A history of sexual, emotional, or physical abuse predicts adjustment during opioid maintenance treatment.

This study examined how having a history of sexual, physical, or emotional abuse is related to overall functioning as assessed by the Addiction Severity Index during short-term opioid maintenance treatment with either buprenorphine/naloxone or methadone. Furthermore, the relation between abuse history and overall functioning by sex was explored. Participants (N = 268) were opioid-dependent adults entering an outpatient randomized clinical trial with buprenorphine/naloxone and methadone. Latent growth modeling indicated that females with an abuse history entered treatment with more problems in the psychiatric and family domains as compared with females without an abuse history. Over the course of treatment, a history of abuse predicted problems in the psychiatric and alcohol domains. Furthermore, a history of abuse predicted slower recovery times and less recovery overall for females in some domains. Males with an abuse history entered treatment with more severe psychiatric and family problems as compared with males with no history of abuse. Victims of abuse may present to substance abuse treatment with weaknesses in the areas of family relations, psychiatric status, and alcohol use. The nature of these problems and their trajectory over time differed by sex.

Clinical evidence in guardianship of older adults is inadequate: findings from a tri-state study.

PURPOSE: This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform. DESIGN AND METHODS: Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded. RESULTS: The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in our ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D - with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania. IMPLICATIONS: In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.

Statutory reform is associated with improved court practice: results of a tri-state comparison.

PURPOSE: This study investigates the impact of statutory reform in adult guardianship on court practice. METHODS: Case files for 298 cases of adult guardianship were reviewed in three states with varying degrees of statutory reform: MA (no reform), PA (major amendments in 1992), and CO (full re-enactment of statute per UGPPA in 2000). Five court practices associated with progressive statutory reform were studied: (1) diversion to less restrictive alternatives; (2) minimal and appropriate use of emergency procedures; (3) presence of the alleged incapacitated person at the hearing; (4) use of functional evaluation; (5) use of limited orders. RESULTS: CO more frequently utilized all five practices, whereas PA used diversion to less restrictive alternatives and less frequent emergency procedures, but not other practices. MA files rarely showed evidence for use of any of these reforms. IMPLICATIONS: Statutory reform may improve court practice. More study of the effects of reform on court practices, and the vulnerable adults served by these courts, is needed.