Review of Dual diagnosis: Counseling the mentally ill substance abuser.

Reviews the book, Dual diagnosis: Counseling the mentally ill substance abuser by Katie Evans and J. Michael Sullivan (1991). This book is intended to be a practical guide for counseling a particularly difficult group of clients. The authors hope that it will be read by a wide audience, including psychologists, psychiatrists, social workers, chemical dependency counselors, family and marital therapists, child protective service workers, court examiners, school counselors, and others. The 10 chapters cover a variety of topics, touching on several aspects of working with "dual diagnosis" clients (i.e., people who present for treatment with both substance use and major psychiatric disorders). The authors have attempted to cover a complicated and extensive set of problems and a variety of issues and approaches in this short book. Many readers will appreciate the practical and straightforward suggestions for assessing and treating the dual diagnosis client. However, along with the straightforward approach comes simplification of some difficult problems. For example, the chapter on identifying chemical dependency includes no discussion of assessing patterns of drug or alcohol use or the antecedents or consequences that may be peculiar to people with a particular disorder. Dual diagnosis clients seem to use mental health and substance abuse services at a disproportionately high rate, yet they also seem the most likely to "fall through the cracks." Use of some of the treatment suggestions discussed in this book may help remedy the situation and could be useful for someone not yet familiar with dual diagnosis clients. However, in the end, one wishes that the book was more focused and detailed. Instead, probably because of the large scope of intended readers and clients, it becomes more of an outline and loses some of its practical significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Madness and government: Who cares for the mentally ill?.

Reviews the book, Madness and government: Who cares for the mentally ill? by Emory A. Foley and Steven S. Sharfstein (1983). This book is a fascinating factual account of the struggle to develop community intervention alternatives to the 100-year domination of the state hospital system in the United States. It is the story of the efforts of "Washington's Noble Conspirators," who struggled for more than 20 years after World War II to expand the amount of federal support of medical research, to get federal money into the care of people with mental disorders, and to obtain federal support for the training of mental health personnel and research into the whole area of mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of and Consumer Satisfaction With an Assertive Community Treatment Program for the Severely Mentally Ill: A 3-Year Follow-Up.

Assertive community treatment (ACT) programs have made substantial strides in reducing inpatient hospitalizations and in improving the lives of individuals with a severe mental illness. However, few studies have investigated their effectiveness outside of a 24-month treatment period. The present study investigated treatment outcomes in an ACT program over a 36-month period. Results indicate that participants experienced a statistically significant reduction in hospital bed days during the first 2 years of treatment. Positive outcomes were demonstrated on other variables, including an increase in compliance with outpatient psychiatric appointments and a reduction in emergency outpatient contacts. Results indicate that clients and family members were satisfied overall with ACT services, but family members reported greater satisfaction than clients in all areas assessed. (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)     

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)     

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)     

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)     

Point of entry and functional impairment as predictors of treatment amount and cost for patients with mental illness and substance abuse disorders in Santa Barbara County Mental Health Services.

This study examines point of entry, functional impairment, comorbid diagnosis, and demographic variables as predictors of treatment amount and cost for patients with mental illness and substance abuse disorders in Santa Barbara County Mental Health Services. Overall, significant results were found for point of entry, with higher costs associated with mental health than chemical abuse point of entry. Furthermore, amount, modality, and cost of service varied widely across such variables as functional impairment with those rated as least impaired receiving the greatest amount of services at the greatest cost. Additional significant findings in treatment amount and cost are reported for variables such as homelessness, ethnicity, and age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A genetic association with the development of alcohol and other substance use behavior in Asian Americans.

Studies of Asian adults have found that alcohol use and alcohol dependence are related to variation in the aldehyde, dehydrogenase (ALDH2) gene. To investigate the association of ALDH2 with the development of drug involvement, the authors analyzed retrospective information about the onset and regular use of alcohol and other substances as reported by 180 Asian American college students. Possession of an ALDH2*2 allele was not related to initiation of alcohol use or having ever been intoxicated, but individuals with ALDH2*2 alleles were less likely to be regular drinkers, were less likely to have engaged in a binge-drinking episode, reported a lower number of maximum drinks consumed in a 24-hr period, and were less likely to have used tobacco regularly than those without this genetic variant. These findings suggest that ALDH2 is associated with the development of not only alcohol-related behavior but other substance use behavior as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: Within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive- behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N=252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stability and Impact of Environmental Factors on Substance Use and Problems After Adolescent Outpatient Treatment for Cannabis Abuse or Dependence.

Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the MMPI-2 restructured clinical (RC) and clinical scales in a substance abuse treatment sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) restructured clinical (RC) scales were designed to assess the underlying distinctive core components of the MMPI-2 clinical scales in order to enhance discriminant and convergent validity. Analyses utilizing inpatient and outpatient mental health treatment samples (Tellegen et al., 2003) have demonstrated improvements in the psychometric functioning of the RC scales in comparison with the original clinical scales. The current study extends these analyses by comparing the RC and original clinical scales in a sample of 1,284 men assessed at intake to a substance abuse treatment program in a VA setting. Results indicate that the RC scales demonstrate a general improvement in psychometric properties, with some increases in convergent and discriminant validity compared to their clinical scale counterparts. These results replicate Tellegen et al.'s (2003) findings in a different type of treatment setting and with different criteria, and complement their report by examining the validity of scales RC3 and RC9, for which Tellegen et al. (2003) did not have appropriate criteria. Implications for deliverers of psychological services in public sector settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental involvement, psychological distress, and sleep: A preliminary examination in sleep-disturbed adolescents with a history of substance abuse.

The relationships between family environment and psychological distress and between psychological distress and sleep disturbance in adolescents are well established. However, less is known about the influence of family environment on sleep disturbance. The authors' goal is to examine the effects of parental involvement on psychological distress and sleep disturbance in 34 adolescents with a history of substance abuse. Linear regression techniques and confidence intervals were used to test the significance of mediation analyses. Lower levels of parental involvement were associated with higher levels of psychological distress, and higher levels of psychological distress were associated with lower sleep efficiency and more time spent in bed. Follow-up analyses found that higher levels of parental involvement were associated with earlier morning arising times, when controlling for psychological distress. These data indicate that psychological distress is important to consider when examining the relationship between parental involvement and sleep in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial Mediators of Antiretroviral Nonadherence in HIV-Positive Adults With Substance Use and Mental Health Problems.

This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: Individuals with symptoms of attention-deficit/hyperactivity disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully accounts for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)