Trauma and health risk behaviors in people with severe mental illness

The current study tests the association between a composite measure of unsafe sex and sharing syringes for drug use with six of the more common lifetime traumatic/stressful events in 421 community mental health clients with severe mental illness (SMI) while controlling for psychiatric symptoms and related problems. A small but significant proportion of respondents said they had injected drugs with a shared needle in their lifetime (30, 7.2%), and a much larger proportion of respondents had engaged in unprotected sex (165, 39.2%). Unprotected sex and needle sharing were significantly correlated (Spearman’s rho = .20, p < .01). Frequency of lifetime traumatic events that occurred at least once was reported by one third to three quarters of clients depending on type of trauma. Regression analysis revealed that substance abuse and lifetime homelessness were significantly correlated with health risk behaviors. Practitioners need to be continuously vigilant to comorbid substance use and the housing needs of people with SMI. Limitations of the study include its cross-sectional design.     

Appalachian Women’s Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg–Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women’s (N = 400) utilization of addiction treatment. A secondary data analysis included multiple multivariate analyses. The strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to nonvulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.     

A Peek Inside the Box: How Information Flows Through Substance Abuse Treatment Agencies

This article describes how integrated health information technology affects the collection and flow of client-level intake and assessment data within substance abuse treatment agencies. We combined process mapping and qualitative inquiry methods to analyze staff interviews (N = 54) from eight agencies in four U.S. states. Integrated health information technology was related to expedited and improved flow of information, while nonintegrated health information technology systems were associated with double data entry, multiple eligibility screenings, and different intake processes across levels of care. Process mapping is an effective tool to identify barriers to efficient client-level data management and opportunities to leverage health information technology to streamline the intake process of substance abuse treatment agencies, improve staff productivity, and enhance the accuracy and information flow.     

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.     

A qualitative investigation into military veterans’ experiences in a problem-solving court: Factors that impact graduation rates

Veterans treatment courts (VTCs) are designed to offer a rehabilitative approach to criminal justice, focusing on treatment for mental health and substance use disorders. This qualitative study develops an in-depth understanding of a Midwestern VTC by asking participants (n = 15) their views on the most helpful aspects of the program and how the program could be more helpful. Three themes emerged from the data. 1) Military veterans felt that they were treated in a compassionate and caring manner, while also being held accountable for their behaviors. 2) Military veterans felt that they were not labeled by their mental health diagnoses, but that their identities as people and military veterans were more fully recognized. 3) Military veterans were dissatisfied with some of the services they received from the local VA. These findings are discussed in the context of problem-solving courts and military veterans’ experiences of services.     

Personal Trauma and Risk Behaviors Among Youth Entering Residential Treatment

The focus of this study was to determine the prevalence and types of traumas experienced by adolescents prior to admission to long term mental health residential care and the impact of these traumas on their risk behaviors. The research was conducted at a state-supported residential mental health treatment facility functioning under the authority of the Department of State Health Services. Client level data was extracted from social assessment forms (N = 457) in case records of clients. Results confirmed that exposure to trauma was pervasive among adolescents admitted to the facility. Findings also revealed a link between trauma and risk behaviors among youth entering residential treatment facilities. Increased trauma exposure significantly impacted the risk behaviors of youths entering the residential treatment facility. The results indicate that the total number of traumas experienced was a greater predictor of risk behaviors among these youth than the specific traumas experienced. Internalizing behaviors such as self-harm and suicide attempts also increased with the number of traumas experienced by the adolescent. The study demonstrates the need for further exploration of the complex relationship between personal trauma, mental health, and social development in adolescents.     

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.     

Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials

Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.     

Health Promotion using Tablet Technology with Older Adult African American Methadone Clients: A Case Study

This exploratory study examined three single case studies to investigate the feasibility of handheld tablet computers for older adult methadone clients. The intervention targeted African American adults (N = 3) over the age of 50 who were in substance abuse treatment. Subjects participated, via a face-to-face video program, in 12 educational sessions focused on healthy living. Both the feasibility of teaching older adult subjects to use tablet computers and their levels of engagement in the intervention were assessed. In addition, completion of participants’ goals and their ability to remember those goals were tracked weekly. Findings revealed that participants were able to learn how to operate the tablets and enjoyed using the technology. Frequent interactions between the counselors and the participants, using face-to-face video, facilitated success in achieving program goals.     

