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Research from financial stress, disasters, pandemics, and other extreme events, suggests that behavioral health will suffer, including anxiety, depression, and posttraumatic stress symptoms. Furthermore, these symptoms are likely to exacerbate alcohol or drug use, especially for those vulnerable to relapse. The nature of coronavirus disease 2019 (COVID-19) and vast reach of the virus, leave many unknows for the repercussions on behavioral health, yet existing research suggests that behavioral health concerns should take a primary role in response to the pandemic. We propose a 4-step services system designed for implementation with a variety of different groups and reserves limited clinical services for the most extreme reactions. While we can expect symptoms to remit overtime, many will also have longer-term or more severe concerns. Behavioral health interventions will likely need to change overtime and different types of interventions should be considered for different target groups, such as for those who recover from COVID-19, health-care professionals, and essential personnel; and the general public either due to loss of loved ones or significant life disruption. The important thing is to have a systematic plan to support behavioral health and to engage citizens in prevention and doing their part in recovery by staying home and protecting others.

Social support plays a key role in well-being, yet one of the major preventative efforts for reducing the spread of COVID-19 involves social distancing. During times of crisis, social support is emphasized as a coping mechanism. This requires many people to change their typical ways of connectedness and assumes that people have existing healthy relationships or access to technology. The purpose of this article was to explore the potential impact of COVID-19 on loneliness and well-being. Social support is an important consideration for understanding the impact of COVID-19 Psychological First Aid and Skills for Psychological Recovery, which are tools used to inform response methods to help people connect during isolation and are interventions that could be adapted to COVID-specific needs for what may be a prolonged isolation and postisolation. Given the many unknowns of COVID-19, studies are needed to understand the larger behavioral health impact to ensure resources are available, current, and evidence informed. Future studies are also needed to understand how access to technology may help buffer loneliness and isolation and thus improve the social outcomes of the current pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In addition to concern about physical health consequences of COVID-19, many researchers also note the concerning impact on behavioral health and quality of life due to disruption. The purpose of this paper is to explore pathways of COVID-19 behavioral health and quality of life. We found increased anxiety, depression, and alcohol misuse and that the pandemic exacerbated prior problems. Further community indicators also lead to poorer behavioral health and overall decreased quality of life. The nature of COVID-19 and vast reach of the virus suggests that behavioral health concerns should take a primary role in pandemic recovery.

Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.

Objective: To examine which medication could lead to a higher short and long term smoking abstinence in patients with schizophrenia.Methods: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995 – 2011). The cohort consisted of adult smokers with diagnosis of schizophrenia newly initiating cessation medication. Short term and long term outcomes of cessation were measured at 3 weeks and 1 year. Descriptive and chi-square analyses were used to determine the frequencies and associations of patient characteristics with the abstinence outcomes. Logistic regression models were carried out to determine the predictors of short term and long term abstinence. Results: The cohort consisted of 3,976 patients. Abstinence rate was highest for Varenicline, followed by Bupropion, NRT, and lastly combination at week 12. At one year, abstinence rate was highest for Varenicline, followed by combination, NRT, and lastly Bupropion. Age, race, household locations and receiving counseling were associated with abstinence. No significant differences were found between cessation medications. Conclusions: There were no statistically significant differences in quitting with type of cessation medication. Predictors of better abstinence identified included older age, white race, western household location. These factors should be considered when designing future interventions for schizophrenic population as this minority population may need more tailored approaches to achieve a successful cessation outcome.

This mixed methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrated care setting. A two by three factorial design was employed to evaluate three different simulated training conditions with a sample of 22 Masters level behavioral health students. Results support engagement in virtual patient simulation training to increase students’ self-efficacy in brief clinical assessment, and support the use of virtual patient simulations to improve diagnostic accuracy. Results further indicate that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training. Future directions and next steps for the integration of technology enhanced simulations in clinical social services education are explored.

Residing in Mexican American barrios might place individuals at heightened risk for chronic financial and acute stress, which are associated with adverse mental health outcomes. Stressors could be exacerbated for substance users. This research explores relations between chronic financial stress, acute stress, and depressive symptomatology among aging Mexican American heroin and other drug-using men. A prospective cohort study and field-intensive outreach methodology were used to recruit 227 men for in-depth interviews. Participants were categorized into depressed and nondepressed groups based on symptomatology measured by the Center for Epidemiological Studies Depression Scale. Chronic financial stress (i.e., poverty) and acute stress (i.e., Life Events Questionnaire) associated with depressive symptomatology were tested using logistic regression. Findings suggest scores of depressive symptoms among substance users are highly related to chronic financial stress. Community-level interventions targeting chr...

Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.

Background Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. Methods Youth ages 13–24 ( N = 416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. Results Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses ( n = 114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β = 0.55 (0.16), p 0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β = 0.25 (0.09), p = 0.004) and to alcohol use through unmet need (β = 0.20 (0.10), p = 0.04) Conclusions This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

This study presents preliminary feasibility and acceptability data on the use of virtual patient (VP) simulations to develop brief assessment skills within an interdisciplinary care setting. Results support the acceptability of technology-enhanced simulations and offer preliminary evidence for an association between engagement in VP practice simulations and improvements in diagnostic accuracy and clinical interviewing skills. Recommendations and next steps for research on technology-enhanced simulations within social work are discussed.

Purpose: This study assessed the feasibility of virtual reality (VR) exposure as an assessment and treatment modality for youth with social anxiety disorder (SAD). Methods: Forty-one adolescents, 20 of which were identified as having SAD, were recruited from a community sample. Youth with and without SAD were exposed to two social virtual environments—party and public speaking—and two neutral virtual environments. Results: All youth reported significantly higher ratings on the Subjective Units of Distress Scale (SUDS) during the party and public speaking scenarios compared to the two neutral environments, while youth with SAD reported significantly higher SUDS in the public speaking and party environments than those without SAD. Youth also demonstrated acceptable levels of presence and immersion in the VR environments. Discussion: VR exposure treatment appears to be feasible for youth with SAD, highlighting the need for further research on its development.

The influence of the family is not well understood as it relates to drug use behaviors of Hispanic male adults. We examined the family's influence on drug use behavior, as perceived by Hispanic men who use heroin. One-time qualitative interviews were conducted with 21 current and former heroin users who participated in a larger study on long-term heroin use in Mexican-American men. Data were analyzed using a thematic analysis approach. Three main themes emerged: family as a supportive environment for heroin use; heroin as a family legacy; and, the family's strategies for helping to stop using heroin. A sub-theme emerged on the paradox of family involvement, which spanned the three main themes. This research lays a foundation for future work to disentangle the risks and benefits of family involvement to inform culturally-centered therapies and cultural adaptations to traditional therapeutic approaches with Mexican-American men who abuse drugs.

Project Title:Psychosocial Reactions to a Global Pandemic: A Diary Study During COVID-19.Design:The study uses a mixed methods design that includes both a cross-sectional quantitative survey and qualitative diary entries submitted online eight times by student participants.Context of Study:The study timeline spans the full shutdown, phase 1 reopening, and phase 2 reopening of New Orleans Louisiana.Objectives:The study has three primary objectives: (1) To better understand the experiences of Social Work Students during the COVID-19 pandemic; (2) To explore risk and protective factors that influences Social Work Students’ ability to cope with stressors and changes associated with the COVID-19 pandemic; and (3) to track changes over time in coping among Social Work Students during the COVID-19 pandemic.Study Population:Current Master of Social Work (MSW) Students enrolled at Tulane University during the COVID-19 Pandemic will be invited to participate in this study.

The previous scenario is based on a first-person recollection of attending a party that was developed into a virtual reality scenario by Dr. Bordnick at the Virtual Reality Clinical Research Lab. This scenario was used to construct a virtual reality platform to assess and eventually decrease alcohol craving, offering a novel approach to substance abuse treatment.

The OCD Challenge is an interactive self-help website for obsessive compulsive disorder (OCD). OCD is often untreated and many barriers prohibit access to an evidence-based intervention including cost, lack of providers, and stigma. Analysis of 436 website participant's demographic data revealed that 63.1% were female, 80.5% were Caucasian, the mean age was 33.37 and the mean age of onset was 15.37. Results of the 436 website users showed a significant positive correlation between Yale-Brown Obsessive Compulsive Scale (YBOCS) assessment scores and disability as well as anxiety and stress scores. Future studies should examine the feasibility of the OCD Challenge at decreasing OCD, disability, depression, anxiety, and stress scores.

