Comorbidity of drug abuse treatment

Research has suggested that comorbidity, the concurrence of substance abuse disorders with other psychiatric disorders, may have prognostic value and important implications for the treatment of substance abuse. Knowledge of the prevalence of comorbid disorder is important because it will enable treatment services to be appropriately configured and designed for clinical drug treatment populations. The form and duration of comorbidity may be influenced by a variety of factors, which include the class of drug being abused, the duration of drug use, the individual sensitivity to drug effects, and whether the drug effects are acute or due to withdrawal or residual conditions. This paper addresses three important scientific questions: (1) What is the prevalence of comorbid disorders in a drug abuser population? (2) What is the stability of psychiatric diagnoses in a drug abuser population? (3) Does the existence of a comorbid disorder influence the outcome of drug abuse treatment?     

The influence of maternal optimality and infant temperament on parenting stress at 12 months among mothers with substance abuse and psychiatric problems

The present prospective longitudinal study aimed to investigate the long‐term impact of maternal optimality assessed during pregnancy on parenting stress at infant age 12 months. In this study the concept of optimality was utilized to investigate maternal variations regarding resources during pregnancy in relation to later parenting stress, among three different groups of mothers that were recruited from substance abuse treatment, psychiatric outpatient treatment and well‐baby clinics respectively. The influence of infant temperament on parenting stress was also examined. All mothers were interviewed during pregnancy. At 12 months, infant temperament (Colorado Childhood Temperament Inventory; Rowe & Plomin, 1977) and stress in the parent and child domain (Parenting Stress Index; Abidin, 1955) were assessed. Results demonstrated higher levels of parenting stress among mothers in the clinical groups, compared to the non‐clinical group. Furthermore, it was the maternal psychiatric optimality index in combination with child temperament characteristics (child emotionality) that contributed uniquely to stress in the parent domain, while stress in the child domain was significantly associated only with child temperament characteristics (both child emotionality and soothability). The association between maternal psychiatric optimality assessed in pregnancy, infant temperament and parenting stress when the infants were 12 months old, points to the importance of simultaneously addressing the mothers' own psychological distress, and to support positive mother–infant interactions. Each woman's individual optimality profile may be used to display needs of follow‐up in order to prevent enduring effects of non‐optimality on parenting stress.     

Maternal attitudes towards pre-natal substance abuse,medical care,and treatment in a historically disadvantaged South African community

This study explored maternal substance abuse and the access to pre-natal medical care and treatment for substance abuse during pregnancy. Respondent mothers (n?=?102; mean age?=?27.8 years, SD?=?10.9 years) were from Mitchell’s Plain, a historically disadvantaged South African community. The mothers completed a mixed methods interview on the context and influences of their substance abuse during their pregnancy. Findings suggest that these mothers adopt the drug taking behaviour in their social environment. Women with prior histories of substance abuse were active consumers and dependent on drugs while childbearing. These findings may be important for possible intervention strategies among this particular group of vulnerable women.     

Aids-risk behavior among homosexual males: The role of attitudes and substance abuse

Abstract

This paper reports the results of a broad survey of homosexual males regarding AIDS-risk behavior. A very high proportion reported both anxiety over possible HIV infection, and a high probability of exposure to HIV. Although over 80% of respondents reported changes in sexual behavior, the frequency of monogamous, stable relationships is unchanged from that found 16 years ago, and 19% reported continued frequent sexual partners. Consistent with “health belief” models, fear of future exposure and perceived control over behavior were strongly related to behavioral change. However, those who felt they had already been exposed were not substantially more likely to decrease current AIDS-risk behavior, which may have important public health ramifications. Alcohol and drug abuse were related to “high risk” behavior, particularly among respondents who are generally motivated to use substances to decrease “tension” or self-monitoring. Thus, using substances to decrease stress may not only relate to substance abuse itself, but to the role of substances in increasing AIDS-risk behavior.     

Psychopathy and aggressive behaviour among Nigerian male prison inmates: The moderating role of substance abuse

This study investigated the moderating role of substance abuse in the relationship between psychopathy and aggression among male prison inmates. Two hundred and sixty-seven male prison inmates from the Nigerian Prison Services were participants. The inmates were incarcerated for armed robbery (27.3%), theft (31.1%), murder (12.8%), rape/assault/child abuse (19.1%), burglary/arson (5.6%) and kidnapping (1.5%) in Enugu prisons, Nigeria. Their mean age was 28.32; SD = 5.53. Their length of time in prison ranges from 1 to 12 years, with a mean of 3.38 years. Participants responded to self-reported measures of aggression, psychopathy, and drug abuse. The result of the moderated regression analysis indicated substance abuse to moderate the relationship between primary psychopathy and verbal aggression, and between secondary psychopathy and hostility. The study findings underscore the importance of psychological intervention aimed at addressing aggression among prison inmates with histories of substance abuse and psychopathy.     

Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.     