Impact of Parenting Behaviors on Recent Alcohol Use Among African American Students

Parenting is a critical factor in substance abuse prevention. Positive parenting behaviors are identified as a protective factor for substance abuse among youth. Limited research exists that investigates the role of parenting practices on minority youth substance use. The present study seeks to examine correlates between parenting and recent alcohol use among African American youth. Specifically, to what extent do African American students report experiencing specific parenting behaviors that are measured by the National Household Survey on Drug Use and Health?, do specific parenting behaviors increase the risk of recent alcohol use among African American youth?, does the impact of parenting behaviors on recent alcohol use among African American youth differ based on sex (males and females) and age category (12–13, 14–15, and 16–17 years old) were examined in this study? Logistic regression analysis of the National Household Survey on Drug Use and Health was conducted to examine the research questions. Findings indicated that parenting behaviors was associated with recent alcohol among youth. Significant differences were found for males, females, 12–13, 14–15, and 16–17 years olds. Study findings demonstrate the importance of positive parenting behaviors in youth alcohol prevention. Program specialists may target parenting as a means of preventing and reducing youth alcohol use among African American youth.     

Impact of Race on the Implementation of Empirically Supported Treatments in Substance Abuse Treatment

The effort to address the gap between research and practice in substance abuse treatment has largely neglected the role of local resources and political trends. This study seeks to clarify the role of the local environment in implementing empirically supported treatments (ESTs). The study consisted of secondary data analysis of substance abuse treatment centers (N = 13,079) and U.S. Census data to determine the likelihood of using EST by substance abuse treatment centers in counties with 50% or more Black residents. Bivariate and multivariate models were employed. After controlling for various factors, results indicate that substance use disorder treatment agencies that accept federal funding are less likely to use ESTs if they are located in counties with predominantly (> 50%) Black residents. Implementation of ESTs could be influenced by community racial distribution (% Black), but environmental constraints and events might shift implementation patterns.     

Disclosure of Child Sexual Abuse Among Adult Male Survivors

Men who were sexually abused during childhood are a stigmatized, under-studied, and marginalized population that is at risk for long-term mental health problems. However, many mental health practitioners feel under-prepared and ill-equipped to effectively treat male survivors of child sexual abuse. Furthermore, little is known about factors that may impact the mental health of male survivors such as disclosure of the sexual abuse. The purpose of this study was to (a) describe the disclosure process of male survivors using a lifespan approach, (b) identify disclosure differences based on age and type of abuser, and (c) explore relationships between disclosure attributes and current mental health. Using a large, purposive sample of male survivors (N = 487), the study found that, on average, men delayed telling (M = 21.38 years) and discussing the abuse (M = 28.23 years) for many years. Older age and being abused by a family member (i.e., incest) were both related to delays in disclosure. Most participants who told someone during childhood did not receive emotionally supportive or protective responses and the helpfulness of responses across the lifespan was mixed. Several variables (e.g., timing of disclosure, discussing with a spouse, response to disclosure) were related to current mental health problems. These findings are helpful for clinical social workers who practice with clients from this population. Specific suggestions for improving clinical practice (e.g., assessment, treatment, professional training) are discussed.     

Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment

Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index–Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.     

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.     

Differences in substance use,sexual behavior,and demographic factors by levels of ‘outness’ to friends and family about being a male-for-male escort

