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Previously consolidated memories have the potential to enter a state of lability upon memory recall, during which time the memory can be altered before undergoing an additional consolidation-like process and being stored again as a long-term memory. Blocking reconsolidation of aberrant memories has been proposed as a potential treatment for psychiatric disorders including addiction. Here we investigated the effect of systemically administering the protein synthesis inhibitor cycloheximide or the ß-adrenergic antagonist propranolol on reconsolidation. Rats were trained to self-administer cocaine, during which each lever press resulted in the presentation of a cue paired with an intravenous infusion of cocaine. After undergoing lever press extinction to reduce operant responding, the cue memory was reactivated and rats were administered systemic injections of propranolol, cycloheximide, or vehicle. Post-reactivation cycloheximide, but not propranolol, resulted in a reactivation-dependent decrease in cue-induced reinstatement, indicative of reconsolidation blockade by protein synthesis inhibition. The present data indicate that systemically targeting protein synthesis as opposed to the ß-adrenergic system may more effectively attenuate the reconsolidation of a drug-related memory and decrease drug-seeking behavior.

This case study is part of a larger investigation of literacy practices at New Beginnings shelter, a long-term transitional homeless shelter for addicted mothers and their children. We asked, "What is the nature of writing in a homeless shelter committed to the rehabilitation and recovery of mothers from addiction?" At New Beginnings, mandated writing serves as a way to help women confront their addictions and develop necessary skills to live independently. The social nature of writing is partly determined through explicit norms and routines for purpose, format, and audience and includes regular feedback from shelter staff and/or peers. Of the various writing practices undertaken, we discuss (a) required letters addressed to one's inner child, one's body, and one's disease; (b) "staff actions," which is on-demand writing on a required topic due to a shelter infraction; and (c) daily journaling. Drawing upon complementary theories of literacy as a social practice, literacy events and practices, a community of practice, and Foucault's concept of power as relations, we explore the social processes surrounding mandated writing among members of this shelter community. We note how writing can be a signal of legitimate participation in the rehabilitation process and how it serves as a form of dialogue between participants. Although these practices were sometimes filled with tension, their shared nature strengthened the shelter community through a productive process.

The United States' War on Drugs encompasses a body of legislation characterized by punitive approaches to drug control. These policies have resulted in escalating incarceration rates and have extracted a particularly harsh toll on low-income people of color. This article argues that education on the War on Drugs is essential for effective practice with people affected by addictions and is also an important social justice issue. It is thus the responsibility of educators to incorporate a critical examination of drug policy into course work. Strategies for addressing drug policy in social work education are provided, including the use of guest speakers and multimedia presentations, case study assignments that prompt students to examine the intersection of policy and practice, and international drug policy comparisons.

The progression from prescription opioid (RXO) abuse to RXO addiction is not well understood in adolescents, nor is the progression from RXO addiction to heroin abuse. The purpose of this pilot study was to characterize the development of RXO drug abuse, RXO drug addiction, and heroin abuse in a small cohort of adolescents recovering from opioid addiction at Massachusetts Recovery High Schools (RHS). A self-report questionnaire was administered to 31 adolescent, former RXO abusers across two Massachusetts RHS. RXO abuse was primarily initiated due to curiosity; RXOs were initially obtained through illicit and licit methods. Fifty-eight percent (N = 18) of the RXO abusers became addicted to RXOs. Many addicted adolescents initiated RXO abuse under the influence of marijuana, yet believed that they became addicted due to the stress from difficult life situations. A subgroup indicated they abused and became addicted to RXOs that had been obtained from legitimate prescriptions due to their pain. Sixteen percent (N = 5) of the sample abused heroin. Most heroin abusers (4/5) were addicted to RXOs prior to onset of heroin use. Heroin abusers indicated that they considered using heroin after they began tampering with RXOs. A portion of the sample felt that abuse deterrent formulations (ADFs) would have reduced their RXO use. This pilot study discovered areas where further research could be targeted, such as drug combinations, adolescent coping mechanisms, adolescent pain management, and the use of ADFs to disrupt the transition from RXO addiction to heroin use.

This study aimed to examine (a) the impact of the change in the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") from a categorical to dimensional classification of substance use diagnoses, (b) the elimination of the legal criterion, and (c) the inclusion of a craving criterion in the "DSM"-5. Specifically, we aimed to compare the differential diagnostic outcomes among high-risk substance-using adolescents enrolled in a school-based Motivational Enhancement Therapy (MET) intervention. We explored the alterations of diagnoses of adolescents in this sample and the prevalence of diagnostic promotions and demotions. We hypothesized that the dimensional approach of the "DSM"-5 would improve the utility of diagnosis in predicting severity of consequences and treatment outcomes in our sample. Method: Participants included 273 adolescents enrolled in a school-based intervention and were primarily male (76%) and Caucasian (47%), with 17% Asian/Pacific Islander, 17% Hispanic, 7% African-American, and 1% American Indian/Alaska Native. Results: We found that adolescents who lost diagnoses in the "DSM"-5 generally used substances less frequently and had fewer non-diagnostic negative consequences than those who remained consistently diagnosed across systems. Those who gained a diagnosis via the dimensional system tended to show higher use patterns and have more negative consequences than those who were never diagnosed. These findings indicate that the changes in the "DSM" are appropriate in this school-based clinical sample, at least in matching diagnostic status with substance use topography and negative consequences.

