Exploring the Relationship Between Gender,Mental Health Needs,and Treatment Orders in a Metropolitan Juvenile Court

We explored personal, social, and legal factors associated with different types of mental health treatment orders in one Missouri metropolitan court where the majority of system-involved youth are African-American. The research question under investigation is: with objective assessment information at their disposal, do judges order mental health treatment based on indicators of need or do they follow the pattern found in other studies where demographic and legal variables are key indicators? The bivariate results indicate that while males and females do not differ in mental health status, they do differ in psychosocial needs and offense patterns. In the multivariate analysis, the mental health treatment specific model indicates that commonly used indicators of need, prior mental health status and being female are related to receiving treatment orders. In the substance abuse treatment specific model, the significant factors are closely aligned with need: drug offenses, substance abuse problems, and negative influence of peers.     

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.     

The clergy: a valuable resource for church members with alcohol problems

The role of the minister or pastor is pivotal in the development and operation of church-based services and programs and in the delivery of services. They can initiate changes and can equip the officers and members so that families troubled by substance abuse issues can find a climate of acceptance, understanding, and recovery in the local congregation. They can also serve as a referral source to members of the mental health professionals for assistance with alcohol and other substance abuse problems. For our purposes in this article, the term "clergy" refers to congregational and parish clergy. The focus of this discussion pertains to the role of clergy in providing assistance for members of their congregations with substance abuse problems. Implications and recommendations for collaborations and specific resources are also included that may increase the awareness of those issues and to increase effectiveness of service to those needing it.     

Ethically Questionable Behaviors Among Supervisees: An Exploratory Investigation

In spite of numerous studies of program outcomes finding little or no positive effect on violent behavior, the Duluth model remains the most common program type of interventions with perpetrators of domestic violence. In addition, Duluth model programs often ignore serious mental health and substance abuse issues present in perpetrators. These and other issues of possible threat to mental health professional ethics are reviewed in light of the court-mandated, compulsory nature of most Duluth model programs and client and victim expectations for program efficacy.     

Drugs in the workplace: A commentary

The increasingly serious problem of substance abuse in the workplace is reviewed. New initiatives to deal with this major public health problem in the United States are presented. The concerns of industry regarding alcohol and drug abuse in the workplace are discussed: health and safety, accidents, absenteeism, and medical and insurance costs. Employers' rights and responsibilities in insuring a safe work environment are presented. The development of employee assistance programs sensitive to the medical, legal, and work-related issues raised by substance abuse in the workplace is reviewed. Specific suggestions for employers concerned with the drug problem in industry are comprehensively discussed.     

Substance Abuse,Familial Factors,and Mental Health: Exploring Racial and Ethnic Group Differences Among African American,Caucasian, and Hispanic Juvenile Offenders

The present study examined racial, ethnic, and gender differences in family composition substance abuse, and mental health issues, such as depression and self-esteem among adjudicated juvenile offenders. Results revealed a negative relationship between depression and self-esteem among all ethnicities and family compositions. Caucasians reported greater incidence of substance abuse than did African American and Hispanic youth. Moreover, in reconstituted families, Caucasians had lower self-esteem scores than did other ethnicities. The findings illustrate the complexities of risk to substance use among high-risk populations, particularly as they relate to familial factors and the importance of intensive family therapy among this population.     

Substance Abuse Treatment Outcomes: Treatment Practice and Policy Implications

Treatment professionals, whether clinicians, scientists, or policy makers, are interested in developing methods to improve behavioral health treatment outcomes. Clinicians are interested in knowing what treatment practices to incorporate into the services they offer clients. Policymakers request guidance regarding which decisions are most likely to lead to effective treatment approaches and structures. Scientists are eager to contribute knowledge pertinent to building and evaluating effective treatment practices and policies. The papers in this special series provide information on substance abuse treatment practices andpresent findings relevant to clinical practice, policy decisions, and scientific inquiry. This paper provides a brief overview of the National Treatment Improvement Evaluation Study (NTIES) and briefly summarizes the other research papers included in this issue, all of which exemplify practice and policy issues in the substance abuse treatment field and bolster approaches applied to address these issues.     