Objectives: Male sex work (i.e., escorting) is a stigmatized profession, and men in the sex industry may hide their involvement to avoid negative social consequences. There is limited research comparing men who are out about being an escort to their friends and/or family to those who are out to neither friends nor family. Methods: Data were taken from a 2013 online study of male escorts who were categorized into 3 groups based on outness patterns — friends only (48.9%, n = 193), friends and family (26.6%, n = 105), or neither friends nor family (23.5%, n = 93) — and they were compared on demographic and behavioral variables. Results: We hypothesized that men out to neither friends nor family would perform poorer across indicators of health and well-being due to the lack of social support that can come from friends and family. However, with the exception of reporting lower satisfaction and pay from their last male client, this hypothesis was unsupported. Outness patterns were largely unassociated with social and sexual behaviors with the last male client, and the majority eschewed condomless anal sex with their last male client, suggesting escorts — regardless of how out they are to friends and family — could navigate safer-sex behaviors with their clients. Outness was associated with substance use (<12 months) and substance use with their last male client — men out to friends and family were, for the most part, the most likely to have used substances. Men out to friends and family were significantly more likely than others to have been escorting for more than 5 years and to be escorting full-time. Conclusions: Interventions for escorts that address substance use and sexual risk behaviors and incorporate supportive friend and family social networks may be an important area for future research.     

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.     

HIV Infections Among Older Male Clients of Low-Cost Commercial Sex Venues in Southern China

This study aimed to identify the association of unsafe sex behaviors with HIV infection among the male clients who purchase commercial sex in low-cost sex venues. A cross-sectional study was conduct in a southern province of China among male, low-cost commercial sex clients, who were over 50 years old. Participants were interviewed using a structured questionnaire and had completed HIV testing. Among the 3,485 participants, the prevalence of HIV was 2.96% (95% confidence interval: 2.40–3.52%). The associated risk factors studied for HIV infection included (1) not currently married; (2) use of counterfeit TCMs with sildenafil; (3) noncondom use during commercial purchased sex; and (4) recent engagement of commercial sex within past week. Given the high prevalence of HIV infection among the study group, more political policy intervention and health education should be considered for the identified subpopulation (over 50-year-old men in low-cost commercial venues, counterfeit TCMs with sildenafil and noncondom use).     

Sustaining an intimate and sexually fulfilled marriage or partnership in older adulthood with a disability: Perspectives of social workers

ABSTRACT

The American portrayal of sex is often left for only the young, attractive, and able-bodied. In contrast many studies have found that older adults with disabilities in marriages and intimate partnerships have sexual desire and sexually active lives. Social workers are often burdened with balancing the sexual intimacy desires of their older adult clients with disabilities, alongside the need to protect them from sexual abuse and exploitation, particularly among those who may lack the capacity to consent due to cognitive impairment. This phenomenological study aimed to understand the lived professional experience of social workers (N = 5) in supporting married and intimately partnered couples in which at least one person was an older adult with a disability to understand the clients’ needs and common social work practice methods used to address their needs. Inductive coding was used to identify themes and subthemes. Their role included helping their clients to learn about their ability to have sex, consenting to sex, negotiating accommodations for intimacy and sex with their spouses, and counseling those who took on caregiver roles for their spouses. Social workers reported that individual diagnosis, such as dementia, should not alone determine one’s ability to consent to sex.     

Child Sexual Abuse News: A Systematic Review of Content Analysis Studies

Public knowledge and attitudes toward child sexual abuse are shaped through media depictions and coverage. Since the media are the main source of information about child sexual abuse, studies of child sexual abuse news can help us understand how news is created, how child sexual abuse is presented to the public, and what is the possible impact of such presentation and coverage on the audience. A systematic review of content analysis research is conducted using predefined criteria in order to identify quality studies, main findings, research gaps and to develop recommendations for future studies. International databases were systematically searched using keywords in September 2017. A total of 24 original quantitative content analysis studies published in the English language were included in the review and evaluated according to research methodology. The framework of child sexual abuse news media studies is developed and main findings are highlighted: (1) presentation and coverage of child sexual abuse (n = 7); (2) prevalence of coverage of CSA cases reported to the authorities (n = 2); (3) presentation and coverage of child abuse and sexual crimes where child sexual abuse is only a subtopic (n = 9); (4) presentation and coverage of specific child sexual abuse cases or issues (n = 6). Although studies represent valuable contribution, most did not meet content analysis design and reporting standards or both (e.g., calculating intercoder reliability), which seriously compromises validity and replicability requirements. Recommendation for future studies and most common errors in conducting content analysis are emphasized.