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Background: Currently, the capacity to provide buprenorphine treatment (BT) is not sufficient to treat the growing number of people in the United States with opioid use disorder (OUD). We sought to examine participant retention in care rates of primary care delivered BT programs and to describe factors associated with retention/attrition for participants receiving BT in this setting. Objectives: A PRISMA-guided search of various databases was performed to identify the articles focusing on efficacy of BT treatment and OUD. Method: A systematic literature search identified 15 studies examining retention in care in the primary care setting between 2002 and 2020. Random effects meta-regression were used to identify retention rates across studies. Results: Retention rates decreased across time with a mean 0.52 rate at one year. Several factors were found to be related to retention, including: race, use of other drugs, receipt of counseling, and previous treatment with buprenorphine. Conclusions: While we only investigate BT through primary care, our findings indicate retention rates are equivalent to the rates reported in the specialty care literature. More work is needed to examine factors that may impact primary care delivered BT specifically and differentiate participants that may benefit from care delivered in specialty over primary care as well as the converse. [ABSTRACT FROM AUTHOR]

Purpose: This study employed a static group comparison design with 106 men in residential treatment to examine the relationship of race to treatment retention. Methods: A retrospective analysis of retention, by race, including survival analysis, was undertaken. Results: Findings from the study indicated that (a) Caucasian men complete treatment more frequently than African American men, (b) Race was not predictive of time in treatment, and (c) that race was a factor in the receipt of both criminal justice coercion and case-management both of which were strong predictors of time in treatment. Conclusions: Race serves as a factor in the receipt of services related to retention. Future research should focus on further exploration how race impacts retention, and the interaction of race with coercion and the receipt of case-management. (Contains 1 table and 2 figures.)

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville, Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV.

The impact that substance use has on an individual with mental illness has been documented; however, little is known about the impact that this may have for a family caregiver. Data was collected in a cross sectional study using mailed questionnaires to a convenience sample of family members of persons with mental illness (n = 110). Hierarchical linear regression analysis was used to determine the impact of substance use status upon four measures of well-being within a stress-coping model. The variables within the model were able to account for a significant proportion of the variance in each of the measures: perceptions of burden, depression, anxiety and physical health status (R[superscript 2] = 0.419 to 0.202). However, substance use status was not a significant predictor in any of these equations. Symptomatology and a measure of specific social support were the most significant predictors of burden ([beta] = 0.345, p less than 0.001 and [beta] = 0.330, p less than 0.001). Perceptions of caregiver burden were found to be the most significant predictor in each of the other three analyses ([beta] = 0.515, p less than 0.000; [beta] = 0.511, p less than 0.000; [beta] = -0.571, p less than 0.000). Results of this study suggest that substance use may not be as important as the other predictors included in the model in determining the well-being of family caregivers. (Contains 2 tables.)

The threat of HIV/AIDS to African American's health has become the focus of much concern. This study investigated the potential differences between African Americans' and white college students' current and future sexual behaviors and safer sex behaviors with HIV/AIDS awareness, condom use self-efficacy, and safer sex attitudes. A convenience sample of 156 college students from three public universities was used. Of those who were sexually active, more African American than white respondents reported they used condoms frequently, and more African Americans indicated they would use condoms regularly in the future. No racial differences were found in intentions for future casual sex, condom use self-efficacy, or attitudes toward safer sex practices. Although the results suggest that for this sample African American college students appear to have internalized safer sex messages to a greater degree, both groups reported a lack of consistent safe-sex practices, which may put them at risk of HIV/AIDS.

Objective: This article provides an evaluation of a federally funded faith-based program that serves African Americans who use heroin and cocaine and are at risk for HIV/AIDS in Nashville, Tennessee. Methods: Data were collected from 163 individuals at baseline and 6- and 12-month follow-up interviews. A subset of participants (n = 51) completed all three interviews. Results: Results suggested that this culturally relevant set of interventions was successful in reducing substance use and HIV/AIDS risk behaviors. The program was able to show data that supported the efficacy of a faith-based approach emphasizing spirituality rather than directive, aggressive, authoritarian, or coercive counseling techniques. Discussion: The model is important to the continued development of culturally relevant interventions that are vital to decreasing the disproportionate rates of HIV/AIDS within the African American community. (Contains 4 tables.)