Impact of substance abuse and child maltreatment training on service utilization in a rural setting

Substance abuse and child maltreatment have been recognized as co-morbid problems encountered in families presenting in the child protective services (CPS) system. Nonetheless, utilization rates of substance abuse treatment services have generally lagged well behind what the research would suggest are prevalence rates for substance abuse disorders in this population, suggesting problems in recognition and referral practices among CPS workers. In response to this, 25 training programs were funded by the National Center on Child Abuse and Neglect. This study reports data from one program. Trainees indicated a high level of satisfaction and demonstrated significant knowledge gains. More importantly, utilization of substance abuse services increased significantly across time in a multi-county region receiving training relative to a comparison region receiving none. The gain was limited, suggesting that while increased knowledge may translate into increased service utilization, additional barriers to accessing needed services must also be addressed.     

Physical discipline,escalation, and child abuse potential: psychometric evidence for the Analog Parenting Task

Data from three studies provide new evidence to support the validity of the Analog Parenting Task (APT) as an instrument to assess risk for harsh, physically aggressive parenting. In this series of studies, there was a strong association between APT scores of expected use and escalation of discipline strategies and self‐reported disciplinary attitudes. APT scores were also associated with physical abuse potential as assessed by both a well‐established measure of child abuse potential (Child Abuse Potential Inventory) and another instrument designed specifically for use in pre‐parent populations (e.g., Adult–Adolescent Parenting Inventory‐2). This study provides new psychometric evidence to support the use of the APT to assess harsh parenting. Additionally, these data highlight the connection between acceptance and use of physical disciplinary strategies, propensity for disciplinary escalation, and risk for abuse perpetration. The findings are discussed in the context of Milner's Social Information Processing model [Milner, 2003] of abuse, which suggests that parental selection of disciplinary responding and the monitoring of disciplinary responding are key events in the disciplinary process. The APT may prove a useful adjunct to more commonly used self‐report measures to allow for multimethod assessment of risk for punitive parenting. Aggr. Behav. 36:251–260, 2010. © 2010 Wiley‐Liss, Inc.     

Characteristics of seriously emotionally disturbed youth with and without substance abuse in intensive case management

Youth with emotional disturbance who have substance abuse problems are of particular concern to child-serving agencies. Approximately 22% of the youth served in New York State's Intensive Case Management Program for Children and Youth (CYICM) have identified substance abuse problems. We compared youths enrolled in CYICM who abuse substances with those who do not abuse substances. Adolescents with substance abuse problems differed from non-abusing adolescents. The abusing cohort was most likely to be emancipated minors, not enrolled in school, less likely to be members of a minority group, and more likely to have private health care coverage. They also evidenced a different constellation of symptoms than the non-abusing cohort, with abusers tending to display suicidal symptoms and behaviors and sexual acting out. Abusers were also more likely to have been admitted to private psychiatric hospitals and to have had crisis contacts in emergency rooms. Similar to non-abusers, however, abusers spent significantly fewer days as inpatients in state hospitals, and had fewer admissions to these hospitals following their enrollment in CYICM.     

Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type

The authors examined psychosocial correlates of drug and alcohol abuse in 462 hospitalized adolescents, and the extent to which these associations may be affected by gender or by substance type. Participants completed a battery of psychometrically-sound, self-report measures of psychological functioning, environmental stress, drug abuse, and alcohol abuse. Four multiple regression analyses were conducted to determine the joint and independent predictors of drug abuse and alcohol abuse, for males and for females. Multiple regression analysis revealed that seven variables--age, depression, impulsivity, low self-esteem, delinquent predisposition, low peer insecurity, and history of child abuse--jointly predicted both drug and alcohol abuse, for both males and females. However, several differences were found with respect to which variables made independent contributions to the predictive models--with only delinquent predisposition making a significant independent contribution for all four conditions. We found distinct patterns of psychosocial predictor variables for drug and alcohol abuse, as well as distinct patterns for males and females. These results may reflect differing risk factors for drug abuse and alcohol abuse in adolescent psychiatric patients--and differing risk factors for males and females. Such differences have potential implications for prevention and treatment.     

Social and emotional outcomes of childhood sexual abuse: A review of recent research

A total of 41 articles examined the social and emotional outcomes of childhood sexual abuse. The outcomes examined included suicide and substance use, gang involvement, pregnancy, running away, post-traumatic stress disorder (PTSD), risky sexual behavior, and behavioral problems. Results for each of these outcomes tended to vary by developmental period. However, problems of internalizing and externalizing behavior appeared to be specific to sexually abused children of all age groups. Some studies found differences in outcome according to gender, race, and age. Although findings related to abuse characteristics were found to vary from study to study, severity of the abuse, use of force, and victim's relationship to the perpetrator were found to be especially important. Other factors, such as family support and parental monitoring, were found to mitigate a negative outcome. Limitations are discussed along with suggestions for future research.     