Attitudes held by members of the clergy about alcohol

Alcohol, tobacco and other drug abuse continue to cause major threats to the physiological, psychological, sociological and spiritual health of the nation. According to recent statistics, over 80% of the illegal drugs used by youth, both male and female, is marijuana, with cocaine, opium and their derivatives comprising at least 15% of the drugs used by youth. When considering the ill effects of drug abuse, it is the legal one, alcohol that is responsible for the greatest impact on society. While it remains imperative that allied health professionals understand the many ramifications of substance abuse, it is also critical that leaders of faith communities have the knowledge and skills to meet this challenge competently. Due to the relevance of ministries as a possible resource, the focus of this exploratory study is to assess the knowledge, skills and attitudes of clergy about substance use and abuse and to determine their confidence of clergy in assisting their congregation with need related to this area.     

Inclusion of Substance Abuse Training in CACREP‐Accredited Programs

Professional counselors and counselors‐in‐training continue to serve clients who have substance abuse issues, yet systematic training in substance abuse counseling is not available to many counselors. The authors investigated the extent to which students in programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2001) are exposed to clients presenting with substance abuse issues and the relationship between state licensure or certification in substance abuse and the resulting perception of the need for the inclusion of substance abuse training in these programs. Three methods are presented for possibly including substance abuse training in CACREP standards.     

Race Differences in Congregational Social Service Activity

This article uses data from the 1998 National Congregations Study, a survey of a representative sample of 1,236 religious congregations in the United States, to examine the social service activity of African-American congregations. The first goal is to explore the question of whether African-American religious congregations participate more (or less) than other congregations in social service provision in general. Then, the focus shifts to specific types of social service programs in order to determine if African-American congregations tend to specialize in the provision of certain types of services. The rates at which congregations support nine different types of social service programs are reported, and participation in programs is then subjected to logistic regression analysis. Significant race effects for African-American congregations exist for four types of programs: clothing, substance abuse, tutoring/mentoring, and nonreligious education. These findings, particularly the effect on education and mentoring programs, counter the assertion by Lincoln and Mamiya (1990) that African-American congregations are not doing enough in areas that are critical to African-American youth.     

Acculturation and mental health: Current findings and recommendations for future research

Results of existing literature suggest that the relationship between acculturation and mental health is complex. Some studies have found a beneficial association between increased acculturation and mental health, whereas others have found a detrimental association or no relationship at all. We reviewed literature on acculturation and mental health in Hispanics/Latino Americans, Asians/Asian Americans, and other ethnic groups. Results indicate that greater acculturation is associated with increased substance use and abuse. Findings for other disorders and symptoms demonstrate considerable heterogeneity and potential reasons for this variation are provided. Acculturation involves a complex set of processes that appear to have differential impact on mental health outcomes. Critical issues in the measurement of acculturation are discussed, and recommendations for future research are offered.     

Is Fifty Really the New Thirty? The Stigma of Age as a Form of Strain and its Role in Drug and Alcohol Abuse and Dependence by Women

Aging bodies stigmatize women. The effects of stigma, health issues, goal disappointment, and a combination of age and minority group status, overwhelm older women’s coping strategies, leading to maladaptive behaviors. General strain theory posits a relationship between negative stimuli and deviant behavior. Advancing age and age-related stigma reflect this strain. This study explores the relationship between strain and substance abuse or dependence, comparing subsamples of middle age (35- to 49-year-old women) and older middle age (50- to 64-year-old) women. Data suggest that minority age status coupled with acute or mental health issues increase substance abuse or dependence by older women.     

African-American clergy's perceptions of the leading health problems in their communities and their role in supporting parishioners' health

This article is a report on a survey of Southern California pastors to learn of their perceptions of the leading health problems in their congregations. Participants (N=41) identified stress, overweight, and obesity as the top three health indicators that effect the health of their congregations. Tobacco use and substance abuse were listed among the top five. From a list of health problems, pastors felt that from the pulpit they could impact parishioners responsible sexual behavior most. Pastors expressed their opinions about the reasons for certain maladies and addictions. The findings indicate room for improvement in building clergy's understanding of the nature of illness and addiction and in empowering them in their role of supporting healthy behaviors in the African-American community.     