In order to address HIV infection among college students, a comprehensive measure is needed that can be used with samples from culturally diverse populations. Therefore, this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness--factual knowledge, prejudice, personal risk, and misconceptions about HIV transmission, and will enable cross-cultural research. The International AIDS Questionnaire-Chinese Version (IAQ-C) was developed and validated by Davis, Tang, Chan, and Noel (1999) for use with Chinese populations. In this study, the validity and reliability of the International AIDS Questionnaire-English Version (IQA-E) was assessed on a sample of English-speaking college students from the United States (N = 200) and Australia (N = 74). The results of the CFA supported the four-factor model, and the normative data show patterns similar to previous research. The total IAQ-E had a high internal consistency (Cronbach's alpha = 0.88). The Cronbach's alphas for the sub-scales were 0.87 (myths), 0.81 (attitudes), 0.66 (personal risk), and 0.40 (facts). A 2-week test-retest reliability study on a sub-sample of 32 students revealed a Pearson product-moment correlation coefficient of 0.882 (p less than 0.001). This instrument provides a valid and reliable comprehensive measure of HIV/AIDS for use with English-speaking samples. (Contains 4 tables.)

The development of cultural competency skills is important for a clinician in any cross-cultural setting where a working knowledge of the client's culture is important to the delivery of services. This paper suggests that incorporating attendance at Twelve Step recovery programs may begin to facilitate cultural competency for students, or at the very least provide exposure to the culture through a cross-cultural experience. From the perspective of cultural competency, an understanding of the culture of Twelve Step groups is important to any clinician working with clients who may be referred to, and/or are members of a Twelve Step group. This article defines cultural competency, applies this to the culture that has developed around Twelve Step groups, and provides a model of integrating Twelve Step meeting attendance into addictions coursework as a mechanism for development of cultural responsiveness with addicted clients.

Drug courts have been recognized and empirically supported as an effective means of reducing recidivism and use of substances for both juveniles and adults. The paper reports the results of an outcome evaluation of a juvenile drug court in the Upper Cumberland area of Middle Tennessee. As with previous studies, the program showed impressive outcomes for many juveniles. Improvements, however, may be possible. Adding a residential component similar to the one for adults currently operated by the Davidson County Drug Court might enhance program retention, provide housing opportunities during treatment for neglected and abused youth, and offer opportunities for more regular and intensive supervision of specific juveniles. Such programs would likely be both practical and fundable, and should be considered by courts and treatment providers. (Contains 1 table.)

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents.

Background: Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. Methods: A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths. Results: The presence of an NAL had a significant (univariate P -value =.013; multivariable p-value =.010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P -value <.001), MOUD (univariate P -value <.001; multivariable P -value =.009), and Good Samaritan Law (univariate P -value =.033; multivariable P -value =.018). Conclusion: Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate. [ABSTRACT FROM AUTHOR]

This article provides information on harm reduction, a recent development in substance abuse services in response to the HIV/AIDS epidemic. The author outlines abstinence and harm reduction perspectives and the stages of change model and discusses how these perspectives can be integrated in social work practice. He proposes using harm reduction strategies for individuals for whom the abstinence perspective may not be appropriate. Together, the traditional abstinence and harm reduction perspectives provide a basis for a more comprehensive continuum of care for individuals experiencing problems related to their substance use.

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville, Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV. KEY WORDS: crack cocaine; HIV risk; substance abuse, There is a growing awareness of disparities in the incidence of HIV/AIDS, access to care, and survival rate in the context of race in access to health care that disproportionately [...]

The threat of HIV/AIDS to African American's health has become the focus of much concern. This study investigated the potential differences between African Americans' and white college students' current and future sexual behaviors and safer sex behaviors with HIV/AIDS awareness, condom use self-efficacy, and safer sex attitudes. A convenience sample of 156 college students from three public universities was used. Of those who were sexually active, more African American than white respondents reported they used condoms frequently, and more African Americans indicated they would use condoms regularly in the future. No racial differences were found in intentions for future casual sex, condom use self-efficacy, or attitudes toward safer sex practices. Although the results suggest that for this sample African American college students appear to have internalized safer sex messages to a greater degree, both groups reported a lack of consistent safe-sex practices, which may put them at risk of HIV/AIDS. KEY WORDS: AIDS; HIV; prevention, race, In the United States, the threat of HIV/AIDS to African Americans' health is the focus of much concern. It has raised an awareness of the health disparities primarily affecting African [...]