Predictors of treatment attendance among adolescent substance abusing runaways: a comparison of family and individual therapy modalities

This study explored and compared predictors of session attendance among substance abusing runaway adolescents and their parents using three manual‐driven interventions: ecologically‐based family therapy (EBFT), motivational enhancement therapy (MET), and the community reinforcement approach (CRA). Individual and family‐level variables, as well as time between intake and first session were used as predictors of session attendance. Adolescents (N=179) between the ages of 12–17 years old were recruited from the only runaway shelter in Columbus, Ohio. The findings showed that adolescents assigned to EBFT were more likely to attend at least one therapy session than those assigned to either CRA or MET. Fewer days between intake and the first therapy session were associated with higher family therapy attendance. Overall, individual and family factors predicted therapy attendance but these factors differed depending upon the treatment modality.     

Child physical abuse and neglect in Kenya,Zambia and the Netherlands: A cross‐cultural comparison of prevalence,psychopathological sequelae and mediation by PTSS

This study compared the prevalence of self‐reported childhood physical abuse and neglect and the associated psychopathological sequelae among Kenyan, Zambian, and Dutch university students. In addition, we sought to find out the differentiated role of posttraumatic stress symptoms (PTSS) in mediating the associations between childhood maltreatment experiences and psychopathology symptoms. The sample consisted of 862 university students from Kenya (n = 375), Zambia (n = 182), and The Netherlands (n = 305) who completed the Personal and Relationships Profile (PRP). Results showed that physical abuse was highly prevalent in Kenya (59%) and Zambia (40%), and that neglect was even more prevalent than physical abuse in Zambia and The Netherlands at 59%, 54%, and 42% for the Kenyan, Zambian, and Dutch samples respectively. Neglect was associated with psychopathological symptoms in all three samples, whereas physical abuse was associated with psychopathological sequelae in the Kenyan and Zambian samples only. PTSS mediated the association between neglect and psychopathology symptoms in the Dutch sample and between physical abuse and psychopathology symptoms in the Dutch and Kenyan samples. We conclude that physical abuse and neglect are associated with psychopathology symptoms independently of country and cultural context. However, the pathways through which physical abuse and neglect may lead to psychopathological sequelae may be dependent on perceptions of specific parental behavior in different sociocultural contexts.     

Treatment Outcomes and Perceived Benefits: A Qualitative and Quantitative Assessment of a Women's Substance Abuse Treatment Program

This study examines outcomes of a women's substance abuse treatment program based on empowerment, choice, and client/therapist collaboration. The program was assessed through qualitative and quantitative research methods. The article includes extensive quotes from six client interviews as well as data from pre-post surveys of 50 women in the treatment program. Results show that the women felt they benefited from the collaborative treatment approach. Benefits to the women included feeling more empowered and learning to take responsibility for their lives. The importance of taking a broad view of recovery that includes ongoing evaluation of positive changes in various areas of the clients' lives is discussed.     

Empathy and risk status for child physical abuse: the effects of an adult victim's pain cues and an adult victim's intent on aggression

It has been proposed that abusive parents and parents at high risk for child physical abuse could be more likely to view children's behavior as being motivated by hostile intent [e.g., Milner, 1993], as compared to nonabusive and low‐risk parents. This kind of misattribution of other's behavior may inhibit empathic emotion, and therefore, could block the inhibiting effect of a victim's pain cues on aggression [Baron, 1979]. An experiment was designed to analyze the moderating effect of an adult victim's intent on aggression in high‐ and low‐risk participants for child physical abuse. A 2 × 2 factorial design based upon two levels of the participant's risk status (high, low) and two levels of victim's intent (positive, ambiguous) was employed. All participants observed an adult victim's pain cues. Ninety‐five (48 high and 47 low risk for child physical abuse) undergraduate females enrolled in courses at the University of the Basque Country participated in the experiment. The main effects of victims' intent and of participants' risk status were statistically significant. Participants in the ambiguous victim's intent condition aggressed significantly more than participants in the positive victim's intent condition. Moreover, high‐risk participants aggressed more than low‐risk participants regardless of the victim's intent. A significant interaction between risk status and victim's intent was expected. High‐risk subjects for child physical abuse were expected to aggress more than low‐risk subjects only in the ambiguous victim's intent condition. However, results did not support this hypothesis. Aggr. Behav. 32:1–12, 2006. © 2006 Wiley‐Liss, Inc.     

Childhood Abuse Types and Physical Health at the Age of 24: Testing Health Risk Behaviors and Psychological Distress as Mediators

This study examines whether adult psychological distress and health risk behaviors mediate the relationship between childhood abuse and physical health in adulthood. A randomly selected population-based sample, with oversampling to include a one-third subgroup of former child protection cases, completed a structured interview. Questions pertained to childhood exposure to abuse, adult psychological distress, physical health, and health risk behaviors. Previous research using this sample had identified three abuse typologies: emotional abuse, sexual abuse, and polyvictimization (physical abuse, emotional abuse, and neglect). All three typologies were significantly associated with poorer self-reported physical health. Psychological distress and health risk behaviors partially mediated the relationship between nonabuse, sexual abuse, polyvictimization, and physical health, and fully mediated the relationship between emotional abuse and physical health. The results of this study indicate that health risk behaviors and symptoms of psychological distress could contribute to some of the long-lasting consequences of childhood abuse on adult physical health.