Substance addiction has become one of the important issues in the world. The studies concerning substance use reveal the extent of the problem. According to the results of such studies, the number of the people using illicit drugs has increased profoundly in recent years. In this study, it was tried to find out how common substance use among Turkish university students. Moreover, it was aimed to determine the students' attitudes towards addicts. In order to measure the students' attitudes towards addicts, the revised version of "Attitude Scale towards Individuals with Drug Abuse Problems" developed by Tansel (2006) was used. Totally 572 university students responded the survey.The results showed that nicotine and alcohol were the substances most frequently used by the students. Besides, it was seen that university students' attitudes towards addicts were reasonably negative. What is more, it was determined in the study that, the students' gender, faculty that they attended, students class level, their parents educational backgrounds, students' smoking and drinking habits were the factors influencing the students' attitudes towards addicts.

Established in the year 2000, the Begun Center for Violence Prevention Research and Education is a multidisciplinary center located at a school of social work that engages in collaborative, community-based research and evaluation that spans multiple systems and disciplines. The Center currently occupies 4,200 sq. ft. with multiple offices and individual workstations and is comprised of a staff of over 30 content experts in the areas of applied research, rigorous program evaluation, scientific investigation, policy/program development and community-based practice implementation. Our responsibilities for dissemination efforts lie not only in the area of moving project findings into the scientific literature but also in following up that dissemination by working directly with community providers and policy makers to advance and improve violence prevention efforts. We are currently working toward integrating the Center's research activities and outcomes with the Mandel School curricular activities and field experiences into the undergraduate, master's, and doctoral programs. Given our substantive work and relative areas of strength, we are also working toward increasing training activities with our law enforcement and justice system partners who play a critical role as "first social responders" to the many family and interpersonal problems that are related to violence perpetration and violence exposure.

Aims: Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine's estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioiddependent PWIDs have not been examined in Ukraine. Methods: A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in five major Ukrainian cities in 2013 covering drug treatment attitudes, beliefs, knowledge and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST. Findings: A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone's side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment. Conclusions: Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.

Considerable evidence suggests that personality traits may be changeable, raising the possibility that personality traits most linked to health problems can be modified with intervention. A growing body of research suggests that problematic personality traits may be altered with behavioral intervention using a bottom-up approach. That is, by targeting core behaviors that underlie personality traits with the goal of engendering new, healthier patterns of behavior that, over time, become automatized and manifest in changes in personality traits. Nevertheless, a bottom-up model for changing personality traits is somewhat diffuse and requires clearer integration of theory and relevant interventions to enable real clinical application. As such, this article proposes a set of guiding principles for theory-driven modification of targeted personality traits using a bottom-up approach, focusing specifically on targeting the trait of conscientiousness using a relevant behavioral intervention, Behavioral Activation (BA), considered within the motivational framework of expectancy value theory (EVT). We conclude with a real case example of the application of BA to alter behaviors counter to conscientiousness in a substance-dependent patient, highlighting the EVT principles most relevant to the approach and the importance and viability of a theoretically driven, bottom-up approach to changing personality traits.

Introduction: This article reports on a Department of Health UK funded project to implement consensus substance misuse teaching in undergraduate curricula in medical schools in England. The aim was to better equip practising doctors of the future to deal with substance misuse issues. Method: A project coordinator worked with local curriculum coordinators and academic champions in 19 participating medical schools. Substance misuse teaching was mapped using a toolkit outlining national learning outcomes as specified in Tomorrow's Doctors. This enabled a detailed overview of current substance misuse teaching, and identified gaps. Results: Common areas for all schools requiring further development included iatrogenic addiction, professionalism, fitness to practice, attitudes and issues relating to stigma, child-related issues, and social consequences of substance misuse. Students reported lacking confidence in performing key skills, including substance use history taking, discussing options for patients wishing to reduce or stop use, and recommending appropriate help organisations. This led to medical schools developing new or enhanced learning outcomes and teaching materials. Discussion: The project has, through national guidance and changes, enhanced the training and education of student doctors, and established a basis for substance misuse teaching that has already influenced the learning of our future doctors.