Identity formation and social maladaptation in foster adolescents.

The literature on identity formation in individuals from socially devalued racial and ethnic groups in the United States is summarized. Implications are discussed for a particular segment of at-risk adolescents--those in foster care residential group homes--who have received little published attention. The majority, in large urban centers, are African-American or Latino. These young people bear a disproportionate burden of such societal problems as unintended pregnancy and childbearing, academic underachievement and early educational discontinuation, substance abuse, and, ultimately, homelessness and more individually and socially costly forms of dependency (criminal justice, welfare, or mental health systems). It is postulated that their social maladaptation is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial socialization.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

The Role of Sexual Trauma in the Treatment of Chemically Dependent Women: Addressing the Relapse Issue

A review of the literature indicates a high incidence of sexual trauma among women who seek treatment for substance abuse. Additionally, clients who have experienced sexual trauma appear to be more susceptible to relapse, the return to substance abuse. This article explores issues surrounding sexual trauma and chemical dependency. It aims to provide direction for relapse prevention with a relapse-prone population. Application of traditional milieu substance abuse treatment for sexual trauma survivors is explored. Recommendations for working with sexual trauma survivors who are also substance abusers are presented, as are suggestions for research.     

An analysis of post-booking jail diversion programming for persons with co-occurring disorders

For persons with co-occurring disorders, interaction with criminal justice systems is a frequent occurrence. As a result, a variety of diversionary programs have been developed nationwide. In this study, a total of 248 individuals with co-occurring disorders of serious mental illness and substance use disorders who had been arrested and booked on misdemeanor charges participated in a post-booking jail diversion program in two urban communities. A quasi-experimental design was used with individuals assigned to diversion or non-diversion status based upon the decision processes of the mental health-criminal justice systems. The effectiveness of the jail diversion program was evaluated from a variety of sources, including structured interviews, behavioral health service utilization patterns, and criminal justice recidivism patterns. Analyses revealed general main effects for time on many of the outcome variables, with few main effects or interaction effects detected on the basis of diversion status (diverted versus non-diverted). Across all measures assessing mental health and substance abuse, study participants displayed improvements over time, irrespective of their diversion status or program location. Participants generally displayed no significant changes in their rates of accessibility to, or frequency of use of, the various mental health, substance abuse, and other services, and few changes for diversion status were detected with regard to service utilization. Although a number of indicators of criminality and violence were reduced over time, these reductions were statistically insignificant, with changes for diversionary status or time identified at follow-up. These results are discussed in light of their implications for jail diversion programming and future research in this area.     

Substance Abuse in Persons With Disabilities: Treatment Considerations

In this article the authors examine the issues and needs of individuals who are physically disabled and have substance abuse problems. Reasons for the high rate of substance abuse among individuals who are physically disabled are explored. Treatment considerations for such individuals are addressed and include individual, family, and educational counseling. Prevention issues are examined, and the importance of the Americans with Disabilities Act (ADA, 1990) is assessed.     

Health and Social Services for Male-to-Female Transgender Persons of Color in San Francisco

SUMMARY

This article presents findings from an investigation of health needs, service utilization, and perceived barriers to services among male-to-female (MtF) transgender persons of color in San Francisco. Focus groups (n = 48) and survey interviews (n = 332) were conducted with convenience samples recruited from the community. Participants reported a range of health and social services needed during the previous year, with African-Americans and Latinas showing particularly strong service needs. Rates of utilizing services were high for basic health care but lower for social services, substance abuse treatment, psychological counseling, and gender transition-related medical services. No significant ethnic group differences in health service utilization were found. Qualitative findings evinced the call for transgender-specific programs and advanced provider training on transgender issues such as hormone use, gender transition, HIV/ AIDS care and prevention, substance abuse, and mental health problems.     

Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers

Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.