Introduction: Virtual reality (VR) has been shown to be effective in eliciting responses to nicotine cues in cigarette smokers. The primary aim of this study was to investigate whether cigarette-deprived smokers would exhibit increased craving and changes in heart rate when viewing cigarette related cues as compared to non-smoking cues in a VR environment, and the secondary aim was to assess the extent to which self-assessed measures of withdrawal and dependence correlated with VR craving. Methods: Nicotine-dependent cigarette smokers were recruited for a 2 day study. On Day 1, participants smoked as usual and on Day 2 were deprived from smoking overnight. On both days, participants completed self-assessment questionnaires on withdrawal, craving, and nicotine-dependence. Participants completed a VR session during the cigarette deprivation condition only (Day 2). During this session, they were exposed to active smoking and placebo (non-smoking) cues. Results: The data show that self-reported levels of “craving” (p < .01) and “thinking about cigarettes” (p < .0001) were significantly greater after exposure to the active cues versus non-smoking cues. Significant increases in heart rate were found for 3 of 4 active cues when compared to non-smoking cues (p < .05). Finally, significant positive correlations were found between self-reported craving prior to the VR session and craving induced by active VR cues (p < .01). Conclusions: In this report, active VR cues elicited craving during cigarette deprivation. This is the first study to demonstrate that self-reported craving, withdrawal symptoms, and nicotine dependence severity predict cue-induced craving in the VR setting.

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.

Objectives: The cue-reactivity paradigm has been widely used to assess craving among cigarette smokers. Seeking to replicate and expand on previous virtual reality (VR) nicotine cue-reactivity research on nontreatment-seeking smokers, the current study compared subjective reports of craving for cigarettes when exposed to smoking (proximal and contextual) and neutral cues using VR in treatment-seeking and nontreatment-seeking cigarette smokers. Methods: Data from two previously published studies in nontreatment seekers from our group (Bordnick et al., 2004; Bordnick, Graap, Copp, Brooks, & Ferrer, 2005) were compared to results with 82 newly enrolled treatment-seeking smokers. Results: Overall, VR cues produced similar levels of craving for both treatment seekers and nontreatment seekers across the different cue environments. Specifically, craving was greater for both groups in smoking environments (paraphernalia and party) than those in the neutral environments. Conclusions: These findings provide strong evidence that VR is a useful tool that may be used by social workers and other clinical professionals to present smoking (proximal and contextual) cues for assessment and treatment and illustrate the utility of standardizing VR procedures to compare craving between different groups.

Rates of cigarette smoking are 3- to 4-fold greater among those with cocaine-dependence, and compared to non-users, cocaine users are at greater risk of incurring smoking-related negative health effects and death. The current study examined D-cycloserine's (0 or 50 mg once weekly) effects on 1) extinction of cue-induced craving for cigarettes, 2) cigarette smoking in conjunction with cognitive–behavioral therapy, and 3) safety and tolerability in cocaine-dependent smokers. This was a double-blind, placebo-controlled, between groups, outpatient study. Participants (N = 29) were concurrent cocaine- and nicotine-dependent volunteers seeking treatment for their cigarette smoking. Study visits were 3 times per week for 4 consecutive weeks. At each visit, participants received cognitive–behavioral therapy for smoking, were exposed to smoking cues. A subset of participants (N = 22) returned for 6-month follow-up visits. While craving decreased, no significant effects of D-cycloserine treatment were observed. Likewise, significant decreases in smoking were observed at study days 6 (p

Background Smoking cessation may lead to depression in some smokers and result in increased risk of suicide. Objective To compare the risk of suicide attempts/behaviors associated with different smoking cessation medications among schizophrenic patients. Methods A retrospective cohort study was conducted using General Electric (GE) medical record database (1995–2011). The first day of being prescribed a smoking cessation medication defined as index date. Patients were followed up to one year from index date. Patients' suicide behaviors or attempts were identified through ICD-9 codes and E-codes. Cox proportional hazards model was applied to examine the association between smoking cessation medication and suicidal/self-injurious behaviors. Results Our cohort consisted of 3925 patients with diagnosis of schizophrenia or schizoaffective disorder who initiated cessation medication. Among them, 104 (2.65%) had suicide attempts or behavior within one-year follow up. However, statistically significant difference in the risk of suicide attempts/behaviors was not detected across cessation regimens in the Cox proportional hazard analysis. Only comorbidity index was found to be associated with suicide, which showed that higher Charlson comorbidity index was associated with higher risks of suicide behaviors within one year (HR = 1.15, 95% CI = 1.04–1.27). Conclusion There were no significant differences in suicide attempts/behaviors with different cessation medications.

