Evaluation of an online SBIRT training program.

Background: While human ecosystem disruptions have happened in the past, the COVID-19 pandemic is the first situation to warrant such a large, world-wide transition to online education. The pandemic has increased the need for intervention with people in varying stages of substance use disorders.Objectives: In response to the need for more evidence-based, online educational and training options to address this need, this study used pre-posttest evaluations to determine the efficacy of an online training for a specific evidence-based intervention, Screening, Brief Intervention, and Referral to Services (SBIRT).Methods: Social Work students from two universities completed a 4-hour, online training in SBIRT which included a pre/posttest, demographic variables, a satisfaction scale, and a measure of self-efficacy. Mixed Effects Linear regression was used to model the repeated measures of SBIRT knowledge and efficacy, while a linear regression model was used to measure the relationship between satisfaction and participant characteristics.Results: Participants were mostly female (85.9%), mostly White/Caucasian (72.9%), and most already had a bachelor's degree (50%) or higher (9.6%). Individuals who were White, non-Hispanic/Latinx, or had master's level or doctoral level mental health training were more likely to have higher SBIRT scores. Those with the highest levels of self-efficacy had the lowest change scores on the knowledge test. Overall, there was an almost threefold increase in SBIRT knowledge posttraining, indicating the viability of this training format, which is similar to findings from studies of in-person trainings of SBIRT which also found increases in SBIRT knowledge.Conclusion: Recommendations based on the results are provided to encourage improved student outcomes from this type of e-learning.

Service providers' perspectives on substance use and treatment needs among human trafficking survivors.

INTRODUCTION: Understanding substance use and treatment needs for survivors of human trafficking remains an underdeveloped area in the field of substance use treatment. This study assessed the nature of substance use among survivors of all types of human trafficking and identified treatment barriers and needs, as reported by human trafficking service providers in one Midwest major metropolitan area. METHODS: Participants were purposively selected from agencies that served foreign-born and domestic-born survivors of human trafficking. The study interviewed fifteen key informants across 13 agencies directly serving survivors of trafficking. RESULTS: Providers highlighted frequent use of alcohol and marijuana, as well as polysubstance use. They noted survivors' significant use of opioids, associated concerns regarding fentanyl-related deaths, and increased frequency of stimulant use. Barriers for addressing substance use problems with survivors included low self-perceptions of need, lack of available residential or inpatient treatment options, and prioritizing basic needs such as housing over substance use treatment. CONCLUSIONS: Results underscore how broader trends in substance use and overdose in a region can mirror substance use patterns and treatment needs of human trafficking survivors. Further, a need exists for broader substance use screening and low-barrier referral services to address emergent needs of survivors of trafficking.

Racial Equity as a Human Rights Issue: Field Agency Practices and Field Instructors' Knowledge and Attitudes.

Racial equity which, at minimum, is defined as the state in which health, social, and economic outcomes are no longer predicted by race has become a critical issue for social workers who work with and advocate for the rights of marginalized communities. Despite its importance, it remains to be seen if field instructors and the agencies they work for understand racial equity as a human rights issue. Through an anonymous survey, we assessed field instructor's racial equity awareness, knowledge, and understanding and examined actions agencies have taken to address and advance racial equity. It was hypothesized that field instructors who view racial equity as a human right would report promoting and advancing these important concepts with their students and organizations. A total of 170 field instructors accessed the survey through an emailed link in this exploratory effort. Descriptive analyses found that field instructors believe that racial equity is a significant human rights issue and that their agency's culture views racial equity as important; however, issues with time, resources, funding, and expertise to promote racial equity initiatives create obstacles to bring about change. The discussion emphasizes the importance of building capacity among field educators to address racial equity through a human rights lens, which is integral to advancing the collective social work goals of social justice and dismantling systemic oppression.

The relationship of public and private religiosity to African American women caregivers' use of alcohol for coping with caregiving burden.

The number of African American women providing unpaid care to an older person is increasing. Multiple stresses are associated with the caregiving experience. This article examines the relationship of both public and private religiosity to the use of alcohol to cope with these stresses. Data were from the Black Rural and Urban Caregivers Mental Health and Functioning Study. This cross-sectional study included 521 midwestern urban (n = 256) and rural (n = 265) African American women who were caregivers of dependent African Americans age 65 years and older. Results of heiarchical multinomial logistic regression revealed that those who are younger, those living in an urban area, and those with lower levels of religious attendance were more likely to use alcohol to cope with the stresses of caregiving. Helping professionals can use a strengths perspective, which highlights the importance of emphasizing strengths to increase caregivers' personal power, the development of strong coping skills, and the improvement of social support systems to create a positive approach to self-care with a focus on community building.

Stress, stressors, and substance use: Differential risk for hookah use among African American college students.

Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.

Fear of Crime, Racial Bias, and Gun Ownership.

