Adolescents' perceptions of substance abuse prevention strategies

As part of a 3-year evaluation of substance abuse prevention strategies (Harding, Safer, Kavanagh, Bania, Carty, Lisnov, & Wysockey, 1996), this study examined the perceptions of 719 sixth- through ninth-grade Chicago public school students. School-based programs were rated as significantly more effective on six prevention objectives than were television ads, testimonials by famous people, billboards, and print ads displayed on public transportation. Students perceived the two school-based programs, Project DARE (a national program conducted through local police departments) and Captain Clean (an intense live theater program coordinated with student participation), as being equally effective overall, although the interactive theater program was rated as significantly better at encouraging students to talk about their feelings concerning substance abuse issues and at relating to the students' ethnic/racial backgrounds. When students were categorized according to frequency of alcohol use, nonusers, infrequent users, and frequent users differed significantly in their ratings of the school-based programs.     

Computer-assisted strategies for substance abuse prevention: Opportunities and barriers.

This article presents an analysis of the potential role that computer-assisted strategies could play in substance abuse prevention efforts in the future. Four primary areas are addressed. First, substance abuse prevention is discussed within the context of adolescent development. Second, computer-assisted instruction (CAI) is defined in terms of the opportunities it represents for substance abuse prevention. Third, a variety of barriers are described that must be addressed if the potential of CAI for enhancing substance abuse prevention efforts is ever to be realized. Finally, recommendations are made for coordinating research and development efforts, now and in the future, so that the potential of new technology for improving substance abuse prevention efforts will be adequately evaluated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care and technical efficiency in outpatient substance abuse treatment units

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.     

Variation in access to outpatient substance abuse treatment: organizational factors and conceptual issues

We propose to use a general mixing distribution in modeling the heterogeneity of the fecundability of couples. We introduce a sequence of parameters called canonical moments, which is in one to one correspondence with the moments, to characterize the mixing distribution. By using the bootstrap method, we can estimate the standard errors of our estimates. Our method modifies the usual moment estimates so that the resulting mixing distribution is always supported on [0, 1]. Moreover, the downward bias of the moment estimate of the number of support points would be reduced. Our approach can be used for censored data. The application of our technique in finding the sterile subpopulation is also discussed. The theory is illustrated with several data examples and simulations.     

Multimodal treatment package for substance abuse treatment programs.

Describes a multimodal treatment design for a short-term, residential, hospital-based program for drug abusers. Each patient is expected to attend all program services with the intent that one or several will provide the corrective emotional experience facilitating change. Services included medical care, individual counseling/psychotherapy, group counseling, health education seminars, milieu/recreational therapy, Narcotics Anonymous meetings, linkage with aftercare components, and ancillary services (vocational rehabilitation, court liaison, and 90-day follow-up). Psychology interns and students are utilized. Results of internal follow-up show that 40% of Ss admitted over 3 yrs stated they were drug-free at 90 days and 1.5 yrs. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing substance abuse treatment engagement in incarcerated adolescents.

The purpose of this study was to determine whether motivational interviewing (MI), compared with an attention control condition (relaxation training [RT]) enhances substance abuse treatment engagement in incarcerated adolescents. At the start of incarceration, adolescents were randomly assigned to individually administered MI or RT. Subsequently, therapists and adolescents (N = 130) rated degree of adolescent participation in the facility's standard care group-based treatments targeting crime and substance use. All adolescents received the facility standard care treatment after their individual MI or RT session. MI statistically significantly mitigated negative substance abuse treatment engagement. Other indicators of treatment engagement were in the expected direction; however, effect sizes were small and nonsignificant. These findings are significant, given concerns regarding the deleterious effects of treating delinquent adolescents in groups and the potential for adolescents to reinforce each other's negative behavior, which in turn may lead to escalated substance use and other delinquent behaviors after release. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS prevention strategies for ethnic-racial minority substance users.

African Americans and Latinos account for 29% and 16%, respectively, of persons with AIDS, yet collectively represent less than 20% of the US population. Although rates of HIV transmission have slowed among gay Anglo men, there is less evidence to indicate that patterns of transmission have been altered among Black and Hispanic drug users. Risk factors for HIV transmission among drug users are described, and sociocultural aspects of these risk behaviors are discussed. The advantages and disadvantages of various approaches to reducing the spread of HIV among drug users and their associates are considered, particularly as they apply to ethnic–racial minorities. Brief examples are provided of how existing theories of behavior change can be applied in Hispanic and African-American communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse prevention program for treatment of obsessive-compulsive disorder.

18 participants with obsessive-compulsive disorder received 3 wks of intensive treatment by exposure and response prevention, which were followed by either a relapse prevention (RP) program or associative therapy (AT; an attention-control program). Independent evaluators conducted assessments of obsessive-compulsive symptoms, anxiety, and depression, before and after intensive behavior therapy, after the week of intensive RP or AT and at a 6-mo follow-up. Results indicated that the RP program was effective in preventing relapse: Both treatment groups improved immediately after the intensive treatment, but the RP group remained improved at follow-up, whereas the AT group showed some return of symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the MMPI-2 to detect substance abuse in an outpatient mental health setting.

