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Sample records for abuse treatment clinical

  1. HIV Rapid Testing in Substance Abuse Treatment: Implementation Following a Clinical Trial

    Science.gov (United States)

    Haynes, L. F.; Korte, J. E.; Holmes, B. E.; Gooden, L.; Matheson, T.; Feaster, D. J.; Leff, J. A.; Wilson, L.; Metsch, L. R.; Schackman, B. R.

    2011-01-01

    The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial,…

  2. Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: the National Drug Abuse Treatment Clinical Trials Network.

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    Brown, Lawrence S; Kritz, Steven Allan; Goldsmith, R Jeffrey; Bini, Edmund J; Rotrosen, John; Baker, Sherryl; Robinson, Jim; McAuliffe, Patrick

    2006-06-01

    Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the "Infections and Substance Abuse" study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy.

  3. Differences in methylphenidate abuse rates among methadone maintenance treatment patients in two clinics.

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    Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam

    2015-07-01

    Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Influence networks among substance abuse treatment clinics: implications for the dissemination of innovations.

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    Johnson, Kimberly; Quanbeck, Andrew; Maus, Adam; Gustafson, David H; Dearing, James W

    2015-09-01

    Understanding influence networks among substance abuse treatment clinics may speed the diffusion of innovations. The purpose of this study was to describe influence networks in Massachusetts, Michigan, New York, Oregon, and Washington and test two expectations, using social network analysis: (1) Social network measures can identify influential clinics; and (2) Within a network, some weakly connected clinics access out-of-network sources of innovative evidence-based practices and can spread these innovations through the network. A survey of 201 clinics in a parent study on quality improvement provided the data. Network measures and sociograms were obtained from adjacency matrixes created by UCINet. We used regression analysis to determine whether network status relates to clinics' adopting innovations. Findings suggest that influential clinics can be identified and that loosely linked clinics were likely to join the study sooner than more influential clinics but were not more likely to have improved outcomes than other organizations. Findings identify the structure of influence networks for SUD treatment organizations and have mixed results on how those structures impacted diffusion of the intervention under study. Further study is necessary to test whether use of knowledge of the network structure will have an effect on the pace and breadth of dissemination of innovations.

  5. A longitudinal study of organizational formation, innovation adoption, and dissemination activities within the National Drug Abuse Treatment Clinical Trials Network.

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    Roman, Paul M; Abraham, Amanda J; Rothrauff, Tanja C; Knudsen, Hannah K

    2010-06-01

    The National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) to conduct trials of promising substance abuse treatment interventions in diverse clinical settings and to disseminate results of these trials. This article focuses on three dimensions of CTN's organizational functioning. First, a longitudinal dataset is used to examine CTN's formation as a network of interorganizational interaction among treatment practitioners and researchers. Data indicate strong relationships of interaction and trust, but a decline in problem-centered interorganizational interaction over time. Second, adoption of buprenorphine and motivational incentives among CTN's affiliated community treatment programs (CTPs) is examined over three waves of data. Although adoption is found to increase with CTPs' CTN participation, there is only modest evidence of widespread penetration and implementation. Third, CTPs' pursuit of the CTN's dissemination goals are examined, indicating that such organizational outreach activities are underway and likely to increase innovation diffusion in the future.

  6. Technology transfer for the implementation of a clinical trials network on drug abuse and mental health treatment in Mexico.

    Science.gov (United States)

    Horigian, Viviana E; Marín-Navarrete, Rodrigo A; Verdeja, Rosa E; Alonso, Elizabeth; Perez, María A; Fernández-Mondragón, José; Berlanga, Carlos; Medina-Mora, María Elena; Szapocznik, José

    2015-09-01

    Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011-2013. The Florida Node Alliance shared the "know how" for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented.

  7. Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study.

    Science.gov (United States)

    McClure, Erin A; Campbell, Aimee N C; Pavlicova, Martina; Hu, Meichen; Winhusen, Theresa; Vandrey, Ryan G; Ruglass, Lesia M; Covey, Lirio S; Stitzer, Maxine L; Kyle, Tiffany L; Nunes, Edward V

    2015-06-01

    The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (aim #1), specifically among those in the experimental treatment group (aim #2), and the moderating effect of being a smoker on treatment outcomes (aim #3). Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. The use and abuse of attachment theory in clinical practice with maltreated children, part II: treatment.

    Science.gov (United States)

    Allen, Brian

    2011-01-01

    Recent years have witnessed a growing debate about the role of attachment theory in the treatment of maltreated children. Many professional organizations have issued statements against physically restraining children as some attachment therapists promote; however, often lost in these debates is the fundamental issue of what attachment theory and research proposes as the appropriate form of treatment. Given that these attachment therapies are often directed toward maltreated children, it becomes critical for clinicians working with abused and neglected children to understand these issues and recognize unethical and dangerous treatments. This article provides a summary of the theoretical and empirical bases for the use of attachment theory in the treatment of maltreated school-age children, an examination of the ways questionable approaches to treatment have misinterpreted and misapplied attachment theory, and a conceptualization of attachment-based intervention grounded in current theory and research.

  9. Demographic and clinical profile of substance abusing women seeking treatment at a de-addiction center in north India

    Directory of Open Access Journals (Sweden)

    Naresh Nebhinani

    2013-01-01

    Full Text Available Background: In the recent decades increasing number of women have been seeking deaddiction services. Despite that the report data is very limited from India. Objectives: The present research aimed to study the demographic and clinical profile of women seeking deaddiction treatment at a tertiary care center in North India. Materials and Methods: Retrospective structured chart review of 100 women substance abusers seeking treatment at a deaddiction center between September 1978 and December 2011. Results: A typical case was of 36.3 years age, married (65%, urban (61%, nuclear family (59% based housewife (56%, with good to fair social support (69%. The commonest substance of abuse was tobacco (60%, followed by opioids (27%, alcohol (15%, and benzodiazepines (13%. The common reasons for initiation of substance use were to alleviate frustration or stress (49% and curiosity (37%. Family history of drug dependence (43%, comorbidity (25%, and impairments in health (74%, family (57%, and social domains (56% were common. Only a third of the sample paid one or more follow visit, and of those 58% were abstinent at the last follow-up. Significant predictors identified were being non-Hindu and higher educational years for abstinent status at follow-up. Conclusion: The common substances of abuse were tobacco, opioids, and alcohol and benzodiazepines; and family history of drug abuse and comorbidity were common. The follow-up and outcome were generally poor. This profile gives us some clues to address a hidden health problem of the community.

  10. Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.

    Science.gov (United States)

    Peirce, Jessica M; Petry, Nancy M; Stitzer, Maxine L; Blaine, Jack; Kellogg, Scott; Satterfield, Frank; Schwartz, Marion; Krasnansky, Joe; Pencer, Eileen; Silva-Vazquez, Lolita; Kirby, Kimberly C; Royer-Malvestuto, Charlotte; Roll, John M; Cohen, Allan; Copersino, Marc L; Kolodner, Ken; Li, Rui

    2006-02-01

    Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

  11. Expanding the National Drug Abuse Treatment Clinical Trials Network to address the management of substance use disorders in general medical settings

    Directory of Open Access Journals (Sweden)

    Tai B

    2014-07-01

    Full Text Available Betty Tai, Steven Sparenborg, Udi E Ghitza, David Liu Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA Abstract: The Patient Protection and Affordable Care Act (2010 and the Mental Health Parity and Addiction Equity Act (2008 expand substance use disorder (SUD care services in the USA into general medical settings. Care offered in these settings will engage substance-using patients in an integrated and patient-centered environment that addresses physical and mental health comorbidities and follows a chronic care model. This expansion of SUD services presents a great need for evidence-based practices useful in general medical settings, and reveals several research gaps to be addressed. The National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse can serve an important role in this endeavor. High-priority research gaps are highlighted in this commentary. A discussion follows on how the National Drug Abuse Treatment Clinical Trials Network can transform to address changing patterns in SUD care to efficiently generate evidence to guide SUD treatment practice within the context of recent US health care legislation. Keywords: Patient Protection and Affordable Care Act, National Drug Abuse Treatment Clinical Trials Network, substance use disorders, practice-based research network, electronic health records

  12. Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes

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    Deborah C. Mash

    2018-06-01

    Full Text Available Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures. We reviewed clinical results from an open label case series (N = 191 of human volunteers seeking to detoxify from opioids or cocaine with medical monitoring during inpatient treatment. Whole blood was assayed to obtain pharmacokinetic measures to determine the metabolism and clearance of ibogaine. Clinical safety data and adverse events (AEs were studied in male and female subjects. There were no significant adverse events following administration of ibogaine in a dose range that was shown to be effective for blocking opioid withdrawal symptoms in this study. We used multi-dimensional craving questionnaires during inpatient detoxification to test if ibogaine was effective in diminishing heroin and cocaine cravings. Participants also completed standardized questionnaires about their health and mood before and after ibogaine treatment, and at program discharge. One-month follow-up data were reviewed where available to determine if ibogaine’s effects on drug craving would persist outside of an inpatient setting. We report here that ibogaine therapy administered in a safe dose range diminishes opioid withdrawal symptoms and reduces drug cravings. Pharmacological treatments for opioid dependence include detoxification, narcotic antagonists and long-term opioid maintenance therapy. Our results support product development of single oral dose administration of ibogaine for the treatment of opioid

  13. Medical marijuana users in substance abuse treatment

    OpenAIRE

    Swartz Ronald

    2010-01-01

    Abstract Background The rise of authorized marijuana use in the U.S. means that many individuals are using cannabis as they concurrently engage in other forms of treatment, such as substance abuse counseling and psychotherapy. Clinical and legal decisions may be influenced by findings that suggest marijuana use during treatment serves as an obstacle to treatment success, compromises treatment integrity, or increases the prevalence or severity of relapse. In this paper, the author reviews the ...

  14. Triggers of Substance Abuse Slip and Relapse During Outpatient Treatment in Methadone/Buprenorphine Maintenance Therapy Clinics: A Predictive Model with Emphasis on Treatment-Related Factors

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    Saeid Komasi

    2017-07-01

    Full Text Available Background Most addicts relapse in the first year of treatment especially in the first 3 - 6 months, which is the most vulnerable period. Objectives The present study aimed to assess the predictors of substance abuse slip and relapse among addicts in the first 6 months of treatment with an emphasis on treatment related factors. Methods The data of this cross-sectional study collected through assessment of 148 patients who were referred to the Methadone/Buprenorphine maintenance therapy clinics of Kermanshah city during April to September of 2015. Demographic, history, treatment checklist, comorbidity index, and medical records were used for collecting data. Data was analyzed through chi-square, t-test, and Binary logistic regression analysis. Results The mean age of total participants was 42.4 ± 11.3 years and 98% of them were male. 27% and 35.1% of the patients, respectively, had a slip and relapse during the first 6 months of treatment. After adjustment for all demographic data, it was indicated that self-employment (P = 0.037, more treatment costs (P = 0.049, previous treatment history (P = 0.027, not satisfied dose of medication (P = 0.012, and lack of medical therapy history under physicians supervision (P = 0.046 can increase the possibility of a slip significantly. Conclusions Despite the fact that prevention of re-abuse and relapse of disease includes multi-factorial approach, it seems that the treatment-related factors are as the most major factors in relapse and slip during the first 6 months of treatment. Health practitioners’ special attention to treatment related factors in addiction, especially previous treatment history as the most important predictor of relapse, are probably effective in the control and decrease of a slip and relapse.

  15. Addressing Trauma in Substance Abuse Treatment

    Science.gov (United States)

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  16. Reforming Dutch substance abuse treatment services.

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    Schippers, Gerard M; Schramade, Mark; Walburg, Jan A

    2002-01-01

    The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior-oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

  17. Overview: Clinical Identification of Sexually Abused Children.

    Science.gov (United States)

    Corwin, David L.; Olafson, Erna

    1993-01-01

    This introduction to the special issue on clinical identification of sexually abused children reviews the history of the study of child sexual abuse and describes the 14 papers included in the special issue. (JDD)

  18. The national drug abuse treatment clinical trials network data share project: website design, usage, challenges, and future directions.

    Science.gov (United States)

    Shmueli-Blumberg, Dikla; Hu, Lian; Allen, Colleen; Frasketi, Michael; Wu, Li-Tzy; Vanveldhuisen, Paul

    2013-01-01

    There are many benefits of data sharing, including the promotion of new research from effective use of existing data, replication of findings through re-analysis of pooled data files, meta-analysis using individual patient data, and reinforcement of open scientific inquiry. A randomized controlled trial is considered as the 'gold standard' for establishing treatment effectiveness, but clinical trial research is very costly, and sharing data is an opportunity to expand the investment of the clinical trial beyond its original goals at minimal costs. We describe the goals, developments, and usage of the Data Share website (http://www.ctndatashare.org) for the National Drug Abuse Treatment Clinical Trials Network (CTN) in the United States, including lessons learned, limitations, and major revisions, and considerations for future directions to improve data sharing. Data management and programming procedures were conducted to produce uniform and Health Insurance Portability and Accountability Act (HIPAA)-compliant de-identified research data files from the completed trials of the CTN for archiving, managing, and sharing on the Data Share website. Since its inception in 2006 and through October 2012, nearly 1700 downloads from 27 clinical trials have been accessed from the Data Share website, with the use increasing over the years. Individuals from 31 countries have downloaded data from the website, and there have been at least 13 publications derived from analyzing data through the public Data Share website. Minimal control over data requests and usage has resulted in little information and lack of control regarding how the data from the website are used. Lack of uniformity in data elements collected across CTN trials has limited cross-study analyses. The Data Share website offers researchers easy access to de-identified data files with the goal to promote additional research and identify new findings from completed CTN studies. To maximize the utility of the website

  19. Design paper: The CapOpus trial: a randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Anne-Mette

    2008-01-01

    : The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. DESIGN: The trial is designed as a randomized, parallel-group, observer-blinded clinical...

  20. Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study.

    Science.gov (United States)

    Weiss, Roger D; Potter, Jennifer Sharpe; Griffin, Margaret L; Provost, Scott E; Fitzmaurice, Garrett M; McDermott, Katherine A; Srisarajivakul, Emily N; Dodd, Dorian R; Dreifuss, Jessica A; McHugh, R Kathryn; Carroll, Kathleen M

    2015-05-01

    Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS). POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences. At Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR=4.56, 95% CI=1.29-16.04, popioid abstinence. Eight percent (n=27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use. Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Medical marijuana users in substance abuse treatment

    Directory of Open Access Journals (Sweden)

    Swartz Ronald

    2010-03-01

    Full Text Available Abstract Background The rise of authorized marijuana use in the U.S. means that many individuals are using cannabis as they concurrently engage in other forms of treatment, such as substance abuse counseling and psychotherapy. Clinical and legal decisions may be influenced by findings that suggest marijuana use during treatment serves as an obstacle to treatment success, compromises treatment integrity, or increases the prevalence or severity of relapse. In this paper, the author reviews the relationship between authorized marijuana use and substance abuse treatment utilizing data from a preliminary pilot study that, for the first time, uses a systematic methodology to collect data examining possible effects on treatment. Methods Data from the California Outcomes Measurement System (CalOMS were compared for medical (authorized marijuana users and non-marijuana users who were admitted to a public substance abuse treatment program in California. Behavioral and social treatment outcomes recorded by clinical staff at discharge and reported to the California Department of Alcohol and Drug Programs were assessed for both groups, which included a sample of 18 reported medical marijuana users. Results While the findings described here are preliminary and very limited due to the small sample size, the study demonstrates that questions about the relationship between medical marijuana use and involvement in drug treatment can be systematically evaluated. In this small sample, cannabis use did not seem to compromise substance abuse treatment amongst the medical marijuana using group, who (based on these preliminary data fared equal to or better than non-medical marijuana users in several important outcome categories (e.g., treatment completion, criminal justice involvement, medical concerns. Conclusions This exploratory study suggests that medical marijuana is consistent with participation in other forms of drug treatment and may not adversely affect

  2. Supervisory Turnover in Outpatient Substance Abuse Treatment

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    Knight, Danica K.; Broome, Kirk M.; Edwards, Jennifer R.; Flynn, Patrick M.

    2009-01-01

    Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the USA. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover. PMID:19949883

  3. Clinical importance of caffeine dependence and abuse.

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    Ogawa, Naoshi; Ueki, Hirofumi

    2007-06-01

    Caffeine is the most widely consumed psychoactive substance and is a legal stimulant that is readily available to children. Caffeine has occasionally been considered a drug of abuse and the potential for dependence on caffeine has been debated. Presently, due to a paucity of clinical evidence on caffeine dependence or abuse, no such diagnosis is included in the Diagnostic and Statistical Manual of Mental Disorder-fourth edition. The authors present two cases of abuse or dependence on the caffeine contained in 'eutrophic' (energy/nutritional) beverages or caffeine preparations, followed by a review of clinical studies demonstrating evidence that some people can manifest a clinical syndrome of caffeine dependence or abuse. The cases suggest that caffeine can produce a clinical dependence syndrome similar to those produced by other psychoactive substances and has a potential for abuse. In a recent study using a structured interview and the Diagnostic and Statistical Manual of Mental Disorder-fourth edition criteria for substance dependence and abuse, a subset of the general population was found to demonstrate caffeine dependence or caffeine abuse. Therefore, the authors propose that companies or businesses manufacturing or marketing caffeine or products containing caffeine must meet the following guidelines: (i) clearly indicate the caffeine content of products containing comparatively higher quantities of caffeine; (ii) warn that such products should be avoided by infants and children wherever possible, and inform adult consumers about the precise quantity of caffeine that is considered safe for consumption; and (iii) clearly state that consuming large quantities of caffeine and the long-term use of caffeine carry health risks.

  4. Design paper: The CapOpus trial: A randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2008-07-01

    Full Text Available Abstract Background A number of studies indicate a link between cannabis-use and psychosis as well as more severe psychosis in those with existing psychotic disorders. There is currently insufficient evidence to decide the optimal way to treat cannabis abuse among patients with psychosis. Objectives The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. Design The trial is designed as a randomized, parallel-group, observer-blinded clinical trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1 specialized addiction treatment plus treatment as usual or 2 treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient. The primary outcome measure will be changes in amount of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. Trial registration ClinicalTrials.gov NCT00484302.

  5. Residential Treatment Centers for Child Abuse

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    Serhat Nasiroglu

    2014-02-01

    Full Text Available Every year millions of reports are being held and cases regarding those reports in courts are carrying on about abusement and omission against children . Abusement against children has been seen throughout of the history. Significant and permanent impacts can occur upon child abusement and neglect on victim children. It is important to know the psychological dynamics which have been lived by the children by the mental health professionalsto protect the children after the abusement report has been written. Cognitive Behaviour Therapy and medications are being used commonly in the treatment of abusement cases. However in some cases it is necessary to send away the victims from environment, enable them to continue their education life, make sure that they are treated by the professional individuals in safe area. For this end there are many Residential Treatment Centers around the world. and ldquo;Oguz Kagan Koksal Social Care and Rehabilitation Center and rdquo; was established in Adana as the first Residential Treatment Center in Turkey. In this report the historical dimensions of the child abusement, the definition of it, its psychological dynamics, the psychological disorders caused by it, treatment approaches and residential treatment centers have been reviewed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(1.000: 67-78

  6. What Sex Abusers Say about Their Treatment: Results from a Qualitative Study on Pedophiles in Treatment at a Canadian Penitentiary Clinic

    Science.gov (United States)

    Drapeau, Martin; Korner, Annett C.; Granger, Luc; Brunet, Louis

    2005-01-01

    This exploratory study used qualitative methodology to examine what pedophiles think about treatment, as well as their daily experience of a treatment program. To this end, twenty-three offenders receiving treatment from the La Macaza federal penitentiary clinic were interviewed using non-directive semi-structured interviews. Comparative analysis…

  7. Vaccines against drugs of abuse: a viable treatment option?

    Science.gov (United States)

    Kantak, Kathleen M

    2003-01-01

    Drug addiction is a chronically relapsing brain disorder. There is an urgent need for new treatment options for this disease because the relapse rate among drug abusers seeking treatment is quite high. During the past decade, many groups have explored the feasibility of using vaccines directed against drugs of abuse as a means of eliminating illicit drug use as well as drug overdose and neurotoxicity. Vaccines work by inducing drug-specific antibodies in the bloodstream that bind to the drug of abuse and prevent its entry into the brain. The majority of work in this area has been conducted with vaccines and antibodies directed against cocaine and nicotine. On the basis of preclinical work, vaccines for cocaine and nicotine are now in clinical trials because they can offer long-term protection with minimal treatment compliance. In addition, vaccines and antibodies for phencyclidine, methamphetamine and heroin abuse are currently under development. An underlying theme in this research is the need for high concentrations of circulating drug-specific antibodies to reduce drug-seeking and drug-taking behaviour when the drug is repeatedly available, especially in high doses. Although vaccines against drugs of abuse may become a viable treatment option, there are several drawbacks that need to be considered. These include: a lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice;a lack of an effect on drug craving that predisposes an addict to relapse; and tremendous individual variability in antibody formation. Forced or coerced vaccination is not likely to work from a scientific perspective, and also carries serious legal and ethical concerns. All things considered, vaccination against a drug of abuse is likely to work best with individuals who are highly motivated to quit using drugs altogether and as part of a comprehensive treatment programme. As such, the medical treatment of drug abuse will not be radically

  8. Rural Child Sexual Abuse Prevention and Treatment.

    Science.gov (United States)

    Ray, JoAnn; Murty, Susan A.

    1990-01-01

    Reviews literature on rural child sexual abuse and treatment. Surveys providers in rural Washington treatment programs. Responses describe agency characteristics, services, delivery problems, and suggested solutions. Reports providers' perceptions of service quality and interagency cooperation. Cites as problems heavy caseloads, lack of staff, and…

  9. A Distance Education Model for Training Substance Abuse Treatment Providers in Cognitive-Behavioral Therapy

    Science.gov (United States)

    Watson, Donnie W.; Rawson, Richard R.; Rataemane, Solomon; Shafer, Michael S.; Obert, Jeanne; Bisesi, Lorrie; Tanamly, Susie

    2003-01-01

    This paper presents a rationale for the use of a distance education approach in the clinical training of community substance abuse treatment providers. Developing and testing new approaches to the clinical training and supervision of providers is important in the substance abuse treatment field where new information is always available. A…

  10. Failure to get into substance abuse treatment.

    Science.gov (United States)

    Fisher, Dennis G; Reynolds, Grace L; D'Anna, Laura H; Hosmer, David W; Hardan-Khalil, Kholoud

    2017-02-01

    Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment. 2646 participants were administered the Risk Behavior Assessment (RBA) and the Barratt Impulsiveness Scale. The RBA included the dependent variable which was responses to the question "During the last year, have you ever tried, but been unable, to get into a drug treatment or detox program?" In multivariate analysis, factors associated with being unable to access treatment included: Previously been in drug treatment (OR=4.51), number of days taken amphetamines in the last 30days (OR=1.18), traded sex for drugs (OR=1.53), homeless (OR=1.73), Nonplanning subscale of the Barratt Impulsiveness Scale (OR=1.19), age at interview (OR=0.91), and sexual orientation, with bisexual men and women significantly more likely than heterosexuals to have tried but been unable to get into treatment. The answers to the question on "why were you unable to get into treatment" included: No room, waiting list; not enough money, did not qualify, got appointment but no follow through, still using drugs, and went to jail before program start. As expected, findings suggest that limiting organizational and financial obstacles to treatment may go a long way in increasing drug abuse treatment accessibility to individuals in need. Additionally, our study points to the importance of developing approaches for increasing personal planning skills/reducing Nonplanning impulsivity among PWUDs when they are in treatment as a key strategy to ensure access to additional substance abuse treatment in the future. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Management practices in substance abuse treatment programs.

    Science.gov (United States)

    McConnell, K John; Hoffman, Kim A; Quanbeck, Andrew; McCarty, Dennis

    2009-07-01

    Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

  12. TFA Systems: A Unique Group Treatment of Spouse Abusers.

    Science.gov (United States)

    Clow, Daniel R.; And Others

    1992-01-01

    Presents a group treatment model using Thought-Feeling-Action (TFA) Systems, an offense- and offender-specific group treatment for abusers. Describes use of TFA Systems in group of court-referred male spouse-abusers. Reviews evolution of TFA Systems, then focuses on TFA Systems treatment of spouse abusers. Notes that system can be adapted to other…

  13. Predictors of Clinical Outcomes in Sexually Abused Adolescents.

    Science.gov (United States)

    Tocker, Lotem; Ben-Amitay, Galit; Horesh-Reinman, Netta; Lask, Michal; Toren, Paz

    2017-01-01

    This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

  14. Clinical Holistic Medicine: The Case Story of Anna. I. Long-Term Effect of Childhood Sexual Abuse and Incest with a Treatment Approach

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2006-01-01

    Full Text Available The nervous breakdown of a 22-year-old, young woman was caused by severe sexual abuse in childhood, which was repressed over many years. During therapy, the patient accumulated resources to start the painful integration of these old traumas. Using holistic existential therapy in accordance with the life mission theory and the holistic process theory of healing, she finally was able to confront her old traumas and heal her existence. She seemingly recovered completely (including regaining full emotional range through holistic existential therapy, individually and in a group. The therapy took 18 months and more than 100 hours of intensive therapy. In the beginning of the therapy, the issues were her physical and mental health; in the middle of the therapy, the central issue was her purpose of life and her love life; and at the conclusion of the therapy, the issue was gender and sexuality. The strategy was to build up her strength for several months, mobilizing hidden resources and motivation for living, before the old traumas could be confronted and integrated. The therapy was based on quality of life philosophy, on the life mission theory, the theory of ego, the theory of talent, the theory of the evil side of man, the theory of human character, and the holistic process theory of healing. The clinical procedures included conversation, philosophical training, group therapeutic tools, extended use of therapeutic touch, holistic pelvic examination, and acceptance through touch was used to integrate the early traumas bound to the pelvis and scar tissue in the sexual organs. She was processed according to 10 levels of the advanced toolbox for holistic medicine and the general plan for clinical holistic psychiatry. The emotional steps she went through are well described by the scale of existential responsibility. The case story of Anna is an example of how even the most severely ill patient can recover fully with the support of holistic medical

  15. Clinical holistic medicine: the case story of Anna. I. Long-term effect of childhood sexual abuse and incest with a treatment approach.

    Science.gov (United States)

    Ventegodt, Søren; Clausen, Birgitte; Merrick, Joav

    2006-02-02

    The nervous breakdown of a 22-year-old, young woman was caused by severe sexual abuse in childhood, which was repressed over many years. During therapy, the patient accumulated resources to start the painful integration of these old traumas. Using holistic existential therapy in accordance with the life mission theory and the holistic process theory of healing, she finally was able to confront her old traumas and heal her existence. She seemingly recovered completely (including regaining full emotional range) through holistic existential therapy, individually and in a group. The therapy took 18 months and more than 100 hours of intensive therapy. In the beginning of the therapy, the issues were her physical and mental health; in the middle of the therapy, the central issue was her purpose of life and her love life; and at the conclusion of the therapy, the issue was gender and sexuality. The strategy was to build up her strength for several months, mobilizing hidden resources and motivation for living, before the old traumas could be confronted and integrated. The therapy was based on quality of life philosophy, on the life mission theory, the theory of ego, the theory of talent, the theory of the evil side of man, the theory of human character, and the holistic process theory of healing. The clinical procedures included conversation, philosophical training, group therapeutic tools, extended use of therapeutic touch, holistic pelvic examination, and acceptance through touch was used to integrate the early traumas bound to the pelvis and scar tissue in the sexual organs. She was processed according to 10 levels of the advanced toolbox for holistic medicine and the general plan for clinical holistic psychiatry. The emotional steps she went through are well described by the scale of existential responsibility. The case story of Anna is an example of how even the most severely ill patient can recover fully with the support of holistic medical treatment, making her feel

  16. Clinical Holistic Medicine: The Case Story of Anna. I. Long-Term Effect of Childhood Sexual Abuse and Incest with a Treatment Approach

    Science.gov (United States)

    Ventegodt, Søren; Clausen, Birgitte; Merrick, Joav

    2006-01-01

    The nervous breakdown of a 22-year-old, young woman was caused by severe sexual abuse in childhood, which was repressed over many years. During therapy, the patient accumulated resources to start the painful integration of these old traumas. Using holistic existential therapy in accordance with the life mission theory and the holistic process theory of healing, she finally was able to confront her old traumas and heal her existence. She seemingly recovered completely (including regaining full emotional range) through holistic existential therapy, individually and in a group. The therapy took 18 months and more than 100 hours of intensive therapy. In the beginning of the therapy, the issues were her physical and mental health; in the middle of the therapy, the central issue was her purpose of life and her love life; and at the conclusion of the therapy, the issue was gender and sexuality. The strategy was to build up her strength for several months, mobilizing hidden resources and motivation for living, before the old traumas could be confronted and integrated. The therapy was based on quality of life philosophy, on the life mission theory, the theory of ego, the theory of talent, the theory of the evil side of man, the theory of human character, and the holistic process theory of healing. The clinical procedures included conversation, philosophical training, group therapeutic tools, extended use of therapeutic touch, holistic pelvic examination, and acceptance through touch was used to integrate the early traumas bound to the pelvis and scar tissue in the sexual organs. She was processed according to 10 levels of the advanced toolbox for holistic medicine and the general plan for clinical holistic psychiatry. The emotional steps she went through are well described by the scale of existential responsibility. The case story of Anna is an example of how even the most severely ill patient can recover fully with the support of holistic medical treatment, making her feel

  17. Accumulating experience in a child abuse clinic

    African Journals Online (AJOL)

    Behaviour problems were recorded in 73% of cases. Many different ... management is now a priority in our setting. S Afr Med J 1996; 86: ... abused children, registered nurses, social workers and ... physical abuse, emotional abuse, and "-'1§ct. ~N<: .... aggression (10% of patients), 'clinginess' (12%) and temper tantrums ...

  18. Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma.

    Science.gov (United States)

    Holbrook, Amber M

    2015-01-01

    The past decade has seen an increase in rates of opioid abuse during pregnancy. This clinical challenge has been met with debate regarding whether or not illicit and prescription opioid-dependent individuals require different treatment approaches; whether detoxification is preferable to maintenance; and the efficacy of methadone versus buprenorphine as treatment options during pregnancy. The clinical recommendations resulting from these discussions are frequently influenced by the comparative stigma attached to heroin abuse and methadone maintenance versus prescription opioid abuse and maintenance treatment with buprenorphine. While some studies have suggested that a subset of individuals who abuse prescription opioids may have different characteristics than heroin users, there is currently no evidence to suggest that buprenorphine is better suited to treatment of prescription opioid abuse than methadone. Similarly, despite its perennial popularity, there is no evidence to recommend detoxification as an efficacious approach to treatment of opioid dependence during pregnancy. While increased access to treatment is important, particularly in rural areas, there are multiple medical and psychosocial reasons to recommend comprehensive substance abuse treatment for pregnant women suffering from substance use disorders rather than office-based provision of maintenance medication. Both methadone and buprenorphine are important treatment options for opioid abuse during pregnancy. Methadone may still remain the preferred treatment choice for some women who require higher doses for stabilization, have a higher risk of treatment discontinuation, or who have had unsuccessful treatment attempts with buprenorphine. As treatment providers, we should advocate to expand available treatment options for pregnant women in all States.

  19. Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network.

    Science.gov (United States)

    Kidd, Jeremy D; Tross, Susan; Pavlicova, Martina; Hu, Mei-Chen; Campbell, Aimee N C; Nunes, Edward V

    2017-06-07

    Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.

  20. Process Evaluation in Corrections-Based Substance Abuse Treatment.

    Science.gov (United States)

    Wolk, James L.; Hartmann, David J.

    1996-01-01

    Argues that process evaluation is needed to validate prison-based substance abuse treatment effectiveness. Five groups--inmates, treatment staff, prison staff, prison administration, and the parole board--should be a part of this process evaluation. Discusses these five groups relative to three stages of development of substance abuse treatment in…

  1. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

    Directory of Open Access Journals (Sweden)

    Bruce Burchett

    2010-12-01

    Full Text Available Li-Tzy Wu1,2, Walter Ling3, Bruce Burchett1, Dan G Blazer1,2, Jack Shostak2, George E Woody41Department of Psychiatry and Behavioral Sciences, School of Medicine, 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; 3David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; 4Department of Psychiatry, School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA, USAPurpose: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation.Methods: The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002. Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV risk, and quality of life were examined.Results: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were

  2. Abuse

    Science.gov (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... Types of abuse Signs of abuse Reporting abuse Types of abuse Abuse comes in many forms: Physical: ...

  3. Characteristics of Pregnant Teen Substance Abuse Treatment Admissions

    Science.gov (United States)

    ... treatment admission (“other female teen admissions”). Note that TEDS is a census of all admissions to treatment facilities reported to the Substance Abuse and Mental Health Services Administration (SAMHSA) by State substance abuse agencies. IN BRIEF X X Between 2007 and 2010, about 57,000 ...

  4. Readiness and barriers to adopt evidence-based practices for substance abuse treatment in Mexico

    OpenAIRE

    Horigian, Viviana E.; Espinal, Paula S.; Alonso, Elizabeth; Verdeja, Rosa E.; Duan, Rui; Usaga, Ingrid M.; Pérez-López, Alejandro; Marín-Navarrete, Rodrigo; Feaster, Daniel J.

    2016-01-01

    ABSTRACT: Introduction: Evidence shows a lag in adoption of evidence-based practices (EBPs) for substance abuse treatment and supports the need for studying the factors involved in this worldwide problem. Objective: This study aimed to assess the readiness and barriers to adopt EBPs for substance abuse in a sample of outpatient treatment centers of a newly created Mexican Clinical Trials Network. Method: An online survey was administered to directors (n = 8) and clinicians (n = 40) from se...

  5. Psychopharmacologic treatment of children prenatally exposed to drugs of abuse.

    Science.gov (United States)

    Hulvershorn, Leslie A; Schroeder, Kristen M; Wink, Logan K; Erickson, Craig A; McDougle, Christopher J

    2015-05-01

    This pilot study compared the pharmacologic treatment history and clinical outcomes observed in pediatric outpatients with psychiatric disorders exposed to drugs of abuse in utero to those of an age-matched, sex-matched and psychiatric disorder-matched, non-drug-exposed group. In this matched cohort study, medical records of children treated at an academic, child and adolescent psychiatry outpatient clinic were reviewed. Children with caregiver-reported history of prenatal drug exposure were compared with a non-drug-exposed control group being cared for by the same providers. Patients were rated with the Clinical Global Impressions-Severity scale (CGI-S) throughout treatment. The changes in pre-treatment and post-treatment CGI-S scores and the total number of medication trials were determined between groups. The drug-exposed group (n = 30) had a higher total number of lifetime medication trials compared with the non-drug-exposed group (n = 28) and were taking significantly more total medications, at their final assessment. Unlike the non-drug-exposed group, the drug-exposed group demonstrated a lack of clinical improvement. These results suggest that in utero drug-exposed children may be more treatment-refractory to or experience greater side effects from the pharmacologic treatment of psychiatric disorders than controls, although we cannot determine if early environment or drugs exposure drives these findings. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Sex differences in drug abuse: Etiology, prevention, and treatment.

    Science.gov (United States)

    Evans, Suzette M; Reynolds, Brady

    2015-08-01

    This special issue exemplifies one of the major goals of the current editor of Experimental and Clinical Psychopharmacology (Dr. Suzette Evans): to increase the number of manuscripts that emphasize females and address sex differences. Taken together, these articles represent a broad range of drug classes and approaches spanning preclinical research to treatment to better understand the role of sex differences in drug abuse. While not all studies found sex differences, we want to emphasize that finding no sex difference is just as important as confirming one, and should be reported in peer-reviewed journals. It is our intention and hope that this special issue will further advance scientific awareness about the importance of accounting for sex differences in the study of substance abuse. Participant sex is an essential variable to consider in developing a more comprehensive understanding of substance abuse. Rather than viewing investigating sex differences as burdensome, investigators should seize this opportune area ripe for innovative research that is long overdue. (c) 2015 APA, all rights reserved).

  7. Clinical assessment of suspected child physical abuse

    International Nuclear Information System (INIS)

    Rohrer, T.

    2009-01-01

    Violence against children has many faces. Child physical abuse, neglect, sexual abuse and interparental violence can cause acute and permanent damage and affect children's development and their life plans in the long term. In industrialized nations almost 1 child in 10 is affected. Up to 10% of child physical abuse cases involve the central nervous system with 80% of these cases occurring during the first year of life. Worldwide more than 50,000 children die as a result of violence, abuse and neglect every year, according to the United Nations Children's Fund UNICEF. In Germany, there are about 120 cases of non-accidental head injury per year. In addition to the officially known cases there is a large grey area for all forms of violence. Recognition of these cases and the provision of help for the victims require an appropriate suspicion and understanding of the pertinent pathophysiology. Suspicion must be based on a well-documented medical history and multidisciplinary diagnostic assessment. Medical confidentiality prevents the disclosure of such information making early detection networks and guidelines for collaboration absolutely indispensable. (orig.) [de

  8. A plan analysis of pedophile sexual abusers' motivations for treatment: a qualitative pilot study.

    Science.gov (United States)

    Drapeau, Martin; Körner, Annett; Granger, Luc; Brunet, Louis; Caspar, Franz

    2005-06-01

    Many authors have suggested adapting treatment programs to the specific needs of sexual abusers. However, little research has been conducted to understand what these patients seek in therapy or what elements play a key role in keeping them in treatment. In this pilot study, fifteen (N=15) pedophile sexual abusers from La Macaza clinic for sexual abusers were interviewed. Plan analysis was used to investigate the most prevalent components involved in staying in or leaving therapy. Results suggest that many components involved in the plans leading to doing and to avoiding treatment were similar. Differences were found in regards to the outcome of confrontations with the therapists, a tendency to isolate and overcomply, guilt related to the abuse, a need for a stable environment, and a need to be accepted. These results are discussed along with possible ways to improve the patients' involvement in treatment.

  9. Metaphyseal fractures mimicking abuse during treatment for clubfoot

    International Nuclear Information System (INIS)

    Grayev, A.M.; Boal, D.K.B.; Wallach, D.M.; Segal, L.S.

    2001-01-01

    Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

  10. Metaphyseal fractures mimicking abuse during treatment for clubfoot

    Energy Technology Data Exchange (ETDEWEB)

    Grayev, A.M.; Boal, D.K.B. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States); Wallach, D.M.; Segal, L.S. [Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA (United States)

    2001-08-01

    Background. Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. Objective. To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. Materials and methods. Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. Results. All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. Conclusion. In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic manipulation may offer some further insight concerning the pathogenesis of this well-described abuse injury. (orig.)

  11. Clinical pharmacokinetics of non-opiate abused drugs.

    Science.gov (United States)

    Busto, U; Bendayan, R; Sellers, E M

    1989-01-01

    The present review discusses the available data on the kinetic properties of non-opiate abused drugs including psychomotor stimulants, hallucinogens and CNS-depressants. Some of the drugs of abuse reviewed here are illicit drugs (e.g. cannabis, cocaine), while others are effective pharmacological agents but have the potential to be abused (e.g. benzodiazepines). Although some of the drugs mentioned in this review have been in use for centuries (e.g. caffeine, nicotine, cocaine, cannabis), knowledge of their kinetics and metabolism is very recent and in some cases still incomplete. This is partially due to the difficulties inherent in studying drugs of abuse in humans, and to the complex metabolism of some of these drugs (e.g. cannabis, caffeine) which has made it difficult to develop sensitive assays to determine biological pathways. Although drugs of abuse may have entirely different intrinsic pharmacological effects, the kinetic properties of such drugs are factors contributing to abuse and dependence. The pharmacokinetic properties that presumably contribute to self-administration and drug abuse include rapid delivery of the drug into the central nervous system and high free drug clearance. Kinetic characteristics also play an important role in the development of physical dependence and on the appearance of a withdrawal syndrome: the longer the half-life, the greater the likelihood of the development of physical dependence; the shorter the half-life, the earlier and more severe the withdrawal. The balance between these 2 factors, which has not yet been carefully studied, will also influence abuse patterns. The clinical significance of kinetic characteristics with respect to abuse is discussed where possible.

  12. [Child sexual abuse. Epidemiology, clinical diagnostics, therapy, and prevention].

    Science.gov (United States)

    Fegert, J M; Hoffmann, U; Spröber, N; Liebhardt, H

    2013-02-01

    The article provides an overview of the research on sexual abuse and the current political developments in Germany. First, the terminology of sexual child abuse is discussed, followed by the presentation of epidemiological data. The section on diagnostics and therapy shows that--because of mostly nonspecific indicators--the diagnosis of child sexual abuse is very difficult to define. Child sexual abuse is discussed as a traumatic experience for children and adolescents with different psychiatric and physical diseases. Current studies have shown that especially cognitive behavioral therapeutic-oriented approaches are effective in curing posttraumatic stress disorders. Based on the new German Child Protection Act, the focus lies on the clarification of confidentiality for medical professionals and their right to consulting services for child protection. In conclusion, guidelines and minimum standards for a child prevention and protection model are presented as well as institutional recommendations addressed to all institutions (also clinical) that take care of or treat children and adolescents.

  13. Substance Abuse Treatment for Children and Adolescents: Questions to Ask

    Science.gov (United States)

    ... Families - Vietnamese Substance Abuse Treatment For Children And Adolescents: Questions To Ask No. 41; Reviewed July 2013 Many children and adolescents use alcohol and other drugs. Some develop serious ...

  14. Substance abuse in borderline personality disorder: clinical and etiological correlates

    NARCIS (Netherlands)

    van den Bosch, L. M.; Verheul, R.; van den Brink, W.

    2001-01-01

    This work examines differences between female borderline patients with and without substance abuse problems and between borderline patients from different treatment settings. A total of 64 female borderline patients were recruited from mental health services (n = 34) and addiction treatment services

  15. Demographic and Clinical Correlates of Client Motivation among Substance Abusers.

    Science.gov (United States)

    Rapp, Richard C.; Li, Li; Siegal, Harvey A.; DeLiberty, Richard N.

    2003-01-01

    Examines the role of motivation in substance abusers' acceptance of treatment and its relation to treatment outcomes. Better motivation was consistently associated with severity of substance use. Motivation was not related to alcohol and drug use severity six months later. Severity associated with motivation at entry was not related to clients'…

  16. Research on drug abuse and addiction treatment in prisons

    Directory of Open Access Journals (Sweden)

    Kljajević Srđan

    2017-01-01

    Full Text Available The causes of drug abuse and criminal behavior are closely linked. Not surprisingly, there is a high percentage of prisoners who during sentence execution abuse or are dependent on drugs. Antisocial personality disorder can be considered a common predictor of committing criminal offenses and drug abuse. A review of studies has revealed a high prevalence of inmates who use drugs while serving a sentence. Also, prison environment represents only a new context of the continuum of drug abuse by inmates. There are different theoretical approaches in explaining this phenomenon. Treatment programs based on empirically validated principles that guarantee the effectiveness, may be one strategy for solving the problem of drug abuse in prisons, with multiple positive effects.

  17. Transportation and retention in outpatient drug abuse treatment programs.

    Science.gov (United States)

    Friedmann, P D; Lemon, S C; Stein, M D

    2001-09-01

    To determine whether certain types of transportation assistance improve outpatient treatment retention beyond thresholds shown to have therapeutic benefits, we analyzed data from 1,144 clients in 22 outpatient methadone maintenance (OMM) programs and 2,031 clients in 22 outpatient drug-free (ODF) programs in the Drug Abuse Treatment Outcomes Study (DATOS), a national, 12-month, longitudinal study of drug abuse treatment programs. Directors' surveys provided information about provision of car, van, or contracted transportation services or individual vouchers/payment for public transportation. Chart-abstracted treatment retention was dichotomized at 365 days for OMM and 90 days for ODF. Separate multivariate hierarchical linear models revealed that provision of car, van, or contracted transportation services improved treatment retention beyond these thresholds for both OMM and ODF, but individual vouchers or payment for public transportation did not. Future research should validate whether car, van, or contracted transportation services improve retention and other treatment outcomes in outpatient drug abuse treatment.

  18. 28 CFR 550.52 - Non-residential drug abuse treatment services.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services, provided...

  19. Features and challenges of alcohol abuse treatment in Uganda ...

    African Journals Online (AJOL)

    Challenges of the Minnesota model not withstanding treatment providers are faced with inadequate skills and facilities rendering them unable to meet the ever increasing demand. Research into culturally adopted treatment intervention strategies is necessary to enhance the effectiveness and treatment of alcohol abuse in ...

  20. Substance Abuse and Clinical Counseling Students' Characteristics and Career Goals

    Science.gov (United States)

    Goodwin, Lloyd R., Jr.; Sias, Shari M.

    2007-01-01

    Students from a master's program in Substance Abuse and Clinical Counseling (SACC) at a midsize southeastern university were surveyed to determine personal characteristics and career goals. Sixty-two of the 68 students currently enrolled in the program volunteered to anonymously complete the questionnaire. The typical profile of the SACC student…

  1. Meeting the substance abuse treatment needs of lesbian, bisexual and transgender women: implications from research to practice

    Directory of Open Access Journals (Sweden)

    Stevens S

    2012-02-01

    Full Text Available Sally StevensSouthwest Institute for Research on Women (SIROW and Department of Gender and Women’s Studies (GWS, University of Arizona, Tucson, AZ, USAAbstract: Research on the incidence, etiology and substance abuse treatment needs of lesbian, bisexual and transgender (LBT women is limited. Most research indicates higher levels of alcohol and drug abuse among these populations compared to their heterosexual counterparts, with recent research indicating that substance abuse is a particular concern for transgender individuals and an increasing problem among younger LBT individuals. Risk factors and reasons for substance abuse among sexual minority women are similar to those of heterosexual women, yet are substantially complicated by issues of family rejection and lack of social support, stigma and minority stress, as well as abuse and harassment. Historically, substance abuse prevention, early intervention, and clinical treatment programs were designed to meet the needs of the sexual majority population with relatively few programs designed to incorporate the specific needs of sexual minorities. This article reviews findings from previous studies and utilizes new data collected from community-based and residential substance abuse treatment programs to (1 examine issues relevant to LBT women and substance use, and (2 make recommendations for tailoring substance abuse treatment programs to meet the needs of these populations.Keywords: lesbian, bisexual, transgender, substance abuse, family rejection, social support, stigma, minority stress, abuse, harassment

  2. Treatment outcomes for substance abuse among adolescents with learning disorders.

    Science.gov (United States)

    Yu, Jennifer W; Buka, Stephen L; Fitzmaurice, Garrett M; McCormick, Marie C

    2006-07-01

    This paper assesses whether chemically dependent adolescents with comorbid learning disorders (LDs) derived less effective treatment results when compared to chemically dependent adolescents without LD and examines the moderating effects of prior treatments, treatment length, and treatment completion. Two hundred one adolescents were recruited between 1992 and 1993 from Massachusetts residential treatment centers and subsequently followed up 6 months after enrollment. Compared to chemically dependent teenagers without LD, those with LD were twice as likely to re-use substances at least once by follow-up. LD teenagers were more likely to attend Alcoholics/Narcotics Anonymous if they had prior admissions to treatment programs and longer treatment length. LD teenagers who completed treatment also experienced a greater decrease in current depression compared to LD teenagers not completing the treatment. This study is the first to consider outcomes of substance abuse treatment for adolescents with LD and contributes to the growing literature on comorbidity and substance abuse treatment.

  3. Coordination of Care in Substance Abuse Treatment: An Interorganizational Perspective

    OpenAIRE

    Spear, Suzanne Evelyn

    2012-01-01

    The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance abuse treatment systems. One major service gap in the continuum of care for substance use disorders associated with readmissions is not transitioning patients to rehabilitation after a detox service. This study examined the problem of detox readmissions from an interorganizational network perspective. The...

  4. Psychiatric Nursing's Role in Child Abuse: Prevention, Recognition, and Treatment.

    Science.gov (United States)

    Ellington, Erin

    2017-11-01

    Child abuse affects hundreds of thousands of children in the United States each year. The effects from maltreatment extend beyond the physical injuries-the lasting effects on the child's mental health can be lifelong. Psychiatric nurses have a vital role to play in the prevention, recognition, and treatment of child abuse. [Journal of Psychosocial Nursing and Mental Health Services, 55(11), 16-20.]. Copyright 2017, SLACK Incorporated.

