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Adolescent illicit drug, tobacco, and alcohol use can result in sudden and long-term negative health consequences. Primary care environments present the optimal opportunity for screening and brief interventions that target prevention and curtailing use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a service delivery method that could potentially be well-integrated into primary care settings and used to serve a high volume of adolescents. Methods: This qualitative analysis of clinic staff interviews (N = 20), collected during a large cluster-randomized trial to implement two models of adolescent SBIRT, examined barriers and facilitating factors to overall acceptability of SBIRT. This study was conducted in a large, urban Federally Qualified Health Center (FQHC) at 7 sites throughout Baltimore City, Maryland, USA. Participants from each clinic included a range of various roles and responsibilities including: medical assistants (n = 3), nurses (n = 3), primary care providers (n = 4), behavioral health counselors (n = 4), and administrators (n = 6). Results: Results indicate both barriers and facilitating factors for acceptability of SBIRT in terms of (1) universal screening, (2) provider time demands, (3) behavioral health collaboration, and (4) behavioral health caseloads. Discussion: Universal screening was acceptable to participants across organizational roles, but brief interventions and referrals to treatment were found substantially less acceptable. [ABSTRACT FROM AUTHOR]

Although the vehicle horn is a minimal audible unit for communication, we will show that its uses are impressively varied. Drawing upon a corpus of video recordings from dashcams, we show how drivers use the horn for creating awareness; how they target particular vehicles; and how they use it for warnings, for complaints, and in instructing the seeing of an aspect of an ambiguous traffic object. Drivers' use of the horn involves, first, their sounding it in recognizable relations to past, current, and projected configurations of traffic on the road. Second, it involves drivers manipulating the vehicle horn to create sounds of shorter and longer durations that can then produce hearably distinct actions. Third, and finally, the driver can use the horn as an initiating or responsive action in relation to the actions of other members of traffic. The data are from road users in Chennai, India. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses article in the issue on research on collocated interaction topics including research agenda for HCI research; observational study by Luigina Ciolfi and Marc McLoughlin on heritage site; and combining collocation research topic.

While walking has always been mediated, the arrival of smartphones with multiple apps has changed how we walk and how we use apps. In this study, we investigate the relationships of pedestrian-in-the-street and app-user-on-screen actions. We display and describe a series of intersubjective practices constituted by, and with, walking while using a mobile device. The video data used are from a larger study of pedestrians using smartphones in urban settings, with our analysis here turning on how a smartphone is used and interacted around to accomplish walking together. Our approach draws upon ethnomethodological conversation analytic studies of the sequential and category-based organisation of mobile and on-screen actions. The analysis shows how walking actions (such as unilateral-stopping, turning, restarting) are connected to map actions such as displaying the map, manipulating the scale and monitoring the movement of the you-are-here dot. We conclude with remarks on the collaborative inter-subjective nature of walking with apps. [ABSTRACT FROM AUTHOR]

Argument is made for the importance of conducting a national treatment evaluation to permit understanding of the nature and effectiveness of typical treatment programming. Only through such study can we hope to learn areas of success and failure of normative programming relative to population characteristics and treatment strategies, and the extent to which research-based initiatives have been adopted by the field. That information is central to efforts to draw up a research agenda appropriate to the needs of clients and the staffs responsible for their treatment, and to clarify and respond to gaps in the application of potentially useful treatment components. In spite of such need, our understanding of typical treatment programming and of its effectiveness is based on data collected from a treatment cohort of 20 years ago, although patterns of drug use, characteristics of clients, and the treatment components available have all undergone substantial change. The responsibility taken to provide such information to the field, once seen as a central task of research, needs to be reasserted to strengthen and support our treatment efforts. [ABSTRACT FROM PUBLISHER]

While there is a rich collection of studies of consumption and identity, the role of buying practices in ordinary conversations has been largely neglected. Minor items and major purchases regularly play a key role in furnishing our talk with topics, news, jokes and formulations of what kind of people we are. This paper unpacks the idea of post-purchase conversations contained within the common phrase “word of mouth.” What happens when products are examined in ordinary talk is pursued through the close analysis of a series of conversations around a significant purchase (a mountain bike). Drawing on the work of Harvey Sacks, and conversation analysis more broadly, this paper documents how products as a topic provide not only resources for small talk, but also an opportunity to consider our identity and its transformation. In conclusion, this paper argues that the knowledge and experience that circulate outside of the actual marketplace or point of purchase are part of a domain of economics as ordinary practice. [ABSTRACT FROM PUBLISHER]

