Acceptability and availability of harm-reduction interventions for drug abuse in American substance abuse treatment agencies.

[Correction Notice: An erratum for this article was reported in Vol 18(1) of Psychology of Addictive Behaviors (see record 2007-16711-001). On page 208, the first sentence in the note of Table 4 incorrectly reads as follows: "Numbers in parentheses are ns of respondents who provided an 'other' reason for this specific intervention." The sentence should read as follows: "Numbers in parentheses are ns of respondents whose agencies do not offer this intervention."] This study assessed acceptability, availability, and reasons for nonavailability of interventions designed to prevent drug use related harm by substituting pharmaceuticals for illicit drugs; facilitating detoxification; and reducing the occurrence of HIV transmission, relapse, and opiate overdose. A survey was mailed to a sample of 500 randomly selected American substance abuse treatment agencies. Of 435 potentially eligible respondents, 222 (51%) returned usable data. A subset of interventions--including harm reduction education, cue exposure therapy, needle exchange, substitute opiate prescribing, various detoxification regimes, and complementary therapies--were rated as somewhat or completely acceptable by 50% or more of the respondents. Regardless of their acceptability, listed interventions were generally not available from responding agencies; respondents typically attributed unavailability to lack of resources and inconsistency of an intervention with agency philosophy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treating substance abuse: Theory and technique.

Reviews the book, Treating substance abuse: Theory and technique edited by Frederick Rotgers, Daniel S. Keller, and Jon Morgenstern (see record 1995-99052-000). The authors initially postulate the question of "why we produced this book": They indicated that it is "a response to forces of change." Their answers are a reflection of "the increasing uneasiness among substance abuse treatment providers, the unstable, and often poor outcomes that result from mainstream treatments." Those who suffer from psychoactive substance use disorders, (PSUD's) constitute a staggering population; and many fail to benefit from treatment over a period of time. The authors organized the book into five major approaches to treatment theory and techniques. (1) 12-step, (2) Psychodynamic, (3) Marital-Family therapy, (4) Behavioral, and (5) Motivational enhancement. This book is essential for the beginning practitioner in the field of substance abuse, but it also serves as a valuable adjunct for those of us who have been in the field for a period of time. The authors were thorough, organized, and clear in their presentations. The text is well written and certainly a valued, up-to-date, adjunct to the field of substance abuse theory and treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse assessment and treatment: The current training and practice of APA Division 22 members.

Objective: To determine the preparedness of rehabilitation psychologists to work with people with disabilities with primary or secondary substance-related problems by examining their education, training, and current practice. Design: Mail survey. Participants: 76 (47 men, 29 women) Division 22 members of the American Psychological Association. Results: Although 79% of respondents reported treating individuals with alcohol and other drug issues, over half rated their training in substance abuse treatment as inadequate. Referring to self-help groups and instilling cognitive-behavioral coping skills were common treatments. Participants reported a lack of preparation in substance abuse training in their graduate program coursework, practicum, and internship. Conclusion: Continuing education and changes to curriculum requirements, with linkage to existing certification bodies, should be considered to close the gap between training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victimization and substance abuse among women: Contributing factors, interventions, and implications.

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training for substance abuse treatment among psychologists in a rural state.

Is treating substance abuse generally a part of psychological practice? Do psychologists feel prepared to deliver substance abuse treatment? Licensed psychologists in Idaho were surveyed about their training and provision of substance abuse services. Of 144 respondents (66% return rate), nearly all (89%) had contact with substance abusers, yet most rated their graduate training as inadequate preparation for practice. Rural psychologists reported seeing the highest percentage of substance abusers. Many psychologists limited their treatment to self-help group referral. Continuing education offers the most immediate solution and might be related to certification efforts. Predoctoral training of generalist psychologists, especially in rural areas, is advocated with an emphasis on integrated behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Preventing substance abuse among children and adolescents.

Reviews the book, Preventing substance abuse among children and adolescents by Jean E. Rhodes and Leonard Jason (see record 1988-98428-000). This text is a recent volume in Pergamon Press's Psychology Practitioner Guidebooks series. The volumes in the series are reflective of the current trend to "manualize" various intervention approaches to specific behavior problems. The present volume is potentially valuable in that the content and implementation of various school-based prevention programs carried out in recent years (primarily in the context of research protocols) have not been disseminated widely to psychologists through the traditional means of professional texts. When the results of these investigations are presented in scholarly journal articles and chapters, the focus is usually on research aspects (e.g., methodological issues and outcome) and not the "nuts-and-bolts" of actually developing and implementing interventions. Furthermore, the need for materials of this type appears to be increasing. Many local organizations are actively attempting to develop substance abuse prevention programs and recently there have been major increases in federal funding for these activities. Thus, the publication of the text is clearly timely. Despite the shortcomings, the present text certainly fills an existing need. For the professional interested in educating him or herself in substance abuse prevention in adolescence, it is a good place to start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of childhood psychopathology interventions on subsequent substance abuse: Policy implications, comments, and recommendations.

