Elder abuse: a call to action

An estimated 2 million people a year are victims of elder abuse, which ranges from neglect and mistreatment to physical abuse. By the year 2020, a full 22% of the population will be aged 65 or older. This demographic explosion demands that we identify and protect those at risk. To investigate the incidence of elder abuse or neglect (EAN) and to determine clinician awareness of associated risk factors, we conducted a 1-year retrospective review of thermally injured patients aged 60 or older. Data included age, total body surface area burned, mechanism of injury, length of hospital stay, mortality, abuse or neglect risk factors, and referral to the appropriate social agency. We found that our elderly patients (n = 28) were poorly screened for EAN. While 64% to 96% of patients were screened for cognitive impairment, overall health, and financial resources, none were screened for risk factors of emotional isolation. None of the patient's caregivers, including any spouses, roommates, or guardians, were screened for risk factors of substance abuse, familial violence, dependency needs, or external stresses. With the use of available data, we were able to place 11 patients on the following levels of abuse or neglect: 1) low risk for abuse; 2) self-neglect; 3) neglect; and 4) abuse. By this scale, 7 patients (64%) were victims of self-neglect, 3 patients (27%) were victims of neglect, and 1 patient (9%) was a victim of abuse. Adult Protective Services intervened in 2 cases. Recognizing that all cases of EAN should be preventable, we cannot accept the socioeconomic impact of this entity. The 11 patients identified as victims of neglect, self-neglect, or abuse accounted for 135 hospital days and 8 fatalities. Before we can address EAN, health care personnel must be made aware of the problem and routine screening for risk factors must be implemented. The true incidence of EAN is likely underestimated because health care providers have difficulty recognizing its features. A standard assessment tool to screen for neglect or abuse should be used for each older adult admission.     

Clarifying the effects of parental substance abuse, child sexual abuse, and parental caregiving on adult adjustment.

Parental alcoholism, childhood sexual abuse, and other forms of child maltreatment are generally viewed as contributing to adult adjustment problems. The long-term effects of these various factors, however, are actually not well understood. The present study found that the largest amount of variance in 255 college students' psychological distress was explained by parental emotional abuse and neglect, with child sexual abuse, parental substance abuse, and other factors explaining additional but smaller amounts of variance in distress. This suggests that comprehensive conceptualizations of family influences on development will result in a more complete understanding of long-term adjustment outcomes than merely focusing on particular childhood risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive aspects of substance abuse treatment: A psychotherapist's primer.

Reviews research indicating that neuropsychological dysfunction and psychosocial markers are essential predictors of substance abuse treatment outcome. In particular, evidence reveals that the prefrontal cortex plays a significant role in moderating behavior patterns. Clinical research also shows that the prefrontal/frontal region of the brain is often impaired among substance abusers. Left unrecognized and untreated, problems with prefrontal executive functions (e.g., reduced attention, impulsivity, disinhibition) may prevent some substance abusers from fully benefiting from contemporary treatment approaches. A guide for substance abuse clinicians to use during the assessment and treatment of neurocognitive functions is presented. The guide outlines the development of a neurocognitive profile and discusses how deficits can be explained to patients and treated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial treatment of the addictions: Problems in specific populations.

Psychosocial treatment programs have made recent advances in understanding and intervening with the problems of addiction. This article reviews the contributions included in this special series, which encompasses several specific issues facing psychologists who conduct treatment, research, and teaching in the field of addictive behaviors. These topics include a mood management intervention for Spanish-speaking substance abusers, factors influencing crack cocaine use by African-American teens, development of culturally sensitive treatment models, patients with the dual diagnoses of mental illness and substance abuse, and recent developments regarding substance abusers and human immunodeficiency virus and acquired immunodeficiency syndrome. (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)     

What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis.

