Brain damage,diagnosis, and substance abuse among violent offenders

Neuropsychological functioning, diagnoses, and substance abuse were compared among killers, nonhomicidal assaulters, and nonviolent offender controls. The Reitan and Luria-Nebraska Neuropsychological test batteries, the WAIS-R, CT scans, and EEGs were examined with a trend to more neuropathology found in killers and assaulters than in controls. There were no group differences in ICD-9 diagnosis nor on the MMPI, although considerable personality pathology was noted in all groups. Violent offenders scored higher on the Michigan Alcoholism Screening Test (MAST). The violent offenders were more likely to experience alcohol and drug-related mood dysphoria. The interaction of neuropsychological, personality, and substance abuse variables is discussed.     

Prevention education and substance abuse treatment

Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.     

Dual diagnosis: Clinical issues in substance abuse treatment

Dual diagnosis within the context of alcohol and substance abuse has become the focus of considerable interest, particularly when related to anxiety and depression. Depressive symptomatology is frequently associated with substance abuse and chemical dependency and numerous studies report a high concordance with these diagnostic entities and major affective disorder (Galanter,Casteneda, & Ferman, 1988). Depressive symptoms are also related to post treatment of alcohol and substance abuse with reported occurrences of 75 percent occurring with patients who have experienced relapse (Biedermann, Newcome, & Sprich, 1991).     

Adolescent substance abuse

We have become a drug-oriented society. Cummings (1979), citing evidence from the National Institute of Drug Abuse, reports that one of every eleven adult Americans suffers from a severe addictive problem. Drug addition is epidemic among teenagers; one of every six teenagers suffers from a severe addictive problem. This paper focuses on adolescent drug/substance abuse.     

Domestic violence shelter residents' substance abuse treatment needs and options

The association between intimate partner aggression and alcohol and other substance use problems is well-established in the literature. However, the nature and scope of alcohol and other substance use problems in women who seek or are likely to seek domestic violence shelter services is difficult to ascertain. The first goal of the current review was to identify and synthesize the findings of studies in which alcohol and other substance use, problem use, or diagnoses in shelter residents was assessed. Despite methodological limitations, this body of studies provides compelling evidence that a substantial number of domestic violence shelter residents (22–72%) have current or past problems with alcohol or other substances and may benefit from treatment. The second goal of the current review was to provide an overview of the availability and limitations of options that are currently available to address domestic violence shelter residents' substance abuse treatment needs. Although substance abuse is a largely under-met need of women seeking domestic violence shelter, promising findings from model integrated treatment programs, as well as the knowledge gained through implementation of these programs provide useful future directions for addressing these co-occurring issues.     

The therapeutic alliance in adolescent substance abuse treatment: a one-with-many analysis

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes.     

Multinational efforts in substance abuse prevention

This article is a review of the world-wide efforts of clinicians and researchers in the area of diagnosis, treatment, and prevention of multiple substance abuse. Represented are studies in cross-cultural prevention research and substance abuse which address the new and burgeoning area of clinical prevention research from a multidisciplinary perspective. The article also discusses the theory and methods in prevention in New York City, Israel, Italy, Spain, and in Cali, Columbia. The authors hope that this information will result in greater recognition for the need to understand effective measures of drug prevention, and to develop new research directions which shall enrich and enhance our present state of knowledge in substance abuse prevention programming.     

Relationship between perceived health care quality and attitude toward substance abuse treatment

Despite the considerable investment made in recent years in Spain in substance abuse care, treatment adherence remains one of the aspects that determine the effectiveness of programs. Several authors have noted the importance of perceived service quality in this context. This paper is presented with dual purpose of highlighting the role that management of the quality of care for drug addicts has, both as a modulator of users' attitudes and perceptions about the treatment, and as a work philosophy, typical of an organization committed to continuous improvement. Conducting personal interviews with 670 users of drug abuse care services in Galicia and through the application of covariance structure analysis, the close relationship between two factors (perceived quality and attitude toward treatment) was revealed. This research also provides professionals and researchers with a new scale for service evaluation that is short, easy to use and with adequate psychometric properties.     

Mental health treatment need among pregnant and postpartum women/girls entering substance abuse treatment

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.     