  5. Epidemiology of drug abuse treatment in South Africa

    Directory of Open Access Journals (Sweden)

    Shandir Ramlagan

    2010-04-01

    Full Text Available Background. The aim of the study was to explore the epidemiology of drug abuse treatment in South Africa. Methods. Treatment demand statistics were analysed from South African National Council on Alcoholism and Drug Dependence and the South African Community Epidemiology Network on Drug Use records, and a rapid situation assessment was conducted. Twenty-one key informant interviews were conducted in all 9 provinces among provincial substance abuse co-ordinators, and one manager per treatment centre from a sample of treatment centres. Three focus groups were conducted and 46 self-administered questionnaires were distributed among inpatients at 2 selected treatment centres in Free State and North West provinces. Qualitative data were analysed using grounded theory, and quantitative data analysed using SPSS. Results. Treatment records show that the most frequent substance of abuse was alcohol (51%, followed by cannabis (21%, crack/cocaine (9.6%, heroin/opiates (7.9%, methamphetamine (Tik (4.5%, prescription/over-the-counter drugs (2.0%, and cannabis/mandrax (1.7%. More substance abusers were male, of lower education, white or black, than were female, more highly educated, coloured and Indian/Asian. Key informant interviews showed that females are the ‘hidden’ substance abusers and tend not to be identified in research statistics and at treatment centres. Poverty, unemployment, lack of recreational facilities, being surrounded by substance abusers, and long work shifts were also mentioned as factors contributing to substance abuse. The age of initiation of substance abuse using non-drugs such as glue was 9 years old, alcohol 10 - 12 years old, dagga 11 - 12 years old, poly-drug use (alcohol, tobacco and dagga 14 years old, and harder drugs such as cocaine and heroin at 16 - 17 years old, as reported by key informants. Family care and support, improved socio-economic conditions and increased law enforcement would help to discourage substance

  6. Prescription opioid abuse, pain and addiction: clinical issues and implications.

    Science.gov (United States)

    Ling, Walter; Mooney, Larissa; Hillhouse, Maureen

    2011-05-01

    Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge. This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction. Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia. The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  7. 28 CFR 550.53 - Residential Drug Abuse Treatment Program (RDAP).

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Residential Drug Abuse Treatment Program... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.53 Residential Drug Abuse Treatment... components: (1) Unit-based component. Inmates must complete a course of activities provided by drug abuse...

  8. [Treatment program for dual-diagnosis substance abusers].

    Science.gov (United States)

    Kandel, Isack

    2007-01-01

    Dual-diagnosis mentally ill patients, i.e. those characterized with substance abuse problems combined with mental health problems, are a challenge both for systems treating substance abusers and for mental health services. These patients are not easily integrated in either of these healthcare systems and/or are treated only for one aspect of their problem by each of these systems. For such patients it is necessary to create a separate treatment model, combining care of the problem of substance abuse and attention to the patient's mental pathology, according to his individual personality traits. For purposes of this programme a treatment setting operating on the model of a therapeutic community is proposed. This setting will open an affiliated treatment programme for dual-diagnosed patients in a separate treatment programme that is not part of the therapeutic community but will be affiliated with it and will accept dual-diagnosis patients.

  9. Culturally competent substance abuse treatment with transgender persons.

    Science.gov (United States)

    Nuttbrock, Larry A

    2012-01-01

    Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.

  10. Biological basis of sex differences in drug abuse: preclinical and clinical studies.

    Science.gov (United States)

    Lynch, Wendy J; Roth, Megan E; Carroll, Marilyn E

    2002-11-01

    The recent focus on drug abuse in women has brought attention to numerous differences between women and men. In this review, we discuss both preclinical and clinical findings of sex differences in drug abuse as well as mechanisms that may underlie these differences. Recent evidence suggests that the progression to dependence and abuse may differ between women and men; thus, different prevention and treatment strategies may be required. Similar sex differences in drug sensitivity and self-administration have been reported in laboratory animal studies. Females appear to be more vulnerable than males to the reinforcing effects of psychostimulants, opiates, and nicotine during many phases of the addiction process (e.g. acquisition, maintenance, dysregulation-escalation, relapse). Male and female animals differ in their behavioral, neurological, and pharmacological responses to drugs. Although the role of sex in the mechanisms of drug action remains unclear, preclinical and clinical studies indicate that ovarian hormones, particularly estrogen, play a role in producing sex differences in drug abuse. Future research is necessary to provide information on how to design more effective drug abuse treatment programs and resources that are sex specific.

  11. Enhanced Case Management versus Substance Abuse Treatment Alone among Substance Abusers with Depression

    Science.gov (United States)

    Striley, Catherine W.; Nattala, Prasanthi; Ben Abdallah, Arbi; Dennis, Michael L.; Cottler, Linda B.

    2013-01-01

    This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to…

  12. Targeting the treatment of drug abuse with molecular imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schiffer, Wynne K. [Medical Department, Brookhaven National Laboratory, Upton, NY 11973 (United States)], E-mail: wynne@bnl.gov; Liebling, Courtney N.B.; Patel, Vinal; Dewey, Stephen L. [Medical Department, Brookhaven National Laboratory, Upton, NY 11973 (United States)

    2007-10-15

    Although imaging studies in and of themselves have significant contributions to the study of human behavior, imaging in drug abuse has a much broader agenda. Drugs of abuse bind to molecules in specific parts of the brain in order to produce their effects. Positron emission tomography (PET) provides a unique opportunity to track this process, capturing the kinetics with which an abused compound is transported to its site of action. The specific examples discussed here were chosen to illustrate how PET can be used to map the regional distribution and kinetics of compounds that may or may not have abuse liability. We also discussed some morphological and functional changes associated with drug abuse and different stages of recovery following abstinence. PET measurements of functional changes in the brain have also led to the development of several treatment strategies, one of which is discussed in detail here. Information such as this becomes more than a matter of academic interest. Such knowledge can provide the bases for anticipating which compounds may be abused and which may not. It can also be used to identify biological markers or changes in brain function that are associated with progression from drug use to drug abuse and also to stage the recovery process. This new knowledge can guide legislative initiatives on the optimal duration of mandatory treatment stays, promoting long-lasting abstinence and greatly reducing the societal burden of drug abuse. Imaging can also give some insights into potential pharmacotherapeutic targets to manage the reinforcing effects of addictive compounds, as well as into protective strategies to minimize their toxic consequences.

  13. Targeting the treatment of drug abuse with molecular imaging

    International Nuclear Information System (INIS)

    Schiffer, Wynne K.; Liebling, Courtney N.B.; Patel, Vinal; Dewey, Stephen L.

    2007-01-01

    Although imaging studies in and of themselves have significant contributions to the study of human behavior, imaging in drug abuse has a much broader agenda. Drugs of abuse bind to molecules in specific parts of the brain in order to produce their effects. Positron emission tomography (PET) provides a unique opportunity to track this process, capturing the kinetics with which an abused compound is transported to its site of action. The specific examples discussed here were chosen to illustrate how PET can be used to map the regional distribution and kinetics of compounds that may or may not have abuse liability. We also discussed some morphological and functional changes associated with drug abuse and different stages of recovery following abstinence. PET measurements of functional changes in the brain have also led to the development of several treatment strategies, one of which is discussed in detail here. Information such as this becomes more than a matter of academic interest. Such knowledge can provide the bases for anticipating which compounds may be abused and which may not. It can also be used to identify biological markers or changes in brain function that are associated with progression from drug use to drug abuse and also to stage the recovery process. This new knowledge can guide legislative initiatives on the optimal duration of mandatory treatment stays, promoting long-lasting abstinence and greatly reducing the societal burden of drug abuse. Imaging can also give some insights into potential pharmacotherapeutic targets to manage the reinforcing effects of addictive compounds, as well as into protective strategies to minimize their toxic consequences

  14. Sex-Role Attitudes of Drug Abuse Treatment Counselors.

    Science.gov (United States)

    Schor, Carole

    1982-01-01

    Examined the sex-role attitude of the drug abuse treatment counselor. Found: 1) male counselors viewed clients of both sexes more negatively; 2) male clients were viewed more negatively by counselors of both sexes; 3) counselors with less education had more negative attitudes; and 4) attitudes differed with treatment program type. (Author/RC)

  15. Barriers to Successful Treatment Completion in Child Sexual Abuse Survivors

    Science.gov (United States)

    McPherson, Paul; Scribano, Philip; Stevens, Jack

    2012-01-01

    Child sexual abuse (CSA) often requires psychological treatment to address the symptoms of victim trauma. Barriers to entry and completion of counseling services can compromise long-term well-being. An integrated medical and mental health evaluation and treatment model of a child advocacy center (CAC) has the potential to reduce barriers to mental…

  16. Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

    Science.gov (United States)

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

    2011-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

  17. Clinical and forensic signs related to opioids abuse.

    Science.gov (United States)

    Dinis-Oliveira, Ricardo Jorge; Carvalho, Felix; Moreira, Roxana; Duarte, Jose Alberto; Proenca, Jorge Brandao; Santos, Agostinho; Magalhaes, Teresa

    2012-12-01

    For a good performance in Clinical and Forensic Toxicology it is important to be aware of the biological and non-biological signs and symptoms related to xenobiotic exposure. This manuscript highlights and analyzes clinical and forensic imaging related to opioids abuse critically. Particularly, respiratory depression, track marks and hemorrhages, skin "popping", practices of phlebotomy, tissue necrosis and ulceration, dermatitis, tongue hyperpigmentation, "coma blisters", intra-arterial administration, candidiasis, wounds associated with anthrax or clostridium contaminated heroin, desomorphine related lesions and characteristic non-biological evidences are some commonly reported findings in opioids abuse, which will be discussed. For this purpose, clinical and forensic cases from our database (National Institute of Legal Medicine and Forensic Sciences, North Branch, Portugal), in addition to literature data, are reviewed.

  18. Treatment of childhood sexual abuse: an updated review.

    Science.gov (United States)

    Cummings, Marissa; Berkowitz, Steven J; Scribano, Philip V

    2012-12-01

    Childhood sexual abuse (CSA) involves multiple complex factors that make the evaluation of therapeutic interventions especially complicated. PTSD prevalence rates of CSA are approximately 37 % -53 %. Several other psychiatric sequelae of CSA exist. CSA appears to disrupt brain and body physiology. One co-located service delivery model reported a 52 % linkage rate of CSA survivors with mental health treatment. This article reviews current literature on the treatment of CSA, including psychosocial interventions, pharmacotherapy, and early preventative interventions. It also provides an update on the short- and long-term sequelae of CSA and implications for future research directions. A literature search of papers published in the last 3 years was conducted using the keywords treatment, sexual abuse, childhood, epigenetics, resilience and review, and searching the following databases: PsycInfo, PubMed, Substance Abuse and Mental Health Services Administration, and Centers for Disease Control.

  19. Can MDMA play a role in the treatment of substance abuse?

    Science.gov (United States)

    Jerome, Lisa; Schuster, Shira; Yazar-Klosinski, B Berra

    2013-03-01

    A wider array of treatments are needed for people with substance abuse disorders. Some psychedelic compounds have been assessed as potential substance abuse treatments with promising results. MDMA may also help treat substance abuse based on shared features with psychedelic compounds and recent reports indicating that MDMAassisted psychotherapy can reduce symptoms of PTSD. Narrative reports and data from early investigations found that some people reduced or eliminated their substance use after receiving MDMA, especially in a therapeutic setting. MDMA is a potent monoamine releaser with sympathomimetic effects that may indirectly activate 5-HT2A receptors. It increases interpersonal closeness and prosocial feelings, potentially through oxytocin release. Findings suggest that ecstasy, material represented as containing MDMA, is associated with deleterious long-term effects after heavy lifetime use, including fewer serotonin transporter sites and impaired verbal memory. Animal and human studies demonstrate moderate abuse liability for MDMA, and this effect may be of most concern to those treating substance abuse disorders. However, subjects who received MDMA-assisted psychotherapy in two recent clinical studies were not motivated to seek out ecstasy, and tested negative in random drug tests during follow-up in one study. MDMA could either directly treat neuropharmacological abnormalities associated with addiction, or it could indirectly assist with the therapeutic process or reduce symptoms of comorbid psychiatric conditions, providing a greater opportunity to address problematic substance use. Studies directly testing MDMA-assisted psychotherapy in people with active substance abuse disorder may be warranted.

  20. Nonaccidental trauma: clinical aspects and epidemiology of child abuse

    International Nuclear Information System (INIS)

    Hobbs, Christopher J.; Bilo, Robert A.C.

    2009-01-01

    Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice. (orig.)

  1. Nonaccidental trauma: clinical aspects and epidemiology of child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Hobbs, Christopher J. [St James' s University Hospital, Department of Community Paediatrics, Leeds (United Kingdom); Bilo, Robert A.C. [Netherlands Forensic Institute, Department of Forensic Pathology, The Hague (Netherlands)

    2009-05-15

    Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice. (orig.)

  2. Child Sexual Abuse Suspicions: Treatment Considerations during Investigation

    Science.gov (United States)

    Kuehnle, Kathryn; Connell, Mary

    2010-01-01

    This article addresses what, if any, psychotherapeutic interventions should be provided to meet the emotional and clinical needs of alleged child victims of sexual abuse while they await judicial determinations from the family, dependency, or criminal courts. The discussion emphasizes that to minimize iatrogenic outcomes, professionals involved in…

  3. Alcohol abuse and related disorders treatment of alcohol dependence

    Directory of Open Access Journals (Sweden)

    Yu. P. Sivolap

    2014-01-01

    Full Text Available Alcohol abuse and alcoholism are the leading causes of worse health and increased mortality rates. Excessive alcohol consumption is the third leading cause of the global burden of diseases and a leading factor for lower lifespan and higher mortality. Alcohol abuse decreases working capacity and efficiency and requires the increased cost of the treatment of alcohol-induced disorders, which entails serious economic losses. The unfavorable medical and social consequences of excessive alcohol use determine the importance of effective treatment for alcoholism. The goals of rational pharmacotherapy of alcohol dependence are to enhance GABA neurotransmission, to suppress glutamate neurotransmission, to act on serotonin neurotransmission, to correct water-electrolyte balance, and to compensate for thiamine deficiency. Alcoholism treatment consists of two steps: 1 the prevention and treatment of alcohol withdrawal syndrome and its complications (withdrawal convulsions and delirium alcoholicum; 2 antirecurrent (maintenance therapy. Benzodiazepines are the drugs of choice in alleviating alcohol withdrawal and preventing its convulsive attacks and delirium alcoholicum. Diazepam and chlordiazepoxide are most commonly used for this purpose; the safer drugs oxazepam and lorazepam are given to the elderly and patients with severe liver lesions. Anticonvulsants having normothymic properties, such as carbamazepine, valproic acid, topiramate, and lamotrigine, are a definite alternative to benzodiazepines. The traditional Russian clinical practice (clearance detoxification has not a scientific base or significant impact on alcohol withdrawal-related states in addicts. Relapse prevention and maintenance therapy for alcohol dependence are performed using disulfiram, acamprosate, and naltrexone; since 2013 the European Union member countries have been using, besides these agents, nalmefene that is being registered in Russia. Memantine and a number of other

  4. Determinants of nonmedical use, abuse or dependence on prescription drugs, and use of substance abuse treatment.

    Science.gov (United States)

    Bali, Vishal; Raisch, Dennis W; Moffett, Maurice L; Khan, Nasreen

    2013-01-01

    Previous studies have found a negative association between health insurance and nonmedical use of prescription drugs (NMUPD), and abuse or dependence on prescription drugs (ADPD); and mixed associations between health insurance and use of substance abuse treatment (SAT). However, effect of health insurance in the specific subgroups of population is largely unknown. To estimate the relationship between health insurance and (1) NMUPD, (2) ADPD, and (3) use of SAT services among 12-64 years old, noninstitutionalized individuals and to see if these relationships are different in different subgroups of population. This study used cross-sectional survey data from 2007 National Survey on Drug Use and Health. Bivariate and multiple logistic regression analyses were conducted. In 2007, self-reported prevalence of NMUPD was approximately 10% (N=15,509,703). In multivariate analysis, NMUPD was negatively associated with health insurance, age, race other than non-Hispanic White, education, marital status, and income ($40,000-$74,999). Past year use of tobacco and alcohol were positively associated with NMUPD. Among those with private health insurance, Hispanics and individuals with family income less than $20,000 and $40,000-$74,999 were more likely prone to NMUPD than others. High school graduates with public health insurance were less likely prone to NMUPD. Approximately, 13% of nonmedical users reported ADPD (N=2,011,229). Health insurance and age were negatively associated with ADPD. However, people who were unmarried, reported fair/poor health, and used tobacco were more likely to report ADPD. Lastly, the use of substance abuse treatment programs was approximately 73% and 76% between NMUPD and ADPD population, respectively. Health insurance was not associated with use of substance abuse treatment. Individuals with high school education were 2.6 times more likely to use substance abuse treatment than the college graduates. Additionally, no significant interaction effects

  5. Constructive conflict and staff consensus in substance abuse treatment.

    Science.gov (United States)

    Melnick, Gerald; Wexler, Harry K; Chaple, Michael; Cleland, Charles M

    2009-03-01

    Previous studies demonstrated the relationship between consensus among both staff and clients with client engagement in treatment and between client consensus and 1-year treatment outcomes. The present article explores the correlates of staff consensus, defined as the level of agreement among staff as to the importance of treatment activities in their program, using a national sample of 80 residential substance abuse treatment programs. Constructive conflict resolution had the largest effect on consensus. Low client-to-staff ratios, staff education, and staff experience in substance abuse treatment were also significantly related to consensus. Frequency of training, an expected correlate of consensus, was negatively associated with consensus, whereas frequency of supervision was not a significant correlate. The implications of the findings for future research and program improvement are discussed.

  6. Traumatic experiences and re-victimization of female inmates undergoing treatment for substance abuse.

    Science.gov (United States)

    Mejía, Bertha; Zea, Paloma; Romero, Martha; Saldívar, Gabriela

    2015-02-09

    In the past decade, several studies have focused on the treatment needs of female inmates with substance abuse problems. An important finding has been that these women are more likely to report histories of sexual, physical, and emotional abuse-at rates varying from 77% to 90%. The trauma resulting from this kind of abuse is a key contributing factor in behavioral problems in adolescence and subsequent delinquency, substance abuse, and criminality in adulthood. This was a retrospective clinical study. A convenience sample of 112 women who entered the program's treatment groups consecutively for one year form part of the study. Information on traumatic events was obtained using some questions from the Initial Trauma Review. It explores whether the participant experienced physical abuse, sexual abuse, disasters, automobile accidents, or witnessed violence under the age of 18. It also examines experiences as an adult, including sexual and physical abuse, attacks by others who are not intimate partners, and abuse by authorities. Revictimization in sexual abuse was found in 78.1% of participants. Significant differences were identified between women who had experienced a traumatic sexual event from a person five years their senior before the age of 18 and then suffered from sexual violence as an adult, and women who had never undergone either of these events (x(2) = 11.3, df 112/1, p = abuse, the figure was 82.17%. Differences were observed between women who were revictimized through physical abuse before and after the age of 18 (x(2) = 5.91, df 112/1, p = child and subsequently physical violence from their parents, and women who had not undergone either of these events (x(2) = 3.48, df 112/1, p = <.05). Investment in treatment in these areas during the prison sentence and after release may contribute to preventing these women from become repeat offenders. Creating sources of work and halfway houses that continue the program to prevent relapses

  7. Characteristics of Transgender Individuals Entering Substance Abuse Treatment

    Science.gov (United States)

    Heck, Nicholas C.; Sorensen, James L.

    2014-01-01

    Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n=199) and non-transgender (cisgender, n=13440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007–2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment. PMID:24561017

  8. Epidemiology of drug abuse treatment in South Africa

    African Journals Online (AJOL)

    Texas, USA, where alcohol was found to be the primary drug of abuse in ... distributed among inpatients at 2 selected treatment centres ... group participants attributed their reasons for drug use to family ... NW provinces, where one currently finds limited data. .... full-time, 26% were unemployed, and 25% were students.

  9. Medical Marijuana Use among Adolescents in Substance Abuse Treatment

    Science.gov (United States)

    Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian

    2012-01-01

    Objective: To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method: This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age…

  10. [Child sexual abuse: clinical perspectives and ethico-legal dilemmas].

    Science.gov (United States)

    Franco, Alvaro; Ramírez, Luis

    2016-01-01

    In the review of the current literature, the main causing factors of the related conditions with child sexual abuse are the ethical dilemmas and legal implications. A review was conducted on the classic literature on this topic. In this articlesome difficult paradigmatic cases are presented in which the hypothetical dilemmas were solved. The main characteristics of child sexual abuse enable us to have a better argument to address these situations. Taking into account the literature reviewed and predictable courses of action, it is concluded that it is important to take into account each individual each case and its circumstances, and that prudence and clinical objectivity, as well as knowledge of the law, become essential requirements for proper action. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  11. Clinical pattern and prevalence of upper gastrointestinal toxicity in patients abusing ketamine.

    Science.gov (United States)

    Liu, Shirley Yuk Wah; Ng, Stephen Ka Kei; Tam, Yuk Him; Yee, Samuel Chi Hang; Lai, Franco Pui Tak; Hong, Cindy Yuek Lam; Chiu, Philip Wai Yan; Ng, Enders Kwok Wai; Ng, Chi Fai

    2017-09-01

    Evaluations of upper gastrointestinal toxicity from ketamine abuse are uncommon. This study investigated the clinical pattern of upper gastrointestinal symptoms in patients inhaling ketamine. In a cross-sectional study of 611 consecutive patients who were seeking treatment for ketamine uropathy in a tertiary hospital setting between August 2008 and June 2016, their clinical pattern of upper gastrointestinal symptoms was evaluated and compared with a control population of 804 non-users. A total of 168 (27.5%) patients abusing ketamine (mean age 26.3 years, 58.9% female) reported the presence of upper gastrointestinal symptoms. These symptoms were significantly more prevalent in patients inhaling ketamine than in those who were not (27.5% vs 5.2%, P ketamine abuse before symptom presentation was 5.0 ± 3.1 years. The presenting symptoms included epigastric pain (n = 155, 25.4%), recurrent vomiting (n = 48, 7.9%), anemia (n = 36, 5.9%) and gastrointestinal bleeding (n = 20, 3.3%). Uropathy symptoms were preceded by upper gastrointestinal symptoms for 4.4 ± 3.0 years in 141 (83.9%) patients. Logistic regression showed that elder age (odds ratio [OR] 1.06, P = 0.04), active abuser status (OR 1.60, P = 0.04) and longer duration of ketamine abuse (OR 1.00, P = 0.04) were independent factors associated with upper gastrointestinal toxicity. Although epigastric symptoms are unusual in the young population, upper gastrointestinal toxicity was highly prevalent in those inhaling ketamine. Enquiries about ketamine abuse are recommended when assessing young patients with epigastric symptoms. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  12. 29 CFR 825.119 - Leave for treatment of substance abuse.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Leave for treatment of substance abuse. 825.119 Section 825... Leave for treatment of substance abuse. (a) Substance abuse may be a serious health condition if the conditions of §§ 825.113 through 825.115 are met. However, FMLA leave may only be taken for treatment for...

  13. Substance Abuse Treatment Admissions Aged 12 to 14. The TEDS Report

    Science.gov (United States)

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

    This report uses data from the Treatment Episode Data Set (TEDS) for 2008 to provide information on the characteristics of youths aged 12 to 14 admitted to substance abuse treatment. In 2008, approximately 23,770 substance abuse treatment admissions were adolescents aged 12 to 14. The two most frequently reported primary substances of abuse among…

  14. Emotion regulation promotes persistence in a residential substance abuse treatment.

    Science.gov (United States)

    Hopwood, Christopher J; Schade, Nick; Matusiewicz, Alexis; Daughters, Stacey B; Lejuez, Carl W

    2015-01-01

    Emotion regulation at treatment entry was evaluated among 115 patients in an inner-city substance use residential facility who either persisted (N = 94) or discontinued treatment (N = 21). Emotion regulation capacity including emotional clarity and the ability to engage in goal-directed behavior despite emotional distress, as well as lower scores on a measure of trait-negative emotionality, were associated with treatment persistence, whereas motivational variables were not. Findings indicate the importance of regulating negative emotions for treatment engagement among substance abusers.

  15. Substance Abuse-Specific Knowledge Transfer or Loss? Treatment Program Turnover versus Professional Turnover among Substance Abuse Clinicians

    Science.gov (United States)

    Eby, Lillian T.; Curtis, Sara L.

    2014-01-01

    This longitudinal study investigated the extent to which substance abuse (SA) clinician turnover is associated with SA-specific knowledge loss due to change in professions (professional turnover) versus SA-specific knowledge transfer due to movement from one SA clinical setting to another (treatment program turnover). For this study, clinicians had to voluntarily leave their current treatment program. Eligible clinicians completed a quantitative survey while employed and a qualitative post-employment exit interview 1 year later. Compared to those that exited the SA profession (N = 99), clinicians who changed treatment programs (N = 120) had greater SA-specific formal knowledge and were more likely to be personally in recovery. No differences were found between the two groups in terms of SA-specific practical knowledge. PMID:25115318

  16. Brief screening for co-occurring disorders among women entering substance abuse treatment

    Directory of Open Access Journals (Sweden)

    Chernoff Miriam

    2006-09-01

    Full Text Available Abstract Background Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient at five treatment sites were screened at intake (N = 374. Results Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. Conclusion Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment

  17. Sexual abuse

    Directory of Open Access Journals (Sweden)

    Iztok Takač

    2012-11-01

    Conclusions: Effective and efficient treatment of victims of sexual abuse requires a systematic approach to the patient, starting with a thorough history, and continuing with a clinical investigation, diagnosis, treatment and prevention of the consequences of sexual abuse. The complete management must include sampling of any potential biological traces from the body of the victim. The key to success is a coordinated cooperation with investigators and forensics.

  18. Substance-Abusing Parents in the Criminal Justice System: Does Substance Abuse Treatment Improve Their Children's Outcomes?

    Science.gov (United States)

    Phillips, Susan D.; Gleeson, James P.; Waites-Garrett, Melissa

    2009-01-01

    The expansion of the criminal justice system over the last several decades helped to focus attention on children of incarcerated parents, many of whom have parents with substance abuse problems. Since the 1990's, a national grassroots campaign has been underway to make substance abuse treatment an alternative to incarceration for parents who…

  19. [Five years of ROM in substance abuse treatment centres in the Netherlands].

    Science.gov (United States)

    Oudejans, S C C; Schippers, G M; Spits, M E; Stollenga, M; van den Brink, W

    2012-01-01

    Three substance abuse treatment centres set up a benchmarking project for routine outcome management (ROM) of structured cognitive behavioral treatments for outpatients with a substance use disorder. To present the results of five years benchmarking. All patients were included at intake and the follow-up assessment was performed by a call-center nine months later. Twice a year aggregated data were fed back to management and treatment teams. Since 2005, clinical outcome data, including substance abuse data, have been collected for more than half of all 15.786 treated patients. At follow-up, nine months after intake, 23% was abstinent, 28% reported moderate substance use and 49% reported excessive substance use. The Dutch centres for the treatment of substance abuse were successful in setting up ROM projects to monitor and compare the development and the effects of outpatient addiction treatments. The clinical results are acceptable and correspond to the results of the American project called match. It is not yet clear whether the biannual feedback of aggregated outcomes to management and treatment teams has contributed to the creation of learning organisations, but it has provided transparency and has made it possible for teams to learn from the outcomes.

  20. Social capital and job satisfaction among substance abuse treatment employees.

    Science.gov (United States)

    Tsounis, Andreas; Niakas, Dimitris; Sarafis, Pavlos

    2017-02-15

    Job satisfaction is an important predictor for management and clinical ratios. Although it is accepted that is affected by many aspects, the influence of social capital remains to be determined. The main purpose of the article is to examine the relationship between job satisfaction and individual social capital for employees offering services in the treatment of addiction. A cross-sectional study was conducted on 239 employees from 14 therapeutic programs at KETEA (Therapy Center for Dependent Individuals in Greece) (KETHEA). A revised Greek Version of the Social Capital Questionnaire (SCQ-G) for the individual social capital measurement, and of the Job Satisfaction Survey (JSS) for the job satisfaction measurement, were used. Individual Social Capital ranged in medium levels. We observed a significant positive association between social capital and its' different aspects and gender, age, place of residence and working experience. Men, older employees, those who lived in smaller places, and those working more years, reached higher levels of individual social capital. Concerning overall job satisfaction most of the participants were ambivalent (61.5%), while 21.8% were satisfied and 16.7% were dissatisfied. Concerning its separate aspects, 77% were least satisfied with pay, 69.9% were least satisfied with advancement opportunities, 60.3% were least satisfied with fringe benefits, 85.8% were most satisfied with the nature of their work, 80.8% with their relationship with colleagues, and 77.8% were satisfied with supervision. Total Job Satisfaction was positively associated with place of residence and monthly salary. A significant positive correlation between social capital and job satisfaction was also observed. Early evidence suggests that social capital is associated with job satisfaction of employees providing services in the treatment of substance abuse. Further research, regarding social capital on job satisfaction, is suggested. We need to design and implement

  1. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment.

    Science.gov (United States)

    Tims, Frank M; Dennis, Michael L; Hamilton, Nancy; J Buchan, Betty; Diamond, Guy; Funk, Rod; Brantley, Laura B

    2002-12-01

    Risk factors among adolescent substance abusers have been shown to correlate with substance use severity. Characteristics related to severity, such as demographic and family factors, peer influences, psychiatric co-morbidity and HIV risk behaviors, are examined for a sample of adolescent cannabis users entering treatment. These data are from a clinical trial study utilizing blocked random assignment of clients to one of five treatment conditions. The study targeted adolescents entering outpatient treatment for primarily cannabis abuse or dependence. Treatment and research facilities in four metropolitan areas of the US were used to recruit study participants. Treatment was delivered in outpatient drug-free settings. Participants were 600 clients, ages 12-18, admitted to outpatient substance abuse treatment programs for cannabis problems, 96% with DSM-IV diagnoses of substance abuse or dependence, with the remaining 4% having at least one symptom of dependence plus significant problems indicating need for treatment. The Global Appraisal of Individual Needs (GAIN) was used to collect the information presented in this paper. The GAIN incorporates DSM-IV criteria for substance use disorders, conduct disorder and attention deficit hyperactivity disorder, as well as dimensional (scale) measures for physical and mental health. All participants reported at least one symptom of substance use disorders, and 46% met the DSM-IV criteria for substance dependence, while 50% met criteria for a diagnosis of abuse. Only 20% of the participants perceived any need for help with problems associated with their drug or alcohol use. Clients participating in the study typically presented multiple problems at treatment entry, most often including conduct disorder, attention deficit hyperactivity disorder (ADHD), internal (mental) distress, and physical health distress. The co-occurrence of conduct disorder and ADHD was found in 30% of the sample. Clients meeting criteria for substance

  2. A methodological pilot: parenting among women in substance abuse treatment.

    Science.gov (United States)

    Lewin, Linda; Farkas, Kathleen; Niazi, Maryam

    2014-01-01

    Mothers who abuse substances are likely to have insecure emotional attachment with their children, placing their children at risk for social-emotional and psychiatric conditions. Sobriety does not inevitably improve parenting. We tested recruitment methods, audiovisual (AV) recording procedures, the protocol for identifying child abuse risk, the coding of mother-child interactions, and retention of the sample for repeated measures as the first phase in examining mother-child relational quality of women in substance abuse treatment. This innovative study involved AV recordings to capture the in-vivo mother-child interactional behaviors that were later coded and analyzed for mean scores on the 64-item Parent-Child Relational Quality Assessment. Repeated measurement was planned during treatment and two months after discharge from treatment. The pilot involved a small sample (n = 11) of mother-child (interaction behaviors were identified. Mothers showed less enthusiasm and creativity but matched their child's emotional state. The children showed appropriate motor skill items and attachment behaviors. The dyad coding showed less mutual enjoyment between the mother and child. Eight of the participants could not be located for the second measurement despite multiple contact methods. AV recordings capture rich, descriptive information that can be coded for interactional quality analysis. Repeated measurement with this cohort was not feasible, thus needing to assess for additional/more frequent contacts to maintain the sample.

  3. Clinical and forensic signs related to cocaine abuse.

    Science.gov (United States)

    Dinis-Oliveira, Ricardo Jorge; Carvalho, Félix; Duarte, José Alberto; Proença, Jorge Brandão; Santos, Agostinho; Magalhães, Teresa

    2012-03-01

    Good laboratory practice in toxicological analysis requires pre-analytical steps for collection of detailed information related to the suspected poisoning episodes, including biological and non-biological circumstantial evidences, which should be carefully scrutinized. This procedure provides great help to unveil the suspected cause of poisoning, to select the appropriate and correct samples to be analyzed and can facilitate the decision about the analytical techniques to perform. This implies a good knowledge of the signs related to acute and chronic intoxications by drugs of abuse. In this manuscript we highlight and discuss clinical and forensic imaging related to cocaine abuse, namely the midline destructive lesion, dental health, pseudoscleradermatous triad and crack hands, necrosis and gangrene of extremities and several other skin manifestations, reticular purpura, intracerebral and peripheral hemorrhages, angioneurotic edema, rhabdomyolysis, and crack lung. For this purpose, the state of the art on this topic is discussed, using clinical and forensic cases from our professional database in complement to images and mechanistic data from literature.

  4. Poppers: epidemiology and clinical management of inhaled nitrite abuse.

    Science.gov (United States)

    Romanelli, Frank; Smith, Kelly M; Thornton, Alice C; Pomeroy, Claire

    2004-01-01

    Commonly referred to as "poppers," inhaled nitrites have a long history of abuse. Poppers are rapid-onset, short-acting potent vasodilators that produce a rush characterized by warm sensations and feelings of dizziness. Poppers sometimes are used to facilitate anal intercourse because of their actions on the anal sphincter. Epidemiologically, the frequent use of nitrites by men who have sex with men has led some experts to implicate these chemicals in the pathogenesis of Kaposi's sarcoma and acquired immunodeficiency syndrome. Controlled clinical trials to examine this potential correlation have not been conducted, and the use of nitrites simply may be a marker for other high-risk behaviors such as unprotected sex. Although regulated in the United States, many nitrite compounds and isomers are sold at various venues including bars, bookstores, and over the Internet. Adverse effects associated with these products vary from mild allergic reactions to life-threatening methemoglobinemia. The potential for drug-drug interactions and a propensity toward unsafe sex also exist. Clinicians should be familiar with the populations most likely to abuse these agents and with the clinical effects and management guidelines for acute ingestions.

  5. Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment

    Directory of Open Access Journals (Sweden)

    Kelly Peter J

    2012-02-01

    , and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period. Discussion This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioral therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR: ACTRN12611000618954

  6. 28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...

  7. Abuse

    Science.gov (United States)

    ... physical injury, leave marks, or cause pain. Sexual abuse is any type of sexual contact between an adult and anyone younger than 18; between a significantly older child and a younger child; or if one person ...

  8. An Effective Web Presence for Substance Abuse Treatment Facilities.

    Science.gov (United States)

    Link, Thomas W; Hefner, Jennifer L; Ford, Eric W; Huerta, Timothy R

    2016-01-01

    Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page. The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry. This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score. The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites. The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.

  9. Reasons for dropout from drug abuse treatment: symptoms, personality, and motivation.

    Science.gov (United States)

    Ball, Samuel A; Carroll, Kathleen M; Canning-Ball, Monica; Rounsaville, Bruce J

    2006-02-01

    Previous research has identified risk factors for early attrition from substance abuse treatment, but has not assessed reasons for dropout from the client's perspective. Interview and self-report assessment data were collected from 24 clients who prematurely terminated outpatient treatment to evaluate their subjective reasons for dropping out and the association of these reasons with demographic and clinical variables. Items from scales indicating problems with client motivation or conflicts with program staff were the most commonly endorsed. The severity of participant's symptoms and logistical problems interfering with appointments were less commonly reported as reasons for dropping out. Demographic, substance abuse, and motivational stage indicators were infrequently associated with subjective reasons for dropout. In contrast, indicators of maladaptive personality functioning were strongly associated with many reasons for dropping out, especially concerns about privacy and boundary issues within the program. Results from this preliminary evaluation will guide the development of an instrument and intervention focused on dropout risk factors and treatment reengagement.

  10. Clinical, biochemical, serological, histological and ultrastructural features of liver disease in drug abusers.

    Science.gov (United States)

    Weller, I V; Cohn, D; Sierralta, A; Mitcheson, M; Ross, M G; Montano, L; Scheuer, P; Thomas, H C

    1984-01-01

    Heroin abusers are frequently found to have abnormal liver function tests and hepatic histology. Hepatitis viruses A, B, and NANB, other drugs or drug contaminants and excessive alcohol consumption are factors thought to contribute. One hundred and sixteen heroin abusers attending a London treatment centre were studied. Sixty two (53%) had a raised aspartate transaminase. This was not explained by current infection with hepatitis A and B, cytomegalo or Epstein-Barr viruses, excessive alcohol consumption (greater than 80 g/day) or concomitant drug taking. Abnormal liver function tests were as frequent in those with markers of current or past HBV infection as those without and there was evidence that both HBV infection and the cause of the abnormal liver function tests were acquired in the first few years of intravenous drug abuse. Liver biopsies from eight patients showed chronic hepatitis with a mild lobular and portal inflammatory infiltrate, fatty change and prominent sinusoidal cells. Electron microscopy showed cytoplasmic trilaminar tubular structures and dense fused membranes in dilated endoplasmic reticulum. These clinical, biochemical, serological, and histological features would suggest a major role for NANB virus infection in the aetiology of hepatitis in heroin abusers. Images Fig. 2 Fig. 3 Fig. 4 PMID:6423458

  11. Mental Health and Substance Use Characteristics of Flight Attendants Enrolled in an In-Patient Substance Abuse Treatment Program

    Science.gov (United States)

    Horton, Gail; Diaz, Naelys; McIlveen, John; Weiner, Michael; Mullaney, Donald

    2011-01-01

    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…

  12. Substance Abuse in Addicts Referred to Public and Private Substance Abuse Treatment Centers

    Directory of Open Access Journals (Sweden)

    Kadkhodaei M.* MSc,

    2015-06-01

    Full Text Available Aims Drug addiction is a mental, social, and economic problem that comes from abnormal and illicit consumption of substances such as alcohol, opium, hashish, and etc., making the addict psychologically and physiologically dependent to those substances. This study was designed and performed to evaluate the pattern of drug abuse change in the addicts visiting addiction treatment centers of Kashan City, Iran. Instrument & Methods This retrospective descriptive research was performed on 4066 persons referred to addiction treatment and harm reduction therapy centers, monitored by Kashan University of Medical Sciences, during 2004 to 2008. After coding, data were entered into the SPSS 16 software. Chi-square and one-way ANOVA was used to analyze the data. Findings The main reasons of the tendency to drugs were not having fun (72.5%, family problems (55% and not having knowledge (22.7%. The use of opium was the highest in all the years while the crack was used by 7.1% of drug addicts in 2004 and increased to 76% in 2007. 92.8% of drug abuses were through fumigation, 33.7% through injection, 48% orally and 8.6% through inhalants. Conclusion Youths are the most vulnerable age group to drug addiction. Easy access to illegal drugs, wrong friends, and curiosity are of the significant factors spreading drug addiction.

  13. [Abuse of minors. Clinical considerations on physical abuse, sexual aggression and emotional deprivation].

    Science.gov (United States)

    Loredo-Abdalá, A; Trejo-Hernández, J; Bustos-Valenzuela, V

    1999-01-01

    Physicians and other health personnel dealing with the consequences of child abuse ought to have abroad understanding of the magnitude of this serious medical and social phenomenon. The three main patterns of child mistreatment as observed at a pediatric hospital are reviewed, with emphasis on its medical and juridical aspects. Various pathologic entities are to be taken into account for differential diagnoses when child abuse is suspected. Risk factors regarding the victims, the abusers and the psychosocial environment are noted.

  14. Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.

    Science.gov (United States)

    Wu, Li-Tzy; Brady, Kathleen T; Spratt, Susan E; Dunham, Ashley A; Heidenfelder, Brooke; Batch, Bryan C; Lindblad, Robert; VanVeldhuisen, Paul; Rusincovitch, Shelley A; Killeen, Therese K; Ghitza, Udi E

    2016-01-01

    The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Using Electronic Health Records Data for Substance Use Screening, Brief Intervention, and Referral to Treatment among Adults with Type 2 Diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network Study

    Science.gov (United States)

    Wu, Li-Tzy; Brady, Kathleen T.; Spratt, Susan E.; Dunham, Ashley A.; Heidenfelder, Brooke; Batch, Bryan C.; Lindblad, Robert; VanVeldhuisen, Paul; Rusincovitch, Shelley A.; Killeen, Therese K.; Ghitza, Udi E.

    2015-01-01

    Background The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. Methods We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. Discussion By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions. PMID:26563446

  16. Pena Private Freedom with psychiatric treatment and psychological for Abused

    Directory of Open Access Journals (Sweden)

    Mirza Maria Pedrosa Porto de Mendonça

    2016-06-01

    Full Text Available The research aimed to investigate the opinion of professionals in law and health areas on the profile of the sexual abuser of children within the family and the effectiveness of the type of penalty he suffers. The offender is someone who probably does not enjoy enough sanity to control its inclination to unlawful and may or may not be classified as mentally ill. The research covers the incidence and effects of this event on intra-family life. Deals with this issue in order to establish a new legal paradigm in the context of the penalties in the most private sphere of criminal law. The work aims to demonstrate the social relevance of the topic and the need for an effective regulatory sweater for sexual abusers, especially the intra-family and makes a clear proposal for legislative changes with regard to this type of crime, arguing the need to adapt the law the objective reality. It argues that psychoanalytic treatment of offenders as a means of punishment is more important than the simple deprivation of liberty. It argues that the current legislation is incipient and inadequate for such cases and this opinion supported by a significant number of experts. This is not to defend this criminal who practice sexual abuse, but to seek solutions to impunity and respect for the principle of individualization of punishment.

  17. Relationship of trauma exposure and substance abuse to self-reported violence among men and women in substance abuse treatment.

    Science.gov (United States)

    Clark, C Brendan; Reiland, Sarah; Thorne, Chris; Cropsey, Karen L

    2014-05-01

    Past research showed a relationship between substance abuse and aggression and past trauma and aggression. The nature of the relationships between substance use, trauma, and aggression is inconclusive. The current research hypothesized greater aggression among those with a history of substance abuse and trauma compared with those without such a history and an additive relationship between substance abuse and trauma on aggression. Participants were 615 individuals in a substance abuse treatment program for individuals under criminal justice supervision. Data were collected from face-to-face interviews and self-report measures. Univariate and multivariate analyses assessed the relationships among substance use, trauma, and aggression. Participants with a history of trauma and regular substance use reported the highest rates of homicidal ideation, problem behaviors, and person offenses. Participants in this group also reported greater desire for help managing their stress and tension, dealing with problems in their intimate relationships, developing healthier relationships in general, and learning prosocial approaches to express their feelings. Substance abusing participants who experienced trauma reported more externalizing behaviors and a greater desire for coping- and social-skills training than participants who abused substances but did not report a history of trauma. This suggests that participants in substance abuse treatment programs may have improved outcomes with the addition of components to address these issues.

  18. Perceptions of a Prison-Based Substance Abuse Treatment Program among Some Staff and Participants

    Science.gov (United States)

    Goodrum, Sarah; Staton, Michele; Leukefeld, Carl; Webster, J. Matthew; Purvis, Richard T.

    2003-01-01

    Almost 90% of all State and Federal prisons in the U.S. offer some form of substance abuse counseling, and one in eight prisoners have participated in a substance abuse treatment program while incarcerated. Evidence indicates that these programs can be successful in stopping prisoners' substance abuse. While some data are available about the…

  19. Multidimensional Family Therapy (MDFT) for Young People in Treatment for Non-opioid Drug Abuse:

    DEFF Research Database (Denmark)

    Filges, Trine; Rasmussen, Pernille; Andersen, Ditte

    2015-01-01

    The main objectives of this review are to evaluate the current evidence on the effects of MDFT on drug abuse reduction for young people (aged 11-21 years) in treatment for non-opioid drug abuse, and if possible to examine moderators of drug abuse reduction effects, specifically analysing whether...

  20. Child abuse in Odessa region: epidemiology, clinical and psychoneurological features and consequences

    Directory of Open Access Journals (Sweden)

    Aryayev M.

    2016-05-01

    Full Text Available The paper presents the data of world literature in epidemiology and characteristics of the manifestations of child abuse. It was revealed that enough respondents in Odessa for both men and especially women, as a child had been ill-treated (65.6% of respondents. There is insufficient knowledge of the problem of child abuse: only 13% of respondents showed a high level of awareness about domestic violence. The most common forms of ill-treatment were emotional abuse 30.0% (95% CI 26.4–33.5 (especially for girls and physical violence — 21.3% (95% CI 17.8–24.1 (especially for boys. It was found that a significant portion of respondents considered acceptable to use as punishment of children, different variants of the physical (27.6%, 95% CI 25.2–30.7 or aggressive psycho-emotional (21.4%; 95% CI 18.5 –23.5 exposure. Only 19.7% of respondents (95% CI 17.5–22.5 consider at all unacceptable methods of punishment any of child. It was found that a significant proportion of secondary school pupils of Odessa had insufficient level of awareness about core of the problem of school bullying — 85.6% (95% CI, 83.2% — 88.7%. Among the respondents, 86.3% (95% CI 83.2–88.7 students directly or indirectly faced with this phenomenon as a victim, the aggressor, the observer, or a victim advocate. In girls, the prevailing form of abuse is verbal bullying (72.0%, 95% CI 67.2–76.8, while the boys — physical bullying (21.6%; 95% CI 8.2–31.4. Psychosomatic diseases, psychoneurological syndromes, psychoemotional and cognitive disorders are the main clinical features and consequences of psychological abuse.

  1. The effects of residential dual diagnosis treatment on alcohol abuse

    Science.gov (United States)

    Schoenthaler, Stephen J; Blum, Kenneth; Fried, Lyle; Oscar-Berman, Marlene; Giordano, John; Modestino, Edward J.; Badgaiyan, Rajendra

    2017-01-01

    This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve. PMID:28868159

  2. Influence of pretreatment coping strategies on the outcome of outpatient treatment of Danish alcohol abusers

    DEFF Research Database (Denmark)

    Bussey Rask, Marie; Jørgensen, Tina; Pinnerup Jensen, Jeanette

    2006-01-01

    An important issue regarding treatment for alcohol abuse is the high rate of relapse following treatment. In the research on treatment of alcohol abuse, the concept of coping has been proposed as a relevant factor in the relationship between relapse crises and treatment outcome. The present study...

  3. A Comparison of Daily Versus Weekly Electronic Cigarette Users in Treatment for Substance Abuse.

    Science.gov (United States)

    Gubner, Noah R; Pagano, Anna; Tajima, Barbara; Guydish, Joseph

    2018-04-02

    This research examined electronic cigarette (e-cigarette) use by individuals in treatment for substance abuse, a population with a high prevalence of tobacco use and poor smoking cessation outcomes. We surveyed 1127 individuals from 24 substance abuse treatment centers across the United States. Bivariate analyses and logistic regression were used to examine factors associated with daily (N = 87) versus weekly (N = 81) e-cigarette use. Among the full sample, 59.8% reported any lifetime use of e-cigarettes, with 23.6% reporting past 30-day use. Daily e-cigarette users were more likely to have used second-generation, tank-type e-cigarettes, χ2(1,N = 165) = 11.54, p = .001, used more flavors overall, t(168) = 2.15, p = .03, and were more likely to report using their e-cigarette continuously throughout the day, χ2(4,N = 168) = 16.7, p = .002, compared to weekly e-cigarette users. Over half (57.7%) of the daily and weekly e-cigarette users reported having an e-cigarette device that broke. The logistic regression model adjusting for clinic type and days with poor mental health found that daily e-cigarette users were significantly more likely than weekly e-cigarette users to be from methadone clinics (adjusted odds ratio [AOR] = 2.40, p = .04), and former smokers (AOR = 6.37, p users in substance abuse treatment were more likely to be from methadone clinics and former cigarette smokers. However, the majority (73.6%) of daily e-cigarette users were current cigarette smokers. E-cigarette device type reliability (eg, breakage) may be an important factor to consider among drug treatment and other populations with lower socioeconomic status. This study found several differences in the device type, flavors, and use characteristics of daily versus weekly e-cigarette users. While majority of e-cigarette users in substance abuse treatment were current cigarette smokers, daily e-cigarette users were more likely to be former cigarette smokers. Administrators of substance abuse

  4. [Diagnostics and treatment of Wernicke-Korsakoff syndrome patients with an alcohol abuse].

    Science.gov (United States)

    Nilsson, Maria; Sonne, Charlotte

    2013-04-01

    Wernicke-Korsakoff syndrome is a condition with high morbidity and mortality and occurs as a consequence of thiamine deficiency. Clinical symptoms are often ambiguous and post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated. There is sparse clinical evidence concerning optimal dosage and duration of treatment. This article reviews the current literature and concludes that all patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed.

  5. Improving Substance Abuse Treatment: The National Treatment Plan Initiative. Changing the Conversation.

    Science.gov (United States)

    Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

    This report is the result of five expert panels and six regional public hearings around the country that focused on key persistent issues that have characterized discussions of substance abuse over the years: closing the treatment gap; reducing stigma and changing attitudes; improving and strengthening treatment systems; connecting services and…

  6. Utilization of communication technology by patients enrolled in substance abuse treatment.

    Science.gov (United States)

    McClure, Erin A; Acquavita, Shauna P; Harding, Emily; Stitzer, Maxine L

    2013-04-01

    Technology-based applications represent a promising method for providing efficacious, widely available interventions to substance abuse treatment patients. However, limited access to communication technology (i.e., mobile phones, computers, internet, and e-mail) could significantly impact the feasibility of these efforts, and little is known regarding technology utilization in substance abusing populations. A survey was conducted to characterize utilization of communication technology in 266 urban, substance abuse treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy clinics. Survey participants averaged 41 years of age and 57% had a yearly household income of less than $15,000. The vast majority reported access to a mobile phone (91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and yearly mobile contract was higher for White participants, and also for those with higher education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer use was much lower (39-45%), with younger age, higher education and income predicting greater use. No such differences existed for the use of mobile phones however. Concern regarding the digital divide for marginalized populations appears to be disappearing with respect to mobile phones, but still exists for computer, internet, and e-mail access and use. Results suggest that mobile phone and texting applications may be feasibly applied for use in program-client interactions in substance abuse treatment. Careful consideration should be given to frequent phone number changes, access to technology, and motivation to engage with communication technology for treatment purposes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers.