This article makes observations about policy implications and offers a combination of commentary and recommendation regarding the special issue on the impact of childhood psychopathology interventions on subsequent substance abuse. The authors mention forward-looking directives to expand the mandate for early intervention, to expand the research agenda for randomized clinical trials, and to develop a policy-oriented evidence base. They also note topics that require consideration and offer recommendations with regard to how to proceed. The special issue, as well as this discussion, will spark thought and action directed toward the evaluation of interventions for youths to assess the degree to which treating mental disorders has beneficial effects on the sequelae of the initial intervention target. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analytic complexities associated with group therapy in substance abuse treatment research: Problems, recommendations, and future directions.

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary results for an adaptive family treatment for drug abuse in Hispanic youth.

A small randomized trial investigated a new family-based intervention for Hispanic adolescents who met DSM–IV criteria for substance abuse disorder. The Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components. The study used an “add on” design to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components. Twenty-eight Hispanic adolescents and their families were randomized either to the experimental treatment or to traditional family therapy (TFT) and were assessed at baseline and 8-month follow-up. Despite the small sample, results revealed statistically significant time × treatment effects on both self-reported drug use (marijuana + cocaine), F(1, 22) = 10.59, p     

Manual-guided cognitive-behavioral therapy training: A promising method for disseminating empirically supported substance abuse treatments to the practice community.

A gap exists between empirically supported substance abuse treatments and those used in community settings. This study examined the feasibility of training substance abuse counselors to deliver cognitive-behavioral treatment (CBT) using treatment manuals. Participants were 29 counselors. Counselors were randomly assigned to receive CBT training or to a control group. Counselor attitudes were assessed pre- and posttraining. In addition, CBT therapy sessions were videotaped and rated for adherence and skillfulness. CBT counselors reported high levels of satisfaction with the training , intention to use CBT interventions, and confidence in their ability to do so. Ratings indicated that 90% of counselors were judged as having attained at least adequate levels of CBT skillfulness. Findings demonstrate the feasibility of using psychotherapy technology tools as a means of disseminating science-based treatments to the substance abuse practice community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics”: Correction.

Reports an error in "Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics" by Samuel A. Ball, Steve Martino, Charla Nich, Tami L. Frankforter, Deborah Van Horn, Paul Crits-Christoph, George E. Woody, Jeanne L. Obert, Christiane Farentinos and Kathleen M. Carroll (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 556-567). There are two errors in the means and standard deviations reported in Table 1 (p. 561). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the motivational enhancement therapy (MET) column is not 0.21 (SD = 0.35) as reported, but rather 0.28 (SD = 0.40). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the counseling as usual (CAU) column is not 0.28 (SD = 0.40) as reported, but rather 0.31 (SD = 0.41). These corrections do not change any of the values reported for the d, F, or p statistics in this table. (The following abstract of the original article appeared in record 2007-11558-005.) The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome evaluation findings of a Hawaiian culture-based adolescent substance abuse treatment program.

As part of efforts to identify effective culturally appropriate treatment for Hawaiian and Asian and Pacific Islander adolescents with substance abuse and co-occurring disorders, this evaluation research sought to assess the efficacy of the I Mua Mau Ohana program. This long-term residential program combined culturally based experiential learning/therapy, education, spirituality, counseling, and family involvement. Participants were interviewed at intake and followed up at 3, 6, and 12 months using the Government Performance and Results Act (GPRA) Tool and the Global Appraisal of Individual Needs (GAIN) instruments. Results showed long-term improvement in substance use and related problems, decreased criminal justice involvement, and improved mental health and social functioning, while showing positive trends in education and employment. However, unexpected findings were revealed in family functioning. Although promising, further research is needed to substantiate the program's effectiveness and possibility of being considered an "evidence-based program." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of pathological gamblers with and without substance abuse treatment histories.

This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use and abuse among children and teenagers.

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Prospective relations between bulimic pathology, depression, and substance abuse: Unpacking comorbidity in adolescent girls": Correction to Stice et al. (2004).