Substance use and delinquency in Thai adolescents are growing public health concerns. Research has linked neighborhood characteristics to these outcomes, with explanations focused on neighborhood disorganization, social cohesion, and social control. This study examines the independent associations of these neighborhood constructs with Thai adolescents' substance use and delinquency, through peer deviance, to determine which neighborhood aspects are particularly important. Families ("N" = 420) with adolescents aged 13 to 14 were randomly selected from 7 districts in Bangkok, Thailand. Structural equation modeling showed that adolescents', but not parents', perceptions of greater disorganization were related to increased rates of both minor and serious delinquency. Surprisingly, greater neighborhood cohesion was related to greater minor delinquency. Peer deviance was unrelated to neighborhood variables. Findings can inform prevention strategies for Thai adolescents, as results suggest that neighborhoods are important for adolescent behaviors regardless of culture. Further work should help communities make use of social cohesion to benefit residents.

Objective: To test whether the Adult Self-Report Scale for ADHD, six-items version (ASRS-6), measures inattentiveness and hyperactivity independently. Method: The ASRS-6 was completed by 234 university students and 157 outpatients treated for drug dependence. In both samples, the ASRS-6 was subjected to two confirmatory factor analyses, one testing a one-factor model and the other testing a model with two correlated factors indicating inattentiveness and hyperactivity, respectively. Test-retest reliability of the subscales was tested on a subset of the student sample ("n" = 25). Results: In both samples, the one-factor solution did not fit the data, but the two-factor solution fit the data better. Subscales differed in their correlates in ways that mirror the correlates of inattentiveness and hyperactivity in the published literature on ADHD. In the student sample, the test-retest reliability was adequate for hyperactivity ("r" = 0.70) and inattentiveness ("r" = 0.77). Conclusion: The ASRS-6 measures two correlated constructs, rather than one unitary construct. (Contains 3 tables.)

Deficits in cognitive control are implicated in cocaine dependence. Previously, combining functional magnetic resonance imaging and a stop signal task, we demonstrated altered cognitive control in cocaine-dependent individuals. However, the clinical implications of these cross-sectional findings and, in particular, whether the changes were associated with relapse to drug use, were not clear. In a prospective study, we recruited 97 treatment-seeking individuals with cocaine dependence to perform the stop signal task during functional magnetic resonance imaging and participate in follow-up assessments for 3 months, during which time cocaine use was evaluated with timeline follow back and ascertained by urine toxicology tests. Functional magnetic resonance imaging data were analysed using general linear models as implemented in Statistical Parametric Mapping 8, with the contrast "stop error greater than stop success trials" to index error processing. Using voxelwise analysis with logistic and Cox regressions, we identified brain activations of error processing that predict relapse and time to relapse. In females, decreased error-related activations of the thalamus and dorsal anterior cingulate cortex predicted relapse and an earlier time to relapse. In males, decreased error-related activations of the dorsal anterior cingulate cortex and left insula predicted relapse and an earlier time to relapse. These regional activations were validated with data resampling and predicted relapse with an average area under the curve of 0.849 in receiver operating characteristic analyses. These findings provide direct evidence linking deficits in cognitive control to clinical outcome in a moderate-sized cohort of cocaine-dependent individuals. These results may provide a useful basis for future studies to examine how psychosocial factors interact with cognitive control to determine drug use and to evaluate the efficacy of pharmacological or behavioural treatment in remediating deficits of cognitive control in cocaine addicts.

Objective: To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS[R])) System. Method: Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures. Results: A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD[plus or minus]1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38% were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants. Conclusions: Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents. (Contains 2 figures and 3 tables.)

Objective: This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method: Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure, as well as positive and non-positive feedback and advice during the 6-month treatment of cocaine dependence. Average, session-level, and slopes of process scores were evaluated. Primary outcomes were monthly cocaine use (days using out of 30), next session cocaine use, and duration of sustained abstinence from cocaine. Secondary outcomes were endorsement of 12-step philosophy and beliefs about substance abuse. Results: More positive alliances (with counselor) were associated with reductions in days using cocaine per month and next-session cocaine use and increases in endorsement of 12-step philosophy. Patient self-disclosure about the past and degree of participation in the group were generally not predictive of group drug counseling outcomes. More advice from counselor and other group members were consistently associated with poorer outcomes in all categories. Individual differences in changes in process variables over time (linear slopes) were generally not predictive of treatment outcomes. Conclusions: Some group behaviors widely believed to be associated with outcome, such as self-disclosure and participation, were not generally predictive of outcomes of group drug counseling, but alliance with the group counselor was positively associated, and advice giving was negatively associated, with the outcome of treatments for cocaine dependence. (Contains 5 tables.)