We tested special and general explanations of male adolescent sexual offending by conducting a meta-analysis of 59 independent studies comparing male adolescent sex offenders (n = 3,855) with male adolescent non-sex offenders (n = 13,393) on theoretically derived variables reflecting general delinquency risk factors (antisocial tendencies), childhood abuse, exposure to violence, family problems, interpersonal problems, sexuality, psychopathology, and cognitive abilities. The results did not support the notion that adolescent sexual offending can be parsimoniously explained as a simple manifestation of general antisocial tendencies. Adolescent sex offenders had much less extensive criminal histories, fewer antisocial peers, and fewer substance use problems compared with non-sex offenders. Special explanations suggesting a role for sexual abuse history, exposure to sexual violence, other abuse or neglect, social isolation, early exposure to sex or pornography, atypical sexual interests, anxiety, and low self-esteem received support. Explanations focusing on attitudes and beliefs about women or sexual offending, family communication problems or poor parent–child attachment, exposure to nonsexual violence, social incompetence, conventional sexual experience, and low intelligence were not supported. Ranked by effect size, the largest group difference was obtained for atypical sexual interests, followed by sexual abuse history, and, in turn, criminal history, antisocial associations, and substance abuse. We discuss the implications of the findings for theory development, as well as for the assessment, treatment, and prevention of adolescent sexual offending. (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)     

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)     

Parental substance abuse as a predictor of child maltreatment re-reports

This longitudinal study of child abuse and neglect cases closed after investigation examined the impact of parental substance abuse on family functioning and on subsequent referrals to child protective services. The findings support the hypothesis that parental substance abuse would have a negative impact on family functioning, which, in turn, would result in a higher rate of re-reports. As expected, substance abuse also had a direct impact on re-reports. It is critical that the child welfare system recognize and respond to parental substance abuse problems in these families through expanded and improved voluntary, and perhaps, mandatory services.     

Why psychologists should treat alcohol and drug problems.

Because of the prevalence of substance abuse in general clinical populations, it is important for psychologists to have knowledge and skill in this area. Psychologists also have special expertise to offer in the assessment and treatment of alcohol/drug problems. Current evidence indicates that (1) alcohol/drug problems generally obey ordinary behavioral principles and processes, (2) substance abuse frequently occurs within a broader cluster of psychological problems, (3) the treatment approaches most strongly supported by outcome research are fundamentally psychological in nature, (4) cognitive–behavioral principles are of demonstrable value in motivating change in alcohol/drug use, and (5) clinical skills and styles (e.g., empathy) commonly included in the training of psychologists are important determinants of favorable treatment out comes with substance use disorders. These factors in the context of changing health care indicate that psychologists should play an increasing role in assessing and treating addictive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing risk for completed suicide in patients with alcohol dependence: Clinicians' views of critical factors.

The assessment of potential for suicide among patients with a diagnosis of alcohol dependence has consistently been a dilemma for clinicians. Specifically, a problem for both clinicians and researchers has been determining what risk factors distinguish patients with suicidal ideation from those that are in danger of completed suicide. Identifying what clinicians who specialize in substance abuse view as critical in the assessment and treatment of suicidal patients is a first step in gaining a greater understanding of suicide risk within an alcoholic population. The views of these clinicians are presented and compared with empirical findings on the subject. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Inventory of Gambling Situations in problem and pathological gamblers seeking alcohol and drug abuse treatment.

Identifying situations in which individuals gamble may be important for developing or improving treatments, but few instruments exist for examining high-risk gambling situations. This study evaluated the factor structure of the Inventory of Gambling Situations (IGS), an instrument that assesses situations that may lead to gambling episodes. Individuals seeking alcohol and drug abuse treatment who were identified as problem or pathological gamblers (N = 283) completed the IGS, and principal component analysis revealed a 4-factor solution best fit the data; the factors represented items related to Negative Affect, Positive Affect, Gambling Cues, and Social Situations. Across the whole scale, Cronbach's alpha was 0.97, ranging from 0.83 to 0.96 for the four factors. IGS total scores correlated with other indices of gambling problems, including number of pathological gambling criteria endorsed and frequency and intensity of gambling. Race, education, and severity of psychiatric, drug, and alcohol problems were significantly predictive of some factor scores. Specifically, African Americans were more likely to gamble in response to Negative Affect situations than Caucasians, and education was inversely associated with wagering in response to Gambling Cues. Psychiatric symptoms were predictive of gambling in response to both Positive and Negative Affect situations and Gambling Cues. Severity of drug and alcohol problems were related to gambling in Social Situations. Results from this study indicate that the IGS has good psychometric properties and suggest areas in which intervention efforts may be tailored to prevent or treat gambling problems among individuals seeking substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian, Anhui Province, China

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.     