    Science.gov (United States)

    Winters, K C; Stinchfield, R D; Opland, E; Weller, C; Latimer, W W

    2000-04-01

    The treatment outcome of drug-abusing adolescents treated with a 12-Step approach. The study compares drug use outcome data at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting list. Also, among treatment completers, residential and outpatient samples were compared on outcome. The treatment site is located in the Minneapolis/St Paul area of Minnesota. Two hundred and forty-five drug clinic-referred adolescents (12-18 years old), all of whom met at least one DSM-III-R substance dependence disorder. One hundred and seventy-nine subjects received either complete or incomplete 12-Step, Minnesota Model treatment and 66 were waiting list subjects. In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow-up. Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did not complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to 15 and 28% for the incompleter and waiting list groups, respectively. Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake.

  8. Vision screening of abused and neglected children by the UCLA Mobile Eye Clinic.

    Science.gov (United States)

    Yoo, R; Logani, S; Mahat, M; Wheeler, N C; Lee, D A

    1999-07-01

    The purpose of our study was to present descriptive findings of ocular abnormalities in vision screening examinations of abused and neglected children. We compared the prevalence and the nature of eye diseases and refractive error between abused and neglected boys staying at the Hathaway Home, a residential facility for abused children, and boys from neighboring Boys and Girls clubs. The children in the study received vision screening examinations through the UCLA Mobile Eye Clinic following a standard format. Clinical data were analyzed by chi-square test. The children with a history of abuse demonstrated significantly higher prevalence of myopia, astigmatism, and external eye disorders. Our study suggests that children with a history of abuse may be at higher risk for visual impairment. These visual impairments may be the long-term sequelae of child abuse.

  9. Managed care and the quality of substance abuse treatment.

    Science.gov (United States)

    Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

    2002-12-01

    In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that

  10. The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD.

    Science.gov (United States)

    Wagenmans, Anouk; Van Minnen, Agnes; Sleijpen, Marieke; De Jongh, Ad

    2018-01-01

    Background : It is assumed that PTSD patients with a history of childhood sexual abuse benefit less from trauma-focused treatment than those without such a history. Objective : To test whether the presence of a history of childhood sexual abuse has a negative effect on the outcome of intensive trauma-focused PTSD treatment. Method : PTSD patients, 83% of whom suffered from severe PTSD, took part in a therapy programme consisting of 2 × 4 consecutive days of Prolonged Exposure (PE) and EMDR therapy (eight of each). In between sessions, patients participated in sport activities and psycho-education sessions. No prior stabilization phase was implemented. PTSD symptom scores of clinician-administered and self-administered measures were analysed using the data of 165 consecutive patients. Pre-post differences were compared between four trauma groups; patients with a history of childhood sexual abuse before age 12 (CSA), adolescent sexual abuse (ASA; i.e. sexual abuse between 12 and 18 years of age), sexual abuse (SA) at age 18 and over, or no history of sexual abuse (NSA). Results : Large effect sizes were achieved for PTSD symptom reduction for all trauma groups (Cohen's d  = 1.52-2.09). For the Clinical Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES), no differences in treatment outcome were found between the trauma (age) groups. For the PTSD Symptom Scale Self Report (PSS-SR), there were no differences except for one small effect between CSA and NSA. Conclusions : The results do not support the hypothesis that the presence of a history of childhood sexual abuse has a detrimental impact on the outcome of first-line (intensive) trauma-focused treatments for PTSD.

  11. Perception of Helpfulness among Participants in a Prison-Based Residential Substance Abuse Treatment Program

    Science.gov (United States)

    Raney, Valerie K.; Magaletta, Philip; Hubbert, Timothy A.

    2005-01-01

    The purpose of the current study was to determine the extent to which an early prison release incentive impacted inmates' perceptions of substance abuse treatment helpfulness, overall satisfaction and focus on treatment issues. Three groups of inmates participating in their first, third or sixth month of residential drug abuse treatment were…

  12. Clinical Supervision of Substance Abuse Counselors: Current and Preferred Practices.

    Science.gov (United States)

    Culbreth, John R.

    1999-01-01

    Reports on a national survey of substance abuse counselors (N=134) to learn their current and preferred supervision practices. Results suggests that substance abuse counselor are receiving supervision similar to other counselors. No preference was indicated for the sex of the supervisor, nor for the 12-step recovery experience. Counselors did…

  13. Wireless Technologies, Ubiquitous Computing and Mobile Health: Application to Drug Abuse Treatment and Compliance with HIV Therapies.

    Science.gov (United States)

    Boyer, Edward W; Smelson, David; Fletcher, Richard; Ziedonis, Douglas; Picard, Rosalind W

    2010-06-01

    Beneficial advances in the treatment of substance abuse and compliance with medical therapies, including HAART, are possible with new mobile technologies related to personal physiological sensing and computational methods. When incorporated into mobile platforms that allow for ubiquitous computing, these technologies have great potential for extending the reach of behavioral interventions from clinical settings where they are learned into natural environments.

  14. Research on drug abuse and addiction treatment in prisons

    OpenAIRE

    Kljajević Srđan

    2017-01-01

    The causes of drug abuse and criminal behavior are closely linked. Not surprisingly, there is a high percentage of prisoners who during sentence execution abuse or are dependent on drugs. Antisocial personality disorder can be considered a common predictor of committing criminal offenses and drug abuse. A review of studies has revealed a high prevalence of inmates who use drugs while serving a sentence. Also, prison environment represents only a new context of the continuum of drug abuse by i...

  15. Clinical Significance of Brain SPECT in Zipeprol Abusers

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Dai Ok; Kim, Jae Phil; Kim, Deog Yoon; Yang, Hyung In; Koh, Eun Mi; Kim, Kwang Won; Choi, Young Kil [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    1993-03-15

    Drug abuse is widespread in worldwide and has been associated with neurologic complication. Zipeprol is one of drugs which been abused for psychological satisfaction in some adolescents. This agent is non-opioid antitussive agent, which is not legally considered as being capable of creating dependence or abuse liability at therapeutic serum levels. But it has been reported that acute or chronic overdose create neurologic complication such as convulsion as well as dependence. Recently we experienced six zipeprol abusers who admitted due to convulsion and variable neurologic symptoms. The aim of our study was to determine the role of Tc-99m- HMPAO brain SPECT in those patients. EEG and brain CT showed no abnormal finding, but brain SPECT showed focal or multiple perfusion abnormalities in frontal, parietal, occipital cortex, basal ganglia, thalamus and especially at temporal cortex. These results suggest that brain SPECT may be a useful diagnostic tool to evaluate the cerebral dysfunction induced by zipeprol abuse.

  16. Clinical Significance of Brain SPECT in Zipeprol Abusers

    International Nuclear Information System (INIS)

    Cho, Dai Ok; Kim, Jae Phil; Kim, Deog Yoon; Yang, Hyung In; Koh, Eun Mi; Kim, Kwang Won; Choi, Young Kil

    1993-01-01

    Drug abuse is widespread in worldwide and has been associated with neurologic complication. Zipeprol is one of drugs which been abused for psychological satisfaction in some adolescents. This agent is non-opioid antitussive agent, which is not legally considered as being capable of creating dependence or abuse liability at therapeutic serum levels. But it has been reported that acute or chronic overdose create neurologic complication such as convulsion as well as dependence. Recently we experienced six zipeprol abusers who admitted due to convulsion and variable neurologic symptoms. The aim of our study was to determine the role of Tc-99m- HMPAO brain SPECT in those patients. EEG and brain CT showed no abnormal finding, but brain SPECT showed focal or multiple perfusion abnormalities in frontal, parietal, occipital cortex, basal ganglia, thalamus and especially at temporal cortex. These results suggest that brain SPECT may be a useful diagnostic tool to evaluate the cerebral dysfunction induced by zipeprol abuse.

  17. Racial differences in treatment effect among men in a substance abuse and domestic violence program.

    Science.gov (United States)

    Scott, Melanie C; Easton, Caroline J

    2010-11-01

    It is unclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.

  18. Patients Reporting Ritual Abuse in Childhood: A Clinical Syndrome. Report of 37 Cases.

    Science.gov (United States)

    Young, Walter C.; And Others

    1991-01-01

    Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. A clinical syndrome is presented that includes dissociative states with satanic overtones, posttraumatic stress disorder, survivor guilt, unusual fears, and substance abuse. Questions concerning reliability, credibility, and…

  19. Social and Emotional Outcomes of Child Sexual Abuse: A Clinical Sample in Turkey

    Science.gov (United States)

    Ozbaran, Burcu; Erermis, Serpil; Bukusoglu, Nagehan; Bildik, Tezan; Tamar, Muge; Ercan, Eyyup Sabri; Aydin, Cahide; Cetin, Saniye Korkmaz

    2009-01-01

    Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M…

  20. Research design considerations for clinical studies of abuse-deterrent opioid analgesics: IMMPACT recommendations

    Science.gov (United States)

    Turk, Dennis C.; O’Connor, Alec B.; Dworkin, Robert H.; Chaudhry, Amina; Katz, Nathaniel P.; Adams, Edgar H.; Brownstein, John S.; Comer, Sandra D.; Dart, Richard; Dasgupta, Nabarun; Denisco, Richard A.; Klein, Michael; Leiderman, Deborah B.; Lubran, Robert; Rappaport, Bob A.; Zacny, James P.; Ahdieh, Harry; Burke, Laurie B.; Cowan, Penney; Jacobs, Petra; Malamut, Richard; Markman, John; Michna, Edward; Palmer, Pamela; Peirce-Sandner, Sarah; Potter, Jennifer S.; Raja, Srinivasa N.; Rauschkolb, Christine; Roland, Carl L.; Webster, Lynn R.; Weiss, Roger D.; Wolf, Kerry

    2013-01-01

    Opioids are essential to the management of pain in many patients, but they also are associated with potential risks for abuse, overdose, and diversion. A number of efforts have been devoted to the development of abuse-deterrent formulations of opioids to reduce these risks. This article summarizes a consensus meeting that was organized to propose recommendations for the types of clinical studies that can be used to assess the abuse deterrence of different opioid formulations. Due to the many types of individuals who may be exposed to opioids, an opioid formulation will need to be studied in several populations using various study designs in order to determine its abuse-deterrent capabilities. It is recommended that the research conducted to evaluate abuse deterrence should include studies assessing: (1) abuse liability; (2) the likelihood that opioid abusers will find methods to circumvent the deterrent properties of the formulation; (3) measures of misuse and abuse in randomized clinical trials involving pain patients with both low risk and high risk of abuse; and (4) post-marketing epidemiological studies. PMID:22770841

  1. Association of perpetrator relationship to abusive head trauma clinical outcomes.

    Science.gov (United States)

    Scribano, Philip V; Makoroff, Kathi L; Feldman, Kenneth W; Berger, Rachel P

    2013-10-01

    The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥ 1 year (77% vs. 23%, p<0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Childhood Sexual Abuse

    Directory of Open Access Journals (Sweden)

    Evrim Aktepe

    2009-08-01

    behavioral and psychological results by itself, early trauma may also lead to biological effects. Especially traumas during neuron plasticity phase may lead hypersensitivity of neuroendocrine stress response. Early life stresses are shown to lead changes in corticotrophin releasing factor system in preclinical and clinical phase studies. In the treatment of sexual abuse, emotional process related with trauma should be focused on. This process may be conducted with play therapy. Development of higher level defense mechanism, increasing ego capacity, orientation to social activity and personal activity according to skills is aimed. For the elimination of guiltiness related with stigmatization, the child should be told that it is not herhis fault to incorporate into sexual interaction and the culprit is abuser. It is fairly important for medical staff, school and family to have sufficient information about sexual abuse for prevention and early recognition.

  3. Perceptions about recovery needs and drug-avoidance recovery behaviors among youth in substance abuse treatment.

    Science.gov (United States)

    Gonzales, Rachel; Anglin, M Douglas; Glik, Deborah C; Zavalza, Christina

    2013-01-01

    This study used mixed methods to explore youth attitudes about recovery-related needs and important drug-avoidance behaviors after treatment. Focus groups were conducted with 118 substance using youth in treatment (four residential and 10 outpatient settings) throughout Los Angeles County. The average age was 17.4 (SD = 2.9); 78.3% were male, 66.1% Latino; and most were in treatment for primary marijuana (40.9%) or methamphetamine (30.4%) abuse. Quantitatve results from the drug-avoidance activity survey identified the following factors youth rated as important to their recovery after treatment: lifestyle improvement activities (95.7%); changing personal drug behaviors (89.6%); drug environment/culture change activities (82.5%); with the least important being therapeutic activities (78.5%). Qualitative findings from focus groups that asked what youth think are important for recovery programs to address after treatment revealed the following four areas: (1) recovery promotion to developmentally appropriate activities (95%); (2) facilitating the use of coping skills to deal with stress (85%); (3) offering alternative recovery support options (not just abstinence only) (75%); and (4) continuing to provide substance use education (65%). Findings highlight essential aspects of recovery in terms of need and drug-avoidance behaviors considered important to youth in treatment. Such information will help to better address clinical and recovery support models aimed at relapse prevention to ensure that the perceived problems of substance-abusing youth are adequately met.

  4. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

    Directory of Open Access Journals (Sweden)

    Shekarchizadeh Hajar

    2012-06-01

    Full Text Available Abstract Background Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810 in MMT. The Chi-square test and t-test served for statistical analyses. Results A clear majority of the participants were men (96%, more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education, and employed (>70%. The most commonly reported main drugs of abuse prior to MMT entry were opium (69% and crystalline heroin (24%. The patients’ lifetime drug experience included opium (92%, crystalline heroin (28%, cannabis (16%, amphetamines (15%, and other drugs (33%. Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.

  5. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

    Science.gov (United States)

    2012-01-01

    Background Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810) in MMT. The Chi-square test and t-test served for statistical analyses. Results A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients’ lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men. PMID:22676557

  6. American Youths' Access to Substance Abuse Treatment: Does Type of Treatment Facility Matter?

    Science.gov (United States)

    Lo, Celia C.; Cheng, Tyrone C.

    2013-01-01

    Using data from the 2007 National Survey on Drug Use and Health, this study examines whether several social exclusion and psychological factors affect adolescents' receipt of substance abuse treatment. Multinomial logistic regression techniques were used to analyze data. The study asked how the specified factors provide pathways to receipt of…

  7. Residential Treatment for Sexually Abusive Youth: An Assessment of Treatment Outcomes

    Science.gov (United States)

    Jones, Christopher D.; Chancey, Roy; Lowe, Laura A.; Risler, Edwin A.

    2010-01-01

    Objective: This research study assesses the effectiveness of participation in a multimodal/holistic residential treatment program on changing deviant sexual interests and functional impairment among sexually abusive youth. Method: A one-group pretest posttest design was utilized to examine pretest (intake) and posttest (discharge) scores for 58…

  8. Substance Abuse Treatment and Domestic Violence. Treatment Improvement Protocol (TIP) Series 25.

    Science.gov (United States)

    Cook, Paddy; Gartner, Constance Grant; Markl, Lise; Henderson, Randi; Brooks, Margaret K.; Wesson, Donald; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayes, Elizabeth

    The major goal of this TIP, on the best practice guidelines to improve the treatment of substance abuse, is to provide clinicians, educators, and paraprofessionals with the latest findings concerning domestic violence. The information is intended to educate providers about the needs and behaviors of batterers and survivors, and how to tailor…

  9. How Serious of a Problem is Staff Turnover in Substance Abuse Treatment? A Longitudinal Study of Actual Turnover1

    Science.gov (United States)

    Eby, Lillian T.; Burk, Hannah; Maher, Charleen P.

    2010-01-01

    In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19 and 50 percent (Johnson & Roman, 2002; Gallon, Gabriel, & Knudsen, 2003; Knudsen et al., 2003; McLellan et al., 2003). However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, serving a wide range of clients in the public and private sector, provided data for the study over a two year time span (2008–2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity. The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment. PMID:20675097

  10. How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover.

    Science.gov (United States)

    Eby, Lillian T; Burk, Hannah; Maher, Charleen P

    2010-10-01

    In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19% and 50% (J.A. Johnson & P.M. Roman, 2002; S.L. Gallon, R.M. Gabriel, J.R.W. Knudsen, 2003; H.K. Knudsen, J.A. Johnson, & P.M. Roman, 2003; A.T. McLellan, D. Carise, & H.D. Kleber, 2003). However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, serving a wide range of clients in the public and private sector, provided data for the study over a 2-year time span (2008-2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups, the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity. The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  11. Relationships with clinical staff after a diagnosis of breast cancer are associated with patients' experience of care and abuse in childhood.

    Science.gov (United States)

    Salmon, Peter; Holcombe, Christopher; Clark, Louise; Krespi, Rita; Fisher, Jean; Hill, Jonathan

    2007-09-01

    Patients experiencing the crisis of the diagnosis and treatment of breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We tested the prediction that women recalling childhood abuse and lack of parental care would experience poorer support from clinical staff caring for them around the time of diagnosis and surgical treatment of breast cancer. Two to 4 days after surgery, women with primary breast cancer (N=355) self-reported: childhood sexual, physical, and emotional abuse and parental care; perceived social support; support experienced from the surgeon and breast and ward nurses; and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care and on current social support, controlling for emotional distress and age. Women who reported feeling fully supported by clinical staff were more likely to recall no abuse and good parental care. The influence of parental care, but not abuse, was explained by its association with experiencing good social support generally, which was itself associated with feeling fully supported by clinical staff. These relationships were independent of current emotional distress. Patients' ability to feel fully supported by clinical staff reflects not only how much support staff make available but also patients' experience of close relationships in childhood. We suggest that, whereas lack of parental care compromises adult supportive relationships in general, abuse specifically reduces support from clinical staff.

  12. The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment.

    Science.gov (United States)

    Thylstrup, Birgitte; Hesse, Morten

    2016-06-01

    Antisocial behavior is associated with low quality of life for the patient and with adverse effects on society and those close to the antisocial patient. However, most patients with antisocial behavior are not seen in treatment settings that focus on their personality but rather in criminal justice settings, substance-abuse treatment, and social welfare settings. This article describes the adaptation and implementation of a highly structured manualized treatment, Impulsive Lifestyle Counseling (ILC), based on the Lifestyle Issues program, a 10-week psychoeducation program studied in prison settings. ILC consists of four sessions over 4 weeks and a booster session 8 weeks later. The goal of treatment is described to patients as "to help people identify their impulsive thoughts and lifestyle leading to problems with drug use, other people, and the police." Two clinical examples and reflections on our experiences with the training and implementation of the ILC program are presented. © The Author(s) 2011.

  13. Educational paper: Abusive Head Trauma part I. Clinical aspects.

    Science.gov (United States)

    Sieswerda-Hoogendoorn, Tessa; Boos, Stephen; Spivack, Betty; Bilo, Rob A C; van Rijn, Rick R

    2012-03-01

    Abusive Head Trauma (AHT) refers to the combination of findings formerly described as shaken baby syndrome. Although these findings can be caused by shaking, it has become clear that in many cases there may have been impact trauma as well. Therefore a less specific term has been adopted by the American Academy of Pediatrics. AHT is a relatively common cause of childhood neurotrauma with an estimated incidence of 14-40 cases per 100,000 children under the age of 1 year. About 15-23% of these children die within hours or days after the incident. Studies among AHT survivors demonstrate that approximately one-third of the children are severely disabled, one-third of them are moderately disabled and one-third have no or only mild symptoms. Other publications suggest that neurological problems can occur after a symptom-free interval and that half of these children have IQs below the 10th percentile. Clinical findings are depending on the definitions used, but AHT should be considered in all children with neurological signs and symptoms especially if no or only mild trauma is described. Subdural haematomas are the most reported finding. The only feature that has been identified discriminating AHT from accidental injury is apnoea. AHT should be approached with a structured approach, as in any other (potentially lethal) disease. The clinician can only establish this diagnosis if he/she has knowledge of the signs and symptoms of AHT, risk factors, the differential diagnosis and which additional investigations to perform, the more so since parents seldom will describe the true state of affairs spontaneously.

  14. Pharmacologically-mediated reactivation and reconsolidation blockade of the psychostimulant-abuse circuit: A novel treatment strategy

    Science.gov (United States)

    Lee, Tong H.; Szabo, Steven T.; Fowler, J. Corey; Mannelli, Paolo; Mangum, O. Barry; Beyer, Wayne F.; Patkar, Ashwin; Wetsel, William C.

    2012-01-01

    Psychostimulant abuse continues to present legal, socioeconomic and medical challenges as a primary psychiatric disorder, and represents a significant comorbid factor in major psychiatric and medical illnesses. To date, monotherapeutic drug treatments have not proven effective in promoting long-term abstinence in psychostimulant abusers. In contrast to clinical trials utilizing monotherapies, combinations of dopamine (DA) agonists and selective 5-HT3, 5HT2A/2C, or NK1 antagonists have shown robust efficacy in reversing behavioral and neurobiological alterations in animal models of psychostimulant abuse. One important temporal requirement for these treatments is that the 5-HT or NK1 receptor antagonist be given at a critical time window after DA agonist administration. This requirement may reflect a necessary dosing regimen towards normalizing underlying dysfunctional neural circuits and “addiction memory” states. Indeed, chronic psychostimulant abuse can be conceptualized as a consolidated form of dysfunctional memory maintained by repeated drug- or cue-induced reactivation of neural circuit and subsequent reconsolidation. According to this concept, the DA agonist given first may reactivate this memory circuit, thereby rendering it transiently labile. The subsequent antagonist is hypothesized to disrupt reconsolidation necessary for restabilization, thus leading progressively to a therapeutically-mediated abolishment of dysfunctional synaptic plasticity. We propose that long-term abstinence in psychostimulant abusers may be achieved not only by targeting putative mechanistic pathways, but also by optimizing drug treatment regimens designed to disrupt the neural processes underlying the addicted state. PMID:22356892

  15. Counselor Treatment of Coexisting Domestic Violence and Substance Abuse: A Qualitative Study.

    Science.gov (United States)

    Chartas, Nicole D.; Culbreth, John R.

    2001-01-01

    This study explored the philosophical issues hindering the linkage of substance abuse and domestic violence treatment. Results suggest that counselors tend to use treatment models that could not concurrently assign responsibility and address either present or past victimization. (Author)

  16. Treatment for Abused and Neglected Children. The User Manual Series.

    Science.gov (United States)

    Martin, Harold P.

    This manual brings current knowledge about the needs of abused and neglected children together with practical ideas about what can be done to meet those needs. Designed primarily for use by child protective service (CPS) workers, the manual may also be used by other professionals dealing with child abuse and neglect. Chapter 1 briefly discusses…

  17. Treatment of clinical mastitis.

    Science.gov (United States)

    Roberson, Jerry R

    2012-07-01

    In summary, culture-based therapy and severity levels are key to management of clinical mastitis. Antibiotic therapy should be strongly considered for gram-positive clinical mastitis. Antibiotic therapy is not necessary for mild-to-moderate gram-negative clinical mastitis. Antibiotic therapy is warranted for practically all severe clinical mastitis as well as fluids and anti-inflammatory drugs. Clinical mastitis cases due to yeast and fungal pathogens or no growth isolates do not warrant antibiotic therapy.

  18. Family treatment for bipolar disorder and substance abuse in late adolescence.

    Science.gov (United States)

    Miklowitz, David J

    2012-05-01

    The initial onset of bipolar disorder occurs in childhood or adolescence in about 50% of patients. Early-onset forms of the disorder have a poorer prognosis than adult-onset forms and are frequently characterized by comorbid substance abuse. Clinical trials research suggests that family psychoeducational approaches are effective adjuncts to medication in stabilizing the symptoms of bipolar disorder in adults and youth, although their efficacy in patients with comorbid substance use disorders has not been systematically investigated. This article describes the family-focused treatment (FFT) of a late adolescent with bipolar disorder and polysubstance dependence. The treatment of this patient and family required adapting FFT to consider the family's structure, dysfunctional alliance patterns, and unresolved conflicts from early in the family's history. The case illustrates the importance of conducting manual-based behavioral family treatments with a psychotherapeutic attitude, including addressing unstated emotional conflicts and resistances that may impede progress. © 2012 Wiley Periodicals, Inc.

  19. [Current situation on new psychoactive substances abuse among methadone maintenance treatment patients in China].

    Science.gov (United States)

    Cheng, Z; Dai, M M; Cao, X B

    2018-04-10

    Methadone maintenance treatment (MMT) greatly contributed to the successful outcomes of prevention and control on both AIDS and drug abuse in China. However, the features on drug abuse changed in the past decades, and the prevalence of new psychoactive substances abuse potentially somehow offset the achievement of MMT. This paper concised the information on research and surveys of this issue that targeting on the current situation, characteristics, related factors and relevant public health problem on new psychoactive substances abuse, among patients who have been on MMT, in China.

  20. The impact of an educational program on recognition, treatment and report of child abuse.

    Science.gov (United States)

    Ferrara, Pietro; Gatto, Antonio; Manganelli, Nunzia Pia; Ianniello, Francesca; Amodeo, Maria Elisa; Amato, Maria; Giardino, Ida; Chiaretti, Antonio

    2017-08-14

    Pediatricians play a crucial role in the identification and management of child abuse and neglect (CAN) but they often don't have a formal specialized training. We analysed retrospectively data about patients, 0 - 18 years of age, victims of CAN between 1 April 2005 and 30 April 2015. The aim of the study was to evaluate the effect of a multidisciplinary educational program, "CAN: prevention strategies, individuation and treatment", on the knowledge, case recognition, treatment and follow-up of physicians of Gemelli University Hospital in Rome, regarding physical, sexual abuse and neglect. This program, in 3 different editions biannually, respectively in May-July 2010, November-January 2012 and February-May 2014, was based on 4 sessions, each one of 2 days. Considering the number of victims of CAN between 2005 and 2015 we observed 66 cases of maltreatment. We divided the study population in 2 groups: group A, before the educational programs, patients evaluated from 1 April 2005 to 30 July 2010; group B, after the educational program from 1 August 2010 to 30 April 2015. We observed 23 children in group A and 43 children in group B with an improvement of 87%. Analyzing our data about sex, nationality, type of perpetrators, we found that: 37/66 (56%) of children were females compared to 29/66 (44%) males; 41/66 (62%) of children came from Italy compared to 25/66 (38%) of foreign children; 52/66 (79%) of the perpetrators of abuse were parents or family members compared to acquaintances 10/66 (15%) and to strangers 4/66 (6%). Considering the prevalence of CAN, the need to develop clinically competent clinicians and the improving of residency education in child maltreatment is imperative. Improving the clinical skills of pediatricians to identify and evaluate CAN may lead to reduce morbidity and mortality of these children.

  1. Neuropsychological screening of children of substance-abusing women attending a Special Child Welfare Clinic in Norway

    Directory of Open Access Journals (Sweden)

    Skogmo Idar

    2010-07-01

    Full Text Available Abstract Background Exposure to alcohol and illicit substances during pregnancy can have an impact on the child for the rest of his/her life. A Special Child Welfare Clinic (SCWC in Norway provides care for pregnant women with substance abuse problems. Treatment and support are provided without replacement therapy. Methods We performed a neuropsychological screening of 40 children aged four to 11 years whose mothers had attended the SCWC during pregnancy, and of a comparison group of 80 children of women without substance abuse problems. The children were presented with tests chosen from Wechsler Intelligence Scale for Children, third version (WISC-III, Nepsy, Halstead-Reitan and Raven's Progressive Matrices, Coloured Version. The tests were grouped into five main domains; (1 learning and memory, (2 visual scanning, planning and attention, (3 executive function, (4 visuo-motor speed and dexterity and (5 general intellectual ability Results No children in the study had test results in the clinical range in any domain. Bivariate analyses revealed that children of short-term substance-abusing mothers (who stopped substance abuse within the first trimester had significantly lower test scores than the comparison group in three out of five domains (domain 2,3,4. Children of long-term substance abusers (who maintained moderate substance abuse throughout pregnancy had significantly lower test results than the comparison group in one domain of the test results (domain 1. All but one child in the long-term group were or had been in foster homes. Most children in the short-term group stayed with their mothers. Multivariate regression analyses revealed that foster care minimum 50% of life time was associated with better scores on domains (1 learning and memory, (2 visual scanning, planning and attention, and (3 executive functions, while no significant associations with test scores was found for substance abuse and birth before 38 weeks of gestation

  2. Neuropsychological screening of children of substance-abusing women attending a Special Child Welfare Clinic in Norway.

    Science.gov (United States)

    Hjerkinn, Bjørg; Lindbaek, Morten; Skogmo, Idar; Rosvold, Elin Olaug

    2010-07-20

    Exposure to alcohol and illicit substances during pregnancy can have an impact on the child for the rest of his/her life. A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment and support are provided without replacement therapy. We performed a neuropsychological screening of 40 children aged four to 11 years whose mothers had attended the SCWC during pregnancy, and of a comparison group of 80 children of women without substance abuse problems. The children were presented with tests chosen from Wechsler Intelligence Scale for Children, third version (WISC-III), Nepsy, Halstead-Reitan and Raven's Progressive Matrices, Coloured Version. The tests were grouped into five main domains; (1) learning and memory, (2) visual scanning, planning and attention, (3) executive function, (4) visuo-motor speed and dexterity and (5) general intellectual ability No children in the study had test results in the clinical range in any domain. Bivariate analyses revealed that children of short-term substance-abusing mothers (who stopped substance abuse within the first trimester) had significantly lower test scores than the comparison group in three out of five domains (domain 2,3,4). Children of long-term substance abusers (who maintained moderate substance abuse throughout pregnancy) had significantly lower test results than the comparison group in one domain of the test results (domain 1). All but one child in the long-term group were or had been in foster homes. Most children in the short-term group stayed with their mothers. Multivariate regression analyses revealed that foster care minimum 50% of life time was associated with better scores on domains (1) learning and memory, (2) visual scanning, planning and attention, and (3) executive functions, while no significant associations with test scores was found for substance abuse and birth before 38 weeks of gestation. Children raised by former substance abusing

  3. Predictors of Relapse for American Indian Women after Substance Abuse Treatment

    Science.gov (United States)

    Chong, Jenny; Lopez, Darlene

    2008-01-01

    The objective of this study was to describe the predictors of substance use relapse of American Indian (AI) women up to one year following substance abuse treatment. Relapse is defined as any use of alcohol or drugs in the past 30 days at the follow-up points. Data were collected from AI women in a 45-day residential substance abuse treatment…

  4. Encopresis and Sexual Abuse in a Sample of Boys in Residential Treatment.

    Science.gov (United States)

    Morrow, Jan; And Others

    1997-01-01

    This study of 23 boys (ages 6 to 14) in a residential psychiatric treatment program found nine of the boys were encopretic (27 times the incidence of encopresis in the general population of boys 10-12). Seven of the nine boys had histories of sexual abuse by males, suggesting that encopresis may be a marker of sexual abuse. (DB)

  5. Training in the Prevention and Treatment of Child Abuse and Neglect. The User Manual Series.

    Science.gov (United States)

    Broadhurst, Diane D.; MacDicken, Robert A.

    Intended primarily for persons or agencies responsible for providing training to professionals and interested citizens involved in delivery of services to abusive and neglectful families, the manual addresses the importance of training in the identification, reporting, diagnosis, treatment, and prevention of child abuse and neglect. Chapters focus…

  6. Pattern of Illegal Drug Use in Women Referred to Substance Abuse Control Clinic in Fasa, Iran (2009-2011

    Directory of Open Access Journals (Sweden)

    Mohammad mehdi Naghizadeh

    2014-03-01

    Full Text Available Background & Objective: Women’s role as a consumer or as a person who is facing with risks is so important in studies of substance abuse. However, major studies on this field aimed at studying on male population. Therefore, the aim of this study described the pattern of using illegal drugs among women belong to substance abuse control clinic of  Fasa city (south of Iran.Materials & Methods: This cross sectional study as a census was done on all authorized substance abuse treatment centers in Fasa in summer 2011. Information about demographic data, types of drugs, method of using, duration of addiction and onset age was extracted from the files of self-referred women. Results: There were 88 women in Fasa substance abuse treatment centers who were 2.8% of all registered patients. The Mean age of drug onset was 30.8±11.8 years. 62 persons (70.5% used opium and 55 persons (62.5% used Opium sap which were indicated thatthese two drugs were the two common ones among addicted women. With the average of 9.4±7.1 years, Opium had the longest duration of use. There is only one woman who had used injection during the last month. Two of the women had sexual relationship out of the family in the last month in which one of them had the unsafe contact as well.Conclusion: Presently, the pattern of drug abuse among women in Fasa is traditional and is based on the opium derivatives. However, according to the increasing rate and changes in drugs type, monitoring the behavior of drug abuser can have an effective role on the improvement of health in a community.

  7. Substance abuse in pregnant women. Experiences from a special child welfare clinic in Norway

    Directory of Open Access Journals (Sweden)

    Rosvold Elin

    2007-11-01

    Full Text Available Abstract Background Substance abuse during pregnancy may harm the foetus and can cause neonatal abstinence syndrome. Exposure to alcohol and other substances can influence the child for the rest of its life. A special child welfare clinic was set up in 1994 in Kristiansand, Norway, targeting pregnant women with substance abuse problems in the county of Vest-Agder. Pregnancy is not an indication for opioid replacement therapy in Norway, and one of the clinic's aims was to support the drug dependent women through their pregnancy without any replacements. The object of this paper is to describe concurrent health and social problems, as well as the predictors for stopping drug abuse, in the clinic's user group. Methods Retrospective cohort study. Data was gathered from the medical records of all 102 women seen in the clinic in the period between 1992 and 2002. The study includes 59 out of 60 women that were followed until their children were two years old or placed in alternative care, and a comparison group of twice the size. Both groups were presented with a questionnaire concerning both the pregnancy and health and socio-economic issues. Results Four (4.5 percent of the women that completed their pregnancies did not manage to reduce their substance abuse. All the others reduced their substance abuse considerably. The odds ratio for stopping substance abuse within the first trimester was significantly associated with stopping smoking (O.R. 9.7 or being victims of rape (O.R. 5.3. Conclusion A low cost and low threshold initiative organised as a child welfare clinic may support women with substance abuse problems in their efforts to stop or reduce their substance abuse during pregnancy.

  8. Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers.

    Science.gov (United States)

    Jennings, Jerry L; Deming, Adam

    2017-12-01

    This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

  9. Ethical Implications in Vaccine Pharmacotherapy for Treatment and Prevention of Drug of Abuse Dependence.

    Science.gov (United States)

    Carfora, Anna; Cassandro, Paola; Feola, Alessandro; La Sala, Francesco; Petrella, Raffaella; Borriello, Renata

    2018-03-01

    Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. "Drug vaccines" aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, "cocaine and nicotine vaccines" have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining how these vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use.

  10. Sex-specific substance abuse treatment for female healthcare professionals: implications.

    Science.gov (United States)

    Koos, Erin; Brand, Michael; Rojas, Julio; Li, Ji

    2014-01-01

    Gender plays a significant role in the development and treatment of substance abuse disorders. Sex-specific treatment for girls and women has recurrently proven more effective, with better outcomes than traditional treatment. Research on impaired healthcare professionals (HCPs) has largely focused on men, garnering little attention for women and sex differences. With the increasing numbers of female HCPs, it is imperative to identify potential sex differences that may have implications for treatment. Our study compared a convenience sample of male and female HCPs with substance abuse disorders treated in an outpatient program to identify sex differences that may have implications for treatment. Our sample consisted of 96 HCPs (54 men, 42 women) and 17 non-healthcare professional (N-HCP) women. All of the participants were evaluated using the program's clinical interview and the Personality Assessment Inventory (PAI). Chart review data contained categorical variables, qualitative variables, diagnoses, and psychological test scores. A second analysis was conducted through two separate comparisons: the PAI results of comparing impaired female HCPs with impaired male HCPs and the PAI results of comparing impaired female HCPs with impaired female N-HCPs. Statistically significant differences indicated more male participants received prior treatment and more intensive treatment than female participants. More female subjects reported being diagnosed as having a comorbid psychiatric condition and taking psychotropic medications. Several statistically significant differences in the PAI scores were found. Among female HCPs, elevations were found in anxiety, depression, paranoia, and borderline personality disorder. Substantive differences, although not statistically significant, were elevations in somatic complaints and anxiety disorders in female HCPs. In the comparison of female HCPs and N-HCPs, the only statistically significant difference was the significantly higher

  11. Prevalence and predictors of Axis I disorders in a large sample of treatment-seeking victims of sexual abuse and incest

    Directory of Open Access Journals (Sweden)

    Eoin McElroy

    2016-04-01

    Full Text Available Background: Childhood sexual abuse (CSA is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective: This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method: The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434. Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III. Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts and 10 adult clinical syndromes. Results: There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions: The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses.

  12. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

    Science.gov (United States)

    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  13. Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study.

    Science.gov (United States)

    Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind; Brekke, Mette

    2016-05-21

    Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC). All patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry. There were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries. The procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.

  14. Customizing monoclonal antibodies for the treatment of methamphetamine abuse: current and future applications.

    Science.gov (United States)

    Peterson, Eric C; Gentry, W Brooks; Owens, S Michael

    2014-01-01

    Monoclonal antibody-based medications designed to bind (+)-methamphetamine (METH) with high affinity are among the newest approaches to the treatment of METH abuse and the associated medical complications. The potential clinical indications for these medications include treatment of overdose, reduction of drug dependence, and protection of vulnerable populations from METH-related complications. Research designed to discover and conduct preclinical and clinical testing of these antibodies suggests a scientific vision for how intact monoclonal antibody (mAb) (singular and plural) or small antigen-binding fragments of mAb could be engineered to optimize the proteins for specific therapeutic applications. In this review, we discuss keys to success in this development process including choosing predictors of specificity, efficacy, duration of action, and safety of the medications in disease models of acute and chronic drug abuse. We consider important aspects of METH-like hapten design and how hapten structural features influence specificity and affinity, with an example of a high-resolution X-ray crystal structure of a high-affinity antibody to demonstrate this structural relationship. Additionally, several prototype anti-METH mAb forms such as antigen-binding fragments and single-chain variable fragments are under development. Unique, customizable aspects of these fragments are presented with specific possible clinical indications. Finally, we discuss clinical trial progress of the first in kind anti-METH mAb, for which METH is the disease target instead of vulnerable central nervous system networks of receptors, binding sites, and neuronal connections. © 2014 Elsevier Inc. All rights reserved.

  15. 38 CFR 17.80 - Alcohol and drug dependence or abuse treatment and rehabilitation in residential and...

    Science.gov (United States)

    2010-07-01

    ... dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract. 17... of Services of Other Federal Agencies § 17.80 Alcohol and drug dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract. (a) Alcohol and drug dependence or abuse...

  16. Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

    Science.gov (United States)

    Hunt, Priscillia; Hunter, Sarah B; Levan, Deborah

    2017-06-01

    Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. Copyright © 2017. Published by Elsevier Inc.

  17. National Survey of Substance Abuse Treatment Services (N-SSATS-2013)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  18. National Survey of Substance Abuse Treatment Services (N-SSATS-2010)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  19. National Survey of Substance Abuse Treatment Services (N-SSATS-2014)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  20. National Survey of Substance Abuse Treatment Services (N-SSATS-2012)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  1. National Survey of Substance Abuse Treatment Services (N-SSATS-2003)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  2. National Survey of Substance Abuse Treatment Services (N-SSATS-2006)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  3. National Survey of Substance Abuse Treatment Services (N-SSATS-2000)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  4. National Survey of Substance Abuse Treatment Services (N-SSATS-2002)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  5. National Survey of Substance Abuse Treatment Services (N-SSATS-2008)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  6. National Survey of Substance Abuse Treatment Services (N-SSATS-2009)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  7. National Survey of Substance Abuse Treatment Services (N-SSATS-2005)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  8. National Survey of Substance Abuse Treatment Services (N-SSATS-2007)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  9. National Survey of Substance Abuse Treatment Services (N-SSATS-2004)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  10. National Survey of Substance Abuse Treatment Services (N-SSATS-1997-2011)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  11. National Survey of Substance Abuse Treatment Services (N-SSATS-2011)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

  12. Clinical Supervision in Alcohol and Drug Abuse Counseling: Principles, Models, Methods.

    Science.gov (United States)

    Powell, David J.

    A case is made for professionalism in clinical training as substance abuse counseling becomes a unique field. Part 1, "Principles," includes: (1) "A Historical Review of Supervision"; (2) "A Working Definition of Supervision"; (3) "Leadership Principles for Supervisors" and; (4) "Traits of an Effective Clinical Supervisor." Part 2, "Models,"…

  13. Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Pasche Sonja

    2010-03-01

    Full Text Available Abstract Background Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries. This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa. Methods Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in poor communities in Cape Town, South Africa who had accessed substance abuse treatment in 2006. Results Multiple regression analyses revealed that therapeutic alliance, treatment perceptions, abstinence-specific social support, and depression were significant partial predictors of treatment completion. Conclusions Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii strengthening clients' abstinence-oriented social networks and, iii strengthening the counselor-client therapeutic alliance.

  14. Patterns of drug abuse among drug users with regular and irregular attendance for treatment as detected by comprehensive UHPLC-HR-TOF-MS.

    Science.gov (United States)

    Sundström, Mira; Pelander, Anna; Simojoki, Kaarlo; Ojanperä, Ilkka

    2016-01-01

    The most severe consequences of drug abuse include infectious diseases, overdoses, and drug-related deaths. As the range of toxicologically relevant compounds is continually changing due to the emergence of new psychoactive substances (NPS), laboratories are encountering analytical challenges. Current immunoassays are insufficient for determining the whole range of the drugs abused, and a broad-spectrum screening method is therefore needed. Here, the patterns of drug abuse in two groups of drug users were studied from urine samples using a comprehensive screening method based on high-resolution time-of-flight mass spectrometry. The two groups comprised drug abusers undergoing opioid maintenance treatment (OMT) or drug withdrawal therapy and routinely visiting a rehabilitation clinic, and drug abusers with irregular attendance at a harm reduction unit (HRU) and suspected of potential NPS abuse. Polydrug abuse was observed in both groups, but was more pronounced among the HRU subjects with a mean number of concurrent drugs per sample of 3.9, whereas among the regularly treated subjects the corresponding number was 2.1. NPS and pregabalin were more frequent among HRU subjects, and their abuse was always related to drug co-use. The most common drug combination for an HRU subject included amphetamine, cannabis, buprenorphine, benzodiazepine, and alpha-pyrrolidinovalerophenone. A typical set of drugs for treated subjects was buprenorphine, benzodiazepine, and occasionally amphetamine. Abuse of several concurrent drugs poses a higher risk of drug intoxication and a threat of premature termination of OMT. Since the subjects attending treatment used fewer concurrent drugs, this treatment could be valuable in reducing polydrug abuse. Copyright © 2015 John Wiley & Sons, Ltd.

  15. A Cross-Lagged Panel Study of Dissociation and Posttraumatic Stress in a Treatment-Seeking Sample of Survivors of Childhood Sexual Abuse

    DEFF Research Database (Denmark)

    Murphy, Siobhan; Elklit, Ask; Murphy, Jamie

    2017-01-01

    Objective: The current prospective study assessed the temporal relations between dissociation and posttraumatic stress (PTS) in a sample of treatment-seeking female survivors of childhood sexual abuse. PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence...... clinical implications that may affect their treatment and trauma recovery....

  16. Predictors of substance abuse treatment need and receipt among homeless women.

    Science.gov (United States)

    Tucker, Joan S; Wenzel, Suzanne L; Golinelli, Daniela; Zhou, Annie; Green, Harold D

    2011-04-01

    Many homeless women do not receive needed treatment for substance abuse. This study identified social network and other predisposing factors associated with perceived need for and receipt of substance abuse treatment among 273 homeless women who screened positive for past-year substance abuse. Perceived treatment need was more likely among women with drug-using sex partners, a denser network, and an arrest history but less likely for those with a minor child and a longer history of homelessness. Receiving treatment was more likely among women who received informational support from their sex partners and who had an arrest history but less likely among those who had a more street-based social network, had a minor child, considered themselves homeless, and recently needed mental health treatment. Treatment services researchers should attend more closely to social contextual factors, as well as the more traditional individual factors, to understand access and barriers to treatment. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Integrating substance abuse care with community diabetes care: implications for research and clinical practice

    Directory of Open Access Journals (Sweden)

    Ghitza UE

    2013-01-01

    Full Text Available Udi E Ghitza,1 Li-Tzy Wu,2 Betty Tai11Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAAbstract: Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%–60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of

  18. A centralized informatics infrastructure for the National Institute on Drug Abuse Clinical Trials Network

    Science.gov (United States)

    Pan, Jeng-Jong; Nahm, Meredith; Wakim, Paul; Cushing, Carol; Poole, Lori; Tai, Betty; Pieper, Carl F.

    2009-01-01

    Background Clinical trial networks were created to provide a sustaining infrastructure for the conduct of multisite clinical trials. As such, they must withstand changes in membership. Centralization of infrastructure including knowledge management, portfolio management, information management, process automation, work policies, and procedures in clinical research networks facilitates consistency and ultimately research. Purpose In 2005, the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) transitioned from a distributed data management model to a centralized informatics infrastructure to support the network’s trial activities and administration. We describe the centralized informatics infrastructure and discuss our challenges to inform others considering such an endeavor. Methods During the migration of a clinical trial network from a decentralized to a centralized data center model, descriptive data were captured and are presented here to assess the impact of centralization. Results We present the framework for the informatics infrastructure and evaluative metrics. The network has decreased the time from last patient-last visit to database lock from an average of 7.6 months to 2.8 months. The average database error rate decreased from 0.8% to 0.2%, with a corresponding decrease in the interquartile range from 0.04%–1.0% before centralization to 0.01%–0.27% after centralization. Centralization has provided the CTN with integrated trial status reporting and the first standards-based public data share. A preliminary cost-benefit analysis showed a 50% reduction in data management cost per study participant over the life of a trial. Limitations A single clinical trial network comprising addiction researchers and community treatment programs was assessed. The findings may not be applicable to other research settings. Conclusions The identified informatics components provide the information and infrastructure needed for our clinical trial

  19. 3 R's in the Marital Treatment of Alcohol Abuse.

    Science.gov (United States)

    Schlesinger, Stephen E.

    Alcohol abuse imposes financial, social, and emotional burdens on drinkers and their families. Couples suffering from alcohol-related problems who seek therapy often have expectations of retribution, restitution, and refuge. Although thoughts of retribution are difficult to elicit in therapy, non-drinking spouses often expect to inflict pain on…

  20. The Treatment of Wife Abuse in Recent Social Science Literature.

    Science.gov (United States)

    Wardell, Laurie; And Others

    This paper reviews the social science literature dealing with gender relations in marriage and the issues of wife abuse. It is argued that the old anti-woman biases of the literature have not really diminished under the impact of feminism. The sexist assumptions and victim-blaming focus of the new battery literature are examined through…

  1. Elder Abuse and Black Americans: Incidence, Correlates, Treatment and Prevention.

    Science.gov (United States)

    Cazenave, Noel A.

    Existing evidence on family violence rates by age and race as well as the available data on race and physical elder abuse incidence rates suggests that because such data are not based on random or representative samples and tend to reflect a "sampling artifact" of the particular client populations served by the professionals surveyed,…

  2. An investigation of scale effects in family substance abuse treatment programs

    Directory of Open Access Journals (Sweden)

    Lee A James

    2010-07-01

    Full Text Available Abstract This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families was too small to be economical. Although the sample size (just nine programs was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

  3. A rationale and model for addressing tobacco dependence in substance abuse treatment

    Directory of Open Access Journals (Sweden)

    Richter Kimber P

    2006-08-01

    Full Text Available Abstract Most persons in drug treatment smoke cigarettes. Until drug treatment facilities systematically treat their patients' tobacco use, millions will flow through the drug treatment system, overcome their primary drug of abuse, but die prematurely from tobacco-related illnesses. This paper reviews the literature on the health benefits of quitting smoking for drug treatment patients, whether smoking causes relapse to other drug or alcohol abuse, the treatment of tobacco dependence, and good and bad times for quitting smoking among drug treatment patients. It also presents a conceptual model and recommendations for treating tobacco in substance abuse treatment, and provides references to internet and paper-copy tools and information for treating tobacco dependence. At present, research on tobacco treatment in drug treatment is in its infancy. Although few drug treatment programs currently offer formal services, many more will likely begin to treat nicotine dependence as external forces and patient demand for these services increases. In the absence of clear guidelines and attention to quality of care, drug treatment programs may adopt smoking cessation services based on cost, convenience, or selection criteria other than efficacy. Because research in this field is relatively new, substance abuse treatment professionals should adhere to the standards of care for the general population, but be prepared to update their practices with emerging interventions that have proven to be effective for patients in drug treatment.