Objective: Relapse is a major problem in drug addiction treatment. Both drug craving and drug-related cognitions (e.g., attentional bias and implicit attitudes to drugs) may contribute to relapse. Using ecological momentary assessments, we examined whether craving and cognitions assessed during drug detoxification treatment were associated with relapse. Method: Participants were 68 heroin-dependent inpatients undergoing clinical detoxification at an addiction treatment center. Participants carried around a personal digital assistant for 1 week. Participants completed up to 4 random assessments (RAs) per day. They also completed an assessment when they experienced a temptation to use drugs (TA). At each assessment, participants reported their craving and attitudes to drugs. Implicit cognitions were assessed with a drug Stroop task (attentional bias) and an Implicit Association Test (implicit attitudes). Results: Individuals who relapsed during the study week exhibited a larger attentional bias and more positive implicit attitudes to drugs than did nonrelapsers at TAs (but not RAs). In addition, compared to nonrelapsers, relapsers reported higher levels of craving and more positive explicit attitudes to drugs at TAs than at RAs. Additional within-subject analyses revealed that attentional bias for drugs at TAs increased before relapse. Conclusions: Drug-related cognitive processes assessed with ecological momentary assessments were associated with relapse during drug detoxification. Real-time assessment of craving and cognitions may help to identify which individuals are at risk of relapse and when they are at risk of relapse. (Contains 5 tables, 2 figures and 2 footnotes.)

Background: Despite the ample interest in the measurement of substance abuse and dependence, obtaining biological samples from participants as a means to validate a scale is considered time and cost intensive and is, subsequently, largely overlooked. Objectives: To report the psychometric properties of the drug use disorder (DUD) questionnaire including oral fluid and blood sample screening indicators measuring the three most commonly used illicit substances--marijuana, cocaine, and extramedicinal painkillers. Subjects: Participants were a subset ("N" = 2,702) of the 2007 U.S. National Roadside Survey that was administered to daytime and nighttime weekend drivers in the 48 contiguous states to examine the prevalence of substance use and misuse. Measures: Participants completed demographic and substance use questions as well as the DUD--a 12-item measure assessing substance abuse and dependence. Participants could potentially have completed the DUD three times for each of the three substances. Subscales of abuse and dependence were created using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition Text Revision [DSM-IV-TR]) criteria of these diagnoses. Results: The DUD displayed adequate internal consistency on both subscales of substance abuse and dependence (Cronbach's alpha ranging from 0.71 to 0.84 and 0.83 to 0.92, respectively). The DUD also demonstrated construct validity in comparison to biological markers of each substance. Conclusions: The DUD is a biologically validated instrument that is both easy to utilize and may have valuable implications as a research tool among both clinical and nonclinical populations. (Contains 5 tables.)

Experiences of stigma from others among people with a history of drug addiction are understudied in comparison to the strength of stigma associated with drug addiction. Work that has studied these experiences has primarily focused on stigma experienced from healthcare workers specifically even though stigma is often experienced from other sources as well. Because stigma has important implications for the mental health and recovery efforts of people in treatment, it is critical to better understand these experiences of stigma. Therefore, we characterize drug addiction stigma from multiple sources using qualitative methodology to advance understandings of how drug addiction stigma is experienced among methadone maintenance therapy patients and from whom. Results demonstrate that methadone maintenance therapy patients experience prejudice, stereotypes, and discrimination from friends and family, coworkers and employers, healthcare workers, and others. Discussion highlights similarities and differences in stigma experienced from these sources.

Historically, addiction has been an area in which Canadian social workers have received limited formal education. This reality led to the development of 18 core technical competencies through the auspices of the Canadian Centre on Substance Abuse in 2006. A survey of Canadian schools and faculties of social work found that social work students might obtain a grounding in many of these competencies, however, there was no certainty of this. An option now for those interested in becoming more proficient in this field of addiction is a specialized distance education program developed by McMaster University in Hamilton, Ontario. Along with meeting the majority of the core competencies, there are several other attributes that make this program unique. It offers 27 distinct addiction-specific course options at both an introductory and an advanced level; has continuous enrollment allowing students to begin a course at the beginning of any month; has no minimum course load requirement; and meets the academic requirements for optional certification through the Canadian Addiction Counselors Certification Federation. In a nation like Canada, with a small population spread across a large geographic area, the Addiction Studies Program may serve as a template for offering specialized distance education to enhance professional competencies and thus better prepare social workers to serve community needs.

Factor score estimation is a controversial topic in psychometrics, and the estimation of factor scores from exploratory factor models has historically received a great deal of attention. However, both confirmatory factor models and the existence of missing data have generally been ignored in this debate. This article presents a simulation study that compares the reliability of sum scores, regression-based and expected posterior methods for factor score estimation for confirmatory factor models in the presence of missing data. Although all methods perform reasonably well with complete data, expected posterior-weighted (full) maximum likelihood methods are significantly more reliable than sum scores and regression estimators in the presence of missing data. Factor score reliability for complete data can be predicted by Guttman's 1955 formula for factor communality. Furthermore, factor score reliability for incomplete data can be reasonably approximated by communality raised to the [image omitted] power. An empirical demonstration shows that the full maximum likelihood method best preserves the relationship between nicotine dependence and a genetic predictor under missing data. Implications and recommendations for applied research are discussed. (Contains 5 tables, 3 figures, and 5 footnotes.)

The "DSM-5" Task Force has recommended a new substance use disorder to replace substance abuse and dependence. This article provides an overview of substance abuse and dependence, a description of the "DSM-5" substance use disorder, and implications and potential consequences of this change.