Child maltreatment history among newlywed couples: A longitudinal study of marital outcomes and mediating pathways.

Participants included 202 newlywed couples who reported retrospectively about child maltreatment experiences (sexual abuse, physical abuse, psychological abuse, and neglect) and whose marital functioning was assessed 3 times over a 2-year period. Decreased marital satisfaction at T1 was predicted by childhood physical abuse, psychological abuse, and neglect for husbands; only neglect predicted lower satisfaction for wives. Increased maltreatment of various types was also related to T1 difficulties with marital trust and partner aggression. Dyadic growth curve analyses showed that the marital difficulties reported at T1 tended to remain over the course of the study. Further, in several instances, maltreatment exerted an increasingly detrimental influence on marital functioning over time, particularly for husbands. Examination of possible mediators between maltreatment and reductions in marital satisfaction revealed pathways through decreased sexual activity, increased psychological aggression, and increased trauma symptoms reported by husbands. These findings suggest that clinicians should consider how an adult’s history of child maltreatment may contribute to current marital dysfunction. The authors also identify possible targets for intervention when working with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Examines several issues relevant to treating dual diagnosis clients who have coexisting chronic mental illness and substance abuse diagnoses. The development of various theoretical viewpoints on the relationship between substance abuse and mental illness is described along with a critical review of current research efforts. Suggestions are made for professionals to devote more attention to coordinating services and resources within mental health systems, adjusting academic training and professional development, and developing research efforts that will provide practical guidelines for clinicians. Until more definitive research is available, administrators, clinicians, and professional training programs are advised to adopt a broad clinical perspective of work with dual diagnosis clients that incorporates both mental health and substance abuse treatment modalities. (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)     

Strategies for change in substance abuse: Bridging community and clinical approaches.

Suggests that interventions for substance abuse problems in both community and clinical settings require considerations for epidemiology, natural course, and the personal processes necessary for behavior changes. In the community, public health approaches to effect positive health behavior changes are designed to use research and education, adoption of behavioral norms, and enactment of supportive legislation. Similar strategies can be used effectively in clinical settings; specifically, these may be empirically based assessments and feedback, treatment measures and environments that support sober functioning, and appropriate ground rules governing the conditions and expectations of treatment. The unique role of psychologists in the planning, implementation, and evaluation of both community and clinical interventions is described. (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)     

Administration of substance abuse treatment: Local and national developments.

Discusses increases in attention to and funding of solutions for substance abuse problems. At the federal level, more resources have gone to interdiction and supply reduction rather than to substance abuse treatment or prevention. In San Francisco, substance abuse administrators increased the focus on demand reduction by organizing local resources, creatively seeking financial resources, and gathering community support to reduce problems of drug abuse and HIV. The federal reorganization of substance abuse programs presents a unique opportunity to widen the influence of treatment and prevention approaches. The impact of the Alcohol, Drug, and Mental Health Administration Reorganization Act of 1992 and the organization of the newly created Substance Abuse and Mental Health Services Administration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of expressed and received violence across relationship types among men and women substance abusers.

This study examined expressed and received violence among men and women in substance abuse treatment. Rates of past-year partner violence (PV) did not differ by gender, although men reported markedly higher rates of nonpartner violence (NPV). Compared with PV, NPV was associated with more demographic and background factors (e.g., childhood aggression and conduct problems, family history of violence). The most consistent correlates of violence across relationship types were age, minority status, drug-related consequences, psychiatric distress, and frequency of childhood aggression. Only a few gender-specific correlated were identified; most notably, witnessing father-to-mother violence was related to received PV only for women. Identification of correlates of expressed and received violence in partner and nonpartner relationships is essential for the assessment and treatment of individuals in substance abuse treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)