The Effectiveness of Substance Abuse Treatment in Reducing Violent Behavior

The use of alcohol and other drugs has long been associated with violence. Yet relatively little is known about the effect of treatment on specific violent behaviors. This study examines violent behaviors in the National TreatmentImprovement Evaluation Study (NTIES), and assesses the extent to which treatment appears to reduce violence for each measured behavior. It also examines these reductions by gender, treatment modality, and whether the client wasa victim of violence in addition to being a perpetrator. The results indicate large reductions in violence among clients actively violent during the pretreatment period, with virtually no increase in violence among clients not actively violent during that same period, irrespective of gender, modality, or victimization status. On their face, the results strongly suggest that substance abuse treatment is effective in reducing violent behavior. Alternative explanations areproposed and assessed, followed by implications for policy, practice, and future research.     

Relationships Between Treatment Components, Client-Level Factors, and Positive Treatment Outcomes

How different amounts and components of treatment affect substance abuse treatment outcomes is fundamentally important to evaluating current treatment practices and recommending improvements. Through a secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES), the present study examined the relationships between treatment components, client-level factors, and positive treatment outcomes. Several components were shown tohave significant effects on the odds of a positive outcome, over and above the effects of client background characteristics. Depending on treatment modality, these included length of stay; whether or not clients reported seeing their treatment plan hours per month in group and individual counseling; utilization ofeducational, vocational, and other ancillary services; use of antianxiety and drug and alcohol medications; and client matching. Several interactions between client-level factors and treatment components were also observed. Studylimitations are discussed, followed by implications for policy and practiceand suggestions for further research.     

The Economic Benefits of Increased Treatment Duration and Intensity in Residential and Outpatient Substance Abuse Treatment Settings

This study presents estimates of the economic benefits to society from community-based substance abuse treatment. The analysis focused on the impact of length of stay and frequency of counseling on clients' crime-related and health care costs, welfare receipts, and income taxes. The results indicate that the benefits from an additional day of treatment were on average $21 for short-term residential treatment (or 29% the cost of a day of care), $13 for outpatient drug-free treatment (or 94% the cost of a day of care), and $5 for long-term residential treatment (or 9% the cost of a day of care). No benefits were found from additional counseling provided by a client's primary therapist. Withthe exception of short-term residential care, estimated increases in client earnings from longer lengths of stayexceeded the benefits to society. Our estimates do not include benefits realized during treatment or beyond the year after treatment.     

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors.     

Barriers and Supports to Substance Abuse Service Use Among Homeless Adults

Although there is a great need for substance abuse services among the homeless, many homeless individuals do not use those services. This study examined barriers and supports related to service use. Participants recognized a need for treatment and significant barriers to accessing care.     

Health-Related Quality of Life Among Substance Abusers in Residential Drug Abuse Treatment

Health-related quality of life (HRQOL) in substance abusers remains an area of inquiry in need of investigation. The few studies on the topic have found substance abuser HRQOL less than that of the general population. The present research compared 303 substance abusers in long-term residential therapeutic community treatment in New York with a general non-institutionalized adult sample from New York (N = 27,465) whose data were collected between 2002 and 2006 during the yearly administrations of the Behavioral Risk Factor Surveillance System (BRFSS), a state-based system of health surveys gathering data from upwards of 350,000 adults per year across all 50 states. One sample t-tests found that the in-treatment substance abusers reported significantly more physically and mentally unhealthy days over the past 30 days, as well as significantly more inactive days over the past 30 days due to illness.     

Clinical Improvement in Adolescents Comorbid for Substance Abuse and Psychiatric Diagnoses Through Multiple Group Psychotherapy

In a pilot study, the authors examined the outcome of group psychotherapy for the treatment of 19 adolescents, comorbid for substance abuse and psychiatric diagnoses, in terms of symptom reduction. They compared presenting symptomatology of treatment completers with treatment noncompleters. A retrospective study of the outcome of a multiple group psychotherapy treatment program using the Drug Use Screening Inventory-Revised Version (DUSI-R) to assess change over time was conducted. Depressive disorders were the most prevalent psychiatric diagnoses (68%), and marijuana was the substance most commonly abused on a frequent basis. Treatment completers showed improvement in behavior problems, health status, and social competence. As part of an integrated treatment program, multiple group psychotherapy is a promising treatment modality for adolescent patients, comorbid for substance abuse and psychiatric diagnoses, pending further assessment of the complex issues involved in combined treatment.     