A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility in manual development. A preliminary integrative model termed Integrative Family and Systems Treatment is offered as one option in developing and testing a moderate common factors approach. Such a model might then be studied in eventual clinical trials with other well-developed evidence-based protocols to further address the common versus specific factor debate. Implications for further research and practice are offered.

Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot patients, a randomized trial evaluated the efficacy of CM when delivered entirely by clinicians. Sixteen clinicians treated 130 patients randomized to CM or standard care. In both conditions, urine and breath samples were collected twice weekly for 12 weeks. In the CM condition, patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting samples negative for cocaine and alcohol. Primary treatment outcomes were retention, longest continuous period of abstinence, and proportion of negative samples submitted. Results: Patients randomized to CM remained in the study longer (9.5 plus or minus 3.6 vs. 6.7 plus or minus 5.0 weeks), achieved greater durations of abstinence (4.7 plus or minus 4.7 vs. 1.7 plus or minus 2.7 weeks), and submitted a higher proportion of negative samples (57.7% plus or minus 40.0% vs. 29.4% plus or minus 33.3%) than those assigned to standard care. Conclusions: These data indicate that, with appropriate training, community-based clinicians can effectively administer CM. This study suggests that resources ought to be directed toward training and supervising community-based providers in delivering CM, as patient outcomes can be significantly improved by integrating CM in methadone clinics. (Contains 4 tables and 1 figure.)

Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive. Method: Initially cocaine-negative patients (n = 333) were randomized to standard care (SC), SC + CM reinforcing submission of negative samples with $250 in prizes ($250Abs), or SC + CM reinforcing attendance ($250Att). Initially cocaine-positive patients (n = 109) were randomized to SC, $250Abs, or higher magnitude CM ($560Abs). Results: For initially cocaine-negative patients, $250Abs and $250Att were equally efficacious to SC in enhancing longest duration of abstinence (LDA); $250Att patients submitted lower proportions of negative samples when missing samples were considered missing, but these patients also attended more study sessions, provided more samples, and submitted a higher proportion of negative samples than SC patients when expected samples were analyzed, ps less than 0.05. In initially cocaine-positive patients, both CM conditions increased proportions of negative samples relative to SC when missing samples were excluded from analyses, but only $560Abs was efficacious in increasing LDA and proportion of negative samples when expected samples were analyzed, ps less than 0.05. Follow-ups revealed no differences among groups, but LDA was consistently associated with abstinence during follow-up, p less than 0.05. Conclusions: High magnitude abstinence-based reinforcement improved all abstinence outcomes in patients who began treatment while using cocaine. For patients initiating treatment abstinent, both attendance- and abstinence-based CM resulted in improvements on some measures. (Contains 2 tables and 1 figure.)

Substance abuse researchers identify self-efficacy and group cohesion as important components in alcohol and other drug-dependency treatment. Objectives: The purpose of this single-group, pretest-posttest study is to explore the therapeutic value of a challenge course intervention on the self-efficacy and group cohesion of nine chemically dependent, adult females. Methods: Data were collected using two validated outcome measures administered before and after the intervention. Focus groups provided insight into the experiences of participants and were examined using manifest and latent theme analysis. Results: Findings indicate statistically significant improvements on both outcome measures with medium to large effect sizes. Several themes were identified including group unity, trust, interpersonal growth, and self-confidence. Conclusions: Suggestions for practice and future research are provided. (Contains 1 table.)

Factors associated with recent suicide attempts were examined in clients who sought treatment at an addictions facility between 2001 and 2008. Clients who reported being hospitalized for attempting suicide in the past year (n = 76) were compared to all other clients (n = 5914) on demographic, mental health, substance use, and problem gambling variables. Compared to all other clients, clients who attempted suicide were significantly less educated, and more likely to have major depressive disorder, a bipolar disorder, ADHD, a personality disorder, or a gambling problem. While mental health issues have long been linked with suicide, new research, such as the present study, continues to find associations between gambling and suicide. With the strong relationship between mood disorders and gambling, these findings support continued research into the possible connection between gambling and suicide.

The present report is an intent-to-treat analysis involving secondary data drawn from the first randomized clinical trial of prison-initiated methadone in the United States. This study examined predictors of treatment entry and completion in prison. A sample of 211 adult male prerelease inmates with preincarceration heroin dependence were randomly assigned to one of three treatment conditions: counseling only (counseling in prison; n = 70); counseling plus transfer (counseling in prison with transfer to methadone maintenance treatment upon release; n = 70); and counseling plus methadone (methadone maintenance in prison, continued in a community-based methadone maintenance program upon release; n = 71). Entered prison treatment (p less than 0.01), and completed prison treatment (p less than 0.001) were significantly predicted by the set of 10 explanatory variables and favored the treatment conditions receiving methadone. The present results indicate that individuals who are older in age and have longer prison sentences may have better outcomes than younger individuals with shorter sentences, meaning they are more likely to enter and complete prison-based treatment. Furthermore, implications for the treatment of prisoners with prior heroin dependence and for conducting clinical trials may indicate the importance of examining individual characteristics and the possibility of the examination of patient preference. (Contains 2 tables.)