This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 partici- pants completed treatment. The PTSD Checklist-Military version, Patient Health Questionnaire-9 for depression, and the Beck Anxiety Inventory were used as outcome measures. Of those who completed post-treatment assessment, 75% had experienced at least a 50% reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post treatment. Average PSTD scores decreased by 50.4%, depression scores by 46.6%, and anxiety scores by 36%. Intention-to-treat analyses showed that statistically significant improvements in PTSD, depression, and anxiety occurred over the course of treatment and were maintained at follow up. There were no adverse events associated with VRET treatment. This study provides preliminary support for the use of VRET in combat-related PTSD. Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities.

Obsessive Compulsive Disorder (OCD) is a neurobiological illness characterized by unwanted thoughts and/or images followed by repetitive rituals. About 5 million Americans live with Obsessive Compulsive Disorder. OCD is a manageable illness when proper interventions are utilized. Treatment for OCD is limited due to the lack of adequately trained professionals and the high costs of treatment. Cognitive behavioral therapy (CBT) in conjunction with exposure with response prevention (ERP) is the most effective intervention modality available for OCD. To address the treatment gap, an online, interactive self-help website was developed for those living with OCD without access to an effective intervention. This report will explore development of the OCD Challenge website and future implications of its use.

Cue reactivity assessments have been widely used to assess craving and attention to cues among cigarette smokers. Cue reactivity has the potential to offer insights into treatment decisions; however, the use of cue reactivity in treatment studies has been limited. This study assessed the feasibility of using a virtual reality–based cue reactivity assessment approach (VR-NCRAS) during treatment. In a clinical smoking cessation treatment study, 46 treatment-seeking nicotine-dependent adult smokers were assessed for cue reactivity at baseline, Week 4, and Week 10 of treatment. Measures of cue reactivity included subjective craving and attention to cues after exposure to two neutral and two smoking cue environments. Overall, feasibility of using VR-NCRAS was demonstrated and these findings support the use of the cue reactivity assessment during treatment, which can inform treatment decisions.

Virtual reality (VR)-based cue reactivity has been successfully used for the assessment of drug craving. Going beyond assessment of cue reactivity, a novel VR-based treatment approach for smoking cessation was developed and tested for feasibility.In a randomized experiment, 10-week treatment feasibility trial, 46 nicotine-dependent adults, completed the10-week program. Virtual reality skills training (VRST) combined with nicotine replacement therapy (NRT) was compared to NRT alone. Participants were assessed for smoking behavior and coping skills during, at end of treatment, and at posttreatment follow-up.Smoking rates and craving for nicotine were significantly lower for the VRST group compared to NRT-only group at the end of treatment. Self-confidence and coping skills were also significantly higher for the VRST group, and number of cigarettes smoked was significantly lower, compared to the control group at follow-up.Feasibility of VRST was supported in the current study.

Alcohol and cigarette smoking frequently co-occur among adults in the U.S., resulting in a myriad of deleterious health outcomes. Cue reactivity has been posited as one factor that precludes individuals from overcoming alcohol and nicotine dependency. While cue reactivity studies have focused on the impact of proximal cues on cue reactivity, much less is known about the unique impact of complex and contextual cues. This pilot study compares nicotine and alcohol cue reactivity among a sample of nicotine dependent, daily drinkers (N = 21) across neutral, party, and office courtyard virtual reality (VR) contexts embedded with proximal smoking cues to: 1) explore and compare the effects of complex nicotine cues on alcohol cross-cue reactivity between nicotine/alcohol dependent drinkers and nicotine dependent/non-alcohol dependent daily drinkers, and 2) assess the effectiveness of VR for eliciting cue-induced nicotine craving responses using complex nicotine cues. Nicotine dependent/non-alcohol dependent drinkers had significantly lower craving for alcohol in the non-alcohol congruent office courtyard VR scene and there was no difference in the alcohol-congruent party scene when compared to the alcohol dependent group, suggesting that the non-alcohol dependent daily drinking group was more likely to react to contextual cues. Consistent with prior cue reactivity studies, dependent smokers experienced significantly higher craving for nicotine in the VR smoking congruent contexts compared to the neutral contexts; however, nicotine/alcohol dependent participants did not return to baseline craving after exposure to smoking cues. These results suggest substantive differences in the ways that nicotine-dependent, daily alcohol drinkers and nicotine/alcohol dependent drinkers experience craving, whether cross-cue or traditional.