Incarcerated Mothers: Mutual Support Groups Aimed at Reducing Substance Abuse Relapse and Recidivism

Interventions to reduce relapse and recidivism for the increasing number of mothers incarcerated for illicit drug use are needed to prevent maternal/child separation and high public expenditures. This paper describes mutual support groups for women inmates aimed at strengthening family coping skills, especially communication, anger management, and parenting skills. Qualitative data collected during the group sessions indicated that the healing support of shared experiences, stories, poetry, and staying in the present were identified as spiritually uplifting. Problem solving and improved family interactions constituted additional themes extracted from the qualitative data. Future plans include including quantitative outcome measures of success.     

The Influence of Posttreatment Mutual Help Group Participation on the Friendship Networks of Substance Abuse Patients

The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.     

The Substance Abuse Subtle Screening Inventory–3 and Stages of Change: A Screening Validity Study

The sensitivity of the Substance Abuse Subtle Screening Inventory—3 (SASSI‐3) was examined among substance‐dependent adults enrolled in a family drug court. The SASSI‐3 had a high sensitivity rate with this population, even across varying levels of motivation to change.     

Development of a Substance Abuse Consultation and Referral Service in an Academic Medical Center: Challenges, Achievements and Dissemination

Approximately 25% of US hospital beds are occupied by individuals with active substance use disorders (SUD). Acute medical hospitalization provides an opportunity to address SUDs and provide patient-centered intervention and referral for treatment. Nationally, some hospitals have developed substance abuse consultation departments to improve the care of hospitalized substance users. In this paper we describe the Addiction Psychiatry Service (APS) in a large urban hospital which provides bed-side SUD consultation, screening, intervention and referral to treatment. APS utilizes the multiple disciplines of psychology, social work and medicine to integrate substance abuse services throughout the hospital and educate future generations of medical and psychology trainees. We conclude with how the APS service is informing the development of similar programs in other academic departments within our hospital and best practice recommendations to further disseminate this service model.     

Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Assessing Counseling Students' Attitudes Regarding Substance Abuse and Treatment

Undergraduate counselors‐in‐training completed the Substance Abuse Attitude Survey, which measures treatment intervention, treatment optimism, and nonstereotypical attitudes. Treatment optimism was positively correlated with nonstereotypical attitudes and treatment intervention. Results indicated that treatment intervention and nonstereotypical attitudes must be addressed in addiction counseling courses.     

Tracking Substance Abusers in Longitudinal Research: Understanding Follow-Up Contact Difficulty

Studies examining follow-up contact difficulty provide useful information for planning longitudinal studies and for assessing the validity of follow-up data. Contact difficulty was examined among 96 substance abusers following substance abuse treatment. Interview completion rates at the 3-month and 6-month follow-ups were 93 and 97%, respectively. The extent of contact efforts required to complete follow-up interviews varied substantially but tended to be greater at the 3-month follow-up than at the 6-month follow-up. Contact difficulty was related to reuse of substances at the 3-month and at the 6-month follow-ups with reusers requiring greater contact efforts than abstainers. None of the baseline individual and contextual variables examined significantly predicted level of contact effort at follow-ups. Attrition-related validity implications are discussed along with practical suggestions for planning tracking efforts.     

Sex and Aggression: The Relationship Between Gender and Abuse Experience in Youngsters Referred to Residential Treatment

We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

Factor structure of the Treatment Evaluation Inventory: Implications for measurement of treatment acceptability

The Treatment Evaluation Inventory (TEI), a frequently used measure of treatment acceptability, was used by 164 undergraduates to rate the acceptability of each of the following treatments: differential reinforcement of other behavior, exclusionary time-out, overcorrection, medical restraint, contingent electric shock, and physical restraint. TEI ratings of each treatment type were grouped separately, variance-covariance matrices were formed and compared, and data were subjected to factor analysis. The results indicated that the factor structure of the TEI varied with the treatment it was used to evaluate. Item analysis of the TEI indicated a high degree of internal consistency, although item-total correlations varied between rated treatments. The findings suggest that although the TEI is a reliable instrument, sensitive assessment of the treatment acceptability construct probably requires multidimensional measurement.     

The EARLY ALLIANCE Prevention Trial: An Integrated Set of Interventions to Promote Competence and Reduce Risk for Conduct Disorder, Substance Abuse, and School Failure

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.