Although representing 12 percent of the U.S. population, African Americans represent more than one-third of all cumulative AIDS cases and the majority of all new AIDS cases in the United [...]

The response of social worker educators to the Iraq war, in the three countries that initiated war with Iraq, was researched. It was found that most of them had felt that students needed to be educated about the war and had included contents of the war in their courses in different ways such as class discussions and projects.

A federally funded faith-based program is evaluated that has served African Americans using heroin and cocaine and are at risk for HIV/AIDS in Nashville, Tennessee, U.S. The results have shown that a continuum of intensive faith-based and noncoercive outcome, case management and substance abuse treatment services can be implemented and might be effective for the target population.

Notes the rise of the harm-reduction model in the provision of substance abuse services and the history and success of syringe exchange programs. Describes the Xchange Point, a nonprofit community-based AIDS services organization founded in 1996 as a street-based outreach and syringe exchange program. (Contains 15 references.) (GCP)

Despite increasing attention directed to conceptual and methodological issues surrounding spirituality and despite the centrality of 'spiritual transformation' in the recovery literature, there is little systematic evidence to support the role of spiritual change as a necessary condition for substance abuse behavior change. As an explicit conceptualization of mechanisms underlying behavior change is fundamental to effective interventions, this article: 1) briefly reviews relevant behavior change theories to identify key variables underlying change; 2) presents an integrative conceptual framework articulating linkages between program components, behavior change processes, spiritual change mechanisms and substance abuse outcomes; and 3) presents a discussion of how the mechanisms identified in our model can be seen in commonly used substance abuse interventions. Overall, we argue that spiritual transformation at an individual level takes place in a social context involving peer influence, role modeling, and social reinforcement. Keywords: Substance abuse treatment, spiritual change, behavior change models, INTRODUCTION Recently, there has been increasing attention directed to conceptual and methodological issues surrounding spirituality, religiosity, and their implications for health and well being (1). Unfortunately, systematic empirical research regarding [...]

A recent development in the provision of substance abuse services has been the rise of the harm-reduction model and non-abstinence-based services. Harm reduction is based on the suppositions that drug [...]

The past decade has seen a marked increase in the illicit use of opioids, as well as a doubling of the percentage of individuals seeking treatment for opioid use disorders. However, little is known about the differences between opioid users and nonopioid users in residential treatment. Further, no studies have been published that compare opioid users and nonopioid users in treatment for co-occurring substance use and mental disorders. To address this gap, this study examined differences between opioid and nonopioid substance users in residential treatment for co-occurring disorders. Data was drawn from 1,972 individuals treated between 2009 and 2011 at one of three private residential treatment centers that provide integrated treatment for co-occurring substance use and mental disorders. Data was collected at program intake, and 1- and 6-month postdischarge using the Addiction Severity Index and the University of Rhode Island Change Assessment. To examine within-group changes in substance use, addiction severity, and mental health across time, linear mixed-model analyses were conducted with facility, year, age, gender, and race included as covariates. The authors found more similarities than differences between the two groups on baseline characteristics, treatment motivation, length of stay, and outcomes on measures of substance use, addiction severity, and mental health. The results demonstrate that though opioid users entered treatment with higher levels of substance use–related impairment, they were just as successful in treatment outcomes as their non-opioid-using peers. [ABSTRACT FROM PUBLISHER]

Opiate use patterns, user characteristics, and treatment response among young adults are of interest due to current high use prevalence and historical low levels of treatment engagement relative to older populations. Prior research in this population suggests that overall, young adults present at treatment with different issues. In this study the authors investigated potential differences between young adult (18–25 years of age) and older adult (26 and older) opiate users and the impact of differences relative to treatment motivation, length and outcomes. Data for this study was drawn from 760 individuals who entered voluntary, private, residential treatment. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and 6-month post-discharge. Results indicate that older adults with a history of opiate use present at treatment with higher levels of severity for alcohol, medical, and psychological problems and young adults present at treatment with greater drug use and more legal issues. Significant improvement for both groups was noted at 6 months post treatment; there were also fewer differences between the two age groups of opiate users. Results suggest different strategies within treatment programs may provide benefit in targeting the disparate needs of younger opiate users. Overall, however, results suggest that individualized treatment within a standard, abstinence-based, residential treatment model can be effective across opiate users at different ages and with different issues, levels of severity, and impairment at intake. [ABSTRACT FROM AUTHOR]

Objective:The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment.Methods:This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay.Results:Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change.Conclusions:The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment. [ABSTRACT FROM AUTHOR]