Background: Relatively limited empirical evidence exists comparing the impact on HIV sex risk behavior for patients admitted to methadone treatment programs (MTPs) as compared with nontreatment seekers. Methods: This longitudinal cohort study examined HIV sex-risk behavior among 164 out-of-treatment heroin-dependent adults recruited from the street and 351 newly admitted MTP patients. The AIDS Risk Assessment was administered at baseline, 6 months, and 12 months. Generalized linear mixed model and generalized estimating equation analyses were used to examine the changes in sex risk behavior over time. Results: The participants mean age was 41.5 years, 74.8% were African-American, 24.3% were White, and 54.4% were men. There were no significant differences between the groups in age, race, or gender. At baseline, the out-of-treatment group compared with the in-treatment group reported more sex partners ( p < .001) and higher frequency of sex ( p = .001). There was a group x time interaction for three of the sex-risk items and the out-of-treatment group reported having significantly more sex partners at both follow-up time points and having significantly more frequent unprotected sex while high at 6 months (all values of p < .01). Conclusions: Nontreatment seekers are at higher HIV risk than those entering MTPs and should be a focus of sex-risk reduction interventions, even if they are not interested in treatment at that time. [ABSTRACT FROM AUTHOR]

Background: Obtaining data on attitudes toward buprenorphine and methadone of opioid-dependent individuals in the United States may help fashion approaches to increase treatment entry and improve patient outcomes. Objectives: This secondary analysis study compared attitudes toward methadone and buprenorphine of opioid-dependent adults entering short-term buprenorphine treatment (BT) with opioid-dependent adults who are either entering methadone maintenance treatment or not entering treatment. Methods: The 417 participants included 132 individuals entering short-term BT, 191 individuals entering methadone maintenance, and 94 individuals not seeking treatment. Participants were administered an Attitudes toward Methadone scale and its companion Attitudes toward Buprenorphine scale. Demographic characteristics for the three groups were compared using χ2 tests of independence and one-way analysis of variance. A repeated-measures multivariate analysis of variance with planned contrasts was used to compare mean attitude scores among the groups. Results: Participants entering BT had significantly more positive attitudes toward buprenorphine than toward methadone ( p < .001) and more positive attitudes toward BT than methadone-treatment (MT) participants and out-of-treatment (OT) participants ( p < .001). In addition, BT participants had less positive attitudes toward methadone than participants entering MT ( p < .001). Conclusions: Participants had a clear preference for a particular medication. Offering a choice of medications to OT individuals might enhance their likelihood of entering treatment. Treatment programs should offer a choice of medications when possible to new patients, and future comparative effectiveness research should incorporate patient preferences into clinical trials. Scientific Significance: These data contribute to our understanding of why people seek or do not seek effective pharmacotherapy for opioid addiction. [ABSTRACT FROM AUTHOR]

The editing suite is one of the hidden spaces of film - a place where complex forms of embodied collaboration around screens take place. In this paper we present video-recorded data of an editor and director assembling a short documentary. From it we begin to describe editing work in terms of being aware of what media there are, assessing those materials and making them visible. We move on to consider the joint task of assessing clips once they are visible and making proposals about possible sequences. These actions are spatially arranged in a side-by-side format in front of multiple screens with asymmetric access to the controls. The editor's reservations are the areas of film-making for which they are accountable - their characteristic role of caution around the quality of media and intelligibility of a film for its audience. Much of the work on media and interaction assumes that the media are pre-formed and that these interactions are at a distance. Here we study the place where media are still in the process of being made, and while the work of editing is intimately dependent on video it is nevertheless accomplished in the local orders of the editing suite. [ABSTRACT FROM AUTHOR]

Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction because its perceived role in the promotion of meaningfulness in the recovery from addiction. Our review of the literature evaluates different domains relative to the relation between addiction, religion, and psychiatric treatment. Spirituality as a protective or precipitating factor for substance use and as a key component of recovery will be debated. Illustrations of its potential and limitations as a component of treatment will be presented. Types of investigation and integration of this dimension in an eventual therapeutic process strictly respecting the needs and specificities of each one will be discussed. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction surveys, widely used in health care delivery systems, may provide useful data for improving patient retention and outcomes. Objectives: This study examined the relationship between methadone patients’ treatment satisfaction at three months post-admission and their 3-month treatment outcomes and 12-month treatment retention. Methods: New methadone treatment admissions ( N = 283) were assessed at 3 months post-admission for satisfaction with their counselors and programs. Correlations examined the relationship between 3-month satisfaction and Addiction Severity Index (ASI) scores. Regression analysis assessed the relationship between satisfaction and drug testing at 3 months and was used to predict whether participants were retained in treatment at 12 months. Results: Participants who were more satisfied with their counselors and programs had lower Drug and Legal ASI composite scores at 3 months. Participants who were more satisfied with their programs remained in treatment for at least 12 months. Conclusions: Treatment programs should consider administering the CEF to their patients at 3 months post-admission to identify patients with low satisfaction scores who may be at risk for prematurely leaving treatment. Scientific Significance: Measuring patient satisfaction during treatment may help programs meet patients’ needs and improve retention. [ABSTRACT FROM AUTHOR]

Longer retention in drug abuse treatment is associated with better patient outcomes, and research indicates the first 12 months of methadone treatment are critical to patient success. Nevertheless, large-scale multisite longitudinal studies over the past three decades indicate that the majority of patients drop out during the first year of methadone treatment. Through an examination of 42 qualitative interviews with patients prematurely discharged from six methadone treatment programs in Baltimore, this study highlights factors patients describe as contributing to their reasons for being discharged within the first 12 months of the treatment. The two most consistent themes are program-related factors and incarceration. The former factors are richly described through patients' words and underscore the ways in which patients' perceptions of control exerted by the program and by the medication and misunderstandings of program structure can lead to premature discharge. Patients' reasons for discharge were compared to counselors' reasons as indicated in discharge summary forms. An analysis of the patterns of agreement and disagreement are presented. Patient-centered program and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Both heroin-addicted individuals and methadone maintenance patients are likely to face untreated opioid withdrawal while incarcerated. Limited research exists concerning the withdrawal experiences of addicted inmates and their impact on individuals' attitudes and plans concerning drug abuse treatment. In the present study, 53 opioid dependent adults (32 in methadone treatment and 21 out of treatment) were interviewed in an ethnographic investigation of withdrawal experiences during incarceration. When treatment for opioid withdrawal was unavailable, detoxification experiences were usually described as negative and were often associated with a variety of unhealthy behaviors designed to relieve withdrawal symptoms. Negative methadone withdrawal experiences also negatively influenced participants' receptivity to seeking methadone treatment upon release. A minority of participants took a positive view of their withdrawal experience and saw it as an opportunity to detox from heroin or discontinue methadone. Findings support the importance of providing appropriate opioid detoxification and/or maintenance therapy to opioid-dependent inmates. [ABSTRACT FROM AUTHOR]

Background: Despite evidence supporting the efficacy of buprenorphine relative to established detoxification agents such as clonidine, little research has examined: 1) how best to implement buprenorphine detoxification in outpatient settings; and 2) whether extending the length of buprenorphine detoxification improves treatment engagement and outcomes. Objectives: The current study examined the impact on 1) successful detoxification completion; 2) transition to longer-term treatment; and 3) treatment engagement of two different length opioid detoxifications using buprenorphine. Methods: The study compared data obtained from two consecutive studies of early treatment engagement strategies. In one study (n = 364), opioid-addicted participants entered treatment through a Brief (5-day) buprenorphine detoxification. In the other study (n = 146), participants entered treatment through an Extended (i.e., 30-day) buprenorphine detoxification. Results: Results indicated a greater likelihood of successful completion and of transition among participants who received the Extended as compared to the Brief detoxification. Extended detoxification participants attended more counseling sessions and submitted fewer drug-positive urine specimens during the first 30 days of treatment, inclusive of detoxification, than did Brief detoxification participants. Conclusions: Results demonstrate that longer periods of detoxification improve participant engagement in treatment and early treatment outcomes. Scientific Significance: Current findings demonstrate the feasibility of implementing an extended buprenorphine detoxification within a community-based treatment clinic. [ABSTRACT FROM AUTHOR]