Cigarette smokers in laboratory experiments readily respond to smoking stimuli with increased craving. An alternative to traditional cue-reactivity methods (e.g., exposure to cigarette photos), virtual reality (VR) has been shown to be a viable cue presentation method to elicit and assess cigarette craving within complex virtual environments. However, it remains poorly understood whether contextual cues from the environment contribute to craving increases in addition to specific cues, like cigarettes. This study examined the role of contextual cues in a VR environment to evoke craving. Smokers were exposed to a virtual convenience store devoid of any specific cigarette cues followed by exposure to the same convenience store with specific cigarette cues added. Smokers reported increased craving following exposure to the virtual convenience store without specific cues, and significantly greater craving following the convenience store with cigarette cues added. However, increased craving recorded after the second convenience store may have been due to the pre-exposure to the first convenience store. This study offers evidence that an environmental context where cigarette cues are normally present (but are not), elicits significant craving in the absence of specific cigarette cues. This finding suggests that VR may have stronger ecological validity over traditional cue reactivity exposure methods by exposing smokers to the full range of cigarette-related environmental stimuli, in addition to specific cigarette cues, that smokers typically experience in their daily lives.

The purpose of this preliminary investigation was to examine the effectiveness of attachment therapy for adopted children diagnosed with Reactive Attachment Disorder (RAD). Although attachment therapy is widely utilized in the practice community, outcomes of such therapy have not been well documented. In this study a pretest–posttest one-group design was used with a sample of 24 adopted children who received attachment therapy from trained, licensed therapists. Therapy was funded by the Georgia Office of Adoptions under a contract with a non-profit adoptive parent advocacy group which provided training of therapists and direct services to families. RAD was measured with the Randolph Attachment Disorder Questionnaire (RADQ), Third Edition; functional impairment was measured with the Child and Adolescent Functional Assessment Scale (CAFAS). Statistically significant decreases in scores on the RADQ and CAFAS from pretests to posttests indicate improvement for the children who received therapy. In spite of methodological limitations, the current study adds to the limited knowledge about effective treatment for RAD.

The use of virtual reality (VR) programs in behavioral science research has been gaining prominence over the past several years. In the field of substance abuse, VR cue reactivity programs have been successfully tested for feasibility in nicotine and cocaine dependent samples. Seeking to expand VR applications in alcohol cue research, a novel VR alcohol cue reactivity assessment system incorporating visual, auditory, and olfactory stimuli was developed and tested. In a controlled trial, 40 non-treatment-seeking drinkers with alcohol use disorders were exposed to VR alcohol cue environments. Subjective craving, attention to alcohol cues, and level of presence (realism of experience) in VR were assessed across the environments. Overall, subjective craving for alcohol increased across the VR alcohol-related cue environments versus VR neutral cue environments. Participants reported high levels of presence in VR, indicating that the environments were perceived as realistic and compelling. These initial findings support the use of VR based cue reactivity environments for use in alcohol cue-based treatment and research.

Cigarette smokers, when confronted with cues associated with smoking, evidence strong reactions, including increased craving. These reactions have not been extensively studied in young adult smokers, a group that research suggests may respond differently than adults or adolescent smokers. We used virtual reality, which presents a complex array of smoking cues that may be particularly salient to young adult smokers, and measured self-report of craving. Young adult smokers responded strongly to these cues and, unlike adults, did not return to a baseline of craving following cue exposure, suggesting young adult smokers differ from other smokers in terms of cue responses.

Posttraumatic stress disorder (PTSD) is associated with depression, alcohol use disorders and physical health problems. Subthreshold posttraumatic syndromes may contribute to these problems. Participants were previously deployed male peacekeepers who completed a battery of questionnaires, including measures of PTSD symptoms, depression, alcohol use, and physical health. Statistically significant differences were found 1) between groups with full and no PTSD on depressive symptoms, alcohol use disorders, and physical health problems, and 2) between subthreshold and no PTSD groups on depression and physical health problems. Results suggest subthreshold PTSD represents a distinct construct warranting further investigation.

Statewide evaluations of mental health services are colossal undertakings, reports of which are few in the published literature. Social workers are often called on to conduct program evaluations of both small-and large-scale mental health systems. A statewide evaluation system was implemented in the state of Georgia in 1999 to measure the impact of services on mental health, mental retardation, and substance abuse programs. This report delineates the evaluation of substance abuse services for the state of Georgia using the Addiction Severity Index. System-wide outcomes were assessed across 13 mental health regions, and 19 substance abuse programs participated. Consumers admitted to American Society of Addiction Medicine level II services were assessed at intake and 60 days posttreatment. Difficulties with the implementation of the statewide evaluation system, such as attrition, are identified and discussed. Recommendations for improving the evaluation system are also discussed.

