conform to antisocial peers, and sense of stigma associated with being treated by perceived peer pressure toward conformity. Concerns over peer acceptance may be one basis for resistance to substance abuse treatment.     

Substance abuse and dependency risk: the role of peer perceptions, marijuana involvement, and attitudes toward substance use among college students

Many college students are using substances at levels consistent with Substance Abuse or Dependence, yet little explanation for this phenomenon exits. The aim of this study was to explore a risk factor profile that best separates those with low and high potential for having a substance use disorder (SUD). A discriminant function analysis revealed that participants with a high probability of having a SUD misperceive others' alcohol and marijuana use to a greater extent than those with a low probability of having a SUD. Implications for educators and counselors on college campuses are discussed.     

HIV rapid testing in substance abuse treatment: implementation following a clinical trial

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.     

Employing policy and purchasing levers to increase the use of evidence-based practices in community-based substance abuse treatment settings: reports from single state authorities

State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical state-to-provider strategies aimed at accelerating use of evidence-based practices: purchasing levers (financial incentives and mechanisms) and policy or regulatory levers. A sample of 51 state representatives was interviewed. Single State Authorities for substance abuse treatment (SSAs) that fund providers directly or through managed care were significantly more likely to have contracts that required or encouraged evidence-based interventions, as compared to SSAs that fund providers indirectly through sub-state entities. Policy levers included EBP-related legislation, language in rules and regulations, and evidence-based criteria in state plans and standards. These differences in state policy are likely to result in significant state level variations regarding both the extent to which EBPs are implemented by community-based treatment providers and the quality of implementation.     

Rates of pathological gambling in publicly funded outpatient substance abuse treatment

Rates of problem or probable pathological gambling were assessed in substance abusers seeking outpatient treatment in a publicly funded outpatient substance abuse treatment program. The South Oaks Gambling Screen (SOGS) was administered to 467 consecutive admissions at three different sites. Problem gamblers comprised 6.2 percent of the total (n=29), and 4.5 percent scored as probable pathological gamblers (n=21). These rates are two and one-half times greater than would be expected according to a recent state survey using the SOGS. Implications for assessment and treatment of problem gambling are discussed.The author expresses his appreciation to John Ramsay and the staff of Epoch Counseling Center for data collection; to Les Franklin for computational analysis; and Dr. Rachel Volberg for providing supplemental data from her Maryland State Gambling Survey.     

A cross-national study on adolescent substance use: Intentions,peer substance use,and parent-adolescent communication

This longitudinal two-wave cross-national study investigated whether intentions, friends' substance use, and parent-adolescent substance-use specific communication predict adolescent alcohol and cannabis use 1 year later, while estimating reversed links. The temporal order between these two substances was also examined. We used multi-group cross-lagged panel modeling on data from 2 ethnically and socioeconomically diverse samples: Sint Maarten (N = 350; M_age = 14.19) and the Netherlands (N = 602; M_age = 13.50). Results showed that in the Netherlands, cannabis use predicts more subsequent problems (alcohol use, intention to use cannabis, and affiliation with cannabis-using friends). But for Sint Maarten, alcohol use predicts more subsequent problems (cannabis use, intention to use alcohol, and affiliation with alcohol-using friends). These opposing results demonstrate that caution is warranted when generalizing results across countries.     

Residential substance abuse treatment for pregnant and postpartum women and their children: treatment and policy implications

In FY 1993 and FY 1995, the federal government awarded 27 five-year grants that supported 35 residential treatment projects for substance-abusing pregnant and postpartum women and their children. These projects provided comprehensive culturally and gender-specific treatment. Preliminary aggregated data collected in a national cross-site evaluation of 24 of these projects are encouraging with respect to infant mortality and morbidity, treatment retention and completion rates, and behavioral changes in the participating mothers at six months postdischarge. Local evaluations reflect other benefits of treatment. Cost data are expected to demonstrate the efficiencies and benefits of these projects compared to no treatment.     

Adults with dual eligibility for Medicaid and Medicare: access to substance abuse treatment

Access to substance abuse treatment is a noted concern for people with disabilities. Although much is known about elders with dual eligibility for Medicaid and Medicare regarding any care utilization and expenditures, little is known about their younger counterparts and how substance abuse might contribute. Drawing on national Medicaid claims, treatment utilization was explored for adults with and without dual eligibility for Medicare. People with dual eligibility were less likely to both initiate and engage in treatment as compared to those without dual eligibility. Implications relate to how existing systems provide substance abuse treatment to people with disabilities.     

Economic evaluation of continuing care interventions in the treatment of substance abuse: recommendations for future research

The chronic and relapsing nature of substance abuse points to the need for continuing care after a primary phase of treatment. This article reviews the economic studies of continuing care, discusses research gaps, highlights some of the challenges of conducting rigorous economic evaluations of continuing care, and offers research guidelines and recommendations for future economic studies in this emerging field. Rigorous economic evaluations are needed by health care providers and policy makers to justify the allocation of scarce resources to continuing care interventions. The adoption of cost-effective continuing care services can reduce long-term consequences of addiction, thereby potentially increasing overall social welfare.     

The impact of schools self-administering substance abuse surveys: an evaluation

The literature suggests that administering drug surveys to public school students is best done by persons outside of the school system (or at least unfamiliar to the students). This is the approach used by the long-time Monitoring the Future project. Because of the increased costs that administration by outside research associates requires (both time and transportation), we decided to design an experiment that would compare it to administration by school personnel. Six school systems were split, and 3756 surveys were administered, about half by outside research associates and half by school personnel. The results indicate that there were minimal and non-significant differences between the two groups. On the basis of these results, we draw the conclusion that school personnel are able to administer survey instruments without affecting the quality of the results and, thus, that school districts may safely use such data in the evaluation of their drug education and drug prevention programs.     

Problem behaviors,substance abuse and sexual abuse in psychiatrically hospitalized adolescents with bulimia nervosa

Twenty-eight adolescent bulimics were compared to 201 psychiatrically hospitalized non-eating disordered patients. Non-eating disordered patients were found to be reliably more aggressive, delinquent, and under-controlled than patients with bulimia nervosa. Sexual abuse was found to be less prevalent among bulimic adolescents than comparison adolescents. No significant between group differences were achieved on any measure of alcohol/drug abuse. The behavioral profiles of substance abusing bulimics were highly similar to those of non-eating disordered patients. Three months follow-up of bulimic patients found that they were less depressed, had less somatization, and were less overcontrolled; however, they showed no reliable improvements in eating attitudes/behaviours or drug/alcohol use.