Baby Boomer’s Substance Abuse and Researcher Indifference

The current older adult population is more likely to need and seek treatment for alcohol and drug abuse than previous cohorts of older adults, which necessitates the need for age-appropriate substance use treatment. Building on previous research that examined the lack of attention on substance use among older adults, this study examines articles addressing substance use disorders among older adults in leading gerontological and substance abuse journals and federal funding between 2011 and 2017. Publications were identified from ten leading gerontological and ten leading substance abuse journals using Medical Subject Heading (MeSH) terms. During this time-period, there were 68 and 44 articles published in gerontology and substance abuse journals respectively related to substance use disorders in older adults. Most (59.8%) addressed alcohol abuse and 7% involved intervention studies. In the 7-year period, there were 13 federal grants. A paucity of published or funded work exists in this area despite growing misuse and treatment seeking among older adults with substance use disorders. Effectively addressing substance abuse in older adults will require a coordinated effort between researchers and practitioners to establish and implement best practices for practitioners to rely on when working with substance abusing older adults.     

The only child 1 : A study of one hundred only children living at home with both parents,referred, to a child guidance clinic

This study examined differences in attachment typology, early histories of unresolved trauma and loss, and intergenerational patterns of substance abuse in a high-risk sample of African American, White, Mexican American, and Native American mothers involved with the child welfare system. The Adult Attachment Interview and Chemical Dependency Assessment Profile were used to collect data from 24 mothers who were in-patients at a substance abuse treatment center. Consistent with attachment theory mothers classified as secure/autonomous (46%) had positive early attachment relationships, although several mothers in this group had histories of unresolved trauma and loss. The insecure classification included 21% dismissing and 33% preoccupied. The unresolved classification included mothers from all racial/ethnic groups who had histories of trauma and loss. Results indicated prevalence of substance abuse in all racial/ethnic groups as well as patterns of intergenerational substance abuse in the aforementioned attachment classifications.     

Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

Rising to the Challenge of Treating OEF/OIF Veterans with Co‐occurring PTSD and Substance Abuse

This article reviews data on the relatively high incidence of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans reporting mental health and substance abuse problems, and some perceived barriers that may account for low rates of their engaging in treatment. Treatment outcomes for veterans with co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are generally poorer than for those with PTSD or substance abuse alone. Several evidence‐based individual therapy approaches offered by VA Medical Centers are described along with how they conceptualize the relationship of substance abuse to PTSD. Problems with sequential treatment for persons with PTSD and substance abuse in specialized programs are discussed, including notably the practice of requiring veterans to be completely drug and alcohol free for a month or longer prior to entering PTSD treatment. Several integrated treatment programs are described along with a brief summary of evidence supporting their effectiveness. Some recent policy changes from the Department of Veterans Affairs that bode well for the future of PTSD/SUD treatment are described. Differences between younger and older veterans were cited along with their implications for treatment. Recommendations regarding how to better engage and retain OEF/OIF veterans with PTSD/SUD in treatment are presented together with examples of their implementation. The author concludes that to rise to the challenge of treating this difficult population it is necessary to adapt treatment to meet their needs rather than requiring them to adapt to therapies that may not be a good fit.     

An exploratory study of substance abuse among Latino older adults

Substance abuse among older adults is on the rise. Of particular concern is the increase in alcohol and drug use predicted among Latino elders, expected to result from an upsurge in the Latino population and concurrent growth in the number of older adults. Providing effective treatment for this group will require age-specific, culturally competent interventions. However, few studies have focused on geriatric substance abuse among Latinos. This study aims to lay the groundwork for further research by examining perceptions of the problem among treatment providers and researchers in aging and substance abuse. Implications for social work research and practice are addressed.     

Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Accumulated knowledge and experience in the treatment of substance abuse

This article summarizes the accumulated knowledge and experience of people engaged in the institutional treatment of substance abusers in Sweden. The views of the respondents were obtained by means of the Delphi method, which entails compiling several rounds of written dialogue between researcher and respondents. The study had three rounds. The arguments of experienced staff concerning the professionalization of substance abuse treatment are presented, with the main emphasis being on general trends. At the time of the study, the main dividing line, according to the respondents, lies between the 12-step program of Alcoholics Anonymous and psychotherapeutic programs. The majority of the respondents believe that knowledge of psychotherapy provides a better understanding of the treatment process. This finding is particularly evident among the staff of drug treatment institutions, two-thirds of whom are of the opinion that acquiring proficiency in psychotherapy is a way to professionalize treatment. An important aspect is the quality of the relationship between therapist and client. The majority of the respondents believe that it is possible to define the criteria for good treatment.     

Supportive Housing for Addicted,Incarcerated Homeless Adults

ABSTRACT

Homeless populations often suffer from mental illness, substance abuse, and criminality. Interventions, such as supportive housing, can have positive impacts, although benefits can be limited. This study examined outcomes for clients (N = 102) of a new supportive housing intervention. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes. Future research is necessary to understand the relationship between client characteristics and outcomes.     

An inquiry into the significance of nail‐biting 1

Substance abuse is connected to considerable suffering and symptoms. Neuropsychological assessment supports understanding of the distress and the symptoms of the individual client and therefore is increasingly requested in substance abuse treatment. Substances, however, influence neuropsychological functions and emotional states. Therefore, assessment often needs to be postponed. Conducted at a suitable point of time, with respect to abstinence and treatment planning, assessment might provide understanding of the needs and possibilities of the client. This work contributes with suggestions on how neuropsychological assessment might be conducted in substance abuse treatment. Because the effects of substances are considerable, an overview of the effects of varying substances on neuropsychological functioning is presented. It is also suggested that assessment should be understood as a collaborative process that should support clients’ understanding of themselves.     