In this 15-year longitudinal study the authors investigated individual and contextual factors that predispose adolescents from a disadvantaged urban area to drug dependence in adulthood. Adolescents were recruited from schools serving East Harlem in New York City. Of the 838 participants followed to adulthood, 59% were women, 55% were African American, and 45% were Puerto Rican. Self-report data were obtained on externalizing and internalizing problems, substance use, and contextual influences across adolescence and young adulthood. Drug dependence was assessed in adulthood. Multivariate logistic regressions of drug dependence were performed on the whole sample and separately by gender. Each of the domains was associated with adult drug dependence. Although mean gender differences were found, most associations of risk factors with drug dependence did not vary significantly by gender. Treating externalizing and internalizing problems, reducing substance use, and providing coping skills for adverse contextual influences in adolescence and young adulthood may reduce the likelihood of becoming drug dependent in adulthood. (Contains 3 tables.)

This article presents abstracts from the 2011 AMERSA National Meeting. It includes 2011 best abstracts on research, programmatic, and curricular presentations.

Social work students' stereotypical perceptions of excluded populations could be decisive in the way they treat those who are excluded. In an attempt to change such perceptions and enhance knowledge about how to work with an excluded population, a dialogue-in-class model was implemented between students of social work in Israel and persons with drug addiction. The experiences of 292 students were evaluated by utilizing a semi-structured instrument. The findings indicated the potential of this model (in which representatives of an excluded population are the knowledge providers) to expand and enrich the unidimensional and stereotypical way in which students may perceive persons with drug addiction. The participants drew implications for future practice with excluded populations. These included both the importance of coming to a fuller understanding of the unique difficulties and needs of each person and the necessity of overcoming barriers hindering connection with persons in excluded populations, thus reducing their sense of exclusion. (Contains 1 table.)

Introduction: Process research in psychotherapy is important to understand how treatment works. The National Institute of Clinical Excellence guidelines suggest that in methadone maintenance treatment (MMT) for opioid dependence, drug key-working should be based on cognitive behavioural therapy (CBT) principles. This article reports the findings of process research component of a larger study investigating the effectiveness and cost-effectiveness of CBT in MMT in the UK (UKCBTMM project). Method: This was a multicentre randomized controlled trial comparing MMT plus CBT with MMT alone. The following concepts have been measured as part of the process research: (i) coping skills, (ii) self-efficacy and (iii) outcome expectancies. Results: CBT group has gained coping skills over time (as predicted) at 6 months, which were sustained at 12 months. Self-efficacy showed delayed greater increase in the CBT group at 12 months (as predicted). Positive outcome expectancies from reduction of drug use were reduced for the CBT group both at 6 and 12 months whereas negative expectancies had increased (against prediction). Conclusions: As this is the first trial in which the process changes in CBT in opioid dependence have been explored, the reported limited findings are of importance for further development in the field. (Contains 1 table.)

This study explored the prevalence of violent behaviors in patients who are addicted to drugs. A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment was assessed. Information on violent behaviors, sociodemographic factors, consumption factors (assessed by the European version of the Addiction Severity Index [EuropASI]), psychopathology's factors (assessed by Symptom Checklist-90-Revised [CL-90-R]), and personality variables (assessed by Millon Clinical Multiaxial Inventory [MCMI-II]) was collected. Drug-addicted patients who were associated with violent behaviors were compared on all variables with patients who were not associated with violent behaviors. The rate of drug-addicted patients with violent behaviors in this sample was 39.68% (n = 100). There were significant differences between the numbers of patients who did and did not demonstrate violence on some variables. Patients with violence problems were younger than those without violence problems and were more likely to report having been a victim of abuse. Moreover, they were significantly more likely to have experienced an overdose and showed a significantly higher score on several EuropASI, SCL-90-R and MCMI-II variables. According to these results, patients with violence control problems present with both a more severe addiction and several comorbid problems. The implications of these results for further research and clinical practice are discussed. (Contains 4 tables.)

Purpose: There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking. Design/methodology/approach: Focus groups and interviews were conducted with prisoners and staff in three male training prisons in England. The sampling approach endeavoured to gain "maximum variation" so that a broad based understanding of the prison setting could be gathered. The data were analysed in accordance with Attride-Stirling's thematic network approach. Findings: The findings suggest a myriad of social and environmental factors influencing drug use. While staff recognised the scale of the drugs problem, they struggled to cope with creative inmates who were not perturbed by taking risks to gain their supplies. Fellow prisoners played a major role in individuals' decision making, as did the boredom of institutional life and Mandatory Drug Testing (MDT) policies within the institutions. Practical implications: Drug treatment is an essential component of prison healthcare, but it only forms a small part of creating a health-promoting setting. If the health-promoting prison is to be fully realised, a more radical, upstream and holistic outlook is required. Originality/value: The settings approach is an important theoretical and practical approach in health promotion. In comparison to other settings (such as schools), however, there has been limited research on the prison as a health-promoting environment.