An increasing number of Americans are experiencing sleep problems. There is evidence of a complex, bidirectional relationship between sleep disorders, substance abuse, and mental health symptoms. Institutional settings have been shown to elicit sleep problems as well. This pilot study was conducted with 28 patients in private, residential, dual-diagnosis treatment for addiction and mental health disorders. Upon admission, consenting patients were administered the Addiction Severity Index to assess pretreatment substance use and mental health symptoms. Patients followed a normal course of treatment as well as participated in a nightly sleep hygiene group that included relaxation suggestions. Evaluations with the Addiction Severity Index were completed again 30 days after discharge from treatment. Significant improvements in some substance use patterns as well as mental health symptoms were noted. Although results cannot be directly attributed to the use of a sleep hygiene group, this pilot study lays the foundation for future investigations of interventions supporting sleep in the dual-diagnosis population. [ABSTRACT FROM AUTHOR]

Substance use among college-age adults is of interest due to high levels of use and low levels of treatment access and engagement relative to other adults. Data collected from 1,972 clients in residential services were analyzed to investigate differences in use patterns, treatment outcomes, and other life area problems. Participants completed an Addiction Severity Index (ASI) and the University of Rhode Island Change Assessment (URICA) at baseline, and an ASI and Treatment Services Review at 1-month and 6-month postdischarge interviews. Almost a quarter (24.1%) of participants were college age (18–25 years old). They were more likely to be White and male, and less likely to complete treatment although they had a longer average length of stay. College-age adults improved on all outcome measures, and posttreatment service use shows significant difference between college-age and older participants. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Underage drinking, or binge drinking, has become a major concern in U.S. society. At The University of Tennessee (UT) a computer-based intervention was put into place for the past 3 years with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). The intervention was provided to all college students via UT's computer network system and was completed mostly online. Students were given a computerized, standardized assessment of alcohol use, and then a brief intervention was given based on the students' information. The intervention targeted students who were at highest risk for developing unsafe alcohol behaviors and/or increasing prior alcohol consumption habits in their first year of college. More than 54,000 graduate and undergraduate students completed the program. Since the launch of the program binge drinking has dropped 27% on campus, frequent binge drinking dropped 44%, and the number of liquor law violations to 18- to 20-year-olds decreased from 542 in 2004 to approximately 158 in 2007. The use of a computer-based intervention was comprehensive, low cost, and required low maintenance. [ABSTRACT FROM PUBLISHER]

Early in the epidemic, HIV infection and AIDS were rarely diagnosed in women. Today, the HIV/AIDS epidemic represents a growing and persistent health threat to women, especially young women. The purpose of the current study was to conduct an international study with female undergraduate college students to assess knowledge and attitudes about HIV/AIDS, current and future sexual behaviors, and condom use self-efficacy. Participants included several convenience samples of female undergraduate college students from three public universities in the southern region of the United States (n = 112), a large public university in Australia (n = 66), and a public university in Hong Kong (n = 93). This research study utilizes a quantitative survey research design. Seventy-seven percent of American women and 66% of Australian women were sexually active compared with only 21% of Chinese women (χ2 = 67.74, p < .001). Of the sexually active women, 86% of Australian women reported regular use of safer sex practices during the past year compared with 69% of American women and 20% of Chinese women (χ2 = 8.9, p < .05). Although the sample as a whole scored generally high on HIV/AIDS awareness, it is not reflected in safe sex practices or intentions for future safe sex practices. Future studies should focus on further understanding the social, cultural, and psychological factors that hamper safe sex practices among this population as well as successful intervention strategies to overcome these barriers. [ABSTRACT FROM AUTHOR]

Due to the lack of education and the stigma attached to HIV testing, African American men are less likely to seek outreach services; therefore they are often unaware of their HIV status. Stigmatization of homosexuality in communities of color may also influence the availability of HIV/AIDS education and services; compounded with the fact that access to appropriate health care may be limited in these communities. While infection rates among African American men having sex with men (MSM) are well documented, research on effective interventions is not, and is particularly limited for these men who are substance users and participate in the sex trade for drugs. This article explores and documents the experiences of African American MSM in a southeastern metropolitan city who are involved in the commercial sex trade, and presents the results of a focus-group investigation conducted specifically to gain input about accessing outreach services. [ABSTRACT FROM AUTHOR]