  4. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

    Science.gov (United States)

    D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

    2016-01-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

  5. Inequitable access to substance abuse treatment services in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Louw Johann

    2010-11-01

    Full Text Available Abstract Background Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. Methods This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. Results Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of

  6. Perceptions of Organizational Functioning in Substance Abuse Treatment Facilities in South Africa

    Science.gov (United States)

    Bowles, Steven; Louw, Johann; Myers, Bronwyn

    2011-01-01

    Directors' and treatment staff's perceptions of organizational functioning within substance abuse treatment facilities in four provinces in South Africa were examined via the Texas Christian University's Organizational Readiness for Change instrument. Forty-four treatment facilities (out of 89) participated in the study. Results indicated that…

  7. Substance abuse treatment management information systems: balancing federal, state, and service provider needs.

    Science.gov (United States)

    Camp, J M; Krakow, M; McCarty, D; Argeriou, M

    1992-01-01

    There is increased interest in documenting the characteristics and treatment outcomes of clients served with Alcohol, Drug Abuse, and Mental Health Block Grant funds. The evolution of federal client-based management systems for substance abuse treatment services demonstrates that data collection systems are important but require continued support. A review of the Massachusetts substance abuse management information system illustrates the utility of a client-based data set. The development and implementation of a comprehensive information system require overcoming organizational barriers and project delays, fostering collaborative efforts among staff from diverse agencies, and employing considerable resources. In addition, the need to develop mechanisms for increasing the reliability of the data and ongoing training for the users is presented. Finally, three applications of the management information system's role in shaping policy are reviewed: developing services for special populations (communities of color, women, and pregnant substance abusers, and injection drug users), utilizing MIS data for evaluation purposes, and determining funding allocations.

  8. Integrating Substance Abuse Treatment and Child Welfare Services: Findings from the Illinois Alcohol and Other Drug Abuse Waiver Demonstration

    Science.gov (United States)

    Ryan, Joseph P.; Marsh, Jeanne C.; Testa, Mark F.; Louderman, Richard

    2006-01-01

    Alcohol and other drug abuse is a major problem for children and families involved with public child welfare. Substance abuse compromises appropriate parenting practices and increases the risk of child maltreatment. A substantial proportion of substantiated child abuse and neglect reports involve parental substance abuse. Once in the system,…

  9. The Survey of Treatment Entry Pressures (STEP): identifying client's reasons for entering substance abuse treatment.

    Science.gov (United States)

    Dugosh, Karen Leggett; Festinger, David S; Lynch, Kevin G; Marlowe, Douglas B

    2014-10-01

    Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual's treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP's psychometric properties. A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4-7 days later. Analyses were performed to examine the instrument's psychometric properties including item response rates, test-retest reliability, internal consistency, and factor structure. The items displayed adequate test-retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2-factor structure reflecting type of reinforcement schedule. The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client's treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes. © 2014 Wiley Periodicals, Inc.

  10. Arab Parents' Reactions to Child Sexual Abuse: A Review of Clinical Records

    Science.gov (United States)

    Abu-Baker, Khawla

    2013-01-01

    This paper addresses parents' reactions to sexual abuse cases in their families. The study analyzed the clinical records of individual and family therapy sessions with 35 cases of Arab Palestinian clients, citizens of Israel (27 individuals and 8 families). Families were categorized as either functional or dysfunctional. It was concluded that the…

  11. Behavioral and Psychological Assessment of Child Sexual Abuse in Clinical Practice

    Science.gov (United States)

    Malhotra, Savita; Biswas, Parthasarathy

    2006-01-01

    This paper discusses the behavioral and psychological assessment of Child Sexual Abuse (CSA) in clinical practice. Following a brief introduction regarding definition and etiology of CSA and discussion on issues of behavioral/psychological consequences of CSA, the paper reviews the various approaches towards behavioral/psychological assessment in…

  12. Maternal Drug Abuse History, Maltreatment, and Functioning in a Clinical Sample of Urban Children

    Science.gov (United States)

    Onigu-Otite, Edore C.; Belcher, Harolyn M. E.

    2012-01-01

    Objective: This study examined the association between maternal drug abuse history, maltreatment exposure, and functioning, in a clinical sample of young children seeking therapy for maltreatment. Methods: Data were collected on 91 children, mean age 5.3 years (SD 1.0). The Preschool and Early Childhood Functional Assessment Scales (PECFAS) was…

  13. Counselors' Role in Preventing Abuse of Older Adults: Clinical, Ethical, and Legal Considerations

    Science.gov (United States)

    Forman, Julia M.; McBride, Rebecca G.

    2010-01-01

    Mistreatment of older adults is commonplace. These individuals are subjected to abuse, financial exploitation, and neglect. The authors present an overview of the literature concerning mistreatment, with an emphasis on clinical, ethical, and legal considerations. Methods are proposed for prevention, including counselor education, advocacy, and…

  14. Clinical Correlates and Repetition of Self-Harming Behaviors among Female Adolescent Victims of Sexual Abuse

    Science.gov (United States)

    Cyr, Mireille; McDuff, Pierre; Wright, John; Theriault, Chantal; Cinq-Mars, Caroline

    2005-01-01

    This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups…

  15. Issues in the assessment of personality disorder and substance abuse using the Millon Clinical Multiaxial Inventory (MCMI-II).

    Science.gov (United States)

    Flynn, P M; McCann, J T; Fairbank, J A

    1995-05-01

    Substance abuse treatment clients often present other severe mental health problems that affect treatment outcomes. Hence, screening and assessment for psychological distress and personality disorder are an important part of effective treatment, discharge, and aftercare planning. The Millon Clinical Multiaxial Inventory-II (MCMI-II) frequently is used for this purpose. In this paper, several issues of concern to MCMI-II users are addressed. These include the extent to which MCMI-II scales correspond to DSM-III-R disorders; overdiagnosis of disorders using the MCMI-II; accuracy of MCMI-II diagnostic cut-off scores; and the clinical utility of MCMI-II diagnostic algorithms. Approaches to addressing these issues are offered.

  16. Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies.

    Science.gov (United States)

    Lehman, Wayne E K; Fletcher, Bennett W; Wexler, Harry K; Melnick, Gerald

    2009-08-01

    Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.

  17. Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

    Science.gov (United States)

    Lebensohn-Chialvo, Florencia; Rohrbaugh, Michael J; Hasler, Brant P

    2018-04-30

    As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research. © 2018 Family Process Institute.

  18. Comparison of drug treatment histories of single and multiple drug abusers in detox.

    Science.gov (United States)

    Greberman, S B; Jasinski, D

    2001-01-01

    This study was undertaken to determine differences in previous treatment patterns in individuals currently using different numbers of substances. Medical records of 1198 inpatient detoxification (detox) admissions were analyzed. Numbers of past admissions to completed detox, methadone, or other types of drug abuse treatment were totaled and ranked to determine most frequent type. Within gender, treatment histories of single and multiple drug abusers usually do not differ. The one exception is male multiple drug abusers ages 26-30, who show increased admissions. Possible explanations are that men do not seek treatment before developing medical complications of addiction or until external factors influence admission. There were differences in treatment histories between genders in multiple drug abusers only. Before age 30, women reported increased treatment of certain types. Possible explanations are that treatment priority is given to women who are, or may be, pregnant. Also, younger men may not enter or complete treatment. Previous treatment history may influence many behaviors. The results of this study delineate several valuable indicators for assessing past history.

  19. HPA axis response to psychological stress and treatment retention in residential substance abuse treatment: a prospective study.

    Science.gov (United States)

    Daughters, Stacey B; Richards, Jessica M; Gorka, Stephanie M; Sinha, Rajita

    2009-12-01

    Substance abuse treatment programs are often characterized by high rates of premature treatment dropout, which increases the likelihood of relapse to drug use. Negative reinforcement models of addiction emphasize an individual's inability to tolerate stress as a key factor for understanding poor substance use treatment outcomes, and evidence indicates that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis contributes to an individual's inability to respond adaptively to stress. The aim of the current study was to examine whether HPA axis response to stress is predictive of treatment retention among a sample of drug users in residential substance abuse treatment. Prospective study assessing treatment retention among 102 individuals enrolled in residential substance abuse treatment. Participants completed two computerized stress tasks, and HPA axis response to stress was measured via salivary cortisol at five time points from baseline (pre-stress) to 30 min post-stress exposure. The main outcome measures were treatment dropout (categorical) and total number of days in treatment (continuous). A significantly higher salivary cortisol response to stress was observed in treatment dropouts compared to treatment completers. Further, Cox proportional hazards survival analyses indicated that a higher peak cortisol response to stress was associated with a shorter number of days to treatment dropout. Results indicate that a higher salivary cortisol level in response to stress is associated with an inability to remain in substance abuse treatment. These findings are the first to document a biological marker of stress as a predictor of substance abuse treatment dropout, and support the development and implementation of treatments targeting this vulnerability.

  20. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol.

    Science.gov (United States)

    Day, Ed; Bentham, Peter W; Callaghan, Rhiannon; Kuruvilla, Tarun; George, Sanju

    2013-07-01

    Autopsy studies suggest that Wernicke-Korsakoff syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but uncertainty remains about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. This is an update of a review first published in 2004 and last updated in 2008. • To assess the efficacy of thiamine in preventing and treating the manifestations of WKS due to excess alcohol consumption. • To determine the optimum form, dose and duration of thiamine treatment for this indication. ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 6 September 2012 using the term thiamine OR aneurine. ALOIS contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trial databases and grey literature sources. Any randomised trials comparing thiamine with alternative interventions or comparing different thiamine regimens (varying in formulation, dose or duration of administration). All abstracts were independently inspected by two reviewers (ED and PWB), and relevant articles were retrieved and assessed for methodological quality using criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomly assigned participants (n = 107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5 mg/day) with each of the other four doses. A significant difference favoured 200 mg/day compared with the 5-mg/day dose in determining the number of trials needed to meet inclusion criteria

  1. Attachment as an organizer of behavior: implications for substance abuse problems and willingness to seek treatment

    Directory of Open Access Journals (Sweden)

    Troutman Beth

    2006-11-01

    Full Text Available Abstract Background Attachment theory allows specific predictions about the role of attachment representations in organizing behavior. Insecure attachment is hypothesized to predict maladaptive emotional regulation whereas secure attachment is hypothesized to predict adaptive emotional regulation. In this paper, we test specific hypotheses about the role of attachment representations in substance abuse/dependence and treatment participation. Based on theory, we expect divergence between levels of maladaptive functioning and adaptive methods of regulating negative emotions. Methods Participants for this study consist of a sample of adoptees participating in an ongoing longitudinal adoption study (n = 208. The Semi-Structured Assessment of the Genetics of Alcohol-II 41 was used to determine lifetime substance abuse/dependence and treatment participation. Attachment representations were derived by the Adult Attachment Interview [AAI; 16]. We constructed a prior contrasts reflecting theoretical predictions for the association between attachment representations, substance abuse/dependence and treatment participation. Results Logistic regression was used to test our hypotheses. As predicted, individuals classified as dismissing, preoccupied or earned-secure reported the highest rates of substance abuse/dependence. Individuals classified as dismissing reported significantly lower rates of treatment participation despite their high rates of substance abuse/dependence. As expected, the continuous-secure group reported lowest rates of both substance abuse/dependence and treatment participation. Conclusion The findings from this study identify attachment representations as an influential factor in understanding the divergence between problematic substance use and treatment utilization. The findings further imply that treatment may need to take attachment representations into account to promote successful recovery.

  2. Rearrest and Probation Violation Outcomes among Probationers Participating in a Jail-Based Substance-Abuse Treatment Used as an Intermediate Sanction

    Science.gov (United States)

    Linhorst, Donald M.; Dirks-Linhorst, P. Ann; Groom, Ralph

    2012-01-01

    This study compares the characteristics of two groups of probationers ordered to jail-based substance-abuse treatment as an intermediate sanction. It further reviews rearrest and probation failure outcomes of the two groups, along with the demographic, clinical, and criminal factors associated with those outcomes. Probationers jailed for probation…

  3. From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture.

    Science.gov (United States)

    Dell, Colleen Anne; Seguin, Maureen; Hopkins, Carol; Tempier, Raymond; Mehl-Madrona, Lewis; Dell, Debra; Duncan, Randy; Mosier, Karen

    2011-02-01

    First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.

  4. Clinical Characteristics Related to Severity of Sexual Abuse: A Study of Seriously Mentally Ill Youth.

    Science.gov (United States)

    McClellan, Jon; And Others

    1995-01-01

    Variables associated with sexual abuse were examined among youth, ages 5 through 18, with severe mental illness. Review of 499 patient records revealed abuse as an isolated event in 62 cases, intermittent abuse in 61 cases, and chronic abuse in 150. Sexual abuse was associated with inappropriate sexual behaviors, substance abuse, and posttraumatic…

  5. Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain.

    Science.gov (United States)

    Ducharme, Lori J; Chandler, Redonna K; Harris, Alex H S

    2016-01-01

    The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described. Published by Elsevier Inc.

  6. Does comorbid alcohol and substance abuse affect electroconvulsive therapy outcome in the treatment of mood disorders?

    Science.gov (United States)

    Moss, Lori; Vaidya, Nutan

    2014-03-01

    Antidepressant medications remain the principal agents used to treat patients with mood disorders, although 30% to 40% of these patients do not improve. One of the factors associated with poor medication response is alcohol and substance abuse. Persons with mood disorders are at the greatest risk for suicide, and alcoholism is a significant additional risk factor. Electroconvulsive therapy (ECT) is shown to be the most effective treatment for major depression especially when associated with psychosis, catatonia, and suicide intent. However, similar to most antidepressant trials, patients with depression and comorbid alcohol and substance abuse are excluded from ECT efficacy studies. Through a retrospective chart review, we compared response to ECT in patients with mood disorder and comorbid alcohol and drug abuse to those with mood disorder only. From 2004 to 2010, 80 patients with mood disorder received ECT. Fifty of these had comorbid alcohol or drug abuse. Using a 10-item psychopathology scale, we compared pre- and post-ECT symptom severity between the 2 groups. Outcome was determined by measuring a decrease in the pre-ECT and post-ECT score using Wilcoxon rank tests, with statistical significance at P = 0.05. There was no difference between the 2 groups in most demographics, ECT medication, or seizure quality. There was no difference in ECT outcome between those with comorbid alcohol abuse and those without based on percent decrease in pre- and post-ECT symptom scores (abuse: mean [SD], 0.89 [0.2] vs nonabuse: mean [SD], 0.93 [0.16]; Wilcoxon, 1332; P = 0.086). When we compared those who met the criteria for alcohol or drug dependence (19 patients) with those with no abuse, there was a trend for the dependence group to not do as well (dependence: mean [SD], 0.83 [0.25] vs nonabuse: mean [SD], 0.93 [0.16]; Wilcoxon, 405; P = 0.053). Those with combined drug and alcohol abuse (18 patients) did have a significantly worse outcome (combined: mean [SD], 0.82 [0

  7. Novel approaches for the treatment of psychostimulant and opioid abuse - focus on opioid receptor-based therapies.

    Science.gov (United States)

    Bailey, Chris P; Husbands, Stephen M

    2014-11-01

    Psychostimulant and opioid addiction are poorly treated. The majority of abstinent users relapse back to drug-taking within a year of abstinence, making 'anti-relapse' therapies the focus of much current research. There are two fundamental challenges to developing novel treatments for drug addiction. First, there are three key stimuli that precipitate relapse back to drug-taking: stress, presentation of drug-conditioned cue, taking a small dose of drug. The most successful novel treatment would be effective against all three stimuli. Second, a large number of drug users are poly-drug users: taking more than one drug of abuse at a time. The ideal anti-addiction treatment would, therefore, be effective against all classes of drugs of abuse. In this review, the authors discuss the clinical need and animal models used to uncover potential novel treatments. There is a very broad range of potential treatment approaches and targets currently being examined as potential anti-relapse therapies. These broadly fit into two categories: 'memory-based' and 'receptor-based' and the authors discuss the key targets here within. Opioid receptors and ligands have been widely studied, and research into how different opioid subtypes affect behaviours related to addiction (reward, dysphoria, motivation) suggests that they are tractable targets as anti-relapse treatments. Regarding opioid ligands as novel 'anti-relapse' medication targets, research suggests that a 'non-selective' approach to targeting opioid receptors will be the most effective.

  8. Individual and group-based parenting programmes for the treatment of physical child abuse and neglect.

    Science.gov (United States)

    Barlow, J; Johnston, I; Kendrick, D; Polnay, L; Stewart-Brown, S

    2006-07-19

    Child physical abuse and neglect are important public health problems and recent estimates of their prevalence suggest that they are considerably more common than had hitherto been realised. Many of the risk factors for child abuse and neglect are not amenable to change in the short term. Intervening to change parenting practices may, however, be important in its treatment. Parenting programmes are focused, short-term interventions aimed at improving parenting practices in addition to other outcomes (many of which are risk factors for child abuse e.g. parental psychopathology, and parenting attitudes and practices), and may therefore be useful in the treatment of physically abusive or neglectful parents. To assess the efficacy of group-based or one-to-one parenting programmes in addressing child physical abuse or neglect. A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychINFO, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library, Campbell Library (including SPECTR and CENTRAL), National Research Register (NRR) and ERIC, from inception to May 2005. Only randomised controlled trials or randomised studies that compared two treatments were included. Studies had to include at least one standardised instrument measuring some aspect of abusive or neglectful parenting. In the absence of studies using objective assessments of child abuse, studies reporting proxy measures of abusive parenting were included. Only studies evaluating the effectiveness of standardised group-based or one-to-one parenting programmes aimed at the treatment of physical child abuse or neglect were included. Studies were also only eligible for inclusion if they had targeted parents of children aged 0-19 years who had been investigated for physical abuse or neglect. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment

  9. The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network.

    Science.gov (United States)

    Kelly, Thomas M; Daley, Dennis C; Byrne, Mimmie; Demarzo, Larry; Smith, Doris; Madl, Stephanie

    2011-07-01

    The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting "real world" research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our "bidirectional" collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node.Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies.

  10. Organizational Consequences of Staff Turnover in Outpatient Substance Abuse Treatment Programs

    Science.gov (United States)

    Knight, Danica K.; Edwards, Jennifer R.; Flynn, Patrick M.

    2014-01-01

    The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning (SOF) measured work-environment demands (Stress, Inadequate Staffing), and three measured supportive work relationships (Communication, Cohesion, Peer Collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work-environment demands, but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands and decreases perceptions of support, and underscore the need to reduce stress and minimize subsequent turnover among clinical staff. PMID:22154028

  11. Organizational consequences of staff turnover in outpatient substance abuse treatment programs.

    Science.gov (United States)

    Knight, Danica K; Becan, Jennifer E; Flynn, Patrick M

    2012-03-01

    The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. 38 CFR 17.83 - Limitations on payment for alcohol and drug dependence or abuse treatment and rehabilitation.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Limitations on payment for alcohol and drug dependence or abuse treatment and rehabilitation. 17.83 Section 17.83 Pensions... Agencies § 17.83 Limitations on payment for alcohol and drug dependence or abuse treatment and...

  13. Effects of Trauma Intervention on HIV Sexual Risk Behaviors among Women with Co-Occurring Disorders in Substance Abuse Treatment

    Science.gov (United States)

    Amaro, Hortensia; Larson, Mary Jo; Zhang, Annie; Acevedo, Andrea; Dai, Jianyu; Matsumoto, Atsushi

    2007-01-01

    Women in substance abuse treatment often have co-occurring mental health disorders and a history of trauma; they are also at high risk for HIV infection and other sexually transmitted diseases via unprotected sex. A quasi-experimental study evaluated the effectiveness of trauma-enhanced substance abuse treatment combined with HIV/AIDS prevention…

  14. Pretreatment for substance-abusing people with intellectual disabilities : Intervening on autonomous motivation for treatment entry

    NARCIS (Netherlands)

    Frielink, N.; Schuengel, C.; Kroon, A.; Embregts, P.J.C.M.

    2015-01-01

    Background Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a

  15. Pretreatment for substance-abusing people with intellectual disabilities: Intervening on autonomous motivation for treatment entry

    NARCIS (Netherlands)

    Frielink, N.; Schuengel, C.; Kroon, A.; Embregts, P.C.J.M.

    2015-01-01

    Background: Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a

  16. Substance Abuse Treatment Outcomes: A Multi-Site Study of Male and Female Prison Programs

    Science.gov (United States)

    Pelissier, Bernadette; Motivans, Mark; Rounds-Bryant, Jennifer L.

    2005-01-01

    The present study examined whether there were program differences with respect to post-release outcomes in 20 federal in-prison substance abuse programs which used a cognitive-behavioral treatment approach. Recidivism and post-release drug use were examined for a sample of 1,343 individuals--1,065 men and 278 women. Discrete time proportional…

  17. Cost-Effectiveness of Connecticut's In-Prison Substance Abuse Treatment

    Science.gov (United States)

    Daley, Marilyn; Love, Craig T.; Shepard, Donald S.; Petersen, Cheryl B.; White, Karen L.; Hall, Frank B.

    2004-01-01

    Over the past two decades, the criminal justice population in the US has grown by over 200%, most of this due to an increase in drug-involved offenders. Although there is good evidence that prison-based substance abuse treatment programs can be effective in reducing rearrest, few cost-effectiveness studies have been conducted. Using data from the…

  18. Factors Associated with Treatment Completion and Progress among Intrafamilial Sexual Abusers.

    Science.gov (United States)

    Chaffin, Mark

    1992-01-01

    Thirty-six father-daughter/stepdaughter sexual abusers were followed over the course of a two-year outpatient treatment program. Results supported the importance of pretreatment personality assessment and suggested that involvement of the criminal justice system does not interfere with, and may help, therapeutic progress. (Author/DB)

  19. Criminal Violence and Drug Use: An Exploratory Study among Substance Abusers in Residential Treatment

    Science.gov (United States)

    Workowski, Eric J.

    2003-01-01

    This study examined the relationship between criminal violence and type of substance abuse among 184 current and former residents of an inpatient non-hospital drug and alcohol treatment facility. The criminal justice system functioned as the source of referral into the program for 89% of the subjects studied while only 11% came to treatment…

  20. Inpatient Treatment for Early Sexually Abused Adults: A Naturalistic 12-Month Follow-Up Study

    NARCIS (Netherlands)

    Jepsen, E.K.K.; Langeland, W.; Sexton, H.; Heir, T.

    2014-01-01

    To date, most of the inpatient outcome studies among early traumatized individuals lack data on dissociative disorders. More research is needed to evaluate whether severely dissociative patients can improve following specialized inpatient treatment for chronic childhood abuse. The objectives of this

  1. Child Abuse and Multiple Personality Disorders: Review of the Literature and Suggestions for Treatment.

    Science.gov (United States)

    Coons, Philip M.

    1986-01-01

    Multiple personality disorder is associated with a high incidence of physical and sexual abuse during childhood. While difficult to diagnose, multiple personality is easier to treat if diagnosed early in childhood or adolescence. Treatment for multiple personality focuses on establishing trust and communicating with and integrating the…

  2. Markers of Marijuana Use Outcomes within Adolescent Substance Abuse Group Treatment

    Science.gov (United States)

    Engle, Brett; Macgowan, Mark J.; Wagner, Eric F.; Amrhein, Paul C.

    2010-01-01

    Objectives: Despite their popularity, little is known about what distinguishes effective from ineffective or even iatrogenic adolescent group interventions. Methods: Audio recordings and transcripts from 19, 8-10 session, school-based treatment groups comprised of 108, substance abusing 10- to 19-year olds were analyzed. "Group leader empathy" was…

  3. Evaluating Animal-Assisted Therapy in Group Treatment for Child Sexual Abuse

    Science.gov (United States)

    Dietz, Tracy J.; Davis, Diana; Pennings, Jacquelyn

    2012-01-01

    This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child…

  4. Alcohol and drug abusers' reasons for seeking treatment.

    Science.gov (United States)

    Cunningham, J A; Sobell, L C; Sobell, M B; Gaskin, J

    1994-01-01

    Clients at two different treatment facilities were asked at assessment how influential each of 10 possible reasons were in their decision to change their alcohol or drug use. Clients at both facilities most often endorsed "weighing the pros and cons of drinking or drug use" and a "warning from spouse." Client's reasons for seeking treatment were also examined in relation to treatment compliance. Three reasons--"weighing the pros and cons," "hitting rock bottom," and experiencing a "major lifestyle change"--were predictive of treatment compliance. Clients who rated any of these reasons as influential were more likely to enter and complete treatment. Although more research is needed, knowledge of clients' reasons for seeking treatment might be useful in treatment matching.

  5. "Who can you tell?" Features of Arab culture that influence conceptualization and treatment of childhood sexual abuse.

    Science.gov (United States)

    Haboush, Karen L; Alyan, Hala

    2013-01-01

    The literature on child sexual abuse reflects growing recognition of the manner in which culture impacts the conceptualization, experience, and treatment of such cases. Despite heightened visibility of Arab Americans within the United States, population due to recent media attention, little empirical research exists on the occurrence of child sexual abuse within this population. Arab culture is often characterized by an emphasis on collectivism and familial obligations, and such features may prove to either facilitate or impede assessment and treatment of child sexual abuse, depending on how they are manifested. In terms of reporting child sexual abuse, cultural values pertaining to shame and honor as well as the stigma attached to mental health problems may influence the response to abuse. As such, enhancing the cultural competence of the therapist is key to facilitating effective cultural practice. Empirical research is required to investigate and substantiate these concepts as they relate to child sexual abuse in Arab-American populations.

  6. Is substance abuse treatment providing services to the right population?

    Science.gov (United States)

    Ward, Kelly

    2005-01-01

    This study examined the relationship between treatment retention, and drug severity level in a therapeutic community setting for drug and alcohol treatment. Treatment retention is significant because length of time in treatment has been shown to correlate with success after treatment that impacts everyone. The design of this study was exploratory, descriptive, and cross-sectional. Data were collected in 2000 from a convenience sample of 18 to 25 year-old, primarily low-income and minority addicts who were currently in a therapeutic community in New Jersey, USA. The participants were then tracked for 90 days as to their status in the program and staff completed a motivation measure. Results indicated that severity of addiction was significant to treatment retention.

  7. Substance abuse and first-episode schizophrenia-spectrum disorders. The Danish OPUS trial

    DEFF Research Database (Denmark)

    Petersen, Lone; Jeppesen, Pia; Thorup, Anne

    2007-01-01

    To evaluate whether integrated treatment (given by OPUS), in comparison with standard treatment, significantly reduced the number of patients with substance abuse and improved clinical and social outcome in the group of substance abusers after 2 years.......To evaluate whether integrated treatment (given by OPUS), in comparison with standard treatment, significantly reduced the number of patients with substance abuse and improved clinical and social outcome in the group of substance abusers after 2 years....

  8. Clinical Phenomenology of Childhood Abuse-Related Complex PTSD in a Population of Female Patients: Patterns of Personality Disturbance

    NARCIS (Netherlands)

    Dorrepaal, E.; Thomaes, K.; Smit, J.H.; Hoogendoorn, A.; Veltman, D.J.; van Balkom, A.J.L.M.; Draijer, P.J.

    2012-01-01

    Objective: Complex posttraumatic stress disorder (PTSD) involves a variety of personality disturbances presumed to result from repeated interpersonal trauma such as child abuse. As Complex PTSD patients are a heterogeneous population, we searched for clinically relevant personality-based subtypes.

  9. Day-care treatment for multiple drug abusing adolescents: social factors linked with completing treatment.

    Science.gov (United States)

    Feigelman, W

    1987-01-01

    By identifying some of the social correlates linked with completing day-care drug abuse treatment, the present study has sought to broaden understanding of how drug rehabilitations are effected. As the findings have demonstrated, completing care is a result of a complex array of causes and their interaction. The disposition of the entering patient (i.e., their determination and other strengths) has a great bearing on treatment outcome. It is also a result of the patient's family, their motivations, resources and perseverance in enduring a long course of demanding therapeutic interventions. In addition, it is the product of meanings shared and transmitted between the patient's family and the treatment staff. Patients and their families project positive attitudes about the value of the therapeutic enterprise as well as a compliant demeanor. As staff recognize that patients and parents are acting cooperatively, then such perceptions tend to create self-fulfilling prophecies. The data has established that older adolescent patients are more likely to possess the motivational resources needed for program completion than younger patients. Apparently, self-referred patients are also more inclined to meet the demands of program requirements than those referred by the courts or other outside social agencies, although the differences fell short of the .05 level of statistical significance. Those completing the program are less likely to be diagnosed as depressed at intake. Parental characteristics comprise another group of variables that are related to treatment completion. Parents of higher occupational rank, who have had mental health care for themselves, and who are of Jewish ethnicity appear to possess useful strengths for meeting program challenges. The pattern of spouse mutuality in dealing with a child's needs as it exists preceding and during treatment seems to be another useful asset for successfully getting through this form of treatment. While parents with the

  10. Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

    Science.gov (United States)

    McCusker, J; Willis, G; McDonald, M; Lewis, B F; Sereti, S M; Feldman, Z T

    1994-01-01

    The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

  11. Anorexia nervosa and childhood sexual abuse: Treatment outcomes of intensive enhanced cognitive behavioural therapy.

    Science.gov (United States)

    Calugi, Simona; Franchini, Cecilia; Pivari, Silvia; Conti, Maddalena; El Ghoch, Marwan; Dalle Grave, Riccardo

    2018-04-01

    Sexual abuse has been widely studied as a risk factor in anorexia nervosa, but data on its influence on treatment outcomes are scarce. Hence, we compared short- and long-term outcomes of inpatient enhanced cognitive-behavioural therapy (CBT-E) in patients with anorexia nervosa who had and had not suffered sexual abuse. Eighty-one patients were recruited, and body mass index (BMI), Eating Disorder Examination, Brief Symptom Inventory, and Work and Social Adjustment Scale scores were recorded before and after treatment, and at 6- and 12-month follow-ups. Twenty patients (24.7%) reported experiencing childhood sexual abuse before anorexia nervosa onset, while 61 (75.3%) reported none. Both groups displayed similar characteristics before treatment, and similarly large increases in BMI, eating-disorder, general psychopathology, and work and social functioning from baseline to 12-month follow-up. Based on these findings, childhood sexual abuse does not appear to compromise outcomes in patients with anorexia nervosa treated via intensive CBT-E. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Adoption of Evidence-Based Practices Among Substance Abuse Treatment Providers*

    Science.gov (United States)

    Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

    2009-01-01

    This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals’ readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area. PMID:18724657

  13. Plague: Clinics, Diagnosis and Treatment.

    Science.gov (United States)

    Nikiforov, Vladimir V; Gao, He; Zhou, Lei; Anisimov, Andrey

    2016-01-01

    Plague still poses a significant threat to human health and as a reemerging infection is unfamiliar to the majority of the modern medical doctors. In this chapter, the plague is described according to Dr. Nikiforov's experiences in the diagnosis and treatment of patients, and also a review of the relevant literature on this subject is provided. The main modern methods and criteria for laboratory diagnosis of plague are briefly described. The clinical presentations include the bubonic and pneumonic form, septicemia, rarely pharyngitis, and meningitis. Early diagnosis and the prompt initiation of treatment reduce the mortality rate associated with bubonic plague and septicemic plague to 5-50 %; although a delay of more than 24 h in the administration of antibiotics and antishock treatment can be fatal for plague patients. Most human cases can successfully be treated with antibiotics.

  14. A Qualitative Exploration of Drug Abuse Relapse Following Treatment

    Science.gov (United States)

    Islam, Manirul; Hashizume, Masahiro; Yamamoto, Taro; Alam, Faruq; Rabbani, Golam

    2012-01-01

    Drug use is an alarming issue in Bangladesh. Most drug users return to drugs after treatment, in what becomes a vicious cycle of treatment and relapse. This study explored why they return and what pathways they follow. We carried out 5 key informant interviews, 10 in-depth interviews, 2 focus group discussions, 3 case studies, 8 observations, and…

  15. Substance abuse treatment response in a Latino sample: the influence of family conflict.

    Science.gov (United States)

    Fish, Jessica N; Maier, Candice A; Priest, Jacob B

    2015-02-01

    Latino Americans report underutilization of treatment and poor treatment response for substance use and abuse compared to other racial/ethnic groups; thus, it is important to assess factors that contribute to these disparities. The current study objective was to assess the influence of family conflict on substance abuse treatment response in a sample of Latino Americans using two different yet complementary analyses. First, ordinary least squares regression was used to assess the association between overall family conflict and pre- and post-treatment substance use. Second, repeated measures latent class analysis was used to identify groups based on family member conflict and timing of conflict during treatment. Findings indicated that family conflict contributed unique variance to concurrent substance use; however pre-treatment family conflict was not related to post-treatment outcomes. Results also identified three distinct family conflict groups: no/low conflict, pre-treatment conflict, and post-treatment conflict who differed in pre- and post-treatment substance use. Post hoc investigation revealed that those who experienced pre-treatment conflict but low post-treatment conflict showed the greatest decrease in substance use. Findings highlight the importance of considering family conflict during all stages of treatment for Latino American substance users. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Improving the Clinical Pharmacologic Assessment of Abuse Potential: Part 2: Optimizing the Design of Human Abuse Potential Studies.

    Science.gov (United States)

    Sellers, Edward M

    2018-04-01

    This article discusses the conduct of a human abuse potential study as outlined in the Food and Drug Administration Final Guidance to Industry on Assessment of Abuse Potential. In addition, areas where alternative approaches should be considered are proposed. The design, end points, conduct, and interpretation of the human abuse potential study were reviewed, analyzed, and placed in the context of current scientific knowledge and best practices to mitigate regulatory risk and expedite drug development. The guidance is based on regulatory needs and current scientific practices. However, the reliability and utility of such studies can be improved with better subject selection, data collection, standardization of data collection and staff training, and a better understanding of the measurement properties of the dependent measures. The guidance provides a useful framework for conduct of human abuse potential studies. However, design assumptions, poor choice of end points, failure to consider alternate approaches, and limited experience with interpretation can result in an inadequate study or one that does not fairly represent the abuse potential of a new chemical entity. Methodologic development is needed to strengthen the regulatory framework. The Food and Drug Administration or the National Institutes on Drug Abuse could take a targeted initiative to encourage this work.

  17. Environmental factors that distinguish between clinical and healthy samples with childhood experiences of abuse and neglect.

    Science.gov (United States)

    Infurna, Maria Rita; Giannone, Francesca; Guarnaccia, Cinzia; Lo Cascio, Maria; Parzer, Peter; Kaess, Michael

    2015-01-01

    Childhood maltreatment is associated with a wide range of problems in adulthood. However, specific environmental factors (either positive or negative) influence mental health outcomes in maltreated children. The present study investigated the effect of environmental factors by comparing a group of clinical participants with experiences of abuse/neglect with a healthy group with similar patterns of experiences. Environmental factors selected were: separation from parents, financial hardship, parental psychiatric disorders, and low social involvement. The study included 55 mixed clinical participants and 23 healthy participants. All participants were investigated using the Childhood Experience of Care and Abuse (CECA) interview. The two groups were specifically matched with regard to patterns of childhood maltreatment. The findings indicated that psychopathological outcome was associated with a greater presence of negative environmental factors (p < 0.001). In particular, lack of social support seemed to be the only one predictor (OR = 27.86). This study is the first to investigate the influence of specific environmental factors in two groups with similar childhood experiences of abuse/neglect but different mental health outcomes. These findings suggest that efforts should be made to incorporate both familial and external sources of social support in promoting mental health for maltreated children. © 2015 S. Karger AG, Basel.

  18. Relationship power and sexual risk among women in community-based substance abuse treatment.

    Science.gov (United States)

    Campbell, Aimee N C; Tross, Susan; Dworkin, Shari L; Hu, Mei-Chen; Manuel, Jennifer; Pavlicova, Martina; Nunes, Edward V

    2009-11-01

    Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research, however, has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a National Institute on Drug Abuse Clinical Trials Network multisite trial of a women's HIV prevention intervention in community-based drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Possible explanations for these findings are discussed, and future research directions for examining power constructs and developing interventions targeting relationship power among drug-involved women are suggested.

  19. Pattern of Substance Abuse among Clients at a Drug Treatment ...

    African Journals Online (AJOL)

    They were also further assessed with the Treatnet Addiction Severity Index (ASI), MMPI-2™ and had urine toxicology carried out to determine the type of substances used as well as other laboratory investigations. The diagnosis was made from information gathered from interview and clinical investigations throughout the ...

  20. Substance Abuse Counselors’ Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation

    Science.gov (United States)

    Nielson, Elizabeth M.

    2016-01-01

    Purpose The purpose of this paper is to better understand the relationship between substance abuse counselors’ personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders. Methods A phenomenological qualitative study enrolled 12 practicing substance abuse counselors. Results Within this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients’ struggles. Discussion Since empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors’ recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments. PMID:28626597

  1. Substance Abuse Counselors' Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation.

    Science.gov (United States)

    Nielson, Elizabeth M

    2016-01-01

    The purpose of this paper is to better understand the relationship between substance abuse counselors' personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders. A phenomenological qualitative study enrolled 12 practicing substance abuse counselors. Within this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients' struggles. Since empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors' recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments.

  2. Who Benefits from Gender Responsive Treatment? Accounting for Abuse History on Longitudinal Outcomes for Women in Prison.

    Science.gov (United States)

    Saxena, Preeta; Messina, Nena; Grella, Christine E

    2014-04-01

    This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). In order to identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post- treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6- and 12-months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression ( OR = .29, p < .05, 95% CI = .10 - .86) and lowered rates of number of substances used ( IRR = .52, p < .05, 95% CI = 0.28-0.98), in comparison to those who reported abuse and were randomized to the non-GRT group. GRT for women offenders who have experienced prior abuse would maximize the benefits of the trauma-informed, gender-sensitive intervention.

  3. Neurobiology of hedonic tone: the relationship between treatment-resistant depression, attention-deficit hyperactivity disorder, and substance abuse

    Directory of Open Access Journals (Sweden)

    Sternat T

    2016-08-01

    Full Text Available Tia Sternat,1,2 Martin A Katzman1–4 1START Clinic for Mood and Anxiety Disorders, 2Department of Psychology, Adler Graduate Professional School, Toronto, 3Division of Clinical Sciences, The Northern Ontario School of Medicine, 4Department of Psychology, Lakehead University, Thunder Bay, ON, Canada Abstract: Anhedonia, defined as the state of reduced ability to experience feelings of pleasure, is one of the hallmarks of depression. Hedonic tone is the trait underlying one’s characteristic ability to feel pleasure. Low hedonic tone represents a reduced capacity to experience pleasure, thus increasing the likelihood of experiencing anhedonia. Low hedonic tone has been associated with several psychopathologies, including major depressive disorder (MDD, substance use, and attention-deficit hyperactivity disorder (ADHD. The main neural pathway that modulates emotional affect comprises the limbic–cortical–striatal–pallidal–thalamic circuits. The activity of various components of the limbic–cortical–striatal–pallidal–thalamic pathway is correlated with hedonic tone in healthy individuals and is altered in MDD. Dysfunction of these circuits has also been implicated in the relative ineffectiveness of selective serotonin reuptake inhibitors used to treat anxiety and depression in patients with low hedonic tone. Mood disorders such as MDD, ADHD, and substance abuse share low hedonic tone as well as altered activation of brain regions involved in reward processing and monoamine signaling as their features. Given the common features of these disorders, it is not surprising that they have high levels of comorbidities. The purpose of this article is to review the neurobiology of hedonic tone as it pertains to depression, ADHD, and the potential for substance abuse. We propose that, since low hedonic tone is a shared feature of MDD, ADHD, and substance abuse, evaluation of hedonic tone may become a diagnostic feature used to predict subtypes

  4. [Kleptomania: clinical characteristics and treatment].

    Science.gov (United States)

    Grant, Jon E; Odlaug, Brian L

    2008-05-01

    Kleptomania, a disabling impulse control disorder, is characterized by the repetitive and uncontrollable theft of items that are of little use to the afflicted person. Despite its relatively long history, kleptomania remains poorly understood to the general public, clinicians, and sufferers. This article reviews the literature for what is known about the clinical characteristics, family history, neurobiology, and treatment options for individuals with kleptomania. Kleptomania generally has its onset in late adolescence or early adulthood and appears to be more common among women. Lifetime psychiatric comorbidity is frequent, mainly with other impulse control (20-46%), substance use (23-50%) and mood disorders (45-100%). Individuals with kleptomania suffer significant impairment in their ability to function socially and occupationally. Kleptomania may respond to cognitive behavioral therapy and various pharmacotherapies (lithium, anti-epileptics, and opioid antagonists). Kleptomania is a disabling disorder that results in intense shame, as well as legal, social, family, and occupational problems. Large scale treatment studies are needed.

  5. HIV/AIDS, Drug Abuse Treatment, and the Correctional System.

    Science.gov (United States)

    Lipton, Douglas S.

    1997-01-01

    Discusses in-prison prevalence and transmission of Human Immunodeficiency Virus (HIV). Focuses on epidemiology in prison settings, the role of ethnicity and gender in transmission, screening for HIV, segregating the HIV-positive inmate, condom distribution, medical treatment for HIV-positive inmates, HIV education and prevention, and tuberculosis…

  6. New Treatment for Drug-Abusing Women Offenders in Virginia.

    Science.gov (United States)

    Clement, Mary

    1997-01-01

    Compares a new approach to treatment using traditional social work. Reports on the therapeutic regimen and Results/Kinesiology (RK), which addresses body-mind control, brain hemispheric integration, energy balancing, and stress elimination. Examination of 40 women addicted to alcohol and/or drugs indicated that RK helped with anxiety,…

  7. Early Childhood Interventionists' Perceptions of the Child Abuse Prevention and Treatment Act: Provider Characteristics and Organizational Climate

    Science.gov (United States)

    Herman-Smith, Robert L.

    2013-01-01

    Research Findings: A 2003 amendment to the Child Abuse Prevention and Treatment Act (CAPTA) required states to develop plans to ensure that children younger than the age of 3 years who are victims of substantiated abuse or neglect have access to developmental screenings. Programs authorized under Part C of the Individuals with Disabilities…

  8. Understanding abuse of buprenorphine/naloxone film versus tablet products using data from ASI-MV® substance use disorder treatment centers and RADARS® System Poison Centers.

    Science.gov (United States)

    Butler, Stephen F; Black, Ryan A; Severtson, Stevan Geoffrey; Dart, Richard C; Green, Jody L

    2018-01-01

    The objectives were to examine the abuse prevalence and route-of-administration (ROA) profiles of sublingual buprenorphine/naloxone combination (BNX) film in comparison with the BNX tablet and to identify clinically-relevant subgroups of patients or geographic patterns. Between Q1 2015 through Q3 2015, data were collected from two major surveillance systems: (1) assessment of individuals in substance use disorder (SUD) treatment collected from the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO®) ASI-MV® system and (2) intentional abuse/misuse exposures in the RADARS® System Poison Center Program. Poisson regression models were tailored to each system's data characteristics by population (all SUD treatment patients, US census) and adjusted for prescription volume. Effects of gender, race, age and US region as well as ROA profile were examined. For the ASI-MV study, 45,695 assessments of unique adults evaluated for substance use problems were collected. The abuse rate unadjusted for prescription volume of BNX tablet formulation was 2.64 cases/100 ASI-MV respondents versus 7.01 cases for the film formulation (RR=0.390, pfilm) (RR=1.25, pfilm abuse (0.0364) were greater than for tablet (0.0161), while prescription-adjusted rates were greater for tablet (0.2114) than for film (0.1703) per 100,000 prescriptions. ASI-MV ROA analyses indicated less abuse of the film by any alternate route, insufflation or injection than the tablet. Poison center data found more injection of tablets than film, although insufflation was not significantly different. On a prescription-adjusted basis, overall abuse of the BNX tablet is greater than that of the sublingual film formulation. For those who continue to abuse BNX, use by alternate ROAs was, in general, lower for the film. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Condom use assessment of persons in drug abuse treatment.

    Science.gov (United States)

    Ross, Dana; Schumacher, Joseph E

    2004-12-01

    The purpose of this study was to objectively and quantitatively assess individual skill level of male condom use. This study developed a reliable and face valid assessment of correct male condom use based on Centers for Disease Control and Prevention criteria. Participants (N= 163) were recruited from persons in treatment for cocaine addiction. Condom use was assessed on the basis of correct completion of eight discrete steps. An overall score of 40% correct condom use indicated the need for training in this sample. Assessment showed training needs especially related to steps involving reduction of ejaculate leakage and steps related to potential hazards of nonoxynol-9 use. Frequency of condom use was also assessed; there was no correlation between frequency of condom use and condom use skill. Drug addiction treatment programs are encouraged to incorporate HIV risk reduction programs that teach condom use skills and use the CUDOS as an empirical measure of condom skill acquisition.

  10. Treatment and Rehabilitation of Abused and Neglected Children an Inpatient Center Model

    Directory of Open Access Journals (Sweden)

    Sunay Fırat

    2014-09-01

    Full Text Available Rehabilitation and treatment centers are organizations that provide services for children and adolescents, with the main goal being to implement a “mental health” treatment plan for the individuals under their care. These organizations, which provide a continuous 24-hour service, may differ from one another in terms of the specific programs and treatment methods they apply. The Oğuz Kağan Köksal Children and Youth Center was established in the Adana Province to provide for the treatment and rehabilitation of girls between the ages of 8 and 18 who have been subject to abuse or neglect, who suffer from alcohol/substance abuse, who are in need of treatment for mental problems and/or who live on the streets. A study was made of 72 girls who had been admitted to the institution for treatment and rehabilitation since 2004 with a history abuse and neglect. The girls were assessed with the Beck Depression Inventory (BDI, the State Anxiety Inventory (STAI-I, the Trait Anxiety Inventory (STAI-II and the Maudsley Obsessive Compulsive Inventory (MOCI upon being admitted to the institution and at the end of their stay (i.e. their discharge. The differences between the mean admission and discharge scores of the girls in the BDI, STAI-I, STAI-II and MOCI assessments was determined to be statistically significant (p<0.001. According to the duration of stay groups (0–3 months; 4–6 months; 7–9 months and ≥10 months, a statistically significant difference was identified between the mean admission and discharge scores of children who remained in the institution for 3–7 months, with the post-treatment scores of the inventories being significantly lower in comparison to the baseline values (p≤0.05. These results suggest discharging patients from the center prior to their third month of stay or a stay period of longer than seven months does not affect with any significance the scores of the depression, anxiety and obsession inventories. To ensure a

  11. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    DEFF Research Database (Denmark)

    Hesse, Morten; Stefánsson, Ragnar

    2008-01-01

    -III. Baserate scores indicated a prevalence of 95% of personality disorders. A logistic regression analysis correctly identified 95% of the sample, and showed that antisocial personality disorder traits were characteristic of the prison sample, and masochistic personality disorder traits were characteristic......Abstract  A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory...... of the inpatient sample. The findings indicate that treatment models used in prison settings should be adjusted to meet the needs of antisocial patients....

  12. Prefrontal cortex and drug abuse vulnerability: translation to prevention and treatment interventions.

    Science.gov (United States)

    Perry, Jennifer L; Joseph, Jane E; Jiang, Yang; Zimmerman, Rick S; Kelly, Thomas H; Darna, Mahesh; Huettl, Peter; Dwoskin, Linda P; Bardo, Michael T

    2011-01-01

    Vulnerability to drug abuse is related to both reward seeking and impulsivity, two constructs thought to have a biological basis in the prefrontal cortex (PFC). This review addresses similarities and differences in neuroanatomy, neurochemistry and behavior associated with PFC function in rodents and humans. Emphasis is placed on monoamine and amino acid neurotransmitter systems located in anatomically distinct subregions: medial prefrontal cortex (mPFC); lateral prefrontal cortex (lPFC); anterior cingulate cortex (ACC); and orbitofrontal cortex (OFC). While there are complex interconnections and overlapping functions among these regions, each is thought to be involved in various functions related to health-related risk behaviors and drug abuse vulnerability. Among the various functions implicated, evidence suggests that mPFC is involved in reward processing, attention and drug reinstatement; lPFC is involved in decision-making, behavioral inhibition and attentional gating; ACC is involved in attention, emotional processing and self-monitoring; and OFC is involved in behavioral inhibition, signaling of expected outcomes and reward/punishment sensitivity. Individual differences (e.g., age and sex) influence functioning of these regions, which, in turn, impacts drug abuse vulnerability. Implications for the development of drug abuse prevention and treatment strategies aimed at engaging PFC inhibitory processes that may reduce risk-related behaviors are discussed, including the design of effective public service announcements, cognitive exercises, physical activity, direct current stimulation, feedback control training and pharmacotherapies. A major challenge in drug abuse prevention and treatment rests with improving intervention strategies aimed at strengthening PFC inhibitory systems among at-risk individuals. Copyright © 2010 Elsevier B.V. All rights reserved.

  13. Predicting Time Spent in Treatment in a Sample of Danish Survivors of Child Sexual Abuse.

    Science.gov (United States)

    Fletcher, Shelley; Elklit, Ask; Shevlin, Mark; Armour, Cherie

    2017-07-01

    The aim of this study was to identify significant predictors of length of time spent in treatment. In a convenience sample of 439 Danish survivors of child sexual abuse, predictors of time spent in treatment were examined. Assessments were conducted on a 6-month basis over a period of 18 months. A multinomial logistic regression analysis revealed that the experience of neglect in childhood and having experienced rape at any life stage were associated with less time in treatment. Higher educational attainment and being male were associated with staying in treatment for longer periods of time. These factors may be important for identifying those at risk of terminating treatment prematurely. It is hoped that a better understanding of the factors that predict time spent in treatment will help to improve treatment outcomes for individuals who are at risk of dropping out of treatment at an early stage.