This study examined the utility of the MMPI–2 in detecting substance-abuse problems in an outpatient mental health setting. Specifically, the utility of the Addiction Acknowledgment Scale (AAS; N. C. Weed, J. N. Butcher, T. McKenna, & Y. S. Ben-Porath, 1992), the Addiction Potential Scale (APS; N. C. Weed et al., 1992), and the MacAndrew Alcoholism Scale—Revised (MAC—R; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegan, & B. Kaemmer, 1989) in the prediction of substance abuse was evaluated. In addition, the incremental validity of the AAS and the APS in comparison to the MAC—R scale was evaluated. The sample consisted of 500 women and 333 men from a large community mental health center in Northeastern Ohio. Results indicated that the MAC—R scale, the AAS, and the APS were related to interviewer ratings of substance abuse in this outpatient treatment setting. Specifically, the results pointed to the superiority of AAS over APS in substance-abuse identification and the significant contribution of AAS to the information available from the MAC—R scale alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sophomore medical students as substance abuse prevention teachers

Medical education should emphasize health promotion and disease prevention and should offer educational experiences that require students to be active, independent learners and problem solvers. The purpose of this project was to enable sophomore medical students to apply their own innovative methods of instruction to a program for adolescent substance abuse prevention. Medical students developed and taught a school-based prevention program to 36 middle school students who represented a variety of socioeconomic backgrounds and abilities. They used demonstrations, role-playing, and drug abuse prevention commercials created by the adolescents for their peers. Medical students kept weekly journals to record their thoughts about and activities used in teaching substance abuse prevention to adolescents. The journals revealed an increased understanding of adolescent thinking and behavior and an increased confidence in teaching substance abuse prevention to adolescents.     

Cognitive–behavioral treatment for depression: Relapse prevention.

This study presents 2-year follow-up data of a comparison between complete cognitive–behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive–behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group treatment for substance abuse in schizophrenia

OBJECTIVES: A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery. METHOD: Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months. RESULTS: At the follow-up assessment, 8 subjects (44%) were abstinent. CONCLUSIONS: This type of treatment appears to be effective for reducing substance abuse in this population.     

Handwriting in assessing treatment for substance abuse

Analysis of Mathematics and Language Arts scores for 11,438 fourth- and 8,972 seventh-grade students in compensatory education programs on the performance assessments for the Iowa Test of Basic Skills indicated the students performed poorly, particularly in mathematics.     

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of inpatient substance abuse treatment

OBJECTIVE: To identify the characteristics of cost-effective inpatient substance abuse treatment programs. DATA SOURCES/STUDY SETTING: A survey of program directors and cost and discharge data for study of 38,863 patients treated in 98 Veterans Affairs treatment programs. STUDY DESIGN: We used random-effects regression to find the effect of program and patient characteristics on cost and readmission rates. A treatment was defined as successful if the patient was not readmitted for psychiatric or substance abuse care within six months. PRINCIPAL FINDINGS: Treatment was more expensive when the program was smaller, or had a longer intended length of stay (LOS) or a higher ratio of staff to patients. Readmission was less likely when the program was smaller or had longer intended LOS; the staff to patient ratio had no significant effect. The average treatment cost $3,754 with a 75.0% chance of being effective, a cost-effectiveness ratio of $5,007 per treatment success. A 28-day treatment program was $860 more costly and 3.3% more effective than a 21-day program, an incremental cost-effectiveness of $26,450 per treatment success. Patient characteristics did not affect readmission rates in the same way they affected costs. Patients with a history of prior treatment were more likely to be readmitted but their subsequent stays were less costly. CONCLUSIONS: A 21-day limit on intended LOS would increase the cost-effectiveness of treatment programs. Consolidation of small programs would reduce cost, but would also reduce access to treatment. Reduction of the staff to patient ratio would increase the cost-effectiveness of the most intensively staffed programs.     

Future trends in substance abuse.

Argues that as illicit drugs with increased abuse liability come into vogue, a broader segment of the population will be at risk for becoming addicted. Consequently, the attendant effects of abuse, including acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, will grow proportionately. Health care providers will need to become more astute and creative to provide effective rehabilitation for addicted individuals. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary trends in substance abuse.

A clinical consensus has evolved as to the specific areas to be addressed in a comprehensive clinical interview with substance abusers. Knowledge of specific psychopathology and associated comorbidities among addicts will refine this assessment. There are several reasonably reliable and valid objective psychological tests that can be used to provide supplementary information for diagnostic and treatment decisions. Etiological theories, including the disease concept, family systems theory, psychodynamic formulations, and behavioral approaches, have generated treatment interventions of clinical utility. Recent research suggests that psychotherapy, combined with traditional approaches, results in increased therapeutic benefits that were heretofore considered unlikely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)