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.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

Program evaluation of trauma-informed yoga for vulnerable populations

BackgroundTrauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences.MethodsTrauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing.ResultsStudents were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga.ConclusionOur findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.     

Co-Occurring Disorders Among Jail Inmates: Bridging the Treatment Gap

ABSTRACT

This paper presents findings based on a retrospective review of health and mental health records of 359 mentally ill jail inmates. Regardless of demographic group, substance-related disorders are the most prevalent disorder. Sixty-seven percent of the sample had a substance-related disorder, 37% an adjustment disorder, 23% a mood disorder, and 12% had schizophrenia or another psychotic disorder. Comorbidity was extensive with close to 45% of the sample having both a substance-related disorder and an additional major mental illness. Study findings indicate that there is a great need to strengthen services and create jail-community linkages for inmates with comorbid mental health and substance abuse disorders. Innovative program and resource information are provided.     

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.     

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.     

Voices from the stories untold: Lesbian,gay, bisexual,trans, and queer college students' experiences with campus climate

ABSTRACT

Twelve self-identified college students within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) spectrum were interviewed on campus climate perceptions and their experiences of discrimination and isolation at their university. Thematic analysis was conducted to identify themes from the data. This process resulted in the emergence of three themes, identified as discrimination, isolation, and avoidance. The most salient experiences of discrimination and isolation reported by participants came from within LGBTQ organizations or from lesbian or gay male individuals that participants sought out for social support. LGBTQ intra-community discrimination was considered to be particularly damaging to participants' sense of belonging and involvement within the LGBTQ community. Discrimination and isolation from straight-identified organizations or individuals was reported mostly in the context of fraternities/sororities and religious organizations. Furthermore, actions by members of these latter groups caused participants to avoid these groups out of expectations of negative interactions. These results inform empirical research to bring awareness to acts of discrimination that continue to take place within the university toward LGBTQ students. Specific implications for social work practice with LGBTQ college students and future research on diverse LGBTQ populations and resources are discussed.     

An exploratory study examining needs,access, and competent social services for the transgender community in Phoenix,Arizona

ABSTRACT

Phoenix is the sixth largest city in the United States, with a vibrant yet underserved lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Despite an extensive community presence, social service delivery bias persists among members of the LGBTQ community, but more often among transgender individuals. Existing research has examined social services from the perspective of either the client or the practitioner. This exploratory study specifically examines social services in the Phoenix metropolitan area for the transgender community. Data collected from interviews with participants and providers contributed to an assessment of the current level of social services for the transgender community, with a specific emphasis on identifying service gaps and recommendations for culturally competent and comprehensive services.     

Perceived barriers to mental health treatment among men enrolled in a responsible fatherhood program

ABSTRACT

Low-income men may experience elevated risk for mental health concerns and be less likely to seek treatment; this may be due in part to perceived barriers to accessing and receiving treatment. Men who enrolled in a community based responsible fatherhood program self-identified their health and mental health conditions. Although participants reported serious health conditions at rates consistent with the general population, we found higher than expected rates of depression, anxiety, or other mental health conditions and explored perceived barriers to mental health treatment among this sample. Findings suggest that low income men face a variety of perceived psychosocial and structural barriers impacting access to and compliance with mental health treatment.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.     

Lesbian,Gay, Bisexual,Sexual-Orientation Questioning Adolescents Seeking Mental Health Services

Summary

Lesbian, gay, bisexual, and sexual-orientation questioning (LGBQ) adolescents have many of the same health needs as straight adolescents. In addition, they must learn to manage a stigmatized identity that may create confusion, anxiety, and emotional turbulence for them. Beyond stigma, LGBQ youth are often found to be at higher risk for substance abuse, violence, depression, suicide, and sexual health problems. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this article examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. Findings indicate that LGBQ youth are at higher risk than straights, and express greater desire to talk about substance use, health, their personal lives, and their friends. Mental health practitioners working with these young persons must properly assess and address their risks by creating a sense of community and safe environment for open discussion.     