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (one-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions. The present study (based on 5,022 inmates from eight residential prison treatment programs) examines evidence on scale reliabilities and measurement structures of these tools. Results confirmed their integrity and usefulness as indicators of individual and group-level therapeutic dynamics. (Contains 1 figure, 2 tables and 1 note.)

Unlike for other health system stakeholders, there have been few visible efforts to support the use of research evidence in community-based organisations (CBOs). To begin to address this gap, we conducted focus groups and interviews with executive directors and programme managers of CBOs from the HIV/AIDS, diabetes and mental health and addictions sectors to examine their roles in health systems, their views about and experiences with research evidence, and their preferences for making systematic reviews easier to use. This study provides practical tools for supporting the use of research evidence by CBOs and for providing the results of reviews in a more accessible format.

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either "effects of smoking on pain" or "effects of pain on smoking". We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (Contains 2 figures, 2 tables and 1 footnote.)

Objective: To examine predictors of opioid abstinence in buprenorphine/naloxone (Bup/Nal)-assisted psychosocial treatment for opioid-dependent youth. Method: Secondary analyses were performed of data from 152 youth (15-21 years old) randomly assigned to 12 weeks of extended Bup/Nal therapy or up to 2 weeks of Bup/Nal detoxification with weekly individual and group drug counseling. Logistic regression models were constructed to identify baseline and during-treatment predictors of opioid-positive urine (OPU) at week 12. Predictors were selected based on significance or trend toward significance (i.e., p less than 0.1), and backward stepwise selection was used, controlling for treatment group, to produce final independent predictors at p less than or equal to 0.05. Results: Youth presenting to treatment with previous 30-day injection drug use and more active medical/psychiatric problems were less likely to have a week-12 OPU. Those with early treatment opioid abstinence (i.e., weeks 1 and 2) and those who received additional nonstudy treatments during the study were less likely to have a week-12 OPU and those not completing 12 weeks of treatment were more likely to have an OPU. Conclusions: Youth with advanced illness (i.e., reporting injection drug use and additional health problems) and those receiving ancillary treatments to augment study treatment were more likely to have lower opioid use. Treatment success in the first 2 weeks and completion of 12 weeks of treatment were associated with lower rates of OPU. These findings suggest that youth with advanced illness respond well to Bup/Nal treatment and identify options for tailoring treatment for opioid-dependent youth presenting at community-based settings. (Contains 3 tables.)

Background: We investigated the role of psychosocial and proximal contextual factors on nicotine dependence in adolescence. Methods: Data on a multiethnic cohort of 6th to 10th graders from the Chicago public schools were obtained from four household interviews conducted with adolescents over two years and one interview with mothers. Structural equation models were estimated on 660 youths who had smoked cigarettes by the first interview. Results: Pleasant initial sensitivity to tobacco use, parental nicotine dependence (ND), adolescent ND and extensiveness of smoking at the initial interview had the strongest total effects on adolescent ND two years later. Perceived peer smoking and adolescent conduct problems were of lesser importance. Parental ND directly impacted adolescent ND two years later and had indirect effects through pleasant initial sensitivity and initial extensiveness of smoking. Parental depression affected initial adolescent dependence and depression but adolescent depression had no effect on ND. The model had greater explanatory power for males than females due partly to the stronger effect of conduct problems on dependence for males than females. Conclusions: The findings underscore the importance of the initial drug experience and familial factors on adolescent nicotine dependence and highlight the factors to be the focus of efforts targeted toward preventing ND among adolescents.

Smith and Farah (2011) presented a scholarly review of critical areas related to their intriguing title "Are Prescription Stimulants 'Smart Pills'?" We contend that they accomplished the main goal of the article, to get the facts straight about possible cognitive enhancement via the nonmedical use of stimulant drugs by individuals without a diagnosis of attention-deficit/hyperactivity disorder (ADHD). At the same time, they justified their main conclusions that (a) individuals are seeking and engaging in nonmedical use of stimulant drugs with the expectations of cognitive enhancement despite uncertainty whether such expectations are valid and (b) on some tasks, there are small average benefits of nonmedical use, but the overall pattern is not clear (e.g., small beneficial effects across most individuals or large beneficial effects only in a few individuals, both of which result in small average effects). We offer comments in 3 areas to amplify key topics mentioned but not emphasized by Smith and Farah: (a) characterization of the cognitive effects of medical use of stimulants to contrast with the cognitive effects of nonmedical use; (b) justification of medical use of stimulants by placement on a normally distributed dimension of behavior rather than categorical diagnosis of ADHD, which varies widely across countries; and (c) evaluation of the potential risks of nonmedical use to individuals and to society (e.g., the likelihood of addiction to stimulant drugs in a small minority of the population) rather than just the potential benefits of cognitive enhancement.