Objective: Gender differences were explored among 355 in- and out-of-treatment opioid-addicted adults in Baltimore. Methods: Addiction Severity Index and other variables were compared among: 1) in-treatment women vs. out-of-treatment women; 2) out-of-treatment: women vs. men; and, 3) in-treatment: women vs. men. Results: Analysis indicated that in-treatment and out-of-treatment women worked less and used more cocaine than their male counterparts (ps < .01). Moreover, out-of-treatment women used heroin and cocaine more often, spent more money on drugs, earned more illegal income, and had fewer treatments than in-treatment women (ps ≤ .01). Conclusions: Findings indicate greater severity of drug and employment problems of opioid-addicted women and underline the need for gender-specific drug-treatment services. [ABSTRACT FROM AUTHOR]

We spend ever-increasing periods of our lives travelling in cars, yet quite what it is we do while travelling, aside from driving the vehicle itself, is largely overlooked. Drawing on analyses of video records of a series of quite ordinary episodes of car travel, in this paper we begin to document what happens during car journeys. The material concentrates on situations where people are travelling together in order to examine how social units such as families or relationships such as colleagues or friends are re-assembled and re-organised in the small-scale spaces that are car interiors. Particular attention is paid to the forms of conversation occurring during car journeys and the manner in which they are complicated by seating and visibility arrangements. Finally, the paper touches upon the unusual form of hospitality which emerges in car-sharing. [ABSTRACT FROM AUTHOR]

This study compared the characteristics of opioid-addicted adults seeking (n = 169) and not seeking (n = 74) methadone treatment in Baltimore, Maryland. Participants entering treatment were recruited from six methadone treatment programs, while out-of-treatment participants were recruited from the streets using targeted sampling methods. Measures included the Addiction Severity Index, a Supplemental Questionnaire, and urine drug test. Data were analyzed using ANOVA, χ2, and regression, holding key background variables constant. Despite the lack of differences between the samples in demographic characteristics, the out-of-treatment sample reported significantly more days of heroin, cocaine, and alcohol use and spent significantly more money on drugs and earned more illegal income at baseline. [ABSTRACT FROM AUTHOR]

In prior research, Katz et al. found that role induction (RI) improved engagement for substance dependent clients relative to standard outpatient treatment orientation. The current study replicates and extends these findings to an examination of long-term outcomes. Substance dependent clients entering outpatient drug-free treatment (N = 353) were randomly assigned to RI or to Standard (ST) orientation followed by routine clinic treatment. Measures of employment, crime, and substance use were collected at intake and at six- and 12-months post-intake. Controlling for baseline differences in substance use, results partially replicated our earlier findings of better engagement for RI, as compared to ST participants; more RI than ST participants attended at least one post-orientation counseling session. RI improved 12-month substance use outcome relative to ST. The potential gain in retention and in reduced substance use at follow-up associated with a single RI session, recommend this strategy for further development and study. [ABSTRACT FROM AUTHOR]

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability. [ABSTRACT FROM AUTHOR]

This article describes a TC-oriented aftercare program for homeless mentally ill chemical abusers (MICAs) in a supported housing facility, and presents some preliminary data on program effectiveness. The study divided the clients who had completed a residential modified TC program into two groups—those who participated in the TC-oriented supported housing program and those who did not. The data show similarities in the profile of the two groups. Improvement in negative behaviors (e.g., drug use and crime) occurred during the residential program and stabilized during the supported housing program, while improvement in prosocial behaviors (e.g., psychological functioning and employment) was incremental and continuous over the course of both programs. Those who participated in the TC-oriented supported housing program demonstrated significantly better outcomes than those who did not. These findings provide preliminary evidence for the effectiveness of a TC-oriented supported housing program as an aftercare strategy for homeless MICA clients following residential treatment. [ABSTRACT FROM AUTHOR]

Presents a study that examined the influence of physical activity on bone mineral density among older U.S. women. Predictors for positive bone density; Prevalence of osteoporosis in the country; Economic cost of osteoporotic fractures in the country; Percentage of women affected by the disease.