  14. Understanding the etiology of prescription opioid abuse: implications for prevention and treatment.

    Science.gov (United States)

    Rigg, Khary K; Murphy, John W

    2013-07-01

    Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

  15. Sexual revictimization in a clinical sample of women reporting childhood sexual abuse

    DEFF Research Database (Denmark)

    Lau, Marianne; Kristensen, Ellids

    2010-01-01

    BACKGROUND: Child and adolescent sexual abuse (CSA) increases the risk for adult sexual assault (ASA), and psychological vulnerability as well as aspects of CSA and upbringing might influence the risk. AIMS: The aims of this study were to investigate whether women who reported both CSA and ASA: 1......: The results showed an increased psychological vulnerability among women with ASA, but whether the results are cause or effect of sexual revictimization or can be generalized to other clinical samples are not clear. Interventions targeting the increased risk of ASA should be developed, implemented and tested...

  16. An historical review of racial bias in prison-based substance abuse treatment design

    OpenAIRE

    Kerrison, EM

    2017-01-01

    © 2017 Taylor & Francis. This study leverages critical race and legal epidemiological frameworks to illustrate the race-based historical evolution of U.S. rehabilitation paradigms directed at imprisoned heroin and opioid users. What began as a racist early-20th-century federal antinarcotic trafficking effort has since assumed a state-based treatment agenda whose programmatic operations are largely based in correctional settings disproportionately reserved for poor substance abusers of color...

  17. The role of culture in substance abuse treatment programs for American Indian and Alaska Native communities.

    Science.gov (United States)

    Legha, Rupinder Kaur; Novins, Douglas

    2012-07-01

    Culture figures prominently in discussions regarding the etiology of alcohol and substance abuse in American Indian and Alaska Native (AI/AN) communities, and a substantial body of literature suggests that it is critical to developing meaningful treatment interventions. However, no study has characterized how programs integrate culture into their services. Furthermore, reports regarding the associated challenges are limited. Twenty key informant interviews with administrators and 15 focus groups with clinicians were conducted in 18 alcohol and substance abuse treatment programs serving AI/AN communities. Transcripts were coded to identify relevant themes. Substance abuse treatment programs for AI/AN communities are integrating culture into their services in two discrete ways: by implementing specific cultural practices and by adapting Western treatment models. More important, however, are the fundamental principles that shape these programs and their interactions with the people and communities they serve. These foundational beliefs and values, defined in this study as the core cultural constructs that validate and incorporate AI/AN experience and world view, include an emphasis on community and family, meaningful relationships with and respect for clients, a homelike atmosphere within the program setting, and an “open door” policy for clients. The primary challenges for integrating these cultural practices include AI/AN communities' cultural diversity and limited socioeconomic resources to design and implement these practices. The prominence of foundational beliefs and values is striking and suggests a broader definition of culture when designing services. This definition of foundational beliefs and values should help other diverse communities culturally adapt their substance abuse interventions in more meaningful ways.

  18. Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan

    Directory of Open Access Journals (Sweden)

    Abadi MH

    2012-04-01

    Full Text Available Melissa Harris Abadi1, Stephen R Shamblen1, Knowlton Johnson1, Kirsten Thompson1, Linda Young1, Matthew Courser1, Jude Vanderhoff1, Thom Browne21Pacific Institute for Research and Evaluation – Louisville Center, Louisville, KY, USA; 2United States Department of State, Bureau of International Narcotics and Law Enforcement, Washington, DC, USAAbstract: Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT centers assesses (a the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91% reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50% experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one’s own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.Keywords: Afghanistan, women, human rights, mental health, drug abuse treatment

  19. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria.

    Science.gov (United States)

    Onifade, Peter O; Somoye, Edward B; Ogunwobi, Olorunfemi O; Ogunwale, Adegboyega; Akinhanmi, Akinwande O; Adamson, Taiwo A

    2011-09-18

    Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7%) and Opioids (0.7%) use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria. The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version). All the units completed the online questionnaire. A large proportion (48%) was located in the South-West geopolitical zone of the country. Most (58%) were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%). No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147) and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services. The study revealed a dearth of substance abuse treatment units (and of funds for the available ones) in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring, funding and continuous quality improvement, the units need to

  20. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria

    Directory of Open Access Journals (Sweden)

    Akinhanmi Akinwande O

    2011-09-01

    Full Text Available Abstract Background Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3% in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7% and Opioids (0.7% use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria. Methods The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version. Results All the units completed the online questionnaire. A large proportion (48% was located in the South-West geopolitical zone of the country. Most (58% were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%. No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147 and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services. Conclusions The study revealed a dearth of substance abuse treatment units (and of funds for the available ones in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring

  1. Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan.

    Science.gov (United States)

    Abadi, Melissa Harris; Shamblen, Stephen R; Johnson, Knowlton; Thompson, Kirsten; Young, Linda; Courser, Matthew; Vanderhoff, Jude; Browne, Thom

    2012-01-01

    Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT) centers assesses (a) the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b) whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91%) reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50%) experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one's own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.

  2. Incorporating a Healthy Living Curriculum within Family Behavior Therapy: A Clinical Case Example in a Woman with a History of Domestic Violence, Child Neglect, Drug Abuse, and Obesity

    Directory of Open Access Journals (Sweden)

    Holly B. LaPota

    2014-01-01

    Full Text Available Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems. This research was supported by a grant from the National Institute on Drug Abuse (1R01DA020548-01A1 awarded to Brad Donohue. The authors wish to thank Sally K. Miller, PhD, APN, FAANP and Associate Professor, UNLV School of Nursing for her work in completing the initial in-home health evaluation/physical for the current project.

  3. Issues in consultation for treatments with distressed activated abuser/protector self-states in dissociative identity disorder.

    Science.gov (United States)

    Chefetz, Richard A

    2017-01-01

    The identified "problem self-state" in a dissociative disorder consultation is like the identified patient in a family therapy; the one who is identified may have an assigned role to be blamed which serves the function of deflecting the activities of painful self-states in other family members. In consultation, the "family" includes the therapist in addition to the patient. When the state identified as a problem self-state is an abuser/protector self-state, complications often involve the profound nature of transference-countertransference enactments between patient and therapist, the delusion of separateness, chronic and acute threats of suicide, negative therapeutic reactions, and the evocation of intense negativity. They also involve affect phobia in both patient and therapist, and the emergence of intense shame in the clinical dyad amongst additional potential burdens in these complicated treatments. The task of the consultant is to protect both patient and therapist from an untoward outcome while relieving the painful burdens entailed by the treatment. The typical core dynamic of the abuser/protector state is as a repository for shame/humiliation welded to anger/rage. This dynamic, and others, must be understood in order to resolve these impasses and create useful movement toward growth in both patient and therapist.

  4. [Gender and accessibility barriers to treatment in alcohol abuse patients in the Autonomous Region of Valencia].

    Science.gov (United States)

    Tomás-Dols, Sofía; Valderrama-Zurián, Juan Carlos; Vidal-Infer, Antonio; Samper-Gras, Teresa; Hernández-Martínez, Ma Carmen; Torrijo-Rodrigo, Ma José

    2007-01-01

    This study aimed at identifying the factors that contribute to delaying the access of alcohol abuse patients to specific treatment centres in the Autonomous Region of Valencia (Spain). 563 patients from Addictive Behaviours Units (UCA) and Alcohology Units (UA) were interviewed. A survey was conducted which included items on previous requested treatment in other centres and on barriers of accessibility to treatment in specific ambulatory centres. A descriptive analysis and t-student and ANOVA with Scheffé post-hoc tests were carried out. 59.7% of respondents said they had requested previous treatment in non-specific resources due to physical or psychical trouble that they now relate to their alcohol use although they did not do so at the time, in addition to being motivated by their own alcohol abuse (42.8%). The most attended resources were Primary Care and Specialist Unit Care. Women showed a higher demand for treatment in Mental Health Services (p gender differences in barriers that delay access to treatment do exist. It is necessary to build gender-adapted intervention guidelines to be used in Primary Care and Mental Health services to reduce the accessibility barriers to treatment.

  5. Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs

    Science.gov (United States)

    Terry-McElrath, Yvonne M; Chriqui, Jamie F; McBride, Duane C

    2011-01-01

    Objective To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. Data Sources Secondary analysis of 2003–2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data. Study Design We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage. Data Extraction Methods State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available. Principal Findings Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income. Conclusions SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access. PMID:21105870

  6. The relevance of psychodynamic psychotherapy to understanding therapist-patient sexual abuse and treatment of survivors.

    Science.gov (United States)

    Yahav, Rivka; Oz, Sheri

    2006-01-01

    Regardless of the therapy modality, research continues to point to the therapeutic relationship as a major salient factor in clinical success or failure. When a patient is sexually abused by his or her therapist, this therapeutic relationship is cynically exploited in a way that does not properly serve the essential needs of the patient. When this patient then seeks reparative therapy, the subsequent therapist needs to pay close attention to issues of the relationship which were breached by the previous clinician. In this article, two case studies showing very different dynamics will be presented in order to demonstrate: (1) relevant factors related to transference, countertransference, projective identification, and the analytic third pertaining to the former, abusive therapy; and (2) needs versus wishes, and issues related to boundaries and self-disclosure in the corrective therapy.

  7. Improving the Clinical Pharmacologic Assessment of Abuse Potential: Part 1: Regulatory Context and Risk Management.

    Science.gov (United States)

    Sellers, Edward M

    2018-02-01

    This article brings to the attention of drug developers the Food and Drug Administration's (FDA's) recent final Guidance to Industry on Assessment of Abuse Potential and provides practical suggestions about compliance with the Guidance. The Guidance areas are reviewed, analyzed, and placed in the context of current scientific knowledge and best practices to mitigate regulatory risk. The Guidance provides substantial new detail on what needs to be done at all stages of drug development for central nervous system-active drugs. However, because many psychopharmacologic agents have unique preclinical and clinical features, the plan for each agent needs to be not only carefully prepared but also reviewed and approved by the FDA. Examples are provided where assumptions about interpretation of the Guidance can delay development. If the expertise and experience needed for assessing abuse potential during drug development do not exist within a company, external preclinical and clinical expert should be involved. Consultation with the FDA is encouraged and important because the specific requirements for each drug will vary.

  8. Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network.

    Science.gov (United States)

    Susukida, Ryoko; Crum, Rosa M; Stuart, Elizabeth A; Ebnesajjad, Cyrus; Mojtabai, Ramin

    2016-07-01

    To compare the characteristics of individuals participating in randomized controlled trials (RCTs) of treatments of substance use disorder (SUD) with individuals receiving treatment in usual care settings, and to provide a summary quantitative measure of differences between characteristics of these two groups of individuals using propensity score methods. Design Analyses using data from RCT samples from the National Institute of Drug Abuse Clinical Trials Network (CTN) and target populations of patients drawn from the Treatment Episodes Data Set-Admissions (TEDS-A). Settings Multiple clinical trial sites and nation-wide usual SUD treatment settings in the United States. A total of 3592 individuals from 10 CTN samples and 1 602 226 individuals selected from TEDS-A between 2001 and 2009. Measurements The propensity scores for enrolling in the RCTs were computed based on the following nine observable characteristics: sex, race/ethnicity, age, education, employment status, marital status, admission to treatment through criminal justice, intravenous drug use and the number of prior treatments. Findings The proportion of those with ≥ 12 years of education and the proportion of those who had full-time jobs were significantly higher among RCT samples than among target populations (in seven and nine trials, respectively, at P difference in the mean propensity scores between the RCTs and the target population was 1.54 standard deviations and was statistically significant at P different from individuals receiving treatment in usual care settings. Notably, RCT participants tend to have more years of education and a greater likelihood of full-time work compared with people receiving care in usual care settings. © 2016 Society for the Study of Addiction.

  9. Identifying the substance abuse treatment needs of caregivers involved with child welfare.

    Science.gov (United States)

    Chuang, Emmeline; Wells, Rebecca; Bellettiere, John; Cross, Theodore P

    2013-07-01

    Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia.

    Science.gov (United States)

    Mohd Mydin, Fadzilah Hanum; Othman, Sajaratulnisah

    2017-08-01

    This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.

  11. What characterizes substance abusers who commit suicide attempts? Factors related to Axis I disorders and patterns of substance use disorders. A study of treatment-seeking substance abusers in Norway.

    Science.gov (United States)

    Landheim, A S; Bakken, K; Vaglum, P

    2006-01-01

    The frequency of suicide attempts and clinical characteristics of attempters among poly-substance abusers and alcoholics were examined. A consecutive sample (n = 260) of in- and outpatients from two Norwegian counties were assessed by Composite International Diagnostic Interview (Axis I disorders), Millon's Clinical Multiaxial Inventory (Axis II disorders) and the Norwegian National Client Assessment Form. When analysing the association between suicide attempters and the range of predictor variables, logistic regression analysis was conducted. Almost half (47%) of the sample reported lifetime suicide attempts; significantly more frequently in poly-substance abusers (58%) than alcoholics (38%). A substance use disorder with duration of >or=15 years and an early onset (suicide attempter after controlling for Axis I disorders. In addition, eating disorders, agoraphobia and major depression were strongly and independently associated with being a suicide attempter. Attempts at preventing suicidal behaviour should not ignore the suicide risk among poly-substance abusers. In addition, prevention of suicidal behaviour demands a treatment programme focusing concomitantly on both addictive behaviour and comorbid psychiatric disorders. Copyright 2006 S. Karger AG, Basel.

  12. Improving quality of care in substance abuse treatment using five key process improvement principles

    Science.gov (United States)

    Hoffman, Kim A.; Green, Carla A.; Ford, James H.; Wisdom, Jennifer P.; Gustafson, David H.; McCarty, Dennis

    2012-01-01

    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: 1) Understand and involve the customer; 2) Fix key problems; 3) Pick a powerful change leader; 4) Get ideas from outside the organization; and 5) Use rapid-cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate application of each principle. Results suggest that the most successful organizations integrate and apply most, if not all, of the five principles as they develop and test change strategies. PMID:22282129

  13. Employed men and women substance abusers: job troubles and treatment outcomes.

    Science.gov (United States)

    Slaymaker, Valerie J; Owen, Patricia L

    2006-12-01

    The majority of U.S. adults with substance abuse or dependence are gainfully employed. However, little is known about outcomes among stably employed people in treatment for substance dependence. Participants (N = 212) entering a residential treatment program completed the Addiction Severity Index (ASI) at intake and 6 and 12 months follow-up. Significant improvements were seen in absenteeism, number of employment problem days, and whether their job was in jeopardy 12 months later. Overall, 65% were retained by their original employer. ASI composite alcohol, drug, legal, family, and psychiatric scores also improved significantly. Continuous abstinence was achieved by 65% and 51% at 6 and 12 months, respectively. Although less likely to be referred to treatment by their employer, women responded to treatment as well as men, reporting similar abstinence rates and overall quality of life during the year following discharge from treatment.

  14. "Transcend": initial outcomes from a posttraumatic stress disorder/substance abuse treatment program.

    Science.gov (United States)

    Donovan, B; Padin-Rivera, E; Kowaliw, S

    2001-10-01

    This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.

  15. Impact of dissociation and interpersonal functioning on inpatient treatment for early sexually abused adults

    Directory of Open Access Journals (Sweden)

    Ellen K. K. Jepsen

    2013-12-01

    Full Text Available Background: Little is known about the possible predictors of treatment outcome in early chronically sexually abused adults. The current study aimed to investigate what impact initial levels of dissociation and pre-treatment negative change in interpersonal functioning have on treatment response after 3 months of first-phase trauma inpatient treatment as well as after a period of 1 year the patients returned to their usual lives. Methods: The sample comprised 48 inpatients with childhood sexual abuse histories and mixed trauma-related disorders who were examined at discharge and prospectively followed up for a period of 1 year under naturalistic conditions. Outcome variables were general psychiatric symptoms and interpersonal problems as measured with the Symptom Check List-Revised (SCL-R and the Inventory of Interpersonal Problems (IIP Circumplex. Results: The central findings were that pathological dissociation and deterioration in interpersonal functioning prior to admittance predicted general psychiatric symptom levels and interpersonal problems at the end of treatment and at 1-year follow-up. Pathological dissociation, involving memory and identity problems, alone predicted negative outcome at the end of treatment. The findings at 1-year follow-up indicate that it is not pathological dissociation in isolation that affects outcomes, but rather the interaction between dissociation and change in interpersonal functioning prior to treatment. Conclusion: These findings indicate the need of addressing dissociation and interpersonal problems in treatment planning and favor an integrated treatment approach for complex trauma patients. Future research should investigate whether and how this leads to better outcome, including long-term maintenance of gains after the end of treatment.

  16. Genetic modulation of plasma NPY stress response is suppressed in substance abuse: association with clinical outcomes.

    Science.gov (United States)

    Xu, Ke; Hong, Kwangik Adam; Zhou, Zhifeng; Hauger, Richard L; Goldman, David; Sinha, Rajita

    2012-04-01

    Neuropeptide Y (NPY) is involved in stress regulation. Genetic variations predict plasma NPY and neural correlates of emotion and stress. We examined whether the functional NPY haplotype modulates stress-induced NPY and anxiety responses, and if plasma NPY stress responses are associated with substance dependence outcomes. Thirty-seven treatment-engaged, abstinent substance dependent (SD) patients and 28 healthy controls (HCs) characterized on NPY diplotypes (HH: high expression; HLLL: intermediate/low expression) were exposed to stress, alcohol/drug cues and neutral relaxing cues, using individualized guided imagery, in a 3-session laboratory experiment. Plasma NPY, heart rate and anxiety were assessed. Patients were prospectively followed for 90-days post-treatment to assess relapse outcomes. HH individuals showed significantly lower stress-induced NPY with greater heart rate and anxiety ratings, while the HLLL group showed the reverse pattern of NPY, anxiety and heart rate responses. This differential genetic modulation of NPY stress response was suppressed in the SD group, who showed no stress-related increases in NPY and higher heart rate and greater anxiety, regardless of diplotype. Lower NPY predicted subsequent higher number of days and greater amounts of post-treatment drug use. These preliminary findings are the first to document chronic drug abuse influences on NPY diplotype expression where NPY diplotype modulation of stress-related plasma NPY, heart rate and anxiety responses was absent in the substance abuse sample. The finding that lower stress-related NPY is predictive of greater relapse severity provides support for therapeutic development of neuropeptide Y targets in the treatment of substance use disorders. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

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    E. Y. Ponomareva

    2014-07-01

    Full Text Available Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

  18. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2011-01-01

    Full Text Available Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

  19. Assessment and Treatment of Abuse Risk in Opioid Prescribing for Chronic Pain

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    Robert N. Jamison

    2011-01-01

    Full Text Available Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of opioids is prominent in patients with chronic back pain and early recognition of misuse risk could help physicians offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this review, we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic back pain and present an overview of assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic back pain have significant medical, psychiatric and substance use comorbidities that affect treatment decisions and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no “gold standard” for opioid misuse risk assessment, several validated measures have been shown to be useful. Controlled substance agreements, regular urine drug screens, and interventions such as motivational counseling have been shown to help improve patient compliance with opioids and to minimize aberrant drug-related behavior. Finally, we discuss the future of abuse-deterrent opioids and other potential strategies for back pain management.

  20. Sexual Abuse of Individuals with Disabilities: Prevention Strategies for Clinical Practice

    Science.gov (United States)

    McEachern, Adriana G.

    2012-01-01

    Sexual abuse of individuals with disabilities occurs in alarming proportions, although the prevalence and incidence of such abuse is difficult to determine. Although all states maintain statistics on child sexual abuse, the rate of victimization for individuals with disabilities is not specific. This paper reviews several studies conducted on…

  1. The Prevalence of Sexual Abuse and Its Impact on the Onset of Drug Use among Adolescents in Therapeutic Community Drug Treatment.

    Science.gov (United States)

    Hawke, Josephine M.; Jainchill, Nancy; De Leon, George

    2000-01-01

    Describes the prevalence of sexual abuse among adolescents (N=938) admitted to residential therapeutic communities for treatment of substance abuse and related disorders. Results indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than for boys. History of…

  2. Social exclusion, personal control, self-regulation, and stress among substance abuse treatment clients.

    Science.gov (United States)

    Cole, Jennifer; Logan, T K; Walker, Robert

    2011-01-01

    The purpose of this study was to examine the relationship of social exclusion, personal control, and self-regulation to perceived stress among individuals who participated in publicly funded substance abuse treatment. Participants entered treatment between June 2006 and July 2007 and completed a 12-month follow-up survey by telephone (n=787). The results of the OLS regression analysis indicate that individuals with greater social exclusion factors (e.g. greater economic hardship, lower subjective social standing, greater perceived discrimination), lower perceived control of one's life, and lower self-regulation had higher perceived stress. Furthermore, a significant interaction was found suggesting a stress-buffering effect of personal control between subjective social standing and perceived stress. Interestingly, income status was not significantly related to perceived stress, while economic hardship, which assesses participants' inability to meet basic expenses, was significantly associated with perceived stress. Future research should examine how to integrate the AA/NA teaching about powerlessness and its role in recovery with the importance of increased personal control and self-control in decreasing perceived stress. Implications for future research and substance abuse treatment are discussed. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. The specifics of opiate abuse in women as a basis of prevention programs and treatment

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    Raketić Diana

    2013-01-01

    Full Text Available The aim of this research is to determine the specifics of opiate addiction in women in our environment, so as to create a specific plan of action in preventing and treatment opiate addiction in women based on the conducted description and results analysis. The sample consists of 32 examinees. Sociodempgraphic questionnaire and widely applied ASI structured interview (McLellan, Cacciola, 1982 were used. The results are in accordance with foreign research. 62.5% of opiate addicted women live with someone who is a drug addict, either as a family member or a partner. 40.6% of the examinees were physically abused, 21.9% were sexually abused as well, and 43.7% were positive for HCV. Positive criminal status and doing illegal business were present in 56% of the examinees. 56.3% of the examinees reported depression, while 84.4% are anxious. 65.6% are unemployed. Research results indicate some significant specifics of opiate addiction in women, with regard to which valuable recommendations for prevention and treatment can be made in our environment. Prevention and treatment must be multidisciplinary with the emphasis on the preserved capacities and the development of positive behavior in opiate addicted women.

  4. LESSONS FROM THE EVALUATION OF A PUBLIC OUT-PATIENT SUBSTANCE ABUSE TREATMENT PROGRAMME IN THE WESTERN CAPE

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    Strebel, Anna

    2013-05-01

    Full Text Available Substance abuse is widely regarded as a major health and social problem in South Africa, and particularly in the Western Cape (Corrigall, Ward, Stinson, Struthers, Frantz, Lund, Flisher & Joska, 2007; Myers, Fakier & Louw, 2009. The complex nature of patterns of substance abuse, as well as the particular problems associated with this abuse, has implications for the development and implementation of treatment interventions. The most common primary drug of abuse in the Western Cape amongst patients admitted to treatment programmes is methamphetamine (known locally as “tik” (Dada, Plüddemann, Parry, Vawda & Fourie, 2012. The previous decade saw a dramatic rise in methamphetamine (hereafter indicated as MA use, particularly among youths, with over half the patients in treatment for MA abuse being younger than 25 years (Plüddemann, Parry, Dada, Bhana, Bachoo & Fourie, 2010. MA is also often used in combination with other drugs, and this prevalence of poly-substance abuse needs to be taken into account in the planning of services (Harker, Kader, Myers, Falkier, Parry, Flisher, Peltzer, Ramlagan & Davids, 2008.

  5. Differences between U.S. substance abuse treatment facilities that do and do not offer domestic violence services.

    Science.gov (United States)

    Cohn, Amy; Najavits, Lisa M

    2014-04-01

    Victimization by and perpetration of domestic violence are associated with co-occurring mental and substance use disorders. This study used data from the National Survey of Substance Abuse Treatment Services to examine differences in organizational factors, treatment approaches offered, and client-level factors among 13,342 substance abuse treatment facilities by whether or not they offered domestic violence services. Only 36% of the facilities offered domestic violence services. Those that offered such services were more likely than those that did not to treat clients with co-occurring disorders. Principal-components analysis reduced eight treatment approaches to two factors: psychosocial services and traditional substance abuse services. Regression models indicated that the frequency with which psychosocial services were offered depended on the percentage of clients with co-occurring disorders who were being treated in the facility and whether or not that facility offered domestic violence services. Specifically, facilities that did not offer domestic violence services and that had a high percentage of clients with co-occurring disorders were more likely to offer psychosocial services than facilities that offered domestic violence services. A larger proportion of facilities offering domestic violence services offered traditional substance abuse treatment services, compared with facilities not offering domestic violence services, but this relationship was not contingent on the percentage of clients with co-occurring disorders at each facility. Improved efforts should be made to tailor treatments to accommodate the links between domestic violence, mental disorders, and substance abuse.

  6. Treatment effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder.

    Science.gov (United States)

    Thomaes, K; Dorrepaal, E; Draijer, N; de Ruiter, M B; Elzinga, B M; van Balkom, A J; Smit, J H; Veltman, D J

    2012-11-01

    Functional neuroimaging studies have shown increased Stroop interference coupled with altered anterior cingulate cortex (ACC) and insula activation in post-traumatic stress disorder (PTSD). These brain areas are associated with error detection and emotional arousal. There is some evidence that treatment can normalize these activation patterns. At baseline, we compared classic and emotional Stroop performance and blood oxygenation level-dependent responses (functional magnetic resonance imaging) of 29 child abuse-related complex PTSD patients with 22 non-trauma-exposed healthy controls. In 16 of these patients, we studied treatment effects of psycho-educational and cognitive behavioural stabilizing group treatment (experimental treatment; EXP) added to treatment as usual (TAU) versus TAU only, and correlations with clinical improvement. At baseline, complex PTSD patients showed a trend for increased left anterior insula and dorsal ACC activation in the classic Stroop task. Only EXP patients showed decreased dorsal ACC and left anterior insula activation after treatment. In the emotional Stroop contrasts, clinical improvement was associated with decreased dorsal ACC activation and decreased left anterior insula activation. We found further evidence that successful treatment in child abuse-related complex PTSD is associated with functional changes in the ACC and insula, which may be due to improved selective attention and lower emotional arousal, indicating greater cognitive control over PTSD symptoms.

  7. Pedophilia: Clinical Features, Etiology and Treatment

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    Ayten Erdogan

    2010-08-01

    Full Text Available There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally <13 years for a period of at least 6 months. It is difficult to estimate the true prevalence of pedophilia because few pedophiles voluntarily seek treatment. Most of the available data are based on individuals who have become involved with the legal system. Most individuals who engage in pedophilia are male. When compared with other sex offenders, pedophiles are in the older adult age range (age, 40-70 years. Pedophiles may engage in a wide range of sexual acts with children. These activities includes exposing themselves to children, looking at naked children, masturbating in the presence of children, physical contact, rubbing, fondling a child, engaging in oral sex, or penetration of the mouth, anus, and/or vagina. Generally, pedophiles do not use force to have children engage in these activities but instead rely on various forms of psychic manipulation and desensitization. People with pedophilia use internet to be a vehicle capable of meeting their needs: obtaining information, monitoring and contacting victims, developing fantasy, overcoming inhibitions, avoiding apprehension, and communicating with other offenders. The compulsive-aggressive trait is more pronounced in people with pedophilia. Generally they plan the sexual offending with the intention of relieving internal pressures or urges. Pedophiles generally experience feelings of inferiority, isolation or loneliness, low self-esteem, internal dysphoria, and emotional immaturity. There are likely multiple factors and multiple pathways involved in the development of pedophilia. Since there has been no treatment method that can

  8. Personal networks of women in residential and outpatient substance abuse treatment.

    Science.gov (United States)

    Kim, HyunSoo; Tracy, Elizabeth; Brown, Suzanne; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung; McCarty, Chris

    This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t -tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse.

  9. Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

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    Gospodarevskaya Elena

    2012-04-01

    Full Text Available Abstract Background Post-traumatic stress disorder (PTSD is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT over non-directive counselling as a more efficacious treatment. Methods A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI, and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model. Results In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT. Conclusion Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation

  10. Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany.

    Science.gov (United States)

    Dauber, Hanna; Braun, Barbara; Pfeiffer-Gerschel, Tim; Kraus, Ludwig; Pogarell, Oliver

    2018-01-01

    Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System ( N  = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.

  11. Long-term residential substance abuse treatment for women: lessons learned from Israel

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    Schori M

    2012-02-01

    Full Text Available Maayan Schori1, Yaffa Sapir2, Eli Lawental31School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA; 2Central School for the Training of Social Welfare Workers, Ministry of Social Affairs and Social Services, Tel Aviv, Israel; 3Department of Social Work, Tel-Hai College, Upper Galilee, IsraelBackground: Policymakers and treatment providers must consider the role of gender when designing effective treatment programs for female substance abusers. This study had two aims. First, to examine female substance abusers' perceptions regarding factors that contribute to their retention (and therefore positive treatment outcomes in a women-only therapeutic community in Northern Israel. Second, to explore pretreatment internal and external factors including demographic, personal and environmental factors, factors associated with substance use and with the treatment process, and networks of support that contribute to retention and abstinence.Methods: The study was a conducted using a mixed methods approach. Semi-structured qualitative interviews examining perceptions towards treatment were conducted in five focus groups (n = 5 per group; total n = 25. Intake assessments and a battery of questionnaires examining pretreatment internal and external factors related to treatment retention and abstinence were collected from 42 women who were treated in the program during the 2 year study period. Twenty-three women who completed the 12 month program were compared to the 19 women who did not, using chi-square for categorical variables and t-tests for continuous variables. Nineteen of the 23 women who completed the questionnaires also completed a post-treatment follow-up questionnaire.Results: A content analysis of the interviews revealed five central themes: factors associated with treatment entry; impact of treatment in a women-only setting; significant aspects of treatment; difficulties with the setting; prospects for the future

  12. Clinical features of the head injury caused by child abuse in infants

    International Nuclear Information System (INIS)

    Nishimoto, Hiroshi; Kurihara, Jun

    2007-01-01

    The diagnosis and managements of the head injury in battered children are greatly complicated by medical history and the mechanisms of injury. In the present study, we evaluated the clinical features of the head injury in battered children. Clinical signs and symptoms, the mechanisms of injury, intracranial pathology, and prognosis of 25 battered children with head injury treated between 1984 and 2003 were retrospectively analyzed. The age of 25 children was between 1 month and 2 years old. The average of the ages was 7 months old. In 68% of 25 patients, the age was 6 months or less. The medical history of head injury was unclear in 16 children. The chief complains were disturbance of consciousness, convulsion, vomiting and hypothermia. Retinal hemorrhages were recognized in 88% of the patients and these were bilateral in 68%. Acute subdural hematomas (19 cases) and chronic subdural hematomas (6 cases) were shown on CTs or MRIs. In four cases, cerebral contusions were complicated as intracranial pathology. In 44% of the patients, the hypoxic-ischemic injury was confirmed on CTs or MRIs. Fractures of limbs and ribs were recognized on skeletal survey in 40% of the patients. 71% of 17 survival cases had moderate or severe psychomotor disabilities at the end of follow-up periods. In children under 2 years of age with subdural hematomas, clinical investigations other than CT and MRI, included ophthalmoscopy by ophthalmologist and skeletal survey, are crucial and mandatory for early diagnosis of the child abuse. (author)

  13. EFFECT OF JOB SKILLS TRAINING ON EMPLOYMENT AND JOB SEEKING BEHAVIORS IN AN AMERICAN INDIAN SUBSTANCE ABUSE TREATMENT SAMPLE.

    Science.gov (United States)

    Foley, K; Pallas, D; Forcehimes, A A; Houck, J M; Bogenschutz, M P; Keyser-Marcus, L; Svikis, D

    2010-10-26

    Employment difficulties are common among American Indian individuals in substance abuse treatment. To address this problem, the Southwest Node of NIDA's Clinical Trials Network conducted a single-site adaptation of its national Job Seekers Workshop study in an American Indian treatment program, Na'Nizhoozhi Center (NCI). 102 (80% men, 100% American Indian) participants who were in residential treatment and currently unemployed were randomized to (1) a three session, manualized program (Job seekers workshop: JSW) or (2) a 40-minute Job Interviewing Video: JIV). Outcomes were assessed at 3-month follow up: 1) number of days to a new taxed job or enrollment in a job-training program, and 2) total hours working or enrolled in a job-training program. No significant differences were found between the two groups for time to a new taxed job or enrollment in a job-training program. There were no significant differences between groups in substance use frequency at 3-month follow-up. These results do not support the use of the costly and time-consuming JSW intervention in this population and setting. Despite of the lack of a demonstrable treatment effect, this study established the feasibility of including a rural American Indian site in a rigorous CTN trial through a community-based participatory research approach.

  14. Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan.

    Science.gov (United States)

    Chiang, Shu-Chuan; Chan, Hung-Yu; Chang, Yuan-Ying; Sun, Hsiao-Ju; Chen, Wei J; Chen, Chih-Ken

    2007-02-01

    The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.

  15. Hospitalization of adolescents for psychiatric and substance abuse treatment. Legal and ethical issues.

    Science.gov (United States)

    Schwartz, I M

    1989-11-01

    It has been estimated that as many as 12%-15% of the nations 63 million children are in need of mental health treatment. We have a responsibility to do everything we can to see to it that these children receive the services they need. Unfortunately, there is mounting evidence that a significant proportion of our health care resources are being misspent on the unnecessary and inappropriate hospitalization of children and youths in psychiatric and substance abuse treatment programs. More alarming is the evidence of poor quality programs, abusive practices, and greed. The intense competition to capture a "share of the market" and turn a profit or keep a nonprofit hospital from closing its doors is contributing to unprofessional and unethical advertising and public relations practices. In the end these practices will reflect poorly on the broader mental health and health care community. Hopefully, the stakeholders in the system will recognize these problems and assume a leadership role in turning the situation around. If not, we can expect intervention from forces outside the system (e.g., courts, elected public officials, public interest groups, the business community, and child advocates).

  16. Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature.

    Science.gov (United States)

    Macy, Rebecca J; Goodbourn, Melissa

    2012-10-01

    Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.

  17. Types of Treatment: Clinical Trials

    Science.gov (United States)

    ... disease type and stage; your age, gender and race; and other treatments you've used. Your doctor ... Drug Listings Radiation Therapy Immunotherapy Chimeric Antigen Receptor (CAR) T-Cell Therapy Vaccine Therapy Stem Cell Transplantation ...

  18. Changes in the treatment of abused children: a retrospective review of a practice.

    Science.gov (United States)

    Tsaltas, M O

    1994-01-01

    Using the population of sexually abused children from three periods of my practice, I have described changes in my practice of play therapy over the past 30 years. These changes have come about in part due to the pioneering work of psychiatrists specializing in studies of development in children not designated as emotionally disturbed or mentally ill (Chess and Thomas, 1986; Greenspan, 1981; Winnicott, 1953, 1965, 1971) as well those who have described treatment techniques and theoretical constructs of the experience of traumatized children (Finkelhor and Browne, 1985; Terr, 1991). Because of these convincing works, I have been able to shorten treatment, and shift my goals from direct efforts at unconscious conflict resolution to the more indirect but more effective method of re-establishing maturational tracks through involvement of families, dialogue with children in multiple play techniques as well as words, and to plan ahead for these traumatized children. It remains to be seen what the eventual outcome of this change in treatment will be. Although I always ask families and children to keep in touch even by postcard, only about 20% of them do. Naturally, these are families that are doing well. I am not sure that this necessarily means the other 80% are not doing well but I simply do not know. Because all of these patients are known to one authority or another (police, Rape Centers, courts and Department of Welfare) it should be possible to plan long-term studies of treatment outcome at the time of the initial contact. It seems important enough to me to do this because betrayed trust has a very long lag time before its full effects may be seen in the adults these children become. Because there are so many cases of child abuse, defining the relative effectiveness and efficacy of different kinds of treatment could be useful in managing what is, in effect, a public health problem.

  19. Living conditions in the districts of Oslo and poisonings by substances of abuse treated at casualty clinic level.

    Science.gov (United States)

    Akopian, Maja; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind; Brekke, Mette

    2015-11-17

    Use of and acute poisoning by substances of abuse represent a major health problem and are often linked to social destitution. We describe associations between place of residence, living conditions and the incidence of poisoning by substances of abuse in Oslo. All patients who were 12 years of age or older and resident in Oslo and who were treated for acute poisoning by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) were included prospectively for a continuous period of one year, from October 2011 to September 2012. The 15 districts of Oslo were categorised into three groups of living conditions, from the best (I) to the poorest (III) living conditions, based on the City of Oslo's living conditions index. Homeless people were grouped separately. The incidence of poisoning by substances of abuse treated in the OAEOC was estimated. Of a total of 1,560 poisonings by substances of abuse, 1,094 cases (70%) affected men. The median age was 41 years. The most frequent toxic agents were ethanol, with 915 cases (59%), and heroin, with 249 cases (16%). The incidence of poisoning by substances of abuse treated in the OAEOC per year per 1,000 inhabitants amounted to 1.75 in living conditions group I, to 2.76 in living conditions group II and 3.41 in living conditions group III. Living conditions group III had a significantly higher incidence than living conditions group II (p < 0.001), and living conditions group II had a significantly higher incidence than living conditions group I (p < 0.001). The incidence of acute poisoning by substances of abuse was higher, the poorer the living conditions in the district.

  20. What Adolescents Need to Prevent Relapse after Treatment for Substance Abuse: A Comparison of Youth, Parent, and Staff Perspectives

    Science.gov (United States)

    Acri, Mary C.; Gogel, Leah P.; Pollock, Michele; Wisdom, Jennifer P.

    2012-01-01

    Objective: Little is known about what factors and supports youths identify as important for their sustained recovery after substance abuse treatment, and if their caregivers and treatment staff identify similar needs. The purpose of this study was to explore what youths, caregivers, and staff perceive as important to remain substance free after…

  1. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review

    NARCIS (Netherlands)

    Dorrepaal, Ethy; Thomaes, Kathleen; Hoogendoorn, Adriaan W.; Veltman, Dick J.; Draijer, Nel; van Balkom, Anton J. L. M.

    2014-01-01

    Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. A quantitative review of the literature was performed, identifying seven studies, with treatments specifically

  2. The Use of Art and Music Therapy in Substance Abuse Treatment Programs

    Science.gov (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M.; Bride, Brian E.

    2014-01-01

    While the implementation of evidence-based practices (EBPs) in the treatment of substance use disorders (SUD) has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs’ use of Motivational Enhancement Therapy (MET) was positively related to offering art therapy, while use of Contingency Management (CM) was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings, and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents. PMID:25514689

  3. The use of art and music therapy in substance abuse treatment programs.

    Science.gov (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M; Bride, Brian E

    2014-01-01

    Although the implementation of evidence-based practices in the treatment of substance use disorders has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs' use of Motivational Enhancement Therapy was positively related to offering art therapy, whereas use of contingency management was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents.

  4. Trauma complexity and child abuse

    DEFF Research Database (Denmark)

    Riber, Karin

    2017-01-01

    and categories emerged in the domains childhood physical abuse (CPA), childhood emotional abuse (CEA), and neglect. Participants articulated wide personal impacts of child abuse in emotional, relational, and behavioral domains in their adult lives. These narratives contribute valuable clinical information...

  5. Decision-making authority and substance abuse treatment for adolescents: a survey of state laws.

    Science.gov (United States)

    Lallemont, Tori; Mastroianni, Anna; Wickizer, Thomas M

    2009-04-01

    State laws concerning decision-making authority for voluntary inpatient substance abuse (SA) treatment of minors may be a potential barrier to appropriate treatment. We sought to identify and classify relevant laws related to the provision of voluntary inpatient SA treatment to adolescents 12 to 17 years (minors) as an exploratory assessment to improve understanding of how these laws might affect treatment decisions. In summer 2006, we conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia regarding the authority of parents (or guardians) and minors to make treatment decisions for voluntary inpatient SA treatment. All 50 states have laws applicable to voluntary inpatient SA treatment for adolescents, and the laws vary significantly throughout the nation. If a minor and parent disagree about SA treatment, some states defer to the decision-making authority of the minor, whereas other states defer to the parent. Most significantly, the majority of states fail to specify whether the minor's or the parent's decision will control in the event of a conflict. The lack of clarity in state laws regarding decision-making authority for voluntary inpatient SA treatment of minors may create a potential barrier to treatment for adolescents, especially those with more serious SA problems. This lack of clarity could lead to confusion among parents, adolescents, healthcare professionals, and treatment facilities, and ultimately could result in a failure to treat adolescents in need of medical attention. Policymakers should ensure that state laws clearly specify procedures to enable treatment if a conflict arises between adolescents and parents, including procedures to ensure that the due process rights of adolescents are protected.

  6. Workforce Diversity in Outpatient Substance Abuse Treatment: The Role of Leaders’ Characteristics

    Science.gov (United States)

    Guerrero, Erick G.

    2012-01-01

    Although the outpatient substance abuse treatment field has seen an increase in referrals of African American and Latino clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. Program leaders have significant influence to leverage resources to develop staff diversity. Analysis of panel data from 1995 to 2005 showed that the most significant predictors of diversity were the characteristics of leaders. In particular, programs with managers with racially and ethnically concordant backgrounds and their education level were positively related to the percentage of Latino and African American staff. A high percentage of African American staff was positively associated with managers’ tenure, but inversely related to licensed directors. Diversification of the field has increased, yet efforts have not matched increases in client diversity. Implications for health care reform legislation seeking to improve cultural competence through diversification of the workforce are discussed. PMID:22658932

  7. Workforce diversity in outpatient substance abuse treatment: the role of leaders' characteristics.

    Science.gov (United States)

    Guerrero, Erick G

    2013-02-01

    Although the outpatient substance abuse treatment field has seen an increase in referrals of African American and Latino clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. Program leaders have significant influence to leverage resources to develop staff diversity. Analysis of panel data from 1995 to 2005 showed that the most significant predictors of diversity were the characteristics of leaders. In particular, programs with managers with racially and ethnically concordant backgrounds and their education level were positively related to the percentage of Latino and African American staff. A high percentage of African American staff was positively associated with managers' tenure, but inversely related to licensed directors. Diversification of the field has increased, yet efforts have not matched increases in client diversity. Implications for health care reform legislation seeking to improve cultural competence through diversification of the workforce are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients.

    Science.gov (United States)

    Byrne, Shannon A; Cherniack, Martin G; Petry, Nancy M

    2013-09-01

    Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58-20.28). These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Fixed and dynamic predictors of treatment process in therapeutic communities for substance abusers in Belgium.

    Science.gov (United States)

    Goethals, Ilse; Vanderplasschen, Wouter; Vandevelde, Stijn; Broekaert, Eric

    2012-10-11

    Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients' early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument. Data was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients' early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process). Clients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients' ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients' ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores. Special attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients' (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the

  10. Trend Analysis of Substance Abuse Treatment Admissions in New Orleans From 2000-2012: A Population-Based Comparison Pre- and Post-Hurricane Katrina.

    Science.gov (United States)

    Shuler, Monique N; Wallington, Sherrie F; Qualls-Hampton, Raquel Y; Podesta, Arwen E; Suzuki, Sumihiro

    2016-10-14

    Substance abuse treatment following a natural disaster is often met with challenges. If treatment is available, facilities may be unequipped to service an influx of patients or provide specialized care for unique populations. This paper seeks to evaluate trends in substance abuse treatment over time and assess changes pre- and post-Hurricane Katrina. Substance abuse treatment admission data (N = 42,678) from New Orleans, Louisiana, for years 2000 through 2012 were obtained from the Treatment Episode Data Set. Admissions were examined to evaluate demographic, socioeconomic, psychiatric, and criminality trends in substance abuse treatment and assess changes following Hurricane Katrina. Treatment admissions have decreased from 2000 to 2012. About one in five admissions had a psychiatric illness in addition to a substance abuse problem. A staggering 76% of admissions with a psychiatric illness were referred by the criminal justice system post-Katrina as compared to pre-Katrina. Rates of alcohol and marijuana admissions have remained stable from 2000 to 2012. Cocaine/crack admissions have declined and admissions who abused heroin have increased over time. Treatment admissions stabilized following Hurricane Katrina; however, since 2009, they have begun to decline. Targeted exploration of factors affecting admission to treatment in New Orleans with populations such as the homeless, those with a psychiatric illness in addition to a substance abuse problem, and those referred by the criminal justice system is essential. The results of this study assist in identifying variations in substance abuse treatment characteristics for those admitted to treatment in New Orleans.

  11. Child abuse, a case report

    Directory of Open Access Journals (Sweden)

    Andri M.T. Lubis

    2004-03-01

    Full Text Available Child abuse is a pervasive social and medical problem that remains a major cause of disability and death among children. The annual incidence of abuse is estimated to be 15 to 42 cases per 1,000 children and appears to be increasing. Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children will eventually be seen by an orthopedic surgeon. We report a 7-month-old boy who was suspected to be abused. Our diagnosis was based on findings of multiple fractures, delay in seeking medical treatment and discrepancy between the history of illness and the clinical findings. He sustained multiple fractures in variety of healing, namely fractures on left supracondylar humeri, left radius and ulna, right radius and ulna, both femora, right tibia, and left tibia and fibula. Radiological examination was an important modality in revealing the possibility of abuse on this child. He had received medical treatment, protection, consultation team for the parents and an underway police investigation. (Med J Indones 2004; 13: 59-65 Keywords: child, abuse

  12. Age differences in heroin and prescription opioid abuse among enrolees into opioid treatment programs

    Directory of Open Access Journals (Sweden)

    Fong Chunki

    2011-06-01

    Full Text Available Abstract Background In the United States, among those entering opioid treatment programs (OTPs, prescription opioid (PO abusers tend to be younger than heroin users. Admissions of older persons to OTPs have been increasing, and it is important to understand typical patterns of use among those older enrolees. Methods To disentangle the effect of age on recent heroin and PO abuse 29,114 enrolees into 85 OTPs were surveyed across 34 states from 2005-2009. OTPs where PO use was prevalent were oversampled. Results Mean age was 34; 28% used heroin only. Younger enrolees had increased odds of using POs relative to using heroin only but mixed model analysis showed that much of the total variability in type of use was attributed to variation in age between OTPs rather than within OTPs. Conclusions Organizational and cultural phenomena (e.g., OTP characteristics must be examined to better understand the context of individual characteristics (e.g., age. If nesting of enrolees within OTPs is ignored, then associations that primarily operate at the OTP level may be misinterpreted as exclusively dependent on individuals.

  13. The comparition of Personality Patterns, irrational beliefs and impulsivity in males with with drug abuse disorder under Treatment

    Directory of Open Access Journals (Sweden)

    samere asadi

    2015-03-01

    Full Text Available Objective: the aim of this research was to determine the difference between personality Patterns, irrational beliefs and impulsivity in men with drug abuse disorder under Treatment. Method: in this casual- comparative research, 80 men ( 40 males with drug abuse under Treatment and 40 of normal males that were selected with available sampling .Groups were matched in terms of demoghraphy characteristics ( age, sexuality, education level and marital status and were valued with means of Eysenk Perceived Stress Inventory, Jonze Irrational Beliefs Scale and Baret Impulsivity Inventory. Results: The result of variance analysis showed that addicts compared to normal people, get more scores on extraversion, neuroticism and psychosis. Addicts group had Higher men scores in irrational beliefs compare of other group. There was significant difference between groups in impulsivity and impulsivity in addicts persons is the most. Conclussion: The traits of Personality, irrational beliefs and Unrealistic and high level impulsivity are factors that propel individuals toward more drug abuse and finally addict and aiming this factors in individuals with abuse disorder under Treatment can lead to prevent of Substance Abuse Relapse.

  14. Effects of Methadone Maintenance Treatment on Decision-Making Processes in Heroin-Abusers: A Cognitive Modeling Analysis

    Directory of Open Access Journals (Sweden)

    Arash Khodadadi

    2010-05-01

    Full Text Available A B S T R A C TIntroduction: Although decision-making processes have become a principal target of study among addiction researchers, few researches are published according to effects of different treatment methods on the cognitive processes underlying decision making up to now. Utilizing cognitive modeling method, in this paper we examine the effects of Methadone maintenance treatment (MMT on cognitive processes underlying decision-making disorders in heroin-abusers. Methods: For this purpose, for the first time, we use the balloon analog risk task (BART to assess the decision-making ability of heroin-abusers before and after treatment and compare it to the non heroin-dependent subjects. Results: Results demonstrate that heroin-abusers show more risky behavior than other groups. But, there is no difference between the performance of heroin-abusers after 6 months of MMT and control group. Modeling subjects’ behavior in BART reveals that poor performance in heroin-abusers is due to reward-dependency and insensitivity to evaluation. Discussion: Results show that 6 months of MMT decreases reward-dependency and increases sensitivity to evaluation.

  15. Predictors of residential treatment retention among individuals with co-occurring substance abuse and mental health disorders.

    Science.gov (United States)

    Choi, Sam; Adams, Susie M; MacMaster, Samuel A; Seiters, John

    2013-01-01

    A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.

  16. Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Risk for Child Abuse.

