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)     

Correlates of stages of change for substance abuse among psychiatric outpatients.

Brief algorithms are used to determine stage of change; however, psychometric support in substance users other than smokers is minimal. The authors examined the reliability and validity of a self-report algorithm in a sample of 84 persons with both psychiatric and substance use disorders. A 1-week retest resulted in 75% of persons being reassigned to the same stage. Compared with precontemplators, participants in the preparation stage reported higher problem recognition, steps taken toward change, cons of using, and benefits of quitting. The pros of using did not differ across stages. The action stage was marked by less frequent substance use and lower perceived costs of quitting. These results support the reliability and validity of staging algorithms in patients with comorbid disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on adult survivors of childhood sexual abuse.

Sexual abuse researchers need to use more complex models of abuse and more sophisticated research designs for studying long-term effects and for evaluating treatment programs. The articles that comprise this special section integrate the study of sexual abuse with perspectives on adult victimization, developmental psychopathology, and attachment theory and also offer specific methodological suggestions for improving research on long-term effects and therapy with the abuse survivor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls.

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N?=?496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size. (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)     

Introduction to the special issue on personality and psychopathology.

The goal of this Special Issue is to enhance this reintegration of normal-range personality and abnormal psychology, 30 years after they were split apart. The articles in the Issue examine the topic from a variety of approaches, but each of them addresses the central problem of how normal-range individual differences are related to abnormal behavior. Seven of these articles examine personality in relation to specific types of psychopathology: personality disorders, alcoholism and antisocial personality, mood and anxiety disorders, dissociative disorders, somatoform disorders, eating disorders, and schizophrenia. It is impossible to summarize the wealth of findings that are contained in these articles; each deserves to be examined carefully. However, we can note some general conclusions here. First, it is abundantly clear that personality traits and psychopathological disorders are, in fact, empirically related. Second, although the observed relations tend to be orderly and psychologically meaningful, they also are relatively nonspecific. That is, one does not see a one-to-one correspondence between a given trait and a specific disorder; rather, each of the extensively studied traits is associated with several diagnostic categories. Third, due to a paucity of relevant data, the nature of these observed relations is still largely unclear. Several different explanatory models have been proposed, and each has received at least suggestive support in the literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on attachment and psychopathology: Part 1.

Research derived from attachment theory has generated a rich and rapidly growing body of findings on the importance of early caregiving experience in the development of psychopathology and in the promotion of adaptation. This special section presents research and scholarship on the relation of attachment status to psychiatric classifications and diagnosis in child, adolescent, and adult populations. Included as well are articles that explore the cross-generational transmission of attachment patterns and investigate the relation of attachment status to response to psychotherapy. These articles are representative of the notable impact that attachment theory and research are making in the field of developmental psychopathology. The special section is intended to help bridge the gap between thinking about attachment and clinical research and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of the evidence base for treatment of childhood psychopathology: Internalizing disorders.

This article reviews the empirical literature on psychosocial, psychopharmacological, and adjunctive treatments for children between the ages of 6 and 12 with internalizing disorders. The aim of this review was to identify interventions that have potential to prevent substance use disorders in adolescence by treating internalizing disorders in childhood. Results suggest that a variety of behavioral, cognitive-behavioral, and pharmacological interventions are effective in reducing symptoms of childhood depression, phobias, and anxiety disorders. None of the studies reviewed included substance abuse outcomes. Thus, little can be said about the relationship between early treatment and the prevention of later substance use. The importance of evaluating the generalizability of research-supported interventions to community settings is highlighted and recommendations for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Problems of alcohol and drug abuse among children and adolescents are drawing unprecedented attention from researchers, policymakers, and the lay public. Clearly warranted, that attention focuses on vexing questions about the nature and prevention of substance abuse among youth. The most common questions include these: Are substance rates among youth on the rise? Why do young people use alcohol and drugs? How can we prevent substance abuse among youth? What works in the fight against alcohol and drug abuse? Do we need special programs to prevent substance abuse among youths from different backgrounds? Where should we put our resources to exert a maximum impact on the demand for drugs and alcohol among youth? By answering these and other questions, the 10 articles in this special series lay a foundation for future practice, policy, and research on alcohol and drug abuse among youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Eating disorders represent a major health problem in the United States. This special series cannot hope to answer definitively the many questions about eating problems facing the scientific and health care communities. However, it is the intention of this series to clarify some of the issues facing clinicians and scientists. In accomplishing this task, we have tried first to apprise the reader of the scope and significance of the problem. The first article addresses this broad task and pays special attention to anorexia and bulimia. This article provides a suitable overview for the more specific articles that follow. The remaining articles in the series provide the reader with a view of the most persuasive and innovative views of diagnosis, treatment, and prevention. Their topics range from normal eating to obesity, and they review primary preventions and provide information on the biological precursors and consequences of eating disturbances as well as on cultural-familial contributors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient interventions for adolescent substance abuse: A quality of evidence review.