Psychosocial distress,physical illness,and social behaviour of close relatives to people with substance use disorders

ABSTRACT

This study explores how a family member with substance use disorder (SUD) affects the psychosocial, behavioral, and physical states of other family members. Sixteen in-depth interviews with relatives of Icelandic individuals afflicted with SUD were performed. The interviewees were selected from a pool of Icelandic families whose members included one or more chronic SUD users. They represented different relations to the user (spouses, parents, children, and siblings) and both genders. All participants except for siblings expressed that SUD had negatively affected their mental health by inducing depression, anxiety, and stress-related physical illness. All had experienced physical violence, mental abuse and financial loss. Parents indicated that the SUD of the family member had isolating psychosocial impacts on their children and caused a loss of connection among their family members. All participants, except the siblings, regarded their workplace as a shelter. The study’s findings can help social professionals to better understand the effects of SUD on families, family systems, and public health in general.     

Activating adult allies from a rural community on lesbian,gay, bisexual,transgender, and queer student issues in school using photovoice

Purpose: Many students who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) face hostile school environments that can negatively impact their mental health and education. This study involved a photovoice project where high school students from a gay-straight alliance in the rural southeastern United States took photographs that depicted the issues LGBTQ students were facing and then exhibited their photographs and stories to individuals from the school system and local community to promote awareness, dialogue, and action. Methods: Twenty adults who attended the photovoice exhibit responded to an online survey about their experiences with the intervention. Results: Eighty-five percent of adults reported that the intervention made them think about issues they had not previously considered, including the struggles LGBTQ youths face, gender issues, and living in a rural community. Common emotions experienced at the intervention included feeling excited, concern for the youths, and proud of the youths. Furthermore, 81% of the adults indicated that they would take action or behave differently as a result of the intervention, including supporting and affirming LGBTQ students, using gender-neutral and -inclusive language, and confronting bias in themselves and others. Conclusions: Photovoice is a promising strategy for LGBTQ students to activate adult allies in their community.     

Examination of the Role of Therapeutic Alliance,Treatment Dose,and Treatment Completion in the Effectiveness of The Seven Challenges

Adolescent alcohol and illicit drug (AOD) use is a major public health concern. This longitudinal study examines the effectiveness of The Seven Challenges in reducing adolescent substance use and mental health problems, as well as the process by which it is effective. Participants were 89 adolescents (72 male, 17 female) enrolled in a 3 month intensive outpatient adolescent substance abuse treatment program using The Seven Challenges and who provided self-report data at pre- and post-treatment. Results indicated that The Seven Challenges was effective at increasing the number of days refrained from using AOD, reducing use of tetrahydrocannabinol (THC) and other drugs, and reducing substance use problems and internal mental distress. Results also indicated that The Seven Challenges drug counselors effectively established and maintained therapeutic alliance but this seems to not play a role in the effectiveness of The Seven Challenges. Both treatment dose and completion played a role in the effectiveness of The Seven Challenges; they were both positively related to post-treatment days refrained from AOD use, and negatively related to days of THC use, substance use problems, and internal mental distress. However, the strength of the influence of treatment completion was stronger when treatment dose was low than when it was high. Despite a small sample and other limitations, findings add to existing literature that suggests that The Seven Challenges is an effective substance abuse treatment for adolescents. Furthermore, findings suggest that adolescent substance abuse treatment should focus on clients meeting pre-determined program goals as well as on dose.     

Serving our (in)visible elders: The impact of a LGBTQ+ aging presentation on a rural college campus

ABSTRACT

As the number of individuals 65 and older continues to grow, so too does the richness and complexity of their identity. Specifically, the culture of aging within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community has received little attention in the literature. In order to best serve this population, human service professionals must understand the reality of aging within diverse communities. This article explores the impact of an invited campus speaker focused on LGBTQ+ aging on a rural college campus. Results indicate a general increase in overall knowledge and appreciation for issues directly impacting the aging LGBTQ+ community. Recommendations for practice, grounded in a social justice framework, are shared.     

Latina and African‐American Girls in the Juvenile Justice System: Needs,Problems, and Solutions

This review focuses on Latina and African‐American girls in the juvenile justice system with a special emphasis on their mental health, substance abuse, and treatment needs. Like many young women in the juvenile justice system, Latina and African‐American girls often have histories of neglect, abuse, and trauma, which contribute to later mental health and substance abuse issues. Despite these histories, juvenile justice professionals sometimes rely on stereotypes rooted in cultural deficit thinking to explain Latina and African‐American girls' delinquency. Relying on gendered, racialized, and classed stereotypes and assumptions can result in decisions that negatively impact Latina and African‐American girls' access to mental health, substance abuse, and other types of treatment. Policy and practice implications for better addressing the needs of Latina and African‐American girls are discussed.