An Exploratory Study of Substance Abuse Among Latino Older Adults

ABSTRACT

Substance abuse among older adults is on the rise. Of particular concern is the increase in alcohol and drug use predicted among Latino elders, expected to result from an upsurge in the Latino population and concurrent growth in the number of older adults. Providing effective treatment for this group will require age-specific, culturally competent interventions. However, few studies have focused on geriatric substance abuse among Latinos. This study aims to lay the groundwork for further research by examining perceptions of the problem among treatment providers and researchers in aging and substance abuse. Implications for social work research and practice are addressed.     

Ownership differences in the provision of outpatient substance abuse services

The authors examine the assumption of the 1980s that the provision and costs of substance abuse services, among others, could best be met by expanding programs in the private sector. The study presents a comparison of public and private substance abuse services, based on data drawn from a national sample of outpatient units, and develops a profile of treatment and financing within three auspice (ownership) categories--private nonprofit, private for-profit, and public. An input-throughput-output framework was used to assess the public-private differences within a wide range of organizational characteristics.     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.     

Implementing a Gero-Infused Curriculum in Advanced-Level MSW Courses in Health,Mental Health and Substance Abuse: An Evaluation

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.     

Social support available for substance‐dependent mothers from families with parental substance abuse

Substance‐dependent mothers, who have grown up with parental substance abuse, struggle during and after treatment to abstain from substances while trying to process traumatic experiences and integrate their family into society. The aim of this study was to explore the social support available for these mothers to help them stay abstinent and create safe family environments for themselves and their children. Using purposeful sampling, we approached nine mothers admitted for 1 year to a family ward at a substance abuse clinic and their significant others. Through in‐depth, qualitative interviews, first with the mothers, later with their significant others, we investigated characteristics of the available social support. The findings indicated that the significant others had limited resources and were themselves exposed to adverse and cumulative psychosocial and socioeconomic risk factors. Their relationships with the mothers were, nevertheless, close, consistent and reliable. Supporting the existing social network should be an integrated part of the work of family welfare services aiming to help substance‐dependent mothers from families with parental substance abuse to rehabilitate and to integrate successfully into local communities.     

Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Supervisor ideology and organizational response: HIV/AIDS prevention in outpatient substance abuse treatment units

Distinct practice ideologies or ideologies of care are deemed to influence greatly the selection of intervention methods and the mix of services adopted by the providers. Examined here is the relation between clinical supervisor ideology and variation among human service organizations in their provision of HIV/AIDS prevention services. Data were drawn from a 1990 national, representative sample of outpatient substance abuse treatment (OSAT) units. The study affirms that ideology is central to both means and ends in HSOs, helping to define the organization's mission and goals, and establishing guidelines for practice and procedures. Future research on the relationship between ideology and HIV/AIDS education can benefit from efforts to develop alternative strategies for measuring ideologies of care among both managers and staff in substance abuse settings.     

CHILD PROTECTION: PARADOXES OF PUBLICITY,POLICY AND PRACTICE

Recent media coverage of child abuse in Victoria is critically analysed. Parallels are drawn between the substance and style of newspaper coverage of child abuse cases in the late nineteenth century ‘first wave’ of the child rescue movement and that in the late twentieth century ‘second wave’ of the child rescue movement. The twin themes of vengeance and voyeurism are clearly evident in both periods. The classic late nineteenth century concepts of Freud and Durkheim are drawn upon to illuminate the psychological and sociological sources of these themes. The current Victorian child protection system is used as a case study to explore the paradoxes for policy and practice which arise in part from the publicisation and associated politicisation of child abuse. These paradoxes include the redirection of resources from prevention and treatment to investigation services.     

Childhood maltreatment among Norwegian drug abusers in treatment

This article reports on the investigation of the correlation between the European Addiction Severity Index (EuropASI) and the Childhood Trauma Questionnaire (CTQ) among 102 Norwegian drug abusers admitted to treatment. The aim of the study is to explore how different types and levels of childhood trauma and social and psychiatric factors, medical situation and experienced family history are interrelated. The study addresses three main questions: 1) What is the prevalence of different kinds of childhood trauma among drug abusers in treatment? 2) Does type or level of maltreatment in childhood predict specific substance abuse problems as adults and/or specific social, psychiatric and medical problems as adults? 3) Do substance abuse problems and mental health problems in the primary family predict different types and levels of childhood maltreatment? Twenty‐five per cent of the total sample was included in the high‐level trauma group and 54% in the intermediate‐level group. Females had significantly higher scores than males in all types of childhood trauma. The strongest correlations were found between childhood trauma and lifetime psychiatric problems and psychiatric status during the last 30 days before admission for treatment. More research, and especially prospective studies, is needed to clarify the importance of parents' substance abuse and psychiatric problems in childhood/adolescent compared with trauma in the client's childhood and the client's current psychiatric status.     

The Substance Abuse Treatment Self-Efficacy Scale

Abstract

Evaluating substance abuse services in ordinary treatment environments requires the use of instruments to measure various dimensions of the intervention process in order to link those processes with client outcomes. This paper reports on the further validation of the Alcohol and other Drug Self-Efficacy Scale (AODSES), designed to measure social workers' perceived self-efficacy with regard to the implementation of substance abuse services. In the first validation study, Kranz (2003) employed exploratory factor analysis to reduce the original 98 items to six factors (43 items) that accounted for 76% of the variance, and demonstrated excellent internal consistency. The current study is a reanalysis of the same data using confirmatory factor analysis, a more stringent test of construct validity. Results were strongly supportive of a 5-factor model with seven of eight indices showing excellent fit of the observed data to the model, and high internal consistency for all subscales. Potential practical applications for clinical evaluation in substance abuse environments and limitations of the study are discussed.