Crack cocaine use and dependence has been steadily increasing since the mid-1980s. Treatment approaches vary from simple psychotherapy to intensive medication regimens. One clear phenomenon that has been implicated in the continued use and abuse of crack cocaine is craving. Craving is believed to be a response that has been conditioned with previous drug using episodes, and is elicited by environmental cues. The current study investigated the use of three aversion therapies (chemical, covert sensitization, and faradic) designed to eliminate craving for cocaine. Seventy subjects were randomly assigned to one of three aversion treatments or a relaxation control condition. Results indicate that aversion therapy reduces crack cocaine craving. The use of aversion therapy as an adjunct to traditional treatment programs for reducing craving is discussed. Copyright © 2004 John Wiley & Sons, Ltd.

Alcohol use disorders are primarily characterized by excessive consumption of alcohol and the behavioral, cognitive, and psychosocial problems associated with problem drinking. Although social workers are routinely involved in the treatment of people with problems related to alcohol, there is limited literature in professional social work concerning practical assessment instruments that social workers may use to guide effective practice. This article reviews a number of empirically supported instruments for the diagnosis and assessment of alcohol dependence and abuse in social work practice settings.

Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a)20 years; b) 20-25 years, and c)25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20-25-year onset group usually had intermediate scores. The20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogeneous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments.

This study examined the relationship between verbal reports of craving and actual cocaine use across different treatment phases using a longitudinal design. Participants (n = 32) were cocaine-dependent patients who completed an inpatient chemical dependency program and then participated in an 8-week outpatient relapse prevention program. Craving ratings and urine samples were collected during hospitalization, at 12 weekly outpatient treatment sessions, and at 1, 2, 4, 8, 12, and 24-week follow-up. Craving increased significantly from inpatient to outpatient treatment. Cocaine-abstinent participants reported lower craving across outpatient treatment and follow-up compared to moderate and heavy cocaine users. The overall relationship between craving and total proportion of cocaine positive urines was highly significant. Implications of these findings for advancing our theoretical and practical knowledge about craving and cocaine use, are explored.

This paper describes an evaluation of the potential efficacy of adult in-patient psychiatric treatment provided at a private general hospital. Using a simple pretest-posttest group design, 78 consecutively admitted patients, and a valid measure of psychiatric symptomatology (Symptom Checklist-90-R), it was found that the diverse group of patients were statistically significantly improved at discharge, relative to their admission status. This study illustrates a practical effort by social workers to integrate simple evaluative efforts into routine clinical services provided by mental health facilities, efforts consistent with managed care, the demands of third-party-payers, and the profession's initiatives in the direction of empirically-based practice.

Cocaine dependent patients ( n =27) with and without concurrent alcohol dependence disorder were compared on measures of substance use, addiction severity (ASI), coping, and psychopathology taken before, during, and after outpatient relapse prevention treatment for cocaine dependence. At pre-treatment, the cocaine–alcohol (CA) group reported more frequent alcohol use, and more severe alcohol and family/social problems compared to the cocaine-only (CO) group. By the end of treatment, both groups reported significantly fewer days of alcohol and cocaine use, with sustained reductions observed at 24 weeks following treatment. On most of the addiction severity and psychiatric symptomatology scales, results indicated overall improvement as a function of time, however scores remained relatively `worse' in the CA group. Implications of these findings and the need for specific programming in the treatment of dual drug use are explored.

Background This study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users. Methods Secondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one's place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one's place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase. Results Participants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization. Conclusion The findings showed that the presence of outpatient treatment facilities—particularly services in Spanish—may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.

The validity of conceptualizing trichotillomania (TCM) and obsessive-compulsive disorder (OCD) as separate and distinct diagnoses was examined in a study of 20 patients with each disorder. A comparison of demographic, psychometric, and clinical features between the two groups revealed a number of statistically significant differences. Patients meeting the criteria for OCD scored higher on measures of psychiatric symptomatology including ratings of obsessions and compulsions, depression, interpersonal sensitivity, general anxiety, phobic anxiety, and psychoticism. Patients meeting the criteria for TCM reported an earlier age at onset than those with OCD. Stressors associated with onset were also significantly different between groups. These results support the validity of conceptualizing TCM and OCD as differing behavioral disorders.