Reports an error in "Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls" by Eric Stice, Emily M. Burton and Heather Shaw (Journal of Consulting and Clinical Psychology, 2004[Feb], Vol 72[1], 62-71). The findings of Leon, Fulkerson, Perry, Keel, and Klump ("Three to four year prospective evaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys," Journal of Youth and Adolescence, 1999, Vol. 28, No. 2, pp. 181-196), cited on page 62, were incorrectly reported. Leon et al. (1999) found that the latent variable of negative affect/attitudes determined at study entrance significantly correlated with final year eating disorder risk score when conducted with the full sample and when removing Time 1 high eating disorder risk subjects. This latent variable consisted of the GBI Depression, MPQ Negative Emotionality, EDI Ineffectiveness, EDI Interoceptive Awareness, and EDI Body Dissatisfaction scales. A subsequent univariate analysis of Time 1 Negative Emotionality scale score on Time 3 eating disorder risk, adjusting for initial eating disorder risk score, showed a nonsignificant effect size (Stice, E. [2002]. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848). (The following abstract of the original article appeared in record 2004-10364-006.) To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family therapy, substance abuse, and adolescents: Moving from isolated cultures to related components.

Reviews the books The family context of adolescent drug abuse, by R. H. Coombs (1988); Practical approaches in treating adolescent chemical dependency: A guide to clinical intervention and assessment, by P. B. Henry (1989); Consequences of adolescent drug abuse, by M. D. Newcomb and P. M. Bentler (1989); Adolescent drug abuse: Analyses of treatment research, by E. R. Rahdert and J. Grabowski (1988); Breakthroughs in family therapy with drug-abusing and problem youth, by J. I. Szapocznik and W. M. Kurtines (see record 1989-98115-000); and Family therapy approaches with adolescent substance abusers, by T. C. Todd and M. Selekman (in press). This spate of books includes representatives of three "cultures" interested in family therapy with substance-abusing adolescents: developmentally oriented research on substance abuse (Combs; Newcomb & Bentler; Rahdert & Grabowski), family therapy applied to substance abuse (Szapocznik et al.; Todd & Selekman), and the addiction/self-help approach (Henry). The coincidental publication of this large number of writings on families and adolescent substance abuse is encouraging. It suggests that all three cultures are vital and contributing. There are important well-written contributions in volumes from each culture. The disjointed status of the field may be a prelude to a significant integrative shift from the isolated cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of childhood abuse on treatment outcomes of substance users.

The impact of childhood emotional, physical, and sexual abuse on treatment outcomes for substance users is not well understood. This study assessed the prevalence and impact of these kinds of maltreatment among a sample of American Indian, Mexican American, and Anglo American female and male substance users in residential treatment programs. Compared to men, women in all ethnic groups reported more abuse. Compared to a no-abuse group, respondents who reported abuse had lower self-esteem scores and higher depression scores at treatment entry and lower self-esteem scores at treatment completion. Although childhood abuse was not related to treatment outcome, gender and ethnicity were. Treatment implications for providers of drug abuse services and services to victims of violence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples- versus individual-based therapy for alcohol and drug abuse: Effects on children's psychosocial functioning.

The study compared the effect of couples-based vs individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (1) behavioral couples therapy (BCT), (2) individual-based treatment (IBT) or (3) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol (N=71) and drug-abusing men (N=64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-mo follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating and overcoming barriers to taking abuse histories.

Psychologists are frequently faced with issues of whether, when, and how to ask clients if they have been abused. Despite the demonstrated relationship between child abuse and adult psychopathology, researchers report that many clinicians still do not routinely inquire about abuse. A questionnaire completed by 63 psychologists and 51 psychiatrists in New Zealand revealed that factors related to reluctance to ask about abuse include the following: more pressing issues, fear of disturbing clients, a diagnosis of schizophrenia, biological etiology beliefs, and fear of inducing "false memories." Significant differences were found between psychologists and psychiatrists on some of these factors. Practice guidelines for enhancing the frequency and efficacy of abuse inquiry are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The substance abuse problems: New issues for the 1980’s (vol. 2).

Reviews the book, The substance abuse problems: New issues for the 1980’s (vol. 2) by Sidney Cohen (1984). In this second volume of writings on substance abuse problems, Sidney Cohen offers the reader a glimpse into the many substance abuse issues facing society, treatment personnel, and the individual. The 54 chapters in this book, divided almost equally among the sections, offer brief and insightful vignettes on a variety of substance abuse issues. Overall, this book provides information and intellectual stimulation on a broad range of topics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)