A follow-up study of homeless women

This article presents an in-depth analysis of the changes observed in 25 homeless women with drug and alcohol abuse problems participating in a case management program. Participation in the program ranged from 6 to 44 months. Thirty-two percent of all participants' situations were considered to have improved, while 20% remained stable. Less improvement was noted in the situations of women followed for 3 years or more (14.3% improved, 28.6% stable). Domains showing the most improvement were housing, financial situation, and substance abuse. Deterioration was primarily attributable to physical and mental health problems. These findings could indicate that although a case management program can initially contribute to improving the living conditions of its clients, acquisitions are difficult to maintain over an extended period. Health and substance abuse play a crucial role in the deterioration process.     

Compulsory residential care: An examination of treatment improvement of individual and family functioning

The aim of the present study was to examine the treatment progress of both adolescent's and their families' functioning in a new compulsory residential treatment program. The sample consisted of 339 admitted adolescents (56.3% boys). The mean age at time of entry was 15.69 (SD = 1.30). Adolescents stayed on average 9.42 months (SD = 4.66) in a new residential treatment program. Data on adolescents' internalizing and externalizing problems were assessed using self-reports, parent reports, and group care worker reports. In addition, adolescents reported their substance use and delinquency and parents also reported family functioning and level of perceived parental stress. The findings revealed a significant decrease in adolescents' self-reported internalizing and externalizing problems, delinquency, and substance use. According to parent ratings, a significant improvement was found concerning adolescents' problem behaviors during treatment. However, according care worker ratings, adolescents showed no improvement on internalizing problems and showed an increase in externalizing problems. Concerning families, although there was no improvement in family functioning, parental stress significantly improved over time. Further research should examine whether improvements experienced during treatment are maintained after treatment.     

Recovery Processes in a Treatment Program for Women

ABSTRACT

Recovery processes of 32 women were explored in six focus groups following completion of treatment in a community based women-specific substance abuse group program. Grounded theory analysis yielded an over-arching theme of Building a House of Recovery and several sub-themes describing women's perceptions of the processes that were central to their recovery.     

Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse

The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners’ (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior (p < .001) in the area of “gender difference with substance abuse,” moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees’ knowledge about gender difference and substance abuse among pregnant patients.     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.     

Culturally Competent Substance Abuse Treatment for Asian/Pacific Islander Women

Summary

In response to the urgent need for substance abuse treatment among pregnant and postpartum Asian/Pacific Islander (A/PI) women, heath care and social service providers in a rural community of Hawaii established a culturally based, women-centered residential treatment program. The program was designed to address barriers that often prevent A/PI women from engaging and completing treatment. Treatment included Hawaiian healing practices or deep cultural therapy, provision for newborns to live with their mothers, infant health-care services, parent education, and infant-mother bonding guided by kupu-na (elders) of the community.

Analysis of twenty-one in-depth interviews revealed factors that A/ PI women participants found vital to their treatment process: having their children with them in a non-punitive, mutually respectful treatment milieu; working with consistent, competent residential staff and culturally-sensitive interdisciplinary professionals; and involvement in a range of substance abuse interventions, including cultural healing practices.

Findings underscore the importance of learning about and affirming women's lived-experiences and cultural contexts in the development of culturally competent practice models, interventions, research procedures, and policies that focus on the complex needs of chemically dependent pregnant and parenting women (Brindis & Theidon, 1997).     

Using social support for LGBTQ clients with mental illness to be out of the closet,in treatment,and in the community

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are often faced with societal challenges that can lead to mental health or substance abuse issues. They may be misunderstood or mistreated when seeking services because of a lack of training in offering culturally sensitive treatment by service providers. A program, the Rainbow Heights Club, was developed to support LGBTQ individuals with a mental health diagnosis. All of the members are in treatment for their mental health and/or substance abuse problems, but prior to the development of the program did not have a place to feel accepted, supported, or have a sense of community. Members were surveyed determine if Rainbow Heights was helpful in maintaining themselves in the community. Results indicated that 75% of members are more consistent in following prescribed treatments, keeping them free from inpatient hospitalization, and 79% reported being clean and sober since coming to the Club.     