    Science.gov (United States)

    Kelley, Michelle L; Bravo, Adrian J; Braitman, Abby L; Lawless, Adrienne K; Lawrence, Hannah R

    2016-03-01

    Risk for child abuse was examined prior to and after behavioral couples treatment (BCT) among 61 couples in which one or both parents were diagnosed with substance use disorder (SUD). All couples were residing with one or more school-age children. Mothers and fathers completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Results of piecewise latent growth models tested whether the number of BCT sessions attended and number of days abstinent from drugs and alcohol influenced relationship satisfaction and its growth over time, and in turn if relationship satisfaction and change in relationship satisfaction influenced risk for child abuse. For both mothers and fathers, attending more BCT sessions lead to a direct increase in relationship satisfaction, which in turn led to stronger reductions in risk for child abuse. This effect was maintained from the post-intervention through the 6-month post-intervention follow-up. For fathers, number of days abstinent significantly influenced reduction in child abuse potential at post-intervention via relationship satisfaction. This indirect effect was not present for mothers. The overall benefits of BCT on mothers' and fathers' risk for child abuse suggest that BCT may have promise in reducing risk for child abuse among couples in which one or both parents have SUD. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Clinical Correlates of Alleged Satanic Abuse and Less Controversial Sexual Molestation.

    Science.gov (United States)

    Leavitt, Frank

    1994-01-01

    This study found that 39 women alleging satanic ritual abuse and 47 women reporting less controversial forms of sexual trauma as children were characterized by high but nondiscriminating levels of psychiatric pathology. Patients alleging satanic ritual abuse reported higher levels of dissociation, in the range often exhibited by patients with…

  18. Comparison of cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse treatment settings.

    Science.gov (United States)

    Miller-Thomas, Tonya; Leoutsakos, Jeannie-Marie S; Terplan, Mishka; Brigham, Emily P; Chisolm, Margaret S

    2014-01-01

    Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.

  19. Drug abuse

    International Nuclear Information System (INIS)

    Simon, T.R.; Seastrunk, J.W.; Malone, G.; Knesevich, M.A.; Hickey, D.C.

    1991-01-01

    This paper reports that this study used SPECT to examine patients who have abused drugs to determine whether SPECT could identify abnormalities and whether these findings have clinical importance. Fifteen patients with a history of substance abuse (eight with cocaine, six with amphetamine, and one with organic solvent) underwent SPECT performed with a triple-headed camera and Tc-99m HMPAO both early for blood flow and later for functional information. These images were then processed into a 3D videotaped display used in group therapy. All 15 patients had multiple areas of decreased tracer uptake peppered throughout the cortex but mainly affecting the parietal lobes, expect for the organic solvent abuser who had a large parietal defect. The videotapes were subjectively described by a therapist as an exceptional tool that countered patient denial of physical damage from substance abuse. Statistical studies of recidivism between groups is under way

  20. Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status

    Science.gov (United States)

    2014-01-01

    Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico. PMID:25074067

  1. Investigation of Prevalence of Child Abuse in Addicts Referring to the Addiction Withdrawal Clinic

    Directory of Open Access Journals (Sweden)

    G Dastjerdi

    2010-09-01

    Full Text Available Introduction: Child abuse includes abuse of the body, mental and sexual abuse or misbehavior against children that leads to damage to the child's heath and comfort. Therefore, the present study was done in order to determine the prevalence of child abuse in opiate addicts referring to addiction withdrawal centers. Methods: The cross sectional study included 300 participations (150 addicts and 150 non-addicts The addicted group comprised of opiate addicts referring to addiction withdrawal centers of Yazd. The non addicted group was selected randomly from healthy people. Data collection was performed via a standard questionnaire. Data assessment was done via statistical analysis (K S Results: Collected data in the addicted group showed the following results about 56 percent were child tormentors, 1- 45.3% males, 10.7% females, 2-18.7% uneducated, 3-46% with divorce history in their family and 4-38% child body abuse. The most prevalent type of the body abuse was slapping (24%, mostly because of bad training (26%. Collected data in the no addicted group showed the following results 42% were child tormentors (26% male and 15.3% female 23.4% with family divorce history, 30.4% were child body abuse and the most prevalent type of body abuse was slapping (22.79%, mostly because of bad training (33.3% Conclusion: A direct relationship was observed between child abuse and persons addicted to opiates. Factors playing an important role include illiteracy, divorce history in the family and history of child abuse in childhood period. Therefore, compilation of rules supporting children, establishment of support and parent education centers can be effective to reduce child persecution.

  2. A reinforcement-based therapeutic workplace for the treatment of drug abuse: six-month abstinence outcomes.

    Science.gov (United States)

    Silverman, K; Svikis, D; Robles, E; Stitzer, M L; Bigelow, G E

    2001-02-01

    This study evaluated a novel drug abuse treatment, the Therapeutic Workplace. In this treatment, patients are paid to perform jobs or to participate in job training. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplace. Pregnant and postpartum drug abuse patients (N = 40) were randomly assigned to a Therapeutic Workplace or usual care control group. Therapeutic Workplace participants were invited to work 3 hr every weekday for 6 months and could earn up to $4,030 in vouchers for abstinence, workplace attendance, and performance. On average, 45% of participants attended the workplace per day. Relative to controls, the Therapeutic Workplace nearly doubled patients' abstinence from opiates and cocaine (33% vs. 59% of thrice-weekly urine samples drug negative, respectively, p Workplace can effectively treat heroin and cocaine abuse in pregnant and postpartum women.

  3. Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up.

    Science.gov (United States)

    Mauri, M C; Di Pace, C; Reggiori, A; Paletta, S; Colasanti, A

    2017-10-01

    The study reports a follow-up assessment of 48 patients with concomitant drug abuse at the first admission for psychosis. We focused on the diagnostic distinction between primary psychosis with concomitant drug abuse and drug induced psychosis, to observe whether the diagnoses are stable over time and whether the clinical course significantly differs. The study examined 25 primary psychotic disorder with comorbid drug abuse and 23 drug-induced psychotic disorder patients. Diagnostic and psychopathological assessments were made at baseline and at follow-up. Mean follow-up period was 4.96 years. Patients with comorbid Drug Abuse exhibited higher scores in the item Unusual Content of Thought at baseline than drug-induced psychotic disorder patients: 5.48 vs 4.39 while the two patients groups did not differ in any of the BPRS items evaluated at follow-up. The primary psychosis with comorbid drug abuse and the substance induced psychosis groups were similar regarding diagnostic stability, and a diagnosis of schizophrenia at follow-up occurred similarly. There was no evidence that Drug Induced psychotic patients' symptoms tend to improve more after cessation of drug abuse. An earlier age of onset was found in primary psychotic patients, particularly for patients diagnosed as affected by schizophrenia at follow up. These results might reflect the uncertainty of the distinction between Primary and Drug Induced Psychosis and the difficulties in applying the DSM IV-TR criteria for diagnosing comorbid drug use disorders and psychotic disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Facility-level, state, and financial factors associated with changes in the provision of smoking cessation services in US substance abuse treatment facilities: Results from the National Survey of Substance Abuse Treatment Services 2006 to 2012.

    Science.gov (United States)

    Cohn, Amy; Elmasry, Hoda; Niaura, Ray

    2017-06-01

    Cigarette smoking is common among patients in substance abuse treatment. Tobacco control programs have advocated for integrated tobacco dependence treatment into behavioral healthcare, including within substance abuse treatment facilities (SATFs) to reduce the public health burden of tobacco use. This study used data from seven waves (2006 to 2012) of the National Survey of Substance Abuse Treatment Services (n=94,145) to examine state and annual changes in the provision of smoking cessation services within US SATFs and whether changes over time could be explained by facility-level (private vs public ownership, receipt of earmarks, facility admissions, acceptance of government insurance) and state-level factors (cigarette tax per pack, smoke free policies, and percent of CDC recommended tobacco prevention spending). Results showed that the prevalence of SATFs offering smoking cessation services increased over time, from 13% to 65%. The amount of tax per cigarette pack, accepting government insurance, government (vs private) ownership, facility admissions, and CDC recommended tobacco prevention spending (per state) were the strongest correlates of the provision of smoking cessation programs in SATFs. Facilities that received earmarks were less likely to provide cessation services. Adult smoking prevalence and state-level smoke free policies were not significant correlates of the provision of smoking cessation services over time. Policies aimed at increasing the distribution of tax revenues to cessation services in SATFs may offset tobacco-related burden among those with substance abuse problems. Copyright © 2017. Published by Elsevier Inc.

  5. Accelerating cocaine metabolism as an approach to the treatment of cocaine abuse and toxicity

    Science.gov (United States)

    Schindler, Charles W; Goldberg, Steven R

    2012-01-01

    One pharmacokinetic approach to the treatment of cocaine abuse and toxicity involves the development of compounds that can be safely administered to humans and that accelerate the metabolism of cocaine to inactive components. Catalytic antibodies have been developed and shown to accelerate cocaine metabolism, but their catalytic efficiency for cocaine is relatively low. Mutations of human butyrylcholinesterase and a bacterial cocaine esterase found in the soil of coca plants have also been developed. These compounds accelerate cocaine metabolism and antagonize the behavioral and toxic effects of cocaine in animal models. Of these two approaches, the human butyrylcholinesterase mutants show the most immediate promise as they would not be expected to evoke an immune response in humans. PMID:22300096

  6. Managerial capacity and adoption of culturally competent practices in outpatient substance abuse treatment organizations.

    Science.gov (United States)

    Guerrero, Erick G

    2010-12-01

    The field of cultural competence is shifting its primary emphasis from enhancement of counselors' skills to management, organizational policy, and processes of care. This study examined managers' characteristics associated with adoption of culturally competent practices in the nation's outpatient substance abuse treatment field. Findings indicate that in 1995, supervisors' cultural sensitivity played the most significant role in adopting practices, such as matching counselors and clients based on race and offering bilingual services. Staff's exposure to cross-cultural training increased from 1995 to 2005. In this period, positive associations were found between managers' cultural sensitivity and connection with the community and staff receiving cross-cultural training and the number of training hours completed. However, exposure to and investment in this training were negatively correlated with managers' formal education. Health administration policy should consider the extent to which the decision makers' education, community involvement, and cultural sensitivity contribute to building culturally responsive systems of care. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Trends in sociodemographic and drug abuse variables in patients with alcohol and drug use disorders in a Nigerian treatment facility.

    Science.gov (United States)

    Adamson, T A; Onifade, P O; Ogunwale, A

    2010-01-01

    Globally, patterns of the use of psychoactive substances have been changing. To evaluate the trend in two five year periods, 1992 to 1997 versus 2002 to 2007, of alcohol and substance use disorders and associated variables in patients admitted to a drug abuse treatment facility. This was a comparative cross-sectional study involving all patients admitted into Drug Abuse Treatment, Education, and Research (DATER), Unit of the Neuropsychiatric Hospital, Aro, Nigeria within the study period. All subjects had a structured psychiatric interview, a physical examination, laboratory investigations and DATER Questionnaire protocols that elicited socio-demographic, drug and family variables. The patients in 2002 to 2007 versus those of 1992 to 1997 were younger (chi squared 13.29; p,0.01). More last borns were using drugs by 2002 to 2007 (chi squared, 11.37; p,0.01). Cannabis was the most abused drug in 2002 to 2007 (53.5%) as compared to cocaine (44%) in 1992 to 1997 (chi squared 35.5; p,0.001). Polydrug abuse was high in the two periods but significantly the drug combination changed to cannabis in combination with alcohol in 2002 to 2007 as against cocaine in combination with opiates in 1992 to 1997 chi squared 45.3, p 0.001). More patients had co-morbid psychiatric disorders in 2000 to 2007 (67.6% as against 38.5% in 1992 to 1999 chi squared 28.32, p,0.001). In both periods, co-morbidity associated with cannabis use rather than any other drug of abuse as the odds ratio was greater than one. The findings in the trend in the two five year periods underscore the imperatives of continuous evaluation of the drug abuse patient population in treatment which may help drive changes in treatment inputs.

  8. Changes in the sexual self-schema of women with a history of childhood sexual abuse following expressive writing treatment.

    Science.gov (United States)

    Pulverman, Carey S; Boyd, Ryan L; Stanton, Amelia M; Meston, Cindy M

    2017-03-01

    Sexual self-schemas are cognitive generalizations about the sexual self that influence the processing of sexually pertinent information and guide sexual behavior. Until recently sexual self-schemas were exclusively assessed with self-report instruments. Recent research using the meaning extraction method, an inductive method of topic modeling, identified 7 unique themes of sexual self-schemas: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism from essays of 239 women (Stanton, Boyd, Pulverman, & Meston, 2015). In the current study, these themes were used to examine changes in theme prominence after an expressive writing treatment. Women (n = 138) with a history of childhood sexual abuse completed a 5-session expressive writing treatment, and essays on sexual self-schemas written at pretreatment and posttreatment were examined for changes in themes. Women showed a reduction in the prominence of the abuse, family and development, virginity, and attraction themes, and an increase in the existentialism theme. This study supports the validity of the 7 themes identified by Stanton and colleagues (2015) and suggests that expressive writing may aid women with a history of sexual abuse to process their abuse history such that it becomes a less salient aspect of their sexual self-schemas. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Clinical evaluation of treatment plans

    Energy Technology Data Exchange (ETDEWEB)

    Emery, E W [Radiotherapy Department, University College Hospital, London (United Kingdom)

    1966-06-15

    Since the start of radiotherapy, the aim of all radiotherapists has been to treat as many patients who suffer with malignant tumours as possible, so as to give an effective curative dose to the whole tumour, at the same time, doing as little damage as possible to normal tissues. Until 1945, damage to the skin was usually the limiting factor. Since the war, with the rapid development of more powerful X-ray machines and sources of irradiation, we have had at our disposal much more penetrating radiation, allowing us to give effective tumour doses, with little or no damage to the skin. However, with higher tumour doses, there is more likelihood of damage to structures in proximity to the tumour - i.e. bone, nerves, muscle, liver, kidney etc. This has focussed the interest of all radiologists on the need for careful planning, and physicists have worked out with great care the differential absorptions of X-rays on differing tissue, i. e. bone, muscle, fat etc., so that very accurate and correct treatment planning can now be undertaken. This entails a great deal of accurate and complicated work and has had to be done by our physicist colleagues, who may take hours or days to work out a complicated treatment plan. The acceptance of the plan as being the most suitable for a patient is governed by these factors: (a) The dose must be given to the whole tumour area; (b) The nearby structures, i. e. nerves, bowel, kidney etc. must not receive a dose which may cause serious damage; (c) All parts of the tumour must have an effective dose; (d) The integral dose must be such that the patient is not unduly upset. All these factors vary from patient to patient, and thus each plan has to be considered in conjunction with each individual patient so that, although patients have similar tumours, what may be an optimal plan for one may not be for another. Also clinicians themselves vary in their opinions on the size of tumour, general condition of the patient, and the amount of damage

  10. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes.

    Science.gov (United States)

    Timko, Christine; Valenstein, Helen; Stuart, Gregory L; Moos, Rudolf H

    2015-11-01

    The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. © 2014 John Wiley & Sons Ltd.

  11. Parenting training for women in residential substance abuse treatment. Results of a demonstration project.

    Science.gov (United States)

    Camp, J M; Finkelstein, N

    1997-01-01

    This paper presents findings on the impact of implementing a parenting component in two urban residential treatment programs in Massachusetts for pregnant and parenting chemically-dependent women. The parenting component consisted of multiple services for both women and their infants while they were in residential treatment as well as aftercare services after discharge from treatment. Findings presented focus on: (a) the characteristics of the 170 pregnant and parenting women who participated in the parenting component during its 48 months of implementation; (b) changes in the parenting skills and self-esteem of women who completed parenting training; (c) the quality of mother-child interaction; and (d) the participants' perceptions about the impact of the parenting training. Women in both programs made dramatic improvements in self-esteem and experienced significant gains in parenting knowledge and attitudes. The participants were also overwhelmingly positive about the impact of the parenting training on their lives. Study findings underline the importance of parenting services for pregnant and parenting women in residential substance abuse treatment.

  12. Predicting substance-abuse treatment providers' communication with clients about medication assisted treatment: a test of the theories of reasoned action and planned behavior.

    Science.gov (United States)

    Roberto, Anthony J; Shafer, Michael S; Marmo, Jennifer

    2014-01-01

    The purpose of this investigation is to determine if the theory of reasoned action (TRA) and theory of planned behavior (TPB) can retrospectively predict whether substance-abuse treatment providers encourage their clients to use medicated-assisted treatment (MAT) as part of their treatment plan. Two-hundred and ten substance-abuse treatment providers completed a survey measuring attitudes, subjective norms, perceived behavioral control, intentions, and behavior. Results indicate that substance-abuse treatment providers have very positive attitudes, neutral subjective norms, somewhat positive perceived behavioral control, somewhat positive intentions toward recommending MAT as part of their clients' treatment plan, and were somewhat likely to engage in the actual behavior. Further, the data fit both the TRA and TPB, but with the TPB model having better fit and predictive power for this target audience and behavior. The theoretical and practical implications for the developing messages for substance-abuse treatment providers and other health-care professionals who provide treatment to patients with substance use disorders are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Demographic and Clinical Characteristics of Sexually Abused Children and Adolescents Referred to Child and Adolescent Psychiatry for Psychiatric Assessment

    Directory of Open Access Journals (Sweden)

    Sevcan Karakoç Demirkaya

    2017-04-01

    Full Text Available Objectives: Child abuse has been a continuous, hidden health and social problem in all over the world. Identifying risk factors are crucial to implement protective services. In Turkey, data of the legal cases are still lacking. This study aims to assess the sociodemographic and psychiatric features of the sexually abused children who have been referred for forensic evaluation together with their identity issues. Materials and Methods: The forensic files of the sexually abused cases (tı 11: 9 boys, 32 girls who had been referred to the child psychiatry outpatient clinic were evaluated. Psychiatric diagnoses in the files were based on the Schedule for Affective Disorders and Schizophrenia for School-age children- Turkish Version. Data on age, gender, socioeconomic status and diagnoses of the victims and characteristics of the abusers were gathered and analysed by descriptive statistical methods. Results: Mean age of the victims was 11.54±3.31 years. Socioeconomic levels of their families were mostly lower class with rate of 51.2%. All perpetrators were male with a mean age of 23 years (min 14; max 67. When the consanguinity of the abusers and victims were taken into consideration, it was found that they were intrafamilial (fathers and brothers rate:12.2%, close relatives (19.5%, distant relatives (22.0%, other familiar (such as neighbours, friends: 14.6% and unfamiliar (24.4% people for the victims. 19.5% of the victims had mental retardation. The most common diagnoses of the victims were posttraumatic stress disorder (46.3%, other anxiety disorders (17.1%, and major depression (24.4%. Conclusion: Identified risk factors for sexual abuse, determined as the result of this study, are being a female child, late childhood period, mental retardation, and low economic status. The abusers were males who were familiar to the child victims. Preventive measures should be implemented for the entire population, particularly involving the high- risk groups

  14. Domestic violence and treatment seeking: a longitudinal study of low-income women and mental health/substance abuse care.

    Science.gov (United States)

    Cheng, Tyrone C; Lo, Celia C

    2014-01-01

    A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.

  15. Clinical diagnosis and treatment of thyroid microcarcinoma

    International Nuclear Information System (INIS)

    Gao Xuemei; Zhang Yajing; Gao Zairong

    2013-01-01

    Thyroid cancer is the most common malignant carcinoma in the endocrine system. With the increasing incidence of thyroid cancer, the incidence of thyroid microcarcinoma has been elevating gradually. But there is still a large ambiguity on thyroid microcarcinoma about the diagnosis and treatment. The epidemiology, clinical diagnosis, biological behavior and treatment programs of thyroid microcarcinoma were reviewed in this article. (authors)

  16. Can Addiction-Related Self-Help/Mutual Aid Groups Lower Demand for Professional Substance Abuse Treatment?

    Science.gov (United States)

    Humphreys, Keith

    1998-01-01

    Discusses the potential of self-help/mutual-aid groups as a way to reduce the demand for professional substance-abuse treatment and proposes a model that combines the two approaches for cost-effective and therapeutically effective networks of services. (SLD)

  17. Targeted Expansion Project for Outreach and Treatment for Substance Abuse and HIV Risk Behaviors in Asian and Pacific Islander Communities

    Science.gov (United States)

    Nemoto, Tooru; Iwamoto, Mariko; Kamitani, Emiko; Morris, Anne; Sakata, Maria

    2011-01-01

    Access to culturally competent HIV/AIDS and substance abuse treatment and prevention services is limited for Asian and Pacific Islanders (APIs). Based on the intake data for a community outreach project in the San Francisco Bay Area (N = 1,349), HIV risk behaviors were described among the targeted API risk groups. The self-reported HIV prevalence…

  18. Using Case-Mix Adjustment Methods To Measure the Effectiveness of Substance Abuse Treatment: Three Examples Using Client Employment Outcomes.

    Science.gov (United States)

    Koenig, Lane; Fields, Errol L.; Dall, Timothy M.; Ameen, Ansari Z.; Harwood, Henrick J.

    This report demonstrates three applications of case-mix methods using regression analysis. The results are used to assess the relative effectiveness of substance abuse treatment providers. The report also examines the ability of providers to improve client employment outcomes, an outcome domain relatively unexamined in the assessment of provider…

  19. Clinical features of pedophilia and implications for treatment.

    Science.gov (United States)

    Cohen, Lisa J; Galynker, Igor I

    2002-09-01

    The authors discuss the diagnostic criteria for pedophilia and review the literature on its clinical features, including data on prevalence, gender, age of onset, number of victims, frequency and type of acts, violence, impulsivity, and insight. Findings concerning the characteristics of victims (e.g., sex, age, relationship to the pedophile) and research on pedophilic subtypes-exclusive versus nonexclusive; incestuous versus nonincestuous; heterosexual, homosexual, or bisexual-are reviewed. Studies have shown that pedophiles may share many psychiatric features beyond deviant sexual desire, including high rates of comorbid axis I disorders (affective disorders, substance use disorders, impulse control disorders, other paraphilias) as well as severe axis II psychopathology (especially antisocial and Cluster C personality disorders). The authors present several possible etiological models for pedophilia and conclude that further research is needed concerning the etiological role of a childhood history of sexual abuse as well as the underlying neurobiology of deviant sexual arousal and decreased erotic differentiation. Finally, findings concerning pharmacological and cognitive-behavioral treatments for pedophilia are briefly reviewed. Recidivism, drop-out, and noncompliance are significant problems in the treatment of pedophilia. The authors review predictors of treatment outcome and conclude that pedophilia is extremely difficult to treat and that effective treatment needs to be intensive, long-term, and comprehensive, possibly with lifetime follow-up.

  20. A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment.

    Science.gov (United States)

    Ramchand, Rajeev; Griffin, Beth Ann; Harris, Katherine M; McCaffrey, Daniel F; Morral, Andrew R

    2008-12-01

    This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the United States. Youth were surveyed at intake and every 3 months for a 1-year period. Thirty percent of youth reported ideating in at least one interview, and 12% reported attempting suicide; almost half of all youth reported receiving outpatient mental health treatment at least once, and close to one-third of all youth reported being on prescription drugs for an emotional or behavioral problem. Higher levels of conduct disorder symptoms were associated with both ideation and attempts, while higher levels of depressive symptoms and being female were associated with ideation only. Among all youth, older youth were less likely to receive outpatient and prescription drug treatment, and Black and Hispanic youth were less likely to receive prescription drug treatment than White youth. Among youth who reported ideating, those with conduct disorder were less likely to receive prescription drug treatment 3 months later. These findings emphasize a high prevalence of suicide risk behavior in substance abuse treatment programs and provide insight into the specialized treatment youth in substance abuse treatment at risk for suicide currently receive. 2008 APA, all rights reserved

  1. Evaluating the working conditions and exposure to abuse of Filipino home care workers in Israel: characteristics and clinical correlates.

    Science.gov (United States)

    Ayalon, Liat

    2009-02-01

    Filipino home care workers provide the majority of around-the-clock personal care to frail individuals in Israel. To date, the working conditions as well as exposure to work-related abuse of Filipino home care workers in Israel have not been evaluated. A survey of 245 Filipino home care workers was conducted to evaluate their working conditions and exposure to abuse as well as their clinical correlates (e.g. burnout as measures by the Maslach Burnout Inventory). This was integrated with findings from interviews with Filipino home care workers, social workers, and family members of care recipients cared by Filipino home care workers. A majority of the workers (88%) reported paying large amounts of money in order to work in the country. Overall, 43% reported being asked to do more than was specified in their job description, 41% reported being verbally abused, and 40% reported not receiving adequate food. Almost half reported work-related injuries. The most consistent predictor of burnout (as measured by the Emotional Exhaustion and Depersonalization scales) was exposure to work-related abuse. Interview data identified system and societal barriers that prevent workers from using the legal system for their protection. The present study calls for further supervision of this caregiving arrangement. Psychoeducational programs directed towards all stakeholders (e.g. social workers, home care workers, care recipients, and family members of care recipients) are needed.

  2. Addiction and Women Gender Differences Concerning Drug Abuse and its Treatment

    Directory of Open Access Journals (Sweden)

    Fatemeh Safari

    2003-05-01

    Full Text Available This article focuses on the quantitative grounds for the emergence and spread of addiction among women, its medical, social and psychological problems, impediments for the treatment of addiction among women as well as gender differences concerning drug abuse and its treatment. This article is a translation of a statistical research on addiction among women and a number of other researches. Based on conclusions drawn from the said researches, women become inclined to addiction mostly by their husbands due to their cordial relationships. Moreover, the negative attitudes of peer groups can overshadow girls and women more than boys and men. From the viewpoint of psychological disorders, the relationship between disorders resulting from psychological pressure after an incident and addiction is stronger among girls and women compared to boys and men. Addiction among women in addition to certain ailments such as malnutrition, hypertension and cancer, can expose them to dangerous diseases such as Hepatitis and AIDS. There is more possibility for addicted women to be infected with AIDS and other sexually transmitted diseases compared to men and they are more exposed to female ailments compared to other women. As far as treatment impediments are concerned, women face a greater social stigma due to their addiction compared to men. Social approach considering addicted women as an indecent person is a major impediment for their treatment. Taking care of the child is also another obstacle for their treatment. There is less possibility for women to receive support from their families for quitting their addiction compared to men. Treatment programs also unwantedly may create obstacles for the treatment of women such as financial constraints, administrative bureaucracy, concentration of treatment programs for men and lack of sensitivity towards women’s addiction. The psychological impediments to treatment include internalizing the notion that addiction is a

  3. The role of the EAP in the identification and treatment of substance abuse.

    Science.gov (United States)

    Kramer, R M

    1998-12-01

    Employee Assistance Programs (EAPs) are cost-effective strategies for employers to contain the substantial direct and indirect costs of substance abuse in the workplace. EAPs offer prevention, early detection, assessment of referral, and after-care programs to help stem the enormous costs of substance abuse in the workplace. Most effective employer substance abuse programs integrate drug-testing and EAP services to ensure a well coordinated, cost-effective program.

  4. National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training.

    Science.gov (United States)

    Gust, Steven W; McCormally, Judy

    2018-07-01

    For more than 25 years, the National Institute on Drug Abuse (NIDA) has supported research-training programs, establishing a global research network and expanding the knowledge base on substance use disorders. International research to inform approaches to opioid addiction is particularly important and relevant to the United States, where opioid misuse, addiction, and overdose constitute an emerging public health crisis. This article summarizes the NIDA International Program and illustrates its impact by reviewing recent articles about treatment approaches for opioid use disorders (OUD). Studies in several countries have demonstrated the effectiveness of physician office-based opioid substitution therapies. Other research has demonstrated the effectiveness of different formulations and doses of the opioid antagonist naltrexone, as well as different approaches to providing naloxone to treat opioid overdose. Continuing research into implementation of evidence-based treatment in international settings with limited resources is applicable to US regions that face similar structural, legal, and fiscal constraints. The current review describes international research on OUD treatment and opioid overdose, most coauthored by former NIDA fellows. The findings from outside the United States have important implications for best practices domestically and in other countries that are experiencing increases in OUD prevalence and related overdose deaths.

  5. Review of the efficacy of treatments for bipolar disorder and substance abuse.

    Science.gov (United States)

    Secades-Álvarez, Adrián; Fernández-Rodríguez, Concepción

    The aim of this study was to provide a descriptive overview of different psychological and pharmacological interventions used in the treatment of patients with bipolar disorder and substance abuse, in order to determine their efficacy. A review of the current literature was performed using the databases Medline and PsycINFO (2005-2015). A total of 30 experimental studies were grouped according to the type of therapeutic modality described (pharmacological 19; psychological 11). Quetiapine and valproate have demonstrated superiority on psychiatric symptoms and a reduction in alcohol consumption, respectively. Group psychological therapies with education, relapse prevention and family inclusion have also been shown to reduce the symptomatology and prevent alcohol consumption and dropouts. Although there seems to be some recommended interventions, the multicomponent base, the lack of information related to participants during treatment, experimental control or the number of dropouts of these studies suggest that it would be irresponsible to assume that there are well established treatments. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  6. Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees.

    Science.gov (United States)

    Mundon, Chandra R; Anderson, Melissa L; Najavits, Lisa M

    2015-01-01

    Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation.

  7. Addressing the Clinical Burden of Child Physical Abuse and Neglect in a Large Metropolitan Region: Improving the Evidence-Base

    Directory of Open Access Journals (Sweden)

    Shanti Raman

    2014-10-01

    Full Text Available Children at risk of abuse are more likely to be hospitalized and utilize health services according to international research. In a large metropolitan health region in New South Wales, Australia, there was little known of the clinical burden of child physical abuse and/or neglect (PAN, or of systems for clinical assessment of children presenting with abuse/neglect. We aimed to identify the number of children presenting with suspected PAN to emergency departments (EDs and paediatric services in this region, to determine enablers and barriers to assessment for children with PAN presenting to frontline services, and to identify best practices to address gaps. We collated available data on children presenting to EDs and paediatric services with suspected PAN in 2007. We interviewed 36 health professionals from nine hospitals and 12 statutory child protection professionals, across the region before undertaking relevant document analysis. Of 64,700 paediatric ED presentations, a quarter were due to injury; 2%–5% of these were due to maltreatment. Clinician estimates and assessments of PAN varied widely; health and welfare workers identified major practice gaps, as well as good local practice. We identified feasible minimum standards for improving clinical assessment and follow-up for children presenting with PAN, given the right organizational support.

  8. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton

    2007-01-01

    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...

  9. Implementing solutions to barriers to on-site HIV testing in substance abuse treatment: a tale of three facilities.

    Science.gov (United States)

    Hood, Kristina B; Robertson, Angela A; Baird-Thomas, Connie

    2015-04-01

    Due to the scarcity of resources for implementing rapid on-site HIV testing, many substance abuse treatment programs do not offer these services. This study sought to determine whether addressing previously identified implementation barriers to integrating on-site rapid HIV testing into the treatment admissions process would increase offer and acceptance rates. Results indicate that it is feasible to integrate rapid HIV testing into existing treatment programs for substance abusers when resources are provided. Addressing barriers such as providing start-up costs for HIV testing, staff training, addressing staffing needs to reduce competing job responsibilities, and helping treatment staff members overcome their concerns about clients' reactions to positive test results is paramount for the integration and maintenance of such programs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Pedophilia: Clinical Features, Etiology and Treatment

    OpenAIRE

    Ayten Erdogan

    2010-01-01

    There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally

  11. New drugs of abuse.

    Science.gov (United States)

    Rech, Megan A; Donahey, Elisabeth; Cappiello Dziedzic, Jacqueline M; Oh, Laura; Greenhalgh, Elizabeth

    2015-02-01

    Drug abuse is a common problem and growing concern in the United States, and over the past decade, novel or atypical drugs have emerged and have become increasingly popular. Recognition and treatment of new drugs of abuse pose many challenges for health care providers due to lack of quantitative reporting and routine surveillance, and the difficulty of detection in routine blood and urine analyses. Furthermore, street manufacturers are able to rapidly adapt and develop new synthetic isolates of older drugs as soon as law enforcement agencies render them illegal. In this article, we describe the clinical and adverse effects and purported pharmacology of several new classes of drugs of abuse including synthetic cannabinoids, synthetic cathinones, salvia, desomorphine, and kratom. Because many of these substances can have severe or life-threatening adverse effects, knowledge of general toxicology is key in recognizing acute intoxication and overdose; however, typical toxidromes (e.g., cholinergic, sympathomimetic, opioid, etc.) are not precipitated by many of these agents. Medical management of patients who abuse or overdose on these drugs largely consists of supportive care, although naloxone may be used as an antidote for desomorphine overdose. Symptoms of aggression and psychosis may be treated with sedation (benzodiazepines, propofol) and antipsychotics (haloperidol or atypical agents such as quetiapine or ziprasidone). Other facets of management to consider include treatment for withdrawal or addiction, nutrition support, and potential for transmission of infectious diseases. © 2014 Pharmacotherapy Publications, Inc.

  12. Differential responsiveness to a parenting intervention for mothers in substance abuse treatment.

    Science.gov (United States)

    Paris, Ruth; Herriott, Anna; Holt, Melissa; Gould, Karen

    2015-12-01

    This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent-child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social-emotional development. Additionally, clinicians provided assessments of the parent-child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal-Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent-child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social-emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Psychedelics as medicines for substance abuse rehabilitation: evaluating treatments with LSD, Peyote, Ibogaine and Ayahuasca.

    Science.gov (United States)

    Winkelman, Michael

    2014-01-01

    Substances known as psychedelics, hallucinogens and entheogens have been employed in ethnomedical traditions for thousands of years, but after promising uses in the 1950's and 1960's they were largely prohibited in medical treatment and human research starting in the 1970's as part of the fallout from the war on drugs. Nonetheless, there are a number of studies which suggest that these substances have potential applications in the treatment of addictions. While these substances are generally classified as Schedule I, alleging no established medical uses and a high drug abuse potential, there is nonetheless evidence indicating they might be safe and effective tools for short term interventions in addictions treatment. Evidence suggests that the psychedelics have a much greater safety profile than the major addictive drugs, having extremely low levels of mortality, and producing little if any physical dependence. This paper reviews studies evaluating the use of LSD, peyote, ibogaine and ayahuasca in the treatment of dependencies and the possible mechanisms underlying the indications of effectiveness. Evidence suggests that these substances help assist recovery from drug dependency through a variety of therapeutic mechanisms, including a notable "after-glow" effect that in part reflects their action on the serotonin neurotransmitter system. Serotonin has been long recognized as central to the psychedelics' well-known phenomenological, physical, emotional and cognitive dynamics. These serotonin-based dynamics are directly relevant to treatment of addiction because of depressed serotonin levels found in addict populations, as well as the role of serotonin as a neuromodulators affecting many other neurotransmitter systems.

  14. A genetic network model of cellular responses to lithium treatment and cocaine abuse in bipolar disorder

    Directory of Open Access Journals (Sweden)

    Keller Benjamin J

    2010-11-01

    Full Text Available Abstract Background Lithium is an effective treatment for Bipolar Disorder (BD and significantly reduces suicide risk, though the molecular basis of lithium's effectiveness is not well understood. We seek to improve our understanding of this effectiveness by posing hypotheses based on new experimental data as well as published data, testing these hypotheses in silico, and posing new hypotheses for validation in future studies. We initially hypothesized a gene-by-environment interaction where lithium, acting as an environmental influence, impacts signal transduction pathways leading to differential expression of genes important in the etiology of BD mania. Results Using microarray and rt-QPCR assays, we identified candidate genes that are differentially expressed with lithium treatment. We used a systems biology approach to identify interactions among these candidate genes and develop a network of genes that interact with the differentially expressed candidates. Notably, we also identified cocaine as having a potential influence on the network, consistent with the observed high rate of comorbidity for BD and cocaine abuse. The resulting network represents a novel hypothesis on how multiple genetic influences on bipolar disorder are impacted by both lithium treatment and cocaine use. Testing this network for association with BD and related phenotypes, we find that it is significantly over-represented for genes that participate in signal transduction, consistent with our hypothesized-gene-by environment interaction. In addition, it models related pharmacogenomic, psychiatric, and chemical dependence phenotypes. Conclusions We offer a network model of gene-by-environment interaction associated with lithium's effectiveness in treating BD mania, as well as the observed high rate of comorbidity of BD and cocaine abuse. We identified drug targets within this network that represent immediate candidates for therapeutic drug testing. Posing novel

  15. A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment

    OpenAIRE

    Ramchand, Rajeev; Griffin, Beth Ann; Harris, Katherine M.; McCaffrey, Daniel F.; Morral, Andrew R.

    2008-01-01

    This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the U.S. Youth were surveyed at intake and every three months for a one year period. Thirty percent of youth reported ideating in at least one interview and 12% reported attempting suicide; almost half reported receiving outpatient mental health treatment at least once and close to one-third reported being on prescription drugs for a...

  16. 78 FR 53789 - Technology Innovations for Substance Abuse and Mental Health Treatment Conference & Related...

    Science.gov (United States)

    2013-08-30

    ... OFFICE OF NATIONAL DRUG CONTROL POLICY Technology Innovations for Substance Abuse and Mental... National Drug Control Policy. ACTION: Notice. Location: Eisenhower Executive Office Building, South Court....m.-1:00 p.m. SUMMARY: The Office of National Drug Control Policy (ONDCP) and the Substance Abuse and...

  17. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton

    2007-01-01

    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... and knowledge of HIV led to short-term trials using surrogate outcomes such as viral load and CD4 count. This established a faster drug approval process that complimented the rapid need to evaluate and provide access to drugs based on short-term trials. However, no treatment has yet been found that eradicates...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...

  18. Behavior of pharmaceuticals and drugs of abuse in a drinking water treatment plant (DWTP) using combined conventional and ultrafiltration and reverse osmosis (UF/RO) treatments

    Energy Technology Data Exchange (ETDEWEB)

    Boleda, Ma Rosa [AGBAR-Aiguees de Barcelona, Gral Batet 5-7, 08028 Barcelona (Spain); Galceran, Ma Teresa [University of Barcelona, Department Analytical Chemistry, Av. Diagonal 647, 08028 Barcelona (Spain); Ventura, Francesc, E-mail: fventura@agbar.es [AGBAR-Aiguees de Barcelona, Gral Batet 5-7, 08028 Barcelona (Spain)

    2011-06-15

    The behavior along the potabilization process of 29 pharmaceuticals and 12 drugs of abuse identified from a total of 81 compounds at the intake of a drinking water treatment plant (DWTP) has been studied. The DWTP has a common treatment consisting of dioxychlorination, coagulation/flocculation and sand filtration and then water is splitted in two parallel treatment lines: conventional (ozonation and carbon filtration) and advanced (ultrafiltration and reverse osmosis) to be further blended, chlorinated and distributed. Full removals were reached for most of the compounds. Iopromide (up to 17.2 ng/L), nicotine (13.7 ng/L), benzoylecgonine (1.9 ng/L), cotinine (3.6 ng/L), acetaminophen (15.6 ng/L), erythromycin (2.0 ng/L) and caffeine (6.0 ng/L) with elimination efficiencies {>=}94%, were the sole compounds found in the treated water. The advanced treatment process showed a slightly better efficiency than the conventional treatment to eliminate pharmaceuticals and drugs of abuse. - Highlights: > The presence of pharmaceuticals and drugs of abuse in surface water was demonstrated. > Elimination in both potabilization processes reached levels >99% for most compounds. > Four pharmaceuticals and three drugs of abuse survived the potabilization process. - The efficiency of potabilization processes to eliminate or transform pharmaceuticals and illicit drugs is evaluated.

  19. Behavior of pharmaceuticals and drugs of abuse in a drinking water treatment plant (DWTP) using combined conventional and ultrafiltration and reverse osmosis (UF/RO) treatments

    International Nuclear Information System (INIS)

    Boleda, Ma Rosa; Galceran, Ma Teresa; Ventura, Francesc

    2011-01-01

    The behavior along the potabilization process of 29 pharmaceuticals and 12 drugs of abuse identified from a total of 81 compounds at the intake of a drinking water treatment plant (DWTP) has been studied. The DWTP has a common treatment consisting of dioxychlorination, coagulation/flocculation and sand filtration and then water is splitted in two parallel treatment lines: conventional (ozonation and carbon filtration) and advanced (ultrafiltration and reverse osmosis) to be further blended, chlorinated and distributed. Full removals were reached for most of the compounds. Iopromide (up to 17.2 ng/L), nicotine (13.7 ng/L), benzoylecgonine (1.9 ng/L), cotinine (3.6 ng/L), acetaminophen (15.6 ng/L), erythromycin (2.0 ng/L) and caffeine (6.0 ng/L) with elimination efficiencies ≥94%, were the sole compounds found in the treated water. The advanced treatment process showed a slightly better efficiency than the conventional treatment to eliminate pharmaceuticals and drugs of abuse. - Highlights: → The presence of pharmaceuticals and drugs of abuse in surface water was demonstrated. → Elimination in both potabilization processes reached levels >99% for most compounds. → Four pharmaceuticals and three drugs of abuse survived the potabilization process. - The efficiency of potabilization processes to eliminate or transform pharmaceuticals and illicit drugs is evaluated.

  20. Reducing Sex under the Influence of Drugs or Alcohol for Patients in Substance Abuse Treatment

    Science.gov (United States)

    Calsyn, Donald A.; Crits-Christoph, Paul; Hatch-Maillette, Mary A.; Doyle, Suzanne R.; Song, Yong S.; Coyer, Susan; Pelta, Sara

    2009-01-01

    Aims In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. Design Men in methadone maintenance (n=173) or outpatient psychosocial treatment (n=104) completed assessments at baseline, 3- and 6-months post intervention. Participants were randomly assigned to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI), or HIV education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. Findings Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (tintervention=−2.16, p=.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial outpatient treatment, were associated with engaging in SUI. Conclusions Overall a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up. PMID:20078464

  1. Power of automated algorithms for combining time-line follow-back and urine drug screening test results in stimulant-abuse clinical trials.

    Science.gov (United States)

    Oden, Neal L; VanVeldhuisen, Paul C; Wakim, Paul G; Trivedi, Madhukar H; Somoza, Eugene; Lewis, Daniel

    2011-09-01

    In clinical trials of treatment for stimulant abuse, researchers commonly record both Time-Line Follow-Back (TLFB) self-reports and urine drug screen (UDS) results. To compare the power of self-report, qualitative (use vs. no use) UDS assessment, and various algorithms to generate self-report-UDS composite measures to detect treatment differences via t-test in simulated clinical trial data. We performed Monte Carlo simulations patterned in part on real data to model self-report reliability, UDS errors, dropout, informatively missing UDS reports, incomplete adherence to a urine donation schedule, temporal correlation of drug use, number of days in the study period, number of patients per arm, and distribution of drug-use probabilities. Investigated algorithms include maximum likelihood and Bayesian estimates, self-report alone, UDS alone, and several simple modifications of self-report (referred to here as ELCON algorithms) which eliminate perceived contradictions between it and UDS. Among the algorithms investigated, simple ELCON algorithms gave rise to the most powerful t-tests to detect mean group differences in stimulant drug use. Further investigation is needed to determine if simple, naïve procedures such as the ELCON algorithms are optimal for comparing clinical study treatment arms. But researchers who currently require an automated algorithm in scenarios similar to those simulated for combining TLFB and UDS to test group differences in stimulant use should consider one of the ELCON algorithms. This analysis continues a line of inquiry which could determine how best to measure outpatient stimulant use in clinical trials (NIDA. NIDA Monograph-57: Self-Report Methods of Estimating Drug Abuse: Meeting Current Challenges to Validity. NTIS PB 88248083. Bethesda, MD: National Institutes of Health, 1985; NIDA. NIDA Research Monograph 73: Urine Testing for Drugs of Abuse. NTIS PB 89151971. Bethesda, MD: National Institutes of Health, 1987; NIDA. NIDA Research

  2. Establishing treatment protocols for clinical mastitis.

    Science.gov (United States)

    Roberson, Jerry R

    2003-03-01

    Each farm has a unique mix of mastitis pathogens and management procedures that have evolved over time. The herd veterinarian should work with the manager/owner to systematically develop treatment protocols that meet the needs and management of the farm. To establish a mastitis treatment protocol, it is necessary to develop a system to routinely identify clinical mastitis cases, develop a herd-specific severity level assessment system, manage the clinical mastitis cases based on severity level and culture result (when available), avoid antibiotic residues, and monitor the success of the system and alter the protocol as necessary.

  3. Clinical diagnosis and treatment of olfactory meningioma

    International Nuclear Information System (INIS)

    Li Xiangdong; Wang Zhong; Zhang Shiming; Zhu Fengqing; Zhou Dai; Hui Guozhen

    2005-01-01

    Objective: To analyze the clinical diagnosis and treatment of olfactory meningioma. Methods: In this group 17 olfactory meningiomas were operated, and the clinical presentations and the surgery results were obtained. Results: The symptoms of psychiatrical disorder, visual disturbances and eclipse at presentation was higher. In 16 cases the grade of resection was Simpson II, 1 case Simpson III, most of the cases had a good recovery. Conclusion: Attention should be paid to the early symptom at presentation such as psychiatrical disorder to obtain an early diagnosis. Microsurgery is useful in the treatment of olfactory meningioma. (authors)

  4. Activity based costing of probation with and without substance abuse treatment: a case study.

    Science.gov (United States)

    Alemi, Farrokh; Taxman, Faye; Doyon, Victoria; Thanner, Meridith; Baghi, Heibatollah

    2004-06-01

    Since many offenders have drug problems, investigators have proposed that drug testing and treatment should be an integral part of probation. In 1994, the Office of National Drug Control Policy (ONDCP) funded a demonstration project designed to integrate drug treatment with traditional supervision services. As part of this demonstration a new procedure called 'seamless' probation was set up in which treatment providers were co-located with probation officers and probation officers coordinated offenders' participation in treatment. This study examines the cost of providing substance abuse treatment coordination through probation agencies. We used Activity Based Costing (ABC) to examine the cost of probation with and without treatment coordination in one probation agency. Agency budget was analyzed and allocated to various programs. A questionnaire was developed to assess probation officer's activities. The cost of coordinating treatment for one offender was calculated by dividing the total cost of the program by units of various activities done by the probation officers. Preliminary test of reliability of the instrument showed that it was accurately portraying the probation officers time allocation. Probation officers spent 6.9% of their time in seamless supervision and 83.3% time in traditional supervision (83.83%). The seamless probation officers had more group meetings and more phone contact with their offenders than traditional probation officers. The average cost per offender per day was 12 dollars for seamless probation and 7 dollars for traditional probation. This study is limited because it focuses on one agency at one point in time. Results may not be relevant to other agencies or to the same agency as it makes its operation more efficient. This study provides a method of allocating budget cost to per client costs using survey of probation officer's activities -- a tool developed in this study. Comparison of seamless and traditional supervision activities

  5. Neuromyelitis optica: clinical features, immunopathogenesis and treatment

    Science.gov (United States)

    Jarius, S; Wildemann, B; Paul, F

    2014-01-01

    The term ‘neuromyelitis optica’ (‘Devic's syndrome’, NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition. Other Articles published in this series Paraneoplastic neurological syndromes. Clinical and Experimental Immunology 2014, 175: 336–48. Disease-modifying therapy in multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy: common and divergent current and future strategies. Clinical and Experimental Immunology 2014, 175: 359–72. Monoclonal antibodies in treatment of multiple sclerosis. Clinical and Experimental Immunology 2014, 175: 373–84. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders. Clinical and Experimental Immunology 2014, 175: 385–96. Requirement for safety monitoring for approved multiple sclerosis therapies: an overview. Clinical and Experimental Immunology 2014, 175: 397–407. Myasthenia gravis: an update for the clinician. Clinical and Experimental Immunology 2014, 175: 408

  6. Comparison of mania patients suitable for treatment trials versus clinical treatment.

    Science.gov (United States)

    Talamo, Alessandra; Baldessarini, Ross J; Centorrino, Franca

    2008-08-01

    It remains uncertain whether bipolar disorder (BPD) patients in randomized-controlled trials (RCTs) are sufficiently representative of clinically encountered patients as to guide clinical-therapeutic practice. We complied inclusion/exclusion criteria by frequency from reports of 21 RCTs for mania, and applied them in a pilot study of patients hospitalized for DSM-IV BPD manic/mixed states to compare characteristics and clinical responses of patients who did versus did not meet exclusion criteria. From 27 initially identified inclusion/exclusion criteria ranked by citation frequency, we derived six inclusion, and 10 non-redundant-exclusion factors. Of 67 consecutive patients meeting inclusion criteria, 15 (22.4%) potential "research subjects" met all 10 exclusion criteria. The remaining 52 "clinical patients" differed markedly on exclusion criteria, including more psychiatric co-morbidity, substance abuse, involuntary hospitalization, and suicide attempts or violence, but were otherwise similar. In both groups responses to clinically determined inpatient treatments were similar, including improvement in mania ratings. Based on applying reported inclusion/exclusion criteria for RCTs to a pilot sample of hospitalized-manic patients, those likely to be included in modern RCTs were similar to patients who would be excluded, most notably in short-term antimanic-treatment responses. The findings encourage further comparisons of subjects included/excluded from RCTs to test potential clinical generalizability of research findings. The pilot study is limited in numbers and exposure times with which to test for the minor differences between "research subjects" and "clinical patients." (c) 2008 John Wiley & Sons, Ltd.

