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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.)

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.)

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.

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.

Racial and ethnic disparities affect access to prevention and treatment of substance use disorders (SUDs). Traumatic events can present additional hardship for women with SUD. The participants included 180 low-income African American and Hispanic/Latina women with a history of incarceration, homelessness, commercial sex work, substance use or co-occurring substance use and mental disorders living with or at risk for HIV/AIDS and hepatitis-C, and experiencing multiple barriers to accessing SUD treatment services. Statistically significant decreases in alcohol-binge drinking, illegal drug use, and same-day alcohol and drug use were observed when comparing the baseline and 6-month follow-up interviews. Participants reported improvement in psychosocial functioning, substance use, and self-sufficiency. This study provides evidence for the effectiveness of an integrated, trauma-informed program and expands our understanding of barriers faced by minority women with substance use disorders. [ABSTRACT FROM AUTHOR]

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]

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]

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. [ABSTRACT FROM AUTHOR]

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 prevents 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 [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]

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]

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]

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]

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.

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]

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]