ADHD,depression, and substance abuse risk among beginning college students

Abstract

Objective: This study examined differences in substance use, depression, and academic functioning among ADHD and non-ADHD college students. Participants: Included 1,748 students (ages 18–25; women 68.4%; Caucasian 71.3%) with and without history of ADHD. Methods: We assessed the relationship of ADHD to substance use variables, controlling for depressive symptoms and examined relationships with GPA. Results: ADHD students were more likely to have engaged in frequent alcohol use, binge drinking, regular marijuana use and to have used other drugs in the last year. They reported higher depression symptoms than non-ADHD students, although substance abuse risk remained high even when controlling for depressive symptoms. ADHD students had lower overall GPA than those without ADHD. However, this difference was no longer significant when controlling for depression and marijuana use. Conclusions: College campuses should consider programing aimed at identifying ADHD students at risk for developing substance abuse problems and emotional difficulties.     

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.     

The Relationship Between Child Sexual Abuse and Alexithymic Symptoms in a Population of Recovering Adult Substance Abusers

ABSTRACT

Recovering substance abusers with a history of childhood sexual abuse (n = 69) or no history of childhood sexual abuse (n = 68) completed the Toronto Alexithymia Scale (TAS) and a background survey assessing demographic data and (In the case of sexually abused respondents) parameters of the childhood abuse experienced. The sexually abused group scored significantly higher than the non-abused group on the TAS. Within the abused group, measured alexithymic symptomatology was found to be related positively to the duration of the abuse. Alexithymia was significantly higher when the sexual abuse first occurred after the victim had reached the age of 12, when a perpetrator of the sexual abuse was a father or stepfather, and when the abuse involved oral, vaginal, and/or anal penetration. Results were interpreted as indicating that the development of alexithymic symptoms may represent another defense victims may employ to insulate themselves from painful affect, along with dissociative symptoms and substance abuse, which have been shown previously to characterize adult survivors of child sexual abuse.     

Parenting in Females Exposed to Intimate Partner Violence and Childhood Sexual Abuse

Child sexual abuse and intimate partner violence may have a significant impact on parenting. The current study expands on existing research by examining the effects of child sexual abuse and intimate partner violence on parenting styles and parenting self-efficacy. In women from a parenting intervention program (n?=?20), child sexual abuse was related to lower parenting self-efficacy and more permissive parenting. In women at a domestic violence shelter (n?=?45), child sexual abuse was related to current sexual coercion of the partner, and authoritative parenting was related to higher parenting self-efficacy. These results indicate that having a history of child sexual abuse should be taken into consideration when dealing with mothers in violent relationships.     

Networks,Neighborhoods, and Depression: Negative Interactions by Social Support Members as a Mediator of Neighborhood Characteristics and Depressive Symptoms in a Sample of Recovering Substance Abusing Women

Abstract

Although social networks and substance abuse have been extensively studied, less is known about the role social networks play in the context of neighborhood disorder and depression. Sixty-five women were recruited from CASAWORKS for Families, a national demonstration project for substance abusing women. Average participant age was 31; half of the sample was European American, 40% African American, and 10% was other ethnicities. The average length of time in the program was about three months. We found that negative interactions partially mediated the relationship between neighborhood disorder and depression. Specifically, higher levels of neighborhood disorder predicted increased negative social exchange that in turn predicted higher levels of depressive symptoms. However, mediation analysis indicated that the strength of the relationship between neighborhood disorder and depression was attenuated when negative interactions were considered. These results support the importance of community endeavors that seek to improve basic living conditions in disadvantaged communities.     

Prevention Efforts Underlying Decreases in Binge Drinking at Institutions of Higher Education

Abstract

Analyses of 94 Fund for the Improvement of Post-Secondary Education (FIPSE)-sponsored drug-prevention programs and their outcomes used the Core Survey to identify 34 institutions where college students' binge drinking increased (M = 5.44%) and 60 institutions where it decreased (M = -4.59%) during 2 years of program operation. The authors used an inductively derived taxonomy of prevention program elements, student variables, student substance use, use-related variables, and institutional variables to compare the 2 groups of institutions. Only prevention program elements discriminated between groups. Factor analysis of discriminating elements identified 8 prevention factors that improved base-rate prediction of institutional decrease in binge drinking by 28.1%. Factor synthesis yielded a 3-construct binge-drinking prevention model based on student participation and involvement strategies, educational and informational processes, and campus regulatory and physical change efforts. This model improved base-rate prediction of decreased binge drinking by 33.2%.     