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents. [ABSTRACT FROM AUTHOR]

Drug courts have been recognized and empirically supported as an effective means of reducing recidivism and use of substances for both juveniles and adults. The paper reports the results of an outcome evaluation of a juvenile drug court in the Upper Cumberland area of Middle Tennessee. As with previous studies, the program showed impressive outcomes for many juveniles. Improvements, however, may be possible. Adding a residential component similar to the one for adults currently operated by the Davidson County Drug Court might enhance program retention, provide housing opportunities during treatment for neglected and abused youth, and offer opportunities for more regular and intensive supervision of specific juveniles. Such programs would likely be both practical and fundable, and should be considered by courts and treatment providers. [ABSTRACT FROM AUTHOR]

The role of social workers in political activism has been characterized with ambivalence, and few studies have addressed political activism within the social work academic setting. The purpose of the current study was to explore how social work educators responded to the war with Iraq from an educational perspective as well as a personal perspective. Undergraduate social work faculty (N = 65) from accredited social work programs in each state throughout the USA completed a brief quantitative survey via email about the war with Iraq including the following topics: educational responses; personal responses; personal views; academic freedom; and demographic data. Findings revealed that 70% of respondents felt that social work faculty had a responsibility to educate students about the war with Iraq, however, only 36% of respondents felt that social work faculty had a responsibility to advocate for or against the war with Iraq. The majority of the faculty surveyed incorporated the war with Iraq in their class activities (88%) and participated in war activities outside of class on their own campus (80%). A significant minority of faculty felt restricted by their institution from expressing their views of the war with Iraq during class time (14%) and on their own campus (17%). [ABSTRACT FROM AUTHOR]

The purpose of this study was to add to the limited research on secondary traumatic stress in child welfare by investigating correlates of secondary traumatic stress (STS) in child protective services workers. Specifically, we examined the relationship between levels of STS in CPS professionals and personal history of trauma, peer and administrative support, intent to remain employed in child welfare, professional experience, and size of caseload. This study documents the existence of secondary traumatic stress in the population and the relationship between levels of secondary traumaticstress in CPS professionals and the group of potential correlates: personal history of trauma in the past year and lifetime, peer support, administrative support, intent to remain employed in child welfare, professional experience, and size of caseload. [ABSTRACT FROM AUTHOR]

The governing body of international social work, the International Federation of Social Workers (IFSW), provides ethical standards by which social workers around the globe are to abide. In terms of political activism, IFSW lays out guidelines that state that member associations are responsible for promoting debate, education and research regarding ethical questions (Healy, 2001). Furthermore, in terms of social work standards for agencies and organizations, it states that if necessary remedies are not achieved after channels have been exhausted, appropriate appeals to higher authorities or the wider community interest should be initiated (Healy, 2001). Therefore, social workers are encouraged to get involved in political activism. Issues that were once viewed as local or national are now being recognized as global issues impacting all levels of society (Lyons, 2006). However, many writers have documented how social workers have abandoned their mission of social and political action for a more clinical or therapeutic approach with clients (Gil, 1990; Hawkins et al., 2001; Schriver, 1987; Specht and Courtney, 1994), and how radical social work has changed paradigms in the current social work framework (Fook, 1993; Healy and Leonard, 2000; Leonard, 1995, 1996). Another issue of consideration is that many social workers who are employed by the government or seeking federal funds are hampered by real and perceived limits imposed by the federal government on their ability to engage in political activism, particularly when linked to the employment setting (Thompson, 1994). This may have an impact on social work educators who are employed by state-funded universities, seeking federally-funded grants or collaborating with federally-funded agencies. [ABSTRACT FROM AUTHOR]

African American women involved in high-risk, substance use-related behaviors are affected by extremely high rates of HIV infection. While research has demonstrated that HIV is preventable, in order for prevention efforts to be successful in reducing disparities, perceptions of African American women who use crack cocaine need to be taken into account. This qualitative study presents results of eleven focus groups with eighty-nine African American women respondents presenting their perceptions of service needs and preferences for service delivery. The results indicate two important findings for social service providers: the respondents' lack of a perceived need for HIV prevention services as a spontaneously identified need, and respondents' desires for more basic services such as childcare, safe shelter, basic necessities, and especially substance abuse treatment before they could be approached about HIV prevention services. The findings are relevant for developing gender- and culture-specific prevention strategies to reduce the spread of HIV. [ABSTRACT FROM AUTHOR]