The EU Action Plan on Drugs (2005-2008) calls for member states of the European Union to provide information on five key epidemiological indicators. These are: general population surveys, prevalence and patterns of problem drug use, drug related infectious diseases, drug related deaths and mortality of drug users, and demand for drug treatment. The goal is to improve the comparability of data across the Member States, which is a central task of the EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). Ireland has made progress on a national level in meeting this obligation. Currently the core information systems used to monitor the drugs problem in Ireland and to inform policy making are in the health and law enforcement areas including treatment, mortality and crime data. The dominance of such objective indicators and treatment outcome measures has contributed to obscuring the view of communities experiencing drugs problems on a day to day basis. The data are summations of the individual experience of drug problems and contribute little to understanding the broader question of how drug problem effect communities. This article draws on a community drugs study to review the contribution of traditional indicators of drug problems and consider some of the limitations of this data. It then presents an analysis of community data to identify possible community indicators of drug problems.

This study explores experiences and understandings of people who have engaged with the process of recovery from alcohol or drug problems over a long period of time. Although there is a large body of research studies on recovery, few have examined long-term recovery from a qualitative perspective. The participants in this study were women who have not used alcohol or drugs for 15 years or longer and who described themselves as "in recovery." They have been involved with AA throughout this time. Data were collected using semi-structured interviews in conjunction with participants' drawings. Participants' accounts suggest that their involvement with AA activities and processes over a long period evolved into habitual actions which became interwoven into their ordinary daily activities. It is suggested that the qualitative approach of IPA can be seen as complementing and illuminating quantitative studies. This study can provide a basis for future studies using larger samples or different groups and move towards making more general claims.

The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of anxiety, major depressive disorder, dysthymia, and dependent personality disorder. Quality of life indicators suggested that the flight attendants were slightly above average in life satisfaction for a treatment population. Implications for clinical practice with this population were also discussed.

An existing database was used to compare problem gamblers (N = 138) who presented for treatment of their gambling problem to two other groups: alcohol and/or drug addiction clients who also had a gambling problem (N = 280) or who did not have a gambling problem (N = 2178). Clients with gambling as their primary problem were more likely to be female; employed or retired; more highly educated; married, divorced, or widowed; without legal problems; and older than the other groups. They also had different patterns of recent mental health diagnoses and problematic substance use. The other problem gambling clients were more similar to the substance only clients. These findings indicate that those who present for treatment of problem gambling are a distinct subset of addiction clients who have gambling problems, and emphasize the importance of considering the reasons for seeking treatment, not just the presence of a gambling problem.

The number of people in need of care, support and assistance from afflictions (natural and artificial) keeps expanding by the day. From a simple traditional based dislocation to a sophisticated "man induced" social problems of wars, refugees, drug addiction, homosexuality, HIV/AIDS pandemics etc, the society today (either developed or under-developed) have had to grapple with increasing number of the un-served (mostly adults) requiring different types of support and assistance. As divergent as these problems and the people affected are, the means of resolving these problems by government remains exclusively, contemporary social work practice. This paper is an attempt at appraising the traditional practices with a view to drawing out practices capable of helping resolve some "emerging" social problems. The paper believes that relying on contemporary practice as the official means of resolving social problem, without an attempt at utilizing some traditional practice of resolving problems is absurd. The paper proposes the integration of some practicable traditional practices as solution to some of the "emerging" social problems.

Foetal alcohol spectrum disorder (FASD) is the most common non-genetic cause of learning disability, affecting around 1% of live births in Europe, and costing an estimated $2.9 million per individual across their lifespan. In adulthood, non-reversible brain damage is often compounded by secondary disabilities in adulthood, such as mental health problems and drug addiction. The challenge for today's educators is: "How do we teach children with FASD?" Their unusual style of learning and their extreme challenging behaviour is out of the experience of many teachers. This article, written by Professor Barry Carpenter, OBE, National Director of the Specialist Schools & Academies Trust Complex Learning Difficulties and Disabilities Research Project, considers the status of FASD in the UK, and provides an overview of the author's recent research into effective educational strategies within the framework of "Every Child Matters". Only government-led approaches can lead to improvements in the quality of teaching and learning for children with FASD and their future life chances.

Chronic pain and substance use disorders frequently co-occur. The pharmacological treatment of pain is complicated in individuals with substance use disorders because of the potential for abuse and diversion of many prescription pain medications. One potential approach is to use a combination of cognitive-behavioral and acceptance-based strategies to manage pain and decrease substance misuse with chronic pain acceptance to help increase contact with valued life activities. After reviewing the literature on pain and substance use, this report provides an overview of a new manualized treatment for chronic pain in those with drug or alcohol misuse. Pilot data are presented as preliminary evidence for the feasibility of delivering this intervention to individuals in drug or alcohol treatment. Future directions for research on co-occurring pain and substance use are discussed. (Contains 3 tables.)