Cultural context and substance abuse in Hispanic adolescents

Much emphasis has been placed on the significant substance abuse problem being faced by Hispanic as well as other minority youth in the United States. However, little research has focused on the relative importance of culturally determined factors in the development of substance abuse in Hispanic youths. In this study, we propose an approach to measuring cultural factors through the activity orientations that youths endorse. We studied over 4000 Mexican-American and Mexican youths living along the U.S.-Mexico border with respect to their recent drug use, problem drug use, depressive symptomatology, and their activity orientation. While culturally related activity orientation does significantly increase risk for substance abuse, we found that symptoms of distress/depression and sociodemographic factors exerted a stronger effect on these youths.     

Neurocognitive insights into substance abuse

Cognitive studies are revealing key aspects of how drug abusers monitor and respond to negative feedback differently from non-abusers, and in doing so are adding an important piece to the conceptual puzzle that must be solved to understand, treat, and prevent drug abuse. In this review, we bring together two quite different lines of research, one addressing the selection of gambles in a risky decision task, and the other focused on imaging neural systems related to the detection and processing of errors. We suggest that diminished behavioural control, which is a cardinal feature of drug abuse, may be linked to alterations in the psychological and neural mechanisms that detect error signals and which, in turn, lead to optimization of behavioural responses.     

Inpatient versus outpatient treatment of substance abuse: Recent developments in the controversy

There has been considerable controversy the past decade on which is more effective, inpatient or outpatient treatment of substance abuse. During this same decade substance abuse treatment grew into a $40 billion industry with for-profit hospital programs accounting for as much as one-half the total figure. Recently, controlled studies have replaced the previous research literature which was largely composed of uncontrolled studies. A research consensus is developing that states inpatient rehabilitation has no advantages over outpatient treatment and that even hospitalization for detoxification is unnecessary for 90% of patients. Implications for public policy are that we are over-spending in the treatment of substance abuse by misallocating resources to the most intrusive intervention.Nicholas A. Cummings, PhD, is founder and chairman of the board of directors of American Biodyne and president of the Biodyne Institute, president of the National Academies of Practice, former president of the American Psychological Association, and founder of the four campuses of the California School of Professional Psychology.     

Impact of pre-existing levels of hostility and aggression on substance abuse treatment outcome

The impact of the change in level of hostility and aggression on subsequent substance abuse (drug, alcohol, or combined) recovery was investigated. One hundred and thirty-two dually diagnosed veterans completed an inpatient treatment programme at a large DVA Medical Centre. Results showed significant decreases in addiction severity over 3 month and 12 month following-up. At 3 months, pretreatment severity was predictive of drug, alcohol, and drug/alcohol severity whereas change in hostility and aggression scores were not. At 12 months, however, pretreatment severity was predictive only of drug severity whereas change in hostility and aggression were predictive of alcohol and combined drug/alcohol severity. Implications for changes in substance abuse correlates over time are discussed.     

Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.     

Behavioral health care dot-com and beyond: computer-mediated communications in mental health and substance abuse treatment

Computer-mediated communications (CMC) such as e-mail, websites, and CD-ROM and DVD programs, both on and off the Internet, will play an ever larger role in the future of behavioral health care. This address describes the current rapid expansion of CMC and some profound changes that are likely in the future. The reasons for using such CMC programs are addressed, and an example of a new multimedia version of the Addiction Severity Index is described. Issues and concerns about future uses of CMC are raised, as are possible implications for psychology.     

Prevalence of childhood and adolescent sexual abuse among sex offenders.

A simple nonstandardized questionnaire was developed and administered to 150 men convicted of various sexual offenses currently on probation or parole, living in the community, admitting their offenses and attending treatment. The hypothesis that men who engaged in sexual activity as adolescents with women would be at a higher risk of committing statutory rape-type sexual offenses was not substantiated.     

Adolescent substance abuse: practice implications

The incidence of substance abuse and implications for practice are reviewed. Variables that might be altered to prevent abuse among clients are discussed. Substance abuse theory, school and peer environment, family, the media, community movements, and business and industry are explored in regard to prevention and treatment.     

Child sexual abuse: offenders,disclosure, and school-based initiatives

Children are being sexually abused at an alarming rate. Prevalence estimates suggest that one out of four girls and one out of ten boys experience sexual abuse. This paper examines the devastating impact of child sexual abuse and explores the contributions of school-based interventions to remedy the problem.     

Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.