Linking Housing,Social Services and Family Well-Being

Abstract

Securing adequate housing is a key component in achieving family well-being and a decent quality of life. It is expected that as many as twenty percent of the families currently on welfare, many of whom are disproportionately female and African American, may not be employable by the end of their lifetime benefit. These families, classified as “hard-to-serve” or “hard-to-employ,” are headed by an adult who may be struggling with substance abuse, physical or mental health problems, as well as low literacy and social competency issues that inhibit achieving self-sufficiency. This author will examine existing literature on welfare-dependent households coping with substance abuse and mental health problems, and how the lack of affordable housing impacts their ability to achieve self-sufficiency. This article presents a case study     

The Role of Hawaiian Elders in Substance Abuse Treatment Among Asian/Pacific Islander Women

SUMMARY

The elders of a culture are often the designated transmitters of long-standing values and ways that define the unique essence of a people. Küpuna (elders) teachings are especially important to Native Hawaiians who have experienced the cumulative effects of cultural imperialism, which has taken their lands, discouraged use of their language and cultural ways, damaged their identity as a people and destroyed their sovereignty.

Modern day cultural imperialism, which universalizes the dominant group's experience and culture, renders minority groups as invisible while marginalizing them (Young, 1990). The chronic stress of this insidious form of oppression can translate into physical, mental health problems which lead to decreased life expectancy (McEwen, 1998; Schulkin, Gold & McEwen, 1998). Statistics on Hawaiians and other Asian/Pacific Islanders in Hawaiì indicate these groups have high rates of health problems and increasing rates of substance abuse (Office of Hawaiian Affairs, 1998).

This article describes the roles and Hawaiian practices of küpuna who acted as facilitators in the healing of Asian/Pacific Islander pregnant and postpartum women who participated in a culturally based substance abuse treatment program (CBSATP). The findings of a qualitative study, which examined the effectiveness of küpuna in these roles and their implications for practice are discussed.     

Building Trauma Informed Practice: Appreciating the Impact of Trauma in the Lives of Women with Substance Abuse and Mental Health Problems

ABSTRACT

This paper examines the lifetime interpersonal abuse experienced by a substance abuse treatment sample of 1,955 women with co-occurring disorders. Substantial rates of intimate and community-based interpersonal abuse and other life stressors are documented. Regression analysis shows that while trauma severity is significantly related to trauma distress, its impact on psychological symptom distress and drug severity is quite modest. The implementation of a trauma informed approach featuring trauma-specific treatment, service integration and consumer empowerment is described as a promising practice model for assisting women seeking help in substance abuse treatment programs.     

Characteristics of substance-abusing women on welfare. Findings from the evaluation of CASAWORKS for Families pilot demonstration

AIM: To describe and compare the characteristics and needs of substance-abusing women on Temporary Assistance to Needy Families (TANF) who enroll in a multi-service "welfare to work" program (n = 673) with two other relevant groups: (a) women from the general TANF population in the same locales (n = 157) and (b) a sample of substance-abusing women on TANF who entered standard outpatient substance-abuse treatment programs (n = 520). DESIGN: A field study with repeated measures and intent-to-treat sampling. INTERVENTION: The CASAWORKS for Families (CWF) program was delivered in 11 sites in 9 states across the country. The CWF intervention featured integration of substance-abuse treatment and employment-work readiness services, using case management to tailor needed services (parenting, victimization, mental health, physical health, legal, and basic needs). MEASUREMENT: The Addiction Severity Index, supplemented with subject-appropriate questions, was used at treatment admission. FINDINGS: The CWF sample exhibited multiple serious problems in the areas of substance abuse, victimization, medical and psychiatric health, and basic needs. The severity of their lifetime problems and their recent service needs were significantly higher in all these areas, except physical health, than were those of the general welfare sample of women in the same locales. Compared with women on TANF from standard addiction-treatment programs, CWF women exhibited similar substance-use problems but generally more severe co-occurring problems.     

A Computer-Assisted Self-Interview (CASI) Assignment in the MSW Classroom

ABSTRACT

This article reviews the research regarding computer-assisted self-interviews and describes a specific program, the Addiction Severity Index-Multimedia Version (ASI-MV), a self-administered audio assessment of substance use as well as concurrent psychosocial problems. This program was integrated into a graduate substance abuse course through a simulated exercise intended to introduce students to computer-based assessments. Students (N = 21) later evaluated the exercise and their reactions to computerized assessment at the end of the semester. Overall, students reported increased assessment skills, more comfort with the use of computers to assess clients, and willingness to incorporate computers into social work practice.     

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.