In order to address HIV infection among college students, a comprehensive measure is needed that can be used with samples from culturally diverse populations. Therefore, this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness-factual knowledge, prejudice, personal risk, and misconceptions about HIV transmission, and will enable cross-cultural research. The International AIDS Questionnaire-Chinese Version (IIQ-C) was developed and validated by Davis, Tang, Chan, and Noel (1999) for use with Chinese populations. In this study, the validity and reliability of the International AIDS Questionnaire-English Version (IQA-E) was assessed on a sample of English-speaking college students from the United States (N = 200) and Australia (N = 74). The results of the CFA supported the four-factor model, and the normative data show patterns similar to previous research. The total IAQ-E had a high internal consistency (Cronhach's alpha = 0.88). The Cronbach's alphas for the sub-scales were 0.87 (myths), 0.81 (attitudes), 0.66 (personal risk), and 0.40 (facts). A 2-week test-retest reliability study on a sub-sample of 32 students revealed a Pearson product-moment correlation coefficient of 0.882 (p < 0.001). This instrument provides a valid and reliable comprehensive measure of HIV/AIDS for use with English-speaking samples. [ABSTRACT FROM AUTHOR]

The integrated treatment model has been touted as more effective than standard approaches to treating individuals with co-occurring substance use and mental health disorders. However, most studies on the effectiveness of integrated treatment lack control or comparison groups, limiting the conclusions that can be drawn. This article reviews studies that compare the effectiveness of integrated and nonintegrated treatment of co-occurring mental and substance use disorders on substance use, mental health, and community stability outcomes. Additional research is clearly needed to determine whether integrated treatment models for co-occurring disorders are, in fact, more effective than nonintegrated models. [ABSTRACT FROM AUTHOR]

Substance abuse can have such a destructive impact on a family that it can both interrupt and transform the entire family's life. The impact of chronic illness on the family has been researched primarily from a stress-coping paradigm. Within the mental health literature, the impact of one family member's mental illness on other family members has begun to be investigated in a systema-tic and scientific manner. Within a stress-coping paradigm, the results of this empirical research have borne out the tremendous objective and subjective burdens placed on family caregivers (Biegel, Song, and Chakravarthy, 1994; Lefley, 1996). This article suggests that the impact of substance abuse on families may also be conceptualized within this paradigm and posits an evidence-based stress-coping model for conceptualizing this process. [ABSTRACT FROM AUTHOR]

It is important for clinicians to develop cultural competency skills in any cross-cultural setting where a working knowledge of the client's culture is important to the delivery of services. Twelve Step recovery programs represent a distinct culture, where members have developed their own set of norms, behaviors and even language. An understanding of this culture is important to any clinician working with clients who may be referred to and/or are members of a Twelve Step group. This article defines cultural competency, applies this to the culture that has developed around Twelve Step groups, and provides information to familiarize clinicians to these cultural norms. [ABSTRACT FROM AUTHOR]

The development of cultural competency skills is important for a clinician in any cross-cultural setting where a working knowledge of the client's culture is important to the delivery of services. This paper suggests that incorporating attendance at Twelve Step recovery programs may begin to facilitate cultural competency for students, or at the very least provide exposure to the culture through a cross-cultural experience. From the perspective of cultural competency, an understanding of the culture of Twelve Step groups is important to any clinician working with clients who may be referred to, and/or are members of a Twelve Step group. This article defines cultural competency, applies this to the culture that has developed around Twelve Step groups, and provides a model of integrating Twelve Step meeting attendance into addictions coursework as a mechanism for development of cultural responsiveness with addicted clients. [ABSTRACT FROM PUBLISHER]

The article focuses on spiritual mechanisms underlying substance abuse behavior change in faith-based substance abuse treatment. Several definitions of faith-based organizations are being discussed. An integrative conceptual framework articulating connections between spiritual intervention components, behavior change processes and substance abuse outcomes is presented. Faith-based substance abuse treatment programs concerns the distinction between religion and spirituality. The article states that the ecological perspective and the model of social work practice provide for the incorporation of the element of personal spirituality, and therefore spiritual change, in viewing any individual presenting for services. A number of human and social service organizations have been addressed by faith-based programs. It has been found that religious or spiritual involvement may serve as a protective factor against the development of substance abuse problems. During substance abuse treatment some spiritual changes occur and substance abuse interventions may be effective for those for whom religion or spirituality is salient.