Firearm-related violence is a significant threat to public health and safety in America. However, research highlights a critical disparity in firearm-related deaths by race. Researchers often cite racial bias as a contributing factor for the racial disparity in firearm-related deaths. To provide a foundation for potential social work interventions, the present article discusses the results of an assessment of whether explicit racial biases toward four racial and ethnic groups (white, black, Asian, Hispanic/Latino), fear of crime, and the quantity and quality of interactions with neighbors of a different race are predictors of gun ownership. Findings suggest that explicit racial bias toward black, Asian, and Hispanic/Latino individuals is a significant predictor of gun ownership. Fear of crime and more frequent interactions with neighbors of a different race are also significant predictors of gun ownership. Taken as a whole, findings suggest that gun owners are more likely to be more vigilant toward people of color because of stereotypical assumptions that racial and ethnic minorities are more likely to be involved with crime. Social work practice and policy implications include developing interventions aimed at reducing implicit bias and identifying policies that are associated with lower levels of implicit bias among gun owners.

Solution-Focused Strategies for Effective Sexual Health Communication among African American Parents and Their Adolescents.

The high rates of sexual risk behaviors, particularly among African American youths who may not be aware of their HIV status, provide indication that, unless prevention efforts are enhanced, this vulnerable group of youths will remain at greater risk for negative health status outcomes. Parents are important in efforts to reduce risk among youths and often have a willingness to be sexuality educators for their children; however, communication barriers often impede their ability to provide preventive sexual health knowledge to their youths. Social workers are often presented with opportunities to help parents develop effective sexual health communication skills in informal settings when formal interventions are not feasible. The present effort considers solution-focused strategies social workers can use to help parents overcome barriers and communicate more positively with their youths about sexual health.

Comparing factors associated with maternal and adolescent reports of adolescent traumatic event exposure.

Existing research indicates that there is very little agreement between youth and their parents on youth trauma exposure and subsequent treatment. Few studies, however, have attempted to examine factors that may contribute to this lack of agreement. This study addressed this gap by examining youth and maternal-reported youth traumatic event exposure using a sample of 100 urban, African American adolescent-maternal dyads. Cumulative report of youth potentially traumatic event exposure (57%) was higher than youth (41%) and maternal (27%) reports. Findings indicate that there was agreement for sexual assault, being shot or stabbed, and auto accidents. Maternal depression was the only factor that was associated with both youth and maternal report of youth qualifying event. Other factors that distinguished youth reports included maternal event exposure, substance use disorder, antisocial personality behaviors, and youth reports of arguments with the mother and running away from home. Implications for reconciling reports of trauma exposure among youth and their mothers are discussed.

Training meals on wheels volunteers as health literacy coaches for older adults.

Homebound older adults constitute a "hardly reached" population with respect to health communication. Older adults also typically suffer from health literacy challenges, which put them at increased risk of adverse health outcomes. Suboptimal interactions with providers are one such challenge. Interventions to improve interactive health literacy focus on training consumers/patients in question preparation and asking. Meals on Wheels volunteers are uniquely suited to coach their clients in such interaction strategies. Seventy-three Meals on Wheels volunteers participated in workshops to train as health literacy coaches. The 3- to 4-hour workshops included units on communicating with older adults, on the nature of health literacy, and on the process of interactive health literacy coaching. Participants viewed and discussed videos that modeled the targeted communication behaviors for older adult patients interacting with physicians. They role-played the coaching process. After 9 months, coaches participated in a "booster" session that included videos of ideal coaching practices. Evaluation questionnaires revealed that participants had favorable reactions to the workshops with respect to utility and interest. They especially appreciated learning communication skills and seeing realistic videos. A measure of knowledge about the workshop material revealed a significant increment at posttest. Fidelity of coaching practices with respect to workshop curriculum was confirmed. This training in interactive health literacy for community-based lay volunteers constitutes one way to implement the National Action Plan to Improve Health Literacy for one "hardly reached" population. An online tool kit containing all workshop materials is available.

Self-esteem mediates the relationship between volunteering and depression for African American caregivers.

Research on the influence of volunteering on mental health outcomes has not placed enough focus on African American female caregivers who are at risk for adverse outcomes such as depression. This study addresses this gap by examining the mechanism through which volunteering might influence depressive symptoms using data collected from 521 African American female caregivers of older adults. Regression results indicate that although volunteering is inversely associated with depressive symptoms, self-esteem mediates this relationship. Findings suggest inclusion in volunteering for African American female caregivers may be relevant to promotion of their mental well-being.

Risk factors for gun-related behaviors among urban out-of-treatment substance using women.