Drug user treatment clients with 5 or more HIV tests (frequent testees—N = 43) and 0–2 HIV tests (infrequent testees—N = 56) were compared on demographic characteristics, risk behaviors, perceived risk of HIV infection to self, involvement with family members, and psychological functioning. Extreme groups of HIV testees did not differ on any variables other than an index of perceived vulnerability to HIV infection (e.g., “You think that you really could get AIDS”). That measure of felt vulnerability was not correlated significantly with needle or sexual risk behaviors, family involvement, psychological functioning or other measures of perceived risk. It was reasoned that, in a community in which both dangers and protective behaviors are widely understood, frequent testees experience a generalized and heightened concern unrelated to specific behaviors or characteristics. [ABSTRACT FROM AUTHOR]

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed. [ABSTRACT FROM AUTHOR]

This paper uses the results from an ethnographic study of a groupware system in use to argue against two accepted views on groupware systems. Firstly, this paper argues that groupware is useful in how it supports existing everyday organizational processes, rather than as an agent of radical organizational change. Discussing the use of Lotus Notes in a British oil company shows how groupware supports mundane processes such as tracking repairs to equipment or encouraging good ideas. In this case groupware is a useful, yet unradical, technology. This is contrasted with discussions of groupware as a technology of radical change. Secondly, this paper argues that rigidity-the inability to change how a system works-can be a positive feature of a groupware system, or indeed, a very requirement of that system. A Notes system is shown being used to support accountability, in that staff used the record kept within the system to make their actions seem orderly and sensible to others. In this case the rigidity of the system was needed to convince others that the record was not being altered or fabricated. This is contrasted with those who have argued that groupware systems should be highly customisable by their users. More generally, this study uncovers the 'artful use' of groupware systems, how they are inventively integrated into work processes by those who use them. [ABSTRACT FROM AUTHOR]

The term “chronic relapsing disorder/disease” is viewed as an unfortunate shorthand expression that does an injustice to the accomplishments of treatment patients and treatment providers, and inadequately describes the findings from treatment evaluation research. Studies are reported that make clear relapse is not an inevitable consequence of substance abuse treatment, while substantial reductions in drug use and crime are routinely obtained consequent to treatment. It is past time to retire a term whose only virtue is brevity, and whose vices risk harm to a treatment population that is already stigmatized and a treatment system that is under frequent pressure. Thus, retiring this term provides the important benefit of recognizing the real achievements in behavior change obtained by treatment clients in conjunction with their service providers. [ABSTRACT FROM PUBLISHER]

We interviewed 70 substance abusers in methadone maintenance treatment regarding the life experiences of their 188 children. Sixty-four percent of the mothers reported using psychoactive drugs during their pregnancies. Eighty percent of parents reported an arrest during the time the child was growing up, 34% reported receiving treatment for an emotional disorder, and 14% were hospitalized. Four percent of the parents reported that their children had been placed in adoptive care, 9% in foster care, and 1% had a child in a group home. Forty-one percent of the parents reported that at least one of their children repeated a grade in school, 19% were involved in truancy, and 30% had been suspended from school. Twenty percent of parents reported their children's involvement with the law, and 17% reported drug or alcohol use. Problems with the law correlated highly with 1) being held back a grade, 2) truancy, 3) suspension from school, 4) expulsion from' school, and 5) treatment for alcohol or drug abuse. [ABSTRACT FROM AUTHOR]

Presents statistical computing program packages and product information. Development of GLIM software for statistical teaching; Operation of an easy-to-use mapping system; Formation of the computer laboratory manual.

Most libraries record a wide variety of numerical measures and descriptive statistics in an attempt to measure the use of their collections and services and to track any changes in those patterns. Nevertheless, if this information has no practical applications, then the entire data collection process is of little utility. In this article, the concept of triage management (which separates tasks into categories of "can wait," "hopeless," and "urgent") and the use of descriptive statistics are discussed in terms of how they relate to various functions of access services. Examples of the use of simple numerical measures to better manage changing patterns of work loads behveen areas of access services are examined from the University of Montana, Mansfield Library. [ABSTRACT FROM PUBLISHER]