  7. [Clinical laboratory approaches to parodontitis treatment optimization].

    Science.gov (United States)

    Soboleva, L A; Shul'diakov, A A; Oseeva, A O; Aleksandrova, E A

    2010-01-01

    In order to determine cycloferon liniment clinical-pathogenetic efficacy in comprehensive parodontitis therapy examination and treatment of 80 patients was done. It was determined that the cycloferon liniment use in comprehensive treatment of patients with parodontitis let to reduce infectious load in parodontal pockets and local inflammation intensity, to normalize the secretory immunoglobulin level and immune status indices that provided speed up of healing process and reduction relapse frequency.

  8. Abuse of prescription drugs.

    OpenAIRE

    Wilford, B B

    1990-01-01

    An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disable...

  9. Sleep and aggression in substance-abusing adolescents: results from an integrative behavioral sleep-treatment pilot program.

    Science.gov (United States)

    Haynes, Patricia L; Bootzin, Richard R; Smith, Leisha; Cousins, Jennifer; Cameron, Michael; Stevens, Sally

    2006-04-01

    To examine whether change in total sleep time during an integrative, behavioral sleep intervention is associated with aggression. Specifically, we tested whether adolescents who reported experiencing aggressive thoughts or actions after treatment had worse treatment trajectories (e.g., less total sleep time across treatment) than adolescents with no aggressive thoughts or actions after treatment. Nonpharmacologic open trial with 9 weeks of weekly assessment. University of Arizona Sleep Research Laboratory Twenty-three adolescents recently treated for substance abuse in outpatient community centers. Six-week integrative, behavioral sleep intervention. Weekly sleep-summary indexes were calculated from daily sleep diaries and entered as dependent variables in a series of growth-curve analyses. Statistically significant Session x Post-treatment Aggressive Ideation interactions emerged when predicting changes in total sleep time, gamma13 = 9.76 (SE = 4.12), p aggressive ideation and the frequency of substance use, as assessed at baseline. A similar pattern of results was seen for self-reported aggressive actions occurring during conflicts. These pilot data suggest that inadequate sleep in substance-abusing adolescents may contribute to the experiencing of aggressive thoughts and actions. Limitations include a small sample size and a restricted assessment of aggression. Nonetheless, these findings lend preliminary support to the breadth of therapeutic effectiveness of an integrative, behavioral sleep-therapy program for adolescents with a history of substance abuse and related behaviors.

  10. Prevalence of Primary Methamphetamine-Related Cases and Treatment-Centre Preparedness among Youth Outpatient Substance Abuse Treatment Centres in British Columbia, Canada

    Science.gov (United States)

    Callaghan, Russell C.; Rush, Brian; Tavares, Joey; Taylor, Lawren; Victor, J. Charles

    2009-01-01

    Adolescent methamphetamine use is a prominent concern for Canadian media and government. Few empirical studies, however, have established the scope of adolescent methamphetamine use or associated outpatient substance abuse treatment utilization. The current study aimed to answer the following questions: (1) What was the overall proportion of…

  11. Current and future funding sources for specialty mental health and substance abuse treatment providers.

    Science.gov (United States)

    Levit, Katharine R; Stranges, Elizabeth; Coffey, Rosanna M; Kassed, Cheryl; Mark, Tami L; Buck, Jeffrey A; Vandivort-Warren, Rita

    2013-06-01

    Goals were to describe funding for specialty behavioral health providers in 1986 and 2005 and examine how the recession, parity law, and Affordable Care Act (ACA) may affect future funding. Numerous public data sets and actuarial methods were used to estimate spending for services from specialty behavioral health providers (general hospital specialty units; specialty hospitals; psychiatrists; other behavioral health professionals; and specialty mental health and substance abuse treatment centers). Between 1986 and 2005, hospitals-which had received the largest share of behavioral health spending-declined in importance, and spending shares trended away from specialty hospitals that were largely funded by state and local governments. Hospitals' share of funding from private insurance decreased from 25% in 1986 to 12% in 2005, and the Medicaid share increased from 11% to 23%. Office-based specialty providers continued to be largely dependent on private insurance and out-of-pocket payments, with psychiatrists receiving increased Medicaid funding. Specialty centers received increased funding shares from Medicaid (from 11% to 29%), and shares from other state and local government sources fell (from 64% to 46%). With ACA's full implementation, spending on behavioral health will likely increase under private insurance and Medicaid. Parity in private plans will also push a larger share of payments for office-based professionals from out-of-pocket payments to private insurance. As ACA provides insurance for formerly uninsured individuals, funding by state behavioral health authorities of center-based treatment will likely refocus on recovery and support services. Federal Medicaid rules will increase in importance as more people needing behavioral health treatment become covered.

  12. CLINIC, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF GALACTOSEMIA

    Directory of Open Access Journals (Sweden)

    N.V. Zhurkova

    2008-01-01

    Full Text Available The data of different firms of hereditary galactosemia was analyzed in this article. Clinical and biochemical characteristics and molecular and genetic features of diagnostics of this disease were described. The information about differential diagnosis and problems, related with hereditary galactozemia screening in Russia was given.Key words: children, galactosemia, treatment, screening.

  13. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?

    International Nuclear Information System (INIS)

    Trout, Andrew T.; Strouse, Peter J.; Mohr, Bethany A.; Khalatbari, S.; Myles, Jamie D.

    2011-01-01

    Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive. To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables. CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and ≥2 abnormal labs or physical exam findings. (orig.)

  14. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?

    Energy Technology Data Exchange (ETDEWEB)

    Trout, Andrew T.; Strouse, Peter J. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Mohr, Bethany A. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Pediatrics, Ann Arbor, MI (United States); Khalatbari, S.; Myles, Jamie D. [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States)

    2011-01-15

    Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive. To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables. CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and {>=}2 abnormal labs or physical exam findings. (orig.)

  15. Treatment of Co-Occurring Substance Abuse and Suicidality among Adolescents: A Randomized Trial

    Science.gov (United States)

    Esposito-Smythers, Christianne; Spirito, Anthony; Kahler, Christopher W.; Hunt, Jeffrey; Monti, Peter

    2011-01-01

    Objective: This study tested a cognitive-behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. Method: Forty adolescents (M[subscript age] = 15 years; 68% female, 89% White) and their families recruited from an inpatient psychiatric hospital were…

  16. Internet addiction disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program.

    Science.gov (United States)

    Yung, Kathryn; Eickhoff, Erin; Davis, Diane L; Klam, Warren P; Doan, Andrew P

    2015-02-01

    Internet addiction disorder (IAD) is characterized by the problematic use of online video games, computer use, and mobile handheld devices. While not officially a clinical diagnosis according to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), individuals with IAD manifest severe emotional, social, and mental dysfunction in multiple areas of daily activities due to their problematic use of technology and the internet. We report a 31year-old man who exhibited problematic use of Google Glass™. The patient has a history of a mood disorder most consistent with a substance induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia and obsessive compulsive disorder, and severe alcohol and tobacco use disorders. During his residential treatment program at the Navy's Substance Abuse and Recovery Program (SARP) for alcohol use disorder, it was noted that the patient exhibited significant frustration and irritability related to not being able to use his Google Glass™. The patient exhibited a notable, nearly involuntary movement of the right hand up to his temple area and tapping it with his forefinger. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. Over the course of his 35-day residential treatment, the patient noted a reduction in irritability, reduction in motor movements to his temple to turn on the device, and improvements in his short-term memory and clarity of thought processes. He continued to intermittently experience dreams as if looking through the device. To our knowledge, this is the first reported case of IAD involving problematic use of Google Glass™. Published by Elsevier Ltd.

  17. Pregnant substance-abusing women in involuntary treatment: Attachment experiences with the unborn child

    Directory of Open Access Journals (Sweden)

    Myra Siv Merete

    2016-07-01

    Full Text Available BACKGROUND – Use of coercion against pregnant women who misuse substances was legalised in Norway in 1996. The background for the law was that substance abuse during pregnancy represents a significant health problem for the child.

  18. Muscarinic Acetylcholine Receptor Subtypes as Potential Drug Targets for the Treatment of Schizophrenia, Drug Abuse and Parkinson's Disease

    DEFF Research Database (Denmark)

    Dencker, Ditte; Thomsen, Morgane; Wörtwein, Gitta

    2011-01-01

    's disease and drug abuse. Dopaminergic systems are regulated by cholinergic, especially muscarinic, input. Not surprisingly, increasing evidence implicates muscarinic acetylcholine receptor-mediated pathways as potential targets for the treatment of these disorders classically viewed as "dopamine based...... site. Such agents may lead to the development of novel classes of drugs useful for the treatment of psychosis, drug abuse and Parkinson's disease. The present review highlights recent studies carried out using muscarinic receptor knock-out mice and new subtype-selective allosteric ligands to assess...... the roles of M(1), M(4), and M(5) receptors in various central processes that are under strong dopaminergic control. The outcome of these studies opens new perspectives for the use of novel muscarinic drugs for several severe disorders of the CNS....

  19. The Mediator Role of Early Maladaptive Schemas Between Childhood Sexual Abuse and Impulsive Symptoms in Female Survivors of CSA.

    Science.gov (United States)

    Estévez, Ana; Ozerinjauregi, Nagore; Herrero-Fernández, David; Jauregui, Paula

    2016-04-24

    Child abuse is a traumatic experience that may have psychological consequences such as dysfunctional beliefs. The aim of this study was to analyze the impulsive behaviors (alcohol abuse, gambling, drug abuse, eating disorders, Internet abuse, videogame abuse, shopping and sex addiction) in sexual abuse survivors and to study the mediating role of early maladaptive schemas in the appearance of impulsive behaviors in adult female victims. The sample consisted of 182 adult women who had suffered childhood sexual abuse (CSA), mostly referred by associations for the treatment of childhood abuse and maltreatment. Sexual abuse was found to be positively related to the domains of Disconnection/Rejection and Impaired Autonomy. Moreover, these domains were significantly related to impulsivity and impulsive behaviors. Finally, the Disconnection/Rejection domain was found to mediate between CSA and eating disorders and alcohol abuse. These results may provide important guidance for clinical intervention. © The Author(s) 2016.

  20. Inhalant Abuse and Dextromethorphan.

    Science.gov (United States)

    Storck, Michael; Black, Laura; Liddell, Morgan

    2016-07-01

    Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving an altered mental state. As an important, yet underrecognized form of substance abuse, inhalant abuse crosses all demographic, ethnic, and socioeconomic boundaries, causing significant morbidity and mortality in school-aged and older children. This review presents current perspectives on epidemiology, detection, and clinical challenges of inhalant abuse and offers advice regarding the medical and mental health providers' roles in the prevention and management of this substance abuse problem. Also discussed is the misuse of a specific "over-the-counter" dissociative, dextromethorphan. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Prevalence of child abuse in child and adolescent clinical population referred to psychiatric facilities in Tabriz University of Medical Sciences, Iran

    Directory of Open Access Journals (Sweden)

    Seyyed Gholamreza Nourazar

    2014-08-01

    Full Text Available Introduction: The present study was ‎designed to evaluate the prevalence of child abuse in a child and adolescent psychiatric clinical population. Methods: This cross-sectional study was conducted in a clinical population of children and adolescents aged 8-18 years. 80 out-patients and 94 in-patients were selected according to probability proportional to size sampling. Kiddie schedule for affective disorder and schizophrenia questionnaire, a demographic questionnaire, and child abuse self-report scale were filled for each subject. Data were analyzed by using Stata software. Results: Among the out-patient subjects, 50 were male (62.5% and 30 were female (37.5%; for in-patient these subjects numbers were 76 (80.9% and 18 (19.1%, respectively. The mean age of subjects was 15.2 years in the in-patient group and 11.7 years in the out-patient group. In 66.1% of abuse cases the perpetrators were parents, 5.2% siblings, and 28.7% someone else. Among in-patient subjects, summed up prevalence rates of severe and very severe psychological abuse, neglect, physical abuse, and sexual abuse were 11.7, 33.0, 2.1, and 0.0%, respectively; for out-patient subjects these values were 3.8, 11.2, 3.8, and 0.0%, respectively. Moreover, among in-patient subjects, prevalence rates of moderate psychological abuse, neglect, physical abuse, and sexual abuse were 27.7, 27.7, 24.5, and 4.3%, respectively; and for out-patient subjects these values were 30.0, 27.5, 11.2, and 0.0%, respectively. Subjects with attention-deficit/hyperactivity disorder (ADHD suffered a higher rate of physical abuse, whereas, subjects with bipolar mood disorder (BMD suffered a higher rate of sexual abuse. Conclusion: The prevalence of child abuse is highly prevalent in children and adolescents with psychiatric disorders. It is recommended that this population be screened routinely for child abuse.

  2. Clinical Presentation Of The Abuse Of Insulin: Hypoglycaemic Coma And Aspiration Pneumonia In Non-Professional Bodybuilders

    Directory of Open Access Journals (Sweden)

    Petrovic Ivica

    2015-12-01

    Full Text Available The use of medications that improve the physical performance of an individual represents a very serious worldwide health problem. The abuse of these medications is increasing. Herein, we describe a patient, at the age of 20, who was hospitalized due to loss of consciousness and difficulty breathing. At admission, the patient was unconsciousness, tahi-dyspnoic, and had a pale complexion and an athletic build. In gas analyses, extremely low saturation was observed, followed by acidosis, heavy hypoxia with normocapnia, higher lactates, hypocalcaemia and severe hypoglycaemia. The patient was treated with a hypertonic solution of glucose and intubated, with the aspiration of sanious content from the respiratory tract. After treatment, the patient woke from coma but was very confused. In the first 6 hours of hospitalization, severe hypoglycaemia occurred several times, despite the continuous administration of glucose. Due to the growth of inflammatory syndrome since the first day of hospitalization, the patient was kept in the hospital for treatment along with the administration of antibiotic treatment. On the fourth day of hospitalization, the patient stated that for the last year, he had been taking testosterone at a dose of 1 g a week, as well as tamoxifen pills and 15 i.j. of fast-acting human insulin (Actrapid® daily for their combined anabolic effect. Hypoglycaemic coma, caused by the abuse of insulin, represents a severe complication in patients, which can be followed by confusion, a slowed thinking process, the weakening of cognitive functions and even death. It is necessary to invest great efforts into the prevention of the purchase of these medications via the Internet or on the black market for purposes of abuse in order to prevent such serious and life-threatening complications.

  3. Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach

    Science.gov (United States)

    Chie, Qiu Ting; Tam, Cai Lian; Bonn, Gregory; Dang, Hoang Minh; Khairuddin, Rozainee

    2016-01-01

    This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18–69 years; n = 30) and staff (ages 30–72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive–behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support. PMID:27303313

  4. Pericoronitis: treatment and a clinical dilemma.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2009-06-01

    Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

  5. Pericoronitis: treatment and a clinical dilemma.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2009-08-01

    Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

  6. Ehlers-Danlos syndrome(s) mimicking child abuse: Is there an impact on clinical practice?

    Science.gov (United States)

    Castori, Marco

    2015-12-01

    Ehlers-Danlos syndrome is a heterogeneous group of heritable connective tissue disorders characterized by increased fragility of various non-ossified tissues. It is usually ascertained due to abnormal skin texture, scarring complications, vascular fragility, or chronic symptoms, such as fatigue and musculoskeletal pain. Sometimes, Ehlers-Danlos syndrome remains undetected until the patient, usually in the pediatric age, shows extensive or severe mucocutaneous injuries after only minor traumas. In this scenario, the misdiagnosis of Ehlers-Danlos syndrome with child abuse is a possibility, as occasionally reported in the literature. Recently, more attention was posed by lay people between the possible association of Ehlers-Danlos syndrome and bone fragility. Literature and personal experience show a strong association between Ehlers-Danlos syndrome, generalized joint hypermobility and reduced bone mass density in older children and adults, especially fertile women. The existence of a true increased risk of fracture in Ehlers-Danlos syndrome is still a matter of debate in children and adults with little and conflicting evidence. In case of suspected child abuse, Ehlers-Danlos syndrome is certainly on the differential for bruising, especially in EDS types with marked cutaneous and capillary involvement. In suspected child abuse cases, careful examination of the index case and her/his extended family is routine, as well as exclusion of other disorders such as osteogenesis imperfecta. The hypothesis of Ehlers-Danlos syndrome as an alternative explanation for infantile fractures remains speculative. © 2015 Wiley Periodicals, Inc.

  7. Management systems, patient quality improvement, resource availability, and substance abuse treatment quality.

    Science.gov (United States)

    Fields, Dail; Roman, Paul M; Blum, Terry C

    2012-06-01

    To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. © Health Research and Educational Trust.

  8. Update on the treatment of narcolepsy: clinical efficacy of pitolisant

    Directory of Open Access Journals (Sweden)

    Calik MW

    2017-04-01

    Full Text Available Michael W Calik1,2 1Department of Biobehavioral Health Science, 2Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL, United States Abstract: Narcolepsy is a neurological disease that affects 1 in 2,000 individuals and is characterized by excessive daytime sleepiness (EDS. In 60–70% of individuals with narcolepsy, it is also characterized by cataplexy or a sudden loss of muscle tone that is triggered by positive or negative emotions. Narcolepsy decreases the quality of life of the afflicted individuals. Currently used drugs treat EDS alone (modafinil/armodafinil, methylphenidate, and amphetamine, cataplexy alone (“off-label” use of antidepressants, or both EDS and cataplexy (sodium oxybate. These drugs have abuse, tolerability, and adherence issues. A greater diversity of drug options is needed to treat narcolepsy. The small molecule drug, pitolisant, acts as an inverse agonist/antagonist at the H3 receptor, thus increasing histaminergic tone in the wake promoting system of the brain. Pitolisant has been studied in animal models of narcolepsy and used in clinical trials as a treatment for narcolepsy. A comprehensive search of online databases (eg, Medline, PubMed, EMBASE, the Cochrane Library Database, Ovid MEDLINE, Europe PubMed Central, EBSCOhost CINAHL, ProQuest Research Library, Google Scholar, and ClinicalTrials.gov was performed. Nonrandomized and randomized studies were included. This review focuses on the outcomes of four clinical trials of pitolisant to treat narcolepsy. These four trials show that pitolisant is an effective drug to treat EDS and cataplexy in narcolepsy. Keywords: narcolepsy, pitolisant, histamine

  9. Federal Strategy for Prevention of Drug Abuse and Drug Trafficking, 1982. Prepared for the President Pursuant to the Drug Abuse Office and Treatment Act of 1972.

    Science.gov (United States)

    Office of Policy Development, Washington, DC.

    This document describes the Federal response to drug abuse and drug trafficking. The actions of President Reagan, in Executive Order 12368, establishing an official advisor on drug abuse policy matters, and the priorities, issues, and objectives (international cooperation, drug law enforcement, education and prevention, detoxification and…

  10. Adopting evidence-based medically assisted treatments in substance abuse treatment organizations: roles of leadership socialization and funding streams.

    Science.gov (United States)

    Blum, Terry C; Davis, Carolyn D; Roman, Paul M

    2014-01-01

    This paper examines the organizational adoption of medically assisted treatments (MAT) for substance use disorders (SUDs) in a representative sample of 555 US for-profit and not-for-profit treatment centers. The study examines organizational adoption of these treatments in an institutionally contested environment that traditionally has valued behavioral treatment, using sociological and resource dependence frameworks. The findings indicate that socialization of leadership, measured by formal clinical education, is related to the adoption of MAT. Funding patterns also affect innovation adoption, with greater adoption associated with higher proportions of earned income from third party fees for services, and less adoption associated with funding from criminal justice sources. These findings may generalize to other social mission-oriented organizations where innovation adoption may be linked to private and public benefit values inherent in the type of socialization of leadership and different patterns of funding support.

  11. Opioid Addiction and Abuse in Primary Care Practice: A Comparison of Methadone and Buprenorphine as Treatment Options

    Science.gov (United States)

    Bonhomme, Jean; Shim, Ruth S.; Gooden, Richard; Tyus, Dawn; Rust, George

    2014-01-01

    Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200 000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care. PMID:23092049

  12. A family-oriented treatment program for youths with ketamine abuse and their caregivers: a pilot study in Taiwan

    Directory of Open Access Journals (Sweden)

    Wang LJ

    2015-07-01

    Full Text Available Liang-Jen Wang,1 Shing-Fang Lu,1 Wen-Jiun Chou,1 Mian-Yoon Chong,2 Yao-Hsing Wang,1 Yu-Lian Hsieh,1 Yi-Hsuan Lee,1 Ching Chen2 1Department of Child and Adolescent Psychiatry, 2Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Objective: The abuse of ketamine by youths has grown into a serious public health issue. However, a reliable and efficient treatment has still not been found for youths who abuse ketamine. This pilot study investigated the effects of a family-oriented treatment program for ketamine-using youths and their caregivers.Methods: To carry out this study, 42 youths with ketamine use (mean age 16.6±1.1 years who were referred to take part in a 10-week treatment program based on motivational enhancement principles were selected, as were their principal caregivers (mean age 46.4±7.1 years, who were similarly referred to take part in a 10-week training program for parenting skills. The study had the youths complete the Chinese Craving Beliefs Questionnaire, the Adolescents’ Behavior problem Scale, and the Family APGAR both immediately before and after the program. Likewise, the youths’ caregivers completed the Family APGAR, the 12-item version of the Chinese Health Questionnaire, and the Parenting Stress Index.Results: Of the 42 youth–caregiver pairs that took part in this study, 37 (88% completed the 10-week program and both sets of assessments. After the treatment, the participating youths’ substance cravings declined (t=3.88, P<0.001, while family function, as perceived by the participating caregivers, significantly increased (t=2.22, P=0.033. The improvement in caregivers’ perceptions of family function were positively related to the improvement of the caregivers’ health status (r=-0.36, P=0.022.Conclusion: According to its results, this pilot study submits that family-oriented treatment programs may be considered a potentially effective

  13. Feasibility of brief intensive exposure therapy for PTSD patients with childhood sexual abuse: a brief clinical report

    Directory of Open Access Journals (Sweden)

    Lotte Hendriks

    2010-12-01

    Full Text Available Despite the strong empirical support for the effectiveness of exposure-based treatments in ameliorating post-traumatic stress disorder (PTSD, improvement of treatment is wanted given relatively high dropout rates and challenges of treating patients with high comorbidity and treatment-interfering stressors. The purpose of the current paper is to introduce an intensive exposure treatment program, illustrated by four case descriptions of PTSD patients, who suffered multiple (sexual traumas in childhood, had high levels of comorbidity and psychosocial stressors, and failed to improve during “regular” trauma-focused treatment programs. The program consisted of psychoeducation, prolonged imaginal exposure, exposure in vivo, exposure by drawings combined with narrative reconstructing, and writing assignments about central trauma-related cognitions. The treatment included 5 working days with individual sessions (in total 30 h of treatment provided by a team of four therapists. The PTSD symptoms of all patients decreased substantially and the effect sizes were large (Cohen's d resp. 1.5 [pre–post], 2.4 [pre-FU1 month], and 2.3 [pre-FU3 months]. Also, none of the patients showed symptom worsening or dropped out. The evaluation of these four pilot cases suggests that it is possible to intensify exposure treatment, even for multiple traumatized PTSD patients with high comorbidity. We concluded that the first results of this new, intensive exposure program for PTSD patients with childhood sexual abuse are promising.

  14. On the Comparison of Cognitive Function in Substance Abusers and Addicts under Methadone Treatment with Normal Individuals

    Directory of Open Access Journals (Sweden)

    reza mohammadzadeghan

    2015-09-01

    Full Text Available Objective: This study was an attempt to compare cognitive functioning in substance abusers and addicts under methadone treatment with normal individuals. Method: The current study was a causal-comparative one. The statistical population of this research consisted of all male substance abusers who had referred to addiction treatment centers of Khoy city in 2013. The total of 40 addicts under methadone treatment, 40 active drug users, and 40 non-addicts were selected as the participants of this study via convenience sampling method. Wisconsin Card Sorting Test and Wechsler Memory Scale were administered to the three groups for data collection purposes. Results: The results showed that the substance abusers’ scores in Wisconsin card sorting test and Wechsler memory scale were significantly different from those of addicts under methadone treatment and normal individuals. In the same way, there was a significant difference between addicts under methadone treatment and normal individuals in terms of cognitive function however, there was no significant difference between these two groups in terms of perseveration error. Conclusion: It can be concluded that chronic use of psychoactive substances causes damage to multiple brain regions such as prefrontal cortex and hippocampus and, thereby, it leads to cognitive malfunctioning in these areas.

  15. Lyme disease: clinical diagnosis and treatment

    Science.gov (United States)

    Hatchette, TF; Davis, I; Johnston, BL

    2014-01-01

    Background Lyme disease is an emerging zoonotic infection in Canada. As the Ixodes tick expands its range, more Canadians will be exposed to Borrelia burgdorferi, the bacterium that causes Lyme disease. Objective To review the clinical diagnosis and treatment of Lyme disease for front-line clinicians. Methods A literature search using PubMed and restricted to articles published in English between 1977 and 2014. Results Individuals in Lyme-endemic areas are at greatest risk, but not all tick bites transmit Lyme disease. The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a “bull’s eye rash”, fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms. Late Lyme disease in North America typically manifests with oligoarticular arthritis but can present with a subacute encephalopathy. Antibiotic treatment is effective against Lyme disease and works best when given early in the infection. Prophylaxis with doxycyline may be indicated in certain circumstances. While a minority of patients may have persistent symptoms, evidence does not demonstrate that prolonged courses of antibiotics improve outcome. Conclusion Clinicians need to be aware of the signs and symptoms of Lyme disease. Knowing the regions where Borrelia infection is endemic in North America is important for recognizing patients at risk and informing the need for treatment. PMID:29769842

  16. Addressing the service linkage problem. Increasing substance abuse treatment engagement using personalized feedback interventions in heavy-using female domestic violence shelter residents.

    Science.gov (United States)

    Ogle, Richard L; Baer, John S

    2003-11-01

    Two personalized substance abuse assessment and feedback interventions were tested for effectiveness in engaging female domestic violence shelter residents in substance abuse treatment. One hundred forty-seven residents were assessed for quantity andfrequency of substance use, negative consequences due to use, motivation to change substance use behavior, and psychopathological symptoms related to substance abuse. Assessment identified (33) 22% of participants as heavy substance users. Twenty of the 33 heavy-using residents received one of two personalized substance use feedback interventions:face-to-face feedback or writtenfeedbackplaced in shelter mailboxes. Treatment engagement was defined as attending at least one substance abuse treatment session within 30 days after the intervention. Results showed a significant difference in treatment engagement rates in favor of the face-to-face feedback group (60% vs. 0%). The results provide preliminary data suggesting that substance abuse assessment can be effectively accomplished in the shelter environment and that the face-to-face feedback procedure may be an effective intervention to bridge the service linkage problem between domestic violence services and substance abuse treatment.

  17. Clinical assessment of suspected child physical abuse; Klinischer Verdacht auf Kindesmisshandlung

    Energy Technology Data Exchange (ETDEWEB)

    Rohrer, T. [Universitaetsklinikum des Saarlandes, Klinik fuer Allgemeine Paediatrie und Neonatologie, Homburg/Saar (Germany)

    2009-10-15

    Violence against children has many faces. Child physical abuse, neglect, sexual abuse and interparental violence can cause acute and permanent damage and affect children's development and their life plans in the long term. In industrialized nations almost 1 child in 10 is affected. Up to 10% of child physical abuse cases involve the central nervous system with 80% of these cases occurring during the first year of life. Worldwide more than 50,000 children die as a result of violence, abuse and neglect every year, according to the United Nations Children's Fund UNICEF. In Germany, there are about 120 cases of non-accidental head injury per year. In addition to the officially known cases there is a large grey area for all forms of violence. Recognition of these cases and the provision of help for the victims require an appropriate suspicion and understanding of the pertinent pathophysiology. Suspicion must be based on a well-documented medical history and multidisciplinary diagnostic assessment. Medical confidentiality prevents the disclosure of such information making early detection networks and guidelines for collaboration absolutely indispensable. (orig.) [German] Gewalt gegen Kinder hat viele Gesichter: Kindesmisshandlung, Vernachlaessigung, sexueller Missbrauch und elterliche Partnerschaftsgewalt koennen bei Kindern und Jugendlichen zu akuten und bleibenden Schaeden fuehren und ihre Entwicklung und Lebensentwuerfe nachhaltig beeinflussen. Betroffen ist in Industrienationen fast jedes zehnte Kind. Bis zu 10% der Kindesmisshandlungen betreffen das zentrale Nervensystem. Von diesen ereignen sich ca. 80% im ersten Lebensjahr. Weltweit sterben nach Angaben der Kinderhilfsorganisation UNICEF jaehrlich ueber 50.000 Kinder an den Folgen von Gewalt, Missbrauch und Vernachlaessigung. In Deutschland ereignen sich pro Jahr ca. 120 Faelle an nichtakzidentellen Kopfverletzungen. Den oeffentlich bekannten Faellen steht eine hohe Dunkelziffer aller Formen von Gewalt

  18. The Effect of Matrix Method on Anxiety and Attitude Toward Methamphetamine and Crack Abuse in Males Referring to Addiction Treatment Centers in Tonkabon, Iran

    Directory of Open Access Journals (Sweden)

    Hemmati Sabet

    2015-11-01

    Full Text Available Background Drug abuse is a major problem in the communities and has many harmful effects on human body. Objectives The current study aimed to compare the efficacy of matrix method on anxiety and attitude of male crack abusers referred to addiction treatment centers in Tonkabon, Iran, in 2014. Patients and Methods The current semi -experimental study included 1,000 males referred to addiction treatment centers in Tonkabon with crack abuse history in 2014. Based on Morgan sample volume formula, 278 males with anxiety and higher attitude to drug abuse were randomly selected from 1,000 males referred to addiction treatment centers in Tonkabon. Then, 30 subjects were reselected out of them and equally assigned into two groups of experimental and control, 15 subjects in each group. The experimental group received 24 sessions of 30 - 60 minutes matrix treatment method in group, but the control group received no training. At the end of training period the post-test was carried out. The research findings confirmed the efficacy of matrix method on anxiety and attitude to crack abuse among those referring to the addition treatment center. Results The single covariance analysis of ANCOVA indicated that the value of Eta about 72% of variance of anxiety variable and about 76% of variance of drug abuse variable are taken in to account for variable of group. The intervention was effective in reducing anxiety and attitude to crack in males. Evaluating the adjusted mean showed the effectiveness of matrix method on anxiety and attitude to crack abuse in males. Conclusions The research result showed that matrix method affected the reduction of methamphetamine and attitude to crack abuse in males referred to the addition treatment center.

  19. Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States

    OpenAIRE

    Gubner, Noah R.; Andrews, K. Blakely; Mohammad-Zadeh, Ana; Lisha, Nadra E.; Guydish, Joseph

    2016-01-01

    Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N=1,113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-ciga...

  20. PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

    Directory of Open Access Journals (Sweden)

    T. V. Korotaev

    2018-01-01

    Full Text Available soriatic arthritis (PsA is a chronic inflammatory disease of the joints, spine and entheses from a group of spondyloarthritis (SpA, which is usually observed in patients with psoriasis (Ps. The diagnosis of PsA is based on the CASPAR criteria for psoriatic arthritis. The disease results from interactions between genetic, immunological and environmental factors. The main clinical manifestations of PsA include peripheral arthritis, enthesitis, dactylitis, and spondylitis. PsA must be differentiated from rheumatoid arthritis, gout, reactive arthritis, osteoarthritis, and ankylosing spondylitis. Due to the fact that PsA is a clinically heterogeneous disease, its activity is assessed using complex indices, by taking into account that the patient has arthritis, enthesitis, dactylitis, and spondylitis. The goal of treatment for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent radiographic progression, to increase life expectancy and quality of life in the patients, and to reduce the risk of comorbidities, which is achieved through a wide range of drugs of different classes. Therapy should be chosen based on the clinical manifestations of PsA and comorbidities in the patients. 

  1. Substance Abuse Treatment, Anticipated Maternal Roles, and Reentry Success of Drug-Involved Women Prisoners

    Science.gov (United States)

    Robbins, Cynthia A.; Martin, Steven S.; Surratt, Hilary L.

    2009-01-01

    This article reports analyses of recidivism and relapse experiences of substance-abusing women inmates as they reenter the community. Outcomes are compared for women who completed a work-release therapeutic community program, women who entered but did not complete the program, and those who did not receive work-release therapeutic community…

  2. PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva

    2014-01-01

    Full Text Available The lecture gives basic information about psoriatic arthritis (PsA, a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of

  3. One dozen considerations when working with women in substance abuse groups.

    Science.gov (United States)

    Bright, Charlotte Lyn; Osborne, Victoria A; Greif, Geoffrey L

    2011-01-01

    Women and men have different histories, presentations, and behaviors in substance abuse groups. Twelve considerations are offered for the beginning group leader when encountering women with substance abuse issues. These include understanding sexism, what brings women to treatment, and how women behave in group treatment. Implications for clinical practice with women in single-gender and mixed-gender groups are included.

  4. The Interactive Effects of Antisocial Personality Disorder and Court-Mandated Status on Substance Abuse Treatment Dropout

    Science.gov (United States)

    Daughters, Stacey B.; Stipelman, Brooke A.; Sargeant, Marsha N.; Schuster, Randi; Bornovalova, Marina A.; Lejuez, C.W.

    2013-01-01

    The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment through a pretrial release to treatment program. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5 % (n = 171) were mandated to treatment by the court system. Results indicated a significant interaction between ASPD and CM status, such that ASPD patients voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete-time survival analyses to predict days until dropout using Cox proportional hazards regression indicated similar findings, with ASPD patients voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining ASPD patients, as well as the role of ASPD in predicting treatment dropout for individuals who are voluntarily in treatment. Implications are discussed including the potential value of early implementation of specialized interventions aimed at improving adherence for ASPD patients who are receiving treatment voluntarily. PMID:17869050

  5. Clinical peer review in the United States: history, legal development and subsequent abuse.

    Science.gov (United States)

    Vyas, Dinesh; Hozain, Ahmed E

    2014-06-07

    The Joint Commission on Accreditation requires hospitals to conduct peer review to retain accreditation. Despite the intended purpose of improving quality medical care, the peer review process has suffered several setbacks throughout its tenure. In the 1980s, abuse of peer review for personal economic interest led to a highly publicized multimillion-dollar verdict by the United States Supreme Court against the perpetrating physicians and hospital. The verdict led to decreased physician participation for fear of possible litigation. Believing that peer review was critical to quality medical care, Congress subsequently enacted the Health Care Quality Improvement Act (HCQIA) granting comprehensive legal immunity for peer reviewers to increase participation. While serving its intended goal, HCQIA has also granted peer reviewers significant immunity likely emboldening abuses resulting in Sham Peer Reviews. While legal reform of HCQIA is necessary to reduce sham peer reviews, further measures including the need for standardization of the peer review process alongside external organizational monitoring are critical to improving peer review and reducing the prevalence of sham peer reviews.

  6. Substance abuse in first-episode non-affective psychosis

    DEFF Research Database (Denmark)

    Larsen, Tor K; Melle, Ingrid; Auestad, Bjørn

    2006-01-01

    Abuse of alcohol and drugs is an important and clinically challenging aspect of first-episode psychosis. Only a few studies have been carried out on large-sized and reliably characterized samples. These are reviewed, and the results are compared with a sample of 300 first-episode psychosis patients...... recruited for the TIPS (Early Treatment and Identification of Psychosis) study from Norway and Denmark. Prevalence rates from the literature vary from 6% to 44% for drugs and 3% to 35% for alcohol. In our sample, 23% abused drugs and 15% abused alcohol during the last 6 months. When compared to non......-abusers, the drug-abusing group is characterized by the following: male gender, younger age, better premorbid social, poor premorbid academic functioning, and more contact with friends in the last year before onset. Alcohol abusers were the oldest group and they had the least contact with friends. A group...

  7. Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa.

    Directory of Open Access Journals (Sweden)

    Carolyn M Audet

    Full Text Available Traditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism.We studied the cause of five traditional illnesses known locally as "Mavabyi ya nhloko" (sickness of the head, by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS disorders. Participating healers were primarily female (77%, older in age (median: 58.0 years; interquartile range [IQR]: 50-67, had very little formal education (median: 3.7 years; IQR: 3.2-4.2, and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5-30. Healers reported having the ability to successfully treat: seizure disorders (47%, patients who have lost touch with reality (47%, paralysis on one side of the body (59%, and substance abuse (21%. Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR:0.47, patients who had lost touch with reality (OR:0.26; p-value<0.05, paralysis of one side of the body (OR:0.36, and substance abuse (OR:0.36 versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13-0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (~US$35 to treat substance abuse, 1000 Rand (~US$70 for seizure disorders or paralysis of one side of the body, and 1500 Rand (~US$105 for patients who have lost touch with reality.While not all healers elect to treat MNS

  8. Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Childhood Abuse Based on Psycho-Education and Cognitive Behavioral Therapy: A Pilot Study

    Science.gov (United States)

    Dorrepaal, Ethy; Thomaes, Kathleen; Smit, Johannes H.; van Balkom, Anton J. L. M.; van Dyck, Richard; Veltman, Dick J.; Draijer, Nel

    2010-01-01

    Objective: This study tests a Stabilizing Group Treatment protocol, designed for the management of the long-term sequelae of child abuse, that is, Complex Posttraumatic Stress Disorder (Complex PTSD). Evidence-based treatment for this subgroup of PTSD patients is largely lacking. This stabilizing treatment aims at improving Complex PTSD using…

  9. Animal models of substance abuse and addiction: implications for science, animal welfare, and society.

    Science.gov (United States)

    Lynch, Wendy J; Nicholson, Katherine L; Dance, Mario E; Morgan, Richard W; Foley, Patricia L

    2010-06-01

    Substance abuse and addiction are well recognized public health concerns, with 2 NIH institutes (the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism) specifically targeting this societal problem. As such, this is an important area of research for which animal experiments play a critical role. This overview presents the importance of substance abuse and addiction in society; reviews the development and refinement of animal models that address crucial areas of biology, pathophysiology, clinical treatments, and drug screening for abuse liability; and discusses some of the unique veterinary, husbandry, and IACUC challenges associated with these models.

  10. Drug Abuse in Southeast Asia.

    Science.gov (United States)

    Scorzelli, James F.

    This report examines the incidence of drug abuse and the methods of treatment and prevention of drug abuse used in Southeast Asia. Countries studied include Malaysia, Singapore, Thailand, Indonesia, and the Philippines. Because of Malaysia's intensive effort to eliminate its drug abuse problem, emphasis is placed on this country's treatment and…

  11. Drug Abuse

    Science.gov (United States)

    ... Cocaine Heroin Inhalants Marijuana Prescription drugs, including opioids Drug abuse also plays a role in many major social problems, such as drugged driving, violence, stress, and child abuse. Drug abuse can lead to ...

  12. Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline

    DEFF Research Database (Denmark)

    Baandrup, Lone; Østrup Rasmussen, Jesper; Klokker, Louise

    2016-01-01

    BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key...... therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence...

  13. Clinical needs of in-treatment pregnant women with co-occurring disorders: implications for primary care.

    Science.gov (United States)

    Lee King, Patricia A; Duan, Lei; Amaro, Hortensia

    2015-01-01

    We investigated social vulnerability and behavioral health clinical profiles (symptom severity) of pregnant women with co-occurring disorders, defined as substance abuse, mental illness, and trauma at treatment entry compared to their nonpregnant counterparts and the role of interpersonal abuse in clinical presentation among pregnant women. Our objective was to provide primary health care providers with insight into the needs of pregnant patients with high behavioral health risks to serve them better during the critical window of opportunity for long-term impact. We conducted cross-sectional secondary analysis of baseline data from women enrolled in treatment programs in the Women, Co-occurring Disorders and Violence Study from nine sites across the United States. We used analysis of variance and Cochran-Mantel-Haenszel statistical analyses to compare means and frequencies of social vulnerability indicators and baseline Addiction Severity Index, Brief Symptom Inventory of mental health, and Posttraumatic Stress Diagnostic Scale scores between 152 pregnant and 2,577 nonpregnant women, and between pregnant women with and without current interpersonal abuse. Compared to nonpregnant women, pregnant women evidenced more social vulnerability but better behavioral health clinical profiles at treatment entry. Current interpersonal abuse was associated with increased mental health and trauma symptomatology but not with alcohol or drug abuse severity among pregnant women. The prenatal period is an important time for screening and intervention for factors such as social vulnerability and co-occurring disorders, known to affect pregnancy and infant outcomes; social and behavioral health services are particularly essential among pregnant women with co-occurring disorders.

  14. Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

    2016-02-22

    In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

  15. Temperament and character profiles associated with depression and treatment response in patients with or without comorbid substance abuse.

    Science.gov (United States)

    Paavonen, Vesa; Luoto, Kaisa; Koivukangas, Antti; Lassila, Antero; Leinonen, Esa; Kampman, Olli

    2016-11-30

    There is limited knowledge on the relationship between temperament and character profiles and substance abuse comorbidity in depressed patients. We recruited 127 depressed patients without alcohol use problems (non-AUP) and 89 depressed patients with alcohol use problems (AUP). We assessed all patients using the Temperament and Character Inventory (TCI-R) at baseline and after 6 weeks of treatment. Using univariate general linear models (GLMs), we analyzed differences in TCI-R between AUP and non-AUP. GLMs were also used in analyzing the associations between TCI-R changes and antidepressive treatment responses measured with changes in Montgomery Åsberg Depression Rating Scale score (ΔMADRS). Alcohol use explained independently significant proportions of the variation in Novelty Seeking, Self-Directedness, and Persistence. Reward Dependence score change explained 14.1% of the ΔMADRS in AUP, but was non-significant in non-AUP. Character score changes in Self-Directedness and Self-Transcendence explained together 14.1% of ΔMADRS in non-AUP, whereas they were all non-significant in AUP. AUP compared with non-AUP patients had lower Self-Directedness and Persistence and higher Novelty Seeking scores. Detected changes in Reward Dependence and lower Self-Directedness in AUP patients could be reflective of different biological mechanisms associated with depressive symptomatology in alcohol abuse. Changes in character are associated with acute treatment response in non-AUP. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

    Science.gov (United States)

    Galanter, M; Keller, D S; Dermatis, H; Egelko, S

    2000-01-01

    This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

  17. Motivating Treatment Seeking and Behavior Change by Untreated Military Personnel Abusing Alcohol or Drugs

    Science.gov (United States)

    2015-10-01

    alleviating problems related to alcohol and substance abuse, intimate partner violence, problem gambling , body image and eating disorders, and aggressive... alcohol over the past month. Typi- cal drinking was assessed by asking participants the average number of drinks consumed during a typical occasion in...Lewis,M.A., Lee, C.M., Desai, S., . . . Larimer, M. E. (2010). Group identification as a moderator of the relationship between social norms and alcohol

  18. Evaluation of Retention in Methadone Treatment in Patients Attending Baharan Hospital Clinic in Zahedan City

    Directory of Open Access Journals (Sweden)

    M.D. Mohebi

    2015-04-01

    Full Text Available Introduction & Objectives: Substance abuse and opioid dependency refers to hazardous use of psychoactive substance .Prevention and treatment of opiate dependence has not been success-ful. Most effective drug in agonist treatment of opiates is methadone maintenance therapy (MMT.But the lack of cooperation of addicts in methadone maintenance therapy has always been a big problem to continue. The purpose of this study is to investigate the retention in the MMT. Materials & Methods: This historical cohort study analyzed the medical records of patients of Baharan hospital in Zahedan. All 912 cases of methadone maintenance clinic of Baharan hos-pital in Zahedan 2011-2012 were studied and the data were analyzed using SPSS. Tables and indexes were analyzed by the Chi-square test and survival curves were plotted using Kaplan–Meier method and analyzed by Log-Rank test. Results: This study reviewed records from 912 patients with a mean age of 34.67% and stan-dard deviation of 10.88 and the range of 15-86 years. 735 were male and 177 ware female. 1-moth retention rate was 71%, 3 months was 59%, 6 months was 47%, 1 year was 30% and 2 years was 17%. Kaplan-Meier median survival time of 8 months was estimated by relation-ship. Doses higher than 60 mg/d of methadone was associated with increased survival on MMT. Conclusion: Age increase, increase of employment time, increasing of the duration of drug abuse, increasing the daily dose of methadone, oral substance abuse increased retention rate and heroin abuse and smoking were associated with decrease retention rate of methadone maintenance therapy. So, with an emphasis on each of these factors effective steps can be taken to improve the cooperation of patients in MMT. (Sci J Hamadan Univ Med Sci 2015; 22 (1:30-36

  19. School Refusal: Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Kayhan Bahali

    2010-12-01

    Full Text Available Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of

  20. The relationship between child maltreatment and substance abuse treatment outcomes among emerging adults and adolescents.

    Science.gov (United States)

    Garner, Bryan R; Hunter, Brooke D; Smith, Douglas C; Smith, Jane Ellen; Godley, Mark D

    2014-01-01

    Emerging adulthood is the period of greatest risk for problematic substance use. The primary aim of the current study was to examine the relationship between a broad measure of child maltreatment and several key outcomes for a large clinical sample of emerging adults (n = 858) and adolescents (n = 2,697). The secondary aim was to examine the extent to which the relationship between child maltreatment and treatment outcomes differed between emerging adults and adolescents. Multilevel latent growth curve analyses revealed emerging adults and adolescents who experienced child maltreatment reported significantly greater reductions over time on several treatment outcomes (e.g., substance use, substance-related problems, and emotional problems). Overall, analyses did not support differential relationships between child maltreatment and changes over time in these substance use disorder treatment outcomes for emerging adults and adolescents. The one exception was that although emerging adults with child maltreatment did reduce their HIV risk over time, their improvements were not as great as were the improvements in HIV risk reported by adolescents who had experienced child maltreatment. © The Author(s) 2014.

  1. Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.

    Science.gov (United States)

    Ramsey, Alex T; van den Berk-Clark, Carissa

    2015-05-12

    Substance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation. Direct service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire "fit continuum". Discrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use. The

  2. IGF-1 abuse in sport: clinical and medico-legal aspects.

    Science.gov (United States)

    Molinelli, A; Bonsignore, A; Cicconi, M; Cioè, A; Traverso, A

    2010-12-01

    The frequent revisions of prohibited substances list established by WADA are aimed at keeping up with those drugs that, being increasingly used in medicine and in sports, play on one side a therapeutic role and, on the other, a doping role. Among the various hormone substances widely used in sports, the authors draw particular attention on IGF-1, a growth factor that is rapidly widespreading among athletes. Moreover, IGF-1 diffusion is not exclusively correlated with the doping phenomenon, being various the pathological conditions that may require the therapeutic use of this substance. As a consequence, during pathologies or medical treatments of various nature, the athletes should be informed of the IGF-1 administration because, if they are not duly apprised, they risk undergoing unjust sanctions from the competent authority. In fact, the athlete is given the possibility of communicating, before using, he is taking a medication of the WADA list for therapeutic reasons by applying for a TUE (Therapeutic Use Exemption). If this application is accepted on certified clinical grounds, the athlete will be allowed to use that substance even during sports competitions. However, the IGF-1 detection in the athlete's body shows, at the present state-of-art, two different problems: the first one has a technical character and concerns the differential diagnosis between the quantity of the physiologically produced substance and the quantity of the exogenously administrated substance; the second problem has an economic character and regards to the high cost of the analysis and, consecutively, the necessity of finding a well-equipped laboratory centre.

  3. Behavior of pharmaceuticals and drugs of abuse in a drinking water treatment plant (DWTP) using combined conventional and ultrafiltration and reverse osmosis (UF/RO) treatments.

    Science.gov (United States)

    Boleda, M A Rosa; Galceran, M A Teresa; Ventura, Francesc

    2011-06-01

    The behavior along the potabilization process of 29 pharmaceuticals and 12 drugs of abuse identified from a total of 81 compounds at the intake of a drinking water treatment plant (DWTP) has been studied. The DWTP has a common treatment consisting of dioxychlorination, coagulation/flocculation and sand filtration and then water is splitted in two parallel treatment lines: conventional (ozonation and carbon filtration) and advanced (ultrafiltration and reverse osmosis) to be further blended, chlorinated and distributed. Full removals were reached for most of the compounds. Iopromide (up to 17.2 ng/L), nicotine (13.7 ng/L), benzoylecgonine (1.9 ng/L), cotinine (3.6 ng/L), acetaminophen (15.6 ng/L), erythromycin (2.0 ng/L) and caffeine (6.0 ng/L) with elimination efficiencies ≥ 94%, were the sole compounds found in the treated water. The advanced treatment process showed a slightly better efficiency than the conventional treatment to eliminate pharmaceuticals and drugs of abuse. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Alternative drugs of abuse.