We examine the prevalence and factors associated with lifetime gun-carrying among 858 urban out-of-treatment substance using women using data collected between 2000 and 2004 in a large Midwestern city. Instruments assessed gun ownership, carrying and access, psychopathology and personal lifestyle risk factors. Analyses were conducted using logistic regression. Illegal activities for income and lifetime violent victimization were the most significant predictors of gun carrying. The implications for practice and future research are discussed along with the study's limitations. The work was supported by grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

History of sexual trauma and recent HIV-risk behaviors of community-recruited substance using women.

This study examines whether substance using women exposed to a lifetime sexual trauma (n = 457) are distinguishable from substance using women exposed to non-sexual trauma (n = 275) in terms of demographics, psychopathology and high-risk sexual behaviors. Baseline data were collected from out-of-treatment substance using women enrolled in an HIV prevention study. Logistic regression analyses revealed that when demographics, psychopathology and lifetime indicators of sexual risk were assessed simultaneously, poor health, depression, antisocial personality disorder and lifetime sex-trading were associated with sexual trauma exposure. When these significant factors were controlled, the experience of sexual trauma predicted recent (past 4 month) high risk sexual behaviors such as higher than average sexual partners. Treatment efforts with women who have experienced a sexual trauma may be enhanced by the inclusion of assessments of physical and mental health needs as well as sexual risk awareness training.

The association of trauma and PTSD with the substance use profiles of alcohol- and cocaine-dependent out-of-treatment women.

The association of trauma and posttraumatic stress disorder (PTSD) with alcohol and cocaine use is explored to determine if there is additive risk associated with dual dependence. Data were collected from out-of-treatment women enrolled in an HIV-prevention study. Women who experienced a DSM-IV qualifying event (n = 791) were stratified into four substance use groups based on lifetime alcohol and cocaine use. Women with lifetime comorbid alcohol and cocaine dependence experienced significantly more traumatic events and had a higher prevalence of violent events and lifetime diagnosis of PTSD and PTSD-related impairment. There is added risk for associated trauma and subsequent PTSD among women who have dual substance dependence.

Substance use, post-traumatic stress disorder and violence.

PURPOSE OF REVIEW: The present review focuses on the co-occurrence of substance use disorder and post-traumatic stress disorder, with special attention to measurement and the role of violence as a contributor to the comorbidity. RECENT FINDINGS: Symptoms of post-traumatic stress disorder in the presence or absence of a post-traumatic stress disorder diagnosis are comorbid with several substance use dependencies and with a range of severity of substance use. SUMMARY: Lack of consistency in terms of substance use classification and measurement of post-traumatic stress disorder across studies continues to hinder comparisons of rates of comorbid substance use disorder and post-traumatic stress disorder. More attention to the role of violence as a contributor to the comorbidity and its impact on treatment outcomes is warranted.

Health care disparities among out-of treatment cocaine users in St. Louis.

Cocaine users experience barriers to health care, including mental illness, drug use, and lack of insurance. Being male and a minority member increases the health care disparity. These factors were evaluated among 961 street-recruited cocaine users' baseline and three month follow-up data. Gender-related disparities in care and attitudes towards care emerged. In multivariate models controlling for baseline visits and intervention group, follow-up visits increased among depressed men and female sex traders with insurance.

Comorbid substance use and HIV risk in older African American drug users.

OBJECTIVE: This analysis examines substance abuse/dependence and related HIV risk behaviors among older drug users in comparison to their younger counterparts. METHODS: Data related to substance use disorders and HIV related behaviors were collected from 1,079 African American drug users recruited using a street outreach method. RESULTS: Older users were less likely to have engaged in recent sexual activity, but those who did engage did not vary significantly in their sexual risk behaviors than did drug users aged 25 to 44. Older users were more likely to abuse cocaine and be opiate dependent than younger users were, and this abuse and dependence, along with alcohol abuse, were associated with older users' perception of their risk for HIV/AIDS. DISCUSSION: Although the years 25 to 44 are considered a critical age for HIV risk, older substance users have similar levels of risk for HIV/AIDS. However, older users may not understand how some behaviors contribute to HIV risk.

The association of substance use disorders with trauma exposure and PTSD among African American drug users.

This study examines the association of traumatic exposure, PTSD and substance use among 1098 out-of-treatment African American drug users. Over 40% of the respondents experienced a DSM-III-R qualifying traumatic event with 44% of those developing PTSD. Early onsets of marijuana and heroin use, alcohol dependence and opiate dependence were each associated with exposure to a traumatic event for males and early onset alcohol use and alcohol dependence were associated with females' exposure to a traumatic event. Alcohol dependence and depression disorder were co morbid with PTSD in men, while the early onset of alcohol and alcohol dependence were associated with PTSD in women. In the 16% of the sample who reported trauma exposure and poly-substance use, the trauma occurred after the onset of all substance use, with the exception of crack cocaine use. Implications for multifaceted treatment which addresses multiple psychopathologies, PTSD, and risk for exposure are discussed.

The association of sexual dysfunction and substance use among a community epidemiological sample.

This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use.