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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]

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]

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]

Like many areas of the country, the state of Tennessee is experiencing a recent and growing rise in the rate of methamphetamine use, particularly in rural areas of the state. While substance use is a known risk factor for contracting HIV/AIDS, there is limited information regarding the risk behaviors of rural methamphetamine users. This paper seeks to document the existence of known HIV risk behaviors as they relate to rural southern methamphetamine use. Qualitative interviews with ninety-seven current and former methamphetamine users from the Cumberland Plateau area, a rural mountainous region in the state of Tennessee, suggest that methamphetamine users are putting themselves at risk for contracting HIV/AIDS and other blood-borne diseases through high-risk injection and sexual behaviors. Additionally, the results present the perceptions of respondents regarding the impact of methamphetamine use on rural communities and related service needs. [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]

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]

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]

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. [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.

Reports on the 2005 issue of "Stress, Trauma, and Crisis: An International Journal" which focuses on the interaction between stress, trauma, and substance use. Solicitation of manusripts for the journal; Types of interaction between the three concepts; Review of neuroscientific research on stress.

This study explores the impact of managed care on the substance abuse service system by reviewing the current status of the programs that were among the elite service providers in 1988. A survey was conducted assessing the status of the one hundred centers touted as "the 100 best treatment centers for alcoholism and drug abuse" (Sunshine & Wright, 1988). Findings include the following: Almost a third of these centers (31 %) are no longer providing services, the majority of the programs who reported data continue to provide services primarily at a residential level of care (92%); however occupancy rates haye dropped, the number of annual inpatient admissions have risen, and the length of treatment episodes has significantly decreased. In 1988, almost all (97.5%) facilities adhered to the 28-day treatment regiment, as evidenced by average treatment episodes of 26 days or longer. However, in 2001, the majority of programs (57.5%) reported treatment episodes of 25 days or less. While these facilities represent a fraction of the number of facilities that provide substance abuse services, they do exemplify elite programs that should be insulated from economic troubles, and help to document the changes that have occurred in the delivery system. Awareness of these changes is important for every social worker that advocates for substance abuse services. [ABSTRACT FROM AUTHOR]

Significant health disparities in the rates of HJV infection exist that primarily impact African American women. While research has demonstrated that HIV is preventable through changes in high-risk behaviors facilitated by substance abuse treatment, an individual must first be able to access and engage with treatment to derive any benefit from these services. While there is some research that identifies barriers to treatment access and engagement for African American women who use crack cocaine, these barriers require further examination. Current lit erature has focused primarily on internal motivation and treatment readiness without placing these concepts within the unique environmental context of social stressors for crack cocaine-using African American women. This study presents the results of eleven focus groups with eighty-nine African American women in which respondents document the HIV risk behaviors of crack cocaine users, present their experiences [ABSTRACT FROM AUTHOR]

The article presents an analysis of literature on substance abuse among U.S. Latinos. High fertility and high immigration rates have made Latinos the largest minority in the U.S. Therefore, alcohol and illicit drug use within this population give reason for concern. Beginning in early adolescence, Latinos and native Americans lead the nation in alcohol and illicit drug use. They also have a high need for alcohol and illicit drug treatment compared to Whites and African-Americans. Even though family and peers have been shown to play an important role in the etiology of substance abuse across ethnic groups, research indicates that important differences exist within ethnic groups on these and other factors. In the article, research concerning ethnic differences has been reviewed in order to gain an understanding of the patterns and trajectories of substance use within the Latino community. Prevention and treatment interventions specific to Latinos have been described, and gaps in the literature are noted. Finally, implications of the current research findings for social workers and recommendations for future research have been discussed.

The purpose of this article is to present the Harm Reduction Model and its potential as a framework from which to provide prevention services for adolescents. While it may be uncomfortable for service providers to acknowledge, the vast majority of adolescents in the United States will have used mood-altering substances sometime during their teen years. While non-abstinence-based prevention services have existed for some time, they are not without controversy. This article proposes Harm Reduction as a complimentary or alternative perspective for work with adolescents for whom abstinence may not be immediately possible and/or may not be a realistic outcome for services. This article outlines the abstinence-oriented and Harm Reduction perspectives, as well as the Stages of Change model; utilizing empirical support, it then discusses how these perspectives can work together in social work practice in the adolescent substance abuse prevention arena. [ABSTRACT FROM PUBLISHER]

A structured diagnostic interview (Practical Adolescent Diagnostic interview) designed to gather basic information about substance use disorders, other mental health conditions, and related experiences was used in a variety of clinical settings. Anonymous data from 279 adolescents interviewed as part of routine clinical assessments in a variety of clinical programs were analyzed to assess the ability of the questions to identify potential problem areas and to provide a preliminary exploration of interrelationships between those problems. Results demonstrated that the vast majority of individuals manifested indications of multiple problems. For a given diagnostic condition, the trend is for those meeting at least the minimal DSM-IV criteria to exhibit substantially more than the minimum number of symptoms. Internal consistencies for item groups defining the various conditions range from more than .700 to over .900 indicating adequate to excellent internal consistency and reliability. Utility of the instrument for routine clinical use is also discussed. [ABSTRACT FROM AUTHOR]

The measurement of beliefs and attitudes on poverty and housing is important to researchers and social workers interested in examining the role that belief structures have on the development of policy and programs in these areas. This article reports pilot study findings of a new scale, The Poverty and Housing Scale (PHS), that measures this concept and evaluates its psychometric properties. Preliminary reliability was in the very good range. Examinations of content and face validity provided support of the instrument as a valid measure of beliefs and attitudes on poverty and housing. The factor analysis emerged a one factor, 13-item scale. Unlike other related scales, the PHS attempts to link the social factor of poverty and housing together. Theoretical and methodological strengths and weaknesses are considered and the implications for social work practice are discussed. The authors provide recommendations for additional testing of the instrument. [ABSTRACT FROM AUTHOR]

This article describes a pilot project that provided Internet-based outreach and HIV educational information to Men Who Have Sex with Men (MSM). The project provided services via chat rooms designated for MSM who meet them anonymously for sexual encounters. Services were designed to support behavior changes as well as serving a gateway function for additional services at the host agency. The experiences of the project suggest that the target population may engage in high-risk sexual activity mote than what was initially assumed; and that Internet outreach provides a relevant means of conducting outreach to this group. [ABSTRACT FROM AUTHOR]

gesting interventions should emphasize individual risk perceptions and alcohol expectancies. Understanding these relationships between race/ethnicity and HIV risk behaviors may help design culturally specific intervention and service programs. [ABSTRACT FROM PUBLISHER]

It is estimated that approximately half of all new HIV infections are related to injection drug use (Holmberg, 1996), as used syringes can harbor blood with traces of viable HIV for over 4 weeks (Abdala, Stephens, Griffith, & Heimer, 1999). Due to this concern, Syringe Exchange Programs (SEPs) and other related HIV prevention programs for active injection drug users have been developed and expanded in many urban areas of the United States over the past 15 years. Based on the Harm Reduction model of service provision, SEPs seek to reduce the harm associated with injection drug use through the elimination of the primary means by which HIV risk is spread, the shared syringe. Despite extensive research supporting the efficacy of SEPs, significant barriers exist to the delivery of these services, as SEPs are often viewed as being outside the traditional continuum of care for HIV/AIDS and/or substance abuse. All social workers involved in HIV/AIDS services should be aware of these programs and continued expansion and integration with other HIV/AIDS services should be a priority. [ABSTRACT FROM PUBLISHER]