    Science.gov (United States)

    Sutter, M E; Chenoweth, J; Albertson, T E

    2014-02-01

    The incidence of drug abuse with alternative agents is increasing. The term "alternative drugs of abuse" is a catch-all term for abused chemicals that do not fit into one of the classic categories of drugs of abuse. The most common age group abusing these agents range from 17 to 25 years old and are often associated with group settings. Due to their diverse pharmacological nature, legislative efforts to classify these chemicals as a schedule I drug have lagged behind the development of new alternative agents. The potential reason for abuse of these agents is their hallucinogenic, dissociative, stimulant, anti-muscarinic, or sedative properties. Some of these drugs are easily obtainable such as Datura stramonium (Jimson Weed) or Lophophora williamsii (Peyote) because they are natural plants indigenous to certain regions. The diverse pharmacology and clinical effects of these agents are so broad that they do not produce a universal constellation of signs and symptoms. Detailed physical exams are essential for identifying clues leading one to suspect an alternative drug of abuse. Testing for the presence of these agents is often limited, and even when available, the results do not return in a timely fashion. Intoxications from these agents pose unique challenges for health care providers. Physician knowledge of the physiological effects of these alternative agents and the local patterns of drug of abuse are important for the accurate diagnosis and optimal care of poisoned patients. This review summarizes the current knowledge of alternative drugs of abuse and highlights their clinical presentations.

  5. Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse.

    Science.gov (United States)

    Baril, Karine; Tourigny, Marc; Paillé, Pierre; Pauzé, Robert

    2016-07-01

    Considering the importance of mother's support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother-child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3-18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.

  6. Hemoglobinopathies: clinical manifestations, diagnosis, and treatment.

    Science.gov (United States)

    Kohne, Elisabeth

    2011-08-01

    Hemoglobinopathies are among the most common inherited diseases around the world. They have become much more common recently in northern and central Europe, including Germany, due to immigration. Selective review of the literature with consideration of national guidelines. The hemoglobinopathies encompass all genetic diseases of hemoglobin. They fall into two main groups: thalassemia syndromes and structural hemoglobin variants (abnormal hemoglobins). α- and β-thalassemia are the main types of thalassemia; the main structural hemoglobin variants are HbS, HbE and HbC. There are many subtypes and combined types in each group. The highly variable clinical manifestations of the hemoglobinopathies range from mild hypochromic anemia to moderate hematological disease to severe, lifelong, transfusion-dependent anemia with multiorgan involvement. Stem-cell transplantation is the preferred treatment for the severe forms of thalassemia. Supportive, rather than curative, treatment consists of periodic blood transfusions for life, combined with iron chelation. Drugs to treat the symptoms of sickle-cell disease include analgesics, antibiotics, ACE inhibitors and hydroxyurea. Blood transfusions should be given only when strictly indicated. More than 90% of patients currently survive into adulthood. Optimally treated patients have a projected life span of 50 to 60 years. Hemoglobinopathies are a public health issue in today's multiethnic German population. Adequate care of the affected patients requires a wide variety of diagnostic and therapeutic measures.

  7. [Lyme disease--clinical manifestations and treatment].

    Science.gov (United States)

    Stock, Ingo

    2016-05-01

    Lyme disease (Lyme borreliosis) is a systemic infectious disease that can present in a variety of clinical manifestations. The disease is caused by a group of spirochaetes--Borrelia burgdorferi sensu lato or Lyme borrelia--that are transmitted to humans by the bite of Ixodes ticks. Lyme disease is the most common arthropode-borne infectious disease in many European countries including Germany. Early localized infection is typically manifested by an erythema migrans skin lesion, in rarer cases as a borrelial lymphocytoma. The most common early disseminated manifestation is (early) neuroborreliosis. In adults, neuroborreliosis appears typically as meningoradiculoneuritis. Neuroborreliosis in children, however, is typically manifested by meningitis. In addition, multiple erythema migrans lesions and Lyme carditis occur relatively frequently. The most common manifestation oflate Lyme disease is Lyme arthritis. Early manifestations (and usually also late manifestations) of Lyme disease can be treated successfully by application of suitable antibacterial agents. For the treatment of Lyme disease, doxycycline, certain penicillins such as amoxicillin and some cephalosporins (ceftriaxone, cefotaxime, cefuroxime axetil) are recommended in current guidelines. A major challenge is the treatment of chronic, non-specific disorders, i. e., posttreatment Lyme disease syndrome and "chronic Lyme disease". Prevention of Lyme disease is mainly accomplished by protecting against tick bites. Prophylactic administration of doxycycline after tick bites is generally not recommended in Germany. There is no vaccine available for human beings.

  8. Pertussis leukocytosis: mechanisms, clinical relevance and treatment

    Science.gov (United States)

    Carbonetti, Nicholas H.

    2016-01-01

    The significant and sometimes dramatic rise in the number of circulating white blood cells (leukocytosis) in infants suffering from pertussis (whooping cough) has been recognized for over a century. Although pertussis is a disease that afflicts people of all ages, it can be particularly severe in young infants, and these are the individuals in whom leukocytosis is most pronounced. Very high levels of leukocytosis are associated with poor outcome in infants hospitalized with pertussis and modern treatments are often aimed at reducing the number of leukocytes. Pertussis leukocytosis is caused by pertussis toxin, a soluble protein toxin released by Bordetella pertussis during infection, but the exact mechanisms by which this occurs are still unclear. In this minireview, I discuss the history of clinical and experimental findings on pertussis leukocytosis, possible contributing mechanisms causing this condition and treatments aimed at reducing leukocytosis in hospitalized infants. Since recent studies have detailed significant associations between specific levels of pertussis leukocytosis and fatal outcome, this is a timely review that may stimulate new thinking on how to understand and combat this problem. PMID:27609461

  9. Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support.

    Science.gov (United States)

    Keller, Stephanie M; Zoellner, Lori A; Feeny, Norah C

    2010-12-01

    Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Early alliance was associated with PE adherence (r = .32, p history was not predictive of a lower early alliance. Given the associations with adherence, clinicians may find it useful to routinely assess alliance early in treatment. Positive trauma support, not CSA history, may be particularly important in the development of a strong early therapeutic alliance. (c) 2010 APA, all rights reserved.

  10. PERCEIVED FEASIBILITY OF ESTABLISHING DEDICATED ELDER ABUSE PROGRAMS OF CARE AT HOSPITAL-BASED SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CENTETR.

    Science.gov (United States)

    Du Mont, Janice; Mirzaei, Aftab; Macdonald, Sheila; White, Meghan; Kosa, Daisy; Reimer, Linda

    2014-12-01

    Elder abuse is an increasingly important issue that must be addressed in a systematic and coordinated way. Our objective was to evaluate the perceived feasibility of establishing an elder abuse care program at hospital-based sexual assault and domestic violence treatment centers in Ontario, Canada. In July 2012, a questionnaire focused on elder abuse care was distributed to all of Ontario's Sexual Assault/Domestic Violence Treatment Centre (SA/DVTC) Program Coordinators/Managers. We found that the majority of Program Coordinators/ Managers favored expansion of their program mandates to include an elder abuse care program. However, these respondents viewed collaboration with a large network of well trained professionals and available services in the community that address elder abuse as integral to responding in a coordinated manner. The expansion of health services to address the needs of abused older adults in a comprehensive and integrated manner should be considered as an important next step for hospital-based violence care programs worldwide.

  11. Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

    Directory of Open Access Journals (Sweden)

    B Myers

    2017-02-01

    Full Text Available Background. A performance measurement system – the Service Quality Measures (SQM initiative – has been developed to monitor the quality of South Africa (SA’s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. Objective. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. Methods. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. Results. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63. In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df=3.70, p=0.015, awareness (r=0.78, p<0.0001, leadership support (r=0.70, p<0.0001, resources (r=0.65, p<0.0001, openness to change (r=0.372, p=0.001, and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE 0.08, t=4.4, p<0.0001 and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001 were significantly associated with readiness to adopt this system. Conclusion. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

  12. Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, B; Petersen Williams, P; Johnson, K; Govender, R; Manderscheid, R; Koch, J R

    2017-01-30

    A performance measurement system - the Service Quality Measures (SQM) initiative - has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

  13. Sudden losses and sudden gains during a DBT-PTSD treatment for posttraumatic stress disorder following childhood sexual abuse

    Directory of Open Access Journals (Sweden)

    Antje Krüger

    2014-09-01

    Full Text Available Background: Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD. However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD. Objective: The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined. Methods: Female participants (N=74 were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS. Sudden changes were computed as suggested by the literature on sudden gains. Results: During treatment, only one participant (3% experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments. Conclusions: Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome.

  14. Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm.

    Science.gov (United States)

    Derrington, Taletha Mae; Bernstein, Judith; Belanoff, Candice; Cabral, Howard J; Babakhanlou-Chase, Hermik; Diop, Hafsatou; Evans, Stephen R; Kotelchuck, Milton

    2015-10-01

    Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes.

  15. Attributions of Blame in a Hypothetical Child Sexual Abuse Case: Roles of Behavior Problems and Frequency of Abuse.

    Science.gov (United States)

    Theimer, Kate; Hansen, David J

    2017-06-01

    Youth who are blamed for their sexual abuse may experience increased negative outcomes, such as amplified self-blame. Similarly, blaming nonoffending parents can impede their ability to support their child following disclosure. Understanding the factors that influence how people perceive victim, caregiver, and perpetrator responsibility is imperative for the protection and treatment of families who have experienced sexual abuse. Little research has explored victim and abuse characteristics that influence the perception of sexual abuse. As such, the purpose of this study was to examine the roles of behavior problems and frequency of abuse in the attribution of blame in a hypothetical sexual abuse case. In addition, the relationship between several respondent characteristics and assignment of responsibility were explored as secondary aims. The study used a two (behavior problems: three suspensions in one school semester vs. no mention of behavior problems) by two (one abuse occurrence vs. five abuse occurrences) between-subjects design. Seven hundred forty-two participants read one of the four child sexual abuse (CSA) vignettes and completed measures related to responsibility. ANOVAs revealed those who read a vignette where the youth experienced multiple abuse incidents rated the victim as more responsible regardless of whether or not the youth was described as having behavior problems. Results indicate that respondents may have attributed more blame to the victim due to the belief that she could have done something to stop the abuse after the first incident. The abuse frequency manipulation when combined with the behavior manipulation appeared to relate to how respondents perceived the victim's parents. Males and younger respondents attributed more blame to the victim; however, sexual abuse or assault history did not associate with victim responsibility ratings. Clinical and research implications were discussed.

  16. Monoclonal antibody form and function: manufacturing the right antibodies for treating drug abuse.

    Science.gov (United States)

    Peterson, Eric; Owens, S Michael; Henry, Ralph L

    2006-05-26

    Drug abuse continues to be a major national and worldwide problem, and effective treatment strategies are badly needed. Antibodies are promising therapies for the treatment of medical problems caused by drug abuse, with several candidates in preclinical and early clinical trials. Monoclonal antibodies can be designed that have customized affinity and specificity against drugs of abuse, and because antibodies can be designed in various forms, in vivo pharmacokinetic characteristics can be tailored to suit specific clinical applications (eg, long-acting for relapse prevention, or short-acting for overdose). Passive immunization with antibodies against drugs of abuse has several advantages over active immunization, but because large doses of monoclonal antibodies may be needed for each patient, efficient antibody production technology is essential. In this minireview we discuss some of the antibody forms that may be effective clinical treatments for drug abuse, as well as several current and emerging production systems that could bridge the gap from discovery to patient use.

  17. Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals.

    Science.gov (United States)

    Cowley, Laura E; Maguire, Sabine; Farewell, Daniel M; Quinn-Scoggins, Harriet D; Flynn, Matthew O; Kemp, Alison M

    2018-05-09

    The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants' evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to 'low', 'medium' or 'high' likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals' confidence in their decision-making when investigating suspected AHT, but may be of less value in court. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. Recreational drugs of abuse.

    Science.gov (United States)

    Albertson, Timothy E

    2014-02-01

    The use of recreational drugs of abuse continues to expand without limitations to national boundaries, social status, race, or education. Beyond the prevalence of illicit drug use and dependence, their contribution to the global burden of disease and death are large and troubling. All medical providers should be aware of the evolving drugs of abuse and their medical and social consequences. In addition to heroin and stimulants such as cocaine and methamphetamine, new designer stimulants called "bath salts" and cannabinoids called "spice," along with the abuse of prescription drugs and volatile substances, are now widely recognized problems in many societies. The wide variety and continuingly expanding clinical manifestations of toxicity of recreational drugs of abuse is not widely appreciated by clinicians. This edition attempts to summarize six major classes of drugs of abuse and their clinical effects with special emphasis on their immunological and respiratory effects.

  19. [Clinical evaluation of triage as drug-of-abuse test kit].

    Science.gov (United States)

    Yoshioka, Toshiharu; Kohriyama, Kazuaki; Kondo, Rumiko; Goto, Kyoko; Yashiki, Mikio

    2003-01-01

    There are about 60,000 chemical substances which may cause poisoning. Identifying the cause substances is, therefore, very important for patient at emergency department. Triage is an immunoassay kit for the qualitative test for the metabolites of 8 major abuse drugs in urine. We assessed the usefullness of Triage on two patient groups. The first Group consists of the patients considered having not taken substances at initial diagnosis; the second Group consists of the patients considered having taken substances. The result are as follows. 1) The rate of Triage positive patients in the first Group were: attempt-suicide 23%, coma 24%, shock 10%, trauma 7%, respectively. Except for the habitually used medicine, narcotic and stimulant drugs were detected. In the first Group, negative result of Triage was effective in diagnosing the patients as not poisoned, excluding the possitivity of 8 major drugs usage. 2) The rate of Triage positive patients in the second Group were very high: attempt-suicide 77%, coma 51%, shock 57%, trauma 30%, respectively, showing mostly any of 8 major drugs were the cause of poisoning. In the second Group, positive result of Triage was effective in diagnosing the patient as poisoning or as coexisting poisoning with other diseases. 3) The specificity of Triage diagnosis in the first Group was 80% (113/142). The specificity and the sensitivity in the second Group were 64% (50/78) and 97% (74/76), respectively. These results means that Triage is very useful for diagnosis on 8 major drugs poisoning. 4) Triage is efficient for identifying the cause substances in drug poisoning and, therefore, can save medical expense. Triage is a very useful test kit at emergency department.

  20. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review

    Directory of Open Access Journals (Sweden)

    Ethy Dorrepaal

    2014-10-01

    Full Text Available Introduction: Effective first-line treatments for posttraumatic stress disorder (PTSD are well established, but their generalizability to child abuse (CA-related Complex PTSD is largely unknown. Method: A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. Results: Only six studies with one or more cognitive behavior therapy (CBT treatment conditions and one with a present centered therapy condition could be meta-analyzed. Results indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers’ analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. Conclusion: Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results.

  1. Predictors of Treatment Completion for Families Referred to Trauma Focused-Cognitive Behavioral Therapy after Child Abuse.

    Science.gov (United States)

    Celano, Marianne; NeMoyer, Amanda; Stagg, Anna; Scott, Nikia

    2018-05-22

    Despite advances in the dissemination of evidence-based therapy for abuse-related traumatic stress, many referred children fail to complete treatment. Using archival data from a sample of children participating in trauma-focused cognitive behavioral therapy (TF-CBT) at a hospital-based child advocacy center, analyses explored the impact of baseline child traumatic stress symptoms, a second (nonprimary) caregiver's treatment attendance, and the number of assessment sessions on treatment completion while controlling for demographic variables. We conducted analyses separately for the total sample (n = 77) and for a subsample of children 6 years of age or older (n = 65) who completed measures of traumatic stress. Families who completed TF-CBT had fewer pretreatment assessment sessions, odds ratio (OR) = 0.41, 95% CI [0.19, 0.88], and greater nonprimary caregiver session attendance, OR = 1.30, 95% CI [1.03, 1.64], than families who did not complete treatment. Child age, race, and insurance status did not predict treatment completion. Among children at least 6 years of age, treatment completion was related to younger child age, OR = 0.76, 95% CI [0.59, 0.98], and fewer diagnostic evaluation sessions, OR = 0.29, 95% CI [0.11, 0.74], but not to baseline traumatic stress symptoms. Findings may suggest benefits of shortening the assessment period and including a second caregiver in TF-CBT. Copyright © 2018 International Society for Traumatic Stress Studies.

  2. Infectious myocarditis (Clinic, diagnostics, principles of treatment

    Directory of Open Access Journals (Sweden)

    Yu. P. Finogeev

    2016-01-01

    Full Text Available Infective myocarditis can be considered as a case of myocardial damage caused by different infectious agents. Traditionally discusses the questions of diagnostics and treatment infectious myocarditis. The paper has repeatedly stressed the difficulty of clinical diagnosis, and the laboriousness and economic costs of laboratory tests and additional researches. Endomyocardial biopsy findings remain the gold standard for unequivocally establishing the diagnosis. However, it is technically extremely invasive test and can be performed only in specialized cardiology centers. The paper analyzes in detail not only own materials, but also results of researches published in numerous domestic and foreign sources of literature. Publication of «Infectious myocarditis» is necessary due to the fact that patients with a diagnosis of «Myocarditis » account for 11% of all cardiovascular disease in the world. Article is timely and necessary for many professionals, senior students of medical universities.

  3. Subclinical hyperthyroidism: clinical features and treatment options.

    Science.gov (United States)

    Biondi, Bernadette; Palmieri, Emiliano Antonio; Klain, Michele; Schlumberger, Martin; Filetti, Sebastiano; Lombardi, Gaetano

    2005-01-01

    Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.

  4. Narcolepsy: etiology, clinical features, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Jolanta B. Zawilska

    2012-10-01

    Full Text Available [u][/u] Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil. Cataplexy is treated with sodium oxybate (GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  5. Occurrence and environmental implications of the presence of drugs of abuse in wastewater treatment plants of Valencia (Spain)

    Science.gov (United States)

    Picó, Yolanda; Andres-Costa, M. Jesus; Andreu, Vicente

    2014-05-01

    Drugs of abuse are continuously discharged into wastewaters due to human excretion as parent compounds and/or secondary metabolites after consumption or accidental disposal into the toilets. (Boles and Wells,2010). Incomplete removal of these compounds during wastewater treatment results in their release to the environment. Pollution by illicit drug residues at very low concentrations is generalized in populated areas, with potential risks for human health and the environment. The impact of treated wastewater effluent on the quality of receiving waters can be evaluated performing an investigated performing an ecotoxicological risk assessment calculating the risk quotient (RQ) of the drugs of abuse level observed. In addition, back-calculation from the concentration of illicit drug in the influents of wastewater treatment plants (WWTPs) provides an important tool for estimating its local consumption (Daughton 2001). Sampling campaigns were in three years, 2011 (March 9th to 15th), 2012 (April 17th to May 1st) and 2013 (March 6th to 12th) in influents and effluents from 3 Wastewater Treatment Plants (WWTPs), Pinedo I, Pinedo II and Quart-Benàger, that treats most of the wastewater of Valencia City and its surrounding towns. Cocaine (COC), amphetamine (AMP), methamphetamine (MAMP), ecstasy (MDMA) and ketamine (KET), Benzoylecgonine (BE), 6-acethylmorphine (6-MAM), and 11-nor-9-carboxy-delta9-tetrahydrocannabinol (THC-COOH) were analyzed using mass spectrometry techniques such as liquid chromatography triple quadrupole mass spectrometry (LC-QqQ-MS/MS) Illicit drugs were extracted using solid phase extraction (SPE) and determined by liquid chromatography tandem mass spectrometry (LC-MS/MS) in positive ionization with an electrospray ionization source (ESI). The determination of drugs of abuse in the influent of the selected WWTP shows that all compounds were detected in 100% of influents from Pinedo I, Pinedo II and Quart-Benàger in samples analyzed during three years

  6. Sex differences in drug-related stress-system changes: implications for treatment in substance-abusing women.

    Science.gov (United States)

    Fox, Helen C; Sinha, Rajita

    2009-01-01

    Extensive research indicates that chronic substance abuse disrupts stress and reward systems of the brain. Gender variation within these stress-system alterations, including the impact of sex hormones on these changes, may influence sex-specific differences in both the development of, and recovery from, dependency. As such, gender variations in stress-system function may also provide a viable explanation for why women are markedly more vulnerable than men to the negative consequences of drug use. This article therefore initially reviews studies that have examined gender differences in emotional and biophysiological changes to the stress and reward system following the acute administration of drugs, including cocaine, alcohol, and nicotine. The article then reviews studies that have examined gender differences in response to various types of stress in both healthy and drug-abusing populations. Studies examining the impact of sex hormones on these gender-related responses are also reported. The implications of these sex-specific variations in stress and reward system function are discussed in terms of both comorbid psychopathology and treatment outcome.

  7. Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment.

    Science.gov (United States)

    Subramaniam, Anusuiya; Silong, Abu Daud; Uli, Jegak; Ismail, Ismi Arif

    2015-08-13

    Effective talent development requires robust supervision. However, the effects of supervisory styles (coaching, mentoring and abusive supervision) on talent development and the moderating effects of clinical learning environment in the relationship between supervisory styles and talent development among public hospital trainee doctors have not been thoroughly researched. In this study, we aim to achieve the following, (1) identify the extent to which supervisory styles (coaching, mentoring and abusive supervision) can facilitate talent development among trainee doctors in public hospital and (2) examine whether coaching, mentoring and abusive supervision are moderated by clinical learning environment in predicting talent development among trainee doctors in public hospital. A questionnaire-based critical survey was conducted among trainee doctors undergoing housemanship at six public hospitals in the Klang Valley, Malaysia. Prior permission was obtained from the Ministry of Health Malaysia to conduct the research in the identified public hospitals. The survey yielded 355 responses. The results were analysed using SPSS 20.0 and SEM with AMOS 20.0. The findings of this research indicate that coaching and mentoring supervision are positively associated with talent development, and that there is no significant relationship between abusive supervision and talent development. The findings also support the moderating role of clinical learning environment on the relationships between coaching supervision-talent development, mentoring supervision-talent development and abusive supervision-talent development among public hospital trainee doctors. Overall, the proposed model indicates a 26 % variance in talent development. This study provides an improved understanding on the role of the supervisory styles (coaching and mentoring supervision) on facilitating talent development among public hospital trainee doctors. Furthermore, this study extends the literature to better

  8. Utilization of substance abuse treatment services under Medicare, 2001-2002.

    Science.gov (United States)

    Vandivort, Rita; Teich, Judith L; Cowell, Alexander J; Chen, Hong

    2009-06-01

    In 2006, the Medicare program covered 37 million elderly persons and 7 million persons younger than 65 years, but little is known about substance abuse (SA) service utilization. Using the 5% Sample of Medicare claims data, the study examines individuals who used SA detoxification ("detox") and/or rehabilitation ("rehab") services under Medicare in 2001 and 2002. SA claimants less than 65 years of age (disabled) were compared to claimants more than 65 years of age (elderly). The disabled were more likely to have a co-occurring mental disorder than elderly claimants (50% vs. 14%) and more likely to have serious mental illness (21% vs. 2.3%). Disabled claimants were more than three times as likely to receive any detox service as elderly claimants (17% vs. 6%). The rate of claimants receiving rehab services within 30 days of detox is about one third for disabled claimants and one quarter for elderly claimants.

  9. 77 FR 52337 - National Institute on Alcohol Abuse and Alcoholism; Notice of Closed Meetings

    Science.gov (United States)

    2012-08-29

    ... Alcohol Abuse and Alcoholism; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Alcoholism Initial Review Group Clinical, Treatment and Health Services Research Review... Abuse & Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rm. 2019, Rockville, MD 20852, 301...

  10. 78 FR 21616 - National Institute on Alcohol Abuse and Alcoholism; Notice of Closed Meeting

    Science.gov (United States)

    2013-04-11

    ... Alcohol Abuse and Alcoholism; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Alcoholism Initial Review Group Clinical, Treatment and Health Services Research Review... on Alcohol Abuse & Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rm. 2019, Rockville...

  11. 75 FR 69091 - National Institute on Alcohol Abuse and Alcoholism; Notice of Closed Meeting

    Science.gov (United States)

    2010-11-10

    ... Alcohol Abuse and Alcoholism; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alcoholism Initial Review Group; Clinical Treatment and Health Services Research Review Subcommittee. Date..., Scientific Review Officer, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health...

  12. Implications of central immune signaling caused by drugs of abuse: mechanisms, mediators and new therapeutic approaches for prediction and treatment of drug dependence.

    Science.gov (United States)

    Coller, Janet K; Hutchinson, Mark R

    2012-05-01

    In the past two decades a trickle of manuscripts examining the non-neuronal central nervous system immune consequences of the drugs of abuse has now swollen to a significant body of work. Initially, these studies reported associative evidence of central nervous system proinflammation resulting from exposure to the drugs of abuse demonstrating key implications for neurotoxicity and disease progression associated with, for example, HIV infection. However, more recently this drug-induced activation of central immune signaling is now understood to contribute substantially to the pharmacodynamic actions of the drugs of abuse, by enhancing the engagement of classical mesolimbic dopamine reward pathways and withdrawal centers. This review will highlight the key in vivo animal, human, biological and molecular evidence of these central immune signaling actions of opioids, alcohol, cocaine, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA). Excitingly, this new appreciation of central immune signaling activity of drugs of abuse provides novel therapeutic interventions and opportunities to identify 'at risk' individuals through the use of immunogenetics. Discussion will also cover the evidence of modulation of this signaling by existing clinical and pre-clinical drug candidates, and novel pharmacological targets. Finally, following examination of the breadth of central immune signaling actions of the drugs of abuse highlighted here, the current known common immune signaling components will be outlined and their impact on established addiction neurocircuitry discussed, thereby synthesizing a common neuroimmune hypothesis of addiction. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Response to Individualized Homeopathic Treatment for Depression in Climacteric Women with History of Domestic Violence, Marital Dissatisfaction or Sexual Abuse: Results from the HOMDEP-MENOP Study.

    Science.gov (United States)

    Macías-Cortés, Emma Del Carmen; Llanes-González, Lidia; Aguilar-Faisal, Leopoldo; Asbun-Bojalil, Juan

    2018-06-05

     Although individualized homeopathic treatment is effective for depression in climacteric women, there is a lack of well-designed studies of its efficacy for depression in battered women or in post-traumatic stress disorder. The aim of this study was to assess the association between individualized homeopathic treatment or fluoxetine and response to depression treatment in climacteric women with high levels of domestic violence, sexual abuse or marital dissatisfaction.  One hundred and thirty-three Mexican climacteric women with moderate-to-severe depression enrolled in the HOMDEP-MENOP Study (a randomized, placebo-controlled, double-blind, double-dummy, three-arm trial, with a 6-week follow-up study) were evaluated. Domestic violence, marital dissatisfaction and sexual abuse were assessed at baseline. Response to depression treatment was defined by a decrease of 50% or more from baseline score of Hamilton scale. Association between domestic violence, sexual abuse, and marital dissatisfaction and response to depression treatment was analyzed with bivariate analysis in the three groups. Odds ratio (OR) and 95% confidence interval (CI) were calculated.  Homeopathy versus placebo had a statistically significant association with response to depression treatment after adjusting for sexual abuse (OR [95% CI]: 11.07 [3.22 to 37.96]), domestic violence (OR [95% CI]: 10.30 [3.24 to 32.76]) and marital dissatisfaction (OR [95% CI]: 8.61 [2.85 to 25.99]).  Individualized homeopathic treatment is associated with response to depression treatment in climacteric women with high levels of domestic violence, sexual abuse or marital dissatisfaction. Further studies should be conducted to evaluate its efficacy specifically for post-traumatic stress disorder in battered women. CLINICALTRIALS. NCT01635218,:  URL: http://clinicaltrials.gov/ct2/show/NCT01635218?term=depression+homeopathy&rank=1. The Faculty of Homeopathy.

  14. Predictors of Substance Abuse Assessment and Treatment Completion for Parents Involved with Child Welfare: One State's Experience in Matching across Systems.

    Science.gov (United States)

    Traube, Dorian E; He, Amy S; Zhu, Limei; Scalise, Christine; Richardson, Tyrone

    2015-01-01

    To date, few studies have examined the effect of interagency collaboration on substance abuse assessment ity of Southern California and treatment completion for parents who are involved in child welfare. The purpose of this paper is to: (1) describe a statewide, interagency collaborative program aimed at providing targeted substance abuse assessment and treatment to parents engaged in the child welfare system; (2) document the specialized assessment and treatment outcomes for parents engaged through this collaborative program; and (3) determine factors related to successful treatment completion for parents involved in the child welfare system. This is a retrospective study of an open cohort of 13,829 individuals admitted to the New Jersey Child Protection Substance Abuse Initiative (CPSAI) program from October 1, 2009, through September 30, 2010. Data were drawn from two unique administrative data sources. Multivariate Cox regression models were used to explore factors related to successfil treatment completion for parents involved in the child welfare system. Trend analysis for the total sample in the CPSAI program revealed that, of the 10,909 individuals who received a CPSAI assessment, 59% were referred to treatment. Of those referred to treatment, 40% enrolled in a treatment program. Once enrolled in a treatment program, 55% completed or were in the process of completing substance abuse treatment. These findings suggest that when adequate screening and treatment is available through a streamlined process, many of the ethnic and gender disparities present among other populations of individuals seeking treatment are minimized. Utilizing inherent child welfare case factors appears to be an important motivating element that aids parents during the assessment and treatment process.

  15. Course of self-reported symptoms of attention deficit and hyperactivity in substance abusers during early treatment

    DEFF Research Database (Denmark)

    Hesse, Morten

    2010-01-01

    Attention deficit and hyperactivity disorder has been associated with poor outcome in studies of substance use disorders. This study aimed to assess the course of self-reported symptoms of both attention deficit and hyperactivity among adults presenting for treatment for substance use disorders....... A sample of 75 substance abusers were assessed after they were admitted to a centralized intake unit, and followed at 3 and 6 months after intake by independent interviewers (follow-up rate 81%). Symptoms of attention deficit and hyperactivity were assessed with the Adult Self-report Scale for ADHD (ASRS......). Both types of symptoms declined significantly during follow-up, but attention symptoms had a high intraclass correlation (0.79), and hyperactivity had a moderate intraclass correlation (0.64). Both baseline attention deficit and hyperactivity symptoms were associated with worse work and social...

  16. Combining Clinical Treatment and Peer Support: A Unique Approach to Overcoming Stigma and Delivering Care

    National Research Council Canada - National Science Library

    Heber, Alexandra; Grenier, Stephane; Richardson, Donald; Darte, Kathy

    2006-01-01

    .... These include post-traumatic stress disorder, depression and substance abuse. The Canadian Forces and Veterans Affairs Canada have established mental health clinics, called Operational Trauma and Stress Support Centres (OTSSC's...

  17. Analysis of infantile subdural hematoma caused by abuse

    International Nuclear Information System (INIS)

    Park, Young-Soo; Nishio, Kenji; Fujimoto, Takatoshi; Nakase, Hiroyuki; Okuchi, Kazuo

    2010-01-01

    We report infantile subdural hematoma caused by abuse. Between January 2006 and December 2009, 10 cases of definite and highly suspicious abusive subdural hematoma in infants were treated at Nara Medical University Hospital. The mean age was 5.4 months. On CT examination, severe cerebral swelling was seen in 8 (80%) and wide spreading cerebral ischemia and atrophy in 9 (90%). Retinal hemorrhage was commonly seen in this series (90%). Subdural drainage and/or subdural-peritoneal shunt surgeries were performed in 6 cases, and intensive combined therapy of mild hypothermia and barbiturate was adapted in 7 cases. Favorable outcome was achieved in only 3 cases. In spite of aggressive treatment, clinical outcome are still bad. In our series, assailants were predominantly not father but mother. There were various and complex factors for child abuse. Cautious insight and suspicion are necessary to detect abusive injuries in infants. It is very important to endeavor to prevent recurrences of abusive injuries. (author)

  18. Racial/Ethnic Differences in Social Vulnerability among Women with Co-Occurring Mental Health and Substance Abuse Disorders: Implications for Treatment Services

    Science.gov (United States)

    Amaro, Hortensia; Larson, Mary Jo; Gampel, Joanne; Richardson, Erin; Savage, Andrea; Wagler, Debra

    2005-01-01

    Little attention has been given to racial/ethnic differences in studies of co-occurring disorders among women. In this article, we present findings from analyses conducted on the influence of racial/ethnic differences on the demographic and clinical profiles of 2,534 women in the Substance Abuse and Mental Health Services Administration-sponsored…

  19. What every clinical geneticist should know about testing for osteogenesis imperfecta in suspected child abuse cases.

    Science.gov (United States)

    Pepin, Melanie G; Byers, Peter H

    2015-12-01

    Non-accidental injury (NAI) is a major medical concern in the United States. One of the challenges in evaluation of children with unexplained fractures is that genetic forms of bone fragility are one of the differential diagnoses. Infants who present with fractures with mild forms of osteogenesis imperfecta (OI) (OI type I or OI type IV), the most common genetic form of bone disease leading to fractures might be missed if clinical evaluation alone is used to make the diagnosis. Diagnostic clinical features (blue sclera, dentinogenesis imperfecta, Wormian bones on X-rays or positive family history) may not be present or apparent at the age of evaluation. The evaluating clinician faces the decision about whether genetic testing is necessary in certain NAI cases. In this review, we outline clinical presentations of mild OI and review the history of genetic testing for OI in the NAI versus OI setting. We summarize our data of molecular testing in the Collagen Diagnostic Laboratory (CDL) from 2008 to 2014 where NAI was noted on the request for DNA sequencing of COL1A1 and COL1A2. We provide recommendations for molecular testing in the NAI versus OI setting. First, DNA sequencing of COL1A1, COL1A2, and IFITM5 simultaneously and duplication/deletion testing is recommended. If a causative variant is not identified, in the absence of a pathologic clinical phenotype, no additional gene testing is indicated. If a VUS is found, parental segregation studies are recommended. © 2015 Wiley Periodicals, Inc.

  20. Systematic evaluation of "compliance" to prescribed treatment medications and "abstinence" from psychoactive drug abuse in chemical dependence programs: data from the comprehensive analysis of reported drugs.

    Science.gov (United States)

    Blum, Kenneth; Han, David; Femino, John; Smith, David E; Saunders, Scott; Simpatico, Thomas; Schoenthaler, Stephen J; Oscar-Berman, Marlene; Gold, Mark S

    2014-01-01

    This is the first quantitative analysis of data from urine drug tests for compliance to treatment medications and abstinence from drug abuse across "levels of care" in six eastern states of America. Comprehensive Analysis of Reported Drugs (CARD) data was used in this post-hoc retrospective observational study from 10,570 patients, filtered to include a total of 2,919 patients prescribed at least one treatment medication during 2010 and 2011. The first and last urine samples (5,838 specimens) were analyzed; compliance to treatment medications and abstinence from drugs of abuse supported treatment effectiveness for many. Compared to non-compliant patients, compliant patients were marginally less likely to abuse opioids, cannabinoids, and ethanol during treatment although more likely to abuse benzodiazepines. Almost 17% of the non-abstinent patients used benzodiazepines, 15% used opiates, and 10% used cocaine during treatment. Compliance was significantly higher in residential than in the non-residential treatment facilities. Independent of level of care, 67.2% of the patients (n = 1963; Pabuse detected in either the first or last urine samples (abstinence). Moreover, in 2010, 16.9% of the patients (n = 57) were abstinent at first but not at last urine (deteriorating abstinence), the percentage dropped to 13.3% (n = 174) in 2011; this improvement over years was statistically significant. A longitudinal analysis for abstinence and compliance was studied in a randomized subset from 2011, (n = 511) representing 17.5% of the total cohort. A statistically significant upward trend (p = 2.353×10-8) of abstinence rates as well as a similar but stronger trend for compliance ((p = 2.200×10-16) was found. Being cognizant of the trend toward drug urine testing being linked to medical necessity eliminating abusive screening, the interpretation of these valuable results require further intensive investigation.

  1. Medical students' experiences of professional lapses and patient rights abuses in a South African health sciences faculty.

    Science.gov (United States)

    Vivian, Lauraine M H; Naidu, Claudia S; Keikelame, Mpoe J; Irlam, James

    2011-10-01

    To elicit South African medical students' experiences of witnessing patient rights abuses and professional lapses during their clinical training in order to inform an appropriate and effective response. During June and July 2009 at the University of Cape Town Faculty of Health Sciences, the authors surveyed 223 fourth-, fifth-, and sixth-year medical students in selected clinical rotations concerning abuses they had observed. Volunteers were later interviewed individually. The authors coded interview transcripts for key themes using a constant-comparative grounded theory approach. Of 223 students surveyed, 183 (82%) responded, 130 (71%) of whom reported witnessing patient rights abuses and professional lapses, including physical abuse (38%), verbal abuse (37%), disrespect for patients' dignity (25%), and inadequately informing patients about their treatment (25%). Students attributed abuse to stressed health workers, overburdened facilities, and disempowered patients. Most students who witnessed abuse (59%) did not actively respond, and 64% of survey respondents felt unprepared or uncertain about challenging abuses in the future. Interviews with 28 students yielded detailed accounts of the abuses witnessed and of students' emotional reactions, coping strategies, and responses. Most students did not report abuses; they feared reprisal or doubted it would make a difference. This study demonstrates the disjunction between what these students were taught about human rights and ethics and what they witnessed in clinical settings. The high prevalence of patient rights abuses experienced by these students highlights the need to align medical ethics and human rights with medico-legal protocols in theory and clinical practice.

  2. Abuse Potential of Pregabalin

    DEFF Research Database (Denmark)

    Schjerning, Ole; Rosenzweig, Mary; Pottegård, Anton

    2016-01-01

    BACKGROUND: Several case reports and epidemiological studies have raised concern about the abuse potential of pregabalin, the use of which has increased substantially over the last decade. Pregabalin is, in some cases, used for recreational purposes and it has incurred attention among drug abusers...... for causing euphoric and dissociative effects when taken in doses exceeding normal therapeutic dosages or used by alternative routes of administration, such as nasal insufflation or venous injection. The magnitude of the abuse potential and the mechanism behind it are not fully known. OBJECTIVE: The aim...... of this study was to present a systematic review of the data concerning the abuse potential of pregabalin. METHODS: We performed a systematic literature search and reviewed the preclinical, clinical and epidemiological data on the abuse potential of pregabalin. RESULTS: We included preclinical (n = 17...

  3. Substance abuse associated with elder abuse in the United States.

    Science.gov (United States)

    Jogerst, Gerald J; Daly, Jeanette M; Galloway, Lara J; Zheng, Shimin; Xu, Yinghui

    2012-01-01

    Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community's environment, especially if older persons are involved. Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

  4. Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs.

    Science.gov (United States)

    Lalor, Kevin; McElvaney, Rosaleen

    2010-10-01

    This paper reviews the literature on the nature and incidence of child sexual abuse, explores the link between child sexual abuse and later sexual exploitation, and reviews the literature on prevention strategies and effective interventions in child sexual abuse services. Our understanding of the international epidemiology of child sexual abuse is considerably greater than it was just 10 years ago, and studies from around the world are examined. Childhood sexual abuse can involve a wide number of psychological sequelae, including low self-esteem, anxiety, and depression. Numerous studies have noted that child sexual abuse victims are vulnerable to later sexual revictimization, as well as the link between child sexual abuse and later engagement in high-risk sexual behaviour. Survivors of child sexual abuse are more likely to have multiple sex partners, become pregnant as teenagers, and experience sexual assault as adults. Various models which attempt to account for this inter-relationship are presented; most invoke mediating variables such as low self-esteem, drug/alcohol use, PTSD and distorted sexual development. Prevention strategies for child sexual abuse are examined including media campaigns, school-based prevention programmes, and therapy with abusers. The results of a number of meta-analyses are examined. However, researchers have identified significant methodological limitations in the extant research literature that impede the making of recommendations for implementing existing therapeutic programmes unreservedly.

  5. Clinical application of esophageal stent in the treatment of benign and malignant esophageal strictures

    International Nuclear Information System (INIS)

    Guo Weiping; Wang Zhimin; Yang Renjie; Wang Yiqing; Zhang Hongxin; Wu Zhiqun; Li Wenxian; Ni Daihui; Guan Yan

    2001-01-01

    Objective: To investigate the indications and complications in the treatment of benign and malignant strictures using esophageal stents in order to avoid abusing effects in clinical practice. Methods: A series of 20 patients, 12 men, 8 women, aged from 45-72, with esophageal stricture. There were 3 cases had stricture at the anastomosis site. 4 cases with esophagobronchial fistula. 1 case with esophago-mediastinal fistula after surgical operation ten cases used imported stents and another 10 with domestic Nickel-Titanium stents. Results: Successful stent placement was achieved in all cases. Dysphagia were relieved in most of 20 cases. The fistula vanished in 5 cases of complications with esophagobronchial and esophago-mediastinal fistulas. Conclusions: The esophageal stent placement is an effective treatment for benign and malignant esophageal strictures. The domestic Nickel-Titanium stents is well effective as the imported ones

  6. Inhalant Abuse

    Science.gov (United States)

    ... is when you pour the product into a bag, hold it over your mouth and nose, and inhale. How is inhalant abuse diagnosed? If you think your child is abusing inhalants, talk to them. Be honest and open. Tell them ...

  7. Abusive Relationships

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Abusive Relationships KidsHealth / For Teens / Abusive Relationships Print en español Relaciones de maltrato Healthy Relationships = Respect & Trust Healthy relationships involve respect, trust, and ...

  8. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  9. Clinical treatment strategies and experimental studies in polytrauma

    NARCIS (Netherlands)

    van Wessem, K.J.P.

    2013-01-01

    This thesis describes the clinical treatment of polytrauma patients and the underlying pathophysiological mechanisms causing injury-induced inflammatory response. Even though the treatment of polytrauma patients has improved over the years, trauma is still the leading cause of death

  10. Cow-specific treatment of clinical mastitis: an economic approach

    NARCIS (Netherlands)

    Steeneveld, W.; Werven, van T.; Barkema, H.W.; Hogeveen, H.

    2011-01-01

    Under Dutch circumstances, most clinical mastitis (CM) cases of cows on dairy farms are treated with a standard intramammary antimicrobial treatment. Several antimicrobial treatments are available for CM, differing in antimicrobial compound, route of application, duration, and cost. Because cow

  11. Hyponatraemia diagnosis and treatment clinical practice guidelines

    NARCIS (Netherlands)

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J.; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; van Biesen, Wim; Nagler, Evi; Gonzalez-Espinoza, Liliana; Ortiz, Alberto

    2017-01-01

    Hyponatremia, defined as a serum sodium concentration <135 mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity

  12. An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, and Substance Abuse

    Science.gov (United States)

    Bouis, Stephanie; Reif, Susan; Whetten, Kathryn; Scovil, Janet; Murray, Andrea; Swartz, Marvin

    2007-01-01

    The challenge of providing effective treatment services for the growing population of HIV-positive individuals who are also dually diagnosed with substance use and mental disorders has only recently been recognized as an important public health concern affecting both HIV treatment and prevention. This article describes a treatment model that was…

  13. GunderKids: Design of a Clinical Care Management Program for Parents With Substance Abuse and Their Newborn Children with a Focus on Preventing Child Abuse.

    Science.gov (United States)

    Budzak-Garza, Ann E; Allmon Dixson, Allison L; Holzer, Renee A; Lillard-Pierce, Kaitlin E; Devine, Carolynn J

    2018-03-01

    In response to an increased need to care for babies born to mothers with substance abuse issues, we developed GunderKids, a care management program that provides integrated medical care beyond standard-of-care, well-child appointments for these socially complex families. The program incorporates frequent visits to the pediatrician and the care team, which includes pediatric nurses, a pediatric social worker, and a child psychologist. Enrollment is voluntary. Each visit addresses parenting challenges, home environment, basic needs, safety issues, and maintenance of sobriety, as well as child development and health issues. We found that mothers and fathers (or parents) welcome intense support following delivery, appreciate the relationship that is built with the care team, and prefer frequent visits at the medical center over in-home visits, which they perceive as potentially intrusive. We describe here the planning and implementation of the program, as well as insights gained in our first year. Copyright© Wisconsin Medical Society.

  14. Effect of Educational Program to Encourage Safe Sexual Behaviors Among Addicted Men Refered to Substance Abuse Treatment Centers in Hamadan, Western Iran: Applying the Theory of Planned Behavior

    Directory of Open Access Journals (Sweden)

    Babak Moeini

    2014-06-01

    Full Text Available Introduction: Unsafe sexual behaviors as important risky behaviors can expose individuals and society to dangerous infectious disease such as AIDS and viral hepatitis. Considering the high prevalence of unsafe sexual behaviors, this study aimed to determine the effect of educational programs to encourage safe sexual behaviors among substance abusers referred to substance abuse treatment centers in Hamadan, Western Iran by applying the theory of planned behavior. Materials & Methods: This quasi-experimental study was performed on 104 men substance abusers (52 participants in each of the control and intervention groups referred to substance abuse treatment centers in Hamadan. Data collection tool was a questionnaire containing demographic information and the theory of planned behavior constructs. Before the educational program, questionnaires were completed by both groups. After the pretest in both groups, participants in the intervention group participated in four educational sessions designed based on the theory of planned behavior. Two months after the end of program, posttest was performed. Data was analyzed using independent T-test, chi-square, fisher exact test, McNemar’s test and multiple linear regressions using SPSS-16. Results: After educational intervention, the mean scores of the theory constructs (attitude toward behavior, subjective norms, behavioral control, behavioral intention and behaviors, in the intervention group increased significantly (P<0.05, despite the fact, changes were not significant in the control group. Conclusion: Implementation of educational courses to encourage safe sexual behaviors based on the theory of planned behavior can be beneficial for substance abusers referred to substance abuse treatment centers.

  15. Abuse of prescription drugs.

    Science.gov (United States)

    Wilford, B B

    1990-01-01

    An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disabled by personal problems with drugs or alcohol; dated in their knowledge of current pharmacology or therapeutics; or deceived by various patient-initiated fraudulent approaches. Even physicians who do not meet any of these descriptions must guard against contributing to prescription drug abuse through injudicious prescribing, inadequate safeguarding of prescription forms or drug supplies, or acquiescing to the demands or ruses used to obtain drugs for other than medical purposes. PMID:2349801

  16. A systems perspective on research and treatment with abused and neglected children.

    Science.gov (United States)

    Clyman, R B

    2000-01-01

    To discuss two systems-level changes in the organization and financing of mental health and child welfare services that will increasingly affect abused and neglected children: the implementation of managed care processes and the incorporation of accountability mechanisms in the management of mental health and child welfare services, particularly the use of systematic outcomes assessments. A central goal of the paper is to identify critical research questions which will help us to understand the impact of these changes on maltreated children. These two systems-level changes are described, and ways they may affect maltreated children are addressed. Both managed care and the growing focus on managing services by monitoring outcomes may positively or negatively affect maltreated children. Both of these trends are affecting the mental health and child welfare systems. It is likely that they will affect maltreated children's access to and the quality, cost, and outcomes of mental health and child welfare services. Systematic research on the impact of these large-scale changes can increase the likelihood that these changes will benefit maltreated children. A number of critical areas are identified for future research.

  17. Adolescent Abuse.

    Science.gov (United States)

    Foreman, Susan; Seligman, Linda

    1983-01-01

    Discusses legal and developmental aspects of adolescent abuse, as distinguished from child abuse. The role of the school counselor in identifying and counseling abused adolescents and their families is discussed and several forms of intervention and support services are described. (JAC)

  18. Elder abuse

    OpenAIRE

    1999-01-01

    Elder abuse takes many forms and occurs in a variety of settings; it is both under-recognised and under-reported. Despite a lack of statutory guidelines or legislation, effective management is possible. More could be done to recognise abuse, and healthcare workers need to be vigilant, paying attention to both the circumstances in which abuse occurs and its warning signs.

  19. Nephrogenic systemic fibrosis: clinical picture and treatment

    DEFF Research Database (Denmark)

    Marckmann, Peter; Skov, Lone

    2009-01-01

    , and the histology of deep skin biopsies. Symptomatic treatment with intensive physiotherapy and painkillers is important, but there is no known curative medical treatment. Spontaneous remission of NSF symptoms may occur with recovery of renal function after an episode of acute renal failure, or with kidney...

  20. [Migraine type childhood headache aggravated by sexual abuse: case report].

    Science.gov (United States)

    Kaleağasi, Hakan; Ozge, Aynur; Toros, Fevziye; Kar, Hakan

    2009-04-01

    Although the vast majority of chronic headache is idiopathic in origin, child abuse can be a very rare cause of paroxysmal headaches in children. The aim of this report was to present a case of migraine headache aggravated after sexual abuse, which did not respond to treatment. An 11-year-old girl admitted to the outpatient department of the Neurology Clinic with headache complaint for the past two years. Neurological examination, neuroimaging and laboratory tests were normal. According to the International Classification of Headache Disorders (ICHD)-II criteria, the headache was diagnosed as migraine without aura and treatment as prophylaxis was planned. Her headache did not respond to treatment, so she was consulted with the Department of Child and Adolescent Psychiatry and diagnosed as major depressive disorder. During one of the psychological interviews, she confessed that she had been sexually abused by her mother's boyfriend for two years. After this confession and punishment of the abuser, her headache improved dramatically. The prevalence of physical, sexual, and emotional abuse during childhood has been estimated between 13% and 27%, and these children may suffer chronic pain, headache or depression. Sexual abuse has been strongly associated with the migraine-depression phenotype when abuse first occurred before the age of 12 years. Despite the high prevalence of abuse, many physicians do not routinely ask about abuse history. In conclusion, child abuse must be kept in mind in intractable childhood headache. A multidisciplinary approach with the Departments of Forensic Sciences and Child and Adolescent Psychiatry and detailed psychiatric evaluation should be useful in these cases.