Previous reviews of outpatient interventions for adolescent substance abuse have been limited in the extent to which they considered the methodological quality of individual studies. The authors assessed 31 randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality. A quality of evidence score was calculated for each study and used to compare the evidence in support of different outpatient interventions. Across studies, frequently reported methodological attributes included presence of an active comparison condition, reporting of baseline data, use of treatment manuals, and verification of self-reported outcomes. Infrequently reported attributes included power and determination of sample size, techniques to randomize participants to condition, specification of hypotheses and primary outcomes, use of treatment adherence ratings, blind assessment, and inclusion of dropouts in the analysis. Treatment models with evidence of immediate superiority in 2 or more methodologically stronger studies included ecological family therapy, brief motivational interventions, and cognitive-behavioral therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classes of substance abuse relapse situations: A comparison of adolescents and adults.

Research in the process of relapse has uncovered important developmental differences in the situations that make adolescents and adults most vulnerable to relapse after substance abuse treatment. This study takes a developmental, person-centered approach to relapse by examining the latent class structure of relapse precursors in adolescents and adults. Adults (N = 160) and adolescents (N = 188) in substance abuse and psychiatric treatment were followed up to 18 months after discharge to gather detailed information about their first relapse after treatment. Both adolescents and adults exhibited a 2-class structure of relapse precursors. Adult classes were labeled social and urges situations (primary precursors: social pressure and urges; 67%) and negative and urges situations (primary precursors: negative affect and urges; 33%), while teen classes were labeled social and positive situations (primary precursors: enhancing a positive emotional state and social pressure; 69%) and complex situations (primary precursors: negative affect, negative interpersonal situations, social pressure, and urges; 31%). Findings are discussed in relation to developmental and clinical considerations in treating clients with substance use disorders and comorbid psychopathology. (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)     

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)     

Introduction to the special section on clinical adolescent psychology: Developmental psychopathology and treatment.

This article addresses implications of the interface between developmental psychology and clinical psychology for research on adolescence and describes the importance of considering developmental level when designing treatments for adolescent patients. In addition, the articles that constitute the special section, "Clinical Adolescent Psychology: Developmental Psychopathology and Treatment," are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population.

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed. (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)     

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)     

Understanding attitudes toward use of medication in substance abuse treatment: A multilevel approach.

Individual and organizational variables influence attitudes toward use of naltrexone, methadone, and buprenorphine for the treatment of alcohol and drug disorders. Previous research has not considered both sets of influences simultaneously. Hierarchical linear modeling tested the contribution of individual and organizational variables with data from the National Drug Abuse Treatment Clinical Trials Network treatment unit and workforce surveys (n = 2,269 staff nested within 247 treatment units). Individual-level variables consistently had more influence on attitudes, but a unique blend of variables existed for each medication. One predictor, support for psychiatric medications, influenced attitudes across all medications. Staff attitudes toward addiction medications varied significantly between treatment units. Implications for increasing the appropriate use of addiction medications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)